AccountId: 011433970860
ContactId: c2128555-486c-43f5-90d0-4a255326239f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532109 ms
Total Talk Time (AGENT): 196720 ms
Total Talk Time (CUSTOMER): 179111 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/c2128555-486c-43f5-90d0-4a255326239f_20250121T18:29_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm great, how are you?
[CUSTOMER][NEUTRAL] Doing all right thank you. I've got a provider on the line calling regarding a claim um the original stated that we were missing the EOB. She did tell me when that was sent over to us, uh, and that claim just registered as a duplicate, so I just wanted to make sure that all of that information was correct.
[AGENT][NEUTRAL] OK, may I have a policy number?
[CUSTOMER][NEUTRAL] Yes, it is 1568739.
[CUSTOMER][NEUTRAL] And it is for part 4.
[AGENT][NEUTRAL] OK, and who's on the line?
[CUSTOMER][NEUTRAL] Uh, we're speaking with [PII].
[AGENT][NEUTRAL] You have a callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII] 0 wait [PII] sorry.
[AGENT][POSITIVE] OK. Thank you. I am ready.
[CUSTOMER][NEUTRAL] Uh, I have both of those claim numbers if you'd like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so the original claim was uh 353-565-5.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the one that she stated was the EOB uh was 3541405.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] All right. Of course, thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, [PII], this is [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] I am wonderful thanks for asking and I'll be happy to verify the claim status for you. Please be advised that verification of coverage does not guarantee the payment of a claim. Let me get this pulled up for you.
[AGENT][NEUTRAL] And I'm looking at data service 624-2024.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, just waiting on the image to load one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this one date of service 624-239 was the bill amount and.
[AGENT][NEUTRAL] Blue Cross and Blue Shield EOP is attached. Let me see.
[AGENT][NEUTRAL] This looks like.
[AGENT][NEUTRAL] Was there also a facility bill?
[AGENT][NEUTRAL] Because this ELB is matching.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm not sure the one I'm looking at is a 1500 form.
[AGENT][NEUTRAL] OK, I'm looking at a 1500 form for CPT 99282 and the EOB has revenue codes 270, 450, 450, 636. Let me see if there's anything else out here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, this one only has one CBT code on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like there's 3 claims out here. Let me get that pulled up.
[AGENT][NEUTRAL] And this is 6:24.
[AGENT][NEUTRAL] OK, I'm showing a date. It's [PII] for 99282. That's not it. Let me go to the next one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do apologize our system is slow.
[AGENT][NEUTRAL] And this one is also [PII].
[AGENT][NEUTRAL] 199282. So if you do have the corrected EOB for 624 CPT code 99285, if you fax that over, we can get that processed. This does not match what we have in house does not match.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so let me see here.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me see what they paid on it.
[CUSTOMER][NEUTRAL] OK, it looks like Blue Cross left.
[CUSTOMER][NEUTRAL] Like $33 so.
[CUSTOMER][NEUTRAL] Let's see if I can find that remit in here.
[AGENT][NEGATIVE] The one I'm looking at also has $33.25 but the date of service is different and the procedure code is different.
[CUSTOMER][NEUTRAL] That's the amount.
[CUSTOMER][NEUTRAL] OK, so this one that I'm looking at right now says it was total charge of 239. They left 3325 to a deductible and a contract adjustment of 20575.
[AGENT][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Is that what you have?
[AGENT][NEUTRAL] I show that as well, yes, ma'am, but my CPT code is 99282.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And your
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The data service is different though.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] OK, hold on
[CUSTOMER][NEUTRAL] OK, let me, I tell you what, instead of making you sound on the phone, let me see if I can.
[CUSTOMER][NEUTRAL] Add in that COB.
[CUSTOMER][NEUTRAL] Um, because.
[CUSTOMER][NEUTRAL] I'm showing something's weird on this one.
[CUSTOMER][NEUTRAL] Because the COB attached to it.
[CUSTOMER][NEUTRAL] Its stating
[CUSTOMER][NEUTRAL] Yeah, the COB that's attached to it is for 1537.
[CUSTOMER][NEUTRAL] Total bill amount.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Go back over to this one.
[CUSTOMER][NEUTRAL] That looks like the facility.
[AGENT][NEUTRAL] Cause we do have that one for the facility as well.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It's for 1537. That was actually sent in with the 1500 form for 99282.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, so it looks like we're missing that one from the 1500, OK, um.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Let me make a note of this.
[CUSTOMER][NEUTRAL] Because you have the facility EOB attached to it.
[AGENT][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] It looks like the facility claim was processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and where can I fax that to?
[AGENT][NEUTRAL] You can fax it to [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK, do I need to attach the um claim with it as well?
[AGENT][NEUTRAL] No, ma'am, actually you can reference claim number.
[AGENT][NEUTRAL] 353-565-555
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right and then do you have a reference number for this call?
[AGENT][NEUTRAL] Yes, it will be my name which is [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, I believe that's it.
[AGENT][POSITIVE] Well, thank you for calling American Public Life, [PII], have a great day. Bye bye.
[CUSTOMER][POSITIVE] Alright, thank you.