AccountId: 011433970860
ContactId: 5224f9cb-194f-44db-a698-8251443ffd45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575630 ms
Total Talk Time (AGENT): 160911 ms
Total Talk Time (CUSTOMER): 169574 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/5224f9cb-194f-44db-a698-8251443ffd45_20250428T19:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] Yes, ma'am. I can assist you with claim status. Um, first, can I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] Last name first initial, [PII], and the callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 23297003.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges for the client.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] For the bill amount of $225 even.
[AGENT][NEUTRAL] OK, thank you. Um, I'm not showing that claim on file. Um, how was it submitted?
[CUSTOMER][NEUTRAL] Actually, it was submitted on [PII].
[AGENT][NEUTRAL] OK. And would you like to verify how was it submitted, uh, was it faxed or?
[AGENT][NEUTRAL] Milden
[CUSTOMER][NEUTRAL] Yeah, actually,
[CUSTOMER][NEUTRAL] Uh, it was actually submitted to electronic.
[CUSTOMER][NEUTRAL] And the electronic payer ID is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[AGENT][NEUTRAL] Yeah, but I'm not showing it on file, but the claim can be resubmitted. Um, you can fax it in, mail it in or send it through the um.
[AGENT][NEUTRAL] Through the EDI system again.
[CUSTOMER][NEUTRAL] OK. Uh, is the date of birth of the patient, uh,
[CUSTOMER][NEUTRAL] Can you check uh with the same patient name is that is different date of birth of [PII]?
[AGENT][NEUTRAL] Yes, ma'am. I'm showing that. [PII] for the date of birth for [PII].
[CUSTOMER][NEUTRAL] And on that, uh that is date of service, uh [PII] for $225.
[AGENT][NEUTRAL] OK, yes, we did receive that claim. We received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3,586,540.
[AGENT][NEUTRAL] And the claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And may I know the patient's plan or policy name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEGATIVE] OK. So it was received on [PII] and denied on [PII] as office visit is not, not covered. So it's a patient responsibility.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] And the claim number is 3,586,540.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And can you fax me this EOB?
[AGENT][NEUTRAL] Yes, what's your fax number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so that's attention Ria A [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yes, I have one more patient to verify.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm still waiting on my system. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can you spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII]. It's spelled [PII].
[CUSTOMER][NEUTRAL] It's [PII], am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And then the last name first.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, and I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yes. Next policy number is
[CUSTOMER][NEUTRAL] 02419432 ML 8.
[AGENT][NEUTRAL] Thank you. Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges for the claim.
[CUSTOMER][NEUTRAL] It's [PII] for $230 even.
[AGENT][NEUTRAL] Uh yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3586666.
[AGENT][NEUTRAL] And this claim is also denying because um office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] So it's the patient responsibility.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And it's also a meddling for, right?
[AGENT][NEUTRAL] Yes, ma'am, it is.
[CUSTOMER][NEUTRAL] OK. And the claim number is 3586666. Am I right?
[AGENT][POSITIVE] Yes, you're correct.
[CUSTOMER][NEUTRAL] OK, thank you. And can you also fax me the EU for this one as well?
[AGENT][NEUTRAL] Um, yes, ma'am. I'm faxing it now.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, that's all right on the fax and the call reference number.
[AGENT][NEUTRAL] Um, yes, ma'am. You should receive this fax in about 10 minutes. Well, both of the faxes in about 10 minutes. And the card reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Your name and today's date as the call reference. OK.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information you provided me on this call.
[AGENT][NEUTRAL] Uh, thank you, [PII] for calling APL. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's all. Thank you for asking.
[AGENT][POSITIVE] OK. I thank you again for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][NEUTRAL] Mm bye.