AccountId: 011433970860
ContactId: cf4a8206-4398-4215-8b7a-394c47bcd785
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557460 ms
Total Talk Time (AGENT): 182147 ms
Total Talk Time (CUSTOMER): 264170 ms
Interruptions: 8
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/cf4a8206-4398-4215-8b7a-394c47bcd785_20250324T12:47_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient information and the provider information.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes and uh first I do need a callback number please ma'am.
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII]. And there is direct line extension.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Um, the claim number, sorry, the member ID is 02546627.
[AGENT][POSITIVE] Thank you [PII] and what is the.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. I can spell it for you. The first name is [PII] and the last name is [PII] And the date of birth is
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, [PII], and I can help you with that claim status. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] That's that.
[CUSTOMER][NEUTRAL] Hm, yes, the date of service is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Alright, if you will bear with me just one moment, I'm going to check on that claim status for you. The policy number you gave me, the effective date was 10-1-2024, so I'm checking to see if she had a policy prior to this one, so bear with me just one moment, see if I can get the correct policy number for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I give you the correct policy number for that data service?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] The correct policy number is 243.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 3185.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this policy was active from [PII]?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] To 101 2024.
[AGENT][NEUTRAL] We do have a claim on file for that data service. What is the facility name?
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] OK, ma'am. And what is the claim status?
[AGENT][NEUTRAL] Can you provide the
[AGENT][NEUTRAL] What is the facility name for that data service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Facility name is Campbell County Jacksboro Clinic.
[AGENT][POSITIVE] All right, thank you, [PII].
[AGENT][NEUTRAL] Now [PII], we did receive that claim on [PII].
[AGENT][NEUTRAL] The claim was processed and denied on [PII].
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] That's that's I.
[AGENT][NEUTRAL] The 99204 was denied as office visits are not covered for the patient's plan.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And then the subsequent procedures were denied as services are not covered when there's no charge.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the claim is denied for the office visits are not covered under the patient's policy, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Just, just allow me a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK. Meanwhile, I know, I, may I know your good name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First initial last name, [PII].
[AGENT][NEUTRAL] And [PII], would you like that claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Claim number is 355.
[AGENT][NEUTRAL] 9181.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Thank you so much, [PII]. And the received date is [PII] and the claim is processed on [PII], sorry, [PII] and they denied on the same date, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and the, uh, sorry, um, may I know which CPT is not covered under the patient's policy?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And what is the time defining limit to submit the corrected thing?
[AGENT][NEGATIVE] There's no timely filing for corrected claim.
[CUSTOMER][NEUTRAL] OK. And what is the mailing address to submit the collected claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. The ZIP code is [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. And what is the limit to submit the appeal?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Appeals um can be submitted 180 days from the date of denial.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And to the same address.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, is there any specific form for bills?
[AGENT][NEUTRAL] We will need a formal appeal letter stating the reason that you are appealing the claim decision.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number is 3559181, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, [PII], do you need to deny ID UB?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, we don't.
[AGENT][NEUTRAL] If you are submitting an appeal, it would, it would be advantageous to submit that EOB with the appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. If we have to submit uh the appeals, we have to attach the EOB with the appeal, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Thank you so much. And what is the call reference number for this call?
[AGENT][POSITIVE] It's been a pleasure to assist you.
[AGENT][NEUTRAL] It would be my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And today's date is [PII]. OK, thank you so much, [PII], for this information. And um I really appreciate your patience and thank you so much for the information. Thank you so much and have a good day. Bye-bye. Take care.
[AGENT][POSITIVE] Yes, my, my pleasure to assist you with that claim status, [PII]. Thank you for calling APL and I hope you have a wonderful day as well.
[AGENT][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.