AccountId: 011433970860
ContactId: b7277e17-e472-40ee-bb92-fd618f077657
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 945000 ms
Total Talk Time (AGENT): 158000 ms
Total Talk Time (CUSTOMER): 255176 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/b7277e17-e472-40ee-bb92-fd618f077657_20250428T20:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 433-267
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is 432 $33.88.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received that on 11-7-2024. I was paid on 11-11-2024, paid $23.31.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, I have some specific question on this line.
[CUSTOMER][NEUTRAL] For the CPT 99.
[CUSTOMER][NEGATIVE] 214 was denied and the previous trip sent the claim back for the reprocess. I just want to know the status for the reprocess.
[AGENT][NEUTRAL] Um, that
[AGENT][NEUTRAL] That CPT code is not covered under the policy, so there's no reprocessing due, not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It was denied as non-covered?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Under the patient plan or provider plan?
[AGENT][NEUTRAL] Under the patient's plan?
[CUSTOMER][POSITIVE] Thank you so much for the information.
[CUSTOMER][NEUTRAL] May I know the filing limit?
[AGENT][NEUTRAL] You what?
[AGENT][NEUTRAL] I'm sorry, I didn't hear you.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] To what limit?
[CUSTOMER][NEUTRAL] The appeal filing limit.
[AGENT][NEUTRAL] 180 days from process date.
[CUSTOMER][NEUTRAL] May I know the corrected filing limit.
[AGENT][NEUTRAL] For the corrected filing limit?
[CUSTOMER][NEUTRAL] For the.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can file a claim at any time.
[CUSTOMER][NEUTRAL] You could
[CUSTOMER][POSITIVE] Thank you so much for the information. Can I get the claim number?
[AGENT][NEUTRAL] My number 352-833-4.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][POSITIVE] Thank you so much for the information. Just a moment.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Can we move to the next client with the same patient, different date of service?
[AGENT][NEUTRAL] Uh, yes, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $364.87.
[CUSTOMER][NEUTRAL] May I know the receipt it and process it?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what, what were the bill charges again?
[CUSTOMER][NEUTRAL] OK, what, what.
[CUSTOMER][NEUTRAL] $364.87.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, there's a few claims, so I'm trying to find which one it is.
[CUSTOMER][NEUTRAL] There's plans.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, claim was received 228-25.
[AGENT][NEUTRAL] Process 3420.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 228 on [PII], right?
[AGENT][NEUTRAL] 2 28 2025.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And process on?
[AGENT][NEUTRAL] 34 2025.
[AGENT][NEUTRAL] Um, that one
[CUSTOMER][NEUTRAL] And I have some specific question on this claim for the CPT 99214 and 82947 and 36416. I just want to know the denied reason for the CPT code.
[AGENT][NEUTRAL] Office visits are not covered under the policy?
[AGENT][NEUTRAL] Let me find the denial for the other ones.
[CUSTOMER][NEUTRAL] The office visit is not covered for the CPT 99214, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what were the other codes you were checking on?
[CUSTOMER][NEUTRAL] 8294736416
[AGENT][NEUTRAL] Uh, looks like those denied for copy of, needed the copy of the explanation of benefits.
[CUSTOMER][POSITIVE] Thank you so much for the information. Can I fax?
[CUSTOMER][NEUTRAL] The primary U?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] 365
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for the information. Can I get the claim number?
[AGENT][NEUTRAL] The number 350-7135.
[CUSTOMER][NEUTRAL] Re
[CUSTOMER][POSITIVE] Thank you so much for the information.
[CUSTOMER][NEUTRAL] Can you move to the next client with the same patient?
[AGENT][NEUTRAL] Yes, so it's the data service.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] In the total charge amount.
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] The claim was received 228-25.
[AGENT][NEUTRAL] Process 3425.
[CUSTOMER][NEUTRAL] 325.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sorry, can you please repeat again the receipt didn't process it.
[AGENT][NEUTRAL] 228 25 34 2025.
[AGENT][NEUTRAL] You need a copy of the X.
[CUSTOMER][NEUTRAL] And I have some specific questions.
[CUSTOMER][NEUTRAL] Yeah. Before that, I have a specific question. 36417. I just want to know the, the reason.
[AGENT][NEUTRAL] You need a copy of the primary explanation of benefits?
[CUSTOMER][NEUTRAL] The benefits
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 357-082-4.
[CUSTOMER][NEUTRAL] 6824
[CUSTOMER][NEUTRAL] Can we move to the next claim with the same patient?
[AGENT][NEUTRAL] Yes, the date of service and bill charges.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and the the total bill the amount is
[CUSTOMER][NEUTRAL] $433.88.
[AGENT][NEGATIVE] And trying to look through these, it was submitted 3 times.
[CUSTOMER][NEUTRAL] Trying to look through these it was.
[AGENT][NEUTRAL] OK, it looks like it was the 99214 is not covered under the policy, and then we needed a primary explanation of benefits.
[CUSTOMER][NEUTRAL] May I know the receipt didn't processed it.
[AGENT][NEUTRAL] The date is
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you so much for the information. Can I get the claim number?
[AGENT][NEUTRAL] 3555532.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 32
[CUSTOMER][POSITIVE] Thank you so much for the information. Can you spell your name, please?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for the information. Can we move to the last line with a different patient?
[AGENT][NEUTRAL] Uh, yes, you have the policy number?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, just a minute.
[CUSTOMER][NEUTRAL] 09
[CUSTOMER][NEUTRAL] 128366
[AGENT][NEUTRAL] I'm not pulling up that policy number. Do you have a group number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can I say again the member ID? It's 0912.
[CUSTOMER][NEUTRAL] 8366.
[CUSTOMER][NEUTRAL] Can you verify by the name? Can I say the patient name?
[AGENT][NEUTRAL] Last name?
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not pulling that up. Do you have a group number or social?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Sorry, I don't have the social security number or group number.
[AGENT][NEUTRAL] OK, I'm not able to locate it with the information provided.
[CUSTOMER][NEUTRAL] Ok alright so I'll.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Can I get the call reference number?
[AGENT][NEUTRAL] That's my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much for patiently assisting me. Have a great day. Bye for now.
[AGENT][POSITIVE] Thanks for calling ABL as well. Bye bye.