AccountId: 011433970860
ContactId: 73ebb7c4-7d8d-49eb-9f7f-784dcaeccb8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434309 ms
Total Talk Time (AGENT): 93884 ms
Total Talk Time (CUSTOMER): 140082 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/73ebb7c4-7d8d-49eb-9f7f-784dcaeccb8a_20250527T19:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for JLR Medical Group, anesthesia to check a claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, the member ID number is 01.
[CUSTOMER][NEUTRAL] 813082.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII], the last name is [PII], and the patient's date of birth is [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Data service is [PII]. Total charge amount is $2460 even.
[AGENT][NEUTRAL] Oh it looks like we received the claim 35-2025 process 3-10-2025.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] On the inpatient benefit calendar, your maximum dollar amount has been met.
[CUSTOMER][NEUTRAL] OK. Do you have a midd?
[AGENT][NEUTRAL] Um, I don't think so.
[AGENT][NEUTRAL] I can't see the exact date. No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'd have to go through every claim.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm. Can you please provide me the uh claim number?
[AGENT][NEUTRAL] Uh, this claim number is 3573262.
[CUSTOMER][NEUTRAL] OK. And this is the modifier QX or QK. Can you please confirm that?
[AGENT][NEUTRAL] Now let me pull up the claim.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I don't see a modifier on the claim.
[CUSTOMER][NEUTRAL] And did you see that who is presenting provider, a physician?
[CUSTOMER][NEUTRAL] Because I, we have filed two claims for the same patient, to individual provider name.
[AGENT][NEUTRAL] Yeah, we've processed both of them they're both denied for the same reason under the same claim.
[CUSTOMER][NEUTRAL] And can you please confirm that the claim number 262, you provided that. Who is the provider for this one? Provider name, please confirm me.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII] aired.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And the other provider is.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] It's the same provider, it was submitted twice.
[CUSTOMER][NEUTRAL] Um, I can see that the provider name is [PII].
[CUSTOMER][NEUTRAL] And could you please confirm the claim number information?
[AGENT][NEUTRAL] Um, I don't see that name.
[AGENT][NEUTRAL] Just got the same claim submitted twice for [PII].
[AGENT][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Do you have another claim number?
[AGENT][NEUTRAL] No, it's the same claim.
[CUSTOMER][NEUTRAL] Same patient have two claims, means they have 5 process the same claim number?
[AGENT][NEUTRAL] Yeah, it's, it's the same claim.
[AGENT][NEGATIVE] We received it twice.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's possible. We have filed two claims for 2 different individual provider name and two different modifiers. And, but the same thing is they have service and charge amount.
[CUSTOMER][NEUTRAL] OK. OK. The same claim was denied for the same reason inpatient benefit to Canada has been made. OK. And do you, uh, on your end, you don't have the med date, is it right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Don't have the what?
[AGENT][NEUTRAL] they, no, no, I don't, yeah.
[CUSTOMER][NEUTRAL] You don't have the med date, is it right? OK. And do you have a UB on your end?
[CUSTOMER][NEUTRAL] For the both claims?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the EOP through fax because we don't have the EOP on my end.
[AGENT][NEUTRAL] Yeah, there's just, there's just 11 EOB. It's the same claim number it was just submitted twice. I don't.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What's your facts?
[CUSTOMER][NEUTRAL] OK. You can 407.
[CUSTOMER][NEUTRAL] 6503235
[CUSTOMER][NEUTRAL] And the attention is [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes a few minutes.
[CUSTOMER][NEUTRAL] So, for this time, we need to bill the patient for the uh reme uh balance amount, is that right?
[AGENT][NEUTRAL] No, we're secondary, so we can't instruct on patient responsibility.
[CUSTOMER][NEUTRAL] OK. I will update here and you can send it back. And could you please provide me the call reference number, sir, [PII]?
[AGENT][NEUTRAL] That's my name and today's date.
[CUSTOMER][POSITIVE] OK, and that's all for the day. Thanks for your assistance. Have a great day.
[AGENT][POSITIVE] Thank you for calling APL you as well.