AccountId: 011433970860
ContactId: 69f20319-ceba-4672-b1a1-457bdc234db0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674909 ms
Total Talk Time (AGENT): 224473 ms
Total Talk Time (CUSTOMER): 192034 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/69f20319-ceba-4672-b1a1-457bdc234db0_20250328T17:11_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Proda's office to verify on our client status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status method. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] The member policy ID yes.
[CUSTOMER][NEUTRAL] 023.
[CUSTOMER][NEUTRAL] 007.
[CUSTOMER][NEUTRAL] 09 M as in Mary, L as in Lima 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII] and the charge amount is 285 dollars.03 cents.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It is NCHMD incorporated.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] The claim number is 3575077.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Denied for the CPT.
[AGENT][NEUTRAL] Right, it's not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But as it is a 99214 code only you know, as it is just an office visit code, how come it uh internet for the office area.
[AGENT][NEUTRAL] Because the policy doesn't cover the service when it's performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] As
[AGENT][NEUTRAL] And that code is saying that it's done in a doctor's office.
[CUSTOMER][NEUTRAL] As you say, the fish.
[CUSTOMER][NEUTRAL] Yes, actually, as for 99214, it's just an office of this code only, so it should be done in the office only as for the patient's plan type as you say this uh code is not covered under the office.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I know the patient plan type?
[AGENT][NEUTRAL] Sure, it's a Metlink supplemental gap insurance?
[CUSTOMER][NEUTRAL] Midline supplement insurance, is that right?
[AGENT][NEUTRAL] Medlink, yes, supplemental gap insurance.
[CUSTOMER][NEUTRAL] We're doing supplement insurance. OK, fine, um.
[CUSTOMER][NEUTRAL] OK, fine, can I move on for the next data service?
[CUSTOMER][NEUTRAL] For the same patient?
[AGENT][NEUTRAL] Yes, and what's the next date of service?
[CUSTOMER][NEUTRAL] The next date of service is [PII].
[CUSTOMER][NEUTRAL] And the charge amount is 517 dollars.01 cents.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 500.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So this claim was received on [PII]?
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 5943.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, 2025, the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] For that patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I go on, uh.
[CUSTOMER][NEUTRAL] Can I get the correct time fra of it?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Can you repeat that question, please?
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] Can I uh get the character time?
[AGENT][NEUTRAL] The corrected time limit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you asking for the time to submit a corrected claim?
[CUSTOMER][POSITIVE] Yes perfect.
[AGENT][NEUTRAL] There's no um timely filing or time to submit a claim, as long as the policy was active, you can submit it at any time.
[CUSTOMER][NEUTRAL] OK, fine, no issues, um, so OK, can I then can I go on for the next client for the same patient for a different data services?
[AGENT][NEUTRAL] OK, how many days of service do you have?
[CUSTOMER][NEUTRAL] Actually it is 4 data services and we have completed with 2 data services. I have another 2 claims.
[AGENT][NEUTRAL] OK, I'm just asking so I can, um, I was gonna note the policy, but I'll wait till the end. OK, and what's the next um date of service?
[CUSTOMER][NEUTRAL] The next date of service is [PII] and the charge amount is $40 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so for this claim, I'm showing we received it on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 5940.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] OK, can I go on for the last data sales?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The next date of service is [PII] with a charge amount of $55 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And for 55, hold on one moment.
[AGENT][NEUTRAL] Alright, so this claim was received on [PII]?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 5948.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, because the service is not covered when performed in the doctor's office or clinic.
[CUSTOMER][NEUTRAL] Can I get the date of that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, same, OK fine.
[CUSTOMER][NEUTRAL] So as for all the CPTs has been denied as for the patient's plan, can I know what can we do as the next time, uh, as we need to change the CPT and rebuild the client?
[AGENT][NEUTRAL] I mean, if it's done in an office, you have to let us know that it's done in an office. They they just, the policy just doesn't have coverage for in-office. It's outpatient facilities and inpatient facilities.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we need to enroll in with the office, is that right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] We need to enroll the patient's plan with office.
[AGENT][NEUTRAL] You need to end the patient's plan with office.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What do you mean by that?
[CUSTOMER][NEUTRAL] Enroll.
[AGENT][NEUTRAL] You need to handle it with the office?
[CUSTOMER][NEUTRAL] Actually, the office visit, as you say, the office visit quotes are not and are not um.
[CUSTOMER][NEGATIVE] are invalid as for the patient's plan.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] So we need to change the CPT or we need to found that whether these codes are built under the offices it cos, is it right?
[AGENT][NEUTRAL] No, the policy does not, anything that you build that is in an office setting, the policy is not going to cover. The policy covers outpatient facilities and inpatient facilities. Outpatient is urgent care, emergency room, outpatient surgery, physical therapy. So if it's in an office setting, this particular policy will not cover it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this only covers for office out of visits. OK, fine, no issues. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Uh, can I get your name spelling then?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] Thank you, [PII] and have a nice day. Bye for now. Have a nice week. Be safe. bye for now.
[AGENT][NEUTRAL] Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, from my side, it's over.
[AGENT][POSITIVE] All right, thanks for calling API. Have a great day.
[CUSTOMER][POSITIVE] Thank you bye for now.
[AGENT][NEUTRAL] Bye bye.