AccountId: 011433970860
ContactId: efb8cb0e-2dbc-4ec9-acbd-534f7799aef5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 904780 ms
Total Talk Time (AGENT): 189646 ms
Total Talk Time (CUSTOMER): 276902 ms
Interruptions: 10
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/efb8cb0e-2dbc-4ec9-acbd-534f7799aef5_20250617T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check the claim status.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check a claim. What's the policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] 02433267.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $433.88.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you by chance have a different amount after primary paid?
[CUSTOMER][NEUTRAL] What's different.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Maybe it may change the sense, but I'm not sure about that.
[AGENT][NEUTRAL] We don't have any claims on file for 43388.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] But I have the claim number.
[AGENT][NEUTRAL] Data service 528 24.
[CUSTOMER][NEUTRAL] I have the claim number.
[AGENT][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] I have the claim number.
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] 352-833-4.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim paid a benefit in the amount of $23.81.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] And the other denial on here is benefits are only payable if they're major medical pays.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The CPD 99214 was denied as offices it was not covered.
[AGENT][POSITIVE] Correct, and the member plan.
[CUSTOMER][POSITIVE] Thank you so much for the information. May I know the, uh, sorry, the city and process date?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Claim is received [PII]. Claim is processed and paid on [PII].
[CUSTOMER][NEUTRAL] I just received them
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I know for which CPT the paid?
[AGENT][NEUTRAL] Procedure code 830368294736416.
[CUSTOMER][NEUTRAL] O.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much for the information and
[CUSTOMER][NEUTRAL] May I know the uh the filing limit and credit filing limit?
[AGENT][NEUTRAL] Uh, there's no timely filing for claims. Appeals must be filed within 180 days of the decision.
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] There is a no claim fi limit.
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you so much for the
[CUSTOMER][NEUTRAL] Information, just a moment, please.
[CUSTOMER][NEUTRAL] Can you move to the next state of service?
[AGENT][NEUTRAL] Same patient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] [PII]. And the total charge amount is $277 even.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] For this one, we send the primary UB.
[AGENT][NEGATIVE] I don't show that the primary EOB has been received on this.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] We submitted through fax on
[CUSTOMER][NEUTRAL] [PII]. Maybe it was received within.
[CUSTOMER][NEUTRAL] 2 to 3 days. Can you please double-check with that?
[AGENT][NEUTRAL] I don't show that we received that for that date of service.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Can I get the fax number?
[AGENT][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 42
[CUSTOMER][NEUTRAL] Yeah, we submitted to that fax number.
[CUSTOMER][NEGATIVE] There is no fax receipt.
[AGENT][NEGATIVE] No fax was received. It'll just need to be resent.
[CUSTOMER][NEUTRAL] OK, just a moment, please.
[CUSTOMER][NEUTRAL] Just a moment, please.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. And the claim was denied for the primary year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know the receipt and process date for the claim?
[AGENT][NEUTRAL] Clams received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] I can you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. Can you move the status service for the same patient.
[AGENT][NEUTRAL] What's the next data service?
[CUSTOMER][NEUTRAL] This, sorry, [PII] and total charge per month is $433 888 cents.
[AGENT][NEUTRAL] So this claim was received [PII] process [PII]. It was denied requesting the primary EOB.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] But we already submitted on [PII].
[AGENT][NEUTRAL] There were no EOBs received on [PII].
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][POSITIVE] Thank you so much for the information. Can you please repeat again the the city and state?
[AGENT][NEUTRAL] [PII]. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 24 [PII].
[CUSTOMER][NEUTRAL] And can I get the status for the CPD 99214?
[AGENT][NEGATIVE] It was denied his office visits are not covered.
[CUSTOMER][POSITIVE] Thank you so much for the information. And can you the last day of service for the same patient?
[AGENT][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] [PII] and the total charge the amount is $437.01.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What was the build amount again?
[CUSTOMER][NEUTRAL] 3, sorry, 437.51.
[AGENT][NEUTRAL] Do you have a claim number for this?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment, let me check here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so this claim was received, uh, partially denied office visits are not covered and requesting the primary EOB.
[CUSTOMER][NEUTRAL] May I know the receipt and process date?
[AGENT][NEUTRAL] [PII]. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the, which CPD was denied for offices it is not covered? And which CP uh which CPD was denied for primary AB?
[AGENT][NEUTRAL] 83036.
[CUSTOMER][NEUTRAL] 83036. Mhm.
[AGENT][NEUTRAL] Office visit?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Every other procedure code was requesting an EOB on that claim.
[CUSTOMER][NEUTRAL] The procedure.
[CUSTOMER][NEGATIVE] 83036 was denied as offices. It was not covered.
[AGENT][NEUTRAL] 83036.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was denied for the office if it is not covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But it is not uh office, is it, right?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, it looks like that's not a covered benefit on the member's policy. That was the reason for the denial.
[CUSTOMER][NEUTRAL] OK, and the CPT 36416 and 82947 was denied for the primary be right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Can I get the claim number?
[AGENT][NEUTRAL] 355-5540.
[CUSTOMER][POSITIVE] Thank you so much for the information. Can I get the call reference number?
[AGENT][NEUTRAL] That is my name with today's date.
[CUSTOMER][NEUTRAL] Can you spell your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That's [PII]
[CUSTOMER][POSITIVE] Thank you so much for patiently assisting me. Have a great day. Bye for now.
[AGENT][NEUTRAL] Mhm. Bye-bye. Bye