AccountId: 011433970860
ContactId: 9ef0ec4c-7ed0-4af6-af5f-440a4804031a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381059 ms
Total Talk Time (AGENT): 112722 ms
Total Talk Time (CUSTOMER): 149148 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/9ef0ec4c-7ed0-4af6-af5f-440a4804031a_20250604T16:30_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL my name is [PII]. How can I assist you today?
[CUSTOMER][POSITIVE] Thank you for calling
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling you from the provider's office to check on the claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yes, of course, it's [PII]. It's a direct line?
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] D. Delta 459-03841.
[AGENT][NEUTRAL] I believe that's their wellness policy number. Do you have a social?
[CUSTOMER][NEUTRAL] Socialist
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service for the claim.
[CUSTOMER][NEUTRAL] D of services.
[CUSTOMER][NEUTRAL] [PII] for $593 even.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you for that information, one moment.
[AGENT][NEUTRAL] OK, I'm showing the claim denied because lab tests are not covered under the policy.
[CUSTOMER][NEUTRAL] Yeah, lab test.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Right. The procedure codes?
[CUSTOMER][NEUTRAL] There is no, there is no, mhm.
[CUSTOMER][NEUTRAL] May I know the received date and claim number for this?
[AGENT][NEUTRAL] Claim number is 359-877-1.
[AGENT][NEUTRAL] And we received the claim on [PII], claim denied on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, could you please uh verify the procedure code you have on file?
[AGENT][NEUTRAL] What procedure code did you bill for? I can verify that.
[CUSTOMER][NEUTRAL] 99204 and G 2211.
[AGENT][NEUTRAL] What's the uh tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's not the code.
[AGENT][NEUTRAL] And it's for [PII], right?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[CUSTOMER][NEUTRAL] We build down the facility name Community Medical Associates.
[AGENT][NEUTRAL] OK, well, we don't, we don't have that claim on file. We don't have that claim on file.
[CUSTOMER][NEUTRAL] And the rendering provider's name is mhm.
[CUSTOMER][NEUTRAL] We submitted to the address. We submitted electronically to the payer ID 04218. Is that the correct payer ID?
[AGENT][NEUTRAL] Um, yes, um, I'll give you a different payer ID you can send it to.
[CUSTOMER][NEUTRAL] OK. That's the correct one?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the member's effective date and term date?
[AGENT][NEUTRAL] Policy was effective [PII] and it's still active.
[CUSTOMER][NEUTRAL] And you are the primary for the member, right?
[AGENT][NEUTRAL] Um, as far as we know, yes.
[CUSTOMER][NEUTRAL] OK. Also, may I know the time of the filing limit?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] To submit the claim?
[AGENT][NEGATIVE] Yeah, there's no timely filing.
[CUSTOMER][NEUTRAL] OK, and the payer ID is 60801. Am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] May I know the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please spell the city?
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII] is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] And the street?
[AGENT][NEUTRAL] [PII]. The state is [PII].
[CUSTOMER][NEUTRAL] OK, thank you so much. And the zip code is [PII], right? [PII], [PII]. And the payer ID is 60801. Am I right?
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct. That's correct.
[CUSTOMER][NEUTRAL] But I, I have a different, uh, payer ID and mailing address in the card copy which is uh [PII] and the payer ID is [PII].
[AGENT][NEUTRAL] OK, well you can send it there then.
[CUSTOMER][NEUTRAL] What is the correct one?
[AGENT][NEUTRAL] They're both correct it's just that you sent it to that one and we didn't get it so I gave you the information to send it directly to us but if you wanna send it to the one you've been sending it to you can do that.
[CUSTOMER][NEUTRAL] It's just that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that. May I know the call reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No sir, thank you so much. Uh,
[CUSTOMER][POSITIVE] For assisting me today. Have a great day and take care. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.