AccountId: 011433970860
ContactId: c6cf5986-f9ec-4356-8050-5588a57e5870
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 5944350 ms
Total Talk Time (AGENT): 1327872 ms
Total Talk Time (CUSTOMER): 1254534 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/c6cf5986-f9ec-4356-8050-5588a57e5870_20250411T14:52_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] and I'm calling from provider's office.
[CUSTOMER][NEUTRAL] Skin and Cancer Associates, could, can I get a claim status on this call?
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim status. Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Before I proceed, please be informed this call is being recorded for training and quality purposes. Would you like us to continue this recording?
[AGENT][NEUTRAL] Yes, that's fine. May I please have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, sure. And the policy number is 02444788 M as Mike L as Lima 8.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is uh [PII].
[AGENT][POSITIVE] Thank you. And date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] Bill amount, um.
[CUSTOMER][NEUTRAL] It's $900 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I get your name?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] Let me show your name.
[AGENT][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] Oh, I didn't get.
[AGENT][NEUTRAL] No claim on files so that.
[CUSTOMER][NEUTRAL] Are you asking about the primary payment, ma'am?
[AGENT][NEUTRAL] Yeah, I'm asking if you have an amount after the primary paid.
[CUSTOMER][NEUTRAL] Yeah, uh, it is for $122 even.
[AGENT][NEUTRAL] OK, no claims on file for those billed amounts and that date of service.
[CUSTOMER][NEUTRAL] Uh, I'm, I, I said about the primary pay amount, $122.40.
[AGENT][POSITIVE] Thank you so much. So we don't have a claim on file for $12,240 or for $900. date of service [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second. Um.
[CUSTOMER][NEUTRAL] Uh, is it, is there any, um, claim for $150.51?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK, but one second. Mm.
[CUSTOMER][NEUTRAL] But actually we received an claim, I mean, EOB, but uh the, there is a partial payment. Could you please check on it? I have the claim number.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Uh, it is 3573798.
[AGENT][NEGATIVE] So on this claim, there was a benefit payment sent in the amount of $80. Uh, there were two denials on it. One is office visits are not covered by the member's policy, and then secondly, uh, the insured's major medical provided full benefits, so there was nothing additional for us to pay.
[CUSTOMER][NEUTRAL] I see the same reason in the OP but uh my question is why the office visit is not covered.
[AGENT][NEGATIVE] The member's plan does not cover that.
[CUSTOMER][NEUTRAL] OK, may I know the member's plan?
[AGENT][NEUTRAL] The member has a medlink plan.
[CUSTOMER][NEUTRAL] Is it midlink?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Mm.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] And the other reason, um.
[AGENT][NEUTRAL] Uh, because the insured's major medical covered the entire thing. Yeah.
[CUSTOMER][NEUTRAL] Major medical coverage.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So that means the mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can we find the member's plan type in the card copy?
[AGENT][NEUTRAL] In the hard copy of
[CUSTOMER][NEUTRAL] Members, yeah.
[AGENT][NEUTRAL] We don't have the primary insurance as far as this plan type. It's a secondary medlink plan. I'm not sure what other information do you need?
[CUSTOMER][NEUTRAL] Um, I didn't understand the deny for major medical coverage provided.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So their, their major medical paid for everything, so we're not their primary insurance, we're the secondary.
[CUSTOMER][POSITIVE] Yeah, got it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, OK. I understand now. And uh, can I, uh, I also have the another claim. Can I proceed with that?
[AGENT][NEUTRAL] Is it the same patient or different?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] No, actually it is for the same patient but different date of service.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $464 even.
[AGENT][NEUTRAL] OK, there's one claim on file for the state of service. There was a benefit payment sent for $80.
[AGENT][NEUTRAL] There was one denial on here for procedure code 99212. Of visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] Can I proceed with the next memo?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Sure. Is there, uh, is there any call reference for different patients?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date.
[CUSTOMER][NEUTRAL] OK. Thank you for that. And the next member ID is
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 60801. Uh, could you please uh check with the member's name? I don't have the correct member ID for this. I'm not sure this is the correct one. I see here it is uh 60801.
[AGENT][NEUTRAL] What's the member's last name?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What state does the uh insured liv[PII] in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Do you have a claim number anything like that?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And for the previous claim, you said that uh the patient plan doesn't cover the offices, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh the balance that was not covered, is this, is that a patient responsibility or providers just mean.
