AccountId: 011433970860
ContactId: eaa505db-0d1d-4b1f-b387-da7a0fc0720f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 505269 ms
Total Talk Time (AGENT): 161934 ms
Total Talk Time (CUSTOMER): 178065 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/eaa505db-0d1d-4b1f-b387-da7a0fc0720f_20250324T14:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling for the provider Kicksville Missouri Hospital Company. Please note this call is being recorded and monitored for quality and training purposes. I'm calling to check on the claim status.
[AGENT][NEUTRAL] What is your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What is your callback number [PII]? Thank you.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] 134
[CUSTOMER][NEUTRAL] 1910.
[AGENT][NEUTRAL] OK, I have that as 1,341,910 for the policy number. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, yes, just [PII], it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, one moment, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and again you're calling for claim status. I can assist you, [PII]. Now also you can check claim status on our secure website at [PII] and on that website you'll be able to obtain an EOB if you need one. And what is that date of service and the total charge amount, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total charges is $209 even.
[AGENT][NEUTRAL] $209 even. OK, and that's [PII]. 1 moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Can you verify the procedure code or codes billed for this service date, please?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, it's 99214.
[AGENT][NEUTRAL] OK, so just one procedure code and one moment please.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, we did receive a claim with several procedure codes in addition to the 99214. Um, if you could please verify the billing provider again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is the billing provider.
[CUSTOMER][NEUTRAL] Uh, Tyson Peter.
[AGENT][NEUTRAL] And what facility was that, please?
[CUSTOMER][NEUTRAL] Facility was.
[CUSTOMER][NEUTRAL] Crisville, Missouri Hospital Company.
[AGENT][NEUTRAL] OK, thank you very much. The claim was received and it denied as office visits are not covered by the policy.
[AGENT][NEUTRAL] Let me get the information for you, the claim details for you, one moment.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] OK. That claim was received on [PII] and processed and denied [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] OK, just denied it. The office visits, office visits are not covered by the policy.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. May I know the policy was uh not covered under patient's plan or provider's plan or uh pay guidelines?
[AGENT][NEUTRAL] For the patient's policy with APL, it does not cover office visits.
[CUSTOMER][NEUTRAL] OK, um, the CPT 9924 is not covered, right?
[AGENT][POSITIVE] That is correct, [PII].
[CUSTOMER][NEUTRAL] OK. And then um uh may I have the claim number?
[AGENT][NEUTRAL] Yes, certainly. The claim number is 3,542,720.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So it's supposed to be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What about.
[CUSTOMER][NEUTRAL] OK. Uh, but, uh, we received a payment on
[CUSTOMER][NEUTRAL] For the CPT, can I have the claim number for the payment?
[AGENT][NEUTRAL] Sure, please.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] that's still.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Can you give the check number uh can you able to pull up the claim?
[AGENT][NEUTRAL] OK, what is the check number?
[CUSTOMER][NEUTRAL] It's 821.
[CUSTOMER][NEUTRAL] 061
[CUSTOMER][NEUTRAL] 000.
[CUSTOMER][NEUTRAL] 159485.
[AGENT][NEUTRAL] OK. Now, I will tell you, [PII], that is not one of our check numbers.
[CUSTOMER][NEUTRAL] OK um.
[CUSTOMER][NEUTRAL] Um, OK. Could you please give the resubmission for this claim as a corrected or appeal for this one?
[AGENT][NEUTRAL] I'm sorry, are you asking for the pills information, [PII]?
[CUSTOMER][NEUTRAL] I'm asking that uh what will be the uh mode of resubmission it will be a corrected claim or appeal for this one.
[AGENT][NEUTRAL] OK, again, the policy does not cover office visits, so you're able to submit an appeal if you would like, I can give the information to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK may I have the mailing address and time referring limits?
[AGENT][NEUTRAL] Of course. [PII]'s mailing address is APL Claims Attention Appeals department.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The time to submit that that appeal is 180 days from the.
[AGENT][NEUTRAL] Process date, which was [PII].
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there any specific appeal form needed?
[AGENT][NEUTRAL] No, there's no form, there's no specific form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And then,
[CUSTOMER][NEUTRAL] Uh, for re submitting the appeal, we need to attach the you be with that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And an explanation please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Certainly, my name is spelled [PII] Last initial is [PII], and we do not provide reference numbers. You can use my name in today's date, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, I think I got all information. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] And thank you for calling APL. Have a great day as well bye.