AccountId: 011433970860
ContactId: d4291da3-9e1a-437a-b0d8-1d9f9bcf0dfe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565039 ms
Total Talk Time (AGENT): 223239 ms
Total Talk Time (CUSTOMER): 167639 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/d4291da3-9e1a-437a-b0d8-1d9f9bcf0dfe_20250430T19:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling.
[AGENT][NEUTRAL] Can, how may I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] calling from Anesthesia Associates of Kansas City, and I received a duplicate denial on a claim, and I just wanna make sure that the original is still processing.
[AGENT][NEUTRAL] Oh, OK. Well, I can definitely help you with the claim, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02480526.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, let's see here. [PII], date of birth is one second [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment. Is this for data service [PII]?
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Duplicate.
[AGENT][NEUTRAL] OK, there goes the duplicate.
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold while I look at these claims?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so what now? OK, wait a minute.
[AGENT][NEUTRAL] This one has a modifier, so it's different than those, which is hint the different, OK, so.
[AGENT][NEUTRAL] The dupe is 35.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] 359183. OK. So we
[AGENT][NEUTRAL] Paid and then we
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] 180, so that's the dupe.
[AGENT][NEUTRAL] 1180.
[AGENT][NEUTRAL] Right, so back.
[AGENT][NEUTRAL] First
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So the original claim and the duplicate came in and processed on the same day. So, um, let me give you the claim number for the original, which was paid out on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Uh, so that one, hold on, let me go back to that screen.
[AGENT][NEUTRAL] Alright, so, um, we received it on [PII].
[AGENT][NEUTRAL] And that claim number is 3,591,180.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and did they process both of the charges?
[AGENT][NEUTRAL] There's only one line, 018, uh code 01810 for $220.
[CUSTOMER][NEUTRAL] Yeah, but is it with the QX modifier or the QK because there are two.
[AGENT][NEUTRAL] I don't, it's just this one. I don't see a modifier on. What's the name of your provider's office?
[CUSTOMER][NEUTRAL] Anesthesia Associates of Kansas City.
[AGENT][NEUTRAL] OK, yeah, this is y'all. So yeah, there's no modifier on this claim. It just has procedure code 01810 for $220 and that's how much we paid.
[CUSTOMER][NEUTRAL] Mm, interesting. How much does it have? Does it have the build amount?
[AGENT][NEUTRAL] Hm let me see, hold on one second.
[AGENT][NEUTRAL] 400 and
[CUSTOMER][NEUTRAL] That could be why there's a duplicate because there's.
[CUSTOMER][NEUTRAL] There's 2459. OK, OK, so they still need to pay the 376.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK, so now my question is, is, is the, yeah, see the duplicates on the 376.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Because I'm looking at it and then the payments on the 459.
[AGENT][NEUTRAL] The duplicate
[AGENT][NEUTRAL] No, I'll give you the information. So both of these claims are exactly the same. They were both billed for code 01810, but if you meant to file something else, you still can. There's no timely filing, but this claim is denied as a duplicate.
[CUSTOMER][NEUTRAL] No, they're
[CUSTOMER][NEUTRAL] Right, that's why I'm asking because they are built correctly. One has a modifier QX and the other has a QK.
[CUSTOMER][NEUTRAL] That's why they're different dollar amounts too.
[AGENT][NEUTRAL] But what I'm trying to explain to you is what we, what we received is exactly the same, the $220 for 01810. We don't have anything else from y'all for this data service.
[CUSTOMER][NEUTRAL] So how do I, why?
[CUSTOMER][NEUTRAL] No, that
[CUSTOMER][NEUTRAL] Yeah, that's what I'm saying so how come your guys' system didn't pick up the modifiers that were sent on the claim?
[CUSTOMER][NEUTRAL] Because they're different, one's a doctor, one's a CRNA. So what do you need me to send you then for this duplicate the, the records?
[AGENT][NEUTRAL] What's the code on the claim that you're trying to file for?
[CUSTOMER][NEUTRAL] OK, so the one I have the duplicate denial on is the $376 and it's a 01810 with the QX modifier.
[AGENT][NEUTRAL] Right, so what I'm explaining to you is that part we have not received. All we have is the 01810 for $220. The original and the duplicate are the same thing. So you still need to file the claim for the $300 and something dollars. It's not here.
[AGENT][NEGATIVE] That's why this one was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, so the claim
[CUSTOMER][NEUTRAL] OK, so the claim number I have for 3591183 shows it's on $376.
[CUSTOMER][NEGATIVE] That they denied for duplicate.
[AGENT][NEUTRAL] On your side or on our explanation of benefits?
[CUSTOMER][NEUTRAL] Find the explanation of benefits.
[CUSTOMER][NEUTRAL] That's what I'm trying to say, like, because you just said the one that paid was the $459 which is fine, that's fine, but this duplicate is on the $376.
[CUSTOMER][NEGATIVE] So they didn't get the modifiers, which is weird. I don't understand why they didn't get the modifiers but.
[AGENT][NEUTRAL] Let me see your claim form. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, and then my computer wants to get an attitude with me. Hold on one second.
[CUSTOMER][NEUTRAL] Mm, yeah.
[CUSTOMER][NEUTRAL] over there
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] 416.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm just waiting for the documents to come up. I'm sorry. Hold on one moment.
[CUSTOMER][NEUTRAL] No, you're fine. Yeah, no, it's a common denial we get because there's, it's the same code it's just they have different doctors on them and different modifiers. That's why it's kinda.
[CUSTOMER][POSITIVE] Anesthesia is fine.
[CUSTOMER][NEUTRAL] So it's all the time is a common thing, so.
[AGENT][NEUTRAL] 601.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, OK. So when I pull up the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The the modifier, the modifier uh boxes are blank.
[AGENT][NEUTRAL] So maybe that's why.
[CUSTOMER][NEUTRAL] Mm, that's weird.
[AGENT][NEUTRAL] Yeah, maybe that's why it came in like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's odd. OK, so.
[CUSTOMER][NEUTRAL] OK, so looking at this denial, it just has the PO box on there. Does it have to be mailed or can it be faxed?
[AGENT][NEUTRAL] No, you can fax it and you can um send it electronically too if you like.
[CUSTOMER][NEGATIVE] I don't even know how I can send my form that way um what's the fax number?
[AGENT][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][POSITIVE] 23 got it. OK, thank you.
[AGENT][POSITIVE] You're welcome. Um, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that is all I had.
[AGENT][POSITIVE] All right, sir. Well, thanks for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. Bye bye.