AccountId: 011433970860
ContactId: e2543906-5c94-4808-86c1-ce164f526494
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2653449 ms
Total Talk Time (AGENT): 448020 ms
Total Talk Time (CUSTOMER): 869575 ms
Interruptions: 7
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/e2543906-5c94-4808-86c1-ce164f526494_20250527T14:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information, uh, the provider's information?
[AGENT][NEUTRAL] OK. [PII], what is the policy number? We'll verify claim status for you.
[CUSTOMER][NEUTRAL] The policy number is 018741117. And could you please tell me your name once again I didn't catch your name.
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII]. And [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK, the callback number is [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] OK, thank you. Let me one moment and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Uh, so, yeah, before I verify, [PII], could you please tell me how many claims can you assist me today?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, we don't have a limit. How many claims do you have?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I do have only 6 claims.
[AGENT][NEUTRAL] OK, verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] OK. The patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the amount of charges will be
[CUSTOMER][NEUTRAL] Give me a second, it's loading.
[CUSTOMER][NEUTRAL] $1,732.50.
[AGENT][POSITIVE] OK, thank you. Give me one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] we have to get there.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from USACS Observation Medicine Service of Colorado.
[AGENT][NEUTRAL] So is this for a facility or physician's charge?
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] This is for facility.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what's the name of the provider's office again?
[CUSTOMER][NEUTRAL] It's USACS Observation Medicine Services of Colorado.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the balance after Primary has processed the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yeah. It's $130.12.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't show we received that claim. Uh, can you verify the mailing address it was submitted to?
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Mm mm it's [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Uh, that is the correct address. If you like, I can give you a fax number. You can fax the claim to our office.
[CUSTOMER][NEUTRAL] OK. And have you any, uh, received any claim for $1,732.50?
[AGENT][NEGATIVE] We have not received the claim.
[CUSTOMER][NEUTRAL] OK, just a second, so the claim is not on file, am I right?
[AGENT][NEGATIVE] As I stated, we have not received the claim.
[CUSTOMER][NEUTRAL] OK. Could you please help me, uh, is the member active on the date of service? Could you please tell me that?
[AGENT][NEUTRAL] Yes, effective date is [PII] and the policy was active at the time of service.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And the member is still active?
[AGENT][NEUTRAL] Yes, the policy, well, no, the policy term [PII], but they were active at the time of service.
[CUSTOMER][NEUTRAL] January.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII]. OK. Are you primary or secondary for the member?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] OK. Could you please help me with when was the last coordination of benefits were updated?
[AGENT][NEUTRAL] We don't coordinate benefits. Well, we don't have to coordinate benefits. This is a secondary supplemental policy only.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It will always be secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] And could you please tell me what will be the claim submission timely filing limit?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] And could you please state me the address once again, the PO box number and the ZIP code?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK perfect and what will be the pay ID for you guys?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and the preferred mode of submission will be either uh whether it will be a mail or electronic accept both.
[AGENT][NEUTRAL] Either way is fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the call reference number, your name and today's today?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][NEUTRAL] Is it for the same patient or a different patient?
[CUSTOMER][NEUTRAL] It's for the different patient.
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, just a second, it's loading. Give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The next policy number is 024.
[CUSTOMER][NEUTRAL] 74837.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service, amount of the charge?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is [PII] and the amount charges are $1570 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] And for this one, just a second, give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And for this one, I'm looking for an appeal status. I'm looking for an appeal.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, it looks like initially a claim paid $500 and with that payment it matched the benefit for the data service. The appeals, uh, I see.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The pill status was sent out on [PII].
[AGENT][NEGATIVE] And no changes have been made.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So the appeal is still in process or it's been denied for the same reason.
[AGENT][NEGATIVE] It's been denied for the same reason and the pill status was mailed out on [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. And when you guys received uh the appeal?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you have any appeal document control number?
[AGENT][NEUTRAL] No. Well, it's a claim number, but it's, um, you could just refer back to the initial claim number.
[CUSTOMER][NEUTRAL] OK, yeah, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Payment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually.
[CUSTOMER][NEUTRAL] Actually, I don't have the claim number with me. Could you please verify the claim number from your end?
[AGENT][NEUTRAL] 349-056-7
[CUSTOMER][NEUTRAL] 349.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well it's a.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Just a second, [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, could you please state the claim number once again?
[AGENT][NEUTRAL] 349-056-7.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. So, [PII], uh, could you please tell me
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What are the allowed services amount per time frame?
[AGENT][NEUTRAL] Per the policy, the max payable is $500 which was paid.
[AGENT][NEUTRAL] And that marks the benefit for the data service.
[CUSTOMER][NEUTRAL] Mm mm mm. OK, so $500 has been paid.
[CUSTOMER][NEUTRAL] And it's maxed out.
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Are you done with this claim?
