AccountId: 011433970860
ContactId: 6967e64b-6e79-4130-a846-ceb45853dfd2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 581229 ms
Total Talk Time (AGENT): 122636 ms
Total Talk Time (CUSTOMER): 118581 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/6967e64b-6e79-4130-a846-ceb45853dfd2_20250403T16:26_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII] and I'm calling from um Miami Beach Anesthesiology, and I'm calling to get status on a claim.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And may I have that policy number, please?
[CUSTOMER][NEUTRAL] Um, yes, the policy number is 01600.
[CUSTOMER][NEUTRAL] 381
[AGENT][NEUTRAL] OK. And to repeat and confirm, I have that as 01600381.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, your call claim status. I can help you with that. What is that date of service and the total charge amount?
[CUSTOMER][NEUTRAL] It is [PII] and the total charge was $1200.
[AGENT][POSITIVE] Thank you very much. One moment.
[AGENT][NEUTRAL] And if you could verify the procedure codes that were billed for the services for the member.
[CUSTOMER][POSITIVE] Um, yes, let me get that for you.
[CUSTOMER][NEUTRAL] That would be 00731.
[AGENT][NEUTRAL] OK, was it just one procedure code?
[CUSTOMER][NEUTRAL] There was 2. it's the same. One line is just for the nurse anesthetist and then the other line is for the um anesthesiologist.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Almost there.
[AGENT][NEUTRAL] OK, it shows that the claim was received and a payment was made in the amount of $203.55.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, because we still show a balance of 203 to 55.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] We only paid one line, um, 00731. The other line was denied. One moment, let me get that denial for you.
[AGENT][NEUTRAL] It shows that we requested the explanation of benefits for the second line item 00731.
[AGENT][NEUTRAL] We're both did both have the same modifier?
[CUSTOMER][NEUTRAL] So that's
[CUSTOMER][NEUTRAL] Uh, no, one line, um, has, give me one minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One line is the QKQS and then the second line is the QXQS so when we actually did submit that information, that information was sent on.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, and where you process that claim on [PII]. Um, give me one moment I place you on a brief hold, OK, one moment.
[CUSTOMER][POSITIVE] Sure, no problem. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 255.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you so much for your patience, [PII]. I was just checking, looking at the claim that was submitted to us back in [PII]. On this particular EOB submitted, it only shows um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 00731 modifier QKQS so that's why only one line item was paid.
[CUSTOMER][NEUTRAL] OK, so maybe they just posted it incorrectly. OK, I will go ahead and fax it with the um QXQS um modifier EOB and we'll go from there, um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] And also ma'am when you're able to check, of course, of course, while you're doing that you can check claim status on a secure website at [PII] as well.
[CUSTOMER][NEUTRAL] Give me one
[CUSTOMER][NEUTRAL] I'm sorry, what is it called [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] And do you provide um reference numbers?
[AGENT][NEUTRAL] We do not, but you can use my name [PII]. Last initial is [PII] like [PII], and today's date. And is there anything else I can help you with, please?
[CUSTOMER][NEUTRAL] Uh, nope, that'll be all.
[AGENT][POSITIVE] OK, thank you so much for calling APL. Have have a good day bye.
[CUSTOMER][NEUTRAL] You too bye bye.