AccountId: 011433970860
ContactId: 4cc9b39f-3cb9-41d2-a761-925f3292f7a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 518070 ms
Total Talk Time (AGENT): 249277 ms
Total Talk Time (CUSTOMER): 175260 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/4cc9b39f-3cb9-41d2-a761-925f3292f7a6_20250109T20:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] from provider's office looking for a claim status. Could you help me with that?
[AGENT][NEUTRAL] I can help you with that, [PII] What is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] have the extension of [PII]?
[AGENT][POSITIVE] Thank you, [PII], and it would be my pleasure to assist you with that claim status. What is the patient's policy number?
[CUSTOMER][POSITIVE] Sure. Give me a second. I get it for you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I have the member ID is going to be 020.
[CUSTOMER][NEUTRAL] 89751
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure. I have the patient's name is going to be.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you, [PII], that would be my pleasure to assist you with that claim status. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have the claim number I'm sorry. I have the data services for 18-2023 total charge is $1660 even and I have a claim, so, uh, one second, I check in my end.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh oh, I'm sorry. I don't have the claim number in mind. Sorry for that.
[AGENT][NEUTRAL] All right, no problem. What is the facility name?
[CUSTOMER][NEUTRAL] Uh-huh, mhm.
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] It's Prisma Health University. Yeah, it's Prisma Health University Medical Group. I have the data services for 18 of 2023.
[AGENT][POSITIVE] All right, thank you. Uh, it would be my pleasure to assist you with that claim status. Let me get that claim pulled up real quick.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Max, we received that claim on 65-23.
[AGENT][NEUTRAL] It was processed on 65-23.
[AGENT][NEUTRAL] And the claim is denied as.
[AGENT][NEUTRAL] Per our records.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] Premium for this service date was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. I'm not, uh, understand the reason. Could you explain the reason for me?
[AGENT][NEUTRAL] Mhm. According to our records, we did not receive premium for that data service to provide coverage for data service for 1823. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] Oh, I think that, mm, oh, I think the patient is not active during the data source, right?
[AGENT][NEUTRAL] So the policy was active, but for that specific date.
[AGENT][NEGATIVE] The premium was not received therefore benefits are not payable.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, how is it possible?
[AGENT][NEUTRAL] So, for that date,
[CUSTOMER][NEUTRAL] Um, mhm. Go ahead, sorry.
[AGENT][NEUTRAL] Mhm. For that date.
[AGENT][NEGATIVE] They, they were not eligible for benefits.
[CUSTOMER][NEUTRAL] Uh, may I know why the specific date for [PII] the patient not cover, uh, like the any specific benefit?
[AGENT][NEUTRAL] Because according to our records, premium for that service date was not received.
[CUSTOMER][NEUTRAL] Mhm. Then, uh, how can I solve this claim? How can I get the payment for this one?
[AGENT][NEUTRAL] You would need to contact the patient.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you want any uh medical records or any, any information to process this claim?
[AGENT][NEUTRAL] No, sir, it just means that for that date there's no benefits that we can pay. The policy was not eligible for benefits for that data service. It the policy turned on [PII], but for that date of service of [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Our records indicate that we did not receive premium for the policy for that data service.
[CUSTOMER][NEUTRAL] OK. On the data service, the patient's policy premium, premium it's not on that data service, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] What is the patient's plan name and plan type?
[AGENT][NEUTRAL] The plan name is Limited Hospital indemnity.
[CUSTOMER][NEUTRAL] Could you spell that for me?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm. Limited Hospital indemnity. Indemnity is IND.
[AGENT][NEUTRAL] E M as in Mike.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] N is November I T Y.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, for my documentation purpose, what is the mailing address to file the claim, and may I know you accept the contact claim?
[AGENT][NEUTRAL] You can send a corrected claim, however, there is no benefits for that data service that we can pay due to not receiving the premium for that data service.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But you can
[AGENT][NEUTRAL] You can definitely send in a corrected claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're needing the address? I apologize.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The address to send in claims [PII].
[CUSTOMER][NEUTRAL] Yep, yep mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Um, but in my end, I have a different address. It's [PII].
[AGENT][NEUTRAL] That is where you would send the initial claim but for corrected claim, you would send it to the address I gave you.
[CUSTOMER][NEUTRAL] Um, if you don't mind, could you repeat one more time for me. Sorry for that.
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Thank you for that assistance.
[AGENT][POSITIVE] It's my pleasure. Anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] What is the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801 for corrected claim.
[CUSTOMER][NEUTRAL] Thank you. And what is the time you falling to file the correct claim?
[AGENT][NEUTRAL] No family filing to file a corrected claim.
[CUSTOMER][NEUTRAL] Thank you. Yeah, for the same patient, same data service, I have one more claim. It's for the total charge of $1640 even.
[CUSTOMER][NEUTRAL] And before that, what is the claim number for this one?
[AGENT][NEUTRAL] Is that for the QX or the QK?
[CUSTOMER][NEUTRAL] Um, I think it's, uh,
[CUSTOMER][NEUTRAL] One moment, I get that for you.
[CUSTOMER][NEUTRAL] Uh, we completed QK or no, we're looking for QX. Are you looking for the client number for QK?
[AGENT][NEUTRAL] For QK that's the claim that we were just discussing for 4:18.
[CUSTOMER][NEUTRAL] Mhm yeah.
[AGENT][NEUTRAL] OK, this claim number is 330.
[CUSTOMER][NEUTRAL] Claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1745.
[CUSTOMER][POSITIVE] 1745. Thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] And now you're looking for the QK, I mean the QX for 1640? OK.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I got it, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim we received on.
[AGENT][NEGATIVE] 65 and processed on 65 it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] 330-1749
[CUSTOMER][NEUTRAL] Thank you. What is the reference number for this call?
[AGENT][NEUTRAL] The reference number is my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you. Thanks for assisting me today. Have a nice day.
[AGENT][POSITIVE] [PII], it's been a pleasure to assist you with that claim status. Thank you for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.