AccountId: 011433970860
ContactId: 470f843f-85b4-4ef3-8a24-bf446c171a30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269230 ms
Total Talk Time (AGENT): 91758 ms
Total Talk Time (CUSTOMER): 162697 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/470f843f-85b4-4ef3-8a24-bf446c171a30_20250603T18:23_UTC.wav
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[AGENT][NEUTRAL] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm calling from a doc's office and we're trying to figure out why, um, a claim for a patient with the gap insurance, uh, keeps getting rejected. We don't know if we might have the wrong EDI payer ID, but wanted to see if you can check if any claims have come through for him.
[AGENT][NEUTRAL] Sure, can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, my first name is [PII], last initial [PII] and call back is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh huh [PII].
[AGENT][POSITIVE] Thank you. And pronounce your name again?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], could you provide me with the policy number of the member?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, it's 021-235-553.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. First name is [PII], last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And what is the data service to make sure that the claim is not on file?
[CUSTOMER][NEUTRAL] Data service is 5725.
[AGENT][NEUTRAL] There is no claim on file. Could you verify the payer ID that you're using or the billing address?
[CUSTOMER][NEUTRAL] Yep, so we're using American Public Life payer ID 660801.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is the payer ID 60801.
[AGENT][NEUTRAL] But the mailing address, let me know when you're ready for it.
[CUSTOMER][NEUTRAL] OK, because we've tried.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, we, we just file these electronically through our EMR system so we don't mail that paper claim.
[AGENT][NEUTRAL] It's 60801. I'm not sure what is.
[CUSTOMER][NEUTRAL] Yeah, that's where we're.
[AGENT][NEUTRAL] Going on with the payer ID, but the payer ID is 60801. What is the next another date of service?
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Um, let me check if he's got any other dates of service here.
[CUSTOMER][NEUTRAL] So that 57 was the last data service. It's really the only recent data service we have for this patient. It was submitted primarily to Blue Cross as the primary and then it went through to American Public Life as a supplement.
[AGENT][NEUTRAL] Right, but is the primary, are you guys?
[CUSTOMER][NEGATIVE] And there's and I'm getting a no.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I was about to ask or.
[CUSTOMER][NEUTRAL] The, the primary was Blue Cross Blue, yeah, which they paid. Blue Cross paid it and then it went to American Public Life, and they're saying that the it's an invalid payer that comes it's coming back to us as invalid payer even though we have the correct EDI payer ID.
[AGENT][NEUTRAL] Are they putting in the 60801?
[CUSTOMER][NEUTRAL] Yeah, that's the payer ID that we're using for APL.
[AGENT][NEUTRAL] Are you able to do it now while you're on the phone?
[CUSTOMER][NEUTRAL] Um, let's see, so I've got the APL here.
[CUSTOMER][NEUTRAL] And secondary policy, let me, I don't, I don't know if I can just, yeah.
[AGENT][NEUTRAL] Or maybe she should put American Public Life.
[CUSTOMER][NEGATIVE] Yeah, American Public Life, uh, 60801 payer ID and that's how we've been submitting it, but for some reason it just keeps pumping back as like an invalid payer for some reason just don't understand why.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] Huh, OK, um, because the only way I can resubmit this claim is to resubmit it back back to Medicare also, so I have to do Medicare and the supplement both even though Medicare already paid.
[AGENT][NEUTRAL] Did you try it now?
[AGENT][NEGATIVE] Oh, no, you don't have to do that. Well, I'm not sure how it works because see, I'm not sure if you, if they're sending it to, if you're sending it to the primary, but once you receive that EOB back then you're supposed to send it here to us like they don't cross over.
[CUSTOMER][NEUTRAL] Yeah, should ro oh they don't cross over. Oh jeez, OK, I see. So alright, so I'm gonna contact our biller and let her know and see if because I, I just, I haven't been trained on this I don't know how to do the crossover so OK alrighty so I'll let our biller know I.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah, because the, because this is a gap insurance and we're not affiliated with the primary insurance so you have to submit it once you receive those EOBs then you have to send it over yourself.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] Submit manually. OK, perfect. That makes sense. Let me, uh, I'll let her biller know. Thanks so much for that info.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] Thank you goodbye.
[AGENT][NEUTRAL] Bye.