AccountId: 011433970860
ContactId: 9e3e96f8-8f1c-4ac1-bae7-0029d2738041
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1237339 ms
Total Talk Time (AGENT): 344603 ms
Total Talk Time (CUSTOMER): 380082 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/9e3e96f8-8f1c-4ac1-bae7-0029d2738041_20250530T16:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from doctor's office regarding the status of a client. Can you please help me for checking over that?
[AGENT][NEUTRAL] I can help you with claim status, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] with the extension of [PII]. Can I get your name, please?
[AGENT][NEUTRAL] My name is [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] HSN Hospital. OK. Hi, [PII], how are you doing today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good, thanks for asking. [PII]. I have one patient with 3 data services. I just wanted to verify the status of the claim. Can you please help me for that?
[AGENT][NEUTRAL] Uh, what is the policy number?
[CUSTOMER][NEUTRAL] Sure, the policy number, one moment, I'm just filling in the.
[CUSTOMER][NEUTRAL] One second
[CUSTOMER][NEUTRAL] Was it here?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The policy number is 02.
[CUSTOMER][NEUTRAL] 48
[CUSTOMER][NEUTRAL] 5255 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Sure. The patient's name is
[CUSTOMER][NEUTRAL] Uh [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the date of service or the claim number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, I have the date of services. The first date of services is uh [PII] with the bill amount on.
[CUSTOMER][NEUTRAL] $175.02.
[AGENT][NEUTRAL] And you said
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, let's do that one first.
[CUSTOMER][NEUTRAL] OK, and I have 2 more.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We'll go one by one.
[AGENT][NEUTRAL] And you said it was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing any claims for [PII].
[CUSTOMER][NEUTRAL] Oh, you have not that's you're saying that's a no claim on the file.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Oh, hold on one moment. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Please take your time.
[AGENT][NEUTRAL] OK, yeah, I just looked, there's there's nothing for that date of service.
[CUSTOMER][NEUTRAL] OK. Uh, you're saying there's no claim on the file. Uh, one thing, uh, the claim was recent, most the claim was submitted on, one moment, please.
[CUSTOMER][NEUTRAL] The most recent claim was submitted on [PII]. And uh that's a primary insurance that is PCBS is a primary insurance. So they have paid the claim and they have sent this for the process. It's a crossed over claim.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm not showing a claim for [PII]. I will say that this policy wasn't active until [PII].
[CUSTOMER][NEUTRAL] Oh, when was the effective?
[AGENT][NEUTRAL] So the effective date for this policy is [PII]. The policy lapsed on [PII].
[CUSTOMER][NEUTRAL] [PII]. So the patient is eligible for this date of service.
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, not for [PII], not for [PII].
[CUSTOMER][NEUTRAL] So one moment.
[CUSTOMER][NEUTRAL] How can this, uh, he's been effective from [PII]. This is not March. This is [PII].
[AGENT][NEUTRAL] I had it as March, so give me just a second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] I'm still not showing a claim for [PII]. I'm not showing a claim for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you're saying uh that there's no claim on the file and checking the member eligibility is effective from [PII] and termed on [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, but we don't have timely filing, so you can resubmit the claim. Do you have our fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment. Can I get the mailing address for submitting the claim?
[AGENT][NEUTRAL] OK. The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One moment. Uh, it is [PII]. Am I right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry, one.
[CUSTOMER][NEUTRAL] 2,489,500
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, 4.
[AGENT][NEUTRAL] Dash
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I'll repeat to you. It is [PII], [PII].
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[AGENT][NEUTRAL] Yes, ma'am. Yes.
[CUSTOMER][NEUTRAL] OK. OK, [PII], thanks for the uh mailing address. And what is the thing, can you please provide me the payer ID?
[AGENT][NEUTRAL] The payer ID is 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, what is the fax number?
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so there's no timely filing limit for submitting the first claim, no.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, no TFL for submitting the fresh claim.
[CUSTOMER][NEUTRAL] OK. So, there's no claim on the file. Uh, shall we go for the next date of service for the same patient? The call reference number will be the same for all ord first for each date of services.
[AGENT][NEUTRAL] We don't have call reference numbers. You'll just use my name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Last initial in today's date. Yes, ma'am.
