AccountId: 011433970860
ContactId: 4afd267a-663a-4ebf-9c10-032d4b2d0ee3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 784349 ms
Total Talk Time (AGENT): 215207 ms
Total Talk Time (CUSTOMER): 244729 ms
Interruptions: 5
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/4afd267a-663a-4ebf-9c10-032d4b2d0ee3_20250102T15:10_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh yeah, hi [PII]. My name is [PII]. I'm calling with the provider's office. I want to know about the claim status.
[AGENT][POSITIVE] OK, I'd love to help you with claim status, Ms. [PII], do you mind if I get a really good call back number for you?
[CUSTOMER][NEUTRAL] Yeah, sure I just don't need
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Just a minute, holding. So 02479120.
[AGENT][NEUTRAL] And your patient's first and last name and date of birth please?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] initial is J. Last is [PII] Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][MIXED] All right, perfect, thank you so much. So unfortunately.
[CUSTOMER][POSITIVE] All right. Perfect. Thank you so much.
[AGENT][NEUTRAL] We do not handle claims for this insured um but I can give you the contact number for who you need to reach out to and I can also transfer you if you'd like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, what was the number?
[AGENT][NEUTRAL] The number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 9458. OK.
[CUSTOMER][NEUTRAL] Um, I have 2 more claims. Maybe you might handle handle this.
[AGENT][NEUTRAL] Yeah, um, let me, what are the other policy number? What's the next one?
[CUSTOMER][NEUTRAL] The next is 20169054.
[AGENT][NEUTRAL] 201.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 6954, did I get that right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And that patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 201, uh no, I think uh you wrote the wrong patient member ID. It's 02169054.
[AGENT][NEUTRAL] 20169054
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's um.
[CUSTOMER][NEUTRAL] It's not 20, it's written as 02.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So 2169054.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, I'm sorry about that, thank you. And this patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The first name of the member is uh [PII]. Last name is [PII].
[AGENT][NEUTRAL] Perfect, and her date of birth?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][POSITIVE] All right, thank you, thank you, and
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And the date of service for this patient?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's um just a minute.
[CUSTOMER][NEUTRAL] Give me one quick minute.
[AGENT][POSITIVE] No, take your time no worries.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] [PII]. Perfect. Mhm.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] $221 even.
[AGENT][POSITIVE] Wonderful, thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the name of the facility on the file for this claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, it's NHS Northern Eastern Health System.
[AGENT][POSITIVE] Wonderful. Thank you so much. I have your claim here. It looks like we received it [PII]. We processed the claim on [PII].
[CUSTOMER][NEUTRAL] process.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your claim number is 32943006.
[CUSTOMER][NEUTRAL] Your number is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And I do show that this claim was denied. The reason stating is that um these services were rendered after the coverage was terminated.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, the denial is the services were rendered after coverage terminated.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So member is not is not, is inactive on the data service.
[AGENT][NEUTRAL] Correct. Uh, their termination date was [PII].
[CUSTOMER][NEUTRAL] Uh, may I know the uh full coverage range?
[CUSTOMER][NEUTRAL] The starting uh termination.
[AGENT][NEUTRAL] Yes, um, they were effective from [PII] through [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's the [PII]. That's correct?
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So [PII]. Actually, we don't have this EOV with us. Can you fix this UV to me?
[AGENT][NEUTRAL] Yeah, let me see if I can get it pulled up. One second.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that gonna be made out to the patient account number or to yourself, ma'am?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it's a patient account number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is that fax number?
[CUSTOMER][NEUTRAL] Yeah, just a minute. It's uh [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Alright, and I'm hitting send on that now. You should receive it within 5 to 15 minutes.
[CUSTOMER][POSITIVE] OK. Thank you so much. May I have the conference number for this claim?
[AGENT][NEUTRAL] Yes, it's gonna be my name, [PII] initial last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And you had another claim you're on to look at today, ma'am?
[CUSTOMER][POSITIVE] Yeah, sure. I have one more thing.
[AGENT][POSITIVE] All righty, and I'm ready for that policy number when you are, my friend.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a minute.
[CUSTOMER][NEUTRAL] Yeah, so the member ID is 02169054.
[AGENT][NEUTRAL] So the same one?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] This is the same one. [PII] was just.
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Yeah, the same one, right.
[AGENT][NEUTRAL] OK perfect and the data service for the claim you wanna look at?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Um, no, no, just.
[CUSTOMER][NEUTRAL] Wait, let me confirm.
[CUSTOMER][NEUTRAL] [PII], yes, [PII].
[AGENT][POSITIVE] Perfect. All right, and.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me get it all pulled up for you.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII]. We processed it [PII] and.
[AGENT][NEUTRAL] It looks like your claim number here is, I'm so sorry, one second, 3.
[CUSTOMER][NEUTRAL] Do
[AGENT][NEUTRAL] 327 5.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 146.
[AGENT][NEUTRAL] And it looks like this claim was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. The services were render after coverage terminated. May I know the coverage range?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be the same, uh, [PII].
[CUSTOMER][NEUTRAL] OK. OK. Got it.
[CUSTOMER][NEUTRAL] Can you fix this UV to us also because we don't have this UV.
[AGENT][POSITIVE] No worries, um, I have that coming your way.
[CUSTOMER][NEGATIVE] Don't have this
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Perfect. And then was there anything else I could help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] Hey, it's my pleasure thank you so much for calling APL you have such a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.