AccountId: 011433970860
ContactId: 3016e840-65a7-434e-8069-c1af7b70888f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1468439 ms
Total Talk Time (AGENT): 327006 ms
Total Talk Time (CUSTOMER): 495151 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/3016e840-65a7-434e-8069-c1af7b70888f_20250224T15:41_UTC.wav
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[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] This is. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Caros Pediatrics. Please be informed that this call is being recorded and monitored for quality and training purposes, and I made this call to get a claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status and what was the name of the facility again that you're calling for?
[CUSTOMER][NEUTRAL] It is Care Plus Pediatrics.
[AGENT][NEUTRAL] OK, thank you sir and then what is the uh callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My callback number is [PII]. It is a direct line. There is no extension.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] Could you spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome [PII] and then what is the name of the patient, the date of birth and the policy number?
[CUSTOMER][NEUTRAL] OK. For this, the patient's first name is [PII], and the last name is [PII]. Date of birth is [PII]. And the member ID number is 017921 uh I'm sorry, I will repeat it. It's 01792110.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] OK, the rate of services, um, it is [PII] with the bill amount of $174 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually we have billed for the primary it's $224 and uh.
[CUSTOMER][NEGATIVE] We bill for second it's $174 even and the remaining amount needs to be paid at $30.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold, [PII], while I look up this uh this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. I did um I did look for the claim and on that data service of [PII] is not a claim on file.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] So, I'm I audible?
[AGENT][NEUTRAL] Yes I can hear you now.
[CUSTOMER][NEUTRAL] Oh, OK. Actually, uh, I can find we have submitted, uh, the claim nearly 12, uh, nearly 3 to 4 times from the port by the portal.
[AGENT][NEUTRAL] OK, I'm not finding the claim on file for the data service of [PII].
[CUSTOMER][NEUTRAL] Uh, we have sometimes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I can understand. So there is no claim on file and also we have submitted as a portal submission. Sometimes we have submitted as an appeal. So we need to submit it through, uh, the address.
[AGENT][NEUTRAL] Uh, let me look and see, um, when was the last time you submitted it through the portal?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] When was the time you submitted it through the portal?
[CUSTOMER][NEUTRAL] Oh, your voice is breaking. I'm sorry.
[CUSTOMER][NEUTRAL] OK. Recently we have submitted.
[AGENT][POSITIVE] Oh sorry about that. Let me see if I can fix that real quick.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mm, upon checking here, recently we have submitted.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK, let me look and see.
[CUSTOMER][NEUTRAL] Along with the EOB we have submitted OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it would the claim be under a different name other than Kapless Pediatric?
[CUSTOMER][NEUTRAL] Mm, I'm sorry. You're asking, uh, we have submitted a different member?
[AGENT][NEUTRAL] No, would it be under a different facility name?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, let me check. I am maybe the facility name known as QS.
[CUSTOMER][NEUTRAL] PEDS, uh, pediatrics medicine uh LLC, DBA Care Plus Pediatric Urgent Care.
[AGENT][NEUTRAL] No, I don't find one.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Let me give you the mailing address.
[CUSTOMER][POSITIVE] No problem. We, we may submit it that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. The mailing address is.
[CUSTOMER][NEUTRAL] Mm, yeah, I will get it. Please give me a moment.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][POSITIVE] Yeah, I'm ready for the address.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And that is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the timely filling limit?
[AGENT][NEUTRAL] We don't have one
[CUSTOMER][NEUTRAL] Oh, there is no specific timely filing limit. OK. May I know the effective and termination date for the member.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The effective date is.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy terminated on [PII].
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] And you are the secondary for the member, am I correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, I think I gathered all the information. Um, nearly, I have 5 more clients. If you don't mind, could you help me with that?
[AGENT][NEUTRAL] Do you have another claim that needs to be researched?
[CUSTOMER][NEUTRAL] Uh, yeah, I have nearly 1234.
[CUSTOMER][NEUTRAL] Uh, nearly 6 to 7 clients I have on my end and the different patient and different provider.
[AGENT][NEUTRAL] OK. All right, let's start with the next patient.
[CUSTOMER][NEUTRAL] Mm Sure. Before that, could you help me with the call reference number?
[AGENT][NEUTRAL] Yes it's my name [PII] and today's date and that'll be the call reference number on everyone.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much once again please give a moment. I will provide the next information for you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I got the next information. May I go ahead?
[AGENT][NEUTRAL] OK, what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, for the next one, the policy number is.
[CUSTOMER][NEUTRAL] Mm, OK, yeah, it is 60801.
[AGENT][NEUTRAL] OK, that is our.
[CUSTOMER][NEUTRAL] And the first name is
[AGENT][NEGATIVE] That's not a good policy number, that's our payer ID number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me check it out.
[CUSTOMER][NEUTRAL] Uh, yeah, that's
[CUSTOMER][NEUTRAL] Oh that's.
