AccountId: 011433970860
ContactId: 81205d3b-f9c0-4844-87fa-efbeaaccd1d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578890 ms
Total Talk Time (AGENT): 275033 ms
Total Talk Time (CUSTOMER): 216143 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/81205d3b-f9c0-4844-87fa-efbeaaccd1d3_20250328T17:19_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], my name is [PII] and I'm calling from AdventHealth, and I need to get some information on a claim. Um, it looks like it processed and denied as a duplicate, but I don't see that it's ever been processed with payment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I could try to get clarification on that and find that original if I'm able to, um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] My callback number is [PII] and that is a direct number.
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is
[CUSTOMER][NEUTRAL] Um, all that.
[CUSTOMER][NEUTRAL] The outpatient benefit certification number?
[AGENT][POSITIVE] Yes, yes, please.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. It is 01707416 ML 8.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Um, oh, I'm sorry, that's for [PII], so that may be different. Um, her name is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you have her date of birth?
[CUSTOMER][NEUTRAL] And her date of birth is.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. OK, uh, what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Data service for this claim is [PII].
[AGENT][NEUTRAL] [PII]. OK, one moment please.
[AGENT][NEUTRAL] And then did you have that uh billed amount?
[CUSTOMER][NEUTRAL] Um, the total charges on the claim is, let me get back over to that, $268.63.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Uh, now, was that before or after major medical paid?
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] Aetna processed as primary and they allow $121.56 to patient deductible and it looks like we, we rebuild them I'm, I'm guessing because it looks like they recouped and then they reprocessed under a different claim claim number um but it still shows the 12156 to the patient's deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got it, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, and then just to clarify, I'm sorry this was uh Florida radiology imaging?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, so I did find that original claim the first claim that we received was for $121.56 and we did pay that benefit. Um, if you'll give me one moment, I'll get that claim number and that check information for you as well.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Then also I know it's the same amount but just to confirm that was for procedure code 76705.
[CUSTOMER][NEUTRAL] Yes, yes, it is.
[AGENT][NEUTRAL] Got it. OK, alrighty, uh, I've got that claim number uh whenever you're ready I can give you that information.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So this is 342-899-998.
[CUSTOMER][NEUTRAL] And when was that paid?
[AGENT][NEUTRAL] Yes, OK, ah, wait a minute.
[AGENT][NEUTRAL] OK hang on I think I see where we got a hiccup here OK so um I can give you that original check number, but I am showing that it was voided so I think we had tried reissuing this check. Give me just a moment let me try to find that because I'm showing this one was originally issued.
[AGENT][NEUTRAL] Oh my goodness, [PII].
[AGENT][NEUTRAL] And then as of [PII], it was voided. So give me just a moment, let me try to find an update on that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it might have just been voided simply because it was outstanding for so long, so might just need to get that reissued then. OK, so I can go ahead if you need, uh, this information just in the meantime I can send you this original EOB just so you do have that information for the original claim because I think you said the um what you have is going to duplicate correct?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, but, um, and I would appreciate that, but why, so I'm on your portal. Why do I not show the initial claim? The only claim that I see is the one that I have that's denied is a duplicate.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, is there, I'm sorry, I'm really not familiar with how the providers can use it. Uh, is there a way you can search with the claim number?
[CUSTOMER][NEUTRAL] Yep and 00 the OK that's why because I searched with the claim number.
[CUSTOMER][NEUTRAL] OK, let me put in this other uh.
[AGENT][NEUTRAL] It is a bit confusing. It is a bit confusing and it makes it kind of harder on y'all if you don't know the original claim number. It is most definitely Friday.
[CUSTOMER][NEUTRAL] It's, it's Friday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Let me see if I can get and there it is, yeah, they completed I've got it right here so you don't need to send it to me. I've got it right here.
[AGENT][POSITIVE] Oh OK OK awesome just said that you've got, you know, paper trail of that correct information so alrighty I will try to go ahead and get this uh reissued to you um do you, did you have any other questions for me? Well, actually I'm sorry, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, can you tell me where, where the payment was sent to?
[AGENT][NEUTRAL] That's exactly what I was about to verify just to make sure that what we've got is right, um, OK, so the address we've got is [PII] is that correct?
[CUSTOMER][NEUTRAL] So is there any way that you can update it to the [PII] that's in [PII] that's on the claim?
[AGENT][NEUTRAL] If we um let's see, we would have to have a new claim form resubmitted or a um oh my goodness, a W-9 sent to us yes ma'am.
[CUSTOMER][NEUTRAL] A W 9.
[CUSTOMER][NEUTRAL] Can I fax you a W-9 that gives you the [PII] because that's the address that's actually on the claim for where to send the payment to.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, um, I've got that fax number whenever you're ready.
[CUSTOMER][NEUTRAL] Go right ahead.
[AGENT][NEUTRAL] OK, that is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I will get that faxed over as soon as we get off the phone and then um.
[CUSTOMER][NEUTRAL] Will you get that to be able to attach it for reprocessing or how do I need to follow up on it?
[AGENT][NEUTRAL] I can go ahead and do that um I'll go ahead and submit that uh information now in the meantime, um, can you go ahead and give me that correct address this is going to be sent to in [PII] just so I can reference that.
[CUSTOMER][NEUTRAL] Yes, OK, it is Florida Radilogy Imaging. It's gonna be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back, make sure I heard that correctly. So it was still Florida Radilogy Imaging and that was [PII] sorry.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] It is [PII]. I may have said it wrong.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, no, that's what I've got [PII]. I might have repeated it wrong, but that's what I've got, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And then that was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Got it. OK, so yeah, you go ahead and send that information to us. I will go ahead and get this uh sent to the this information sent to them so we can go ahead and get that underway and they'll keep an eye out for that fax.
[CUSTOMER][POSITIVE] OK, that'll work. Thank you, [PII], and last but not least, can I get a call reference for today?
[AGENT][POSITIVE] All right, you are very welcome.
[AGENT][NEUTRAL] Absolutely that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] last initial is A.
[CUSTOMER][POSITIVE] That'll work. Thank you, [PII]. I appreciate it.
[AGENT][POSITIVE] All right you're very welcome thank you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.