AccountId: 011433970860
ContactId: 00e60893-f495-4e16-a436-ccd4e90cf33e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602960 ms
Total Talk Time (AGENT): 209869 ms
Total Talk Time (CUSTOMER): 211548 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/00e60893-f495-4e16-a436-ccd4e90cf33e_20250327T20:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Very good afternoon. This is [PII], and I'm calling you from provider office, and I just need to discuss about the claim.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And you're needing to discuss a claim, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] The callback number that is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then the policy number please for the member you're calling about.
[CUSTOMER][NEUTRAL] So for the policy number that is.
[CUSTOMER][NEUTRAL] 01986343
[AGENT][POSITIVE] OK, [PII], thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Uh-huh, thank you.
[CUSTOMER][NEUTRAL] And how do you, how do you spell it out your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], got it.
[AGENT][NEUTRAL] And is there any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth that is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please, [PII]?
[CUSTOMER][NEUTRAL] The date of service that is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount on the claim that is.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so the total bill amount on the claim that is
[CUSTOMER][NEUTRAL] $264.57 264.57.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and do you already have the claim number, [PII]?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The claim number is 356-535-6.
[AGENT][NEUTRAL] OK. So yes, sir, I have that claim. How can I help you today with that?
[CUSTOMER][NEUTRAL] So, uh, I just, uh, need to confirm what is the status of the claim. It got denied because I'm checking here. There is a denial, but I'm unable to locate what is the actual denial over here.
[AGENT][NEUTRAL] OK, so the reason for the denial states receipt of the reference claim is acknowledged. However, in order for us to process this claim, we need the explanation of benefits that matches the claim's information.
[CUSTOMER][NEUTRAL] OK, you mean to say that the claim was denied due to primary EOB.
[AGENT][NEUTRAL] Yes, sir. We received, yes, sir, because, well, we need a, the correct EOB, the explanation of benefits that we received with the claim.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEGATIVE] Did not match the claim information.
[CUSTOMER][NEUTRAL] And you received the, uh, you received the, uh, primary UB already.
[AGENT][NEGATIVE] It did not match the, the explanation of benefits that was received did not match the claim information that was.
[AGENT][NEUTRAL] Received.
[AGENT][NEUTRAL] So we need the correct explanation of benefits.
[CUSTOMER][NEGATIVE] OK, so you said you want to say that you received the uh primary UV but did not match.
[AGENT][MIXED] That is correct. It did not match the claim information.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let, let me tell you, let me tell you, uh, as I'm checking here, claim already processed and paid by primary insurance, which is BCBS, and, uh, uh, shall like, uh, what, uh, I just need to confirm from your side. I have the primary EOB, uh, so could you please uh
[CUSTOMER][NEUTRAL] Uh, uh, I can provide the claim number so you can check from that claim number. It's the correct, uh, UV. After that I can attach the UB and rebuild the claim again along with primary UV.
[AGENT][NEUTRAL] OK, I can't see, um, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It's still loading some information for me, [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I'm waiting for some information to load.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] So which information like shall I provide the claim number of BCBS?
[AGENT][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can, you may provide, uh, I, I'm looking at the information that we received.
[AGENT][NEUTRAL] So you can give me the claim number for them if you would like and I can tell you if that's what we received or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure, the claim number that is 020243485011 N as in Nancy 070 XX like X-ray.
[AGENT][NEUTRAL] No, so that is not the same as the claim, the claim number that we received on the explanation of benefits is different.
[AGENT][NEUTRAL] Than that.
[CUSTOMER][NEUTRAL] OK, OK, so let me, OK, no issue. I'm going to
[CUSTOMER][NEUTRAL] Attach this EOB.
[CUSTOMER][NEUTRAL] And send the remit the claim.
[AGENT][NEUTRAL] Give me that number one more time, [PII]. Give me that number one more time.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] The, the claim, the claim number.
[AGENT][NEUTRAL] Uh yes, sir.
[CUSTOMER][NEUTRAL] It's 020243485011 N as in Nancy 070 X X like X-ray and let me let me provide the details as well there is a paid amount $85.
[AGENT][NEUTRAL] OK, so that
[AGENT][NEUTRAL] Now, that is not, yes, sir, but that is.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That is the primary TCN that is not the actual claim number that's on this explanation of benefits. That's the primary TCN number.
[AGENT][NEUTRAL] But again, this claim, the claim information.
[CUSTOMER][NEUTRAL] OK, so the claim number, the, the, mhm.
[AGENT][NEGATIVE] The claim information and the explanation of benefits that were received do not match.
[CUSTOMER][NEUTRAL] OK, there is another claim number that is 515,580 V like Victor 21352.
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] Yes sir, that is the the claim number that is on this explanation of benefits, but this information does not match the information on the claim itself.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] No issue. Let me send the attach this claimants and the.
[CUSTOMER][NEUTRAL] Claim to you
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we need to resubmit the claim along with primary UB, right?
[AGENT][NEUTRAL] Yes, sir, the correct DOB to match the claims information.
[CUSTOMER][NEUTRAL] OK, can I have the call reference number?
[AGENT][NEUTRAL] Yes sir, you would use my name in today's date and if you need a copy of the explanation of benefits, [PII] with the remarks on it that I read to you, you can print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK and uh do you have any fax number?
[CUSTOMER][NEUTRAL] You can
[AGENT][NEUTRAL] [PII]. Attention claims department.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and the call reference number, your name, and today's date, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] So [PII], that's all for today. Thank you. Have a nice day. Bye bye.
[AGENT][POSITIVE] OK, well, you're welcome.