AccountId: 011433970860
ContactId: 1a0be925-141e-4568-96f2-6022ef1351f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1608369 ms
Total Talk Time (AGENT): 430026 ms
Total Talk Time (CUSTOMER): 416547 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/1a0be925-141e-4568-96f2-6022ef1351f7_20250204T18:20_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes ma'am, I need to find out, um, I have a patient who, um, has you guys as their secondary insurance, and I need to follow up on some claims to see if, um, y'all picked up any of the um.
[CUSTOMER][NEUTRAL] The secondary charges.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] OK my name is [PII].
[AGENT][NEUTRAL] [PII], what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] Sorry I gotta switch clinics here um.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] 0184.
[CUSTOMER][NEUTRAL] 1149.
[CUSTOMER][NEUTRAL] The letter M, the letter L, the number 7.
[AGENT][NEUTRAL] OK, what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, my direct line is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and you said that you had several claims. How many do you have?
[CUSTOMER][NEUTRAL] Um, I have.
[CUSTOMER][NEUTRAL] Um, where did that go?
[CUSTOMER][NEUTRAL] Um, I'm showing.
[CUSTOMER][NEUTRAL] Data service 8:15 through 111 there are.
[CUSTOMER][NEUTRAL] 56789 1011 1213 1415 1617 claims.
[AGENT][NEUTRAL] Is it for the same provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For this one patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the patient's date of birth?
[CUSTOMER][NEUTRAL] The patience is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the patient's name again, is it [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and so what I can do, [PII] is help you create an online account, um, since it's so many for one person and it might be a little easier and quicker, um, let me give you the web address and then I can help you set the account up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the provider's office, go ahead.
[CUSTOMER][NEUTRAL] OK, is it the?
[CUSTOMER][NEUTRAL] Is it the um
[CUSTOMER][NEUTRAL] [PII] and then log in. OK, yeah, OK.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] I'm already on there so.
[AGENT][NEUTRAL] OK, give me one of the, you gave me 8:15 24.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me look at this one.
[AGENT][NEUTRAL] And what's the charge for that day?
[CUSTOMER][NEUTRAL] Uh, the total.
[CUSTOMER][NEUTRAL] Charge amount.
[CUSTOMER][NEUTRAL] What in the world? OK, let me do it this way, um.
[CUSTOMER][NEUTRAL] The total charge was 680.
[CUSTOMER][NEUTRAL] I don't know how much of that got passed to you guys being secondary.
[AGENT][NEUTRAL] Was that what the patient owes is that the total bill charge?
[CUSTOMER][NEUTRAL] That was the total bill charge.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see this claim, so this would be a good one that we can use to locate it online or it's as far as showing you how to um download it or review it or view it on the online service center.
[AGENT][NEUTRAL] Um, and so,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you have not created an account before you're gonna click the uh new user tab to the right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it's gonna ask you to select which role that best describes you.
[CUSTOMER][NEUTRAL] OK, um, I am the third party billing agency, so, uh.
[AGENT][NEUTRAL] Are you calling from a medical or dental provider's office?
[CUSTOMER][NEUTRAL] I'm calling on behalf of them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so you would select that last one. I'm a, I'm a medical provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] And then click next it's gonna ask you for the provider's tax identification number and as you enter that information if you could say out loud what that number is because it has to match what we have in our system in order for you to retrieve the document so give me one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what is the provider's tax ID number for this claim?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and then what is the patient account number? Is this a CMS 1500 form?
[AGENT][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] Um, yeah, I have.
[AGENT][NEUTRAL] Instead of a hospital bill?
[CUSTOMER][NEUTRAL] No, it's um outpatient physical therapy.
[AGENT][NEUTRAL] OK, and so.
[AGENT][NEUTRAL] The patient account number assigned to this claim by the doctor's office should be in box number 26 if it's on a HIFA form.
[AGENT][NEUTRAL] Or a CMS 1500 form.
[AGENT][NEUTRAL] So is it on a hospital claim?
[CUSTOMER][NEUTRAL] Uh, no, it's not.
[AGENT][NEUTRAL] It's professional, OK, so it should be that number should be in box number 26.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] letting me um.
[CUSTOMER][NEUTRAL] Mm, let's see here.
[CUSTOMER][NEUTRAL] Let me do it this way here.
[CUSTOMER][POSITIVE] I'm sorry, thank you for helping me.
[AGENT][NEUTRAL] Oh, you're fine.
[AGENT][POSITIVE] The OSC is a good feature.
[CUSTOMER][NEUTRAL] 1584.
[CUSTOMER][NEUTRAL] Search
[CUSTOMER][NEUTRAL] OK, here is.
[CUSTOMER][NEUTRAL] Let's see um.
