AccountId: 011433970860
ContactId: 634453cb-f0bc-49a4-a648-21e13e6889bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 654679 ms
Total Talk Time (AGENT): 132291 ms
Total Talk Time (CUSTOMER): 202324 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/634453cb-f0bc-49a4-a648-21e13e6889bb_20250519T18:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from provider's office to on address.
[AGENT][POSITIVE] All right, I'm happy to help today, [PII]. You need to check on a claim, is that what you had said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] 02560355
[AGENT][NEUTRAL] And patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] [PII]. The bill amount is $4,756 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Do you have a billed amount after the primary paid?
[CUSTOMER][NEUTRAL] $609.89.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] $609.89.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, one moment.
[AGENT][POSITIVE] Give me just one moment to check and see if this is the right one or not. I appreciate your patience.
[CUSTOMER][NEUTRAL] Yeah. Uh, ma'am, uh, the claim was submitted on [PII].
[AGENT][NEUTRAL] OK, so it looks like we did originally receive a claim.
[AGENT][NEUTRAL] Um, in January for the 4,756. It looks like there was a benefit payment sent. It was for 12419.
[CUSTOMER][NEUTRAL] Yes, ma'am. Initially, BCB uh primary insurance was processed uh $124 even.
[CUSTOMER][NEUTRAL] $124.19. Uh, again, the primary insurance was, uh, recouped the payment and then it was processed again.
[CUSTOMER][NEUTRAL] For a patient responsibility of $609.89. That's why we resubmitted the claim to APL.
[AGENT][NEUTRAL] I'm not showing anything on file for that billed amount.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh, that's why I gave you, uh, uh, we submitted date, claim was submitted on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the only claim that we have reported on was on [PII] that was the.
[AGENT][NEUTRAL] Denied as a duplicate claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When it was received?
[CUSTOMER][NEUTRAL] Oh, you said received on [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] 423 [PII] 25 and then it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, could you please send the claim for a reprocess?
[CUSTOMER][NEUTRAL] Due to initially this uh claim was, sorry, primary claim was processed correctly. So, so they recoup the payment again it was processed with a different amount.
[CUSTOMER][NEUTRAL] Uh, actual, the actual patient responsibility is $609.89.
[CUSTOMER][NEUTRAL] That's why we submitted the claim.
[AGENT][NEUTRAL] Let me look at the resubmission. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] good.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim that was received on the [PII] is the same as what we received on [PII]. It's not corrected, so I don't see where it's showing any patient responsibility in the amount of the $609.89 so it would need to be resubmitted as a corrected claim if it was submitted incorrectly to begin with.
[CUSTOMER][NEUTRAL] On the [PII] it's the same what we received on January.
[CUSTOMER][NEGATIVE] This is not correct.
[CUSTOMER][NEUTRAL] So I don't see her showing.
[CUSTOMER][NEUTRAL] $109.
[CUSTOMER][NEUTRAL] So it would have the the correctly.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. Give me a minute. Let me verify with the clearing house how it was submitted and how much it was submitted.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK. Ma'am, upon checking with the clearing house, I can see that the primary was processed.
[CUSTOMER][NEUTRAL] You can see box number 54.
[CUSTOMER][NEUTRAL] Yeah, box number.
[CUSTOMER][NEUTRAL] The box number 55.
[CUSTOMER][NEUTRAL] You can see $609.89.
[AGENT][NEGATIVE] The copy that we have, box 55, is empty.
[CUSTOMER][NEUTRAL] Copy that we have.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] I can see that in original claim box number 55, I can see $124.19. For another one, it was uh $609.89.
[AGENT][NEUTRAL] We already processed and paid the claim for the 120, uh, that was paid. I'm just saying that we don't have one for the 609 89, so it needs to be resubmitted.
[CUSTOMER][NEUTRAL] That said the claims for the 120.
[CUSTOMER][NEUTRAL] Uh, that was OK. I'm just saying that we don't have one for the 6.
[CUSTOMER][NEUTRAL] Would need to be resubmitted.
[CUSTOMER][NEUTRAL] OK, no claim filed 460989. Uh, we need to resubmit the claim like a corrected claim.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] That would be my name with today's date. My name is [PII], that's [PII], today's date.
[CUSTOMER][NEUTRAL] My name for today's bank. My name is [PII]'s [PII].
[CUSTOMER][NEUTRAL] The claim family filing limit.
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEUTRAL] That was no kind of violence.
[CUSTOMER][POSITIVE] OK. Thank you so much. Have a great day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes