AccountId: 011433970860
ContactId: 1fb5f13a-2fad-4c21-b8e2-7ddb988fea4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1156589 ms
Total Talk Time (AGENT): 285478 ms
Total Talk Time (CUSTOMER): 356823 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/1fb5f13a-2fad-4c21-b8e2-7ddb988fea4e_20250513T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes, and I'm looking for the corrected claim status.
[AGENT][NEUTRAL] OK, I could check on that time for you. uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, yeah, I do have the policy number. It will be.
[CUSTOMER][NEUTRAL] 01973092.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yeah. The name of the member will be [PII], and date of birth will be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you for that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK and then do you have that uh billed amount?
[CUSTOMER][NEUTRAL] Yeah, I do have to bill amount. The bill amount will be.
[CUSTOMER][NEUTRAL] OK, bear with me just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's $1,699.88.
[AGENT][POSITIVE] OK, got it. Thank you. One moment please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK and then uh what was the tax ID uh for this provider [PII]?
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[AGENT][POSITIVE] OK, thank you for that one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the only claim I have on file for this member for this state of service from that provider, [PII], uh, was for the amount of $286.34. Is that the remaining balance after major medical paid?
[AGENT][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEUTRAL] Uh yeah, I'm just checking. Give me a minute, yeah, I was talking on the.
[AGENT][POSITIVE] Oh sure, yeah, no worries.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's loading, bear with me.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Uh, after, OK, after the
[CUSTOMER][NEUTRAL] Amount, the secondary amount remains is for $305.93. It is not $286.34.
[AGENT][NEUTRAL] OK then it appears that we've not received that claim [PII] again this is the only claim we have for this day of service uh from this provider.
[CUSTOMER][POSITIVE] OK, perfect. Just a moment. Give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, just a moment, give me a second.
[AGENT][NEUTRAL] You're fine, of course.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please tell me is the patient active on the date of service?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, OK, and I will also tell you [PII] that the policy number you had originally given me was an older policy number. So whenever you're ready, I'll give you the policy that is uh active during this date of service.
[CUSTOMER][NEUTRAL] OK, you can give me.
[AGENT][NEUTRAL] OK, that is 0243.
[AGENT][NEUTRAL] 5032.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. This policy number is active.
[AGENT][NEUTRAL] Yes, so this one's effective date was [PII], and it is currently active.
[CUSTOMER][NEUTRAL] OK, still active.
[CUSTOMER][NEUTRAL] And for the which one the member ID which I gave you is not active on the date of service.
[AGENT][NEUTRAL] That's correct. That one terminated [PII].
[CUSTOMER][NEUTRAL] OK. Bear with me just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, so, uh, we need to build, uh, you guys the claim with the new member ID, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you primary or secondary for the member?
[AGENT][NEUTRAL] This is their secondary medical policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So we would need the primary EOB uh when you send us this information.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] OK, perfect. And when was the last coordination of benefits updated? Do you have any information?
[AGENT][NEUTRAL] I do not.
[CUSTOMER][NEUTRAL] What will be claim submission, uh, timely filing?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] And what will be the mailing address to submit the corrected claim?
[AGENT][NEUTRAL] Yes, so I've got a mailing address, a fax number, and a payer ID if you'd like that, um, so our mailing address is [PII].
[CUSTOMER][NEUTRAL] To do a 3 by 19.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So uh.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] And what will be the pay ID?
[AGENT][NEUTRAL] That is 60801.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, and the preferred mode of submission will be either mail or electronic.
[AGENT][NEUTRAL] Uh, or our facts.
[CUSTOMER][NEUTRAL] And facts
[AGENT][NEUTRAL] Yes, that fax number that is 8877365.
[CUSTOMER][NEUTRAL] Fax number?
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Perfect. OK, and the call reference number will be your name and today's date.
[AGENT][NEUTRAL] Uh, first name, last initial, and today's date. Uh, so my last initial is [PII], and was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] And could you please tell me
[CUSTOMER][NEUTRAL] Yeah, could you please tell me your name once again?
[AGENT][NEUTRAL] Oh, sure, it's [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] OK. And uh, could you please assist me with a few more claims. I have more 3 claims on the file.
[AGENT][NEUTRAL] Was this for the.
[AGENT][NEUTRAL] OK, was this for the same member [PII] or were these for different members?
[CUSTOMER][NEUTRAL] It's for the different member.
[AGENT][NEUTRAL] OK, yes, one moment, I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[AGENT][POSITIVE] OK, I appreciate your patience. You can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 02449756.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, the first name of the member will be [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service please?
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] The date of service for this one is [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then uh that bill amount please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $31,000 900, OK. It's $31,900 even.
[AGENT][POSITIVE] OK, OK, thank you one moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Was this from uh a different provider [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, it's for a different provider.
[AGENT][NEUTRAL] OK, what was the name of this provider?
[CUSTOMER][NEUTRAL] It's orthopedic surgery center of San Antonio.
[AGENT][NEUTRAL] Got it. OK, thank you for verifying that. One moment please.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And [PII], I just need the copy of you before this member.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Do you happen to have that claim number, [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, I do have the claim number. The claim number is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 353-927-2
[AGENT][NEUTRAL] OK, so for that claim that one is stating that that one is a duplicate. So if you'll give me one moment, I will, uh, I can still send that to you if you'd like um did you want me to try to find the original claim for you?
[CUSTOMER][NEUTRAL] Uh yeah, bear with me just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] So the claim number which I gave it's denied as duplicate.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, I do have the one more claim. Just a moment, claim number.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah. The claim number is 3516592.
[AGENT][NEUTRAL] OK. Let me get that.
[AGENT][NEUTRAL] OK, yes, so this is the one that we did pay a benefit for, um, and you just needed that EOB you didn't need any further information regarding this claim?
[CUSTOMER][NEUTRAL] Uh, no, I need, don't need the further information. I will just verify the information with you. And the claim was received on [PII], processed on [PII], and paid on [PII]. Am I right?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let's see, give me just a moment. So yes, received [PII], processed [PII]. Let me get that check information. One moment, please.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, yes, uh, so the check was issued, uh, [PII] and it was cleared [PII], and that amount again was $481.01.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, yeah, you're right. So could you please send me the copy of UP?
[AGENT][NEUTRAL] Absolutely. Do you have a fax number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] in attention to the patient's account number and the patient's account number will be 1. OK, to the patient's account number and the patient's account number will be 127537 [PII].
[AGENT][NEUTRAL] OK, alrighty, um, so let me read that fax number back to you to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, got it. I will go ahead and send that now. I should get it within about 10 minutes or so. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, it was just the copy of you shall we move to the next one?
[AGENT][NEUTRAL] Um, give me just a moment. Let me get this information sent, and then I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] OK. I really appreciate your patience, [PII]. Thank you so much for waiting. Um, you can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 018.
[CUSTOMER][NEUTRAL] 16167.
[AGENT][NEUTRAL] OK, and then the name and date of birth for this number, please?
[CUSTOMER][NEUTRAL] Yeah, the name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] OK. And date of birth, please?
[CUSTOMER][NEUTRAL] The date of birth will be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then uh what was the date of.
[CUSTOMER][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] [PII]