AccountId: 011433970860
ContactId: 7fe4b858-197a-48d7-bed9-2d37d72ac44c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605719 ms
Total Talk Time (AGENT): 97356 ms
Total Talk Time (CUSTOMER): 197618 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/7fe4b858-197a-48d7-bed9-2d37d72ac44c_20250611T17:13_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling on behalf of the provider to check up on claims.
[AGENT][POSITIVE] I'd be happy to assist with claims today [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, and how are you doing today, [PII]?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm also doing good, thank you for asking.
[CUSTOMER][NEUTRAL] And my name is spelled as [PII] and my best callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number? Oh, I'm sorry.
[CUSTOMER][NEUTRAL] And the extension 13.
[CUSTOMER][NEUTRAL] Uh, yeah, not an issue. It's extension is 13113.
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][NEUTRAL] 01854076 M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service for the claim is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what's the um procedure code?
[CUSTOMER][NEUTRAL] It's 00731.
[AGENT][NEUTRAL] OK, I'm showing that claim was denied because the maximum benefit had already been paid.
[CUSTOMER][NEUTRAL] Maximum benefits exhausted, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And was it in terms of dollar value or number of visits?
[AGENT][POSITIVE] Dollar value.
[CUSTOMER][NEUTRAL] And what's the
[CUSTOMER][NEUTRAL] Total amount that the member has.
[AGENT][NEUTRAL] $200 per day.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] $200 per?
[AGENT][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] OK. The member is entitled to have a reimbursement for only $200 per day.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So maximum benefit for the that date of service only exhausted, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, could I just hold your call for a moment, [PII]? Just for one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright well thanks a lot.
[CUSTOMER][POSITIVE] Thanks a lot, [PII], for kindly.
[CUSTOMER][POSITIVE] Waiting and the call much appreciated for your patience.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, [PII]. Yeah, actually, uh,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, is this claim included in the dollar, made dollar value per day?
[CUSTOMER][NEUTRAL] Or excluded.
[AGENT][NEUTRAL] We received the facility claim before we received your claim and the facility was paid the full $200 per day benefit so that is why your claim denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, thanks a lot. And could you please also
[CUSTOMER][NEUTRAL] Provide me the denial date of this claim.
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] [PII] of year.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] of which year?
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][POSITIVE] Well, thanks [PII] for resolving the issues regarding this claim. I do have one more claim for a different member. Can you help me with that claim?
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 018.
[CUSTOMER][NEUTRAL] 949.
[CUSTOMER][NEUTRAL] 31, M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's one [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the tax ID?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the CPT code?
[CUSTOMER][NEUTRAL] It's [PII], sorry, [PII].
[AGENT][NEGATIVE] I'm showing this claim denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how to submit the primary UV to you?
[AGENT][NEUTRAL] You can fax it, mail it.
[AGENT][NEUTRAL] Electronic with the payer ID.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what's the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the best way to submit the, the primary UV to you?
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] Fax, uh, email, or?
[CUSTOMER][NEUTRAL] Yeah, what's the best way to submit? Uh, is it mailing address through the mailing address or fax or?
[AGENT][NEUTRAL] It's however you choose to send it.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We'll surely submit the primary UB and what are the daily time limits for summitting the primary UB?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, thanks a lot and could you please also provide me the denial date for this claim?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][POSITIVE] Well, thanks a lot, [PII] for your kind help and assistance today. Could you please generate the call reference number for our call?
[AGENT][NEUTRAL] Reference is just my name [PII], last initial [PII], and the date and time of the call. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] And followed by the date and time, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And what will be the time?
[CUSTOMER][POSITIVE] Sorry for that.
[AGENT][NEUTRAL] [PII] Central.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thanks a lot, [PII]. You have helped me resolving all my issues regarding these two claims. Have a wonderful day ahead. Take care and be safe.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Bye.