AccountId: 011433970860
ContactId: 28724bd5-d24e-491c-b3c8-2f80a3a96693
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472640 ms
Total Talk Time (AGENT): 130585 ms
Total Talk Time (CUSTOMER): 148774 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/28724bd5-d24e-491c-b3c8-2f80a3a96693_20250113T21:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh, yes, my first name is [PII], my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] [PII], I can assist you today with claim status. May I have a callback number?
[CUSTOMER][NEUTRAL] Uh, contact number [PII] uh the patient's ID is 02450109.
[AGENT][NEUTRAL] Policy number? OK. Go ahead.
[AGENT][POSITIVE] Thank you. Can I have the um extension you was giving me?
[CUSTOMER][NEUTRAL] The extension code is [PII].
[AGENT][NEUTRAL] And one moment please while I pull up the member's policy.
[AGENT][NEUTRAL] Could you please verify the member's name and their date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] Thank you for verifying the information today you're calling in for claim status. Could you please verify the date of service of the claim you're calling about?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the total charge is $1,787 even.
[AGENT][NEUTRAL] Could you please provide me with the procedure code?
[AGENT][NEUTRAL] Uh, on the claim
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] We have that claim on file. Is this from Commonwealth Radilogy?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Amazing services. So.
[CUSTOMER][NEUTRAL] The CPT code is 76536, so are you saying that uh you don't see any claims for this data service?
[AGENT][NEUTRAL] No, I didn't say that. I didn't say that at all, [PII]. I just was asking you for the procedure code so I can verify because um I need to see um that charge amount is not what I'm seeing, but um let me take a look. I do have a claim for that particular procedure code. Um, let me take up the charge amount.
[CUSTOMER][NEUTRAL] The charge amount is 1000.
[CUSTOMER][NEUTRAL] Oh just hold on $1,787 even after processing, uh, by the primary, the leftover amount which we transfer to the secondary is I'm sorry, $360.95.
[AGENT][NEUTRAL] And the, and this was from radiology?
[AGENT][NEUTRAL] What's the provider?
[CUSTOMER][NEUTRAL] Uh, provider is.
[CUSTOMER][NEUTRAL] San Francis Medical Center.
[AGENT][NEUTRAL] No, I don't have a claim on file for that. Um, could you please um verify the address where you submitted this claim?
[CUSTOMER][NEUTRAL] OK, can.
[CUSTOMER][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] Yes, that is the correct um mailing address. We do have a payer ID number of 6.
[CUSTOMER][NEUTRAL] OK. That's the
[CUSTOMER][NEUTRAL] Uh, yes, they already what is said.
[AGENT][NEUTRAL] 60801. You can also fax it to us [PII]. We would need the claim and also the um explanation of benefits from the primary carrier, but from that provider, I do not have a claim on file. Is there anything else [PII] I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have the
[CUSTOMER][NEUTRAL] Can I have the member's effective date?
[AGENT][NEUTRAL] Sure. The member's effective date is [PII].
[CUSTOMER][NEUTRAL] And what is the timely filing limit?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][POSITIVE] OK, uh, thank you. I have still just one last more patience.
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Could you please provide me with the policy number?
[CUSTOMER][NEUTRAL] Uh yes, the patient's ID 021-73249.
[AGENT][NEUTRAL] Could you please provide me with the name and date of birth of the member?
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] Could you please provide me with the data service that you're calling about today?
[CUSTOMER][NEUTRAL] [PII] and the total charge is uh 16,200.
[CUSTOMER][NEUTRAL] $22.60.
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It does not look like we have a claim on file for that data service.
[CUSTOMER][NEUTRAL] Can I have the uh members effective date?
[AGENT][NEUTRAL] The member's effective date is [PII].
[CUSTOMER][POSITIVE] OK, OK, thank you so much and do you have any call reference number?
[AGENT][NEUTRAL] That will be my name and today's date.
[CUSTOMER][POSITIVE] OK, OK, thank you. That's all I need to have a very blessed day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you