AccountId: 011433970860
ContactId: 5316cf43-9b73-4564-b15e-e9e7c4eaaf35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 905869 ms
Total Talk Time (AGENT): 278751 ms
Total Talk Time (CUSTOMER): 112270 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/5316cf43-9b73-4564-b15e-e9e7c4eaaf35_20250508T17:42_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you. How about you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good. Thank you so much for asking.
[AGENT][NEUTRAL] You're welcome. And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's [PII], no extension.
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from for my notation?
[CUSTOMER][NEUTRAL] HCF Florida Woodmont Hospital.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02457037.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the amount is $5,803.25.
[AGENT][NEUTRAL] OK, so that's [PII].
[AGENT][NEUTRAL] Is that correct? OK. All right. Let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional. And bear with me just a second, let me see if I can find this claim.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Can I get your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. All right, so it looks like we received the claim [PII]. We process [PII] and we requested the primary EOB as of today, we have not received that primary EOB to continue the processing of the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the fax number?
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] And attention to
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] And timely filing limit?
[AGENT][NEUTRAL] With family following limits.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] There's no time limit.
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[AGENT][NEUTRAL] Yes, that is 349-074-6.
[CUSTOMER][NEUTRAL] And call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, yeah, 2 more claims on different patients.
[AGENT][NEUTRAL] OK, bear with me.
[AGENT][NEUTRAL] It's gonna be a minute. I'm making a note on this one.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can you repeat the name of the facility one more time?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sorry, I have closed that one.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] But this is for different facility I think so.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm waiting on the image of the EOB so I can finalize my note. OK, one moment.
[AGENT][NEUTRAL] OK, here we go. And what is the next policy number?
[CUSTOMER][NEUTRAL] 02465901
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the amount is $27,307 even.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] So this one was processed, so let me go ahead and pull the image of the EOB. Looks like it was processed twice. The last one was a duplicate. So I'm gonna give you the original information, OK?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] still waiting on the system to pull the you be.
[AGENT][NEUTRAL] OK, this one is [PII].
[AGENT][NEUTRAL] OK. So it looks like um for this one, it was denied, it was processed [PII].
[AGENT][NEUTRAL] And based on the explanation of benefits, it looks like um benefits are only payable and major medical insurance provides benefits.
[AGENT][NEUTRAL] So if you have an EOB showing that there's an amount applied towards the deductible co-payment and co-insurance, we need a copy of that EOB.
[CUSTOMER][NEUTRAL] OK. Can I get the received date?
[AGENT][NEUTRAL] OK, bear with me just a second.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so this claim was received on
[AGENT][NEUTRAL] 84 [PII], process [PII].
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[AGENT][NEUTRAL] The claim number is 3504584.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. The next one is
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 35045884, right?
[AGENT][NEUTRAL] The claim number 3504584, yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The next one is
[CUSTOMER][NEUTRAL] 0247
[CUSTOMER][NEUTRAL] 3340.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] er and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII]. And the charge amount is $32,575 even.
[AGENT][NEUTRAL] OK, so [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull the most recent one looks like it's gonna be this one. Bear with me.
[AGENT][NEUTRAL] I'm still waiting on the you'll be OK, one moment.
[AGENT][NEUTRAL] OK, so we received the claim on [PII].
[AGENT][NEUTRAL] And let's see, the claim was um denied.
[AGENT][NEUTRAL] So the denial reason.
[AGENT][NEGATIVE] We're unable to assign benefits to the provider on records due to discrepancy with the provider's tax ID.
[AGENT][NEUTRAL] Any payment has been made to the insured.
[CUSTOMER][NEUTRAL] OK. I needed the primary UB?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] This one is indicated that we're unable to assign benefits to the provider on record due to a discrepancy with the tax ID.
[AGENT][NEUTRAL] So a letter has been sent to the provider of service to update the tax ID information. um, we process the claim and any payable amounts was sent to the insured.
[AGENT][NEUTRAL] So you will have to contact the insurer for any payment information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] Yes, um, the claim number is 357-595-1.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][POSITIVE] Have a good day. Bye.
[AGENT][POSITIVE] Thank you bye bye.