[CUSTOMER][NEUTRAL] And today's
[CUSTOMER][NEUTRAL] OK. OK, but uh, can I get the accurate spelling uh spell of your name? [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh I, oh, go ahead.
[CUSTOMER][NEUTRAL] No, no, no, please go ahead.
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, got it here. OK, shall we go for the next date of service for the same patient?
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] Sure, the next date of service for the patient is [PII]. It is [PII]. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] $1200 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we've received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed on [PII].
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 66.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 385.
[AGENT][NEUTRAL] Oh, give me just a moment. It looks like that was a.
[CUSTOMER][NEUTRAL] What is the status of the?
[AGENT][NEUTRAL] It looks like that was a duplicate, so let me, let me find the original.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Give me just a moment while I look that up.
[CUSTOMER][NEUTRAL] Sure. So this claim has been denied as duplicate. We are searching for the original claim.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, it looks like this claim was processed on [PII].
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] Oh, no, no.
[CUSTOMER][NEUTRAL] So you received the claim on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So you received the claim on [PII] and processed on [PII], the original claim. Uh, what was this uh paid the scenario of the claim?
[AGENT][NEUTRAL] It looks like it was voided and let me figure out why.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Go
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] Yes, yeah.
[AGENT][NEUTRAL] It looks like we had to reprocess that claim, so the claim was filed on [PII].
[AGENT][NEUTRAL] It was processed on the same day, [PII].
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 84.
[AGENT][NEUTRAL] 397.
[CUSTOMER][NEUTRAL] 35843997. OK. So the original claim was voided and again uh uh no, the, it was voided and sent for reprocess and it was processed on [PII]. OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What was the payment details? What was the paid amount?
[CUSTOMER][NEUTRAL] Allow the amount to pay the amount.
[AGENT][NEUTRAL] It looks like we paid.
[AGENT][NEUTRAL] $337.43.
[CUSTOMER][NEUTRAL] OK, with no members responsibility.
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK. What is the thing means I'm requesting, uh, can you please uh provide me the payment details? Was it a bulk amount, a single amount, and what was uh the mode of the payment? Is it EFT, VCC, or check?
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] Uh, we paid through it, we paid through a check.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Check. OK.
[AGENT][NEUTRAL] It looks like the check number is.
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] 37
[AGENT][NEUTRAL] 008.
[AGENT][NEUTRAL] And it looks like the check cleared.
[AGENT][NEUTRAL] So the we issued the check on [PII].
[AGENT][NEUTRAL] And the check cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. What was the bulk amount of single amount?
[AGENT][NEUTRAL] It was a single amount in the amount of $337.43.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] OK. uh OK. uh, thanks for the details.
[CUSTOMER][NEUTRAL] Uh, that is, this is the last date of service for the patient. It is [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes. [PII].
[AGENT][NEUTRAL] OK. Give me
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Who's on me about it I get to the.
[CUSTOMER][NEUTRAL] Busy.
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] It looks like that claim was denied.
[AGENT][NEGATIVE] Due to office visits not being covered.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] Due to office visit not covered.
[AGENT][NEUTRAL] Correct. The the policy does not include office visits.
[CUSTOMER][NEUTRAL] OK. Shall we to verify with the correct CPT code for the process?
[CUSTOMER][NEUTRAL] Corrected claim.
[AGENT][NEUTRAL] You want the procedure number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 99, 0.
[CUSTOMER][NEUTRAL] No, no, no. I can we
[CUSTOMER][NEUTRAL] Uh, can we change the CPT code for the uh correct uh.
[CUSTOMER][NEUTRAL] Thing for the process and send a corrected claim.
[AGENT][NEUTRAL] Uh, was it not an office visit?
[CUSTOMER][NEUTRAL] Can we send the corrected.
[CUSTOMER][NEUTRAL] Yes, can we send the corrected claim with the correct CPT code for the process?
[AGENT][NEUTRAL] Yes, you'll send it to that fax number or that mailing address that we have that I I gave you earlier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the claim number?
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 41
[AGENT][NEUTRAL] 648.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thanks for the details you provided. Have a good day.
[AGENT][POSITIVE] Great, thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah, sure, thank you.
[AGENT][NEUTRAL] Bye.