AccountId: 011433970860
ContactId: 49078371-7d3e-488d-aaea-e3ed07b9624e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 4026000 ms
Total Talk Time (AGENT): 677178 ms
Total Talk Time (CUSTOMER): 617025 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/49078371-7d3e-488d-aaea-e3ed07b9624e_20250217T15:52_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from doctor's office. I'm looking for some client status. Could you help me on that?
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, the callback number is [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So the member ID is 02304455.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's last name is.
[CUSTOMER][NEUTRAL] [PII], first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure, it is [PII] for $1,132.
[AGENT][NEUTRAL] OK, so 18 of 25 $1,132 even. And this is for dental or medical?
[CUSTOMER][NEUTRAL] It's for dental?
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] How could you spell your name?
[AGENT][NEUTRAL] That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me pull this EOV. Let me check it and see if this is your claim. Do you mind holding for me?
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, Mr. [PII], uh, we processed this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] And we send a benefit amount of $524 to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need the claim number or?
[CUSTOMER][NEUTRAL] So $524 has been paid for this claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I have the claim number please?
[AGENT][NEUTRAL] Sure, the claim number is 35539007.
[CUSTOMER][NEUTRAL] OK, and you said that the claim was received on [PII], right?
[AGENT][NEUTRAL] No, that's the the um that's the process date. Let me check and see when we got the claim. One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It was received [PII].
[CUSTOMER][NEUTRAL] OK, thank you. So what is the uh payment type whether just check or EFT?
[AGENT][NEUTRAL] It was a check, single check, paper check?
[CUSTOMER][NEUTRAL] Uh, check number please.
[AGENT][NEUTRAL] That is 202-355-5.
[CUSTOMER][NEUTRAL] 202-355-5 right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Issue date please.
[AGENT][NEUTRAL] The same as the process date, [PII].
[CUSTOMER][NEUTRAL] OK, thank you. Can you send the copy of EOB through fax?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] to your attention.
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, let me go ahead and send this out to you while I got you on the line one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Well, what is the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, uh, can I go for the next patient?
[AGENT][NEUTRAL] OK, um, go ahead with the policy.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The next number ID is 025542.
[CUSTOMER][NEUTRAL] 65
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's last name first name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] What is the date on the date of birth?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Alright, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service is [PII] for $1,918.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this one and that was uh [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me pull this up.
[AGENT][NEUTRAL] I'm waiting on the be to pull up, OK, one moment.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, looks like this one we processed on [PII].
[AGENT][NEUTRAL] And it was denied. Let me check the thing now, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then I'll res it is the policy and provide benefits for any procedures or service not listed on the schedule of benefits. So this um procedures, these procedures are not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what is the reason for the not covered whether by the patients plan or else policy side?
[AGENT][NEUTRAL] The member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, what is the claim number?
[AGENT][NEUTRAL] Claim number is 354-842-4.
[CUSTOMER][NEUTRAL] Clam received it.
[AGENT][NEUTRAL] Um, let me get that one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It received on um [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can I send a copy of you before this one too?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold for this one, OK? OK, one moment.
[CUSTOMER][POSITIVE] Thank you. You can take your time.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you it should be there in a few minutes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, can I go for the next patient?
[AGENT][NEUTRAL] Yes, go ahead with the policy number.
[CUSTOMER][NEUTRAL] Sure. It's 1163.
[CUSTOMER][NEUTRAL] 069.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So the patient's last name is [PII], first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] for $4230.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ri
[AGENT][NEUTRAL] Gonna be a minute.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so it looks like we received the claim on [PII] process [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $852.80.
[CUSTOMER][NEUTRAL] OK, so the pay amount was $852.80 right?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] Claim number is 35496006.
[CUSTOMER][NEUTRAL] 9606, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, what is the mode of payment whether by check or EFT?
[AGENT][NEUTRAL] Just a check, a single check, paper check.
[CUSTOMER][NEUTRAL] Track number please.
[AGENT][NEUTRAL] Um, bear with me, that is 202-203-6.
[CUSTOMER][NEUTRAL] OK. And issue date, please.
[AGENT][NEUTRAL] The same as the processed.
[CUSTOMER][POSITIVE] OK, thank you and uh can I send to you for this one too?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] The fax number right?
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] 315254-2173.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's been sent to you. It should be there in a few minutes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, well, there's some more clients. Can I go for the next one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, go ahead with the numbers.
[CUSTOMER][NEUTRAL] Sure, so the next member ID is 02.
[CUSTOMER][NEUTRAL] 096194.
