AccountId: 011433970860
ContactId: 0ef831eb-c7d2-4dc4-9520-aada8b9be120
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1251750 ms
Total Talk Time (AGENT): 411271 ms
Total Talk Time (CUSTOMER): 460999 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/2025/02/20/0ef831eb-c7d2-4dc4-9520-aada8b9be120_20250220T14:52_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] This is [PII] calling from the provider office. I'm checking the claim.
[AGENT][NEUTRAL] I can barely hear you. I do apologize. I can barely hear you.
[CUSTOMER][NEUTRAL] This is [PII] calling from the provider office.
[AGENT][NEUTRAL] Hello, [PII], how can I assist you today?
[CUSTOMER][NEUTRAL] Checking the claims.
[AGENT][POSITIVE] Can I have a callback number for you and that policy number and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Uh, then how can I come to know?
[CUSTOMER][NEUTRAL] What the claim.
[AGENT][NEUTRAL] Could I have, could you provide me with a callback number just in case your call is disconnected and the policy number of the member that you're inquiring claim status for and I will be glad to assist you, [PII].
[CUSTOMER][NEUTRAL] OK. It's 760280-2020.
[CUSTOMER][NEUTRAL] And the member ID is?
[CUSTOMER][NEUTRAL] 01893493 M. for Mary, L for Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] Thank you. Could you verify that patient's name and date of birth that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to check the status of a claim for what date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII] for charge amount.
[CUSTOMER][NEUTRAL] Uh, just a moment. Charge amount is uh $818.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For [PII], correct?
[CUSTOMER][NEUTRAL] For charge amount $818.
[AGENT][NEUTRAL] Give me the member's name and date of birth again if you don't mind.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] First name is [PII] and middle name is
[CUSTOMER][NEUTRAL] [PII], uh sorry, [PII] and the last name is [PII]
[AGENT][NEUTRAL] So, could you spell her first name because I'm not sure if you're saying [PII] or something else.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm not showing the claim on file for this for [PII].
[CUSTOMER][NEUTRAL] So what is the member policy active?
[AGENT][NEUTRAL] This policy effective date is [PII] until [PII] until [PII].
[CUSTOMER][NEUTRAL] OK. So, like, what's your mailing address to submit the claim?
[AGENT][NEUTRAL] The mailing address will be addressed to APL claims department.
[AGENT][NEUTRAL] [PII]. That's [PII], [PII], [PII]. That's [PII], [PII].
[CUSTOMER][NEUTRAL] And what is the time designing for the claim submission?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] So actually already we have tried 2 times uh on mailing address so how we're not receiving the claims. So what's the next step?
[AGENT][NEUTRAL] Could you verify the mailing address that you have? Because I'm not sure.
[CUSTOMER][NEUTRAL] Yeah, we have submitted the mailing address to [PII].
[AGENT][NEUTRAL] No, this is
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The city and state is [PII].
[CUSTOMER][NEUTRAL] Yes, the city, um,
[CUSTOMER][NEUTRAL] I'm repeating it's [PII], [PII].
[AGENT][NEUTRAL] Oh, we don't have a claim on file. Would you like a fax number to send it by fax?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] It's [PII]. That's [PII].
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. I have the other patient to discuss also and provide me the call reference number for this one.
[AGENT][NEUTRAL] We don't provide reference numbers. [PII], however, you can use my name and today's date as a reference.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sure. Can you spell your name?
[AGENT][NEUTRAL] [PII], and today's date as a reference, what is your next policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] The next member ID is 024628.
[CUSTOMER][NEUTRAL] 69 M. for Mary, L for Lima, number 8.
[AGENT][NEUTRAL] Provide me that policy number again.
[CUSTOMER][NEUTRAL] 02462869 M. for Mary, L for Lima 8.
[AGENT][NEUTRAL] Thank you. Could you verify the patient's name and date of birth that you're in you're checking claim status for?
[CUSTOMER][NEUTRAL] It's [PII], and date of birth is [PII].
[AGENT][NEUTRAL] And what is your date of service?
[CUSTOMER][NEUTRAL] It's [PII] for charge amount, $1,632 even.
[AGENT][NEUTRAL] What is your procedure code?
[CUSTOMER][NEUTRAL] This is the code, sir.
[CUSTOMER][NEUTRAL] It's [PII] and 87039.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 9672.
[AGENT][NEUTRAL] 9672 9672.
[CUSTOMER][NEUTRAL] Actually, this one was denied for the PADOB and we have submitted the corrected claim.
[AGENT][NEUTRAL] So this claim was received [PII]. It was processed [PII]. There was no payment made on this claim, and the reason why there was no payment made on this claim is because the benefits are payable only if the primary make a payment, the major primary make a payment, however, it does not look like they made a payment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] But we have submitted the primary. We have submitted you the corrected claim.
[CUSTOMER][NEUTRAL] With the family you.
[CUSTOMER][NEUTRAL] Have you received that?
[AGENT][NEUTRAL] When did you submit it?
[CUSTOMER][NEUTRAL] And it was done on
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] There was a payment of 20375.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 3.75. OK. When did you
[AGENT][NEUTRAL] Give me one moment. You said the date of service was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] We only received one claim and we request it stated that the primary made no payment.
[CUSTOMER][NEUTRAL] Have you received the corrected claim?
[AGENT][NEUTRAL] 96729672. The only claim we that we received for that date of service was received [PII] processed [PII]. There is no corrected claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I actually want to know that that uh is the same mailing address to submit the collected claim. It's [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And uh if it's some we have to submit the prime DOB so what's your fax number?
[AGENT][NEUTRAL] [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK. And the claim number is 3509672. Is it right?
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] 3509672 is the claim number.
[CUSTOMER][NEUTRAL] OK. I have now the other data service for the same patient. It's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What was the date of service? I can barely hear you.
[CUSTOMER][NEUTRAL] For charge amount?
[CUSTOMER][NEUTRAL] It's [PII] for charge amount $252.
[AGENT][NEUTRAL] What is your procedure called?
[CUSTOMER][NEUTRAL] The procedure code is 0601.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was a payment of $43.96 paid on this claim.
[CUSTOMER][NEUTRAL] OK, what is the check number?
[AGENT][NEUTRAL] 2018606
[CUSTOMER][NEUTRAL] 18, can you repeat once again?
[AGENT][NEUTRAL] 2018606
[CUSTOMER][NEUTRAL] OK, is there any patient responsibility?
[AGENT][NEUTRAL] We're not a primary insurance. I can only verify that we pay $43.96.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] 3541339
[CUSTOMER][NEUTRAL] 35413 then after?
[AGENT][NEUTRAL] 39
[CUSTOMER][NEUTRAL] to come.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] 354-1339, is it right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and what is the check issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what is the cash, check, cash date?
[AGENT][NEGATIVE] It has not been cashed.
[CUSTOMER][NEUTRAL] Why it has not been cashed?
[AGENT][NEUTRAL] I'm not sure why it has not been cashed [PII]. That's the question that you would have to ask on your end, not on my end. It just shows that the check has not been cashed. It was sent out [PII]. However, I could send a copy of this to the finance department for them to verify if the check has been cashed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And to what mailing address the check has been issued?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Uh, I have the next state of service.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII] for charge amount $252.
[AGENT][NEUTRAL] There was a payment of $43.96 paid on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] Claim was received [PII]. It was processed [PII]. Check number is 20, 2018607.
[CUSTOMER][NEUTRAL] Under the same.
[CUSTOMER][NEUTRAL] 20186007.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the claim number?
[AGENT][NEUTRAL] 3541344
[CUSTOMER][NEUTRAL] OK. I have the next date of service.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For charge amount?
[CUSTOMER][NEUTRAL] $783.
[AGENT][NEUTRAL] 134 8.
[AGENT][NEUTRAL] 1348.
[AGENT][NEUTRAL] Claim was received [PII]. It was processed [PII]. There was a payment of $188.11 made on this claim.
[AGENT][NEUTRAL] Check number is 201.
[AGENT][NEUTRAL] 8608.
[AGENT][NEUTRAL] 2018608
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the check has been cashed yet or not?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] 3541348.
[AGENT][NEUTRAL] 3541348
[CUSTOMER][NEUTRAL] OK. The next date of service is [PII] for charge amount $252.
[AGENT][NEUTRAL] There was a payment of $43.96 paid on this claim.
[CUSTOMER][NEUTRAL] What is the received date of the claim?
[AGENT][NEUTRAL] 1348.
[AGENT][NEUTRAL] The claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] What is, uh, what is the check number?
[AGENT][NEUTRAL] 2018608. That's 2018608.
[CUSTOMER][NEUTRAL] It is under the same check that has been uh you to give me the information on [PII].
[AGENT][NEUTRAL] This is for [PII], 2018608.
[CUSTOMER][NEUTRAL] 20186.
[CUSTOMER][NEUTRAL] But like my date of service is [PII], so the check number is the same.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Is it right?
[AGENT][NEUTRAL] You think, you gave me [PII].
[CUSTOMER][NEUTRAL] It was previously, but now I gave you the.
[AGENT][NEUTRAL] 1335.
[CUSTOMER][NEUTRAL] [PII] for the charge amount of $252.
[AGENT][NEUTRAL] OK, 1335.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] Mm, so what's the.
[AGENT][NEUTRAL] Check number is 2018603.
[CUSTOMER][NEUTRAL] And the paid amount is 43.96.
[AGENT][NEUTRAL] 43.96.
[CUSTOMER][NEUTRAL] What is the bulk amount of the check?
[AGENT][NEUTRAL] $43.96 is the amount of the check.
[CUSTOMER][NEUTRAL] Yeah, it's a single jackets instead.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] to the movies.
[CUSTOMER][NEUTRAL] The next date of service is [PII] for charge amount $252.
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] What is your procedure called?
[CUSTOMER][NEUTRAL] It's 80601 on [PII].
[AGENT][NEUTRAL] I'm not showing a claim for [PII].
[CUSTOMER][NEUTRAL] Is the member policy active on the state of service?
[AGENT][NEUTRAL] The policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have the next date of service. It's [PII] for charge amount.
[CUSTOMER][NEUTRAL] $783.
[AGENT][NEUTRAL] I'm not showing a claim on file for [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, I have the next patient to discuss.
[AGENT][NEUTRAL] How many more patients do you have?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] I have one data, one patient more and it has uh uh 3 data service.
[AGENT][NEUTRAL] What is that policy number?
[CUSTOMER][NEUTRAL] It's 01568605, M for Mary, L for Lima, number 8.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] What is your first date of service?
[CUSTOMER][NEUTRAL] It's [PII] for charge amount.
[CUSTOMER][NEUTRAL] $859.
[AGENT][NEUTRAL] There's no data service on file.
[CUSTOMER][NEUTRAL] Is the member policy active?
[AGENT][NEUTRAL] This member's policy has been active since [PII] and it's currently active. What is your next date of service, [PII]?
[CUSTOMER][NEUTRAL] So what is that?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] The next date of service is [PII].
[CUSTOMER][NEUTRAL] For charge amount.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] $859.
[AGENT][NEUTRAL] There's no claim on file for [PII]. What's your next date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the next date of service is [PII] for charge amount $840.
[AGENT][NEUTRAL] There's no claim on file for [PII].
[CUSTOMER][NEUTRAL] And also there is no timely filing limit for the confirmation, is that right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is that one.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.