AccountId: 011433970860
ContactId: 7249462b-052c-4d58-91d1-97434d7d20a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384100 ms
Total Talk Time (AGENT): 91137 ms
Total Talk Time (CUSTOMER): 167716 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/7249462b-052c-4d58-91d1-97434d7d20a5_20250502T13:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hello [PII], this is [PII]. I'm calling on behalf of Mount Sinai Medical Center to check claiming status for one of our patients, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number, please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes, patient's policy number is 245.
[CUSTOMER][NEUTRAL] 6394.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] name.
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and do you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yes, um, date of service it's, um, [PII] and bill amount were $944.
[CUSTOMER][NEUTRAL] I have here a claim number if you want to.
[AGENT][NEUTRAL] OK, what's that claim number?
[CUSTOMER][NEUTRAL] Claim number is 024456394.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Yeah, it's not one of our claim numbers. Um, do you have the, what were the bill charges again?
[CUSTOMER][NEUTRAL] Members, um, do you have the what was the bill charges again?
[CUSTOMER][NEUTRAL] $944.
[AGENT][NEUTRAL] I'm 44, OK, let me see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Do you have an EOB in front of you or what were you looking at?
[CUSTOMER][NEUTRAL] Do you have an EOB?
[CUSTOMER][NEUTRAL] Um, no, I don't have any information.
[AGENT][NEUTRAL] Because I have a claim, let's see, it's for.
[CUSTOMER][NEUTRAL] Yes I have a
[AGENT][NEUTRAL] Out of this number. Hold on one moment.
[AGENT][NEUTRAL] Looks like they built several services together, um from [PII] through.
[CUSTOMER][NEUTRAL] Looks like they built several.
[CUSTOMER][NEUTRAL] Services together um from [PII] through.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um, actually, for this claim, there are two, procedures. I have here for um service line 1 CPT 52,000. And for service line number 2, I have CPT 99213.
[AGENT][NEUTRAL] OK, and it was a charge for 228 and then a charge for 7:16, is that right?
[CUSTOMER][NEUTRAL] OK, and it was a charge for 228 and then a charge for 7.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let me check 1 2nd.
[CUSTOMER][NEUTRAL] Um, yes, for, um, you said that for the charges for, um, each CPT 716 and 228.
[AGENT][NEUTRAL] Yes, so it looks like the office visits not covered under the policy.
[CUSTOMER][NEUTRAL] Yes, so it looks like the office visit not covered under the policy.
[CUSTOMER][NEUTRAL] OK, not covered.
[AGENT][NEUTRAL] E
[CUSTOMER][NEUTRAL] On their patient's policy.
[AGENT][NEUTRAL] And then it looks like the other charge.
[CUSTOMER][NEUTRAL] OK, um, mhm.
[AGENT][NEUTRAL] Um, it said explanation of benefits from the primary insurance carrier for the service is required and diagnosis for which treatment was provided on the date of service.
[CUSTOMER][NEUTRAL] Um, it said explanation of.
[CUSTOMER][NEUTRAL] Car
[CUSTOMER][NEUTRAL] Required and I.
[CUSTOMER][NEUTRAL] OK, so you're saying that for CPT 99213 um is not covered because of um patients plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Correct. And for the CPT 52,000 you need the primary EOV.
[AGENT][NEUTRAL] Yes, and then it showed um it didn't have the diagnosis for which treatment was provided.
[CUSTOMER][NEUTRAL] Yes, and then it showed um.
[CUSTOMER][NEUTRAL] It didn't have the diagnosis.
[AGENT][NEUTRAL] Um, so we need the diagnosis as well.
[CUSTOMER][NEUTRAL] And so we need to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, what is the timely filing to submit a claim?
[AGENT][NEGATIVE] Uh, there's no timely filings.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] I don't know, time to time. OK.
[CUSTOMER][NEUTRAL] Um, can I have the payer ID?
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] The payer ID is 608.
[CUSTOMER][POSITIVE] OK, thank you so much [PII], can I have a reference number?
[AGENT][NEUTRAL] A reference number is my name, [PII], first initial to last name [PII], and today's date. And anything else I can help with [PII]?
[CUSTOMER][POSITIVE] Oh, no, that will be all. Thank you so much for the information. Have a nice day.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.
[CUSTOMER][POSITIVE] Thanks for calling AT
[CUSTOMER][NEUTRAL] Bye.