AccountId: 011433970860
ContactId: 2f198a1b-ab49-4d1d-888a-9de38d8eed9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641200 ms
Total Talk Time (AGENT): 170057 ms
Total Talk Time (CUSTOMER): 227695 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/2f198a1b-ab49-4d1d-888a-9de38d8eed9b_20250515T20:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Mercy Hospital checking on the claim status. Your name is [PII]?
[AGENT][NEUTRAL] Uh, with the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And spell your name for me?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] Give me that one more time.
[CUSTOMER][NEUTRAL] And what [PII]
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh [PII], I'm sorry.
[CUSTOMER][POSITIVE] Yes, it's OK.
[AGENT][NEUTRAL] Oh, [PII], got it. And you said that you're checking for claim status. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. Policy number 02511984.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII], with extension [PII].
[AGENT][NEUTRAL] OK. That's a long extension.
[CUSTOMER][NEUTRAL] Mm yeah mm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Patient name, it is spelled as [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Alright and verify the date of uh service and the total charge and we can check status for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of birth [PII]. Total bill charges $7,516.51.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Did you give me that? And I missed it.
[CUSTOMER][NEUTRAL] [PII], yeah, yeah. [PII] date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And is this the surgeon's charge or the facility?
[CUSTOMER][NEUTRAL] Facility.
[AGENT][NEUTRAL] OK, now I'm not showing that we've received the facility chart for [PII] at [PII].
[CUSTOMER][NEUTRAL] OK. For the bill charges $7,516.51.
[AGENT][NEGATIVE] Not received at this time.
[CUSTOMER][NEUTRAL] Because it was admitted to electronic on [PII].
[AGENT][NEUTRAL] To what payer ID number?
[CUSTOMER][NEUTRAL] Mm let me check the ID number.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mhm that's the correct number but I'm not showing it received.
[CUSTOMER][NEUTRAL] OK. Thank you. And can you please provide me the effective date and um date for this number?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And did you need any anything else other than the effective and the effective date?
[CUSTOMER][NEUTRAL] Mailing address and the time finding limit to submit the claim.
[AGENT][NEUTRAL] OK, no, no timely filing limit. The claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 8950.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] The one that you just gave me? Payer ID is 608001 [PII].
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Is that where you sent the claim or was, is that where the claim was submitted?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no time defining limit, right?
[AGENT][NEUTRAL] In one moment.
[AGENT][NEUTRAL] No timely filing. Let me get you the effective date. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Showing a policy effective date of.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And this policy is active.
[CUSTOMER][NEUTRAL] [PII] and still active.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. For this patient, I have one more claim for the different date of service.
[AGENT][NEUTRAL] The data service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of service, [PII].
[CUSTOMER][NEUTRAL] Total bill charges.
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] $7,018.20.
[AGENT][NEUTRAL] OK, and is this the only other claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You can also check your status, your claim status online at [PII] as well.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name of the hospital?
[CUSTOMER][NEUTRAL] Mercy Hospital Lincoln.
[AGENT][NEUTRAL] Does it go by another name?
[CUSTOMER][NEUTRAL] Mm, no, Mercy Hospital.
[AGENT][NEUTRAL] OK, I see that charge but not for mercy.
[AGENT][NEUTRAL] So this must be for a different provider?
[CUSTOMER][NEUTRAL] Uh, actually it's different provider, yeah.
[AGENT][NEUTRAL] And what is the name of the provider of the hospital?
[CUSTOMER][NEUTRAL] Yeah, hospital name Mercy Hospital Lincoln and the NPI number 1962808733.
[AGENT][NEUTRAL] What's the tax identification number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, this is not the claim, so I don't show your claim on file.
[AGENT][NEUTRAL] The NPI and tax ID number doesn't match and the name of the hospital doesn't match.
[CUSTOMER][NEUTRAL] For this one also, I did notice it.
[CUSTOMER][NEUTRAL] Yeah, OK, let me recheck the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Facility name Mercy Hospital Lincoln and the NPA number 1962808733.
[AGENT][NEUTRAL] And we base it off of the tax identification number.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] And I'm saying the claim that we have, ma'am, that does not match the tax ID.
[CUSTOMER][NEUTRAL] OK. Do you have the claim for the, yeah. Do you have the claim for the bill charges $71,820.20?
[AGENT][NEUTRAL] That we have
[AGENT][NEUTRAL] From the facility, the facility name you provided, no, and with the tax identification number you provided, no.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Because for the same date of service, we have submitted two claims. One is $898 even. It's under professional claim. The provider just in.
[AGENT][NEUTRAL] OK, and what's the, what's the total charge?
[CUSTOMER][NEUTRAL] $898 even.
[AGENT][NEUTRAL] And what is the provider's office name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]pital, Lincoln.
[AGENT][NEGATIVE] Mm, don't show it on file.
[CUSTOMER][NEUTRAL] They're showing that East Communities, Mercy Hospital East Communities.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] I'm not showing it on file.
[CUSTOMER][NEUTRAL] Uh, stating that the claim is not on file or the provider?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, the provider's claim is not on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The one that you gave me, the two that you gave me are not on file.
[CUSTOMER][NEUTRAL] For this [PII]
[CUSTOMER][NEUTRAL] OK, got it. For the uh Mercy Hospital Lincoln, you don't have the claim for the date of service [PII]. Bill charges $7,018.20 right?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK. Like the previous one, there is no claim on file.
[AGENT][NEUTRAL] The claims have not been received, ma'am, for Mercy Hospital Lincoln.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Can, is it the same effective date and the term date?
[AGENT][NEUTRAL] It's the same, it's the same family, so that information is gonna be the same.
[CUSTOMER][NEUTRAL] Mailing address and the pay ID.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I said it's for the same policy number, so the effective date is going to be the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] My name and today's date?
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for providing that information. Have a great day. Bye. Take care.
[AGENT][POSITIVE] You're welcome. Thanks for calling APO Monica. Have a good day as well.
[CUSTOMER][POSITIVE] Thank you.