AccountId: 011433970860
ContactId: a57f7fa4-5a51-4c31-ad4c-def086255049
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 875859 ms
Total Talk Time (AGENT): 248564 ms
Total Talk Time (CUSTOMER): 294066 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/a57f7fa4-5a51-4c31-ad4c-def086255049_20250325T14:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII] at Sierra Hotel.
[CUSTOMER][NEUTRAL] [PII] calling for the provider's office Texas physical therapy specialist about the status of the claim which we submitted along with the primary EOBs through fax. And please note this call will be monitored and recorded for the quality and training purposes. So [PII], how are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. Thank you for asking. How are you today?
[CUSTOMER][POSITIVE] Thank you for asking. I'm also doing good.
[AGENT][POSITIVE] Good. And [PII], what is a good callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 1870.
[AGENT][POSITIVE] Thank you, and it would be my pleasure to assist you with that claim status. What is the policy number?
[CUSTOMER][NEUTRAL] I have it for you is uh one moment please. Yes, it's 024.
[CUSTOMER][NEUTRAL] 792
[CUSTOMER][NEUTRAL] 24
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], uh, I'm sorry, [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with that claim status. [PII], do you have the date of service or claim number?
[CUSTOMER][NEUTRAL] Uh, I have the date of services here.
[CUSTOMER][NEUTRAL] I will give you those and one moment please, those are loading.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] So the first one I have here is [PII], I'm sorry, it's
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the charge amount $453 even.
[AGENT][NEUTRAL] Is that a single?
[AGENT][NEUTRAL] Date of service?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I have other data services also.
[AGENT][NEUTRAL] So I don't have a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] For the date you don't have any claim irrespective of the bill amount.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, so we'll go the next uh same number. I'm sorry, next date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the next one I have here is
[CUSTOMER][NEUTRAL] [PII] with $419 even.
[AGENT][NEUTRAL] I'm checking, bear with me just one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said 4:19?
[CUSTOMER][POSITIVE] Mm, it's for 19, yeah, double the amount. That's correct.
[AGENT][NEUTRAL] the total bill amount? OK.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, so I do see that we received that claim.
[AGENT][NEUTRAL] And that claim was received on.
[AGENT][NEUTRAL] 528, 24.
[AGENT][NEUTRAL] Excuse me, and processed on [PII], that claim is pending for the primary EOB.
[AGENT][NEUTRAL] We did not receive the EOB with the claim. The claim number is 346.
[CUSTOMER][NEUTRAL] OK. May I know the claim number, ma'am?
[CUSTOMER][NEUTRAL] Yeah, sure. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, 3461424.
[CUSTOMER][NEUTRAL] OK. Uh, can we go to the next date of service?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Thank you. It's the [PII] with $442 even.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] That claim we received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And that claim is also pending for the primary EOB.
[CUSTOMER][NEUTRAL] May I have the claim number please?
[AGENT][NEUTRAL] Claim number 3465003.
[CUSTOMER][NEUTRAL] OK, thank you. And can we go with the next date of service?
[AGENT][POSITIVE] Yes, sir. I'm ready.
[CUSTOMER][NEUTRAL] Uh, it's [PII] with 459 even.
[AGENT][NEUTRAL] That claim we received on [PII].
[AGENT][NEUTRAL] And processed on [PII] pending primary EOB.
[AGENT][NEUTRAL] And that claim number is 346.
[AGENT][NEUTRAL] 6454.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] I have the next.
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] with the charge amount.
[CUSTOMER][NEUTRAL] 470.
[CUSTOMER][NEUTRAL] Even
[AGENT][NEUTRAL] Mm for [PII], the claim is not on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have here the next one.
[AGENT][NEUTRAL] OK, bear with me just one quick sec.
[CUSTOMER][NEUTRAL] It's [PII]. OK, fine. OK.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It's [PII] with the same charge amount.
[AGENT][NEUTRAL] That claim received on [PII].