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that's up to the provider facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the data service for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the build amount?
[CUSTOMER][NEUTRAL] $241 even.
[AGENT][NEUTRAL] Alright, so claim was received.
[AGENT][NEGATIVE] Uh, it was denied. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When was the claim received?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Claim is received on [PII], denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Claim number is 3576411.
[CUSTOMER][POSITIVE] Thank you. Um.
[CUSTOMER][NEUTRAL] Could you send me the UOB to a fax?
[AGENT][POSITIVE] Mhm, absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] Yes, [PII]. My name.
[AGENT][NEUTRAL] Spring for the first
[CUSTOMER][NEUTRAL] And how much time it will take to receive the EOB?
[AGENT][NEUTRAL] Uh, it can take about 5 minutes. It's on its way.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Can I proceed with the next
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have another claim.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Go ahead with the next member ID [PII] when you're ready.
[CUSTOMER][NEUTRAL] Mm, one second.
[CUSTOMER][NEUTRAL] Yeah, and the next member ID it is 020522.
[CUSTOMER][NEUTRAL] 22 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth.
[AGENT][NEUTRAL] Alright and then data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] build them out
[CUSTOMER][NEUTRAL] Mm, it is for $424 even.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Uh, are you asking about the primary allowed amount or the paid one?
[AGENT][NEUTRAL] The amount remaining after the primary paid.
[CUSTOMER][NEUTRAL] $60.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] There is a claim on file for that date of service. It was denied. Services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. When was this claim received?
[AGENT][NEUTRAL] Uh, let me get the date, one moment.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Denied on [PII].
[CUSTOMER][NEUTRAL] And then I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And also, can I get the effective rates of the member's plan?
[AGENT][NEUTRAL] Patient was effective on [PII].
[AGENT][NEUTRAL] Patient terminated on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and [PII], correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is there any uh other uh
[CUSTOMER][NEUTRAL] Active policies for this member or other, any other secondary insurance?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we uh doesn't have any active policies also, right?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you send me this UB fax?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And also, can I get the um claim number?
[AGENT][NEUTRAL] 3576508.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] EOB is on its way to you, [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The EOB is on its way to you.
[CUSTOMER][NEUTRAL] OK. Mm, can I proceed with the next claim?
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] The next policy ID it is um
[CUSTOMER][NEUTRAL] 9456666
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim is processed on [PII].
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEGATIVE] Was denied office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK. Could you send me the COB?
[AGENT][NEUTRAL] Claim number is
[AGENT][NEUTRAL] Yep, claim number is 3576539.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 653 9. OK.
[AGENT][NEUTRAL] Did you have any others you needed to check today, [PII]?
[CUSTOMER][POSITIVE] Yes, actually.
[AGENT][POSITIVE] OK, ready for the next one you are.
[CUSTOMER][NEUTRAL] One second, my system is loading. Yeah, it is 944,160.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Policy number 944,160.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 949,994,160.
[CUSTOMER][POSITIVE] But actually we be with.
[AGENT][NEUTRAL] 994,160. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What was the member's date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's not the right policy number. Do you have a claim number?
[CUSTOMER][NEUTRAL] No, uh, or else could you check with 944,160.
[AGENT][NEUTRAL] 944,160.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] First and last name again?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, there's no [PII] on here. Spell the last name, I can search by the name.
[CUSTOMER][NEUTRAL] Sorry,
[CUSTOMER][NEUTRAL] Uh, [PII]. It is first name. [PII].
[AGENT][NEUTRAL] And what's [PII]'s last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What state does the patient reside in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What was the bill amount for 1227 24?
[CUSTOMER][NEUTRAL] $197.
[AGENT][NEUTRAL] Claim was received on [PII], denied on [PII]. The calendar year maximum for office visits has already been met. Patient is allowed total of 4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean what those visits um exhausted. May I know the dates?
[AGENT][NEUTRAL] The date of
[AGENT][NEUTRAL] Are you looking for the last office visit date?
[CUSTOMER][NEUTRAL] But actually, I see that from our end they are only.
[CUSTOMER][NEUTRAL] Two office visits from my end.
[CUSTOMER][NEUTRAL] Only one office is I'm not one.
