AccountId: 011433970860
ContactId: 02d7b2bb-9ba7-4840-a729-4773eca1f075
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441630 ms
Total Talk Time (AGENT): 148824 ms
Total Talk Time (CUSTOMER): 184111 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/02d7b2bb-9ba7-4840-a729-4773eca1f075_20250218T15:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] and my last name first initial is [PII]. I'm calling from the provider's office. I need a same status for. Could you please help me with that.
[AGENT][NEUTRAL] Sure, I can verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] and you said your
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it's 02433267.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Uh, it's a direct line extension.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII] with the charge amount of $433.88.
[AGENT][NEUTRAL] OK, and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yeah, that is $63.97 I'm sorry, $63.97.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] A I think.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is the name of the provider's office?
[CUSTOMER][NEUTRAL] Yeah, it's North Atlanta Primary Care, also known as Southeast Medical Group PC.
[AGENT][NEUTRAL] OK, and while I'm looking at claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOV. That site is at secured. AM as in [PII].
[AGENT][NEUTRAL] And I show this claim process as office visits are not covered and for the other charges process is needing primary EOB.
[CUSTOMER][NEUTRAL] OK. So the office code is not covered, am I right?
[AGENT][NEUTRAL] Correct, office visits are not covered under the policy, and like I said for the other charges, we're needing the primary EOB.
[CUSTOMER][NEUTRAL] OK, just hang on please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh, so the office visit doesn't cover under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you for that um.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And for other, other procedure codes, you need the
[CUSTOMER][NEUTRAL] Primary UB.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh when this claim was received and processed?
[AGENT][NEUTRAL] Uh, claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK. Uh, actually, I have 2 more claims for this patient. Could you please check that also one of the data services.
[AGENT][NEUTRAL] Sure. What's the data service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, the date of service it's uh [PII] with the charge amount of $364.87.
[AGENT][NEUTRAL] OK. Balance after primary?
[CUSTOMER][NEUTRAL] $53.67.
[AGENT][NEUTRAL] 3. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] We take it out.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and I show this claim also processes office visits are not covered for the policy and for the other charges, we're needing primary EOB.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Holding on the.
[CUSTOMER][NEUTRAL] OK. Could you please tell me when this claim was received and processed?
[AGENT][NEUTRAL] Uh, received [PII] process on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] little
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] And uh it was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 90. OK. And the denial reason are the same for other games this name of right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] And could you please provide me the claim number?
[AGENT][NEUTRAL] Yes, sir. It's 3505, I'm sorry, 3507135.
[CUSTOMER][NEUTRAL] OK, thank you for that. And the last date of service, it's uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, $298.65 and the balance left by the primary is $40 a year.
[AGENT][NEUTRAL] OK, and the amount of the charge?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And this claim also processes office visits are not covered as well as needing primary EOB.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm. And when this was received and processed?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, this claim was received on [PII] of this year, processed on [PII].
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] OK, thank you for that information. And what's the claim number for the screen?
[AGENT][NEUTRAL] 356-3754.
[CUSTOMER][POSITIVE] OK, thank you for that. Um,
[CUSTOMER][NEUTRAL] What would be the call reference number, uh, just before that, could you please tell me the claim number for the date of service of [PII]. Uh, we missed that.
[AGENT][NEUTRAL] Sure. Uh, it's 355-553-2.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, thank you for that. And what would be the consequence for this call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name today's date.
[CUSTOMER][NEUTRAL] OK. Could you please spell your name for me?
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][POSITIVE] OK, thank you for assisting. Have a great day. Thank you. Bye-bye.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Bye.