AccountId: 011433970860
ContactId: ca2a3bb2-b85d-490f-8e2a-54c3b0278fb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595950 ms
Total Talk Time (AGENT): 220529 ms
Total Talk Time (CUSTOMER): 230553 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/ca2a3bb2-b85d-490f-8e2a-54c3b0278fb0_20250428T19:52_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider office for checking client status.
[AGENT][NEUTRAL] May I have your name again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. What is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. What is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the member ID is 02291436 M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you. And I have that as 02291436 ML8. Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can I verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and you're calling for claim status. I can assist you with this, [PII]. You can check claim status by visiting our secure portal at [PII] and on that website you'll be able to obtain an EOB as well. What is that date of service and the total charge amount? Thank you.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, my date of service is [PII] and total charge amount is $1,128 even.
[AGENT][POSITIVE] OK, thank you very much. One moment, thank you.
[CUSTOMER][NEUTRAL] my
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 1000. Can you confirm or verify the procedure code or codes bill, please?
[CUSTOMER][NEUTRAL] Right, what is the.
[CUSTOMER][NEUTRAL] Hello, could you repeat that again?
[AGENT][NEUTRAL] Can you verify the procedure code that was billed for the service date for the member?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Procedure code. OK. First CPD code is 66984 and modified is QZ and yeah, that is the procedure code.
[AGENT][NEUTRAL] OK, and you say again that was 66984 and Moar QZ? OK.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, Q Z dash P.2-QS.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is a secondary insurance primary insurance is Cigna, right? So.
[AGENT][NEUTRAL] I'm still trying to locate that procedure code for that bill amount. One moment please thank you.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And who is the provider, billing provider?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] You're asking for billing provider NPI or name?
[AGENT][NEUTRAL] I'm asking for the biller provider's name.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Ma'am, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I do not show a claim on file for date of service of [PII] for procedure code 66984 with modifier QZ. I did not show that on file.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] One minute please.
[CUSTOMER][NEUTRAL] Yeah, but we receive a you will be call denied as PR 119 benefits maximum for this time period of occurrence has been reached.
[AGENT][NEUTRAL] OK. What is that
[CUSTOMER][NEUTRAL] From
[AGENT][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] Claim number, it's 353-0943.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that claim receipt, however, it was a different procedure code that was billed.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me just verify to see one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so for procedure code.
[AGENT][NEUTRAL] 6, I'm sorry, the procedure code bill for this particular date of service that you're calling in regards to and with the verified provider's name was billed for 00142.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] With modified Q Z.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And that did deny.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, as shown in my system, it's CPD code is 66984.
[AGENT][NEUTRAL] For in my system, I'm showing procedure code 00142 modifier QZ for that billed amount and the doctor's name. Was this for anesthesia?
[CUSTOMER][NEUTRAL] Mhm. Doctor name is uh.
[AGENT][NEUTRAL] Even if it was, OK, so yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Correct. And again for the, it will be the claim number that you provided me, that procedure code is 00142 with modifier QZP2NQS.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, QZP 2QS.
[AGENT][NEUTRAL] Correct and that procedure code we have is 00142, not 66984.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I send a claim or change the CPD code?
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] Um, that now as far as the claim denied as the outpatient mac for this calendar year has been met, but if you would like to send a corrected claim, you can of course send a corrected claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm. OK. Yes, sure, thank you so much.
[AGENT][NEUTRAL] I can provide the information to you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. Would you like a mailing address, fax number, or payer ID or?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Would you like me to verify?
[CUSTOMER][NEUTRAL] Mhm, may I know the pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] May I know the fax number?
[AGENT][NEUTRAL] Of course, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] OK, may I know the mailing address?
[AGENT][NEUTRAL] Of course, you have [PII].
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Excuse me. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. As per your system, may I know the CPD code once again [PII].
[AGENT][NEUTRAL] The claim was processed with procedure code 00142 with modifiers QZ P like Papa 2 Q like Quebec S like Sierra.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh I have claim number, OK. Uh, may I know the date?
[CUSTOMER][NEUTRAL] Turn on time?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Turnaround time. May I know the time and, uh, turnaround time?
[AGENT][NEUTRAL] For processing claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, once the claim is in office, processing time can take up to 7 to 10 business days.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know your name, [PII], right?
[AGENT][NEUTRAL] My name is [PII], that is correct. And my last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, it's all fine. May I know the call reference?
[AGENT][NEUTRAL] We do not provide call reference numbers [PII]. You can use my name in today's date. Uh, is there anything else I can assist you with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's all fine. I can send the court claim and call back after 10 days.
[AGENT][POSITIVE] Thank you so much for calling A. You have a great day.
[CUSTOMER][NEUTRAL] OK then bye bye.
[AGENT][POSITIVE] Take care bye.