AccountId: 011433970860
ContactId: fe8c0223-3403-4dad-96a5-50ccbc86a06c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 891030 ms
Total Talk Time (AGENT): 261300 ms
Total Talk Time (CUSTOMER): 266822 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/fe8c0223-3403-4dad-96a5-50ccbc86a06c_20250513T15:13_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. I'm calling regarding the claim status. Before proceeding, I would like to share this call is recorded for training and quality purpose. Is it OK for you?
[AGENT][NEUTRAL] Yeah, that's fine. Um, could I please get your name again and a callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII], spell out [PII], and the last name your first is [PII].
[CUSTOMER][NEUTRAL] And the callback number would be [PII].
[AGENT][NEUTRAL] OK. Thank you for calling. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It would be 02134838 Mike Lima number 8.
[AGENT][POSITIVE] Thank you. Now please for.
[CUSTOMER][NEUTRAL] And the patient name is?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yeah. [PII] with the total charge, $5,136 even.
[CUSTOMER][NEUTRAL] Can you also spell out your name for me, please?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Yes, ma'am. Thanks for your patience. Um, I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3593417.
[AGENT][NEUTRAL] And this claim denied because according to the diagnosis code, this was for screening and screenings are not covered under the policy.
[CUSTOMER][NEUTRAL] Just give me.
[CUSTOMER][NEUTRAL] Under the patient's plan, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you can provide me the plan name of the member?
[AGENT][NEUTRAL] It's [PII]. It's spelled [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, and, uh, the claim number will be 3593417.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but on a previous date of service, we got the payment.
[CUSTOMER][NEUTRAL] Uh, with the same procedure codes.
[AGENT][NEUTRAL] Yes, but um it was a different diagnosis code. This claim denied based on the diagnosis code.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Under the same diagnosis code.
[AGENT][NEUTRAL] Right. According to the diagnosis code, this was for screening and screenings are not covered under the policy.
[CUSTOMER][NEUTRAL] Yeah. You're right. But because
[CUSTOMER][NEUTRAL] Payment
[CUSTOMER][NEUTRAL] Uh, on, uh, uh, for the date of service, [PII] under the same diagnosis code.
[AGENT][NEUTRAL] One moment, I'm checking my system.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thanks for your patience.
[AGENT][NEUTRAL] Yes, we're showing other claims on file under that date of service with different diagnosis codes and that's what it was based on.
[CUSTOMER][NEUTRAL] Uh, but, uh, yeah, this is for date of service, [PII]. But on [PII], we got the payment.
[AGENT][NEUTRAL] Yes, that's because uh there's other claims on file for [PII] with different diagnosis codes. So we were able to use that diagnosis code for that claim, but that, that's not what happened um with this new claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But the diagnosis code which is T18.3 and as we billed for this one, it is also same C 80.3.
[AGENT][NEUTRAL] Yes, ma'am. We know that.
[AGENT][NEUTRAL] But there's other claims on file for the same date of service for [PII] with different diagnosis codes. So we were able to use that diagnosis code.
[AGENT][NEUTRAL] For the previous claim that paid out for 2000 for [PII].
[CUSTOMER][NEUTRAL] Yeah, you use for this one or not?
[AGENT][NEUTRAL] But the new
[AGENT][NEGATIVE] No, we can't use it for this one.
[AGENT][NEUTRAL] Because the, the date of service is different.
[CUSTOMER][POSITIVE] OK. Thank you so much. And can you also provide me the call reference number? Uh, actually, I have 3 more claims.
[CUSTOMER][NEUTRAL] For different patient.
[AGENT][NEUTRAL] Yes, the reference number is my name and today's date. My name is Evie. Um it's spelled E V I E. Last initial is M like [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you. I shall go on next thing.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, what's the next policy number?
[CUSTOMER][POSITIVE] Yeah sure thank you so much.
[CUSTOMER][NEUTRAL] It is 01849.
[CUSTOMER][NEUTRAL] Sorry, 01845906. Mike Lima number 8.
[AGENT][NEUTRAL] Please verify the patient's name.
[CUSTOMER][NEUTRAL] Date of, uh, sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII]. And the date of service is [PII], with the total charge $500 even, ma'am.
[AGENT][NEUTRAL] You said the date of service was [PII]?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you please also provide me the
[CUSTOMER][NEUTRAL] Effective date and the date of the member?
[AGENT][NEUTRAL] Um, yes, ma'am. And just let me advise you the verification of coverage does not guarantee payment of claims.
[AGENT][NEUTRAL] Let's see, the effective date on this.
[CUSTOMER][NEUTRAL] It is active for date of service.
[AGENT][NEUTRAL] The effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Active, OK. And claim.
[CUSTOMER][NEUTRAL] Uh, OK. Can you provide me the timely filing limit for this one to submit the claim?
[AGENT][NEUTRAL] There's no time like filing limit?
[CUSTOMER][NEUTRAL] OK. And also, can you provide me the uh uh verify the mailing address?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you so much. Shall we move on next time?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][POSITIVE] Uh thank you so much.
[CUSTOMER][NEUTRAL] It would be the next member ID will be 01634912.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] [PII]. The total charge $500 even.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And please verify the name and date of birth one more time.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII]. The total charge $500 even.
[AGENT][NEUTRAL] OK, we received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 586 9.
[AGENT][NEUTRAL] And the claim denied because we need the EOB from the primary insurance company.
[CUSTOMER][NEUTRAL] OK. Can you provide me the fax number?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And please attention it to the claims department.
[AGENT][NEUTRAL] And also this member has a new policy number that the claim needs to be filed under.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The new claim number is 254.
[AGENT][NEUTRAL] 9504.
[CUSTOMER][NEUTRAL] It is a new
[CUSTOMER][NEUTRAL] Member ID.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And lastly,
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] 02118993 M. Mike Lima number 8.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] with the total charge $500 even.
[AGENT][NEUTRAL] OK. We received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3595558.
[AGENT][NEUTRAL] And this claim is denying because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and fax number would be same and call reference number will be same, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you so much. Have a good day, ma'am.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great day as well. Mm bye.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye.