AccountId: 011433970860
ContactId: 81dbf040-181b-4274-9a57-9f63252f9cc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352950 ms
Total Talk Time (AGENT): 149645 ms
Total Talk Time (CUSTOMER): 139946 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/81dbf040-181b-4274-9a57-9f63252f9cc5_20250312T19:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this side. I'm calling from provider's office. My advisor LLC. I'm having a question against the claim.
[AGENT][POSITIVE] OK, I can verify claim status for you and I'm so sorry, your name is again?
[CUSTOMER][NEUTRAL] Yeah, that one is [PII]. It's [PII], and first initial of my last name is [PII].
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII], OK, and what's that policy number, please?
[CUSTOMER][NEUTRAL] And that one is 01986343.
[AGENT][NEUTRAL] Thank you. And [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And that one is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the extension is [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], you said you're calling to verify claim status, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what was that data service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah that one is [PII].
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the total charge.
[CUSTOMER][NEUTRAL] Uh, I was.
[CUSTOMER][NEUTRAL] $264.57.
[AGENT][NEUTRAL] OK, thank you. And while I'm looking at claim information, 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].
[AGENT][NEUTRAL] And you're calling from again? I apologize.
[CUSTOMER][NEUTRAL] Oh, it's for claim and I'm calling from Medvice LLC.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Uh, OK, I'm sure that claim process as receipt of this reference claim is acknowledged. However, in order for us to process this claim, we need the explanation of benefits that matches the claim information.
[CUSTOMER][NEUTRAL] Explanation of benefits from prime repair.
[AGENT][NEUTRAL] We need the primary EOB with the information matching the claim information submitted.
[CUSTOMER][NEUTRAL] OK, can, uh, we can attach that primary OBA and, uh, rebuild the coin.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it and uh can you spell your name?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, I just need to know that we have to submit a corrective claim for this one.
[AGENT][NEUTRAL] Not a corrected claim, we need the correct EOB because the EOB that we receive, uh, the information does not match the uh claim information received.
[CUSTOMER][NEUTRAL] Just give me a second, let me check that.
[CUSTOMER][NEUTRAL] Uh, actually, uh, which kind of information uh that not match?
[AGENT][NEGATIVE] The total charge amount and the procedure code doesn't match what's on the claim.
[CUSTOMER][NEUTRAL] Uh, actually this is for urgent care facility and uh as per our contract with the Blue Cross Blue Shield, uh, we have to build the S9083 code for um.
[CUSTOMER][NEUTRAL] As for the contact for urgent care.
[AGENT][NEUTRAL] OK, but even the total charge doesn't match, but you told me a total of 26457. So we need to correct the uh we need to correct EOB that matches that same information.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Because the pro
[CUSTOMER][NEUTRAL] Uh, but you, uh, but as for our contract with this, uh, so we have to build the ENM.
[CUSTOMER][NEUTRAL] And as uh we have the contract with the Blue Cross Blue Shield which only process as quote for urgent care.
[CUSTOMER][NEUTRAL] In fact, of ENM. So that's why we build the ENM code. Uh, we build the S code to be Blue Cross Blue Shield, and we build the ENM code to you as secondary.
[AGENT][NEUTRAL] I understand, even the total charge amount does not match. On the EOB is showing a total charge of 19892 as opposed to the amount of 264.57 that you inquired about.
[CUSTOMER][NEUTRAL] Yeah, because both the procedure code having the different charge amount, that's why.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So what we can do in this situation, we can be less good to you.
[AGENT][NEUTRAL] You will need to submit the EOB that matches the information received on the claim.
[CUSTOMER][NEUTRAL] But we only having the COB.
[AGENT][NEUTRAL] Well, you would need to contact the primary insurance in order for us to process the secondary, this information needs to match.
[CUSTOMER][NEUTRAL] OK, uh, what was the claim number?
[AGENT][NEUTRAL] 3551208
[CUSTOMER][NEUTRAL] OK, and what will the quarter for this call?
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. If you like, you may use my name of today's date. And [PII], is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] No thank you so much and have a nice day.
[AGENT][POSITIVE] You too. Thank you for calling APL. Bye.