AccountId: 011433970860
ContactId: 31b3c785-5772-4786-ad74-ab7581f09db7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407559 ms
Total Talk Time (AGENT): 195389 ms
Total Talk Time (CUSTOMER): 95196 ms
Interruptions: 2
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/31b3c785-5772-4786-ad74-ab7581f09db7_20250312T20:40_UTC.wav
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[AGENT][POSITIVE] Good, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. Good afternoon. My name is [PII] and last time [PII].
[AGENT][POSITIVE] Hi, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, I'm calling from provider's office.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, I need a claim status.
[AGENT][NEUTRAL] You have one claim that you're needing status on, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yeah, only one client.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, it's 1192701.
[AGENT][NEUTRAL] 1192701. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] OK, and here, any information that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, now this particular policy is an old policy. This policy was active from [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] Is your data service in that time frame because she does have another policy that is active.
[AGENT][NEUTRAL] Since [PII].
[AGENT][NEUTRAL] With a different policy number.
[CUSTOMER][NEUTRAL] The patient is
[CUSTOMER][NEUTRAL] So, OK. But patient is active or different policy number, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And what is the date of birth again for your patients?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So the correct policy number that you should have for this number is 01569875 with an effective date of [PII].
[AGENT][NEUTRAL] So give me just a moment to get that information pulled up, [PII].
[CUSTOMER][NEUTRAL] I'm still active?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK. And can you please repeat again one more time the member ID 0156975, right?
[AGENT][NEUTRAL] 01569875
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. And at the time you finally able to submit the claim.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] There is no timely filing limit, but give me just one moment and I can check to see if we received and processed it under the correct policy number.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] And what is your date of service area and total bill amount?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Mhm. And the bill amount?
[CUSTOMER][NEUTRAL] And the bill amount is $348 even.
[AGENT][NEUTRAL] 348.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] One moment please, [PII].
[CUSTOMER][NEUTRAL] Yes sure.
[AGENT][NEUTRAL] OK, [PII], so this claim was received, however, I need to, I'm going to send this back for review based on the remark.
[AGENT][NEUTRAL] What I'm showing is that this was denied as a duplicate of a previously submitted claim, but I don't see that that has, we've received another claim, so I will send a request to have this claim relooked at.
[CUSTOMER][NEUTRAL] OK. And, OK. And can you please provide the denied information like the date and denied date and claim number?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] This claim was received [PII], processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3,556,670.
[CUSTOMER][NEUTRAL] The not as a duplicate, right, and there is no claim number.
[AGENT][NEUTRAL] I do not see another claim. No, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII]. Thank you for giving this information.
[AGENT][NEUTRAL] [PII]. Yes, that it's [PII]
[CUSTOMER][NEUTRAL] Yeah, thank you, [PII]. And may I have the call reference number?
[AGENT][NEUTRAL] So I will send this back. Yes, sir, and you would use my name along with today's date.
[AGENT][NEUTRAL] And it would take approximately 7 to 10.
[CUSTOMER][NEUTRAL] Uh, one second, one second. So you, you are claims and back for the process. So, one second. You are claims and back for the process. So it is, is there any ticket number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, so there is not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then please allow approximately 7 to 10 business days.
[CUSTOMER][NEUTRAL] Get you.
[AGENT][NEUTRAL] For the claim to be re-reviewed.
[CUSTOMER][NEUTRAL] Yeah, sure, sure.
[AGENT][NEUTRAL] Mhm. OK, so is there anything else that I can help and if you need a copy of this particular EOB or any EOB when we have a claim on file, you can actually print out from our portal, [PII], by going to [PII].
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][POSITIVE] OK. Well, you're very welcome, and can I help you?
[CUSTOMER][POSITIVE] OK. Thank you. And thank you for giving this information.
[AGENT][POSITIVE] Yeah, you're very welcome. And can I help you with anything else?
[CUSTOMER][NEUTRAL] Uh, no, thanks. That's it.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] Yeah, same to you. Bye-bye.
[AGENT][POSITIVE] Uh, thank you. Bye-bye.