[AGENT][NEUTRAL] OK, we're showing for [PII] that the patient used their office visits.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is there any specific dates?
[CUSTOMER][NEUTRAL] That my mom has made.
[CUSTOMER][NEUTRAL] The visits.
[CUSTOMER][NEUTRAL] Because it is, this is the first visit from our end.
[AGENT][NEUTRAL] Oh, I understand. member could have seen a different provider.
[CUSTOMER][NEUTRAL] OK. May I know which provider is it?
[AGENT][NEUTRAL] Last data service that I saw that the member was seen for an office visit was a quick family urgent care in [PII].
[CUSTOMER][NEUTRAL] Quick. May I know, uh, could you repeat it?
[AGENT][NEUTRAL] Quick
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Family
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Family?
[AGENT][NEUTRAL] Urgent care.
[CUSTOMER][POSITIVE] Waing good.
[CUSTOMER][NEUTRAL] OK, so members section 4 visits only provide a quick family urgent care, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hello? OK. Mhm.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Understand. Could you send me this EOB?
[AGENT][NEUTRAL] It's on its way.
[CUSTOMER][NEUTRAL] OK. And can I get the claim number?
[AGENT][NEUTRAL] For the denied claim?
[AGENT][NEUTRAL] 357-315-9
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And also, uh, could you help me with the dates that member has met his, uh, visits?
[AGENT][NEUTRAL] The last date of service that I'm showing was on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I proceed with the next one?
[AGENT][NEUTRAL] What's the next ID?
[CUSTOMER][NEUTRAL] 02406309 M as Mike L as Lima 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well, the amount $277 even.
[AGENT][NEUTRAL] Claim is received on [PII], denied [PII]. Office visits are not covered under the member policy.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] Mhm. Is it the same one link?
[AGENT][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it same plan that midlink?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, 357 and then.
[AGENT][NEUTRAL] 7525.
[CUSTOMER][NEUTRAL] OK. And also can you send me the COB?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. Mm.
[CUSTOMER][NEUTRAL] Can I proceed with the next one?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, thank you. And it is 02145415 M as Mike, L as Lima, 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] need a service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] $385 even.
[AGENT][NEUTRAL] So, claim is received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim is processed on [PII]. There was a benefit payment sent in the amount of $85.17.
[AGENT][NEGATIVE] One line item was declined, office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] Claim number is 357-7647.
[CUSTOMER][NEUTRAL] Mhm. Thank you. Also, could you send me the COB?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Anniversary the next month.
[AGENT][NEUTRAL] Uh, let me just finish sending the COB one moment please.
[CUSTOMER][POSITIVE] Yes, sure. Take care on time.
[AGENT][NEUTRAL] Alright, next member ID.
[CUSTOMER][NEUTRAL] 01841598 M as Mike [PII] as [PII].
[AGENT][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 415
[CUSTOMER][NEUTRAL] 98 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] $683 even.
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was a benefit payment sent for $37.12.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There were 2 denials. Office visits aren't covered under the member policy. Second denial was because major medical didn't pay anything. We only pay if the major medical pays.
[CUSTOMER][NEUTRAL] Oh, what is the, uh, second reason?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What is the second in a major?
[AGENT][NEGATIVE] It's because their major medical didn't pay anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, one second.
[CUSTOMER][NEUTRAL] But even for the CPT 11102, the measure.
[CUSTOMER][NEUTRAL] Medical was not paid, right? And even though it was uh paid by secondary.
[CUSTOMER][NEUTRAL] And why is this denied?
[AGENT][NEUTRAL] 1102 paid benefit amount of 3712 denial procedure code was on 17,110.
[CUSTOMER][NEUTRAL] Yes, I understand.
[CUSTOMER][NEUTRAL] Yes, I understand. But even though uh the 17,110 is not paid because there's no payment from the primary, right?
[AGENT][NEUTRAL] Correct. So if there's no payment from the primary, then we're not gonna pay.
[CUSTOMER][NEGATIVE] But upon checking for CPT 11102 is even that CPT has no payment from uh Medi Primary, right? But even though it was paid and why is this denied 17,110.
[AGENT][NEUTRAL] We don't show that the major medical paid anything.
[CUSTOMER][NEUTRAL] Both CPTs has not paid by.
[AGENT][NEUTRAL] So we corrected
[CUSTOMER][NEUTRAL] Primary.
