AccountId: 011433970860
ContactId: 7e77871b-6dc9-4a32-b221-ee0ffa337edd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 840659 ms
Total Talk Time (AGENT): 200699 ms
Total Talk Time (CUSTOMER): 351380 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/7e77871b-6dc9-4a32-b221-ee0ffa337edd_20250616T12:47_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, hi, good morning. My name is [PII]. I'm calling from the provider's office. I need to check.
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you. Uh, do you have the policy number?
[CUSTOMER][POSITIVE] Yeah, I do have it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy number is going to be 019.
[CUSTOMER][NEUTRAL] 602
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] M as Michael, L as Lima number 8.
[AGENT][NEUTRAL] What is the patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEGATIVE] Me no free.
[CUSTOMER][NEUTRAL] Mm, your date of birth is [PII].
[AGENT][NEUTRAL] OK. What is the date of service?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's going to be [PII].
[CUSTOMER][NEUTRAL] And total charge amount is $408.62 408.62.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Actually, I have one question regarding this claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, uh, as I can see here, uh, I think it's partially paid. It's paid for all the items that I can see here, but I think it's not paid for CPT code A alpha 7038.
[CUSTOMER][NEUTRAL] Could you please verify that?
[AGENT][NEUTRAL] Uh, yes, one moment.
[AGENT][NEUTRAL] So I do see that. It looks like durable medical equipment. Uh, it looks like it's not a covered benefit, so that's the reason for the denial.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Uh, but it's paid on the other CPD code. Yeah one portal 5 like 4 are paid and only 1 is not paid.
[AGENT][NEUTRAL] 584 was paid, is that what you're asking?
[CUSTOMER][NEUTRAL] No, I'm saying that 4 CPT codes are paid, only 1 is not paid. As I can see here, the CPT code E 0562 is paid for $125 and 4604 is paid for $26.
[CUSTOMER][NEUTRAL] And same like for to others but I cannot see any payment for the 87038. Uh, we have built 6 units.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] So D2E6053 is denied because this item does not meet the definition of durable medical equipment.
[CUSTOMER][NEUTRAL] No. Could you repeat the code again, please?
[AGENT][NEUTRAL] D2E6053
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] No, not that one I'm talking about A 7038.
[AGENT][NEGATIVE] A 7038 is coded. It doesn't meet the definition of durable medical equipment. That's why it was denied.
[CUSTOMER][NEUTRAL] So can we resubmit this code again? What can we do to get payment on this code?
[AGENT][NEUTRAL] We're not able to advise as far as patient responsibility. That's up to the facility or the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have one more question. Uh, do you guys send the remittance or you will be over the fax?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I can send you it via fax. Do you have a fax number?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. And I also need the payment details on the pay like the checking number and all that because.
[CUSTOMER][NEUTRAL] I'm not able to see it here. I just need that as well. Just let me provide you the fax number first. Just give me one second.
[CUSTOMER][NEUTRAL] Yeah, the fax number that you can use is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 249
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's attention to [PII].
[CUSTOMER][NEUTRAL] And you should do last name [PII] for [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh can you get the payment details?
[AGENT][NEUTRAL] The payment on this was.
[AGENT][NEUTRAL] Yeah, the payment on this was a single check. The check number was 202.
[AGENT][NEUTRAL] 0540.
[CUSTOMER][NEUTRAL] Yes, a single check. OK. And do you have any information if the check is uh cleared or not yet?
[AGENT][NEUTRAL] Uh, let me check one moment.
[AGENT][NEUTRAL] Uh, the check has been cashed.
[CUSTOMER][NEUTRAL] That's fanta. Uh, do you have any date on that?
[AGENT][NEGATIVE] I do not, unfortunately.
[CUSTOMER][NEUTRAL] Oh, OK, no worries. Uh I'm just asking for this claim.
[CUSTOMER][NEUTRAL] Uh, can I get the claim number?
[AGENT][NEUTRAL] Claim number is 354-566-3.
[CUSTOMER][NEUTRAL] 3 and the total paid amount from your end is going to be.
