AccountId: 011433970860
ContactId: 39d72998-d80e-46e5-a157-ef511ce01845
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 629330 ms
Total Talk Time (AGENT): 200396 ms
Total Talk Time (CUSTOMER): 212464 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/39d72998-d80e-46e5-a157-ef511ce01845_20250313T18:31_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the product office to check the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh-huh. The callback number is [PII]. It's a direct line. There is no extension.
[AGENT][NEUTRAL] Thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, that's going to be 02032606 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information, [PII]. uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Sure, the date of service is going to be [PII].
[CUSTOMER][NEUTRAL] With the total charges of $790 even.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, I'm sorry, what was the name of this provider?
[CUSTOMER][NEUTRAL] Yes. Our name is [PII].
[AGENT][NEUTRAL] OK, I believe I found it. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now that amount that you gave me, I'm sorry, the 790, is that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, actually, that is the original bill amount and the primary has been already processed the claim and the leftover balance is $203.21.
[AGENT][NEUTRAL] 203 and 21 cents.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Got it. OK, thank you so much for that. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I'm not finding uh a claim for that amount, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So for the the service 124 of 22 on the bill charge of $790 there is no claim on file, right?
[AGENT][NEUTRAL] I'm so sorry. Did you say 124? I had 12:14.
[CUSTOMER][NEUTRAL] No, it's 12:14 only.
[AGENT][NEUTRAL] Oh, OK, yes, so I was looking at 1214 of 22, um, and no, I don't see a claim for that amount.
[CUSTOMER][NEUTRAL] Mhm. OK. So, to refile a claim, what is the normal time filing limit?
[AGENT][NEUTRAL] There is no timely filing limit to file claims.
[CUSTOMER][NEUTRAL] Uh-huh. Sure. So, can I have the payer ID, mailing address and the, yeah, payer ID mailing address to refile the claim.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure, I've also got a fax number if you'd like um so our mailing address.
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] OK and then uh fax number is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course, and then that payer ID is 60801.
[CUSTOMER][POSITIVE] Thank you so much. And also, can you please verify whether the patient is active for the data service or not?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, so this policy's effective date was [PII].
[AGENT][NEUTRAL] And it terminated [PII].
[CUSTOMER][NEUTRAL] Mhm thank you. So the patient is active for the data service.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. And can you go to the next state of service for the same patient?
[AGENT][NEUTRAL] This is for the same member? OK um let's see.
[AGENT][NEUTRAL] Yes, go ahead, uh, with that next date of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The next data service is going to be.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So yes, the next date of service is [PII].
[CUSTOMER][NEUTRAL] With the total charges of $625 even.
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well this policy did terminate [PII]. Uh, let me see if they had a policy that was active at that time.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, they did not this was the only policy that they had with us um but I can still see if we received that claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, no, we have not received that claim for this number.
[CUSTOMER][POSITIVE] Thank you so much for that one. And I do have another patient on file under the same provider. Can you help me with that?
[AGENT][NEUTRAL] Yes, if you'll give me one moment, um, I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Mhm. Sure, of course.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I appreciate your patience, [PII]. You can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, that's going to be 1338796 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for this member?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, for this one, the date of services [PII], but the total charges of $775 even.
[AGENT][NEUTRAL] 775. OK, so this policy also terminated [PII]. So again, let me see if they had one active at that time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, they did not, so I will still just go ahead and check to see if we received this one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you did say [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we have no claims on file for that date of service for this member.
[CUSTOMER][NEUTRAL] Also, the policy got terminated, right?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Also, the policy is not, not active for the data service, right?
[AGENT][NEUTRAL] Correct, yes, this one terminated on [PII].
[CUSTOMER][POSITIVE] Thank you so much for that one. And also, can I have your name spelled out?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Uh-huh. Thank you. And that's all for that you can provide me the reference number for the conversation.
[AGENT][NEUTRAL] Sure, uh, reference number would just be my first name, last initial, and today's date. Um, so my name is spelled [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] No, that's all for that. Thank you so much for asking and thank you so much for your assistance. Have a wonderful day.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You're welcome. Yes, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Sure. Take care. Bye for now.