[AGENT][NEUTRAL] A corrected claim can be resubmitted.
[CUSTOMER][NEUTRAL] Mhm. Can I get the claim number?
[AGENT][NEUTRAL] 3,577,510
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And can I also get the check details?
[AGENT][NEUTRAL] Single check check number 2033977.
[AGENT][NEUTRAL] Issued [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is this is in cash?
[AGENT][POSITIVE] Check still shows outstanding.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Can I also get the check details for the previous claim?
[AGENT][NEUTRAL] Uh, what other details do you need aside from the check number?
[CUSTOMER][NEUTRAL] Um, only the check details.
[CUSTOMER][NEUTRAL] Check number and reissue it.
[AGENT][NEUTRAL] Issue date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Check number is 203.
[AGENT][NEUTRAL] 3977.
[CUSTOMER][NEUTRAL] Oh, is it the same for the previous patient?
[AGENT][NEUTRAL] It's just that one single check, that was it for the benefit payment.
[CUSTOMER][NEUTRAL] I understand. I'm asking about the previous one which was paid for $85.17.
[AGENT][NEUTRAL] $20.17.
[CUSTOMER][NEUTRAL] $85.17.
[AGENT][NEUTRAL] I didn't give any payment details for $85.17.
[CUSTOMER][NEUTRAL] So is it for $25.17?
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so we're speaking on patient [PII].
[AGENT][NEUTRAL] Date of service was [PII] and there was a benefit payment sent for $35.37 dollars 12 cents.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Are you speaking on this patient or are you speaking on a different patient?
[CUSTOMER][NEUTRAL] It is for the different patient.
[AGENT][NEUTRAL] OK, well, yeah, I mean, you didn't tell me we were changing patients.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, for the previous patient, I didn't go to check details.
[AGENT][NEUTRAL] OK, well, we.
[AGENT][NEUTRAL] We can't be going back and forth. You can't switch up. Are you finished with [PII]?
[CUSTOMER][POSITIVE] Yes, I'm finished with this.
[AGENT][NEUTRAL] Previous patient, what was, what was the name on the previous patient?
[CUSTOMER][NEUTRAL] Uh, could you send me this COB?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then what was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Are you ready for the check number on that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Is.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is it in cash?
[AGENT][POSITIVE] Check is still outstanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I proceed with the next memo?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 968008.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Mm [PII], [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] $197 ma'am.
[AGENT][NEUTRAL] Claim is received.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[AGENT][NEUTRAL] And the claim number on this is.
[CUSTOMER][NEUTRAL] OK. Can I get the
[AGENT][NEUTRAL] 357.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 75.
[AGENT][NEUTRAL] 33.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, could you send me the UB?
[AGENT][NEUTRAL] Mhm. Party on its way.
[CUSTOMER][POSITIVE] Mhm thank you. um, can I proceed with the next one?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 2304086
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], I'm still.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] build them out?
[CUSTOMER][NEUTRAL] $277 even.
[CUSTOMER][NEUTRAL] And is there any possibility that you can send this all your with in the bulk?
[AGENT][NEUTRAL] No, they're being sent one by one as we check. Unfortunately I don't have a way to send them in bulk. They've all been marked attention to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A claim for this patient was received on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[AGENT][NEUTRAL] And the claim number for this is going to be 35775007.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] We can proceed to the next when you're ready.
[CUSTOMER][NEUTRAL] Yeah, before that, could you send this UOB?
[AGENT][NEUTRAL] Yeah, already on its way.
[CUSTOMER][NEUTRAL] Mhm. Thank you. And the next one is 02006455 [PII].
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you use service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $407 if it charge you want.
[AGENT][NEUTRAL] Alright, claim was received for this on [PII].
[AGENT][NEUTRAL] It was denied on the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number on this one is going to be 357.
[CUSTOMER][NEUTRAL] Let me.
[AGENT][NEUTRAL] 7508.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Please send this new bill.
[AGENT][NEUTRAL] Mhm, on its way.
[CUSTOMER][NEUTRAL] 1 2nd
[CUSTOMER][POSITIVE] Sure, I'll proceed the next one.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 01608849 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And then data service.
[CUSTOMER][NEUTRAL] [PII] will amount to $405 even.
[AGENT][NEUTRAL] OK, so we did receive a claim for this state of service on [PII].
