AccountId: 011433970860
ContactId: 4e66adaa-28f6-447d-9054-ca822fb02de4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461980 ms
Total Talk Time (AGENT): 210986 ms
Total Talk Time (CUSTOMER): 173703 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/4e66adaa-28f6-447d-9054-ca822fb02de4_20250217T22:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. Did you on client status.
[AGENT][POSITIVE] OK, it would be my pleasure to assist you with the claim status. What is a good call back number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, so passport passport is like [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, it is 02544684.
[CUSTOMER][NEUTRAL] All luggage.
[AGENT][NEUTRAL] And the patient's name and date of birth please, ma'am?
[CUSTOMER][NEUTRAL] Yeah. Uh, it is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you, and I can help you with that claim status. What is the date of service ma'am?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it is on [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And for the amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the bill amount is $1,478 even.
[AGENT][NEUTRAL] I'm checking, bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the facility name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and it is not internal set.
[AGENT][NEUTRAL] Norton maternal fetal medicine.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I'm getting it pulled up bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I didn't know.
[AGENT][NEUTRAL] OK, and I'm still looking, bear with me.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] my
[AGENT][NEUTRAL] Were there 3 CPTs on that code on that claim?
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] [PII] and 76819
[CUSTOMER][POSITIVE] Yeah, that's right. Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Is that also Community Medical Associates?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. So it looks like we received that claim twice the original claim, let me get that original received date for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The original claim we received on [PII] and paid the maximum benefit payable of $50 for that date of service.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I can provide that claim number for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 35295.
[AGENT][NEUTRAL] 92.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And per the policy guidelines we paid that maximum benefit of $50 that's the maximum that we can pay per day of service.
[CUSTOMER][NEUTRAL] OK. So the remaining will be the patient responsibility.
[AGENT][NEUTRAL] We don't determine patient responsibility that is determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. And can you please fax me a copy of you before this?
[AGENT][NEUTRAL] We do have a provider portal where EOBs are obtainable, um, you have 24/7 access to EOBs, claim status and claim submission, and if you would like, I can help you set up that account so you can get that EOB instantly.
[CUSTOMER][NEUTRAL] They know
[CUSTOMER][NEUTRAL] I've I think.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Oh, so I have to register for it.
[AGENT][POSITIVE] I can help you with that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It's a simple self registration.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you will go to [PII] that's SEC.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] How the money
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go in as a new user.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Choose the last question.
[AGENT][NEUTRAL] That you are a medical or dental provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's going to ask you for your tax ID and that's the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It'll ask you for the patient account number and the patient account number is listed in box 26 on the HIA. That account number is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And it'll ask you to create a username and password.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once you've created that username and password, all you have to do is enter to get the EOB you enter the claim number.
[AGENT][NEUTRAL] The patient's first name.
[AGENT][NEUTRAL] And the patient's date of birth and that EOB will be obtainable. You'll have that EOB instantly.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got it here. Thank you.
[AGENT][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, just the reference number.
[AGENT][NEUTRAL] A reference number would be my name and today's date, and I spell my name [PII].
[AGENT][POSITIVE] And it's been a pleasure to assist you with that claim status, [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] No. Thank you for your assistance. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.