AccountId: 011433970860
ContactId: 390cc874-6724-4785-b1e2-524133ff9113
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446380 ms
Total Talk Time (AGENT): 213287 ms
Total Talk Time (CUSTOMER): 148403 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=2.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/390cc874-6724-4785-b1e2-524133ff9113_20250521T16:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good morning [PII]. My name is [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well, [PII], thank you for asking. How are you today?
[CUSTOMER][POSITIVE] Doing good thank you. I am calling. I've got 3 members here that I need to check claim status on if you could help me.
[AGENT][POSITIVE] Oh, it would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And I can help you with that claim status. What is the first policy? Is it all on the same policy or different policies?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, different policies. This first one, it looks like there was a payment made and I saw the check but I didn't have an EOB so there was a balance left on there so I don't know where to distribute.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Um, the rest of the ponies, so, uh, this first member ID that I have, [PII] is 023.
[CUSTOMER][NEUTRAL] 636-53
[AGENT][NEUTRAL] OK, so that one is going to be through web TPA third party administrator. I am going to need to, uh, give you their phone number to contact for claims information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That phone number is [PII].
[CUSTOMER][NEUTRAL] What's that number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, can you check these other two to see if I'll need to call them or you can help? OK, uh, the next policy number that I have is 0247899778.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. And that patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. And what was his date of service?
[CUSTOMER][NEUTRAL] Uh, [PII] for $621.
[CUSTOMER][NEUTRAL] And it looks like this is secondary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the facility name?
[CUSTOMER][NEUTRAL] Fastpaced Mississippi.
[AGENT][NEUTRAL] You said 6:21.
[AGENT][NEUTRAL] All right. I've got that claim pulled up. Excuse me.
[CUSTOMER][NEUTRAL] What's that? Yeah, 62, yep, that's it.
[AGENT][NEUTRAL] OK, so this claim we received on.
[AGENT][NEUTRAL] 37 and processed on [PII].
[AGENT][NEUTRAL] Now, the 99204 was denied as office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the preceding charges after that were denied as services are not covered when performed in a doc doctor's office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I can provide that claim number.
[CUSTOMER][NEUTRAL] OK. So is that
[CUSTOMER][NEUTRAL] Yeah, so that's gonna go to patient responsibility?
[AGENT][NEUTRAL] So we're secondary, not major medical. We don't determine patient responsibility, but there were no benefits payable for those charges.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] And I'm sorry, 3573869. I almost forgot to give you the last four.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, all right, perfect.
[AGENT][NEUTRAL] And we can also pull up those EOBs on our provider portal.
[AGENT][NEUTRAL] Using, have, have you created an account?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't believe so no.
[AGENT][NEUTRAL] It's uh quite simple um you would go to [PII].
[AGENT][NEUTRAL] And then you're gonna use the patient's account number with your facility and your tax ID number.
[CUSTOMER][NEUTRAL] So it's [PII] [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. [PII], perfect. Alright.
[AGENT][NEUTRAL] And then you can just put in the claim number and print those. You can also view claim status um for uh patients as well as submit claims online.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][POSITIVE] Oh awesome thank you. What is your timely filing limitation?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Yeah, do you have that? Do you have a?
[AGENT][NEUTRAL] There's no tell me filing.
[CUSTOMER][POSITIVE] For timely filing.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][POSITIVE] Oh, none? Oh, awesome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wonderful and how do you guys make payment? Is it by check, EFT?
[AGENT][NEUTRAL] Uh, for providers is paper check.
[CUSTOMER][POSITIVE] Paper check. OK, wonderful.
[CUSTOMER][POSITIVE] Awesome, OK, thank you for that.
[AGENT][NEUTRAL] Not a problem at all. And just be sure to use the patient's account number listed in box 26 on the HCA.
[AGENT][NEGATIVE] It's when it says patient account number it's not the policy number. Some people I failed to read that.
[AGENT][NEUTRAL] Portion when creating an account.
[CUSTOMER][NEUTRAL] Alright, so patient account number is in box 26.
[AGENT][NEUTRAL] That's right on the hectare.
[CUSTOMER][POSITIVE] OK, perfect. OK, awesome thank you.
[AGENT][POSITIVE] And I, I'm ready for that last one.
[CUSTOMER][NEUTRAL] OK, the last one that I have is 00982518.
[AGENT][NEUTRAL] And that patient's name and date of birth.
[CUSTOMER][NEUTRAL] That is gonna be [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Alright, and what is that data service?
[CUSTOMER][NEUTRAL] That is for 1182025 for $264.
[AGENT][NEUTRAL] Is that for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And that claim we received for [PII] on let me go back and get that receipt date for you.
[AGENT][NEGATIVE] Received on [PII] and processed on [PII] and that was denied as office visits are not covered under the patient's plan.
[AGENT][NEUTRAL] And I can provide that claim number.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That claim number is 356.
[AGENT][NEUTRAL] 1900.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Can I just get a reference number for the call, [PII]?
[AGENT][NEUTRAL] It's gonna be my name and today's date. I spell my name [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you [PII]. I appreciate all your help.
[AGENT][POSITIVE] Well, [PII], it's been such a pleasure to assist you. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that will be it thank you I really appreciate your time today.
[AGENT][POSITIVE] Uh my pleasure and thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you, [PII]. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.