AccountId: 011433970860
ContactId: f45b047e-56bd-4e6a-833e-c62831dabf8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370600 ms
Total Talk Time (AGENT): 108712 ms
Total Talk Time (CUSTOMER): 161846 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/f45b047e-56bd-4e6a-833e-c62831dabf8f_20250521T14:08_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for uh Previa Medical Group of Georgia. I verified the UB and this call is made for an additional information about the claim denial. And also please note that this call is being recorded and monitored for the quality and training purposes. Thank you.
[AGENT][POSITIVE] Of course, and I can definitely get clarification regarding that claim for you, uh, [PII], before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, of course the callback number is [PII]. No extension directly.
[AGENT][NEUTRAL] OK, thank you and do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, of course, policy number is 01677458 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the number please?
[CUSTOMER][NEUTRAL] Member's name was [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh did you have that claim number?
[CUSTOMER][NEUTRAL] Yes, of course just a moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 85
[CUSTOMER][NEUTRAL] So the claim number is 359-851-2.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] $45.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so it does appear with this claim [PII] that we have not received the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we do need that before we can continue processing this claim.
[CUSTOMER][NEUTRAL] OK. And uh as for checking here, we have submitted the primary UV when we submitted the claim. So could you please kindly check out this whether you received it or not.
[AGENT][NEUTRAL] Yes, um, so with that, uh, the EOP that you send does have to show the amounts paid towards co-pay, deductible and co-insurance, so it, I have not been, uh, detailed, uh, EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So you received the UB but uh
[CUSTOMER][NEUTRAL] The UB doesn't show the amount paid. That's right.
[AGENT][NEUTRAL] We have to have the primary EOB that shows amounts paid towards co-pay, deductible and co-insurance.
[CUSTOMER][NEGATIVE] OK. You received the UV but the amount paid for the co-pay deductible, it's not showing. That's right.
[AGENT][NEUTRAL] I'm not showing that we did receive an EOB. I'm just saying that's the kind that we do need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From the primary.
[CUSTOMER][NEUTRAL] OK, so you still know you doesn't receive, we need to submit the primary UBA.
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][NEUTRAL] And could you please spell out, OK, I got you, and could you please spell out your name for me?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] And I've got a mailing address and a fax number I can give you for that EOB.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][NEUTRAL] OK, and before that, can I verify the mailing address for this claim?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Whether it is [PII], OK, [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and I'm ready for the fax number?
[AGENT][NEUTRAL] OK, that is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] [PII]. That's right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] May whether the timely filing is 180 days from the denial.
[AGENT][NEGATIVE] No, no, no, there's no timely filing limit for missing information. It's only 180 days for an appeal.
[AGENT][NEUTRAL] So for this there is no filing limit.
[CUSTOMER][POSITIVE] OK, to send the primary UB, there is no time limit. That's right.
[CUSTOMER][NEUTRAL] Well
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and for appeals as you said, it is 180 days.
[CUSTOMER][NEUTRAL] From the date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's right. OK, thank you.
[AGENT][NEUTRAL] No, not from the date of service, uh, from the process date of this claim.
[CUSTOMER][NEUTRAL] OK, 180 days from the process. Thank you so much. And uh could you please help me with the call reference number for this call?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, sure, that would be my first name, last initial, and today's date. last initial is [PII], and was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK, so the call reference is [PII] and the initial is K as K as [PII] Kilo, and today's date. That's right.
[AGENT][NEUTRAL] And then um my last initial is [PII] and then today's date.
[CUSTOMER][POSITIVE] OK, I got you. OK, thank you. Thank you for your reference number and thank you so much for your assistance. Have a great day bye bye.
[AGENT][POSITIVE] Thanks for calling. You too bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.