AccountId: 011433970860
ContactId: 5dfdd439-4ff8-49bf-9cdf-896ca353dc8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1210949 ms
Total Talk Time (AGENT): 223425 ms
Total Talk Time (CUSTOMER): 469644 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/5dfdd439-4ff8-49bf-9cdf-896ca353dc8a_20250305T16:14_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling for the provider Privia Medical Medical Group LLC. Please note that this call will be recorded and monitored for quality and training purposes. I'm calling in to check on claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, it is [PII]. It's a direct line.
[AGENT][POSITIVE] OK, thank you so much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure, patient's name, [PII] Date of birth [PII] and the member ID is 024501.
[CUSTOMER][NEUTRAL] 13.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 858619.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and then what is the date of service of the claim?
[CUSTOMER][NEUTRAL] The data of service shows is [PII] with the total charges of
[CUSTOMER][NEUTRAL] $627 even and the outstanding amount of $50 even.
[AGENT][NEUTRAL] OK, and you said you were calling from Vital Medical?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm calling for the Previa Medical Group LLC.
[CUSTOMER][NEUTRAL] Yeah, for the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 354265
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, [PII]. So looking on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For this data service of [PII], I do not find a claim on file in the amount that you have given me.
[CUSTOMER][NEUTRAL] OK, so do you say that the claim is not on file but as uh the patient was not eligible for the data service.
[AGENT][NEUTRAL] No, I just don't find the claim on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so just allow me one quick moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And this particular uh claim was sent through paper.
[CUSTOMER][NEUTRAL] A paper claim.
[CUSTOMER][NEUTRAL] And let me and I'll confirm the address which I have here on the file which is American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, that is the correct address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I have the patient's policy effective date and the termination date?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] And the policy terminated on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Thank you so much for confirming that. And could you please confirm if you're the primary or the secondary insurance for the patient?
[AGENT][NEUTRAL] We are secondary.
[CUSTOMER][NEUTRAL] Thank you so much and could you please verify the claims mailing address that's the one which have previously told us that the correct one?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you so much. And may I have the uh electronic payer ID?
[AGENT][NEUTRAL] Yes, that is 60801.
[CUSTOMER][NEUTRAL] 60801 thank you and may I have the timely filing limit to resubmit the claim?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEGATIVE] So no timely filing limit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Yes, I'm sorry. I'm there. And uh may I know if we can submit an electronic or paper claim via mail?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Yes you can.
[AGENT][POSITIVE] Either way, whichever is easiest for you.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][POSITIVE] Thank you so much and um I do have another claim here so will you be able to assist me on the same call?
[AGENT][NEUTRAL] Yes, ma'am. What is the um patient's name?
[CUSTOMER][NEUTRAL] OK. And may I have the
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, uh, before I give you the second patient's name, may I have the call reference number for this call?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, and the.
[CUSTOMER][NEUTRAL] Next patient's name is [PII]
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII] [PII].
[CUSTOMER][NEUTRAL] And uh member ID is 02439234.
[AGENT][NEUTRAL] OK, let me look up that policy real quick for us.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and then what is the data service for this claim?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] It is 103-2024 [PII] where the total charges of.
[CUSTOMER][NEUTRAL] $341 even and the outstanding amount of $62.55.
[AGENT][NEUTRAL] OK and then what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The name of the facility shows as main office, the practice name Sanders Clinic for Women PA.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] Sure thank you. You are on hold.
[AGENT][NEUTRAL] 341 62.
[AGENT][NEUTRAL] 4
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you very much for holding for me. I do have the claim information for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3545599.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the patient's policy.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, just give me one quick moment. I would like to reconfirm the claim number which is 3545599. Am I correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the claim was denied because the office visits are not covered on the patient's policy.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just give me one quick moment.
[CUSTOMER][NEUTRAL] I'm really sorry. It it is taking longer than I expected to pull up the information. Just give me 1 to 2 minutes of your time while I, uh, put the call on hold on mute and try to pull up the information and get back to you.
[AGENT][POSITIVE] Yes, go ahead and take your time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Sure, thank you so much.
[CUSTOMER][POSITIVE] Thank you so much for staying connected to. I really do appreciate your time and patience.
[CUSTOMER][NEUTRAL] Um, uh, could you please help me with the received date and the denied date? You're welcome.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we received the claim on [PII] and we processed the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean same as the denied date [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. And could you please check and help me whether the CBT or the diagnosis is not covered?
[AGENT][NEUTRAL] It doesn't go by the code, it goes by the facility.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] And office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Got it thank you so much.
[CUSTOMER][NEUTRAL] For confirming that and um do you require a copy of denied EOB when we resubmit a correct claim or when we decide to do an app?
[CUSTOMER][NEUTRAL] Yeah, I don't remember that.
[AGENT][NEUTRAL] I'm sorry, can you repeat that question?
[CUSTOMER][NEUTRAL] Um, sure, uh, prior to that, could you please confirm the mode of resubmission? is it a corrected claim or an appeal?
[AGENT][NEUTRAL] Right, um, if you want to appeal, you have 180 days from the date the claim was initially processed and you need to send the letter Y.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you have a claim correction, there's no time limit, but you need to send a letter why it needs correction.
[CUSTOMER][NEUTRAL] OK, got that. Just to reconfirm that you said it would, uh, for appeal it is 180 days from the initial process date.
[CUSTOMER][NEUTRAL] And um if it is a corrected claim or a claim correction like you said there's no time limit, but we'll have to send a letter why it needs correction.
[AGENT][NEUTRAL] Right and also with the appeal you'll also need to send a letter why you're appealing.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I got that.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Thank you so much. And uh do you require a copy of denied DOB when we resubmit the correct and now correct the claim or when we decide to do an appeal?
[AGENT][NEUTRAL] Do I know if it will be denied?
[AGENT][NEUTRAL] Is that what you just asked?
[CUSTOMER][NEUTRAL] Um, no, do you require the copy of denied EOB?
[CUSTOMER][NEUTRAL] When we resubmit uh corrected claim or when we do decide to do an appeal, do you require a copy of denied you'll be attached for that.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you and could you please mail or fax a copy of an EOB.
[AGENT][NEUTRAL] Yes, I can um what's your fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]. Attention to the patient account number.
[AGENT][NEUTRAL] OK I'm going to put you on a brief hold while I get that faxed over to you and I'll be right back.
[CUSTOMER][NEUTRAL] Sure, just to reconfirm before you fax the information, uh, the patient account number is [PII] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[AGENT][POSITIVE] Alright, it's gonna be a brief hold. I'm gonna get that ready for you.
[CUSTOMER][NEUTRAL] Chance
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Yeah, sorry.
[CUSTOMER][POSITIVE] Sure, thank you so much and uh may I know how long will it take for it to arrive at the facility?
[AGENT][NEUTRAL] How long will it take to get to you? Is that what you're asking, ma'am?
[CUSTOMER][NEUTRAL] Yes, yes, it is.
[AGENT][NEUTRAL] You just have to give it time to come. I've sent it.
[CUSTOMER][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and just reconfirm the claim number is 3545599.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Am I correct?
[CUSTOMER][POSITIVE] Thank you so much and may I have the call reference number?
[AGENT][NEUTRAL] You can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Sure, thank you so much for your assistance and I hope you have a great day. Stay safe and happy Wednesday.
[AGENT][POSITIVE] Thank you you have a great day too [PII]. I appreciate you calling.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You take care. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.