AccountId: 011433970860
ContactId: 6304ea82-dd80-42ad-88f6-49246d1d79b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 926190 ms
Total Talk Time (AGENT): 269177 ms
Total Talk Time (CUSTOMER): 249301 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/6304ea82-dd80-42ad-88f6-49246d1d79b0_20250220T19:27_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider's office. This call is regarding claims. Could you be able to assist me?
[AGENT][NEUTRAL] [PII], it would be my pleasure to assist you with claim information. What is the callback number?
[CUSTOMER][NEUTRAL] That's going to be [PII].
[CUSTOMER][NEUTRAL] [PII]. That [PII] an [PII] number [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 1356244
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes. So here the patient name is going to be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with that claim information. Do you have a claim number or do we need to check claim status?
[CUSTOMER][NEUTRAL] Uh, one moment, I'll give you that.
[CUSTOMER][NEUTRAL] I have the uh claim number. One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The claim number is 3.
[CUSTOMER][NEUTRAL] After 3 consecutive 5s, 122.
[AGENT][NEUTRAL] Thank you [PII] and what is the facility name and date of service?
[CUSTOMER][NEUTRAL] All right. Uh, that's going to be.
[CUSTOMER][NEUTRAL] Specialty orthopedic group.
[CUSTOMER][NEUTRAL] And you need
[AGENT][NEUTRAL] The date of service.
[CUSTOMER][NEUTRAL] That's going to be [PII] for the total charge of $2830.06.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I can help you with that claim information, [PII]. Now the claim number you gave me 33, I'm sorry, 3555.
[AGENT][NEUTRAL] 5122. That claim was denied as a duplicate. I can give you the original claim information.
[CUSTOMER][NEUTRAL] One moment, but first of all, let me take down that one moment.
[CUSTOMER][NEUTRAL] 3123.
[CUSTOMER][NEUTRAL] May I know the process date of the duplicate claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm ready to take down.
[AGENT][NEUTRAL] Alright, the original claim we received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And it was denied also the 99214.
[AGENT][NEUTRAL] Was denied as office visits are not covered under the policy guidelines.
[AGENT][NEUTRAL] And the CPTs 2061073564 and J7318 were denied as services are not covered when performed in the doctor's office.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, if you don't mind.
[CUSTOMER][NEUTRAL] Um, may I get the original claim receipt, uh, process it one more time?
[AGENT][NEUTRAL] Yes, the received date was [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] So, what about the code 99214?
[AGENT][NEGATIVE] It was denied as office visits are not covered for the policy guidelines.
[AGENT][NEUTRAL] And I can provide that original claim number.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] Office visits were not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But the thing is.
[CUSTOMER][NEUTRAL] May I know why does the office was a non-cover?
[AGENT][NEUTRAL] It's per the policy guidelines.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have any article number on that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Do you have any article number for the non-covered charges?
[AGENT][NEUTRAL] Article number what's that?
[CUSTOMER][NEUTRAL] Uh, you said it was not covered charges on the.
[CUSTOMER][NEUTRAL] OK, I totally understand. One moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is, what about the code [PII]?
[AGENT][NEUTRAL] Those are not covered when they are performed in a doctor's office.
[CUSTOMER][NEUTRAL] So the code [PII] is also got denied for non-covered charges.
[AGENT][POSITIVE] That's correct because they were performed in the doctor's office.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEGATIVE] So they were denied for the place of service.
[CUSTOMER][NEUTRAL] Um, specifically these codes 20,610.
[CUSTOMER][NEUTRAL] 73564.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Should I take like this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Should I, should I take like this with the code [PII], uh.
[CUSTOMER][NEUTRAL] God denied us.
[CUSTOMER][NEUTRAL] As it need to be?
[CUSTOMER][NEUTRAL] OK, the denial reason is it needs to be submitted under.
[CUSTOMER][NEUTRAL] Via the, OK, could you please give me the denial reason for [PII].
[AGENT][NEUTRAL] Services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] When performed in doctor's office.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Nongo charges. OK. May I know the current claims mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. [PII], [PII].
[AGENT][POSITIVE] That is correct. 2.
[CUSTOMER][NEUTRAL] What is the zip code?
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Um, do you have any?
[CUSTOMER][NEUTRAL] Uh, sorry, time of filing limit.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have one more client to discuss. Could you be able to assist me?
[AGENT][NEUTRAL] Is it for the same patient?
[CUSTOMER][NEUTRAL] But before that, one moment. Do you have that uh client number for the one that it was got denied?
[AGENT][NEUTRAL] The original claim number is 353.
[AGENT][NEUTRAL] 3133.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So do you want me to give the member ID number?
[AGENT][NEUTRAL] Is it for a different patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] I am ready for that next policy number.
[CUSTOMER][NEUTRAL] Policy number is going to be?
[CUSTOMER][NEUTRAL] 982-078
[AGENT][NEUTRAL] Thank you, [PII]. And what is that name and date of birth?
[CUSTOMER][NEUTRAL] So here the patient name is uh it is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Let me just get everything pulled up one moment.
[AGENT][NEUTRAL] What is that data service?
[CUSTOMER][NEUTRAL] So here the date of service is going to be.
[CUSTOMER][NEUTRAL] [PII] and the total charge is $443.48.
[AGENT][POSITIVE] Alright, thank you. Now we received this claim twice as well.
[AGENT][NEUTRAL] I can give you the original claim information as well as the duplicate claim information.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I get the claim number for the duplicate one?
[AGENT][NEUTRAL] The duplicate claim number is.
[AGENT][NEUTRAL] Bear with me just a second, I'm getting that.
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 5144
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] May I know the original claim process it?
[AGENT][NEUTRAL] Mhm. Original claim was received on the [PII] and processed on 11-22-24.
[AGENT][NEUTRAL] And that claim was
[CUSTOMER][NEUTRAL] 112022.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was denied as office visits are not covered for the policy guidelines.
[CUSTOMER][NEUTRAL] Alright, so it was got certificate claims.
[CUSTOMER][NEUTRAL] And uh what about the original claim uh received date?
[AGENT][NEUTRAL] Original claim received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK, so you said the original original claim was received on [PII] after?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, sorry, that's my mistake. OK.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] [PII]. Alright, processed, uh, about.
[AGENT][NEUTRAL] It was received.
[AGENT][NEUTRAL] It received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the original claim.
[CUSTOMER][NEUTRAL] OK. You said, no, I understand it was processed on number [PII], and what is the status?
[AGENT][NEUTRAL] The original claim was denied as office visits are not covered.
[CUSTOMER][NEGATIVE] It's it's like the same same denied reason.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] Office visits were not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, as for the patient's plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] May I know the call reference number for the entire call?
[AGENT][NEUTRAL] The call reference number is my name and today's date. I spell my name [PII]
[AGENT][POSITIVE] First initial last name [PII], and it's been a pleasure to assist you with that claim status. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm, no, [PII], may I get the call reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] And is that the spelling of your name is [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, um, that's all for the day. Thank you so much for your kind assistance and I wish you have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] Is it my pleasure to assist you with that claim status, [PII]. Thank you for calling APL. Hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Thank you.