AccountId: 011433970860
ContactId: b3e20c9e-7c5d-413a-9c4e-10e1a86610c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507540 ms
Total Talk Time (AGENT): 128502 ms
Total Talk Time (CUSTOMER): 152194 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/b3e20c9e-7c5d-413a-9c4e-10e1a86610c5_20250624T17:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII], calling on behalf of Ocean Country Foot and Ankle Surgical Associates to check on the clarification of the claim. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good as well thanks for asking.
[AGENT][NEUTRAL] You're welcome and [PII] may I please have the callback number?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, it is spelled [PII] last initial of [PII] and today's date will be used as the call reference.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] You're welcome, and may I please have the policy number?
[CUSTOMER][NEUTRAL] Sure. It's uh one moment. It's 01994078 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim. May I please have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the total charge amount is $361.32.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for that claim, it does show that we received it on 64.
[AGENT][NEUTRAL] Of 25. It was processed on 64 of 25.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 360.
[AGENT][NEUTRAL] 9440.
[AGENT][NEUTRAL] And the reason that it shows that the claim did process and it did deny.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Get put in now for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It says that it was an incorrect filing by the provider.
[AGENT][NEUTRAL] Let me look at the claim.
[CUSTOMER][NEGATIVE] Incorrect filing?
[AGENT][NEUTRAL] I'm pulling the claim image up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was for an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The only thing that I can do, go ahead.
[CUSTOMER][NEUTRAL] And Tarika, uh, I just
[CUSTOMER][NEUTRAL] Yeah, sorry for interrupting you. I just need to let you know about uh one thing. So previously, the claim was taken back for review on [PII]. And the ticket number, it's the same as the claim number it taken by the representative. So that, the ticket number is 3599039. Could you please check with that?
[AGENT][NEUTRAL] You said it's a new, it's a ticket number?
[CUSTOMER][NEUTRAL] Yeah, for the three process.
[AGENT][NEUTRAL] We don't give ticket numbers.
[CUSTOMER][NEUTRAL] Yeah, that's why the representative stated that they don't provide the ticket number. Instead they took the claim number as a ticket.
[AGENT][NEUTRAL] OK. Could you give me that number again?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 359-903-9.
[AGENT][NEUTRAL] OK, that's no number that we have listed in our system so I'm not sure which number you're giving me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] So, I could see here we received a correspondence which is mentioned that information received from provider incomplete cannot process until the additional or corrected information received from the provider. Is there any denial in your end like this?
[AGENT][NEUTRAL] That's the information that I just gave you.
[CUSTOMER][NEUTRAL] OK. So may I know what exact uh information you required from us?
[AGENT][NEUTRAL] And as I stated, I was reviewing the claim to see what reason that claim was denied for that, and I was going to inform you that I'm sending this back to the examiner to have them to review.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, I just need that, uh, denial clarification, that's all.
[AGENT][NEUTRAL] And with that, I'm, I'm sending it back to the examiner to have them to review and or process.
[CUSTOMER][NEUTRAL] Yeah, OK, you just send the client back for review, right?
[AGENT][NEUTRAL] That is what I just stated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, that's all I need from you. Is there any ticket number for taken back for the reprocess?
[AGENT][NEUTRAL] I already gave the reference number which is my first name, last initial and today's date. We do not have ticket numbers.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. May I know the turnaround time?
[AGENT][NEUTRAL] Once I submit this back to the examiner, the examiner has a total of 10 to 15 business days before that claim can be reviewed and or reprocessed.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information and that's all I need from you. Thank you so much for your assistance, Tarika and have a great day. Bye for now.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day as well.
[CUSTOMER][NEUTRAL] Yeah,