[CUSTOMER][NEUTRAL] OK. Other than that, the first name is [PII] Last name is [PII], and date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you spell the first name, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] And last name is [PII]
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] OK, let me see if I can find that patient by the name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, OK, actually, I can see here, uh the last name is [PII] Oh I found it in the ID code.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] they
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, and what state does [PII] live in?
[CUSTOMER][NEUTRAL] Mm let me check it up.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK let me see if I have a Carla in [PII].
[AGENT][NEUTRAL] OK, let me try the other name.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Do you have the street address?
[CUSTOMER][NEUTRAL] Um, yes, I have the full address is [PII] State is [PII] Zip code is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I do not have a Carla.
[AGENT][NEUTRAL] [PII] or a Carla Cruz [PII], or [PII] or [PII].
[AGENT][NEUTRAL] In that state with that address in our system.
[CUSTOMER][NEUTRAL] Mm, OK, I found, let me check please give me a moment.
[AGENT][NEUTRAL] If you have the social security number, I'll look that way.
[CUSTOMER][NEUTRAL] Um, sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yes, I have the Social Security number. It is [PII].
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I think I found her. OK, what is the date of service?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Date of services, um, sure. Date of services, um, it's [PII].
[CUSTOMER][NEUTRAL] With a billed amount of
[CUSTOMER][NEUTRAL] OK. $9.87.
[AGENT][NEUTRAL] OK. And what is the charge after primary insurance paid their part?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. Actually, the primary we have billed at $351.34.
[CUSTOMER][NEUTRAL] And for secondary, we have billed worth $9.87 and expecting the payment for $5.08 9 cents.
[AGENT][NEUTRAL] OK, and what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] For this one, the facility name is Millennium Physician Group LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull in this claim. I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I have the claim pulled up um the claim number is 3541516.
[AGENT][NEUTRAL] The claim was paid on [PII].
[AGENT][NEUTRAL] To Millennium Physicians Group.
[AGENT][NEUTRAL] And the check number is 2018539.
[CUSTOMER][POSITIVE] Thank you so much. Uh, I'm audible.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Oh, OK. May I know when the claim has been received and processed?
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] And let's see when it was received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me check it out.
[CUSTOMER][NEUTRAL] OK, thank you so much and uh you said that the claim number is 3541516. Am I correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, it was paid through single check?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the check number which um I hear is 2018539.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] And it, OK, thank you so much. It was issued on [PII] and right now when it got cleared.
[AGENT][NEGATIVE] It has not been cleared.
[CUSTOMER][NEUTRAL] Oh it's still not clear, OK.
[CUSTOMER][NEUTRAL] Could you verify the pay to address and patient account number for me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It was Millennium Physicians Group LLC [PII] and the zip code is [PII].
[CUSTOMER][NEUTRAL] You see.
[CUSTOMER][NEUTRAL] Uh, it's same, uh, could you verify the patient account number for me?
[AGENT][NEUTRAL] Yes, it is the account number that you gave me.
[AGENT][NEGATIVE] No, it's not. You didn't give me that one. I had to look that one up.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Yeah, I do not. Uh-huh, OK.
[AGENT][NEUTRAL] It is 251.
[AGENT][NEUTRAL] 251-436-1.
[CUSTOMER][NEUTRAL] Oh, it's not a patient account number uh.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes, the patient's policy number is.
[CUSTOMER][NEUTRAL] OK, I have the, I
[CUSTOMER][NEUTRAL] No, I'm not verifying about the policy number. Uh, I'm verifying about the patient control number. Um, otherwise, I will provide you. Could you check if it is available on your end?
[AGENT][NEUTRAL] Yes, I'll give it to you. It is [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I got it, but your voice is breaking in between, um, by telling the number. It's OK. I will repeat it. If you don't mind, could check with that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. It is [PII] [PII] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Oh thank you so much once again and uh.
[CUSTOMER][NEUTRAL] Could you send a fax a copy of COB?
[AGENT][NEUTRAL] Yes, I'm gonna, can I get your fax number?
[CUSTOMER][NEUTRAL] Of course, my fax number is [PII], and you may send it in the attention of patient account number.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Can you repeat the fax number for me one more time please?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[CUSTOMER][NEUTRAL] And um I'm sorry, I forgot to ask the allowed and paid amount. May I know how much it uh allowed unpaid amount is?
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] The paid amount is $5.89.
[CUSTOMER][NEUTRAL] OK, same to the allowed amount.
[AGENT][NEUTRAL] Yes, I'm gonna put you on a brief hold again.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK I have that fax on on the way to you now.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah, we move to the next one.
[AGENT][NEUTRAL] OK, I'll need the patient's name, date of birth, and policy number, please.
[CUSTOMER][NEUTRAL] OK, sure. Please give me a moment I will provide.