AccountId: 011433970860
ContactId: 0a69f816-a4fe-4626-8d36-fc0dfb4fb8a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1305199 ms
Total Talk Time (AGENT): 381340 ms
Total Talk Time (CUSTOMER): 349903 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/0a69f816-a4fe-4626-8d36-fc0dfb4fb8a3_20250314T13:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Yes, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from products office to check on a claim status.
[AGENT][NEUTRAL] I'm sure, I can assist you with claim status. Um, first, I'll need to go callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, sure. The callback is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure. Before that, could you please spell out your name for me?
[AGENT][NEUTRAL] My name is [PII]. Um it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Uh the policy number is 130.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] 668-1 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] So, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII] with the bill charge of $1,037 even. It's 1037.
[AGENT][NEUTRAL] OK, for [PII].
[CUSTOMER][POSITIVE] Yes. That's correct.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is this for the ER visit?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Um, what are the bill charges?
[CUSTOMER][NEUTRAL] I'm just looking for a
[CUSTOMER][NEUTRAL] It's 1037.
[CUSTOMER][NEUTRAL] $1,037 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, sir. We received that claim on.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received that claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim paid out for $253.28.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] $253.10.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 38 cents, OK.
[AGENT][NEUTRAL] Uh, $253.28.
[CUSTOMER][NEUTRAL] OK. Go ahead with the claim number.
[AGENT][NEUTRAL] The claim number is 3481759.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1759. OK, may I know the payment details for that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, the payment date is.
[AGENT][NEUTRAL] OK, the payment date, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm showing that the payment was cash. The check was cashed on [PII].
[CUSTOMER][NEUTRAL] [PII]. That's the issue date, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes. Well, no, that's the date that it was cashed. It was issued on [PII].
[CUSTOMER][NEUTRAL] OK. May I know the check number for that?
[AGENT][NEUTRAL] Yes, the check number is 1863148.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 3148.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. May I know it's single or bulk amount?
[AGENT][NEUTRAL] It was a single amount.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] May I know the single amount?
[AGENT][NEUTRAL] $253.28.
[CUSTOMER][NEUTRAL] OK. Could you please verify the patient's account number for me?
[AGENT][NEUTRAL] Verify the patient's account number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Can I go ahead with this?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. The patient's account number on this claim is P like Paul.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 522.
[AGENT][NEUTRAL] 72791.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh sorry, I'm looking for the claim number for.
[CUSTOMER][NEUTRAL] 80152336033
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, what was your question?
[CUSTOMER][NEUTRAL] I'm looking for the patient's account number of P in Paul, 80152336033.
[AGENT][NEGATIVE] I'm unable to look it up by the account number. I would need the uh date of service and the bill charges.
[CUSTOMER][NEUTRAL] Yeah, same date of service is [PII] with the charge amount of $1,037.
[AGENT][NEUTRAL] That's the information I just gave you.
[CUSTOMER][NEUTRAL] OK, then could you please verify the date to address for me?
[AGENT][NEUTRAL] The address is Cleveland Clinic Foundation, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please fax your wish?
[AGENT][NEUTRAL] Yes, I can fax you the EOB. Yes, one moment, please.
[CUSTOMER][NEUTRAL] To pay you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm still here. I'm waiting on my fax system to come up. One moment.
[CUSTOMER][NEUTRAL] OK. Can I provide you the fax number?
[AGENT][NEUTRAL] Yes, what's the fax number?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So, that's attention, [PII] um [PII].
[CUSTOMER][NEUTRAL] That's correct. May I know the turnaround time to receive the fax?
[AGENT][NEUTRAL] You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] I have another client with the same patient.
[AGENT][NEUTRAL] OK, what's the date of service and bill charges on that claim?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] The charge amount of $450 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file with that date of service for this patient.
[CUSTOMER][NEUTRAL] There is no claim on file for the date of service?
[AGENT][NEUTRAL] Right, for [PII]. No, sir.
[CUSTOMER][NEUTRAL] May I know the patient effective and termination date for this claim?
[AGENT][NEUTRAL] Yes, and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and the policy is still active.
[CUSTOMER][NEUTRAL] It's still active.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK. Wait for a moment.
[CUSTOMER][NEUTRAL] May I have the time finding limit?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] You don't have the timely filing limit?
[AGENT][NEUTRAL] Right. The claim can be resubmitted at any time. There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please repeat the mailing address and the time sorry, pay ID for me?
