AccountId: 011433970860
ContactId: 0bd90034-8407-402b-90e9-822c32ca1b4a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691989 ms
Total Talk Time (AGENT): 257278 ms
Total Talk Time (CUSTOMER): 241560 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/0bd90034-8407-402b-90e9-822c32ca1b4a_20250321T17:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, how are you doing today? My name is [PII]. I'm calling to see if you can assist me with two claims that I have in front of me for 2 different patients.
[AGENT][POSITIVE] All right, [PII], I'm good. I'm happy to check on some claims today. Do you have a policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, just let me know when you're ready.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's gonna be 01986034.
[AGENT][NEUTRAL] All right, thank you. Let me pull this up here one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep it's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And then can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, his name is gonna be [PII] and date of birth is [PII].
[AGENT][POSITIVE] All right, perfect. And then date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And build them out.
[CUSTOMER][NEUTRAL] $351.21.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Not showing any claims on file.
[CUSTOMER][NEUTRAL] And what was, what was your name one more time?
[AGENT][NEUTRAL] Uh, no worries. My name is [PII]. That's uh that's OK. It's [PII]
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] Got you alright.
[AGENT][NEUTRAL] Yeah, no claims on file for the [PII].
[CUSTOMER][NEUTRAL] And you said you're not able to see the claim on file? OK, that's not a problem. Um, now do you guys accept claims electronically or would you prefer me to mail it to you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, we do accept them electronically and also via mail. Um, I will let you know that it looks like the patient plan did show a termination date as of [PII] last year, so they're not active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well, that explains why the claim isn't on file.
[AGENT][NEUTRAL] Cause I thought, well, let me check and see if they have another plan. Sometimes that's the case, but it looks like they just had this one and yeah, it ended in December of last year.
[CUSTOMER][NEUTRAL] How are you?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and that was [PII] of last year?
[AGENT][POSITIVE] Mhm. That's correct, [PII]. Yeah.
[CUSTOMER][NEUTRAL] OK, got you, OK, um, well.
[CUSTOMER][POSITIVE] Alright, well, I know what I gotta do for this one.
[CUSTOMER][NEUTRAL] And then uh well let me know when you're ready and I can give you the information for the next person.
[AGENT][NEUTRAL] OK. Uh, you can go ahead whenever you're ready, I can take down the policy.
[CUSTOMER][NEUTRAL] Alright, it's going to be 025.
[CUSTOMER][NEUTRAL] 21717.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, gonna be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what's the data service for Denver?
[CUSTOMER][NEUTRAL] Data service gonna be 131 2025.
[AGENT][NEUTRAL] OK, and the bills amount.
[CUSTOMER][NEUTRAL] $489.60.
[AGENT][NEUTRAL] Do you have an amount after the primary by chance, [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, if I'm looking at it right.
[CUSTOMER][NEUTRAL] Um, after that, the balance that's remaining is $144.33.
[AGENT][NEUTRAL] Hm, OK.
[AGENT][NEGATIVE] We have a couple claims on file for that date, but it does none of the charge amounts are matching up, um.
[CUSTOMER][NEUTRAL] Um let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have one for a charge amount of $159.33?
[AGENT][NEUTRAL] I have one for 15812.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3 1142, I believe and then 84, or no, those two are together. One second, let me add those together, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's all one claim.
[CUSTOMER][NEUTRAL] They might have broke it down.
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] Yeah um.
[AGENT][NEUTRAL] So one's 395 42, it looks like.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This was for a dermatology center.
[CUSTOMER][NEUTRAL] Uh, walk on a dermatology.
[AGENT][NEUTRAL] Mhm, is that the one you're looking for?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm calling from the provider's office now.
[AGENT][NEUTRAL] OK, it looks like the uh.
[CUSTOMER][NEUTRAL] Um, let me see, and you said you have, is that the one, or?
[AGENT][NEUTRAL] Well, they were both from that same provider, so give me just.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so I have.
[CUSTOMER][NEUTRAL] Let me see what I could do here on my end to help.
[AGENT][NEUTRAL] Yeah, I'm just gonna try and pull what was submitted because sometimes.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] The charge amount in the system doesn't.
[AGENT][NEUTRAL] For whatever reason match let me see here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 842
[CUSTOMER][NEUTRAL] Um, if I were to give you, um,
[CUSTOMER][NEUTRAL] The providers MPI would that work?
[CUSTOMER][NEUTRAL] As far as trying to locate the correct one or?
[AGENT][NEUTRAL] Um, let me, give me just a second. I may not need that. Let's see here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found the claim. All right, we did get the claim on um 224-25.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like there was a benefit payment made in the amount of $84.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Is there a check number or uh uh EFT number or anything like that?
[AGENT][NEUTRAL] Mhm, it was a single check and the check number is 202.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 99.
[AGENT][NEUTRAL] 48.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alright, and is there a clear date for that or is the [PII] the same date for that?
[AGENT][NEUTRAL] Let's see, um, I can see if it's been cashed or not.
[AGENT][NEUTRAL] That was the issue date on the check.
[AGENT][NEUTRAL] Um, looks like the check is showing outstanding still, has not been cashed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Um, about how long does it take for you guys to process a check or what you guys processing time frame in general for payments?
[AGENT][NEUTRAL] 30 days is kind of the max on that so if it's not received or cashed by the [PII] of this month, um, at that point then we could void and do a reissue.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's 30 days from the issue date correct?
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said if it doesn't clear then you guys would just reissue another check, correct?
[AGENT][NEUTRAL] Mhm, yeah, it would just be voided and reissued, and I can verify, let me verify where it was sent to see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it was sent to [PII], zip code [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. You said [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you repeat the last part of that? I got everything before I'm just missing the address part.
[AGENT][NEUTRAL] That's OK. It was
[CUSTOMER][NEUTRAL] I got the zip code and I've got every.
[AGENT][NEUTRAL] Yeah, it was sent to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you. That's the part I was missing. He [PII]. I just couldn't figure out where.
[CUSTOMER][NEUTRAL] Alright, um, I think that would be it. Can I get a claim number for this one if it's possible or available?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, absolutely. The claim number for this is 356.
[AGENT][NEUTRAL] 842 4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Here
[CUSTOMER][NEUTRAL] Alright, um, I think that is it then, Miss [PII], could I get a reference number?
[AGENT][NEUTRAL] Absolutely. Call reference would be my name with my last initial than today's date. My name again is [PII], last initial would be [PII], and then today's date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Got you. Alright, thank you, Miss. I appreciate your time and help today.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.