[AGENT][POSITIVE] Let me have that number one more time. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead with the policy number one more time, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, so it's 02096194.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So the patient's last name is [PII] and the first name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, how much is the total charge?
[CUSTOMER][NEUTRAL] It is $126 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I'm waiting on the system.
[CUSTOMER][POSITIVE] Yeah, sure I can take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, um, we process the claim [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was received, um,
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And the claim was denied, the denial reason is that the service was surrendered following the termination of the coverage.
[CUSTOMER][NEUTRAL] OK, so the patient was not effective at the data of service, right?
[AGENT][POSITIVE] Um, correct.
[CUSTOMER][NEUTRAL] OK. Can I have the effective date?
[AGENT][NEUTRAL] Sure. The effective date on the policy is [PII] and it terminated [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, um, I just want to check one more time whether it's effective from [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the claim number please?
[AGENT][NEUTRAL] Uh, sure. That is 354-1307.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And can I go for the next patient?
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] Let me make a note on this.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][NEUTRAL] And [PII], you don't need the the you'll be on this one, right?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] So the member ID is 02517833.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So the patient's last name is [PII]. First name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the date of service that I'm looking for is [PII] for $460.
[AGENT][NEUTRAL] Let me see if I can find.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we process this claim on [PII] and we send a benefit amount of $318.20.
[CUSTOMER][NEUTRAL] OK, uh, can you please repeat the process date again?
[AGENT][NEUTRAL] OK, it was processed on [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] What is the received date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, claim number please.
[AGENT][NEUTRAL] The claim number is 352-2249.
[CUSTOMER][NEUTRAL] OK, so the paid amount is $318.20 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, mode of payment, please check our EFT.
[AGENT][NEUTRAL] Sure. Sure.
[AGENT][NEUTRAL] Single check, paper check, mhm, yes.
[CUSTOMER][NEUTRAL] Single check, right?
[CUSTOMER][POSITIVE] Thank you, check number please.
[AGENT][NEUTRAL] OK, the check number is one moment.
[AGENT][NEUTRAL] OK, that's 2010409.
[CUSTOMER][NEUTRAL] OK, check your date please.
[AGENT][NEUTRAL] The same as the process date, [PII].
[CUSTOMER][NEUTRAL] Thank you and can you send the year before this one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] So for the entire call I can use your name and today's date as a reference number right?
[AGENT][NEUTRAL] Mhm, correct, that is correct. And do you mind holding for me while I send this out to you right now, OK?
[CUSTOMER][POSITIVE] Yeah. Sure, you can take your time.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] Yeah, thank you for that and uh can you assist me with one more time?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh, actually, there's 2 more claims.
[AGENT][NEUTRAL] OK, go ahead with the next one.
[CUSTOMER][NEUTRAL] Well, the next number ID is 02521101.
[CUSTOMER][NEUTRAL] And the last name is [PII]. First name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the date of service that I'm looking for is [PII] for $244.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 2624.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like we have processed this claim on January and [PII], and it was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we send a benefit amount of $173.80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number, please?
[AGENT][NEUTRAL] 351-375-5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] What is the check number, whether it's a single or bulk check?
[AGENT][NEUTRAL] It's a single check.
[AGENT][NEUTRAL] Um, it's going to be check number 2008693.
[CUSTOMER][NEUTRAL] 200.
[AGENT][NEUTRAL] 8693.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Thank you. Uh, can you send the copy of CUB?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] So the issue date is same as the process date, right?
[AGENT][NEUTRAL] Um, yes, the issue date of the check and the process is the same one, correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let me check this out.
[AGENT][NEUTRAL] All
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I went ahead and send that one over.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I, I send that one over so it should be there in a few minutes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you and uh can I go for the next one?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Uh, so the next number ID is 02521101.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, and I missed there are 3 more clients for me to assist you. Can you do for me that?
[AGENT][NEUTRAL] OK. The number you're giving me is the same number you gave me prior. Um, do you have a different number or it's gonna be for the same number?
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Uh, this is for this patient, right?
[CUSTOMER][NEUTRAL] Uh, just now you provided for that one. OK, so the next one is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the first name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And the date of service is 9-3-2024 for $167.
[AGENT][NEUTRAL] One.
[AGENT][NEUTRAL] Can you repeat the date of service one more time just to make sure I got it correctly?
[CUSTOMER][NEUTRAL] Yeah, sure, uh, you want the member ID?
[AGENT][NEUTRAL] No, the date of service.
[CUSTOMER][NEUTRAL] Data services [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And there are still 3 patients left. I forgot to miss. Sorry for that. Can you assist me on that too?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Thanks a lot.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let's see.
