AccountId: 011433970860
ContactId: 194d4e22-3931-4297-b2a5-e7dd4d3d76af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307609 ms
Total Talk Time (AGENT): 119363 ms
Total Talk Time (CUSTOMER): 145996 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/194d4e22-3931-4297-b2a5-e7dd4d3d76af_20250121T16:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I was calling to see if I can get some information on a claim um that we submitted.
[AGENT][NEUTRAL] OK, I can help you with the claim status and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure my name is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is 01666.
[CUSTOMER][NEUTRAL] 167.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Eller date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] 85 2024 amount was 4147.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Equip for life or Greenville Health Corporation?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] What's your tax ID?
[CUSTOMER][NEUTRAL] Um, it is, hang on, let me see here.
[CUSTOMER][NEUTRAL] Uh, let's see which one I use real quicker.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so we have not received a claim. Um, there's no claim on file from your provider. There is one claim for this data service, but it's a different provider and tax ID.
[AGENT][NEUTRAL] Um, but there's no timely filing. So let me see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The policy has been, oh, the policy has been active since [PII]. So there's no timely filing. You can still file the policy as long as the policy was active on your data service. I'm sorry, not file the policy, file the claim.
[CUSTOMER][NEUTRAL] I know what you meant it's OK, um.
[AGENT][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] Well, so there was no under a different was it filed underneath a different.
[CUSTOMER][NEUTRAL] You said a different claim, I mean a different NPI maybe?
[AGENT][NEUTRAL] Well, no, not MPI. It's a different total bill, a different provider and tax ID.
[CUSTOMER][NEUTRAL] Oh, got you, OK.
[AGENT][NEUTRAL] So it's a claim for the same date, but it's different information than y'all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm, that's strange. Oh, I wonder if it was from maybe a hospital visit or something.
[CUSTOMER][NEUTRAL] OK, um, OK, so or maybe whatever happened on that day, um, or maybe it was the doctor's office, maybe it could be too, OK, so we need to resubmit it, you said?
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEUTRAL] OK, let me just make sure that I have the correct address that we're submitting to. Hang on one second. I have [PII].
[AGENT][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] OK, no, so that's the wrong, that's the old claims mailing address. Let me give you the new one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII]
[CUSTOMER][NEUTRAL] And that's
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] It's OK for the um prefix right for [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then go ahead for the.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK, thank you, [PII]. I appreciate your help today and so we'll get that, so new claim submitted.
[CUSTOMER][POSITIVE] And then we will be able to get that paid. OK, wonderful, hopefully so.
[CUSTOMER][NEUTRAL] And then you, so you need the claim, the um progress notes and the.
[CUSTOMER][NEUTRAL] Do do you need the, um, I mean the medical notes and the order from the physician?
[AGENT][NEUTRAL] No, we really just need the, um, so the claim form, the explanation of benefits from primary insurance, the itemized bill um showing the ICD 10 diagnosis codes and the procedure codes and then all the charges.
[CUSTOMER][NEUTRAL] Oh, OK, the EOB, OK.
[CUSTOMER][NEUTRAL] OK, so itemized bill.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Alrighty. Alright. Well, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that should be it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL and I hope you have a great day, [PII]. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thanks you too mhm bye.
[AGENT][POSITIVE] Thank you, bye bye.