AccountId: 011433970860
ContactId: 52e17b25-7a55-455a-8512-9bb6a53811af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341579 ms
Total Talk Time (AGENT): 87860 ms
Total Talk Time (CUSTOMER): 190023 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/52e17b25-7a55-455a-8512-9bb6a53811af_20250130T19:54_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider's office regarding the claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 019434437 M as in Mary, L as in Lima, A as in Alpha.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's first name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, can I get that policy number again?
[CUSTOMER][NEUTRAL] Sure. Mhm.
[CUSTOMER][NEUTRAL] 01943437
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, A as in Alpha.
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, [PII], total bill amount is $542 even.
[AGENT][NEUTRAL] Thank you for that information. I'm not showing we have that claim on file.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Um, as I can see uh we submitted the claim on uh.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, but we don't have it on file, so did you wanna resubmit? Do you need a fax number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, can you please provide me the fax, or, or can we submit fax or uh mail?
[AGENT][NEUTRAL] Yes, however you want.
[CUSTOMER][NEUTRAL] Um, please provide me the fax number and mailing address.
[AGENT][NEUTRAL] Fax is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. After that, can, sorry?
[AGENT][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. And the mailing address, please?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] True.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Thank you so much. Uh, can you please verify me whether member is active for the data service or not? Can you please provide me the policy effective date and term date?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Policy became effective [PII]. Policy term [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Oh.
[CUSTOMER][NEUTRAL] Payer ID please.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. What is the timely filing you to submit the claim?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][POSITIVE] OK, thank you for that. And uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] qualification for this claim.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Face to face, I have one more claim to look.
[CUSTOMER][NEUTRAL] Can we go for another member ID?
[AGENT][NEUTRAL] What's the member ID?
[CUSTOMER][NEUTRAL] One second, ma'am.
[CUSTOMER][NEUTRAL] 01622990
[CUSTOMER][NEUTRAL] M as Mary L as Lima 8 1st name is [PII] and last name is [PII].
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] And the tax ID [PII].
[AGENT][NEUTRAL] I'm showing the claim was denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. I would like to request the denial DOB.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Get my.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright, you should receive that EOB by the close of business today. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Uh, that's it from my hands.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Bye-bye. Thank you. Take care.
[AGENT][NEUTRAL] Mhm.