[AGENT][NEUTRAL] Process on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Pending primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 346.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 64
[AGENT][NEUTRAL] 53
[CUSTOMER][NEUTRAL] OK, and I have the next is [PII].
[CUSTOMER][NEUTRAL] With 573 even.
[AGENT][NEUTRAL] OK, that claim we received.
[AGENT][NEUTRAL] That claim we received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was denied.
[AGENT][NEUTRAL] As benefits are only payable if the primary insurance provides benefits.
[CUSTOMER][NEUTRAL] So for this one also you need the exact primary you'll be right.
[AGENT][NEUTRAL] So it looks like we received the EOB on this one, however, there was nothing applied to the deductible copay or co-insurance. Therefore, there were no benefits payable. Now if the primary reprocesses that claim and does apply something to the deductible copay or co-insurance, then, uh, please submit that for reconsideration.
[AGENT][NEUTRAL] That updated EOB.
[CUSTOMER][NEUTRAL] OK, one moment because I'll check here. I have the primary information available in my system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, yes, I can see here that it processed explanation of benefits in my system.
[AGENT][NEUTRAL] Is there anything applied to the deductible copay or co-insurance for those procedures?
[CUSTOMER][NEUTRAL] Yes, $166.78. I can see here. Initially processed and applied patients responsibility of $137.07. After that, it again it processed and the very next day and we receive the remittance regards that and on the remittance, we can see.
[CUSTOMER][NEUTRAL] The patient's responsibility of $166.78.
[AGENT][NEUTRAL] And is that for a deductible, co-pay, or co-insurance or just patient responsibility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do see it's as the PR on this, the patient's deductable.
[AGENT][NEUTRAL] OK perfect so that one can be resubmitted for reconsideration.
[CUSTOMER][NEUTRAL] OK, one moment, please. So it's enough to submit the primary EOB along with the
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Cover letter.
[AGENT][NEUTRAL] That is correct, as long as you reference the claim number and the policy number.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Um they did our process.
[CUSTOMER][NEUTRAL] UV
[CUSTOMER][NEUTRAL] The claim may drops the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's recording.
[CUSTOMER][NEUTRAL] And I can see here the fax number.
[CUSTOMER][NEUTRAL] Which we already used to send the claims, uh, it will be.
[CUSTOMER][NEUTRAL] [PII] I'm sorry 9423.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] With the attention claims department and the time defined with 180 days from the primary process date.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] And I have the address. It's [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So I just mentioning that yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the claims which, which are not on file, we will send the claim form along with the primary EOB and the claims which are on file and pending for primary EOB we will send the primary EOB only and the claim which is denied for the benefits not provided by the primary, uh, we will send the reprocessed EOB of the money.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] In the same facts. Can we do like this?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, you can sometimes it is better to separate the faxes.
[AGENT][NEUTRAL] But you can send it all together.
[CUSTOMER][NEUTRAL] So you mean the note on file.
[CUSTOMER][NEUTRAL] Because it's under the same patient, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And the same provider.
[AGENT][NEUTRAL] Yeah, I would send the ones, um, yeah, you can send it all in the same fax.
[AGENT][NEUTRAL] Or you can separate it either way. Sometimes, sometimes it's it's best to separate it just because they are separate claims.
[CUSTOMER][NEUTRAL] Um, yeah, sure, and.
[CUSTOMER][NEUTRAL] So I'll do one thing then, then not on file claims which we are going to rebuild the claim freshly. So we'll send the fax separately for that and the primary EOP will send separately and the reconsideration will send separately.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 3 faxes.
[AGENT][NEUTRAL] Right, that would be best.
[CUSTOMER][NEUTRAL] Uh, do you have any reference number for this one?
[AGENT][POSITIVE] It's going to be my name in today's date, and [PII], I spell my name [PII], and it has been a pleasure to assist you with that claim status today, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Um, no sir. Thank you so much for the information. I hope you have a wonderful day. Take care and bye-bye.
[AGENT][POSITIVE] I, I hope you have a wonderful day as well, [PII], and thank you for calling APL. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Mm mhm bye bye.