AccountId: 011433970860
ContactId: 5ac33604-e987-45b8-a07f-e2aa8adf240a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495200 ms
Total Talk Time (AGENT): 97206 ms
Total Talk Time (CUSTOMER): 300412 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/5ac33604-e987-45b8-a07f-e2aa8adf240a_20250612T14:04_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is Ke[PII]How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, hi, Ke[PII]My name is Da[PII]alling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So Ke[PII]may I know how can I help you with the patient's information or the provider's information?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Could I get a callback number please?
[CUSTOMER][NEUTRAL] Yeah, it's 86[PII].
[CUSTOMER][NEUTRAL] 44[PII]No extension, it will be a direct line.
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][POSITIVE] The policy number, yeah, just a second, it's fetching.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] OK, the policy number is 02388738 M as in Mike L as in Lima and the number 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is Ma[PII]nd the last name is Mo[PII]The date of birth will be Ju[PII].
[AGENT][NEUTRAL] Thank you and you did say you were calling for status. What is the data service?
[CUSTOMER][NEUTRAL] The date of service is Ap[PII]nd the total charges will be $184 even.
[AGENT][NEUTRAL] OK, I do show the claim was received. It looks like the claim was denied this policy. The policy plan does not cover physician office visits.
[CUSTOMER][NEUTRAL] Physician office visits. OK, so the office visits are not covered.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, yeah, just a second.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the
[CUSTOMER][NEUTRAL] Claim received date and the denial date.
[AGENT][NEUTRAL] Claim received on Ma[PII]Claim denied on Ma[PII].
[CUSTOMER][NEUTRAL] Ma[PII].
[CUSTOMER][NEUTRAL] And Ma[PII]do you have?
[CUSTOMER][NEUTRAL] The claim number with you?
[AGENT][NEUTRAL] Claim number is 360.
[AGENT][NEUTRAL] I'm sorry. Yes, 360.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 3409.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And which CPT code is not covered under the member's plan?
[AGENT][NEUTRAL] The physician office visit is not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh yeah, but the particular CP 99213 is not covered, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK, perfect. And could you
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and timely filing limit to submit the corrected claim, there is no timely filing limit. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mailing address to submit the corrected claim will be PO[PII]Am I right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And what will be the timely filing limit to submit an appeal?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] And the mailing address will be the same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any specific form for Napi?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] And the IDU is required while submitting the corrected claim or an appeal.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK perfect just a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Perfect. And your call reference number will be your name and today's date.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, let's move to the next claim.
[AGENT][NEUTRAL] Next claim or next patient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Next patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number will be 02388738 M as in Mike.
[CUSTOMER][NEUTRAL] Just a second, just a second.
[CUSTOMER][NEUTRAL] Uh yeah. The policy number is 025646663.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is Je[PII]Last name is D [PII].
[AGENT][NEUTRAL] What is the data service you?
[CUSTOMER][NEUTRAL] The date of birth will be No[PII].
[CUSTOMER][NEUTRAL] No[PII]s the date of service uh date of birth. Date of service will be Fe[PII].
[CUSTOMER][NEUTRAL] 17
[AGENT][NEUTRAL] [PII]e[PII]e[PII]r Fe[PII]?
[CUSTOMER][NEUTRAL] Fe[PII].
[AGENT][NEUTRAL] OK, I do not show we have a claim on file for Fe[PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Fe[PII]OK, perfect, just a second.
[CUSTOMER][NEUTRAL] You that.
[CUSTOMER][NEUTRAL] OK, could you please help me with the uh members effective date and the term date?
[AGENT][NEUTRAL] Policy effective 1 [PII]it's still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Enjoy it.
[CUSTOMER][NEUTRAL] OK, 11[PII].
[CUSTOMER][NEUTRAL] 11[PII].
[CUSTOMER][NEUTRAL] Are you primary or secondary for the member?
[AGENT][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] OK, when was the last coordination of benefits updated?
[AGENT][NEUTRAL] This policy does not coordinate benefits, sir.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK 325.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, perfect. What will be the claim submission timely filing limit?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] 4308.
[CUSTOMER][NEUTRAL] 430.
[CUSTOMER][NEUTRAL] Mailing address?
[CUSTOMER][POSITIVE] That's good.
[AGENT][NEUTRAL] Mailing address is PO[PII].
[CUSTOMER][NEUTRAL] If
[AGENT][NEUTRAL] Eg[PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What will be the pay ID?
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the preferred mode of submission will be either mail or electronic. You will accept both.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The preferred mode of submission will be either.
[CUSTOMER][NEUTRAL] Am I right? you both accept both mail or electronic.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thanks for your assistance, Ke[PII]I hope you have a wonderful day.
[AGENT][POSITIVE] You're welcome, Da[PII]You have a wonderful day yourself. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Bye bye.