AccountId: 011433970860
ContactId: c1693724-4cd5-43e0-80d2-c00f30f81ef0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 404519 ms
Total Talk Time (AGENT): 106099 ms
Total Talk Time (CUSTOMER): 180388 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/c1693724-4cd5-43e0-80d2-c00f30f81ef0_20250529T15:05_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII] How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for uh Access Medical Clinic Arkansas. I verify the UB and this call is made for an additional information about the claim denial. And also, please note that this call is being recorded and monitored for the quality and training purposes. Thank you.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Callback number is [PII]. No extension direct line.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] The policy number is 025856551.
[AGENT][NEUTRAL] Thank you, [PII]. Now, I need the, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] He's of course, patient's names.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] The date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Day of service is [PII]. Charge amount is $243 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And what are the bill charges again? Please repeat that.
[CUSTOMER][NEUTRAL] $243.60.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII]. That's when we received the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and the claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3601343.
[CUSTOMER][NEUTRAL] Thank you so much for the information. After checking your AV to receive the payment for this claim for $75 even. And the code 99213 is paid for $75 and it has been denied for uh $126.60 and the other code which is G2211 is totally denied. So could you please help me with the additional information about the denial?
[AGENT][NEUTRAL] Um, yes, because under this policy for services provided in office, we cover up to $75 per visit.
[AGENT][NEUTRAL] So, the additional charges on this claim denied because the benefit maximum was reached.
[CUSTOMER][NEUTRAL] OK, so the claim is denied because benefit maximum limits has been exit. That's right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And may I know how many visits are allowed for this plane?
[AGENT][NEUTRAL] 5 per calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] For calendar year.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, thank you so much. And may I know whether the code 99213 is partially paid and partially denied?
[AGENT][NEUTRAL] It was paid up to $75.
[CUSTOMER][NEUTRAL] OK, so the balance amount is denied?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much for the information. I checking here, the code G2.
[CUSTOMER][NEUTRAL] 11 G 2211 and 99213 has been billed only.
[CUSTOMER][NEUTRAL] 3 times for a data of service. So could you please kindly check out this and send the claim back for a manual review.
[AGENT][NEUTRAL] No, ma'am. The claim would have to be resubmitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know when was the last service?
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] So, may I know when was the last service reached?
[CUSTOMER][NEGATIVE] No, it ain't nothing
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we cover up to 5 per calendar year.
[CUSTOMER][NEUTRAL] May I know last service rendered date?
[AGENT][NEUTRAL] And the last, um,
[AGENT][NEUTRAL] Yes, the last service rendered was [PII]. This claim was the last one.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] So this is the last service, so it should be paid uh totally.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So is it
[CUSTOMER][NEUTRAL] Any chance to send the claim back for a manual review?
[AGENT][NEUTRAL] No, ma'am. The claim would need to be resubmitted by the provider. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I verify the card to claim mailing address?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And whether the timely filing is one year from the denial?
[AGENT][NEGATIVE] Um, there's no timely filing limit.
[CUSTOMER][POSITIVE] OK, thank you so much and could you please spell out your name for me?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII]. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Could you please help me with the color of this one.
[AGENT][NEUTRAL] So the reference number, you can use my name and today's date.
[CUSTOMER][POSITIVE] E B I E. That's right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, your name is on today's date. Thank you so much for your reference number and thank you so much for your assistance. Have a great day. Bye bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.