AccountId: 011433970860
ContactId: 69345b96-6fb0-4640-9122-6eb20c2be31a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 786000 ms
Total Talk Time (AGENT): 185146 ms
Total Talk Time (CUSTOMER): 205095 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/69345b96-6fb0-4640-9122-6eb20c2be31a_20250205T18:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Last name is [PII] and I'm calling from the provider's office. Can you help me with that claim status?
[AGENT][NEUTRAL] Yeah, sure. I can assist you with claim status, Mr. [PII]. And may I have a callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, the facility name is Advent Health Respiratory and Equipment, also known as Florida Hospital Respiratory and Equipment.
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Patient's policy number is
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 96908.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] For this patient,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the date of service, uh, [PII], we have submitted an appeal.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] I'm sorry. Uh, we have submitted an appeal on [PII]. May I know the appeal status?
[AGENT][NEUTRAL] OK, let me see if I can find the appeal, and that was [PII] for how much?
[CUSTOMER][NEUTRAL] Uh, for, just give me a second.
[CUSTOMER][NEUTRAL] For $685.88.
[AGENT][NEUTRAL] 6 85 88. OK, thank you, one moment.
[CUSTOMER][NEUTRAL] He.
[AGENT][NEUTRAL] OK, let me pull the image on the appeal. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, please take your, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Mr. [PII]? Yes. OK, it looks like we uh processed the claim on [PII] and on the, I'm sorry, the appeal, not the claim, but the appeal, and it looks like it was found that the process was um
[CUSTOMER][NEUTRAL] Hello, yes.
[CUSTOMER][NEUTRAL] Yes, I.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] That is
[AGENT][NEGATIVE] Correctly done, so there are no benefits payable for this service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just give me a second.
[CUSTOMER][NEUTRAL] OK, OK. So can I have the call reference number?
[AGENT][NEUTRAL] You don't have a reference numbers you can use my name in today's state.
[CUSTOMER][NEUTRAL] OK. Can I have the DCN number uh bill which you received?
[AGENT][NEUTRAL] There's not a DCN number, but I can give you the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3485339.
[CUSTOMER][NEUTRAL] Is there any case number which proof that you received the
[CUSTOMER][NEUTRAL] Appeal
[AGENT][NEUTRAL] What do you mean by a case number?
[CUSTOMER][NEUTRAL] Mhm. Do you have the case number?
[AGENT][NEUTRAL] We don't have a case number. Um, we only process, we already sending this information to the provider and it's gonna be under a claim number. It's not gonna be under a reference number, it's gonna be under a claim number.
[CUSTOMER][NEUTRAL] OK. So, may I know when you received the appeal?
[AGENT][NEUTRAL] OK. Let me give you this information one more time. One moment, Mr. [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. So we received the appeal on [PII].
[AGENT][NEUTRAL] We processed the appeal on [PII].
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] [PII], and we process on [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. I have one more thing. Can you help me with that also?
[AGENT][NEUTRAL] Is it for the same member or a different member?
[CUSTOMER][NEUTRAL] For the different number but under the same provider provider ID yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Tax ID.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, um, what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 20, it's 0210030 ML8.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, let me have that number one more time.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Let me have the policy number one more time.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] It's 02100309 ML 8. And for this one, I just want to know the claim status, not appeal status because we haven't sent the bill.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] data services.
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $561.69.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I have that claim and that was October 31 of 244 56169. Is that correct?
[CUSTOMER][POSITIVE] Yes, it's correct.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, we process this claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $472.88 to the provider.
[CUSTOMER][NEUTRAL] OK. When you process this claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And when you receive this claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And as I'm checking, uh, we got the we got the denial on
[CUSTOMER][NEUTRAL] One CPT code as
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It was denied for E. 7038.
[CUSTOMER][NEUTRAL] May I know why it got denied?
[CUSTOMER][NEUTRAL] We didn't receive the payment for 87038.
[AGENT][NEUTRAL] Yes, that is that code is not payable under this policy.
[AGENT][NEGATIVE] The item does not meet the definition of DME.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So any suggestion, what do we have to do with to get payment for this?
[CUSTOMER][NEUTRAL] CPT code.
[AGENT][NEGATIVE] It's not payable by this policy, so it's not gonna be payable. When it's not payable, it's denied and that's what it's under. It's a non-cover service, non-cover code.
[CUSTOMER][NEUTRAL] So can, so.
[CUSTOMER][NEUTRAL] So, can we submit a bill for this?
[AGENT][NEUTRAL] You can always submit an appeal that's 180 days from the decision date to submit an appeal.
[AGENT][NEUTRAL] Yeah, it doesn't guarantee the payment, then you can submit an appeal.
[CUSTOMER][POSITIVE] OK. Thank you so much. Can I have the claim number?
[AGENT][NEUTRAL] Sure, the claim number is 3545075.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And may I know, know your name, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] OK. And the call number is your name and
[CUSTOMER][NEUTRAL] Date of birth, sorry, was today's date, right?
[AGENT][NEUTRAL] Um, today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You as well thank you for calling APL. Bye bye.