AccountId: 011433970860
ContactId: 9bb3d551-5d10-4054-9309-eb6db6f9aa40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310089 ms
Total Talk Time (AGENT): 148534 ms
Total Talk Time (CUSTOMER): 113506 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/9bb3d551-5d10-4054-9309-eb6db6f9aa40_20250210T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. How are you?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] Yeah, I have a real quick question. Uh, let's see, the policy number is 208.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 9583.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And for claim number 332.
[CUSTOMER][NEUTRAL] 3452.
[CUSTOMER][NEUTRAL] And then claim number 3335458.
[CUSTOMER][NEUTRAL] Um, both of the place of service is 19, which I believe is like a, uh, office visited an outpatient campus or something like that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Should it be paid under the um outpatient sickness or no? Because one person paid it and the other person denied it.
[AGENT][NEUTRAL] Let me take a look.
[AGENT][NEUTRAL] You said the other was 3321543?
[CUSTOMER][NEUTRAL] Uh, 332-3452 and then 3335458.
[CUSTOMER][NEUTRAL] Hold on a second.
[CUSTOMER][NEUTRAL] 332.
[CUSTOMER][NEUTRAL] Yeah, 3452.
[AGENT][NEUTRAL] So, it looks like what they usually do is, let me see on that date, let me see if we got the.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Facility one on that one.
[AGENT][NEUTRAL] Yeah, cause what they usually do sometimes is they build the facility and the physician fee separately and it is a clinic. But let me pull up the um facility one on this [PII] and look at it and see if that was the case.
[CUSTOMER][NEUTRAL] Uh-huh. Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, it's a rev code 510. Um, so we did pay the facility claim for the 7923, but it looks like somebody went in there and denied the actual professional fee as a non-covered place of service when they should have not, they should have just processed it as the max has been met for the data service.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that one, that's, that one was processed incorrectly on that 791.
[CUSTOMER][NEUTRAL] No, ending in 5458.
[AGENT][NEUTRAL] Mhm. Yup, cause I'm, I'm looking.
[CUSTOMER][NEGATIVE] OK, should have denied his Max me, OK.
[AGENT][NEUTRAL] Yeah, because we pay the facility bill, um, yeah, so that's what they, they billed the professional fees separate, yep.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause then I have both claims side by side. It's the same physician, so yeah, they usually bill them separate for some reason. I don't know why, but yeah.
[CUSTOMER][NEUTRAL] OK, and you consider it, um, is it, was it paid because the inpatient was paid?
[AGENT][NEUTRAL] A clinic
[AGENT][NEUTRAL] We consider it as clinic because the repcode 510 from the facility bill. And had we not had the facility bill to let us know that it was in a clinic, then it would have been a non-covered place of service.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it, got it.
[AGENT][NEGATIVE] Yeah, but since we had that before, that claim was denied that was processed incorrectly.
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right, very good.
[AGENT][NEUTRAL] So that will need to be reprocessed.
[CUSTOMER][NEUTRAL] changing the diag I mean the remark code.
[AGENT][POSITIVE] Mhm, yeah. And the benefits.
[CUSTOMER][NEUTRAL] So just a hub hub request?
[AGENT][NEUTRAL] Uh, do y'all send it, do y'all still, y'all don't, do y'all send error?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] I don't think we're supposed to. I don't think so, but I don't know how to get it to y'all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I, I'll send it. I'll send it. cause she, yeah, that's gonna need to be corrected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what would you do? Change the um the, the.
[AGENT][NEUTRAL] I'll send it.
[AGENT][NEUTRAL] The benefit, they need to put it under the correct benefit cause we would go ahead and consider it based off the UB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They should have just put it under the outpatient benefit max and that that data for data service has been met for that date.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right. Right. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Tubing, so it'll be just so I'll know like under the benefit is it the outpatient sick benefit?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, mhm, the outpatient seat.
[CUSTOMER][NEUTRAL] OK, instead of not covered, OK.
[AGENT][NEUTRAL] Mhm. Wait, let me see what this. Yeah, it, it will be under the outpatient sick benefit.
[CUSTOMER][NEUTRAL] Roger that.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, got it.
[AGENT][NEUTRAL] Yep.
[AGENT][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Where it's mud.
[CUSTOMER][NEUTRAL] Now
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, OK, alrighty, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm bye.