AccountId: 011433970860
ContactId: 3660b98a-9647-49b5-ac0a-0d55505bd935
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580739 ms
Total Talk Time (AGENT): 209273 ms
Total Talk Time (CUSTOMER): 112669 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/3660b98a-9647-49b5-ac0a-0d55505bd935_20250110T23:07_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] from provider's office looking for a medical claim status.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with claim status today, Ms. [PII], and may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] It is going to be 60801.
[AGENT][NEUTRAL] You said 60801?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] Alright, that's actually our payer ID, um, do you have a different number?
[CUSTOMER][NEUTRAL] Uh, one moment. Shall I provide your claim number? It is 3499.
[AGENT][NEUTRAL] Yeah, I can look it up with mhm.
[CUSTOMER][NEUTRAL] 349-9375.
[AGENT][POSITIVE] Perfect, give me just a moment there.
[AGENT][NEUTRAL] Perfect. And can you verify your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name [PII]. Date of birth, [PII].
[AGENT][POSITIVE] OK, perfect, thank you. And.
[AGENT][NEUTRAL] How can I help you with this claim?
[CUSTOMER][NEUTRAL] I'm looking for a claim status. Actually, the claim, uh, I, I got the correspondence and it is showing that the primary OB is required, but we have submitted several times, but we haven't received any information about it. Can you help me with it?
[AGENT][NEUTRAL] OK, yeah, let me look into that. Yeah, absolutely. One second.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] All right, so I guess I'm not showing.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Hold on, I
[AGENT][NEUTRAL] What was the charge after primary?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What was the total bill after primary?
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] It is $9340 only.
[AGENT][NEUTRAL] And that was after major medical paid?
[CUSTOMER][NEUTRAL] One moment, I'm just checking.
[CUSTOMER][NEUTRAL] Yes, the plan is paid $792.57.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I was looking to see if it was this one, but it actually looks like the date of service is different um.
[AGENT][NEUTRAL] So I'm not showing that we've received anything on our side as far as an updated EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, uh, you could submit that via fax or through.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] are
[AGENT][NEUTRAL] Mailing address?
[CUSTOMER][NEUTRAL] Yes, uh, can I get the fax number and mailing address as well?
[AGENT][NEUTRAL] Yeah, the fax number is [PII].
[CUSTOMER][NEUTRAL] 9, what's the last four digits?
[AGENT][NEUTRAL] Sorry, it is [PII].
[CUSTOMER][NEUTRAL] Thank you. And can I get the mailing address?
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And that is [PII] is the zip code?
[CUSTOMER][NEUTRAL] OK. Can I get the receipt date and process date of the claim?
[AGENT][NEUTRAL] Um, yes, absolutely, it looks like we received your claim on 8-27-2024 and we processed it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have verified uh the fax number also. It has been submitted on [PII] recently. Can you verify it one more time for me?
[AGENT][NEUTRAL] You said you sent it [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have a time stamp on that?
[CUSTOMER][NEUTRAL] Yeah, to the fax number
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEGATIVE] I don't have the time stamp for it.
[AGENT][NEUTRAL] All right, let me just
[CUSTOMER][NEUTRAL] Spain after [PII].
[AGENT][NEUTRAL] You said after [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me take a look and see if I can see any.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Any pending?
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm so sorry. I'm just looking through like every possible place. It could, it could be still.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, I'm really sorry. I'm not showing any faxes uh from that date for this type of policy that are still waiting to be.
[AGENT][NEUTRAL] Sorted um if you could re-fax that, that would be wonderful and if you call back and we still don't have it received, if you have a time stamp they can have somebody um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like do a further look and put in a request for you, OK?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Fine. Uh, what would be the normal processing time limit to receive those information?
[AGENT][NEUTRAL] Um, yeah, absolutely, um, we do have a human process so when facts are received, they get like processed by a human typically anywhere from 2 to 3 days it could be as quick as same day and sometimes it could take up to 3 days, um, to have between receiving the fax and getting it into our online system.
[CUSTOMER][NEUTRAL] Because it has been uh
[CUSTOMER][NEUTRAL] OK. And can I get the follow-up date?
[AGENT][POSITIVE] And I'm so sorry, what do you mean?
[CUSTOMER][NEUTRAL] Uh, shall I call you after 2 to 3 business days?
[AGENT][NEUTRAL] Yeah, I would give us a call maybe Tuesday evening um I would but I would still, I'd resend that fax um and like time stamp it from when you sent it and when you got that like it was confirmed and then.
[CUSTOMER][NEUTRAL] To receive
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, give us a call back maybe Tuesday evening and if they can't find your fax what they can do is they can, um, submit a request for somebody to look into it with the date and time stamp, OK?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Thank you. And what's the reference number for that?
[AGENT][POSITIVE] Hey, it's my pleasure.
[AGENT][NEUTRAL] Oh, you bet you. The reference number is just gonna be my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a wonderful day. Bye for now.
[AGENT][POSITIVE] Hey my pleasure you too bye bye.