AccountId: 011433970860
ContactId: a0897106-479b-4699-a5f6-5445c443a76c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667669 ms
Total Talk Time (AGENT): 283532 ms
Total Talk Time (CUSTOMER): 230679 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/a0897106-479b-4699-a5f6-5445c443a76c_20250313T18:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the provider's office to check the status of a claim. May I know the spelling for your name and the last name initial?
[AGENT][NEUTRAL] My name is [PII] First initial of my last name is [PII].
[AGENT][POSITIVE] And [PII], it would be a pleasure to assist you with claim status. What is a good callback number, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] Thank you, [PII]. And the policy number for the patient, please.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure. It is 01618297.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right. Thank you, [PII], and it would be my pleasure to assist you with that claim status. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] Thank you. I do have the date of service, [PII], 2024 for $700 is double the amount.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Welcome
[AGENT][NEUTRAL] And [PII], what is the name of the facility, please?
[CUSTOMER][NEUTRAL] So it's endoscopic anesthesia group.
[AGENT][NEUTRAL] All right, thank you. And I am checking on that claim status. One moment please, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I do see that we received that claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now that claim was denied. The above claim appears to be a duplicate.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] Uh, a previously submitted expenses, the benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So it is actually denied as a duplicate, right?
[AGENT][NEUTRAL] That's right because um it was previously previously submitted charges.
[CUSTOMER][NEUTRAL] OK, so actually it was billed to the same patient, same date of service and so the amount which is on a different date, right?
[AGENT][NEUTRAL] That's correct. They, uh, we processed and paid to the insured on it. They submitted the claim on a different date.
[CUSTOMER][NEUTRAL] So actually 2 claims have been submitted, right, on the same date.
[AGENT][POSITIVE] That's correct. Now, for the provider.
[CUSTOMER][NEUTRAL] OK. So for the same provider, two claims have been submitted on the same date for the same date of service, right?
[AGENT][NEUTRAL] That's correct for the same billed amount.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Mhm, what is the uh original status of the claim?
[AGENT][NEGATIVE] It was processed and denied because they were duplicate.
[CUSTOMER][NEUTRAL] that's
[AGENT][NEUTRAL] It appears to be a duplicate of previously had submitted charges or expenses. The benefit was made to the insured.
[CUSTOMER][NEUTRAL] That benefits was?
[AGENT][NEUTRAL] Benefit payment.
[AGENT][NEUTRAL] Benefit payment has been made to the insured to your, to the patient.
[CUSTOMER][NEUTRAL] OK, sure. So, the original claim, which was, may I know the date on which it was submitted?
[AGENT][NEUTRAL] So the origin, no, I'm not able to give you that information. The insured submitted a claim for this service prior to receiving the claim from the provider.
[CUSTOMER][POSITIVE] OK, fine. Thank you so much.
[AGENT][NEUTRAL] And benefits were made to the insured.
[CUSTOMER][NEUTRAL] I can see that uh 2 claims have been submitted on the same date for same charge amount. So let me check that with my uh team. And also, could you please provide me the claim number for the original and the duplicate claim.
[AGENT][NEUTRAL] So these claims were uh processed together under one claim number. That claim number is 357.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] 1859.
[CUSTOMER][NEUTRAL] Uh, but you, do you have any, um, access to void the duplicate one since I cannot see that, um, the, the, uh, claim which has been submitted twice, the one is uh with no charge amount.
[AGENT][NEUTRAL] So the claim was processed, the two documents were processed together under one claim number.
[AGENT][NEGATIVE] And the same denial.
[AGENT][NEUTRAL] Because it was for the same provider, same data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this uh one claim must be uh voided, right? Need to be voided.
[AGENT][NEUTRAL] Need to be
[AGENT][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] Yes, uh
[CUSTOMER][NEUTRAL] So, any one of the claims should be voided, right?
[AGENT][NEUTRAL] So we received 2 documents.
[AGENT][NEUTRAL] For that claim information.
[AGENT][POSITIVE] They were, they were processed together we received them on the same day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And process together under one claim number.
[CUSTOMER][NEUTRAL] I could be able to see that information that uh two claims have been submitted on the same date for the same provider for same CPT and one has been voided. I'm, I'm so sorry, and it is
[CUSTOMER][NEUTRAL] both together. I can see that. So, it is also on, under the same service location, right?
[AGENT][NEUTRAL] That's right, let's see, bear with me just one second. I'm checking on that for you, so bear with me.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So what is the 00813 with the QZ modifier?
[AGENT][NEUTRAL] And let me get this other one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me pull this other one up and we'll verify all that for you.
[CUSTOMER][POSITIVE] Yeah, got it. Thank you so much for this information. May the uh call reference?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name. I've already spelled it for you, didn't I?
[AGENT][NEUTRAL] Yeah, these were both for the both of these claims that we received on the same day.
[CUSTOMER][POSITIVE] Got it. Thank you so much.
[AGENT][NEUTRAL] Um, were for the 001813QZ, so they just put those two documents together and process it under one claim.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Yeah. Do you have the EOB on file? Denied EOB?
[AGENT][NEUTRAL] I do and I can tell you where to locate that EOB on our portal.
[AGENT][NEUTRAL] If you would like.
[CUSTOMER][NEUTRAL] May I know the portal name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You are [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Right, [PII].
[AGENT][NEUTRAL] And if you don't have an account, you will go in as a new user.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. Uh.
[CUSTOMER][NEUTRAL] And uh can you fax the DOB also to my provider's office?
[AGENT][NEUTRAL] Yes, ma'am. If you'll bear with me just one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] It takes just a minute. That's, it's a lot quicker to get it off our portal.
[AGENT][NEUTRAL] So if you have access, you can actually.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Download that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I'm working on this if you'll give me just one moment, OK? And then I'll come back and get that fax number.
[CUSTOMER][POSITIVE] OK, fine. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can I put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, that's OK.
[AGENT][NEUTRAL] OK, give me just a moment and I'll come back and get that fax number for me.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And can I give you that claim number?
[CUSTOMER][NEUTRAL] Of course. Can you please, uh, actually, I think you have already given me the claim number. It's 3571859, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], I am ready for that fax number. What is that fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you [PII], and just to verify that fax number, I am sending this to [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct. And also fax this to my provider's office also.
[CUSTOMER][NEUTRAL] [PII]. I mean, to mail this.
[AGENT][NEGATIVE] Yeah, uh, an EOB has been mailed. They just haven't received it yet. It would have gone out on 37.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, uh, because I cannot be able to see any denial on this, uh, payer page. That is the reason I'm asking. So that's OK, no problem. Thank you so much for your assistance and have a great day. Bye. Stay safe.
[AGENT][POSITIVE] Well it's been my pleasure to assist you with that claim status, [PII]. Thank you for calling APL. I hope you have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye now.
[AGENT][NEUTRAL] Bye-bye.