AccountId: 011433970860
ContactId: feed0837-12ba-4282-97fb-1ae6455f3eec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575830 ms
Total Talk Time (AGENT): 95503 ms
Total Talk Time (CUSTOMER): 198706 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/feed0837-12ba-4282-97fb-1ae6455f3eec_20250130T19:40_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling on behalf of provider offers regarding claim status.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] with the extension of [PII]. Um, could you spell your name for me, please?
[AGENT][NEUTRAL] [PII] Last initial is [PII]. And if I can get the policy number, please?
[CUSTOMER][POSITIVE] Uh, thank you so much.
[CUSTOMER][NEUTRAL] Yeah, sure, [PII].
[CUSTOMER][NEUTRAL] And the member ID number is going to be number 02292680.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And the patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure. And the date of service is [PII].
[AGENT][NEUTRAL] Thank you for that information and what is your tax ID?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. Um just a moment.
[CUSTOMER][NEUTRAL] Yeah. And the tax ID is going to be [PII].
[AGENT][NEGATIVE] I'm showing the claim was submitted several times 123 times, and the first time we made a payment in the amount of $68.09 and the other two times they denied us duplicates.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, may I know what happened for the CBD 99203?
[AGENT][NEGATIVE] OK, that's not covered under the policy. That's why it denied.
[CUSTOMER][NEUTRAL] OK. It's dinner as non covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] OK, may I know it's no go under patient plan or providers contract?
[AGENT][NEUTRAL] Patients plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the patient plan type?
[AGENT][NEUTRAL] It's a gap policy.
[CUSTOMER][NEUTRAL] It's like it's gap, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And I checked in my software and found that on previous claim.
[CUSTOMER][NEUTRAL] We added diagnosis point of M79.674 and M79.675 for the CPT 99213 and we resubmit this claim. Um, could you verify that and could you send this claim back for an early process or on a review?
[AGENT][NEUTRAL] Um, I don't understand.
[CUSTOMER][NEUTRAL] Um, OK. Um, I checked in my software and found that previously we added a diagnosis.
[CUSTOMER][NEUTRAL] M 79.674 and M 79.675 for the CPT 99203. Um, could you verify that and could you send this claim back for a review?
[AGENT][NEUTRAL] Why would I send it back for review? The claim denied because of the procedure code, not the diagnosis code. So it doesn't matter what the diagnosis is, that, that procedure code is not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the call reference for this claim, and I have another one more claim to do so. Could you help me with that?
[AGENT][NEUTRAL] The reference is just my name and today's date and time and is the claim for the same member or for a different member?
[CUSTOMER][NEUTRAL] Um, just a moment. I will verify that. And the call reference is today's your name and today's date, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEGATIVE] And just a moment. My system is a little bit slow.
[CUSTOMER][NEUTRAL] And this is for
[CUSTOMER][NEUTRAL] Um, different member.
[AGENT][NEUTRAL] What's the um policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And the policy number is going to be um
[CUSTOMER][NEUTRAL] Yeah. It's
[CUSTOMER][NEUTRAL] 01660281 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. And date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the date of services um.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] So it looks like we received the claim 3 times.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The first time we made the payment of 3271.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And then the other two times it denied as a duplicate.
[CUSTOMER][NEUTRAL] OK. And may I know what happened for the CBT um
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] 214
[AGENT][NEGATIVE] It's denied because it's not covered under the patient's plan. The same thing as the last policy, not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. Got it.
[CUSTOMER][NEUTRAL] Um just a moment.
[CUSTOMER][NEUTRAL] And may I know the patient plan type?
[AGENT][NEUTRAL] It's a gap policy.
[CUSTOMER][NEUTRAL] It's the same, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the build service are not covered under memberspla patient plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] OK. Um, no. Thank you so much and thank you for your assistance and have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] Thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Mm, yeah. Have a great day. Yeah.