AccountId: 011433970860
ContactId: 909a10d2-b35b-4f33-8ce7-8eabbda54aa8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440910 ms
Total Talk Time (AGENT): 110055 ms
Total Talk Time (CUSTOMER): 66201 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/909a10d2-b35b-4f33-8ce7-8eabbda54aa8_20250225T21:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from University Professional Services.
[CUSTOMER][NEUTRAL] Um, I was calling about a claim we had submitted a corrected claim and it looks like it was denied as a duplicate.
[AGENT][NEUTRAL] Um, [PII], what is your callback number if we were disconnected?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you. What is the policy number, please?
[CUSTOMER][NEUTRAL] That is 02448318.
[AGENT][NEUTRAL] Thank you. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] For [PII], [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. And do you have the
[AGENT][NEUTRAL] Claim number that was denied a duplicate.
[CUSTOMER][NEUTRAL] Yeah, it looks like it's 354-7444.
[AGENT][NEUTRAL] Thank you and what is the initial claim number please?
[CUSTOMER][NEUTRAL] I'm sorry, give me just a moment. I'll try to find the initial claim.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] The initial claim number is 3521756.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, let me just look at this just to make certain of that and the procedure code that was billed, it shows 88304 just to verify that information.
[CUSTOMER][POSITIVE] Correct, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's just say the second submission. I'm just going.
[AGENT][NEUTRAL] OK, I'm just gonna go over what we have here as far as what the initial claim was. Procedure code is 88304 modified 26, um, total charge is $32. Is that correct so far?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And that diagnosis. OK, thank you. And that diagnosis code was L like Larry, 91.8.
[CUSTOMER][POSITIVE] Yeah correct
[AGENT][NEUTRAL] OK, OK, it shows the same on the on the 2nd submission. One moment, let's see.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, yeah, the 2nd submission.
[AGENT][NEUTRAL] And what was the correction to the claim?
[CUSTOMER][NEUTRAL] Oh, I just think that we added the modifier no consent to it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm so sorry if you could repeat that on the 2nd submission.
[CUSTOMER][NEUTRAL] Yeah, the second submission we had added another modifier for no consent. It was NCSNT.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so give me one second. May I place you on a brief hold, please?
[CUSTOMER][NEUTRAL] Yeah, of course.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for your patience, [PII]. It shows that the claim initially denied as a non-covered place of service. Um, the member does not have any outpatient facility, uh, benefits under this plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, um, and would you have a reference number for today's call?
[AGENT][NEUTRAL] We do not use reference numbers. You can use my name [PII]. Last initial is [PII], and today's date. Anything else I can assist you with, please, [PII]?
[CUSTOMER][POSITIVE] OK, uh, no, nothing else today, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a great day and take care.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Mm bye.