AccountId: 011433970860
ContactId: 7740200f-e92d-41c0-b0ea-5f7bf36db5f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1231630 ms
Total Talk Time (AGENT): 304620 ms
Total Talk Time (CUSTOMER): 327625 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/7740200f-e92d-41c0-b0ea-5f7bf36db5f8_20250603T19:46_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] I'd be happy to assist with claim status. Can you pronounce your first name for me again please?
[CUSTOMER][NEUTRAL] It's [PII], last name [PII].
[AGENT][POSITIVE] And if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] Uh, no, sorry. The policy number is 2140843.
[AGENT][NEUTRAL] I'm sorry, slow down, say it again.
[CUSTOMER][NEUTRAL] 214-0843.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And the data service for the claim?
[CUSTOMER][NEUTRAL] [PII] for $225 even.
[AGENT][NEUTRAL] Thank you for that and the tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. Um, it looks like we received the claim twice. The first time we made a $50 payment. The second time it denied as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the initial uh original claim details?
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] May I know the original claim details which was received on the first day.
[AGENT][NEUTRAL] We made a $50 payment. Claim was received on [PII]. We made the $50 payment on [PII].
[CUSTOMER][NEUTRAL] OK. But, uh, actually, the, uh,
[CUSTOMER][NEUTRAL] Primary patient responsibility is $60 for this code and you have paid 1.
[AGENT][POSITIVE] Their maximum benefit.
[AGENT][NEUTRAL] Their maximum benefit with us for an office visit is $50 so anything over that is patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's patient responsibility. OK.
[CUSTOMER][NEUTRAL] So it was received on [PII] and processed on [PII] I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] Claim number is 359.
[AGENT][NEUTRAL] 5976.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 359-597-6
[CUSTOMER][NEUTRAL] And can you fax me the EOB?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And to who's attention?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, you should receive that fax within the next 15 minutes. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yes, I have a few more patients. Can you help me?
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] I have still 3 more patients.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] And call reference will be same for the entire call or it will differ for every patient.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] It's the same for, it's just my name and today's date and time.
[CUSTOMER][NEUTRAL] OK. And uh the next uh member ID is [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $383 even.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Um, it looks as though the payment was issued, but then it was voided out.
[AGENT][NEUTRAL] Let me see if somebody requested.
[AGENT][NEUTRAL] OK, I've sent that claim back so that they can um reissue that payment.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] So if you can um allow 7 to 10 business days to receive the updated explanation of benefits.
[CUSTOMER][NEUTRAL] OK, 7 to 10 business days.
[CUSTOMER][NEUTRAL] And may I know the pay to address on file?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] May I know the pay to address on file uh for the payment to be sent?
[CUSTOMER][NEUTRAL] Through check.
[AGENT][NEUTRAL] Um, integrated dermatology, [PII].
[CUSTOMER][NEUTRAL] Uh, no, actually, uh, we are not receiving, uh, the check on the address.
[AGENT][NEUTRAL] I let me see if that's what's on the claim.
[CUSTOMER][NEUTRAL] Shall I provide you the correct name?
[AGENT][NEUTRAL] Let me see if that's what's on the claim, one moment.
[CUSTOMER][NEUTRAL] Yeah, the address which was on the
[CUSTOMER][NEUTRAL] [PII] is the address which we are receiving.
[AGENT][NEUTRAL] OK then you need to submit a corrected claim because that's the address that's on the claim.
[CUSTOMER][NEUTRAL] No, actually, the address was on the service location with box which was on [PII].
[CUSTOMER][NEUTRAL] We have it with the, that address.
[AGENT][NEUTRAL] I'm sorry, what's the policy number? Am I under the right policy?
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02559264.
[AGENT][NEUTRAL] And the data service is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the bill amount is 383?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK then you need to send a corrected claim because the claim that you sent us.
[AGENT][NEUTRAL] Box number 33 has integrated dermatology of South Miami [PII].
[AGENT][NEUTRAL] So a corrected claim because if uh if they reprocess that they're gonna send it to the same address because that's what you guys send us.
