AccountId: 011433970860
ContactId: 4ed6d042-3777-4d5a-930e-4dfad0298ac0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 663469 ms
Total Talk Time (AGENT): 181423 ms
Total Talk Time (CUSTOMER): 288292 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/4ed6d042-3777-4d5a-930e-4dfad0298ac0_20250121T18:58_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, good morning.
[CUSTOMER][NEUTRAL] My name is [PII] uh and my last name initial is [PII]. I want to know the status of claim.
[AGENT][NEUTRAL] Could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I have a callback number for you and that policy number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] The policy number of the member that you're inquiring claim status for today?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Do you need policy number?
[AGENT][NEUTRAL] Yes, I do need the policy number. Do you have a policy number or social?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I have a policy number. It is 1252269 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], can I have the member's name and date of birth that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII], and the patient date of birth is [PII].
[AGENT][NEUTRAL] And the data service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] [PII]. What is your procedure code?
[CUSTOMER][NEUTRAL] Procedure that means.
[AGENT][NEUTRAL] The CPT code
[CUSTOMER][NEUTRAL] Actually I have no UOBs so.
[CUSTOMER][NEGATIVE] I am unable to provide.
[AGENT][NEUTRAL] But the EOB wouldn't come from the the CPT wouldn't come from the EOB it'll come from the claim.
[AGENT][NEUTRAL] That was submitted here that you're checking the status of a claim for.
[CUSTOMER][NEUTRAL] Oh, I want to know the status of claim. Actually, claim was billed on [PII].
[AGENT][NEUTRAL] And do you have a CPT code?
[CUSTOMER][NEUTRAL] No, I have no CPT code.
[AGENT][NEUTRAL] You don't have a procedure code or ICD or CPT code?
[CUSTOMER][NEUTRAL] No, I want to general status of claim.
[AGENT][NEUTRAL] So do you have a bill amount? Do you have the services provided?
[CUSTOMER][NEUTRAL] Yes, bill amount. I, yes, I have a bill amount and uh service provider name is Nicola Children Hospital.
[AGENT][NEUTRAL] So do you have a claim in front of you like with the.
[AGENT][NEUTRAL] A CPT code.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, I have billed amount.
[AGENT][NEUTRAL] What is the bill amount?
[CUSTOMER][NEUTRAL] It's $2,971.43.
[AGENT][NEUTRAL] 854 9.
[AGENT][NEUTRAL] that one.
[AGENT][NEUTRAL] There was no payment made because we're requesting a primary ELB to be sent in.
[CUSTOMER][NEUTRAL] OK, so you have required primary, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So claim was denied because uh need to primary you. May I know the claim number?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] 347-8549. That's 347-8549.
[CUSTOMER][NEUTRAL] 348-549. Am I right?
[AGENT][NEUTRAL] 347-854-9
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And may I know the received date?
[AGENT][NEUTRAL] [PII], it was processed [PII].
[CUSTOMER][NEUTRAL] [PII]. All right.
[CUSTOMER][NEUTRAL] Oh, that's all this claim. May I know the call reference number for this call?
[AGENT][NEUTRAL] We don't provide those. You can use my name in today's date as a reference. It's [PII], and today's date is a reference.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, sorry to say, can you, uh, confirm one more time?
[AGENT][NEUTRAL] S as [PII] as in Howard, Y as in yellow, L as in Lima.
[AGENT][NEUTRAL] A as in Alpha.
[CUSTOMER][NEUTRAL] All right, [PII], and I have uh one more thing. So are you ready for next member ID?
[AGENT][NEUTRAL] For the same member or the different member?
[CUSTOMER][NEUTRAL] Ma'am, but different provider is same.
[AGENT][NEUTRAL] What is the member's number?
[CUSTOMER][NEUTRAL] Oh, it's uh
[CUSTOMER][NEUTRAL] 02042058 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII] and the last name is [PII]. And the patient's date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] So [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] So [PII] or [PII]?
[CUSTOMER][NEUTRAL] No. Uh, actually, this state of service is [PII].
[AGENT][NEUTRAL] I got that, but you're saying [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing a claim on file for those dates of services. Can you verify the date of service to make sure it's correct?
[CUSTOMER][NEUTRAL] Uh, it's uh [PII].
[AGENT][NEUTRAL] Not showing a claim on file.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'm not showing the claim on file for [PII].
[CUSTOMER][NEUTRAL] Yes, right.
[CUSTOMER][NEUTRAL] So there is no claim on file, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so I can resubmit the claim. Uh, so call reference number will be same uh whole uh whole call.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alright, so I have 2 more claims, so I'm ready for next member ID.
[AGENT][NEUTRAL] Give me a moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] It's uh 1167, sorry, it's uh Health.
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] It's 021-897.
[CUSTOMER][NEUTRAL] 69 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII], and the last name is [PII], and the patient's date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring on claim status for?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] What is your bill amount?
[CUSTOMER][NEUTRAL] It's $1,717.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim because we're requesting the EOB to be sent in.
[CUSTOMER][NEUTRAL] All right. May I know the claim number?
[AGENT][NEUTRAL] 349-590-6.
[CUSTOMER][NEUTRAL] Uh, hold on. Can you repeat again? Sorry to say.
[AGENT][NEUTRAL] 349-590-6
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] In this [PII] and processing day. OK, so that's on this patient and I have last more claim. So are you ready for next one?
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] It's uh 01740502 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] My first name is [PII] and the last name is [PII]. And uh date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring on claim status for?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] What is your
[AGENT][NEUTRAL] Bill amount
[AGENT][NEUTRAL] 6
[CUSTOMER][NEUTRAL] It's uh $3,981.04.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 74 and same thing need to primary we have right.
[AGENT][NEUTRAL] That is correct. Claim number is 3536944.
[CUSTOMER][POSITIVE] All right. And that's on my side. [PII] and thanks for your time. Have a nice day.
[AGENT][POSITIVE] You're welcome and thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too. Bye now.