AccountId: 011433970860
ContactId: 37041165-87f4-498d-899d-6474b5714da3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466600 ms
Total Talk Time (AGENT): 138485 ms
Total Talk Time (CUSTOMER): 158168 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/37041165-87f4-498d-899d-6474b5714da3_20250319T14:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] initially. My last name is [PII]. I'm calling from provider's office. I need to check on denied claims.
[AGENT][POSITIVE] Alright, I'm happy to check on a claim for you today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, I do have the policy number. It is 02037588 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, the callback number is [PII] is the extension.
[AGENT][POSITIVE] Thank you. And may I have the
[CUSTOMER][NEUTRAL] Can you help me with the initial your last name?
[AGENT][NEUTRAL] The initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Thank you and data service?
[CUSTOMER][NEUTRAL] Um, the data service is.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $1,032 even.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And date of service just to confirm was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Not showing any claims on file for that date of service.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Bill uh bill amount is
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] OK, just give me a second. I'll provide you the claim number if I have it.
[CUSTOMER][NEUTRAL] Um, OK. Claim number is 3557586.
[AGENT][NEUTRAL] Alright, let me pull this up. One moment.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied [PII].
[AGENT][NEUTRAL] The denial reason was services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm gonna perform
[CUSTOMER][NEUTRAL] Perform an office visit, right?
[AGENT][NEUTRAL] Correct, not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it can be any service, right? I mean, uh, it does not have to be related to uh service, but it is related to the place of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. Um, can you help me out with the
[CUSTOMER][NEUTRAL] Uh, fax number.
[AGENT][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] All right, thank you. Um, can you help me out with the call reference for this one? I have one more claim.
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. My name is [PII], last initial [PII] and today's date.
[CUSTOMER][NEUTRAL] All right, is it S [PII]?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] Thank you. Uh, all right, thank you. Just give me a few seconds, I'll provide you the next member ID.
[AGENT][NEUTRAL] What's the next member's ID?
[CUSTOMER][NEUTRAL] Just a second. It is still loading. It is.
[CUSTOMER][NEUTRAL] 02552057
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is [PII]. The bill amount is $349 even.
[AGENT][NEUTRAL] I apologize. What was the bill amount again?
[CUSTOMER][NEUTRAL] Uh, $349 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This claim was received, it looks like [PII].
[AGENT][NEUTRAL] The claim was denied on [PII]. We need a copy of the explanation of benefits from the member's primary insurance.
[CUSTOMER][NEUTRAL] All right. And do you have any details for the primary insurance?
[AGENT][NEUTRAL] No, we do not have that information. You would have to check with the insured.
[CUSTOMER][NEUTRAL] All right. And what would be the corrected claim filing limit?
[AGENT][NEGATIVE] Uh, there's no timely filing limit.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] What would be the claim number for this one?
[AGENT][NEUTRAL] It is 355.
[AGENT][NEUTRAL] 631 9.
[CUSTOMER][NEUTRAL] 3556319.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Thank you. And is, is it possible for you to uh send a copy of UB via fax?
[AGENT][NEUTRAL] Yeah, I can send that. What's a good fax number?
[CUSTOMER][NEUTRAL] Um, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And uh also, can you help me out with the mailing address as well for the future reference?
[AGENT][NEUTRAL] Claims mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] All right thank you so much um.
[CUSTOMER][NEUTRAL] OK. And uh please send the UV via fax, and the call will be same as the previous, uh, your name and today's date.
[AGENT][POSITIVE] That is correct. EOB is on its way. It should be there in about 5 minutes.
[CUSTOMER][POSITIVE] All right. Thank you so much and you've been such a great help. Have a great day. Bye for now.
[AGENT][NEUTRAL] You too. Bye bye.