[CUSTOMER][NEUTRAL] Uh yeah, just.
[CUSTOMER][NEUTRAL] Uh, no, I do have a few more questions to ask. Uh, could you please tell me when was this type of, uh, when was the, this type of services were last building?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, with the claim that I gave you, with that payment and ma the benefit for the data service.
[CUSTOMER][NEUTRAL] Yeah, the, it was built last on [PII]. Am I right?
[AGENT][NEUTRAL] No, it's claim processed on [PII].
[CUSTOMER][NEUTRAL] I know, uh, I'm talking about when was the last, this type of services were built.
[AGENT][NEUTRAL] I can't give you that information. I can only verify the claim you're inquiring about.
[CUSTOMER][NEUTRAL] And for the same member, when was the last?
[AGENT][NEUTRAL] With that claim, it pays $500 and it states on the EOB with this payment max the benefit for the data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And what is the time period to build the service again?
[AGENT][NEUTRAL] There's not a time limit to submit a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK, and the further details will remain the same. OK. And what the corrected claims mailing address will remain the same, [PII]. Am I right?
[AGENT][NEUTRAL] Correct. And if you're submitting a corrected claim, you must submit a letter stating the reason for the correction.
[CUSTOMER][NEUTRAL] OK, and for what for the appeal, appeal's mailing address will remain the same?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Is there any specific form for nappy?
[AGENT][NEUTRAL] No, you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] OK, and then ID will be required while submitting an appeal or a claim?
[AGENT][NEUTRAL] Any information you have in regards to some uh filing an appeal, you may submit along with the letter.
[CUSTOMER][NEUTRAL] OK, shall we move to the next claim?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And uh [PII], are you there? Just the last question, uh, do we have any second level appeal rights for this one?
[AGENT][NEUTRAL] You may submit a pill one more time cause it's up to 2.
[CUSTOMER][NEUTRAL] Uh yeah, but we have 2nd level appeal, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the second level timely filing and the mailing address will remain the same.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's gonna be
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What is next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next policy number is 02449825.
[AGENT][NEUTRAL] Give me that policy number ag[PII], please.
[CUSTOMER][NEUTRAL] 02449825
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's first name will be [PII] and the last name is [PII]. The date of birth will be [PII]. And yeah.
[AGENT][NEUTRAL] Data service on the charge.
[CUSTOMER][NEUTRAL] The service is [PII] and the charges are $882 even.
[AGENT][NEUTRAL] Balance after primary.
[CUSTOMER][NEUTRAL] Just a 2nd. $615.80.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Name of the provider's office?
[CUSTOMER][NEUTRAL] Hart Place, PLLC.
[AGENT][NEUTRAL] What was the name of the provider's office?
[CUSTOMER][NEUTRAL] Hart Place, PLLC.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't show we received the claim.
[CUSTOMER][NEUTRAL] OK. So could you please tell me if the member active on the date of service?
[AGENT][NEUTRAL] Yes, effective date [PII], the [PII], policy is active.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a second, I need to check the bill amount once again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Wait, I show the claim was received on the [PII] and it's in line for process.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, and it's in line for processing.
[CUSTOMER][NEUTRAL] OK. Just a second.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Just a second, [PII]. My system has been stopped. Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Could you please help me with the claim number?
[AGENT][NEUTRAL] There's no claim number or signed until after the claim has been processed.
[CUSTOMER][NEUTRAL] OK, so you don't have the claim number.
[CUSTOMER][NEUTRAL] OK. And what will be the normal claim processing time?
[AGENT][NEUTRAL] 7 to 10 business days from the time the claim was received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is there any delay in claim processing?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And do you require any additional information from the patient or the provider?
[AGENT][NEUTRAL] Not that I'm aware of. I wouldn't know until after the claim has been processed.
[CUSTOMER][NEUTRAL] OK. And the turnaround time will remain the same as the normal claim processor time, 7 to 10 business days.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] Yes, what is the next policy number?
[CUSTOMER][NEUTRAL] Yeah, it's loading, just a second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah, the
[CUSTOMER][NEUTRAL] The next policy number is 11051.
[CUSTOMER][NEUTRAL] 47 M as in Mike, L as in Lima, and the number 5.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Member's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] And what was the date of birth?
[CUSTOMER][NEUTRAL] OK, go to work.
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[CUSTOMER][NEUTRAL] So $7.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was.
[AGENT][NEUTRAL] And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The rate of service is
[CUSTOMER][NEUTRAL] [PII] and you want the second rebuild amount? Uh
[AGENT][NEUTRAL] I want the total charge amount and then the balance after primary.
[CUSTOMER][NEUTRAL] Yeah, the total charge amount is $408.78.
[CUSTOMER][NEUTRAL] And the balance of the primary will be.
[CUSTOMER][NEUTRAL] $25.03.
