AccountId: 011433970860
ContactId: 4faeb104-8661-4c05-bb87-8f9f9160da8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431380 ms
Total Talk Time (AGENT): 173905 ms
Total Talk Time (CUSTOMER): 172128 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/4faeb104-8661-4c05-bb87-8f9f9160da8b_20250107T18:59_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] Hi, this is Will calling you from the provider's office to check on the claim status.
[AGENT][POSITIVE] OK, I'd love to help you with claim status today. And can I have your name again? I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII], and can I have a good call back number for you?
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. And the policy number for the claim you want to look at today?
[CUSTOMER][NEUTRAL] Yeah, I have the claim number. Uh, if you're able to verify with that, could you please verify with that?
[AGENT][NEUTRAL] Yeah, give me one second. What is that claim number?
[CUSTOMER][NEUTRAL] It's 352-1558.
[AGENT][NEUTRAL] Alright, give me just a second.
[AGENT][NEUTRAL] And your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, uh, just give me a moment. Uh, the patient name is.
[CUSTOMER][NEUTRAL] [PII], uh, just give a minute. It's uh [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And the date of birth is, it's uh [PII].
[AGENT][NEUTRAL] All right, this claim has somebody else's name on it.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The claim number you gave me 3521558 has somebody else's name on it, a different patient.
[CUSTOMER][NEUTRAL] Yes, uh, we have uh you will be, but there is no, uh, detailed information about the payment. That's why I called to check on that.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or you can provide me the general claim status also.
[CUSTOMER][NEUTRAL] Uh, but verifying that.
[AGENT][NEUTRAL] Yeah, so I actually need you to give me the patient's first and last name and date of birth that's on the claim before I can give you any information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient name is [PII]. Yes.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] I'm sorry, I, it's actually a different name on the claim. It's not [PII] on the claim.
[CUSTOMER][NEUTRAL] It's [PII], is that correct? Could you please check it again?
[AGENT][NEUTRAL] I am looking at the claim right now it's for a different patient.
[CUSTOMER][NEUTRAL] It's OK, uh, could you please check it again? It's uh [PII].
[AGENT][NEUTRAL] Sir, I have it pulled up in front of me. The name I have on the claim is not.
[AGENT][NEGATIVE] It's not for that person.
[CUSTOMER][NEUTRAL] OK. Uh, we can proceed with the, uh, member ID and uh.
[CUSTOMER][NEUTRAL] The data of service uh so that uh maybe you can get the uh different claim status maybe I have the wrong uh claim number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, what is the policy number you want me to look at?
[CUSTOMER][NEUTRAL] Yes, it is 02435177 M as in Mary, L as in Lima, and H.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect and then you wanna look at [PII] you said?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect and the date of service on the claim you wanna look at?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Alright and the name of the facility on file?
[CUSTOMER][NEUTRAL] It's Holy Cross Hospital.
[AGENT][NEUTRAL] Unfortunately that patient only has one claim on file for that data service but it's not for your facility.
[CUSTOMER][NEUTRAL] Could you please check it again? It's a Holy Cross Hospital fort.
[AGENT][NEGATIVE] Yes, it's there it's absolutely not the same facility.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The, uh, the facility name is different, you are saying. Uh, and what is, what about the data service? Is that the same as uh it's 092-42024, right?
[AGENT][NEUTRAL] Every word is different.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, everything is matching but the facility name is not matching, right?
[AGENT][NEUTRAL] It's just a different claim like it's not from your facility.
[AGENT][NEUTRAL] The first number you gave me that first claim number was from Holy Cross Hospital, but it was just a different patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but this patient does not have a a facility claim on file for that date of service.
[CUSTOMER][NEUTRAL] Yeah, uh, could you please, uh, provide me the information? How can we resubmit the claim again?
[AGENT][NEUTRAL] Yeah, absolutely you just send the claim to us. I can give you our payer ID or fax or our mailing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the payer ID, that's mailing address and the the details is.
[AGENT][NEUTRAL] Yeah, the payer ID is 60801.
[AGENT][NEGATIVE] And the mailing address is [PII]. I'm so sorry, that is not right. I don't know what I was saying. [PII].
[AGENT][NEUTRAL] And that's gonna be in [PII].
[AGENT][NEUTRAL] Zip code [PII].
[CUSTOMER][NEUTRAL] The ZIP code is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, sir, could you please repeat again the mailing address?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] It's gonna be in [PII].
[CUSTOMER][NEUTRAL] OK, thanks for providing the information. May I, may I know the timely filing limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We do not have a timely filing limit. You're welcome to submit that at any time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] And you said the, yes.
[CUSTOMER][NEUTRAL] Yes, uh,
[CUSTOMER][NEUTRAL] Uh, this is no claim on file, [PII]t? Uh, and yes, uh, could you please spell your name for documentation purpose.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And may I know the call reference number for this call?
[AGENT][NEUTRAL] It's gonna be my name, [PII], first initial last name, [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thanks for putting the information [PII], uh, that's all for the day. Thank you.
[AGENT][POSITIVE] My pleasure you take care.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.