AccountId: 011433970860
ContactId: 3043865d-6d2c-4296-a1d7-ef8bb306824d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577599 ms
Total Talk Time (AGENT): 152569 ms
Total Talk Time (CUSTOMER): 195634 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/3043865d-6d2c-4296-a1d7-ef8bb306824d_20250613T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII], uh, calling from the provider office to check claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, member ID, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the member ID is 01481848 M as in mom, L as in Lima.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] His name is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, data service amount of the data service amount of the charge.
[CUSTOMER][NEUTRAL] Yes, so data service is [PII]. build a mortgage to $121 even.
[AGENT][NEUTRAL] OK thank you hold on one moment please.
[CUSTOMER][NEUTRAL] And could you please spell your name once, actually?
[AGENT][NEUTRAL] I don't show the claim.
[AGENT][NEUTRAL] Sure, it's [PII] last initial [PII], and I don't show the claim has been received. Can you verify the mailing address the claim was submitted to?
[CUSTOMER][NEUTRAL] Uh, sure, definitely. Give me a moment.
[CUSTOMER][NEUTRAL] Surgery, uh.
[CUSTOMER][NEUTRAL] So I can
[CUSTOMER][NEUTRAL] The claim was submitted, uh.
[CUSTOMER][NEUTRAL] Paper and the mailing address is [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], OK. [PII]. Is that correct one?
[AGENT][POSITIVE] Uh, that is correct. Mhm.
[AGENT][NEUTRAL] Um, that is correct mailing address.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Or you can fax it to us if you like.
[CUSTOMER][NEUTRAL] Uh, sure, definitely, but, uh, the mailing address is correct only, right?
[AGENT][POSITIVE] The mailing address is correct.
[CUSTOMER][NEUTRAL] OK. So, could you please check from your side?
[AGENT][NEUTRAL] From our side, what? I already tell you we have not received the claim. So you can either remail it or you can fax it to us.
[CUSTOMER][NEUTRAL] OK, so give me a moment. Let me just crosscheck from my side.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me a second. Uh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 610.
[CUSTOMER][NEUTRAL] OK, so as I can see that uh.
[CUSTOMER][NEUTRAL] Could you please check, uh, is there any rejection on this claim from your side?
[AGENT][NEUTRAL] Sir, we have not received the claim. It has not been received to process. So you can remail it or you can fax it to our office.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, so it was not.
[CUSTOMER][NEUTRAL] So, definitely, so, uh, there is a clearing house, right, to reject the claim. After that, if there is no anything, then they will send it to you, right? So that's the reason uh to, I'm asking you to check the rejection.
[CUSTOMER][NEUTRAL] From the clearing house.
[AGENT][NEUTRAL] Well, I wouldn't know anything as far as the clearing house. All I know is we had not received the claim.
[AGENT][NEUTRAL] So the best option is to resubmit the claim.
[CUSTOMER][NEUTRAL] OK, so it's a no no.
[CUSTOMER][NEUTRAL] OK, so definitely no claim on file, it is. And what is the member's policy effective date and term date?
[AGENT][NEUTRAL] Effective [PII], policy is active.
[CUSTOMER][POSITIVE] Effective
[CUSTOMER][NEUTRAL] January, what is the, the effective date you said?
[AGENT][NEUTRAL] [PII] and the policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No term date, right?
[AGENT][NEUTRAL] No, since I said the policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you very much. And uh uh what is the like uh mailing address is the same and what is the fax or the payer ID? Do you have the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[AGENT][NEUTRAL] Fax number
[CUSTOMER][NEUTRAL] 60801 and I'm mailing.
[AGENT][POSITIVE] You gave the mailing address and it was correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's the fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you very much. And one second, one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And what is the timely filing limit to resubmit this one?
[AGENT][NEUTRAL] There's no time limit to submit.
[CUSTOMER][NEUTRAL] You can submit any time.
[AGENT][NEUTRAL] Yes, since there is no time limit to submit.
[CUSTOMER][NEUTRAL] TFL no. OK, what's the uh call reference number?
[AGENT][NEUTRAL] You may use my name at today's date.
[CUSTOMER][NEUTRAL] OK. And I have one more claim to discuss. Give me a second.
[AGENT][NEUTRAL] Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] OK, so the member ID is uh.
[CUSTOMER][NEUTRAL] D as in Delta 43301781.
[AGENT][NEUTRAL] It's not one of our policy numbers. What is the patient's name, date of birth?
[CUSTOMER][NEUTRAL] His name is uh [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Spell the last name for me, please.
[CUSTOMER][NEUTRAL] Uh, the last name is [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] You said her first name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, and I do not show that patient in our system. So you need to contact the patient to verify their insurance.
[CUSTOMER][NEGATIVE] So, I, I was just sick, uh.
[CUSTOMER][NEUTRAL] It is having the same contact number.
[AGENT][MIXED] OK, but I don't show the person in our system.
[AGENT][NEUTRAL] Why not.
[CUSTOMER][NEUTRAL] OK. So you're unable to find the member?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Sir, they are not in our, that is not our policy number, so you would have to contact the patient to verify their insurance because they're not in our system.
[CUSTOMER][NEUTRAL] So, with the member ID?
[CUSTOMER][NEUTRAL] OK, give me a moment. Let, let's just open the member ID here.
[CUSTOMER][NEUTRAL] Me ID card.
[CUSTOMER][NEUTRAL] OK, uh huh.
[CUSTOMER][NEUTRAL] Yeah yeah
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, thank you. That's all I have today. Thanks for assisting me. Have a good day. Bye. And uh what about water?
[AGENT][POSITIVE] OK. You're welcome. Thanks for calling the APL.