AccountId: 011433970860
ContactId: 8c5f5206-082c-466a-bc61-5595be809030
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 859809 ms
Total Talk Time (AGENT): 210548 ms
Total Talk Time (CUSTOMER): 164741 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/8c5f5206-082c-466a-bc61-5595be809030_20250310T14:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, [PII]. My last name initial will be [PII] calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. And may I have a callback number just in case we get disconnected, [PII]?
[CUSTOMER][NEUTRAL] Yeah, my callback number will be [PII] and an extension is [PII].
[AGENT][NEUTRAL] That was [PII] for the extension.
[CUSTOMER][NEUTRAL] Extension is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And what's your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII]. And Mr. [PII], let me have the first digit of that phone number. I didn't get that.
[CUSTOMER][NEUTRAL] Oh, it's [PII].
[AGENT][NEUTRAL] [PII] is the the code.
[CUSTOMER][NEUTRAL] Uh, it's, uh, starts with the [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEGATIVE] You're breaking up
[CUSTOMER][NEUTRAL] Uh, the, the.
[CUSTOMER][NEUTRAL] Uh, the callback number starts with [PII].
[AGENT][NEUTRAL] [PII]. OK. Mhm. [PII]. OK, thank you. All right, and what is the patron's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the patient's policy will be 01939698.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yup. The patient's uh last name will be, it's uh [PII], and the first name is [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service is [PII] with the total bill amount of uh.
[CUSTOMER][NEUTRAL] $130 even.
[AGENT][NEUTRAL] OK, so 610 of 24 for 1:30.
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. And for future, you can check claim status online through our website at [PII]. And let me see if I can find your claim. Do you know what's the procedure code for your claim?
[CUSTOMER][NEUTRAL] Yeah, the CPT will be 73564.
[AGENT][NEUTRAL] OK, so OK, bear with me, let me pull the E.
[AGENT][NEUTRAL] Waiting on the system.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm sorry, it's taking a little bit to pull up one moment.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII] and we send a benefit amount of $13.24 and this was for procedure code 13564.
[CUSTOMER][NEUTRAL] So upon checking in our end, it shows that we have built the two CPT on the same data service with which we have built the 3564 with the 26 RT modifier and the 3564 with the 26 LT modifier. So we received a payment for, uh, you said earlier, right, we received a payment of $13.24 with which we have received a payment on uh for RT modifier only. But for the LT modifier, we received a denial of.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, non-covered charges.
[AGENT][NEUTRAL] Um, no, the, the denial reason is not non-covered. The denial reason for the rest is because the member has exhausted the benefit. So with the payment of the $13.24 this member has exhausted the benefit.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so one moment please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So when did you receive the claim?
[AGENT][NEUTRAL] OK, let me get that because that's not on the EOB one moment, OK?
[AGENT][NEUTRAL] OK, the claim was received 122. It was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] Um, so, uh, the member has the exit, uh, you said that the member has this.
[CUSTOMER][POSITIVE] Uh, exceeded the benefit, right, uh, in which, in terms of dollar or the visit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be the dollar amount. Um, this one has, let me see the benefit.
[AGENT][NEUTRAL] OK, one moment, let me pull the benefit amount on that time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the outpatient benefit for that data service was $500 per occurrence. So it's every 90 days and they um she already assessed the benefit with the $13.24 we send out.
[CUSTOMER][NEUTRAL] So the dollar amount for every 90 days will be uh $500 right?
[AGENT][NEUTRAL] 500. Mhm. Yes. Mhm.
[CUSTOMER][NEUTRAL] So patient has exceeded the limit uh uh on the last payment of $13.34 right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mm, correct, yes.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Uh, can you please fax you via mail?
[AGENT][NEUTRAL] Yes, um, I can fax it. What is the fax number?
[CUSTOMER][NEUTRAL] Uh, fax number will be [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] To what attention, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, uh, to Charlie.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yeah, not sure. I, I'll be on the line.
[AGENT][POSITIVE] OK, thank you. OK, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, uh, nothing else, sir. Can you please provide me the claim number as well as the call reference number?
[AGENT][NEUTRAL] Um, sure. The claim number is 347-8122. Again, that's 3478122. We don't have reference numbers, you can use my name and today's date if you will.
[CUSTOMER][POSITIVE] Yeah, thanks. So thanks for the kind information I been product today.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day. Yes, ma'am. Bye-bye, Mr. [PII].
[CUSTOMER][POSITIVE] Um, have a nice day.
[CUSTOMER][NEUTRAL] Yeah bye bye.