AccountId: 011433970860
ContactId: 15cb543a-dfce-4cc5-b8f9-fd5994f7135a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1047130 ms
Total Talk Time (AGENT): 215701 ms
Total Talk Time (CUSTOMER): 274572 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/15cb543a-dfce-4cc5-b8f9-fd5994f7135a_20250403T15:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm doing great, thank you for asking. It's for claim status. Can you please help me out?
[AGENT][NEUTRAL] I'm sure, so, hon. I can assist you with client status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yes, it will be [PII] the direct line.
[AGENT][NEUTRAL] Thank you, now I need the first policy number.
[CUSTOMER][NEUTRAL] Yeah, before proceed, this call may be recorded for quality and training purposes. Would you like to continue?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Uh, member ID will be 025.
[CUSTOMER][NEUTRAL] 16003 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and and the date of birth will be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] [PII] and the bill amount will be.
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file for [PII].
[CUSTOMER][NEUTRAL] Data service of [PII].
[AGENT][NEUTRAL] That's correct. I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a moment. Let me check. May I know the payer ID?
[AGENT][NEUTRAL] The pay ID is 60801.
[CUSTOMER][NEUTRAL] But this time in mind.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][NEUTRAL] Yes, that's our payer ID.
[CUSTOMER][NEUTRAL] And the member is active for data service, right?
[AGENT][NEGATIVE] No, the member was not active for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is there any other plan to this station?
[AGENT][NEUTRAL] I'm not showing any in our system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, can we please proceed with another patient?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Can you please proceed with another patient.
[AGENT][NEUTRAL] Um, yes, sir. What's the policy number, please?
[CUSTOMER][NEUTRAL] 02455015 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount will be
[CUSTOMER][NEUTRAL] $359 even.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file for [PII].
[CUSTOMER][NEUTRAL] Uh, his patient is active for data service.
[AGENT][NEUTRAL] Yes, ma'am. Well, yes, sir. Um, she was active on the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me just check.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm still here.
[CUSTOMER][NEUTRAL] Yeah, I'm just checking from my end just.
[CUSTOMER][NEUTRAL] Mm, mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, yeah, I have another patient.
[AGENT][NEUTRAL] What's the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, 02262443 ML 8.
[AGENT][NEUTRAL] Please repeat that policy number.
[CUSTOMER][NEUTRAL] 02262443 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] [PII] and uh bill amount will be $197 even.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] is when we received the claim. [PII] is when the claim was processed.
[AGENT][NEUTRAL] The claim number is 3543346.
[AGENT][NEUTRAL] And the claim is denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. Uh, the claim number was 3543346, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can we proceed with another question?
[AGENT][NEUTRAL] Yes, one more.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 0231.
[CUSTOMER][NEUTRAL] 5555 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Her and the date of birth will be [PII] [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount will be $227 even.
[AGENT][NEUTRAL] OK, we received that claim on
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3563609.
[AGENT][NEUTRAL] And the claim denied because we need the ELB from the primary insurance company.
[CUSTOMER][NEUTRAL] 356-3609, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But we have already submitted the.
[CUSTOMER][NEUTRAL] Primary you'll be.
[CUSTOMER][NEUTRAL] Through fax
[AGENT][NEGATIVE] I'm not showing it. I'm showing that we've received this claim 3 times and each time is denying because we need the primary EOB.
[CUSTOMER][NEUTRAL] OK, I'm just confirming uh fax number [PII]. Is that right?
[AGENT][NEUTRAL] Yes, that's correct and please attention it to the client's department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, last 2 more claims.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The system.
[CUSTOMER][NEUTRAL] 0165.
[CUSTOMER][NEUTRAL] 952-8 ML 8.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] The date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $277 even.
[AGENT][NEUTRAL] OK, we received this claim on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] Let's see, one moment.
[AGENT][NEUTRAL] And the claim is denied because we need the ELB from the primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's that date of service again? Please repeat it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the claim number is 3563829.
[CUSTOMER][NEUTRAL] 395 primary you'll be right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, last patient will be 129.
[CUSTOMER][NEUTRAL] 7496 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] [PII] and the bill amount will be.
[CUSTOMER][NEUTRAL] They still
[CUSTOMER][NEUTRAL] $897 even.
[AGENT][NEUTRAL] OK, I'm not showing this claim on file for [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So you are saying no claim on file for [PII], right?
[AGENT][NEGATIVE] Not for the date of service.
[CUSTOMER][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I worked
[AGENT][NEUTRAL] Right, there's no claim on file for her for [PII].
[CUSTOMER][NEUTRAL] Uh, is patient is active for data service?
[AGENT][NEUTRAL] Um, yes, just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and the policy is still active.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can you please spell your name and call reference for this?
[AGENT][NEUTRAL] Yes, the call reference number is my name and today's date. My name is [PII]. Um it's spelled [PII] Last initial [PII], and today's date is the reference number.
[CUSTOMER][NEUTRAL] E V I E, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] OK, thank you [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.