[AGENT][NEUTRAL] Claim is processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $41.08.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Uh, the denial on here was for the office visit. Office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Reclaim your ma, check details.
[AGENT][NEUTRAL] Is going to be 357-755-1, that would be the claim number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was a single check.
[AGENT][NEUTRAL] And the check number is going to be.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 20339.
[AGENT][NEUTRAL] 78.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Check date.
[AGENT][NEUTRAL] Issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Check is still outstanding.
[CUSTOMER][NEUTRAL] And can you send me this?
[AGENT][NEUTRAL] Mhm, on its way.
[CUSTOMER][NEUTRAL] OK, and one second.
[CUSTOMER][NEUTRAL] Can I proceed with the next one?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Next one, it is 60801.
[AGENT][NEUTRAL] That's gonna be our payer ID. Do you have the member's name, social, claim number?
[CUSTOMER][NEUTRAL] Yeah, my first name, first name is [PII]
[CUSTOMER][NEUTRAL] The last name, [PII]
[CUSTOMER][NEUTRAL] And the date of birth, [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] $197 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want the policy number?
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] 02581441.
[CUSTOMER][POSITIVE] Mhm. Thank you for your time.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is going to be 357.
[AGENT][NEUTRAL] 573 8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. Could you send me the GB?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, can I proceed with the next one?
[AGENT][NEUTRAL] Yup, go ahead.
[CUSTOMER][NEUTRAL] It is 02464411.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Mm ID Daily show. [PII].
[AGENT][NEUTRAL] A a service.
[CUSTOMER][NEUTRAL] [PII] and the bill amount, $277 even.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] The claim was processed and denied on [PII]. Office visits are not covered under the member policy.
[AGENT][NEUTRAL] And the claim number on this is gonna be 357.
[AGENT][NEUTRAL] 4714.
[CUSTOMER][NEUTRAL] Mhm. Yeah, could you send me the CV2?
[AGENT][NEUTRAL] Mhm, sending it now.
[CUSTOMER][NEUTRAL] Mm sure.
[CUSTOMER][NEUTRAL] Go I proceed with the next one.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] 02475985.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build amount?
[CUSTOMER][NEUTRAL] $645 even.
[AGENT][NEUTRAL] OK, so this claim is received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number on this one is gonna be 357.
[AGENT][NEUTRAL] 465 5.
[CUSTOMER][NEUTRAL] 4655.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] Could you send me this also?
[AGENT][POSITIVE] Uh yes, I'm sending that to you now.
[CUSTOMER][NEUTRAL] Mm sure I to the next one.
[AGENT][NEUTRAL] Uh, just one moment.
[CUSTOMER][POSITIVE] Yeah, sure I'll take you on them.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right. Next policy number when you're ready.
[CUSTOMER][NEUTRAL] 02153621.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What is the
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $417 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] No claim on file for [PII].
[AGENT][NEUTRAL] For [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So the policy ID is correct, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm, could you please recheck, but because we have, uh, submitted it two times, it is on, uh, [PII] and uh yeah.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] No, last data service on file for this number is 816 of 24, nothing after that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So there is no claim on file for this date of service, [PII].
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK. And uh just to confirm the claim mailing address is [PII].
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] And the PID is 60801.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. And should I receive the next one.
[AGENT][NEUTRAL] Mhm, go ahead.
[CUSTOMER][NEUTRAL] Mm, sure, it is um 01678145.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then the bill amount?
[CUSTOMER][NEUTRAL] $536 even.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[AGENT][NEUTRAL] And the claim number on this is going to be 357.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 125 9.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Thank you. Should I proceed with the next one?
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] The next one, it is.
[CUSTOMER][NEUTRAL] 1475658 ML 8.
[AGENT][NEUTRAL] I'm sorry, 145.
[CUSTOMER][NEUTRAL] 1475658 ML 8.
[AGENT][NEUTRAL] Uh, patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] and the bill amount $277 even.
[CUSTOMER][NEUTRAL] All I
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Denied [PII].
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy uh claim number is going to be 357-423-3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. I'm gonna proceed with the next one.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, could you send me the COV?
[AGENT][NEUTRAL] Uh yes, let me get that sent to you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, next one.
[CUSTOMER][NEUTRAL] Mm, it is one.