[CUSTOMER][NEUTRAL] Charge ID.
[CUSTOMER][NEUTRAL] It's not showing me the 1500 form because of.
[CUSTOMER][NEUTRAL] But I see where it was billed right here.
[CUSTOMER][NEUTRAL] You all
[CUSTOMER][NEUTRAL] That's the OK, here's the.
[CUSTOMER][NEUTRAL] How can I say the 1500?
[CUSTOMER][NEUTRAL] With it being secondary, uh.
[CUSTOMER][NEUTRAL] Sorry, let me try one more thing, and if that doesn't work then.
[AGENT][NEUTRAL] Oh, to try to find the patient account number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] I'm fairly new in this department so I'm trying to get used to it but I think I, I just had a brain sap. I think I know how to do it.
[AGENT][NEUTRAL] Oh, use the online service center you mean?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, the, uh, find the account number.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEGATIVE] Mm that did not work.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Probably
[CUSTOMER][NEUTRAL] I think I was told they use the same account number for.
[CUSTOMER][NEUTRAL] And it's a certain format um.
[AGENT][NEUTRAL] Do you have a copy of the AD the um claim form, the automized bill?
[CUSTOMER][NEUTRAL] Um, not from you guys. I do from the primary.
[AGENT][NEUTRAL] Yeah, it's gonna the itemized bill that's gonna come from the doctor's office, so not the EOB but the itemized bill.
[AGENT][NEUTRAL] That was sent for payment?
[CUSTOMER][NEUTRAL] OK, I got you, um.
[AGENT][NEUTRAL] That's the form that the um.
[AGENT][NEUTRAL] Patient account numbers on the itemized bill.
[CUSTOMER][NEUTRAL] OK, I'm showing um.
[CUSTOMER][NEUTRAL] Let's see, our system integrates what goes on to the policy.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I mean I can
[CUSTOMER][NEUTRAL] Just um pull up one of his pull up that note and see what's on there.
[CUSTOMER][NEUTRAL] I think it's gonna be the um.
[CUSTOMER][NEUTRAL] One that we auto generate for it um.
[CUSTOMER][NEUTRAL] Am I verifying it with you or am I putting it in this um.
[AGENT][NEUTRAL] Both, um, I wanted, I wanted to know what it is so that I know that it matches what we have in our system and you're gonna also put it there in that patient account field.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Believe it is.
[CUSTOMER][NEUTRAL] D 609137542
[AGENT][NEUTRAL] Yes, that's what we have.
[CUSTOMER][POSITIVE] Oh, awesome.
[CUSTOMER][NEUTRAL] D 60.
[CUSTOMER][NEUTRAL] 91375.
[CUSTOMER][NEUTRAL] 42.
[CUSTOMER][NEUTRAL] 42 OK.
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And it should take you to create a username and password.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, at
[CUSTOMER][NEUTRAL] OK, next.
[CUSTOMER][POSITIVE] Your account has successfully been created.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then so from there.
[CUSTOMER][NEUTRAL] OK, so just.
[CUSTOMER][NEUTRAL] Search the claim.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And so then you're going to.
[AGENT][NEUTRAL] Look for.
[AGENT][NEUTRAL] The um file a claim dashboard.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And below that.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It should say claim status for filing a claim you should see and there's two ways you can search. There is a quick access.
[AGENT][NEUTRAL] And the criteria is the.
[AGENT][NEUTRAL] Claim number which I can provide the patient's first name and then the patient's date of birth, and then the other option.
[AGENT][NEUTRAL] Is
[AGENT][NEUTRAL] The patient's date of birth, the patient's first name, and then we would need the last four digits of the primary, so the policy holder's social.
[AGENT][NEUTRAL] The patient account number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the date of service.
[AGENT][NEUTRAL] I don't know if you all ask for socials anymore. They're kind of doing away with that, but.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It depends on the clinic, um, this particular clinic right here is um.
[AGENT][NEUTRAL] Yeah, it does.
[CUSTOMER][NEGATIVE] Not very good at it, um.
[CUSTOMER][NEGATIVE] Yeah, no social in here.
[AGENT][NEUTRAL] So you could search and so you would have to call us for the claim, for the claim number.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] OK, but you said you can provide me with that 8:15 1 correct?
[AGENT][NEUTRAL] The claim number, yes.
[AGENT][NEUTRAL] And I have it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it's 353.
[AGENT][NEUTRAL] 4980.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] OK, one claim sound.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I greatly appreciate your help.
[AGENT][NEUTRAL] Oh, you're welcome. And so you said that they're all for this patient?
[CUSTOMER][POSITIVE] Yes, and I have a feeling they're all gonna follow in suit.
[AGENT][NEUTRAL] So if you give me the date of.
