AccountId: 011433970860
ContactId: 0c902955-71d9-4c09-84c2-9001b80d799b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 685690 ms
Total Talk Time (AGENT): 220078 ms
Total Talk Time (CUSTOMER): 152583 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/0c902955-71d9-4c09-84c2-9001b80d799b_20250610T15:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status. Can you please help me with that?
[AGENT][POSITIVE] Yes, I'll be more than happy to assist you with the um claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is, it's, just give me one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, I got it. The policy number is, it's
[CUSTOMER][NEUTRAL] It's 2446538.
[AGENT][NEUTRAL] OK, slowly 244-6538. Is that correct?
[CUSTOMER][POSITIVE] That's right, yes.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And can you give the date of birth again? I'm sorry?
[CUSTOMER][NEUTRAL] Sure, the date of birth is, it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. The total bill for the claim is it's
[CUSTOMER][NEUTRAL] It's [PII] for the bill amount, $425 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] [PII] is $250 for you.
[AGENT][NEUTRAL] So I'm just waiting for the claims to pull up here. Hold on one moment.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] All right. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Signal
[CUSTOMER][NEUTRAL] Can you please repeat that?
[AGENT][NEUTRAL] Sure, can you verify the name of the provider's office on the claim, the facility?
[CUSTOMER][NEUTRAL] Yes, it's MUSC physicians.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] My claim number is 358.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3909.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The other code 92015 was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh, which code?
[AGENT][NEUTRAL] 92015.
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much for the information.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Can I get the call reference number for this claim?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I get the carter claim payer ID?
[AGENT][NEUTRAL] I'm sorry, can you repeat that, please?
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's no call reference number, but you can use my name and today's date again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I got it. And can I get the timely filing limit to submit the contact claim?
[AGENT][NEUTRAL] There's no timely filing limit. As long as the policy is active, you can file at any time for corrected claim or additional information once we receive it, we'll just continue processing.
[CUSTOMER][NEUTRAL] I got it. Uh, I have 2 more clients to check. Can you please help me with that?
[AGENT][NEUTRAL] OK, is it the same number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's a different number.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] 02446531
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 2 more claims. This claim and another claim. That's it.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] for the bill amount $480 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would the provider be the same on this claim?
[CUSTOMER][NEUTRAL] The provider is MSC physicians.
[AGENT][NEUTRAL] OK, so yes. Hold on one second.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 358.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3990.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] Can you please repeat that?
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 3990.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Code 99203 was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 17,000 was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much for the information.
[CUSTOMER][NEUTRAL] I have last time to check. Can you please help me with that?
[AGENT][NEUTRAL] Yes, hold on one moment. Let me note this policy.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh 023893887.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] for the bill amount $800 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] the same thing.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] So we received this claim twice. Are you needing the original claim, the second claim, or both?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] For the second claim, for the recent claim. Can you please provide me the status for the recent claim?
[AGENT][NEUTRAL] Mhm hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So I received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 358.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5089.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much for the information that you have provided for me, [PII]. Have a nice day. Take care. Bye-bye.
[AGENT][NEUTRAL] Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] That's all the information needed I know.
[AGENT][POSITIVE] All right, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.