AccountId: 011433970860
ContactId: 48803242-d6b1-4bb7-a706-ad16e25ed009
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416320 ms
Total Talk Time (AGENT): 148866 ms
Total Talk Time (CUSTOMER): 124554 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/48803242-d6b1-4bb7-a706-ad16e25ed009_20250303T20:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is, my name is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Miss [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the name of the facility you're calling from from my notation?
[CUSTOMER][NEUTRAL] Cleveland Clinic Foundation.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss.
[CUSTOMER][NEUTRAL] Yes, one second. The patient policy number is uh
[CUSTOMER][NEUTRAL] 01634842, M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, give me one second.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Patient's uh last name is?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], and the first name is [PII] Sorry, the first name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $807 even.
[AGENT][NEUTRAL] So that's [PII] for 807.
[CUSTOMER][NEUTRAL] Yes, 807.
[AGENT][NEUTRAL] OK, one moment, let me see if I can find this claim and for future you can check claim status online through our website at [PII] and that's optional. Um, one moment, let me pull this EOV and see if you your claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The way on the bear with me.
[CUSTOMER][NEUTRAL] Mm, OK. Sure.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, I don't see one for $807.
[AGENT][NEUTRAL] For that date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And do you know what the procedure code that you're looking for?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 741777.
[AGENT][NEGATIVE] Yeah, we have not received that one.
[CUSTOMER][NEUTRAL] That means no claim on file?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And also please provide me the policy effective on term dates.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Alright, we have an effective date of [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] Mm, OK. And the electronic payer ID, please?
[AGENT][NEUTRAL] OK. This one needs to be sent either by fax or mail because we need the primary you'll be attached to it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the fax number?
[CUSTOMER][NEUTRAL] And the mailing address, please. Yes, please mailing address and the faxing.
[AGENT][NEUTRAL] And the mailing address?
[AGENT][NEUTRAL] OK, the fax number is [PII]. Again, that's [PII]. The um the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And the timely filing limit for permit class.
[AGENT][NEUTRAL] We don't have time limits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And also appeal also no timely filing limit.
[AGENT][NEUTRAL] I'm sorry, you said for an appeal?
[CUSTOMER][NEUTRAL] Yes, is there any time that I made for?
[AGENT][NEUTRAL] Yes, if there is, uh, if we receive a claim and we deny the claim, you can submit an appeal. The appeal needs to be sent within 180 days from the decision date.
[CUSTOMER][NEUTRAL] OK. And also, may I know the attention to whom uh when we submit the primary you'll be along with the claim?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh the fax number is [PII]. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Could you please spell your name for my documentation purposes?
[AGENT][NEUTRAL] Sure, my name is [PII].
[CUSTOMER][NEUTRAL] OK, and the call reference number please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's name.
[CUSTOMER][POSITIVE] OK. Thank you so much for your kind assistance. Have a great day.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APM. Bye bye.
[CUSTOMER][NEUTRAL] Mhm. Bye.