AccountId: 011433970860
ContactId: 36bb1ea0-b3ba-472a-af13-48ababddc490
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 932520 ms
Total Talk Time (AGENT): 439391 ms
Total Talk Time (CUSTOMER): 188381 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/36bb1ea0-b3ba-472a-af13-48ababddc490_20250217T13:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need to verify uh eligibility and see if you guys have a claim on file.
[AGENT][NEUTRAL] OK, you're needing to verify eligibility and you said also see if there is a claim on file for the patient?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Um, the card that I'm looking at, oh, policy assert number.
[AGENT][NEUTRAL] Policy certificate number, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. 02492690.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, like
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] This is for uh [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on this limited benefit plan and this plan is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is your date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] It's for [PII] 2025 for $194 even.
[AGENT][NEUTRAL] 194. Is that correct? 194. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 3554549.
[AGENT][NEUTRAL] And give me just one moment to get all the information pulled up, please.
[AGENT][NEUTRAL] OK, so on one of the codes, it shows the policy doesn't provide a benefit and for which services were not incurred. I'm sorry, discard that one. That's not correct.
[AGENT][POSITIVE] OK, it shows, I'm sorry.
[AGENT][NEGATIVE] We are unable to assign benefits to the provider of record due to a discrepancy with the provider's tax ID number.
[AGENT][NEUTRAL] A letter has been mailed to the provider with instructions on resolving the discrepancy. The provider will need to resolve the discrepancy with our office to resume receiving communications regarding claims decisions and benefits payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our claim decision, including any payable benefits for this charge, have been sent to the insured. Please contact our office with any questions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there any way that I can get a copy of that letter faxed to me so I can get that information taken care of as quick as possible?
[AGENT][POSITIVE] Yes, ma'am. Now you, let me see about the letter. You can print this explanation of benefits, [PII] directly from our portal. Give me just one moment. It is secured.
[CUSTOMER][NEUTRAL] What is the portal?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am, like [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][POSITIVE] [PII]. Uh-huh, that's correct.
[CUSTOMER][NEUTRAL] That we're out of network. Can we get a log in for that?
[AGENT][NEUTRAL] Now with APL yes this is our self registering portal.
[CUSTOMER][NEUTRAL] OK, so even if we're out of network we can get. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I tried to register on that portal and I cannot.
[CUSTOMER][NEUTRAL] Register.
[CUSTOMER][NEUTRAL] For some reason, it's saying that the tax ID is
[CUSTOMER][NEGATIVE] No good.
[AGENT][NEUTRAL] That could be correct. Now, what I can do, let me try and transfer you over to one of the examiners.
[AGENT][NEGATIVE] Who works in this division to see about this letter because I'm not able to see this.
[AGENT][NEUTRAL] It shows a letter but I'm not able to see the letter so if you will give me just a moment, um I can get you connected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But is there anything else that I could help you with, [PII], first?
[CUSTOMER][NEUTRAL] Just a call reference number?
[AGENT][POSITIVE] Sure, you're gonna use my name I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[AGENT][POSITIVE] Absolutely. You are certainly very welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Yes, ma'am. Thank you. So one moment, please.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Well, [PII]. It's [PII]. How are you?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][NEUTRAL] Well, I'm all right other than I got one of the extra calls right out of the gate.
[AGENT][NEUTRAL] So it's on, just let me know when you're ready for the policy number, [PII].
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] 2,492,690. [PII].
[AGENT][NEUTRAL] I have a provider's office on the line. Her name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She's calling on claim 3554549.
[AGENT][NEUTRAL] I read her the remarks pertaining to the provider, so she knows that we sent the benefits to the insurer. Of course, I didn't tell her how much, but it states in this remark that a letter has been mailed to the provider with instructions resolving the discrepancy on the tax ID number.
[AGENT][NEUTRAL] There's no letter in on base.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Cause she was asking, because she can't sign into the portal, obviously, since the, the tax ID is a problem.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah, mm, let me see if I can.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I know they're using a new letter writing system, but I don't, let me see, let me see if I can find anything. Hold on, let's see.