[CUSTOMER][NEUTRAL] 1221549 ML 98 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Mm. [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] Claim is received on.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEGATIVE] [PII], claim was processed and denied on [PII]. Office visits are not covered under [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim number?
[AGENT][NEUTRAL] Is going to be 357.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 3713.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. Could you send me the COV?
[AGENT][NEUTRAL] Mhm. On its way.
[CUSTOMER][NEUTRAL] Mm sure.
[CUSTOMER][NEUTRAL] Mm, should I proceed to the next one.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 02406309 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEGATIVE] Pay the service.
[CUSTOMER][NEUTRAL] [PII] and the bill amount $197 even.
[AGENT][NEUTRAL] Claim was received [PII].
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied, office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim is going to be 357-057-0.
[CUSTOMER][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] Yeah. Can I get this for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On its way.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Should I proceed the next one?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 0194413 ML 8.
[AGENT][NEUTRAL] OK, 0194413.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] M as Mike. L as Lima, 82.
[AGENT][NEUTRAL] Doesn't come up with a name. Do you have a claim number or anything?
[CUSTOMER][NEUTRAL] Uh, no, I don't have the claim number.
[AGENT][NEUTRAL] What's her name?
[CUSTOMER][NEUTRAL] First name, [PII].
[CUSTOMER][NEUTRAL] Girl, Indigo.
[CUSTOMER][NEUTRAL] [PII] [PII], and last name, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what's the uh data service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24.
[AGENT][POSITIVE] Thank you. Build them out.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $241 even.
[AGENT][NEUTRAL] So we received a claim for the state of service on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number is 357.
[AGENT][NEUTRAL] 2730.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, thank you for that. Um, can I proceed with the next one and I get this UV.
[AGENT][NEUTRAL] Mhm. Give me just one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Next policy number, go ahead.
[CUSTOMER][NEUTRAL] 01994319 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me read this back to you. I had 01.
[AGENT][NEUTRAL] 994319.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me the name again.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Spell the last name.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] OK, that ID doesn't have their name on it. So the last name is [PII].
[CUSTOMER][POSITIVE] At this starting [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's the last name.
[AGENT][NEUTRAL] You said first name is [PII]. Is that [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Does the patient live in the state of [PII] or [PII]?
[CUSTOMER][NEGATIVE] Put it down.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] Mm, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] The correct policy number if you'd like that is [PII]. There is no 4.
[CUSTOMER][POSITIVE] OK. Thank you for that. Mm.
[AGENT][NEUTRAL] What's the what's the data service?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is
[CUSTOMER][NEUTRAL] $197 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim is processed and denied on the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, office visits are not covered, and the claim number for this is gonna be 357.
[AGENT][NEUTRAL] 5709.
[CUSTOMER][POSITIVE] Thank you. Just send me the COB.
[AGENT][NEUTRAL] Uh, yes, I can send that to you. Just one moment.
[AGENT][NEUTRAL] OK, EOB is on its way for that.
[CUSTOMER][NEUTRAL] Mhm, should I proceed the next one.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] 01893582 M as Mike L as Lima 8.
[AGENT][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the policy again was 01893582.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] OK, that just have [PII]'s name on it. Let me take a look.
[AGENT][NEUTRAL] Last name you said is [PII]. Is that [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] You don't have a claim number or anything like that, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the member's date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Does the member live in [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEGATIVE] I haven't found a patient plan that matches that information, and the number provided to me does not have that name on it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] You can search by social if you have that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't have the social.
[AGENT][NEGATIVE] OK, unfortunately, I can't find a member plan with a name that matches that information and the member policy number provided is not.
[AGENT][NEUTRAL] Does not have that insured's name on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any other name on file?
[AGENT][NEUTRAL] The policy number that you provided has [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it 01893582 ML 8?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is a patient named [PII]?
[AGENT][NEUTRAL] No, last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But you said the current ID, right? 01893582?
[AGENT][NEUTRAL] Correct. I entered in 01893582. Yes?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So when I enter that in, it comes up with the last name of an insured with the last name of [PII], not [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I proceed to the next one.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] Once again.
[CUSTOMER][NEUTRAL] Um, the next one is 02455015 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Mm [PII], [PII].
[AGENT][NEUTRAL] You just service.
[CUSTOMER][NEUTRAL] Um, [PII] and the bill amount $359 even.
