AccountId: 011433970860
ContactId: d1827012-b309-4ad0-84ca-b7a457ee6695
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1084150 ms
Total Talk Time (AGENT): 368823 ms
Total Talk Time (CUSTOMER): 189313 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/d1827012-b309-4ad0-84ca-b7a457ee6695_20250527T18:37_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for JLR Medical Group anesthesia to check a claim status.
[AGENT][NEUTRAL] Did you say that you're needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It's a direct line. There is no any extension.
[AGENT][NEUTRAL] Thank you and you only have one claim, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, the same patients have 2 claims.
[CUSTOMER][NEUTRAL] So totally one patient.
[AGENT][NEUTRAL] OK, what is your patient's policy number and I can help you with this.
[CUSTOMER][NEUTRAL] Sure, the member ID number is, just give me a second, it's 2549508.
[AGENT][NEUTRAL] 2549508. Is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I provide on any of the claims will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient's first name is
[CUSTOMER][NEUTRAL] [PII], it's [PII], and the last name is [PII]. Patient date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me the policy number again.
[AGENT][NEUTRAL] Because the policy number you gave me doesn't pull up that number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 0, 2549508.
[AGENT][NEUTRAL] Yes, ma'am. That is an incorrect policy number. Give me just, well, just one moment, let me refresh the screen.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And again, what is the patient's date of birth?
[CUSTOMER][NEUTRAL] And date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the first day of service and total build amount for her place?
[CUSTOMER][POSITIVE] Sure, the service it's gonna be.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. Total charge amount is $2460 even.
[CUSTOMER][NEUTRAL] And for this one, the same patients have two claims.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Yes, ma'am, but I have to do one claim at a time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It was processed, whoops, I'm sorry, let's go back. This claim was received on [PII].
[AGENT][NEUTRAL] It was denied on [PII].
[AGENT][NEUTRAL] The claim number is 3535049.
[AGENT][NEUTRAL] And the reason for the denial, [PII] states information received from provider is incomplete, cannot process until additional corrected information is received from the provider.
[CUSTOMER][NEUTRAL] Can you please repeat again one more time? What is that?
[AGENT][NEGATIVE] It states information received from provider incomplete cannot process until additional corrected information is received from the provider.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK. What, what type of information they needed?
[AGENT][NEUTRAL] Give me one moment, [PII] to see if I can tell that because I'm not, I'm not familiar with this remark.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK, so let me look at something because this policy was not even active for your data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we were supposed to be, uh, this is a this policy number that you gave me.
[AGENT][NEUTRAL] Did not even go into effect until [PII].
[AGENT][NEUTRAL] So let me look at the policy that would have been active for your data service.
[AGENT][NEUTRAL] To see if the claim was processed under the correct number.
[AGENT][NEUTRAL] OK, is your other, OK, so I know you have two dates of service before I get over to the policy that we should actually be looking at for [PII], what is the other date of service and total bill amount?
[CUSTOMER][NEUTRAL] Sure. Just give me 1 2nd.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], we have filed two claims for the same date of service and same charge amount. And the same patients have another one date of service here.
[AGENT][NEUTRAL] Right, but she
[AGENT][NEGATIVE] Correct, but the policy number that you gave me is not the correct policy number to encompass the dates of service that you're giving me. That policy number was not even active for your data service.
[CUSTOMER][NEUTRAL] Mhm. Oh, OK.
[CUSTOMER][NEUTRAL] Can you please provide me the correct member ID for the station?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, [PII], you're gonna need to give me a few minutes to get the correct information pulled up.
[CUSTOMER][NEUTRAL] A one
[AGENT][POSITIVE] And I'll be happy to give you all of that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, [PII], the date is the
[AGENT][NEUTRAL] The um
[AGENT][NEUTRAL] Correct policy number that you need to update and put on file for this date of service or these two dates of service that you're calling about?
[AGENT][NEUTRAL] Should be [PII].
[AGENT][NEUTRAL] 81.
[AGENT][NEUTRAL] 3082.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And on the.
[AGENT][NEUTRAL] The first data service that you gave me, the [PII] for the billed amount of $2460.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] The claim number is going to be 357.
[AGENT][NEUTRAL] 326 2.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] The reason for the denial states inpatient benefit for this calendar year has been met.
[AGENT][NEUTRAL] Again,
[CUSTOMER][NEUTRAL] And you provided the claim, sorry, claim number 3573262?
[AGENT][NEUTRAL] Correct. And do you want to repeat the policy number that you should have?
[CUSTOMER][NEUTRAL] No, I got it. That's 01813082. Is that right?
[AGENT][POSITIVE] Yes, ma'am. That is correct. Uh-huh.
[CUSTOMER][NEUTRAL] OK. You stated that claim number 262 and the provider name is [PII] A, is that right?
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEUTRAL] The claim number 262 under the date of service [PII].
[AGENT][NEUTRAL] No, the claim number is, no, ma'am, the, you're missing the entire first part of the number. The claim number is 3573262.
[CUSTOMER][NEUTRAL] Yeah, the claim number previously provided that.
[AGENT][NEUTRAL] Disregard that. That is the correct claim number. I just gave you the correct claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3573262
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is the reason for delay?
[AGENT][NEUTRAL] Again, the reason for the denial states that inpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK. Do you have a medd?
[AGENT][NEGATIVE] It was met on a claim received prior to yours. I cannot provide another provider's claims information.
[CUSTOMER][NEUTRAL] And do you have uh UOB on this one and under this claim UOB?
[AGENT][NEUTRAL] Yes, ma'am, you can fax that. Yes, you can print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then you said for this number there was also a data service of 1023, 2024, and what is that billed amount, [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 1023, he was asking?
[AGENT][NEUTRAL] Yes, you said that there were 2 claims for the same patient.
[CUSTOMER][NEUTRAL] Yes, the same patients have two claims for the same date of service, [PII].
[CUSTOMER][NEUTRAL] And two different
[CUSTOMER][NEUTRAL] And two different modifiers, we file the claim.
[AGENT][NEUTRAL] What is the other billed amount for 10-182024?
[CUSTOMER][NEUTRAL] It's the same, $2460 even.
[AGENT][NEUTRAL] OK, so we,
[AGENT][NEUTRAL] We've only received the one claim for this data service and that is the information that I provided for you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And who is rendering provider?
[CUSTOMER][NEUTRAL] Who is rendering provider for that one?
[AGENT][NEUTRAL] What is the tax? Yes ma'am, you, I can't tell you that. You would have to provide me that information.
[CUSTOMER][NEUTRAL] OK. I can see that two individual providers for the same date of service [PII]. The first provider name is [PII].
[AGENT][NEUTRAL] We only have
[AGENT][NEUTRAL] The tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we've received one claim under that tax ID number, and that is the information that I've just provided for you.
[CUSTOMER][NEUTRAL] And this is the modifier. Can you please confirm that modifier? It's a QK or QX. Can you please confirm that?
[AGENT][NEUTRAL] Um, on here, it does not show either. What, what were your two modifiers?
[CUSTOMER][NEUTRAL] Uh, we have filed two different modifiers, one for QX and another one for QP.
[AGENT][NEUTRAL] I'm sorry, on the 2nd 1, that's P as in Peter?
[CUSTOMER][NEUTRAL] No, Q as in [PII].
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] I'm not able to see that. I would have to um have someone to, to look that information up and call you back.
[AGENT][NEGATIVE] I can only see this one claim and it doesn't indicate the modifier.
[AGENT][NEUTRAL] On what I'm able to see, [PII].
[AGENT][NEGATIVE] But we've only received one.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.