[AGENT][NEUTRAL] We received the claim on [PII], processed [PII].
[AGENT][NEUTRAL] And the claim was denied. Uh, the reason for this denial is, let's see.
[AGENT][NEUTRAL] OK, the policy does not provide benefits for any procedure service not listed on the scheduled benefits. The calendar, your maximum for dental benefit has been exhausted.
[CUSTOMER][NEUTRAL] OK, so the benefits maximum has been reached, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] Whether it's any kind of frequency limitations or else the maximum amount has been met.
[AGENT][POSITIVE] The maximum benefit, yeah, benefit amount. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the client number please?
[AGENT][NEUTRAL] Yes, and the claim number is one moment.
[AGENT][NEUTRAL] OK, 3506482.
[CUSTOMER][POSITIVE] Thank you and uh can you send the year for this one?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I'll send that one it should be there.
[CUSTOMER][POSITIVE] OK, thank you so the client has been sent, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You did?
[AGENT][NEUTRAL] Yes, I'm here. Yes. Hello, can you hear me? Yes, the claim has been sent. Mhm.
[CUSTOMER][NEUTRAL] Hello? Yeah, uh.
[CUSTOMER][NEUTRAL] Yeah, I can hear you.
[CUSTOMER][POSITIVE] OK, thank you. Can I go for the next one?
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Yeah sure the member ID is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mhm. That one is not pulling anything up in my system.
[AGENT][NEUTRAL] Can you repeat the number without the zeros?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, sure it is 025128881.
[AGENT][NEUTRAL] Mm. Yeah, that one is not pulling anything up. Is it 2 8s or 3 8s?
[CUSTOMER][NEUTRAL] Uh, which one? Uh, well, the number is 251-288-1.
[CUSTOMER][NEUTRAL] Without any zeros.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII], first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. What's the date of service and the amount?
[CUSTOMER][NEUTRAL] It is [PII] I'm sorry [PII] for $2,544 even.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't have a claim for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claim was not on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I have the correct payer ID to send the claims?
[AGENT][NEUTRAL] That one is 60801.
[CUSTOMER][NEUTRAL] OK, and the mailing address is [PII], is that right?
[AGENT][NEUTRAL] Yes, in [PII]. Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. So actually, I'll send the claims to the correct mailing address and the correct payer ID. So can you please double check whether the claim was received or not?
[AGENT][NEUTRAL] I have no claims for that date of service. I'm looking at the claim history. There's no claim for that day.
[CUSTOMER][NEUTRAL] OK, OK, then let me go and resubmit the claim.
[AGENT][NEUTRAL] Unless you have a different date, yeah, unless you have a different date, then you probably have it, but we don't have that date [PII] is not on file.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you. Can I go for the next one?
[AGENT][NEUTRAL] One moment. Let me make a note on this one.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. What's the next policy?
[CUSTOMER][NEUTRAL] OK. So the next number ID is 02.
[CUSTOMER][NEUTRAL] 485834
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's last name is [PII], first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Day of service is [PII] for 2 I'm sorry $252.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me put this here.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK, we received the claim [PII], processed [PII]. The claim was denied. The reason for this denial is that the service was rendered after following the termination of coverage.
[CUSTOMER][NEUTRAL] OK, so the coverage was not effective with the data service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What is the effective date?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That is [PII] and it terminated, I'm sorry, not July. It was April, [PII].
[CUSTOMER][NEUTRAL] So it was only 6 days, right?
[AGENT][NEUTRAL] Yes, only one week.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] Claim number is 347-826-2.
[CUSTOMER][NEUTRAL] OK, can I go for the next one?
[AGENT][NEUTRAL] Bear with me. Let me make a note on this one.
[CUSTOMER][NEUTRAL] Sure, this claim would be the last one.
[AGENT][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] So the policy number is 02.
[CUSTOMER][NEUTRAL] 491005.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the first name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data services $529 or 2024 for $216.
[AGENT][NEUTRAL] 3
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, um, we received the claim [PII] and processed [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $148.80.
[CUSTOMER][NEUTRAL] I'm sorry, what is the amount?
[AGENT][NEUTRAL] $148.80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And what is the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3468461.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you and uh what is the check number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Check number is 1857326.
[CUSTOMER][NEUTRAL] And the issue date is same as the process date, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you and uh you'll be.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] You need me to send the fax EV?
[CUSTOMER][NEUTRAL] Yeah, yeah, that's it.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding. OK, I went ahead and send that over to you. It should be there in a few minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Mhm. Thank you for calling APO. Have a good day, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you. You too. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] Yeah. Thank you. Bye-bye.