[AGENT][NEUTRAL] The completion date is that what you're asking for?
[CUSTOMER][NEUTRAL] No, the total paid amount on the plane.
[AGENT][NEUTRAL] Uh, total paid amount was $247.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] $247.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, I have one last claim left for the same insurance. Let me see if it's the same or different number.
[AGENT][NEUTRAL] Just different data service.
[CUSTOMER][NEUTRAL] Yes, sir. No, but just a different, uh, number as well, different policy number.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Oh, OK. Let me just notate this and I can check another one. Give me one moment, please.
[CUSTOMER][POSITIVE] Yeah, thank you very much.
[AGENT][NEUTRAL] OK, what's the next member ID?
[CUSTOMER][NEUTRAL] Yeah, 10611.
[CUSTOMER][NEUTRAL] 530
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And just to reconfirm, the policy number was 10,611,530?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] No, it's 01611530.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Your patient name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It's going to be [PII].
[CUSTOMER][NEUTRAL] And total bill amount is $284.96.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, did you find the claim?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Is real.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Did you really just put me on hold?
[AGENT][NEUTRAL] All right. So it looks like we did receive the claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, there was a benefit payment sent.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] In the amount of $202.82.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the check number, is there any patient responsibility on this?
[AGENT][NEUTRAL] Uh, we're not able to advise on patient responsibility. That's up to the facility or the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. And uh what was the check number?
[AGENT][NEUTRAL] Uh, single check, it was 2004623.
[CUSTOMER][NEUTRAL] I'm sorry 2004.
[AGENT][NEUTRAL] 623.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That's it. OK. And uh can you get the claim number on this one as well?
[AGENT][NEUTRAL] 351-0177
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So 351-077.
[AGENT][NEUTRAL] 351-0177.
[CUSTOMER][NEUTRAL] OK. And just one last thing, is it the, is it cash or not yet? Could you please verify that?
[AGENT][NEUTRAL] One moment, yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That.
[AGENT][POSITIVE] The check does still show outstanding.
[CUSTOMER][NEUTRAL] OK. And just one more thing, could you please also share the UV for this claim on the same fax number as well?
[AGENT][NEUTRAL] Mhm. Yup.
[AGENT][NEUTRAL] Give it about 5 minutes and you should have the EOB. Is there anything else I can check on?
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] He actually tried to like make the report online, online at APL but uh it says that the claim is not verified. So do you have any
[CUSTOMER][NEUTRAL] Another team that can help me on that.
[AGENT][NEUTRAL] I can check another claim. Give me just a moment here.
[CUSTOMER][NEUTRAL] Well, I don't need to check any other claims. I just need uh
[CUSTOMER][NEUTRAL] Because, uh, before calling, we try to access the, your report online, but I wasn't able to log in or.
[CUSTOMER][NEUTRAL] Signed up on the portal.
[CUSTOMER][NEUTRAL] So we have portal access. Can we download the remittance from the web portal?
[CUSTOMER][NEUTRAL] Or do we need to call and like uh take it on the tax.
[AGENT][NEUTRAL] If you haven't registered for the portal then you would need to reregister um to check any sort of claims, but you should be able to check them as a provider online if you would like, but you would need to register the online service center changed and so everybody's having to re-register for the portal.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So can we download the EOB from portal as well?
[AGENT][NEUTRAL] Yes, you should be able to. Uh-huh.
[CUSTOMER][NEUTRAL] But do any number for the like uh provided to this reporter team where we can call and have the portal access.
[AGENT][NEUTRAL] The portal access just has to be set up online through our website.
[CUSTOMER][NEUTRAL] Actually try to go over there. I have entered a tax ID like when I enter the other details it says that claim is not verified, something like that.
[CUSTOMER][POSITIVE] OK, no worries, sir. I'll try again.
[CUSTOMER][NEUTRAL] I think that's gonna be all from my end. Can you give the code number, please?
[AGENT][NEUTRAL] That is my name with today's date, which is [PII], last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. OK. Thank you very much, [PII], for helping me today. Have a wonderful day.
[AGENT][NEUTRAL] You too. Bye-bye.