AccountId: 011433970860
ContactId: 79bf5482-bfa1-4623-9796-79d6b16f9ad8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 868630 ms
Total Talk Time (AGENT): 260708 ms
Total Talk Time (CUSTOMER): 257607 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/79bf5482-bfa1-4623-9796-79d6b16f9ad8_20250515T17:49_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], I received a duplicate denial and I'm needing to know how the original claim processed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what's your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Hey [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII] and my direct extension is [PII].
[AGENT][NEUTRAL] Alright, and do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is 01904327.
[AGENT][NEUTRAL] OK. One moment. Let me look up that policy and I'll help you with your claim.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] A. Has 86-70 is birth date.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alright, let me look that up.
[AGENT][NEUTRAL] Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, the data service is 1-8-2025.
[CUSTOMER][NEUTRAL] I do have the claim number but it's on the duplicate denial. I could give you that one if you'd like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I should be able to look it up by that date of service and then that way I can hopefully see both of them.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You said [PII] of this year, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the claim number that you have so that I know which one to look at?
[CUSTOMER][NEUTRAL] OK, the claim number that I'm looking at is 3593312.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you need the first denial? OK, go ahead.
[CUSTOMER][NEUTRAL] And it, and it's really weird.
[CUSTOMER][NEUTRAL] Yes, yes, yes, um, I was just looking at it and like the first.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the EOB it shows previously submitted duplicate but then there's a second remark uh code that says office visits are not covered by the above numbered policy, so.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so that is really why the claim did not issue payment.
[AGENT][NEUTRAL] Yes, let me double check and make sure on that first one that that is what it said.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Gonna go ahead and look both of them up for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] My computer is going a little bit slow, so give me just a second.
[CUSTOMER][POSITIVE] Oh, you're good you're good thank you.
[AGENT][POSITIVE] Oh, it is taking its sweet little time today. All right.
[CUSTOMER][POSITIVE] It's all good.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, the one that ends in 3312 looks like it was a duplicate.
[AGENT][NEUTRAL] But the office visit is not covered and let me check on that other one just to make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, so it looks like the one that's 356-467-0.
[AGENT][NEUTRAL] Was sent in on [PII] and processed on [PII].
[AGENT][NEUTRAL] Well, the second one was sent in on [PII].
[AGENT][NEUTRAL] And processed on [PII], so the one ending in 3312 was a duplicate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the original one.
[AGENT][NEUTRAL] That ends in 4670.
[AGENT][NEUTRAL] Was denied because office visits are not covered. Let me make sure I got that one right. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Right, office visits are not covered, so that's why the original claim was denied.
[CUSTOMER][NEUTRAL] Um, and I, uh, you just provided me the, um, let me ask you something, can you tell me what the PO box was on that particular one that I just find it weird that we didn't receive the first one, but there was a PO box change at some point, and I didn't and maybe that's why we didn't receive the original claim processing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you're wanting to know the EOB for the one ending in 4670?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I just wanna make sure before I look it up.
[CUSTOMER][NEUTRAL] Yep, yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like it was sent to [PII] in [PII].
[AGENT][NEUTRAL] And is that the one you did not receive?
[CUSTOMER][NEUTRAL] Yep, that's us.
[CUSTOMER][NEGATIVE] That is the one we didn't received. I'm not sure what the bank did with our stuff, but um.
[AGENT][NEUTRAL] Would you like me to fax it to you?
[CUSTOMER][NEUTRAL] OK, and before.
[CUSTOMER][NEUTRAL] Oh no, you don't need to as long as I have that claim number I'm good. Here's the other thing I tried to sign up online and maybe you're not the person to talk to, but it says enter your Medicare num uh Medicare ID number as it shows on box 26, and I did that and it, it kept telling me can't locate patient. is there an IT department that I can call to get us registered?
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh let me see, so.
[AGENT][NEUTRAL] You went in as a new user and you did medical providers, correct?
[CUSTOMER][NEUTRAL] Yes, yes, uh-huh.
[AGENT][NEUTRAL] And the tax ID and you did the patient account number correct?
[CUSTOMER][NEUTRAL] Yes, the patient account number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And like I'm in it right now and when I when I put next it says no user was found with this information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one second.
[CUSTOMER][NEUTRAL] Um please try again.
[AGENT][NEUTRAL] Alright, let me see what's going on here. Give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What tax ID number did you use?
[CUSTOMER][NEUTRAL] I use the 43.
[CUSTOMER][NEUTRAL] Oh, me, do you think I put it in wrong? Uh, let me see what I did.
[AGENT][NEUTRAL] I'm gonna, I'm gonna check and see because I do have those numbers with me so I just wanna uh verify.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. OK, I entered [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the PA number?
[CUSTOMER][NEGATIVE] Um, I entered [PII] and then I put it in with NKC because that's how Medicare shows it and then I did space NKC and it's still nothing, nothing I've tried has worked.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mm, because that is what I'm showing, so you didn't enter it wrong. Just trying to make sure that that's what that, yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Just making sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did it let you try it without the NKC just in case?
[CUSTOMER][NEUTRAL] Oh right, I did, I did it without with with the space it just wouldn't allow me. Oh yeah, I tried every little trick I could think of because I'd rather, you know, it's easier to check online um because sometimes the whole times when we call her an hour.
[AGENT][NEUTRAL] The space all this other fun stuff, OK, OK, OK. I just wanna make sure.
[AGENT][NEUTRAL] Yeah, because sometimes there's a character space limit, but if you entered it in all of the all of the ways.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Whoopsies.
[AGENT][NEUTRAL] Just a second.
[CUSTOMER][POSITIVE] You're good.
[AGENT][POSITIVE] OK, I was able to do hm, I was able to do it with those numbers.
[CUSTOMER][NEUTRAL] You were
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Because I double checked to see what was going on, OK.
[CUSTOMER][NEUTRAL] Should I
[CUSTOMER][NEUTRAL] OK, let me take out.
[AGENT][NEUTRAL] OK, so let me see, let me see what I did. Oh, it's not letting me go back, of course.
[CUSTOMER][NEUTRAL] 431.
[CUSTOMER][NEUTRAL] 639806.
[CUSTOMER][NEUTRAL] And then you didn't put NKC you just put that six digit number I provided you?
[AGENT][NEUTRAL] I put the number and then I did space in KC I didn't capitalize it but I don't know why that would matter but.
[CUSTOMER][NEUTRAL] OK, I'm gonna do just what you just told me like I'm gonna try that again um space NKC.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh thank you, it worked, it worked.
[AGENT][NEUTRAL] I have no
[AGENT][NEUTRAL] I don't know why capitalization would matter because you did it I did it just the way you did it. I just didn't capitalize anything so I don't I don't know what happened maybe it's just because someone's on the phone with you and.
[CUSTOMER][POSITIVE] Oh well I so appreciate this.
[AGENT][NEUTRAL] I know things work for me when people are watching.
[AGENT][NEUTRAL] Anytime.
[CUSTOMER][POSITIVE] Yeah yeah this is awesome OK well have a great day and thank you once again.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, uh [PII], thank you so much for calling ATL and if there's nothing else I can help you with, uh, have a great day.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][NEUTRAL] Alright bye.