[AGENT][NEUTRAL] Name of provider's office?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It's Orange Care Physicians and Partners of Florida.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] I sure we received the claim, but it's for a different amount.
[CUSTOMER][NEUTRAL] It's for $350.04.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What's the status of that claim?
[AGENT][NEUTRAL] It processes office visits are not covered, nor procedures performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. So the office visit is not gone under the member's plan?
[AGENT][NEUTRAL] Per the patient's policy, office visits are not covered, nor procedures performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's the claim, received date, denial date?
[AGENT][NEUTRAL] Claim received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and what will be the claim number?
[AGENT][NEUTRAL] 358-4480.
[CUSTOMER][NEUTRAL] 3,584,480. OK. And which CPT code is not covered under the member's plan?
[AGENT][NEUTRAL] All of the procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all procedure codes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the further details will remain same, am I right time defined to submit the corrected claim, everything else.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So we move to the next one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 17792.
[AGENT][NEUTRAL] It's not a policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so could you please find with the
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Name and date of birth?
[AGENT][NEUTRAL] Sure, what is the patient's name?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name, I would like to spell it, [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Data service amount of the charge.
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII]. And
[CUSTOMER][NEUTRAL] The amount charge is $300.06.
[CUSTOMER][NEUTRAL] And balance after the primary will be.
[CUSTOMER][NEUTRAL] $40 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Showing the claim processes office visits are not covered per the policy.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Are they
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It
[AGENT][NEGATIVE] And service not covered when performed in the doctor's office or clinic.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please help me with the received date and denial date?
[AGENT][NEUTRAL] Claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] 358-849-2.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And which CPT code is not covered under the member's plan?
[AGENT][NEGATIVE] All clothes were not covered.
[CUSTOMER][NEUTRAL] OK, and the further details will remain the same.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Shall we move to the
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Next claim, just last claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And what is the last policy number?
[CUSTOMER][NEUTRAL] Uh yeah. The last policy number is 2552915.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Moment.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's first name will be
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] The date of service will be.
[CUSTOMER][NEUTRAL] [PII] and the amount charges are $562 even.
[AGENT][NEUTRAL] Balance after primary.
[CUSTOMER][NEUTRAL] Yeah it's loading. Give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $435.49.
[AGENT][NEUTRAL] OK, name of the provider's office?
[CUSTOMER][NEUTRAL] The provider's office name will be Tenet Florida Physician Services.
[AGENT][NEUTRAL] OK, I show the claim received on [PII], processed on [PII].
[AGENT][NEUTRAL] And a check was mailed in the amount of 43549.
[CUSTOMER][NEUTRAL] OK, so the claim has been paid for the $43549435.49.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK. Uh, so what, so the amount will be the same as 4 $35.49.
[AGENT][NEUTRAL] Well, it's not really a loud amount, that's just the benefit max that payable.
[CUSTOMER][NEUTRAL] OK. And could you please help me with the claim pay date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what will be the claim number?
[AGENT][NEUTRAL] 36032007
[CUSTOMER][NEUTRAL] 3,603,270.
[AGENT][NEUTRAL] 36032007
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do you have any payment cash clear date?
[AGENT][NEGATIVE] No, I don't show that it's cleared.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And was it a single amount or a bulk amount?
[AGENT][NEUTRAL] Single in the amount of 4, 35, 49.
[CUSTOMER][NEUTRAL] OK. Could you please verify me the
[CUSTOMER][NEUTRAL] OK. How was the payment done via check? Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you please help me with the check number?
[AGENT][NEUTRAL] 204-516-5
[CUSTOMER][NEUTRAL] OK, could you please verify me the payment's mailing address, the pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And could you please verify me the patient's account number?
[AGENT][NEUTRAL] The patient account number that the provider assigned to the claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] 3614417 [PII] 13023.
[CUSTOMER][POSITIVE] Perfect. Could you please send me the copy of UB?
[AGENT][NEUTRAL] Sure, what is the fax number?
[CUSTOMER][NEUTRAL] It's [PII] in attention to the patient's account number which you gave me right now.
[AGENT][NEUTRAL] Uh, give me that number to me one more time, please.
[CUSTOMER][NEUTRAL] It's 361-4417. V as in Victor, 13023.
[AGENT][NEUTRAL] No, no, the fax number.
[CUSTOMER][NEUTRAL] OK, OK, sorry for that. The fax number is [PII] in attention to the patient's account number.
[AGENT][NEUTRAL] [PII]. OK. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, OK, OK. Thanks for your assistance. Thanks for helping me with these things. And just the last question and how much time we will, yeah, just the last question and how much time we receive the copy.
[AGENT][POSITIVE] Mhm. You're welcome. Thanks for calling APL.
[AGENT][NEUTRAL] Uh, in a few moments.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks for your assistance.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye.