AccountId: 011433970860
ContactId: 10d3899e-25a6-4bd1-8974-2f85e69ee693
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1051750 ms
Total Talk Time (AGENT): 297387 ms
Total Talk Time (CUSTOMER): 388769 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/10d3899e-25a6-4bd1-8974-2f85e69ee693_20250619T17:04_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi. This is [PII] calling from provider's office, checking medical claim information. Could you please spell out your name for me?
[AGENT][NEUTRAL] Um, yes, my name is [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] I'm sure I will I can assist you with client status. Um, could I get a good callback number first just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure. The ID is 01826185 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify um the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] So the patient name is [PII] for is [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Sure. So the date of service, it so, I'm sorry, [PII] with the $820.60 8 to 0.60.
[AGENT][NEUTRAL] OK. One moment, please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. Yes, ma'am. We received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3415584.
[AGENT][NEUTRAL] And this claim denied because we need the EOB from the primary insurance company. So there is no timely filing limit. So the EOB, the claim can be resubmitted with the um EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK. Thank you so much. I'm so sorry to interrupt. So, as I'm checking this one, that the your information we already submitted through fax on [PII], which means we already submitted the primary UV through your fax.
[AGENT][NEUTRAL] OK, would you like to verify what fax number you sent it to because we don't show that we received it?
[CUSTOMER][NEUTRAL] OK. So, we did receive that fax number. That is uh [PII].
[AGENT][NEUTRAL] Yes, ma'am. That's correct. Um, the claim can be resubmitted again and this time, make sure that your attention it to the claims department.
[CUSTOMER][NEUTRAL] Yes, we already did that uh information. We submitted it 3 times for the same information. Your side is stating that you already received that claim and you need only the primary OB. So that concern we also submitted the primary OB through fax 3 times.
[AGENT][NEUTRAL] Um, when you resend the claim, are you resending the claim form along with it?
[CUSTOMER][NEUTRAL] Yes, we did that.
[AGENT][NEUTRAL] Well, claims can be also mailed in and we have a pair ID or you could try to resubmit the claim to fax again. I apologize, ma'am, we don't have it on file for some reason, we're not receiving it.
[CUSTOMER][NEUTRAL] So, still now you didn't receive the primary OB and we need to resubmit the claim along with primary OBA, right?
[AGENT][NEUTRAL] Yes, ma'am. Submit the claim form along with the primary insurance EOB.
[CUSTOMER][NEUTRAL] So, is this the same fax number?
[AGENT][NEUTRAL] Yes, it's [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK. [PII] and the attention of the claims department, right?
[AGENT][POSITIVE] Yes, ma'am. You're correct.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you so much. So for this patient we done, I do have 3 more members only. Could you please help me for that?
[AGENT][NEUTRAL] Yes, what's the next policy number, please?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, before moving, is there any reference number for this patient?
[AGENT][NEUTRAL] Yes, for the reference number you can use my name and today's date and my name and today's date would be the reference number for each um claim.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, I got that. Yup. Uh, should I provide the next member ID?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] So, member ID it's 01823114 M as in Mike, L as in Lima, number 6.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Member name is [PII], date for the show, I'm sorry. Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] [PII] with the amount of $204.40. And this one also same concern as the previous.
[AGENT][NEUTRAL] OK. And you said it was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. We still need the UOB for this claim also.
[CUSTOMER][NEUTRAL] But this one also you already double check on there is a note you will be still now, right?
[AGENT][NEUTRAL] That's correct. And also, let me give you the correct policy number um before you rescind this claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me know when you're ready.
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] The correct policy number is 02200833.
[CUSTOMER][NEUTRAL] So the correct policy ID is 02200833, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, this one we done, shall we move that next member?
[AGENT][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yes, ma'am. It is 023.
[CUSTOMER][NEUTRAL] 86873, [PII] [PII] Lima, [PII].
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Member name is here Prime month. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] The service is [PII], with the amount of $204.40.
[AGENT][NEUTRAL] OK, yes, ma'am. We received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3511239.
[AGENT][NEUTRAL] And the claim paid out for $75 even.
[CUSTOMER][NEUTRAL] So pass or event. Thank you. Can I have the payment information, ma'am?
[AGENT][NEUTRAL] Um, yes, it was a single check and the check number is 2004929.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] When was issued unclear.
[AGENT][NEUTRAL] Um, I'm showing that it was issued.
[AGENT][POSITIVE] [PII]. Oh, and I'm showing that it's still outstanding. Um, it didn't clear.
[CUSTOMER][NEGATIVE] Oh, turn on not is clear.
[CUSTOMER][NEUTRAL] Yup. Uh, could you please double check? Did you see that a reissue payment?
[AGENT][NEUTRAL] Um, yes, I'll send a request to reissue payment.
[CUSTOMER][NEUTRAL] Is this a previously one data or not?
[AGENT][NEUTRAL] OK, I'm not showing that on file. Let me check again, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, I'm not showing a request to reissue payment. Um, could you please verify the address where the payment needs to be sent to?
[CUSTOMER][NEUTRAL] Yup, sure. Uh, one more sec.
[CUSTOMER][NEUTRAL] OK, thank you so much for patiently waiting. So the address is uh [PII] sorry, [PII]. Is the same address for you?
[AGENT][NEUTRAL] Um, yes, ma'am. That's the same address and I'll send a request to have the payment reissued.
[CUSTOMER][NEUTRAL] OK. Uh, please do that. Because you, you mentioned previously someone did that same information, but you said that there is no request made, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, do you have any ticket number or a check number for the reissue?
[AGENT][NEUTRAL] Um, no, ma'am, but what you can do is call to check the status of it. Um, just use the member's policy number and you can call and check the status of it within 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK, 7 to 10 business days.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, so today you just send back for a reissue the new payment, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK ma'am, just, yep, uh, the patient should be done. I do have the last one more remember could you please help me?
[AGENT][NEUTRAL] Yes, what's the policy number, please?
[CUSTOMER][POSITIVE] Thank you so much for understanding. Yes, so the last member ID is 02458539 M as in [PII].
[AGENT][NEUTRAL] OK. Thank you. Now please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Member name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Yeah, the data service of [PII] with Billmona for 6 and uh-huh.
[AGENT][NEUTRAL] I'm sorry. Please repeat that.
[CUSTOMER][NEUTRAL] [PII] this year, with the amount of I'm sorry, $682.85.
[AGENT][NEUTRAL] OK. Yes, ma'am. We did receive that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3607963.
[AGENT][NEUTRAL] And this claim paid out for $75.
[AGENT][NEUTRAL] It was a single check.
[AGENT][NEUTRAL] And that check number is 2047784.
[CUSTOMER][NEUTRAL] Have the issue date and they cleared it just to check.
[AGENT][NEUTRAL] The issue date was [PII].
[AGENT][NEUTRAL] And I'm showing that it's still pending and it hasn't cleared yet.
[CUSTOMER][NEUTRAL] It's the same address?
[AGENT][NEUTRAL] Yes, it's the same address as the previous claim.
[CUSTOMER][NEUTRAL] OK. So, make sure I hear the claim number. It's 3607963 and also the check number 047784. Is this right, I hear?
[AGENT][NEUTRAL] Um, the check number is 2047784.
[CUSTOMER][POSITIVE] 02, I missed that. Thank you so much.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, could you please send me the UV through our fax?
[AGENT][NEUTRAL] Yes, what's your fax number, please?
[CUSTOMER][NEUTRAL] Yup. Uh, it's 7, I'm sorry. [PII]. Again, it's uh [PII].
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][POSITIVE] Yes, ma'am. You're right.
[AGENT][NEUTRAL] OK, you should receive it in about 10 minutes. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, nothing else, ma'am. Thank you so much for patiently assisting. That's how we done this call.
[AGENT][POSITIVE] OK. Well, thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.