[AGENT][NEUTRAL] OK, because you, you now can see the claims for that patient.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Or did it just pull up that ELB for that particular claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just that particular claim number um.
[CUSTOMER][NEUTRAL] Clicking on it now and seeing if it maybe provides me any additional.
[CUSTOMER][NEUTRAL] Access.
[AGENT][NEUTRAL] You know I'm thinking if you go the longer way it will probably populate all of the claims.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, really not necessarily because some of the claims may not be from this office, so then it would be based on the date of service and the tax ID. Well, but you have you're in the tax ID number for this provider so any claims that you see should be for this for for donor physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it's only
[CUSTOMER][NEUTRAL] And I wrote that claim number down. I'm gonna see if I can find it somewhere where I have access to it in the future, um.
[AGENT][NEUTRAL] And you don't have a social for this patient, the last 4 of the primary?
[CUSTOMER][NEUTRAL] Uh, no, I do not.
[AGENT][NEUTRAL] OK, because I'm thinking if you had the last 4 and you use the longer search it would possibly populate the claims that they that we paid for the patient.
[AGENT][NEUTRAL] Thus you would be able to see all of them that you have, so do you want me to give you the claim number for each of the ones that you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, that would, that would be great.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So go ahead and give me uh the claim numbers, I mean the dates of service, you can just give me like 5 at a time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we've got.
[CUSTOMER][NEUTRAL] The remainder of August we got the [PII], the [PII], and the [PII].
[AGENT][NEUTRAL] Is it the same charge?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So moving forward they're all gonna be the same charge that first visit was a.
[CUSTOMER][NEUTRAL] First visit charge so um moving forward they're gonna be 4.
[CUSTOMER][NEUTRAL] Oh, that's the insurance adjustment, um.
[CUSTOMER][NEUTRAL] Moving forward they're gonna be $490.
[AGENT][NEUTRAL] 490 even. OK, so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So for the [PII] date of service, the the claim number is 353.
[AGENT][NEUTRAL] 4960.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the [PII] date of service.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 4955.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the
[AGENT][NEUTRAL] 828 date of service it's [PII].
[AGENT][NEUTRAL] 94 I'm sorry 353-4949.
[CUSTOMER][NEUTRAL] OK, and for September we got.
[CUSTOMER][NEUTRAL] Um, the [PII], the [PII], the [PII], [PII], and [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that too many?
[AGENT][NEUTRAL] No, that's fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], it's 353.
[AGENT][NEUTRAL] 4944.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], it's 353-493-9.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] is 353.
[AGENT][NEUTRAL] 4933.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 493 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the [PII].
[AGENT][NEUTRAL] I'm not showing one for [PII], OK, [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] I'm not showing one for [PII] for [PII].
[CUSTOMER][NEUTRAL] Huh.
[AGENT][NEUTRAL] I'll look one more time.
[AGENT][NEUTRAL] Mm, I don't show one for [PII].
[CUSTOMER][NEUTRAL] OK, I'll look into that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII] we've got October and then we've got just two dates in November, um.
[CUSTOMER][NEUTRAL] We've got the [PII].
[CUSTOMER][NEUTRAL] The [PII]
[CUSTOMER][NEUTRAL] The [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is it for [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII] is the [PII] and the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have any October.
[AGENT][NEUTRAL] Claims
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I do see a [PII].
[CUSTOMER][NEUTRAL] That is strange, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh, and that's 354-7806.
[AGENT][NEUTRAL] And then you said [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII] is 354.
[AGENT][NEUTRAL] 7809.
[AGENT][NEUTRAL] And I'm gonna go back to October and look for some of the others.
[AGENT][NEUTRAL] No, 108 is not there.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Looking at EMO Well, I mean if November paid, I don't know if maybe there was a lapse in coverage or.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Not showing one though.
[AGENT][NEUTRAL] Let's see 10:10.
[AGENT][NEUTRAL] Not there. 10:22.
[AGENT][NEUTRAL] Nope, 10:29.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] 10:31.
[AGENT][NEUTRAL] Yeah, I don't have one claim for the month of October for [PII].
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I'm looking back at my.
[CUSTOMER][NEUTRAL] So I can see notes where all the claims were mailed but there's none.
[CUSTOMER][NEUTRAL] There's no record of October being mailed.
[CUSTOMER][NEUTRAL] With primary pay DOBs so.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, do y'all have a stipulation on timely filing?
[AGENT][NEGATIVE] There's no timely filing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and um.
[CUSTOMER][NEUTRAL] I guess since now I have access I.
[CUSTOMER][NEUTRAL] I can OK I can file it online.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect alright well thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Anything else I can assist with today, [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alrighty well thank you for calling [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.