AccountId: 011433970860
ContactId: 160c69f6-1018-4bfc-b39b-0ff41c5cc16d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318760 ms
Total Talk Time (AGENT): 119497 ms
Total Talk Time (CUSTOMER): 62202 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/160c69f6-1018-4bfc-b39b-0ff41c5cc16d_20241230T14:10_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider office to check the claim status. Could you please repeat your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. My name is [PII]'s [PII].
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] And Ms. [PII], may I, you're welcome. May I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The call back is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy ID right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02571804.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, the patient name is [PII]. Date of birth is.
[CUSTOMER][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] OK, perfect. And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this is for dental or this is for medical?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if I can find this claim, and for future you can check claim status online through our website at [PII], and that's just optional. Bear with me, let me see if I have that claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Really
[AGENT][NEUTRAL] Let me put this.
[AGENT][NEUTRAL] Gonna be a and I'm waiting on the EOB.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim [PII].
[AGENT][NEUTRAL] And the claim was, um, it looks like it's denied. Let me check the reason. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so with this one, this goes to a third party, so it's waiting for eligibility for benefits and a card to continue the processing of the claim.
[CUSTOMER][NEUTRAL] Uh sorry, what, what?
[AGENT][NEUTRAL] It's under review.
[AGENT][NEUTRAL] It's pending for eligibility from benefits in a card.
[CUSTOMER][NEUTRAL] Eligibility is uh pending.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm, I don't understand the denial reason.
[AGENT][NEUTRAL] Is pending from eligibility from benefits in a card, so we're waiting for eligibility information from benefits in a card so we can reprocess the claim.
[CUSTOMER][NEUTRAL] Um, so you are the third party to the original PA, am I right?
[AGENT][NEUTRAL] No, we're not the third party. Benefits in a car is the third party.
[AGENT][NEUTRAL] So we're waiting for them to confirm eligibility for us to process the claim. So we need to wait for that eligibility to be processed in order to be processed the claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so the benefits and eligibility handled by other team that's third party. You need the information from them.
[AGENT][NEUTRAL] Which is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Correct?
[AGENT][NEUTRAL] Which is benefits in a card, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know who need to update this information?
[AGENT][NEUTRAL] Benes in a card?
[CUSTOMER][NEUTRAL] OK, may I know the claim number?
[AGENT][NEUTRAL] OK, that is 354.
[AGENT][NEUTRAL] 3859.
[CUSTOMER][NEUTRAL] Thank you. May I get the reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[AGENT][NEUTRAL] Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] No, that's it from my end. Thank you have a great day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL the balance [PII].
[CUSTOMER][NEUTRAL] Bye bye.