AccountId: 011433970860
ContactId: d7ce9585-3c14-4957-ad19-8665dc696e36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220919 ms
Total Talk Time (AGENT): 90275 ms
Total Talk Time (CUSTOMER): 80849 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/d7ce9585-3c14-4957-ad19-8665dc696e36_20250519T16:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I got um a patient's denial on one of the lines and I can't figure out what it's denied for. I don't see the remit code on the EOB, so I was just wondering if you can help me out.
[AGENT][NEUTRAL] Yes, I can help you with the claim status. Um, may I please get your name and your callback number?
[CUSTOMER][NEUTRAL] It's [PII] and my number is sorry um [PII].
[AGENT][NEUTRAL] OK, Miss [PII], and what's the um patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, [PII], um, date of birth is [PII], and then I guess I should give you the policy number first, but it's 02054494.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] 822 2024 and for the whole claim it's 311.
[AGENT][NEUTRAL] OK. And what is the physician's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have a claim number?
[CUSTOMER][NEUTRAL] Mm, I probably do. Let me hold on.
[AGENT][NEUTRAL] OK, I can look it up if you don't.
[CUSTOMER][NEUTRAL] Um, claim was a check date, check number, policy number, reference like a reference number? oh, claim number right here 35, 0 sorry, the claim number is 3591716.
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold while I look up this claim and get the information for you and I'll be right back.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you very much for holding for me, Ms. [PII]. OK, so looking, looking at the claim, I do see that uh procedure 00150 was paid $121.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then procedure 00210 has a remark on it and the remark states that um it's payable every 3 years, um, full mouth series panorex.
[AGENT][NEGATIVE] Uh, are covered once every 3 years. So that's why it was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that procedure code.
[CUSTOMER][NEUTRAL] Once every 3, OK, OK, I had a feeling it had to do with frequency, but the UB we had, it has like the thing, but every mark, but it didn't have any explanation on it, so I wasn't sure like what it was, but OK.
[AGENT][NEUTRAL] Yeah, yes, ma'am.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. All right. Well, Miss [PII], can I help you any further or you have any other questions I can help you with?
[CUSTOMER][POSITIVE] No, that's all I needed thank you.
[AGENT][POSITIVE] You're very welcome. You have a good week and thank you for calling APL.
[CUSTOMER][POSITIVE] You too alright thank you bye.
[AGENT][NEUTRAL] Mm, bye-bye.