AccountId: 011433970860
ContactId: 7c6926a8-c949-498e-8ead-7ce23be2993d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364980 ms
Total Talk Time (AGENT): 154227 ms
Total Talk Time (CUSTOMER): 185266 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/7c6926a8-c949-498e-8ead-7ce23be2993d_20250305T16:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII] calling from provider office looking for claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] Uh, my first name is [PII], spelled as [PII].
[AGENT][NEUTRAL] OK, thank you. And what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, policy number is
[CUSTOMER][NEUTRAL] 01813065 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment, please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yes, callback number is [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much. And verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's first name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling for a claim status, correct?
[CUSTOMER][NEUTRAL] Uh yes. Previously we had submitted um claim with the primary PDUB on uh just allow me a moment.
[CUSTOMER][NEUTRAL] Uh, on [PII]. Can you check that claim?
[AGENT][NEUTRAL] What was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] OK, and the amount of the charge?
[CUSTOMER][NEUTRAL] $624 even.
[AGENT][NEUTRAL] OK. And the balance after primary?
[CUSTOMER][NEUTRAL] Uh sorry?
[AGENT][NEUTRAL] The balance after the primary?
[CUSTOMER][NEUTRAL] Uh yes, I can see that procedure code J9035 is denied of amount $23.51.
[AGENT][NEUTRAL] OK, do you have a total of what was remaining after primary?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] At $23.51. Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office?
[CUSTOMER][NEUTRAL] Murray ocular Oncology and retina INC.
[AGENT][NEUTRAL] OK, thank you. Uh, one moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And while I'm looking at claim information, just to let you know, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and it show initially it looks like the claim paid $55 and that was towards the code 99214. Uh, the other code was processed as needing primary EOB and it looks like we received that claim a second time and it was processed as a duplicate.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, uh, you received the, the primary care UB.
[AGENT][NEUTRAL] Well, for that uh code that you spoke of of J 9035, it processed as a duplicate. Uh, let me look at this claim, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I do show we received that EOB and it looks like for that code, well, it wasn't on the EOB actually.
[CUSTOMER][NEUTRAL] And now
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So that was processed as a duplicate.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You received the UB from the repair.
[AGENT][NEUTRAL] We received the claim a second time and the EOB, but that code of J9035 was not on the EOB. So if you have the EOB with that code and it does show primary applied any amount towards deductible, co-pay or co-insurance, then you can resubmit to our office.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But it looks like even on the initial claim, uh, we received an EOB and it did not have that code on there, so it was processed as a duplicate for the second time.
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, so how can we submit the Prime UB? Do you have any fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, just for confirmation [PII]. Thank you so much. And may I have the call reference number?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name and today's date, and it is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Uh, thank you so much, [PII]. Have a nice day. Bye for now.
[AGENT][POSITIVE] Alright, you're welcome, and thank you for calling APL. Bye.