AccountId: 011433970860
ContactId: 8f92b40d-78b7-4c72-a111-56c994067cfc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385700 ms
Total Talk Time (AGENT): 95058 ms
Total Talk Time (CUSTOMER): 212703 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/8f92b40d-78b7-4c72-a111-56c994067cfc_20250313T16:36_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Can you hear me [PII]?
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling for Cora Health Services to check on the status of a claim. Could you please spell your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Alright man so thank you so much for that information.
[AGENT][POSITIVE] I'll be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Obviously callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 023 04088 M as in Mike L as in Lima number 8.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is gonna be [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] It's [PII]. I'm sorry, it's [PII] with the total bill amount of $680 even.
[AGENT][NEUTRAL] Thank you for that information. I'm not showing we have that claim on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, actually, I talked with previous, uh, representative [PII]. She told the claim was claim was on on file, but, uh, she discussed the call before even giving any claim status. So, uh, could you please double check on that.
[CUSTOMER][NEUTRAL] [PII] with 680.
[AGENT][NEUTRAL] What's your, what's your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, we have a claim from that tax ID, but it's not the charge amount that you gave.
[CUSTOMER][NEUTRAL] $680 even or $150?
[AGENT][NEUTRAL] No, one of the charges is for $230 and the other charges for $90 so if that's what you're looking for, yes, we have that, but the amount that you gave me we don't have.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] So you don't have the claim for $680. Just let me check.
[CUSTOMER][NEUTRAL] OK, so the denied claim process with the EFT number B as in Bravo D as in Delta 1913774. Is that uh helped in any way, in any way?
[AGENT][NEUTRAL] No, that's not one of our claim numbers.
[CUSTOMER][NEUTRAL] I mean it's not a claim number it's uh it's must be a EFT number or the.
[AGENT][NEUTRAL] We don't deny claims that way.
[CUSTOMER][NEUTRAL] Yeah, I get it.
[AGENT][NEUTRAL] We don't
[AGENT][NEGATIVE] You must have sent that to a major medical company because we don't operate that way.
[CUSTOMER][NEUTRAL] So, OK, shall we move to the next date of service so you can, you could find the claims, I guess.
[AGENT][NEUTRAL] What's the next date of service?
[CUSTOMER][NEUTRAL] [PII] with the total bill amount of $180 even.
[AGENT][NEGATIVE] Yes, we have that on file and that denied.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Occupational therapy not covered.
[CUSTOMER][NEUTRAL] OK. While we submitting this, uh, all the claims as a physical therapy codes, with the physical therapy courses, but, uh, patient is uh covered for physical therapy, not for occupation or speech therapy. So, uh, uh, a patient already uh called the insurance. They requested to resubmit the claims tagged on the physical therapy. So is that possible to take the, these claims back for reprocess so uh they will uh review and uh.
[CUSTOMER][NEUTRAL] For physical therapy patient is already covered, so that is a chance to get a payment for this, uh, these claims.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes, if you wanna send a corrected claim with the correct information, then we'll process it.
[CUSTOMER][NEUTRAL] This is the correct information. The codes are based on the physical therapy. It's not for occupation or something else.
[AGENT][NEUTRAL] Then we, then.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We can't just take your word over the phone. You have to correct the claim. You sent the claim stating with um occupational therapy codes. So if that's not correct, then you'll need to send the corrected claims with the correct physical therapy codes and then we can process and pay if they have any benefits left.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, just give me a sec.
[CUSTOMER][NEUTRAL] How would the card the same timely filing limit?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So we have to collect the codes. Uh, are you saying it's, it's, I mean, uh, it's based on the CPDs or modifiers or something else? Do you have any idea?
[AGENT][NEUTRAL] The modifiers.
[CUSTOMER][NEUTRAL] OK, the modifiers.
[CUSTOMER][NEUTRAL] The modifiers is uh indicating the occupational therapy or physical therapy, is it?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Alright then, OK.
[CUSTOMER][POSITIVE] Alright then thank you so much and uh can I get the call reference number for this call, [PII]?
[AGENT][NEUTRAL] References just my name and today's date and time. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Nothing else. You have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APO have a good day.
[CUSTOMER][NEUTRAL] Yes sir.