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][NEUTRAL] Yes, that's the um her ID.
[CUSTOMER][NEUTRAL] Can I know the mailing address?
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. May I have the fax number?
[AGENT][NEUTRAL] The fax number is [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claims Department.
[CUSTOMER][NEUTRAL] OK. Could you please wait for a moment? I'm checking here that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, thank you for staying online, Avi. I have one doubt that
[CUSTOMER][NEUTRAL] We can send this through this mailing address or we need to update the payer ID.
[AGENT][NEUTRAL] Yes, the pay ID is 60801. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] I have another claim.
[CUSTOMER][NEUTRAL] With a different patient.
[AGENT][NEUTRAL] But the, what's the policy number?
[CUSTOMER][NEUTRAL] Uh, wait for a moment. I'm checking the policy number is.
[CUSTOMER][NEUTRAL] The policy number is 1227446 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And the patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] So, the rate of service is [PII] with the charge amount of $690 even.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what are the bill charges?
[CUSTOMER][NEUTRAL] It's $690 even.
[CUSTOMER][NEUTRAL] 690.
[AGENT][NEUTRAL] For [PII]. OK, I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] There is no claim on file for that?
[AGENT][NEGATIVE] Not for the, uh, not for those bill charges and that date of service, no.
[CUSTOMER][NEUTRAL] Can, may I know the policy effective and termination date?
[AGENT][NEUTRAL] Yes, one moment, please.
[CUSTOMER][NEUTRAL] I can know the
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy expired on [PII].
[CUSTOMER][NEUTRAL] Sorry, when is the effective it's [PII] of what date and what month?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it expired on [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any other active policy for the patient for the data service?
[AGENT][NEUTRAL] Yes, the patient was covered under this date of service, uh, between [PII] and [PII], the patient, he said that the
[AGENT][NEUTRAL] Date of service on the claim was [PII], right?
[CUSTOMER][NEUTRAL] Yes, [PII], but the patient was terminated on [PII], right?
[AGENT][NEUTRAL] Right. That means on [PII], the patient was covered.
[AGENT][NEUTRAL] We just haven't received the claim.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, could you please check whether the patient have any other policy for the data service?
[AGENT][NEUTRAL] There is another policy on file, but it doesn't cover the date of service. The other policy on file, the uh active date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] I'm asking that the date of service lies between the effective and termination date.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because the date of service is [PII] but the termination date is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, and the claim is denied because we haven't received the claim. We need to receive the claim.
[CUSTOMER][NEUTRAL] OK, may I know, may I have the timely spending limit?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] So we can submit at any time, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. The mailing address is the same for the previous claim, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK. May I know the payer ID for this plan?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The fax is also the same, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I have another one claim, the last claim.
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] No, it's for a different member.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Just wait for a moment. The policy number is
[CUSTOMER][NEUTRAL] It's 01.
[CUSTOMER][NEUTRAL] 973
[CUSTOMER][NEUTRAL] 043
[CUSTOMER][NEUTRAL] M as in Mike. L as in [PII].
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] The date of service is [PII] with the bill amount of $888 even it's 888.
[AGENT][NEUTRAL] Please repeat that date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] And may I know the effective and termination date?
[AGENT][NEUTRAL] Well, when the claim is submitted, it would need to be um submitted under the new policy. Let me give you the new policy number.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] For the previous two claims also, right?
[AGENT][NEUTRAL] For date of service, for date of service, [PII], the claim will need to be filed under this policy number that I'm about to give you.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, go ahead with the policy number.
[AGENT][NEUTRAL] It is 024.
[AGENT][NEUTRAL] 52069.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. But for the policy number which I have given is not on file, right?
[AGENT][NEUTRAL] That's correct. The effective date on this policy was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy expired on [PII].
[CUSTOMER][NEUTRAL] But the date of service lies between those effective and termination date.
[AGENT][NEUTRAL] Yes. So, when the claim is submitted, it would need to be submitted under this policy number that I just gave you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] The TFL mailing address, paper ID and the fax number is same for the, this claim also, right?
[AGENT][NEUTRAL] Yes, they're the same.
[CUSTOMER][NEUTRAL] OK. May I know the call reference for this entire call?
[AGENT][NEUTRAL] It's my name and today's date.
[CUSTOMER][NEUTRAL] AVI.
[AGENT][NEUTRAL] Yes, and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, that's it. Thank you so much for assisting me. Have a good day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. bye.
[CUSTOMER][NEUTRAL] You too. Bye.