[CUSTOMER][NEUTRAL] Hm. But, uh, from our end, it's only showing as 7800 which we have sent.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] Uh, I'm telling you now what I, I'm looking at, are you looking at the same claim form that I'm looking at?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] Look at [PII]. Look at [PII] for me, please.
[CUSTOMER][NEUTRAL] Yeah, on the [PII], we have all this.
[AGENT][NEUTRAL] What do you see in [PII]?
[CUSTOMER][NEUTRAL] It's [PII] [PII]. Miami Dermatology and Laser Institute [PII].
[AGENT][NEUTRAL] We have that in [PII], but in [PII].
[AGENT][NEUTRAL] We don't have that, so you'll need to send us that claim that you're looking at that has that address in [PII].
[CUSTOMER][NEUTRAL] OK. So we need to resubmit the claim.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the claim which uh you have on file menu date received and processed date.
[AGENT][NEUTRAL] Um, claim was received on.
[AGENT][NEUTRAL] Uh, [PII] claim processed on [PII].
[CUSTOMER][NEUTRAL] And it was voided on?
[AGENT][NEUTRAL] Right, the, the payment was um voided I guess it you guys didn't get it somebody must have called about it and so they stopped payment to and did the reissue but I show where they voided the check but they didn't reissue it, but what I'm saying to you is y'all will need to send the.
[AGENT][NEUTRAL] Uh, um, updated address because if we process it again it's gonna go to the same address that is showing on the claim form that you originally sent, which is the wrong address.
[CUSTOMER][NEUTRAL] OK. So, uh, just we need to resubmit the claim with the primary UB and it won't get denied as duplicate, no.
[AGENT][NEUTRAL] No, it won't be denied as duplicate.
[CUSTOMER][NEUTRAL] OK. And may I know the voided date of the claim?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 356-1183
[CUSTOMER][NEUTRAL] OK. And the mailing address where we need to submit the claim form.
[AGENT][NEUTRAL] It's the same one, the [PII], and that's in [PII] City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] And the timely filing limit?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And shall I provide you the next?
[AGENT][NEUTRAL] OK, I can do one more. I can do one more. What is the policy number?
[CUSTOMER][NEUTRAL] And the date.
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] 945132.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Data service for the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] for $150 even.
[AGENT][NEUTRAL] OK, I'm not showing that claim.
[AGENT][NEUTRAL] What's the um.
[CUSTOMER][NEUTRAL] It's from [PII].
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm showing that claim was.
[AGENT][NEUTRAL] $25 was paid on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] May I know the uh receive and process date?
[AGENT][NEUTRAL] Claim was received on [PII]. Claim processed on [PII].
[CUSTOMER][NEUTRAL] And actually we have uh $45.69 leftover from primary.
[AGENT][NEUTRAL] OK, you'll need to bill the patient.
[CUSTOMER][NEUTRAL] OK. For each patient, uh,
[CUSTOMER][NEUTRAL] The allowed amount will differ.
[AGENT][NEUTRAL] That's correct depending on what type of policy they have.
[CUSTOMER][NEUTRAL] OK. And may I know the payment information?
[AGENT][NEUTRAL] Check number is 204-418-0.
[CUSTOMER][NEUTRAL] 204-418-0. And it's a single check or a bulk check?
[AGENT][NEUTRAL] Single.
[CUSTOMER][NEUTRAL] And it was issued on [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And may I know the pay your address for this one?
[AGENT][NEUTRAL] Claim went to Miami dermatology and laser.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And the claim number?
[AGENT][NEUTRAL] Claim number is.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] 600918
[CUSTOMER][NEUTRAL] 3600918
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And is the ticket has been cashed?
[AGENT][POSITIVE] No, it's still outstanding.
[CUSTOMER][NEUTRAL] So how many days we need to
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So how many days we need to to get the check cleared?
[AGENT][NEUTRAL] Um, 30 days.
[CUSTOMER][NEUTRAL] 30 business days.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And this you will also send to the provider's office with the check?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, thank you. And can you spell your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][NEUTRAL] Just my name and today's date and time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][POSITIVE] You do as well. Thank you. Bye.
[AGENT][NEUTRAL] Mhm bye bye.