[AGENT][NEUTRAL] But I don't see a letter. Yep, I don't see a letter.
[AGENT][NEUTRAL] Because she was asking if we could email the letter or fax the letter rather I believe she said fax, Dina. Oh, not enough coffee and too early. I think she has 4 to be faxed, but
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So they can know exactly what needs to be done, but.
[CUSTOMER][POSITIVE] Yeah, we can definitely fax it to her. I just gotta find out where it's it.
[AGENT][NEUTRAL] Yeah, cause I couldn't locate it.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] I don't see it, but I can research and and make sure we get it sent to her if you just get her fax number.
[AGENT][NEUTRAL] OK. All right. Do you want me to just put it in the note or send a hub ticket?
[CUSTOMER][NEUTRAL] Uh, you can put it in a note and I, and I'll research it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, no, go ahead and send a hub ticket, but I'll still research it though.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll research it.
[AGENT][POSITIVE] OK. All right. I will get that fax number and let her know that we're gonna do that. OK. Thank you. All right. Bye, [PII].
[CUSTOMER][POSITIVE] OK. All right, thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hi [PII]. This is still [PII]. Let me get your fax number and I'm gonna have one of the examiners um to research this and get back to you via, you know, sending it via fax. So go ahead and give me your fax number.
[CUSTOMER][POSITIVE] That's good
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK I'm just gonna repeat that back to you. [PII].
[CUSTOMER][NEUTRAL] That is correct. Now, is there a fax number that I can use? And I, because I'm gonna get W-9s over to you guys anyhow because I'm sure that's probably what this is all about.
[AGENT][NEUTRAL] And just
[AGENT][NEUTRAL] Uh, yes, but I, let me get you where you would need to send that. Just one moment, because that is one I don't know off the top of my head.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let's see.
[AGENT][NEUTRAL] Well, it's gonna take a moment for that to load for me.
[AGENT][NEUTRAL] OK, since I don't know, a lot, I, mm I don't know what the
[AGENT][NEUTRAL] I don't know what the discrepancy is. I can give you if it's.
[AGENT][NEUTRAL] If it's an incorrect.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK, so you can send it to 844.
[AGENT][NEUTRAL] 539.
[AGENT][NEUTRAL] 3507.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That's for the 1099 miscellaneously and corrected W9, that's what it should be faxed to attention.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And make sure to include your phone number that you your name and phone number obviously so that you can be contacted back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and now do you have a regular fax number like if we're faxing over an appeal or medical records?
[AGENT][NEUTRAL] Our claims fax number, now an appeal must be submitted in writing to attention appeals department, but the claims fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do you guys have a timely filing limit set up?
[AGENT][NEUTRAL] We do not. No, ma'am. There is no timeless silence.
[CUSTOMER][NEGATIVE] Alright, no timely.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, and I got the right phone number. OK, that's all I need. I really appreciate all the information. This is a new insurance for me, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, and we are not a major medical carrier, so there's not any credentialing with APL. This would just be, we just need.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right, it's just a matter of W9 I think.
[CUSTOMER][NEUTRAL] I, I have a lot of those doing commercial. They're just small insurances and most of, most of the time it's just that they need a W-9.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And, and again, since I can't see, it just says that it does, there's a discrepancy with the provider's provider's tax ID so.
[AGENT][NEUTRAL] That's all I can see, but one of the examiners, and when they do fax this to you as far as that letter, does it need to have your attention on it, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, please, that would make it a lot easier for me to get it. We have a fax number all of our going to.
[AGENT][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK. Does it, and what is the first initial initial to your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, well, I will make sure to include that.
[CUSTOMER][POSITIVE] Thank you so very, very much. I really appreciate the time that you've spent with me and you have a wonderful rest of your day.
[AGENT][POSITIVE] Oh, well, you are certainly very welcome, [PII]. It was my pleasure and thank you again for calling APL. I hope you have a very nice day as well.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.