AccountId: 011433970860
ContactId: 57d99414-8a9e-4c78-be6d-4a74c79e43b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422489 ms
Total Talk Time (AGENT): 154650 ms
Total Talk Time (CUSTOMER): 116877 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/57d99414-8a9e-4c78-be6d-4a74c79e43b5_20250103T18:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] and I'm calling from South Regional Healthcare. Just wanted to check up on the claim status and discuss the claim denial.
[AGENT][NEUTRAL] OK, so you're wanting clarification of a denial?
[CUSTOMER][NEUTRAL] I wanted the claim status.
[AGENT][NEUTRAL] OK, and clarification of?
[CUSTOMER][NEUTRAL] Um, the timely filing limit as well as the mailing address.
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] It is D as in Delta 47006012.
[AGENT][NEUTRAL] OK, do you have a copy of the card, [PII]? Our number's gonna start with a 0.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I do, but the memor ID starts with a B.
[AGENT][NEUTRAL] Can you spell the patient's first and last name?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and it's spelled as [PII], and the last name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] The last four digits of the phone is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And this extension is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what state does [PII] reside?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And is this a medical claim that you're statusing?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And, um, I've located his policy. What's the date of service, uh, for the claim, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It is for $631.26.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] There is no timely filing in which to submit a claim.
[AGENT][NEUTRAL] And did you say you needed to verify the claim's mailing address or you need the mailing address?
[CUSTOMER][NEUTRAL] Well, if there's any fax number I'd like that and do you see any coin on file?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do and let me give you the fax number.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Attention claims.
[AGENT][NEUTRAL] And I do show that we received the claim [PII], processed it on [PII]. Um, the date of service is after the policy termination date.
[AGENT][NEUTRAL] Uh, the policy term date is [PII].
[CUSTOMER][NEUTRAL] Alright, could you, could you repeat the um receipt date for the claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what's the processing?
[AGENT][NEUTRAL] [PII]. I'm sorry.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] It was received [PII]. Apologize for that, and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much. And the member's policy term back on [PII].
[AGENT][NEUTRAL] Correct. And did you need the the claim number?
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][POSITIVE] Yes, please go ahead.
[AGENT][NEUTRAL] Mhm. 339-867-1.
[CUSTOMER][NEUTRAL] And um could you also let me know the effective date the member's policy?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, and would you be able to fax me the EOB for this?
[AGENT][NEUTRAL] It was actually mailed to the address that's on the claim that was submitted and it's now available to download on our online service center. Let me know when you're ready and I'll give you that web address.
[CUSTOMER][NEUTRAL] Mhm go ahead.
[AGENT][NEUTRAL] It's secured SE [PII].
[AGENT][NEUTRAL] And this next bit is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, and the EOB was actually mailed to the mailing address that was built on the claim form.
[AGENT][NEUTRAL] Yeah, it's automatically generated when the claim is processed.
[CUSTOMER][POSITIVE] OK, thank you so much and lastly, could you please help me with the call reference number?
[AGENT][NEUTRAL] Mhm. My name and today's date, [PII], first initial of my last name is [PII], and your callback number is [PII]?
[AGENT][NEUTRAL] Extension [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] No, thank you so much [PII].
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.