AccountId: 011433970860
ContactId: 460a9899-d626-41d0-89c8-b718981e0a2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1125380 ms
Total Talk Time (AGENT): 262592 ms
Total Talk Time (CUSTOMER): 326758 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/460a9899-d626-41d0-89c8-b718981e0a2b_20250520T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], good afternoon. This is [PII] calling from Mount Sinai Medical Center. I need to verify a claims.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on a claim. Do we have a policy number for the patient?
[CUSTOMER][NEUTRAL] Yes. That will be 0196026.
[AGENT][NEUTRAL] Alright, let me pull this up.
[AGENT][NEUTRAL] And you said it was 019.
[AGENT][NEUTRAL] 6026.
[CUSTOMER][NEUTRAL] 602.
[CUSTOMER][NEUTRAL] 246.
[AGENT][NEUTRAL] 246. OK.
[AGENT][NEUTRAL] Uh, patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you, and then data service.
[CUSTOMER][NEUTRAL] Date of service [PII] with the billed amount of 27,83515.
[AGENT][NEUTRAL] Alright. Do you by chance have a different amount after primary paid?
[CUSTOMER][NEUTRAL] 200283 85.
[AGENT][NEUTRAL] Just gonna check this claim that was sent over.
[AGENT][NEUTRAL] And see if this is it or not. We do have one on file, but I'm not sure based off of the amount, so bear with me just a second here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we did get a claim for the date of service. The claim was received. Do you need the received date?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Showing received on [PII].
[AGENT][NEUTRAL] And then processed for [PII].
[AGENT][NEUTRAL] Looks like there was a benefit payment sent in the amount of $200.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] That was 3592909.
[CUSTOMER][NEUTRAL] The paid amount $200 even?
[AGENT][NEUTRAL] Mhm. And that was the max benefit payable for the date of service.
[CUSTOMER][POSITIVE] Da service OK.
[CUSTOMER][NEUTRAL] Um, that was paid through a check or how was the payment made?
[AGENT][NEUTRAL] Uh-huh. It was, it was a single check. I can give you the check number if you need it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Check number is 204.
[AGENT][NEUTRAL] 0624.
[CUSTOMER][NEUTRAL] 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What would be the reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. My name again is [PII], that's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] OK, give me a moment, because I do have another.
[CUSTOMER][NEUTRAL] I know my status.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When did you guys send the payment?
[AGENT][NEUTRAL] Uh, the claim was processed for 23, so it would have been sent shortly after that.
[CUSTOMER][NEUTRAL] Do you have the date or no?
[AGENT][NEUTRAL] It doesn't have an exact date. No, it just would have been mailed. I don't know what date the [PII] was. Let me see.
[AGENT][NEUTRAL] Yeah, it doesn't give me an exact date. [PII] was a Wednesday, so it would have been mailed out that week.
[CUSTOMER][NEUTRAL] OK, because, um, I need to make sure that this is the correct claim number. If not, I need to fax it over to you guys because I see that payment on the portal, but it doesn't say date of service or anything like that.
[CUSTOMER][NEUTRAL] And this claim was submitted on [PII] electronically over to you guys.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have a claim, did you get a claim number for it or?
[CUSTOMER][NEUTRAL] No, no, it was electronic information.
[CUSTOMER][NEUTRAL] The receive the payment for the um.
[CUSTOMER][NEUTRAL] Primary insurance on [PII], and we submitted the claim on [PII].
[AGENT][NEGATIVE] I don't show anything reported on the [PII] on my side for this patient.
[CUSTOMER][NEGATIVE] So I don't think that is the correct information for the claim.
[AGENT][NEUTRAL] What's the payer ID that you guys have?
[CUSTOMER][NEUTRAL] Um, I don't, it doesn't show, but it made it electronically.
[CUSTOMER][NEUTRAL] Because everything is internally and it's already in the system.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah, I, I don't show anything reported on that date. All I can do is just verify the payer ID was accurate and give that to you again and it can be resubmitted.
[CUSTOMER][NEUTRAL] So you don't have
[CUSTOMER][NEUTRAL] So you don't have the claim.
[CUSTOMER][NEUTRAL] For this data service 3-19 2025.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] We have one claim on file for the 319 of 2025 and that was the information that I provided to you. The providers listed as physicians practice, MSNC.
[CUSTOMER][NEUTRAL] Oh no, they say, no, this is for facility.
[AGENT][NEUTRAL] So then we do not have a claim on file for that uh date of service for that provider.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, um, let me give you the other members ID number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] That will be
[CUSTOMER][NEUTRAL] Um, 02496789.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Um, 3 26 2025.
[AGENT][NEUTRAL] And the bill amount.
[CUSTOMER][NEUTRAL] 1,12409 after primary paid will be 81377.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was processed on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent to the provider in the amount of $813.77.
[CUSTOMER][NEGATIVE] You're breaking up.
[AGENT][NEUTRAL] There was a check sent for 878-13-77.
[CUSTOMER][NEUTRAL] When it was
[AGENT][NEUTRAL] The claim was processed and paid on [PII].
[CUSTOMER][NEUTRAL] Payment
[CUSTOMER][NEUTRAL] And check number?
[AGENT][NEUTRAL] 2042949
[CUSTOMER][NEUTRAL] 22042 949.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that is a single payment, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] 7659.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] OK so OK.
[CUSTOMER][NEUTRAL] OK, I do the other member?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] I have another member for claim status.
[AGENT][NEUTRAL] Oh, a different policy?
[CUSTOMER][NEUTRAL] That is 01673441.
[AGENT][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] [PII] um [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] 328 [PII] with the build amount of 7,6648 75 cents after primary paid 1,0269 even.
[AGENT][NEUTRAL] Don't show any claims on file for [PII].
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] I do have another member.
[AGENT][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] That will be 01.
[CUSTOMER][NEUTRAL] No, hold on.
[CUSTOMER][NEUTRAL] Let me try this one first. 02501736.
[AGENT][NEUTRAL] And if I can get the name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Day of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No claims on file for that date of service.
[CUSTOMER][NEUTRAL] OK. Is that is the correct member ID because I do have another policy number.
[AGENT][NEUTRAL] Mhm. This one is the effective date on it is 6-1-24 still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This was processed just today. I just noticed that. Give me a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This month now that's OK.
[CUSTOMER][NEUTRAL] OK, I do have another member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] ID number is 02496789.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] This will be [PII] [PII].
[AGENT][NEUTRAL] Do you a service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] $7,679.52 after primary paid 198,360.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent on [PII].
[AGENT][NEUTRAL] In the amount of $1,983.60 in a single check.
[AGENT][NEUTRAL] The check number is 204.
[AGENT][NEUTRAL] 372 9.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Number OK.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] 359.
[AGENT][NEUTRAL] 9454.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] 189.
[CUSTOMER][NEUTRAL] OK, I do have another member.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] 02444945.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do a service?
[CUSTOMER][NEUTRAL] It is [PII] with the bill amount $79,393.32 after primary paid $4,405.15.
[AGENT][NEUTRAL] No claims on file for that date of service.
[CUSTOMER][NEUTRAL] OK, let me send this claim um through fax.
[CUSTOMER][POSITIVE] OK, thank you very much. Appreciate it.
[AGENT][NEUTRAL] Mhm. Anything else?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right, have a good day.
[CUSTOMER][NEUTRAL] You too. Bye