AccountId: 011433970860
ContactId: f0768572-e208-44ae-93ff-b0b532795f53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 878260 ms
Total Talk Time (AGENT): 193782 ms
Total Talk Time (CUSTOMER): 196846 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/f0768572-e208-44ae-93ff-b0b532795f53_20250619T16:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Regional Women's Health group to check the claim status. Before that, I would like to say this call has been recorded for quality and training purposes. Is that OK for you?
[AGENT][POSITIVE] Yes, that's fine. I can help, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] It is D as in Delta 4549045400911.
[AGENT][NEUTRAL] Um, that policy number is with 90 degree benefits. Um, we do some of their plans though. I can try looking it up by last name of the patient.
[CUSTOMER][NEUTRAL] Uh, and the last name of the patient is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, do you have her birthday?
[CUSTOMER][NEUTRAL] The patient birth date is [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] It's [PII] with the bill amount of $177 even.
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 174 was the amount?
[CUSTOMER][NEUTRAL] 177.
[AGENT][NEUTRAL] Uh, I've got several charges for that date. Do you have a CPT code you could provide, procedure code?
[CUSTOMER][NEUTRAL] Oh yeah, one second, uh, yeah, the line one is 873-89 and the line 286803.
[CUSTOMER][NEUTRAL] 93,873,409,486,780.
[AGENT][NEUTRAL] Yeah, it looks like we received the claim of 12-4-2024. Pro 126-2024.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, it's not a covered benefit under this policy.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK. OK. Thank you for the information. So, may I know the plan type of the patient?
[AGENT][NEUTRAL] Supplemental
[CUSTOMER][NEUTRAL] Supplementary plan
[CUSTOMER][NEUTRAL] Like I'm asking is there a PPO plan or APO plan?
[AGENT][NEUTRAL] Um, it's neither, it's just, it's a supplemental policy.
[CUSTOMER][NEUTRAL] Supplemental policy.
[CUSTOMER][NEUTRAL] And how much the patient responsibility?
[AGENT][NEUTRAL] Um, we can't determine patient responsibility since it's a supplemental policy.
[CUSTOMER][NEUTRAL] Oh, I didn't get it like you said that the, uh, the services are not covered, uh, not covered benefits under the policy. So whatever the bill one, can we bill patient.
[AGENT][NEUTRAL] We, we can't instruct on how to bill the patient because it's a supplemental policy. So we can't instruct or determine patient responsibility. We can just process the claim according to the plan.
[CUSTOMER][NEUTRAL] OK, so, uh, regarding this, uh, do we need to connect with the 90 degrees or?
[AGENT][NEUTRAL] Um, I, you, you can talk to 90 Degrees. I'm not sure if they have this claim or not.
[AGENT][NEUTRAL] 90 degrees, it's a different type of policy with them.
[AGENT][NEUTRAL] We're separate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you can't uh provide the confirmation like it's a patient responsibility, right?
[AGENT][NEUTRAL] We can't confirm or we can't give any information on patient responsibility. All we can do is tell you how the claim process.
[CUSTOMER][NEUTRAL] OK, so regarding this, uh, do we need to, like, is there any other departments so that we can directly connect with them?
[CUSTOMER][NEUTRAL] Regarding the patient or to confirm whether there's a patient responsibility or not.
[AGENT][NEUTRAL] No, there's not any other department.
[CUSTOMER][NEUTRAL] Um, OK. Uh, no issues. Uh, actually, we do have one more claim for the same patient, uh.
[AGENT][NEUTRAL] OK. The date of service?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] Same date of service [PII], but the bill amount is $201.
[AGENT][NEUTRAL] Yep one of the CPT codes for it.
[CUSTOMER][NEUTRAL] Uh, total 3 CPT codes 876618759187491.
[AGENT][NEUTRAL] It was received on 2-11-2025, process 214-2025.
[AGENT][NEUTRAL] And it's like,
[AGENT][NEUTRAL] Are those are the same CPT codes as the other claims, is that right?
[CUSTOMER][NEUTRAL] No, sir, different DPD reports.
[AGENT][NEUTRAL] OK, this one was received.
[AGENT][NEUTRAL] 124 2024. Pro 126 2024.
[AGENT][NEUTRAL] Uh, it's the same thing, not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, actually they have submit a credit claim by changing the diagnosis code.
[AGENT][NEUTRAL] And was that for?
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] We submitted on [PII].
[AGENT][NEUTRAL] Yeah, we received, we received a duplicate claim. It didn't have any different information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, we changed the diagnosis code.
[AGENT][NEUTRAL] OK, hold on one moment. Let me.
[CUSTOMER][NEUTRAL] We added the diagnosis called Z level 0.3.
[AGENT][NEUTRAL] Hey, it looks like, let me see, let me pull up the original, hold on one moment.
[AGENT][NEUTRAL] It still build the exact same way, so it does nothing was different on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so can you please, uh, let me know like, uh, when was you received the credit claim.
[AGENT][NEUTRAL] Correct the claim was received.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 2 1125 and process 2 1425.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Denied is a duplicate. Nothing was changed on the claim.
[CUSTOMER][NEUTRAL] Uh, actually, we, uh, added the additional diagnosis code C level.3 and we submit the corrected claim only. So why uh denied us duplicate.
[AGENT][NEUTRAL] The diagnosis is A, which points to 7202 or Z202. The original claim was filed with that as the diagnosis and the second claim was filed with that as the diagnosis. Nothing changed.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, first of, when, when we submit the claim, we added the diagnosis code as uh ICD2 Z level 0.3.
[AGENT][NEUTRAL] It looks at the primary diagnosis filed, so the secondary diagnosis doesn't it, the primary diagnosis filed on the claim filed the same primary diagnosis for each claim. Nothing, nothing changed.
[CUSTOMER][NEUTRAL] Yeah, we added as the secondary diagnosis code Z level.3.
[AGENT][NEUTRAL] It's, it's not, I mean, the, the corrected claim just has Z202, so I don't know.
[CUSTOMER][NEUTRAL] Uh, can you please check like, uh, we added Z level.2 as a secondary diagnosis code.
[AGENT][NEUTRAL] The secondary diagnosis doesn't matter. It's it's gonna look at what did you file the claim with the primary diagnosis. So the claim was filed with the primary diagnosis twice.
[CUSTOMER][NEUTRAL] 235.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's, that's what we read is the primary diagnosis.
[AGENT][NEGATIVE] It's not, it's not a cover.
[CUSTOMER][NEUTRAL] OK, so that's the reason is claim denied as duplicate.
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, so the original claim denied for the same reason which you have provided for in the first claim, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Non-covered.
[CUSTOMER][NEUTRAL] OK, so thank you for this information. Can you please send me the call reference number and your good name?
[AGENT][NEUTRAL] Uh call reference is my, my name is [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for your information. Have a good day. Bye for now.
[AGENT][POSITIVE] Thanks for calling APL you as well. Bye bye.