AccountId: 011433970860
ContactId: 835ecf97-053b-40c1-8c42-2ed04a3941aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657280 ms
Total Talk Time (AGENT): 246546 ms
Total Talk Time (CUSTOMER): 226995 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/835ecf97-053b-40c1-8c42-2ed04a3941aa_20250225T16:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII], uh, to check on the point status.
[AGENT][POSITIVE] It would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Thank you, [PII] and a callback number please.
[CUSTOMER][NEUTRAL] Yeah, it's an [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, so it.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah, it's in 02438450.
[AGENT][NEUTRAL] And [PII], what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, it's uh [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Alright thank you and it would be my pleasure to assist you with that claim status for [PII]. What is the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's an [PII].
[AGENT][NEUTRAL] And what is the bill amount please ma'am?
[CUSTOMER][NEUTRAL] Yeah, $1,494 even.
[AGENT][NEUTRAL] And the facility name?
[CUSTOMER][NEUTRAL] Uh, OK. That's a Prisma Health University Medical Group.
[AGENT][NEUTRAL] All right, thank you, and that is for CPT 001965 and that is the QK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And [PII], I'm showing that we received that claim on [PII] and processed on [PII]. The claim was denied because the maximum benefit for that data service has been met.
[CUSTOMER][NEUTRAL] OK. Uh, just a minute. I can document it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] You don't want to play at night.
[CUSTOMER][NEUTRAL] I thought you said he.
[CUSTOMER][NEUTRAL] May I know the denied date?
[AGENT][NEGATIVE] Yes, ma'am. That was denied on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 11, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, may I know, uh, can you fax me the OB?
[AGENT][NEUTRAL] EOBs are obtainable on our provider portal that secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can you fax me the UV or not?
[AGENT][POSITIVE] I can. It's a lot quicker to get it from that portal and I can help you with that if you would like.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, if you would go to secured and it's SEC.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Can I have the mailing, uh billing mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] And would you like for me to help you with that portal so that you can get that EOB?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you will go to [PII], that's [PII].
[AGENT][NEUTRAL] You are [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. May I know
[AGENT][NEUTRAL] And you're gonna
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Yeah, may I know the time limit for this one?
[AGENT][NEGATIVE] No timely filing for appeals, it's 180 days from the date of denial.
[CUSTOMER][NEUTRAL] OK, so, OK.
[AGENT][NEUTRAL] But.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know the, uh, fax number?
[AGENT][NEUTRAL] Fax number is 877.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK. May I know the claim number?
[AGENT][NEUTRAL] The claim number is 351.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. May I know the claim number?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 6504.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the call reference number for this claim?
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Yeah. Can you please uh spell your name?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial, last name, [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. Uh, can I check in another, uh, another claim for the same patient for different bill amount?
[AGENT][NEUTRAL] Yes, ma'am. What is that next?
[CUSTOMER][NEUTRAL] Yeah, the rate of service is [PII].
[AGENT][NEUTRAL] A.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The bill amount is $1,476 even.
[AGENT][NEUTRAL] Is that for the 01965 QX?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] That claim we've received on [PII].
[AGENT][NEUTRAL] Processed on [PII] and that claim was also denied as the maximum benefit has been met for this data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, one minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It the
[CUSTOMER][NEGATIVE] Shut
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Yeah, I have an uh CPD code is 59812.
[AGENT][NEUTRAL] 59812
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Your details
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what was that total bill amount?
[CUSTOMER][NEUTRAL] Yeah, it's a $1,476 even.
[CUSTOMER][NEUTRAL] on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So with that CPT code I don't have that bill amount.
[CUSTOMER][NEUTRAL] Uh like uh.
[AGENT][NEUTRAL] The claim shows with that CPT code, uh, billed amount of $842.
[CUSTOMER][NEUTRAL] But I have on the uh CPT code check-in of 58 59812. You don't have any claims for that CPT code?
[AGENT][NEUTRAL] I do, but what's the build amount for that CPT code?
[CUSTOMER][NEUTRAL] Yeah, it's a $14,494 even.
[AGENT][NEUTRAL] So I have a claim for CPT 59812.
[AGENT][NEUTRAL] But it is not for that amount. It's a different amount on the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I resubmit the claim?
[AGENT][NEUTRAL] Let me, let me get this claim pulled up, bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a different build amount for that CPT code?
[CUSTOMER][NEUTRAL] No, uh, uh, it's, uh, it's another amount is $1,476 even.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, you can resubmit that claim.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK. Can I have the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code [PII].
[CUSTOMER][NEUTRAL] OK. May I know the payer ID?
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] OK. May I know the time limit?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] OK. May I know the policy effective and term date?
[AGENT][NEUTRAL] Effective date [PII] and current.
[CUSTOMER][NEUTRAL] Yeah, the policy is still active.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, can I resubmit the claim?
[AGENT][NEUTRAL] Yes, you can resubmit the claim because we do not have a claim on file for that bill's amount.
[CUSTOMER][NEUTRAL] Yeah, OK. Uh, may I, uh, may I know the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Yeah, OK. Uh, can I submit into, uh, build the amount, can I resubmit the claim?
[AGENT][NEUTRAL] You can.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for your assistance.
[AGENT][POSITIVE] It's been my pleasure to assist you with the claim status, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, nothing. Thanks for your assistance.
[AGENT][POSITIVE] And thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah