AccountId: 011433970860
ContactId: 155098d3-d80f-4fc1-941a-eba651ab3934
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421220 ms
Total Talk Time (AGENT): 149686 ms
Total Talk Time (CUSTOMER): 163220 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/155098d3-d80f-4fc1-941a-eba651ab3934_20250224T16:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank for calling speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling from provider office, and I want to know about claim information. Could you please help me also for that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can verify claim status for you and I'm sorry, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] It is 02465164, M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] and it is a direct line.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] It is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the charge amount is 1,660 30 cents.
[AGENT][NEUTRAL] OK, and the balance after primary process the claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] Yeah. Actually, uh, there is no any balance. Actually, there is Aetna but uh there is no any payment for this claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know about it. Sorry for that. Mhm.
[AGENT][NEUTRAL] No, you're fine. Well, I don't show we received that claim. Can you verify the mailing address the claim was submitted to?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mailing address, right? Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, give me one second. Let me double check something.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, I apologize. I do show that claim has been received and it looks like a process is needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, missing primary, right? Uh, so, could you please provide me the details for received or processed date?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, the claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So this claim is uh missing for uh denied as missing primary EOB and could you please uh provide me the claim number?
[AGENT][NEUTRAL] Sure, it's 354-804-7.
[CUSTOMER][POSITIVE] 47. OK. Thank you so much for this information. Uh, and could you please provide me the call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, Ms. [PII]. If you like, you may use my name in today's date and it's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for this. And actually, [PII], actually, I have one more claim. So could you please help me also for that claim?
[AGENT][NEUTRAL] And is this for the same patient or different patient?
[CUSTOMER][NEUTRAL] Uh, the patient is different.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, uh give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the next policy number?
[CUSTOMER][NEUTRAL] It is 01480443. M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient name is uh [PII], and the date of birth of this member is
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the charge amount is 4,66227 cents.
[AGENT][NEUTRAL] You said $4,652.27?
[CUSTOMER][NEUTRAL] 62.
[AGENT][NEUTRAL] 62. OK. And do you have the balance after primary for that claim?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, and give me a moment, and I forgot to tell you previously, but um we do have an online service center where providers can check claim status as well as print out the EOB. That site is at secured. [PII] and the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, it is for Nicholas Children's Hospital. And do you, uh, provide me again the, uh, which you gave me, um, the site of this, it is secured after that?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I show this claim processed as needing primary EOB.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, uh, could you please provide me the details for receive or process date?
[AGENT][NEUTRAL] A claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] And [PII] [PII], right?
[AGENT][NEUTRAL] Uh, correct, processed on [PII].
[CUSTOMER][NEUTRAL] OK. And could you please provide me the claim number?
[AGENT][NEUTRAL] 354-7478.
[CUSTOMER][POSITIVE] OK. OK. OK. Thank you so much for this information and have a great day.
[AGENT][POSITIVE] All right, you too, Ms. [PII]. Thanks for calling APL. Bye.
[CUSTOMER][POSITIVE] Thank you.