AccountId: 011433970860
ContactId: f9c90ca0-095f-4ef5-aaae-d35a478b5fd3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471109 ms
Total Talk Time (AGENT): 135314 ms
Total Talk Time (CUSTOMER): 102004 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/f9c90ca0-095f-4ef5-aaae-d35a478b5fd3_20250610T15:18_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 private office, and I'm looking for status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get your name one more time, please?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. Last name [PII] is [PII].
[AGENT][POSITIVE] And a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][NEUTRAL] And can I get the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, policy number is 02006183.
[AGENT][NEUTRAL] Alright, give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, patient name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] Hey you.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yeah, date of service is August [PII] of 2024 and total charge amount is $6200 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said August [PII] of 2024?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the hospital name or provider name?
[CUSTOMER][NEUTRAL] Yeah, it's SSM Health Endoscopy Center.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] And it looks like that claim was denied.
[AGENT][NEUTRAL] Uh, it looks like we need more information. Uh, we need you to submit the standard hospital billing, um, or a UB 92 for the services rendered.
[CUSTOMER][NEUTRAL] Yeah, for this one we have billed the claim on UP 92 claim form.
[AGENT][NEUTRAL] Yes, the claim was denied because we're still waiting for that we need the um.
[AGENT][NEUTRAL] The UB with the procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] But we have already billed that claim form.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] So, why it was denied?
[AGENT][NEGATIVE] It was denied
[CUSTOMER][POSITIVE] We have already billed the claim on you be nice.
[AGENT][NEUTRAL] Uh, when did you turn it? When did you submit it?
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With primary it will be because we have received a correspondence letters.
[AGENT][NEUTRAL] Did you send it in with the secondary insurance as well or just the primary?
[CUSTOMER][NEUTRAL] Um, actually, for this one we have received a correspondence letter from your side and you guys requested for prim OB so we send that claim with primary it will be on [PII].
[CUSTOMER][NEUTRAL] Uh it was sent via fax.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not showing anything with procedure codes in the, the claim documents.
[CUSTOMER][NEUTRAL] On the claim form.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm not showing any of that.
[CUSTOMER][NEUTRAL] Can you please check the box number 44?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I wasn't seeing anything that had procedure codes on it for our claim. um, if you send it into the primary.
[AGENT][NEUTRAL] Um, you'll still need to send it with us as well. Do you need our fax number?
[CUSTOMER][NEUTRAL] Mm, yeah, go ahead.
[AGENT][NEUTRAL] OK, our fax number you'll you'll put attention claims department at 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you guys need the claim form with primary or be on this fax number.
[AGENT][NEUTRAL] Right, we need the UB 92.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you check the fax because we have already sent that on your fax number, the same fax number on [PII].
[AGENT][NEUTRAL] The only thing I'm seeing for [PII] was this claim that was sent. Let me check one more time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, the only thing I'm seeing that was faxed in that day or sent in that day was the claim, and I'm not seeing any uh UB 92 with procedure codes.
[CUSTOMER][POSITIVE] OK. OK, thank you so much. Can you just provide me call the number.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial in today's date, so [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you for calling APL. If there's nothing else, I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.