AccountId: 011433970860
ContactId: c57ca2a4-2c31-4c91-b7e1-93d1b9b8bddb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 529210 ms
Total Talk Time (AGENT): 126261 ms
Total Talk Time (CUSTOMER): 174146 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/2025/04/17/c57ca2a4-2c31-4c91-b7e1-93d1b9b8bddb_20250417T13:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling to provide additional information about a claim that has been. Please note this call will be recorded and monitored for training and quality purpose. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][NEUTRAL] I'm doing fine.
[AGENT][NEUTRAL] OK, [PII], can I get a good callback number and then I can help you with claim status.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] 02563342.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the date of service?
[CUSTOMER][NEUTRAL] [PII], total charges 9 $18.
[AGENT][NEUTRAL] OK, looks like we received that on [PII].
[CUSTOMER][NEUTRAL] It looks like we received that um 32,620.
[AGENT][NEUTRAL] And that was processed on [PII].
[CUSTOMER][NEUTRAL] That was processed on [PII].
[CUSTOMER][NEUTRAL] Claim number.
[AGENT][NEUTRAL] number 3583031.
[CUSTOMER][NEUTRAL] Number 3583034.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. So under this claim, did you make a payment for 9322?
[AGENT][NEUTRAL] Uh it looks like this claim is actually a duplicate. Let me find the original.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, here's the original.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, we made a payment of $75.
[CUSTOMER][NEUTRAL] OK, we've made a payment of $75.
[AGENT][NEGATIVE] See what denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please provide me the claim number first?
[AGENT][NEUTRAL] 353-9501.
[CUSTOMER][NEUTRAL] 353-9501.
[CUSTOMER][NEUTRAL] Patient account number, please?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] 7303356 V as in Victor 12833.
[CUSTOMER][NEUTRAL] 303356 V as in Victor 1283.
[CUSTOMER][NEUTRAL] Thank you. So both account numbers are the same. That's services are the same, not the, not the one. So under the original claim, do you, do you make a payment for the 912?
[AGENT][NEUTRAL] Uh, it looks like we paid on let me see.
[CUSTOMER][POSITIVE] You paid off.
[CUSTOMER][NEUTRAL] No, no. Sorry for the interruption. Like I have a few clarification questions with you. I can see here the three CPT codes are still outstanding. One is 91322 and another one is 90408. So the payment for these two.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] CPT code, yes or no?
[AGENT][NEUTRAL] Uh it looks like we had denied for maximum benefit payable for data service has been met, so the max payable is $75. That's the max that we'll pay for this entire date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, allow me just a second. How much you needs are allowed for the date of service for the CPT code for the [PII], sorry, for the [PII]?
[AGENT][NEUTRAL] It's just a, it's just a benefit for the date of service, so it's a $75 maximum benefit payout for the entire day of service.
[AGENT][NEUTRAL] Based on the services rendered.
[AGENT][NEUTRAL] The $75 is just assigned to the entire claim.
[AGENT][NEUTRAL] Not to a specific CPT code.
[CUSTOMER][NEGATIVE] So there is no way to send it back for the reprocess all so right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know
[CUSTOMER][NEUTRAL] A mailing address?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And the timely filing for this one, please?
[AGENT][NEUTRAL] 180 days from the process date.
[AGENT][NEUTRAL] And this was processed on [PII].
[CUSTOMER][NEUTRAL] 180 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the call reference for this entire call? We'll move to the last one patient.
[AGENT][NEUTRAL] Uh it's my name and today's date.
[CUSTOMER][NEUTRAL] Thank you, [PII]. And are you ready for the next the next patient ID?
[AGENT][NEUTRAL] Uh, no, give me one moment, please.
[AGENT][NEUTRAL] And the policy ID?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, next policy ID is gonna be A as in Alpha 6041.
[CUSTOMER][NEUTRAL] 298.
[AGENT][NEUTRAL] Um, that's not one of our policy numbers.
[AGENT][NEUTRAL] Social security number or last name?
[CUSTOMER][NEUTRAL] Last name is gonna be [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name is gonna be [PII]
[CUSTOMER][NEUTRAL] EK, but it's [PII].
[AGENT][NEUTRAL] I'm not pulling up a patient with that name in our system.
[AGENT][NEUTRAL] The social or group number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I don't have numbers here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][POSITIVE] No, no, thank you, [PII]. Have a good day. Happy weekend.
[AGENT][POSITIVE] OK, thank you. Thank you for calling APL you as well.
[CUSTOMER][POSITIVE] I will like it.