AccountId: 011433970860
ContactId: c66be8d9-45d0-4096-ad70-c576c02a1f8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1068060 ms
Total Talk Time (AGENT): 240142 ms
Total Talk Time (CUSTOMER): 295604 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/c66be8d9-45d0-4096-ad70-c576c02a1f8b_20250523T14:47_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]. I'm [PII]. I'm calling from provider's office regarding our claims.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] with an extension of [PII].
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02252690 M Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Number's first name is [PII] and the last name is [PII] and the date of birth is going to be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Mm, actually I do have a claim.
[CUSTOMER][NEUTRAL] Uh, data service on the bill amount because we haven't issued any OB for this claim. The data service is going to be.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] with the bill amount of $1,073 even.
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I'm sorry. And what was the total bill amount?
[CUSTOMER][NEUTRAL] The bill amount is $1,073 even it's $1073 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me see what we have here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, it looks like that claim was denied.
[AGENT][NEUTRAL] Um, but the explanation of benefits that was sent in does not list the amounts applied to the deductible, co-pay, or co-insurance, so we need a more detailed explanation of benefits that shows the amounts for the claim.
[AGENT][NEUTRAL] And then let me
[CUSTOMER][NEUTRAL] Actually, however, we have been submitted the primary explanation of benefits on [PII] of the month of [PII]. mhm, through fax number.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing that that was a that there was multiple sent in so.
[AGENT][NEUTRAL] When they sent it in, you'll need to reference the claim number.
[AGENT][NEUTRAL] And I think because it shows that you got that it was sent in as a duplicate instead of for a specific claim.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So let me give you the claim number.
[AGENT][NEUTRAL] And you'll need to send in that detailed explanation of benefits with this claim number on it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And whenever you're ready I have the claim number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 1899.
[CUSTOMER][NEUTRAL] OK, you're stating that you have received the UOB, like you have, I mean, received the, you have been received the primary OB, but you have been stating it was denied, uh, it will be denied as duplicate because you don't have any claim number was written on the um the denied your claim number 3531899. Am I right?
[AGENT][NEUTRAL] Right, so add that claim number to that document.
[CUSTOMER][NEUTRAL] OK. In this case, we need to submit again the primary or fax number as well, right?
[AGENT][NEUTRAL] And submitted under that claim number.
[AGENT][NEUTRAL] Right, and do you have our fax number?
[CUSTOMER][NEUTRAL] Is the fax number is [PII]?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] [PII] got it. In this case, I will definitely.
[CUSTOMER][NEUTRAL] Submit the primary will be through fax with the adding the claim number, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] In this case, could you please uh help me with the
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, what is the timely finding limit to submit this?
[AGENT][NEUTRAL] Uh, we don't have timely filing limits.
[AGENT][NEUTRAL] So you can submit it any time mhm.
[CUSTOMER][NEUTRAL] OK, got it. Could you please help me the qual difference for this claim?
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial so [PII] in today's date.
[CUSTOMER][NEUTRAL] OK, [PII]. OK. I do have one more claim. Will you help me with that?
[AGENT][NEUTRAL] Is it for the same person? OK, give me one moment.
[CUSTOMER][NEUTRAL] It's a different number.
[CUSTOMER][NEUTRAL] No, it's a different number.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm almost done, give me just one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, and what is the 2nd policy number?
[CUSTOMER][NEUTRAL] The policy number is?
[CUSTOMER][NEUTRAL] 152 415.
[CUSTOMER][NEUTRAL] 6 M as in Mike, L as in Lima, I'm sorry, M as in Mike, I as in India, number 7.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] The date of birth is going to be [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is going to be [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $1,938 even.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You said [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Upon checking, we have been submitted the claim through fax because previously we have been called and scheduled the additional no claim on file, so we have been submitted the claim through fax on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] $1,938 1938 dollars.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] What is the provider's name?
[CUSTOMER][NEUTRAL] I mean you are asking the rendering me.
[AGENT][NEUTRAL] The, the provider's name or the hospital that was that billed the patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Gastrohealth LLC.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Whicharo also.
[AGENT][NEUTRAL] Because I'm not seeing one for that amount, when did you say you sent it in?
[CUSTOMER][NEUTRAL] We have been sent on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Do you know what the date of service was for that claim? Did you say it was?
[CUSTOMER][NEUTRAL] The day [PII]. It's [PII]. Mhm.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am showing that we paid $441.32.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] For that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In this case I just wanted to make sure I know what are the CPTs that was built on the screen.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're asking what was billed?
[CUSTOMER][NEUTRAL] What was the bill CPT?
[CUSTOMER][NEUTRAL] On the claim?
[CUSTOMER][NEUTRAL] I just wanted to verify.
[AGENT][NEUTRAL] Yeah, I'm showing it went to Gastro Health 627-2024.
[AGENT][NEUTRAL] We have a total amount of $2,788. I didn't have one for 1938.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I'm looking for 1938, not for $2000 OK?
[AGENT][NEUTRAL] OK, then I don't see that claim.
[CUSTOMER][NEUTRAL] If you don't have, I will be submit the claim again through fax. Sure, OK, not a problem.
[AGENT][NEUTRAL] Yeah, because I'm not seeing it. OK.
[CUSTOMER][NEUTRAL] OK, in this case, what, uh, may I know what is the time defining limit to submit this?
[AGENT][NEGATIVE] Uh, we don't have time we don't have timely filing limits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, could you please tell me what is your mailing address?
[AGENT][NEUTRAL] Our mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it in this case, man, what is the member effective and termination that's of policy.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Member effective and termination dates of policy.
[AGENT][NEUTRAL] OK, it looks like this policy was was active with an effective date of [PII] and the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] Got it. In this case, I just wanted to make sure, uh, while submitting an appeal, uh, uh, I'm sorry, while submitting the claim through fax, the fax number is [PII]. Am I right? Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] May I know your attention?
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] Attention while submitting a claim.
[CUSTOMER][NEUTRAL] Oh, OK, got it. In this case, while submitting and primary OP also we need to attention to claims department. Am I right?
[AGENT][NEUTRAL] Claims department.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got it. Thank you. That's it all the information I need, and you know, I will definitely send the primaryOB along with the secondary claim number, APL number for the first one through fax, and second one, I will, uh, for the second claim, for the second number, I will definitely send the claim through fax.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With the proper information, OK?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] That's it all the information I need. Thank you for your assistance. Bye for now, [PII]. Mhm.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] Thank you for calling APL Alex. Have a great day.
[CUSTOMER][NEUTRAL] [PII].