AccountId: 011433970860
ContactId: afdda11e-bdb6-405f-a16c-9f969ba5a772
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286369 ms
Total Talk Time (AGENT): 104645 ms
Total Talk Time (CUSTOMER): 88172 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/afdda11e-bdb6-405f-a16c-9f969ba5a772_20250516T18:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] on the care team. I've got an insured on the line that, um, I pulled up the claim and I, I can't see what we're missing because I do see diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Um, so can you help me with that and look at it?
[AGENT][NEUTRAL] Certainly, what's the policy number?
[CUSTOMER][NEUTRAL] Um, policy number is
[CUSTOMER][NEUTRAL] 01660267.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] And that's from [PII].
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's at 360026-26, the most recent claim.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] And it looks like they that one was denied.
[AGENT][NEUTRAL] Is duplicate so I'm gonna also look at that previous mail. It doesn't, I don't see a diagnosis code so let me look at.
[AGENT][NEUTRAL] What must be missing.
[CUSTOMER][NEUTRAL] Yeah, I see, I see a diagnosis code on page 6, or let's see, 7.
[CUSTOMER][NEUTRAL] It's, it's in it's kind of a lighter gray color and it's underneath the.
[CUSTOMER][NEUTRAL] Itemization of the CPT codes on the right.
[CUSTOMER][NEUTRAL] Some, uh, 6 of my CD 10 codes.
[CUSTOMER][NEUTRAL] I'm not sure what we're missing, nor was I sure what it was a duplicate too because I can't find.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, where are the duplicate.
[AGENT][NEUTRAL] OK, it looks like there's a couple different dates of service [PII].
[AGENT][NEUTRAL] And that previous mail.
[CUSTOMER][NEUTRAL] Oh, I see the 4929. I, I do see that duplicate, but.
[CUSTOMER][NEUTRAL] We've got the diagnosis codes and CPT codes. I wasn't sure what where we're.
[CUSTOMER][NEUTRAL] It's eligible to be processed or not.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it said no diagnosis code provided on the 4929, but it's on the 3600.
[CUSTOMER][NEUTRAL] 62
[CUSTOMER][NEUTRAL] 6.
[AGENT][NEUTRAL] OK, I'm looking at that now it's just taking a long time to load my apologies.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, no, no worries.
[AGENT][NEUTRAL] OK, page 7, is that the page you were referring to from the quest, right?
[CUSTOMER][NEUTRAL] Uh-huh, had the diagnostic code in 18.2 and 25.8 E 11.21.
[AGENT][NEUTRAL] Yes, I see it right now, uh huh, 11.21 they did provide the diagnostic code there. OK, so, um.
[AGENT][NEUTRAL] You can do
[AGENT][NEUTRAL] I would just um let the um you have the.
[AGENT][NEUTRAL] Insured on the line you said correct?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK, you can just let them know that you're gonna send it back for review, um, and allow, um, and allow some time for that process and usually I just um like 1 to 3 business days, um, and it should be reprocessed, um, and then.
[AGENT][NEUTRAL] I can uh
[AGENT][NEUTRAL] I guess you probably would want to go ahead and send a hub request and then um or I can do that if you'd like either way but yeah we should send a hub request and then what I'm gonna do is I'll go ahead and take the information right now and put it into our um claims review so if you want to do that um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll go ahead and start that process as well.
[CUSTOMER][POSITIVE] OK, perfect. I'll do a hub request and I'll let him know to just allow up to 3 working days. Does that sound good?
[AGENT][POSITIVE] Yes, mhm, yeah, for that claim turnaround, that's correct, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII].
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Have a good day bye.