AccountId: 011433970860
ContactId: d9077459-d778-494d-a527-9d4980cf2e39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485899 ms
Total Talk Time (AGENT): 81066 ms
Total Talk Time (CUSTOMER): 166320 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/d9077459-d778-494d-a527-9d4980cf2e39_20250609T13:38_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. Uh my name is, uh, [PII]. I'm calling from provider to check on the claims and I have some specific questions. And please note this call is monitored and recorded for quality and training purpose.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have the policy or a good callback number?
[CUSTOMER][NEUTRAL] Uh, yeah, the callback number is [PII]. Extension would be [PII].
[AGENT][NEUTRAL] And the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, the policy number starts with letter D as in Delta.
[CUSTOMER][NEUTRAL] 41601684.
[AGENT][NEUTRAL] Um, do you have the, do you have the claim number?
[CUSTOMER][NEUTRAL] Uh yes, I do have the claim number here. The claim number is 3,510,750.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is, uh,
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was your question on the claim?
[CUSTOMER][NEUTRAL] So, actually, like uh recently, we have submitted corrected claim. Uh, there's some like changes on the diagnosis code for the code 99214. And now the corrected claim is uh denied for like duplicate.
[CUSTOMER][NEUTRAL] Can you please look into this one? Because like we have submitted a claim with the uh remission code 7 and the reference to the original claim number, we have mentioned all the information on the claim form but still lying for duplicate.
[AGENT][NEUTRAL] Um, let me
[AGENT][NEUTRAL] The well, the original claim was denied for eligibility. We hadn't received eligibility from the from the employer.
[AGENT][NEUTRAL] So, where do you see the duplicate denial?
[CUSTOMER][NEUTRAL] Uh, like the recent claim that you have received, like the claim number 3577576.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Let me look at that one.
[AGENT][NEUTRAL] So which, which code was corrected again? What was the code?
[CUSTOMER][NEUTRAL] Uh, like 99214.
[AGENT][NEUTRAL] Well that's the original.
[AGENT][NEGATIVE] But it looks like it was billed the same again. I don't see any difference on the claim.
[CUSTOMER][NEUTRAL] Uh, no, like, uh, if you see the original claim number.
[CUSTOMER][NEUTRAL] So, if, if we have bill with the diagnosis code uh Z760.
[CUSTOMER][NEUTRAL] And I 429 and I 509, and I 10. OK. Now, it has been like changed uh to the primary DS code is like I 10,1429 and 1509 and C760. So like we have sequences, uh 2 these codes.
[AGENT][NEUTRAL] OK, I, I mean, I can send it back through for processing, but it's the reason it was originally denied didn't have anything to do with the diagnosis codes. It was for eligibility purposes. We hadn't received a payment from the employer for eligibility.
[CUSTOMER][NEUTRAL] Mm, OK
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] I can certainly send it back through and it'll probably deny the same way.
[CUSTOMER][NEUTRAL] So like uh
[CUSTOMER][NEUTRAL] Mm, OK, so, like, may I know like what is the original like the member is not active for the date of service.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Yeah, the policy term 8-11-2024.
[CUSTOMER][NEUTRAL] Uh, level.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24 wide.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So still it's showing as inactive.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, OK, one moment.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. So, like, uh, do you have any like letter was sent to the patient from your end?
[AGENT][NEUTRAL] And we sent the explanation of benefits, yes, that had the denial on it.
[CUSTOMER][NEUTRAL] OK, thank you so much. And still the policy is inactive, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And what is the effective date for this policy?
[AGENT][NEUTRAL] Like the date is.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for this information. OK, that's it. Thank you. And do you have any call reference number?
[AGENT][NEUTRAL] It's just my name and today's date.
[CUSTOMER][POSITIVE] OK. All right. Thank you and have a good day.
[AGENT][POSITIVE] OK, thanks for calling APL. You too. Bye-bye.