[AGENT][NEUTRAL] And did you say date of service was [PII]?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No claim on file for [PII].
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is the same um same mailing address that I that I have provided you before.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And can I get the uh time limit?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] Mhm. Sorry?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can I proceed with the next one?
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] It is um 01659528 ML 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Mm [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] $277 even.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Claim is received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII].
[AGENT][NEGATIVE] The calendar year maximum of 4 office visits per covered person per year had been exhausted, so there was nothing payable.
[AGENT][NEUTRAL] The claim number on this was 349.
[CUSTOMER][NEGATIVE] I didn't get it.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I didn't get the denial.
[AGENT][NEUTRAL] A calendar year maximum had been met for office visits.
[CUSTOMER][NEUTRAL] Is it uh units twice or the um visit it twice?
[AGENT][NEUTRAL] The member had exhausted all their visits, or allowed for a year.
[CUSTOMER][NEUTRAL] OK. Is it for the same provider or different?
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Looks like it's a different one.
[CUSTOMER][NEUTRAL] May I know the name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you spell it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You should
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] White
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, vital.
[AGENT][NEUTRAL] MD
[CUSTOMER][NEUTRAL] After wait?
[AGENT][NEUTRAL] MD
[CUSTOMER][NEUTRAL] ND
[AGENT][NEUTRAL] Right. Medical doctor, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, can I get the claim number?
[AGENT][NEUTRAL] 349-400-008.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Thank you. Could you send me this show me?
[AGENT][NEUTRAL] Yeah let me get that sent to you.
[CUSTOMER][NEUTRAL] And the rest amount, is it a patient responsibility?
[AGENT][NEUTRAL] We're not able to advise on that. That's up to the uh the provider facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] Hey, EOB is on its way for that one. Do we have any more?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] How many more do we need to check today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Once again, let me check it.
[CUSTOMER][NEUTRAL] More
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] The next 11 2nd.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 1297496 ML 8.
[AGENT][NEUTRAL] Name and date of birth, please.
[CUSTOMER][NEUTRAL] Mm. [PII].
[CUSTOMER][NEUTRAL] Creooro.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Alright, and date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No claims on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Is it the same mailing address, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][POSITIVE] Gonna proceed with the next one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Next one is, so I don't have the um correct um member ID. Could you check with the patient's name?
[AGENT][NEUTRAL] OK, last name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. First name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient's date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Would you like the patient's policy number?
[CUSTOMER][NEUTRAL] Um, yes, sure.
[AGENT][NEUTRAL] 02.
[AGENT][NEUTRAL] 604-1117.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm data service.
[CUSTOMER][NEUTRAL] [PII] and the bill amount $277.07.
[AGENT][NEUTRAL] No claims on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check one moment. [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] What was the bill amount again? I apologize.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the bill amount?
[CUSTOMER][NEUTRAL] $227 even.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] And then it was denied on [PII]. We requested the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number.
[AGENT][NEUTRAL] 354-3345.
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure, I proceed with the next one. And uh yeah, could you send me this UV.
[AGENT][POSITIVE] Mhm, yeah, absolutely.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Should I proceed with the next one?
[AGENT][NEUTRAL] Uh, let me just get this sent to you and then we can check the next one.
[CUSTOMER][NEUTRAL] Sure. OK.
[AGENT][POSITIVE] OK, I'm ready for the next.
[CUSTOMER][NEUTRAL] Um, one second.
[CUSTOMER][NEUTRAL] The next one is 06, sorry, 01603009 [PII].
[AGENT][NEUTRAL] Read that back to me one more time please, [PII] 016.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 03009 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And then data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $1,682 even.
[AGENT][NEUTRAL] No claims on file for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it [PII], right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's it. Um.
[CUSTOMER][NEUTRAL] Have you, have you sent all the US, right?
[AGENT][POSITIVE] Yes, EOB is in sync, correct.
[AGENT][NEUTRAL] Anything.
[CUSTOMER][NEUTRAL] It will be receiving in a short time, right?
[AGENT][NEUTRAL] I'm sorry, what was that, [PII]?
[CUSTOMER][NEUTRAL] Um, it will be receiving in the, um, within the day, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure. Thank you. Have a great day.
[AGENT][POSITIVE] Thank you for calling. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.