AccountId: 011433970860
ContactId: 5ea41799-a530-4ee4-8108-beda7b49c07a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1706760 ms
Total Talk Time (AGENT): 357357 ms
Total Talk Time (CUSTOMER): 364132 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/5ea41799-a530-4ee4-8108-beda7b49c07a_20250530T21:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from provider's office to check up on a claim.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status, sir. May I please get your callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The policy number is 02313790.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And may I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service will be [PII] and uh the bill amount is $522.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] After the prime, it will be $13.75.
[AGENT][NEUTRAL] OK, and may I please have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Acumen.
[AGENT][NEUTRAL] Can you spell that for me, please?
[CUSTOMER][NEUTRAL] Acuin, A Q U A K U M [PII]
[AGENT][NEUTRAL] OK, thank you very much. I'm gonna put you on a brief hold [PII] while I look up this claim and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK. But uh as uh I've already spoken with one of your representative, but the call get disconnected.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she has checked the claim and she has told me that the claim is not on file.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] But uh in between only the call get disconnected.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you wanted to call back and make sure?
[CUSTOMER][NEGATIVE] Yeah, no, I, I have not get the full information. She only said the claim is not on well and the call get disconnected.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, well I'm gonna put you on a hold and I'm gonna pull it up for us and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][POSITIVE] Thank you very much, [PII]. Uh.
[AGENT][NEUTRAL] OK, so the claim is not on file, you're correct. What is the other information that you may need?
[CUSTOMER][NEUTRAL] OK. So, can I have the payer ID to build the claim?
[AGENT][NEUTRAL] Yes, sir. It's [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][POSITIVE] Yes, sir. Take your time.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] OK, but uh I'm not able to look at that. So, when you build up the paper claim?
[AGENT][NEUTRAL] Yes, you could do pay claim. Let me give you the claim's mailing address.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK. What is it?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. What is the TFL?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] Timely filing limit.
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh anything else I need. OK, call reference number for this one, so we can move to another one.
[AGENT][NEUTRAL] Yes sir, the call reference number is going to be my name [PII] and today's date.
[CUSTOMER][NEUTRAL] OK. Are you ready for the next member ID?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you very much. Uh, so.
[CUSTOMER][NEUTRAL] OK. So the member ID is
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 02443376.
[AGENT][NEUTRAL] Thank you. And what's the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Of [PII], [PII].
[AGENT][POSITIVE] Thank you, let me look that up.
[AGENT][NEUTRAL] OK, and then what's the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Um date of service is uh
[CUSTOMER][NEUTRAL] [PII]. And the bill amount is $288.55.
[AGENT][NEUTRAL] OK, and the charges after the primary paid?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As I can see in my system, it is showing me as primary.
[AGENT][NEUTRAL] OK, and then what is the name of the facility?
[CUSTOMER][NEUTRAL] The facility name is Acumen Plantation.
[AGENT][POSITIVE] OK, thank you, sir. I'm gonna put you on a quick hold and get this one pulled up for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. I do have a claim on file on that date of service for that amount, but it's not for the facility name that you gave me.
[AGENT][NEUTRAL] Is there another facility name?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Just a moment. I will look this up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is the late imaging.
[AGENT][NEUTRAL] Yes, that's it. OK, and I do find the claim, the claim number is 3605615.
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] With the primary EOB?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] To the address that
[CUSTOMER][NEUTRAL] So, can I check who is the primary for the member?
[AGENT][NEUTRAL] I don't have that information.
[CUSTOMER][NEUTRAL] Just a moment as I can see, primary 426 5858 uh.
[CUSTOMER][NEUTRAL] OK. Help me with the call reference number.
[AGENT][NEUTRAL] You can use my name [PII] in today's state.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Surely [PII].
[CUSTOMER][NEUTRAL] But I have to, to, OK. Are you ready for the member ID?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. So the member ID is 02123551.
[AGENT][NEUTRAL] OK, and what's the member's name and date of birth?
[CUSTOMER][NEUTRAL] Started on [PII].
[AGENT][NEUTRAL] OK, let me pull up that information.
[AGENT][NEUTRAL] And may I get the date of service and the charge amount before and after primary?
[CUSTOMER][NEUTRAL] Um, the date of service is [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] After primary, I need to calculate this.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] [PII]. What is this?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Or something.
[AGENT][NEUTRAL] OK. And that's after primary? What's before primary?
[CUSTOMER][NEUTRAL] Before primary, it is [PII].
[AGENT][NEUTRAL] OK. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] OK, and what's the name of the facility?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You can take the same imaging.
[CUSTOMER][NEUTRAL] Or a human moments.
[AGENT][NEUTRAL] Imaging.
[AGENT][NEUTRAL] A light imaging. OK, alright, I'm gonna put you on a brief hold again. I'm gonna look up this one. I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. So this claim number is 3603553.
[AGENT][NEUTRAL] And the claim, um.
[AGENT][NEUTRAL] All payable benefits were applied to the policy deductible of $500.
[CUSTOMER][NEUTRAL] The claim is paid and allowed, what is the allowed amount?
[AGENT][NEUTRAL] $500 all payable benefits were applied to the policy deductible of $500.
[CUSTOMER][NEUTRAL] $500 and it's applied towards
[CUSTOMER][NEUTRAL] T
[CUSTOMER][NEUTRAL] OK. On which date it is paid, like uh this process and?
[AGENT][NEUTRAL] OK. Received and processed.
[CUSTOMER][NEUTRAL] Applied.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] We received the claim on [PII], I'm sorry, [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] OK. What is the received date, [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and processed on [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you share us the like EOB on our fax?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] Just a moment fax number.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][POSITIVE] OK, I'm gonna put you on a quick hold. I'm gonna get that fax ready for you and as soon as I have it sent, I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] OK [PII], I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what is the turnaround time?
[AGENT][NEUTRAL] Uh, it's on its way. You just have to give it a chance to get there.
[CUSTOMER][NEUTRAL] OK, not an issue. So, can you take another one?
[AGENT][POSITIVE] Yes sir, I'm ready whenever you are.
[CUSTOMER][NEUTRAL] 01936826.
[AGENT][NEUTRAL] And the member's name and date of birth.
[CUSTOMER][NEUTRAL] Member's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy.
[AGENT][NEUTRAL] OK, and then what is the data service and charge amount?
[CUSTOMER][NEUTRAL] Um date of service is [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] The bill amount is $288.55.
[AGENT][NEUTRAL] OK, and the charges after primary paid?
[CUSTOMER][NEUTRAL] $50.
[AGENT][NEUTRAL] OK, and then the name of the facility for this one?
[CUSTOMER][NEUTRAL] It's a plantation or L imaging?
[AGENT][NEUTRAL] OK. All right. I'm gonna put you on a brief hold. I'm gonna look up this one. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me. Looking for this one on data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. So I think there is no claim on file.
[CUSTOMER][NEUTRAL] So we need to rebuild the claim.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 217.
[CUSTOMER][NEUTRAL] OK. Can you do the last one?
[AGENT][NEUTRAL] OK, what is the policy number, name, and date of birth?
[CUSTOMER][NEUTRAL] My number is 608601.
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you see another policy number, that number that you gave me is our payer ID number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Your ID paper claims sent. Can you search with the name and date of birth?
[AGENT][NEUTRAL] Yes, will you spell the name for me?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The first name is [PII]
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I can find her.
[AGENT][NEUTRAL] OK, I do not see a [PII].
[AGENT][NEUTRAL] In our system
[AGENT][NEUTRAL] Do you have a social?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I don't have the social.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I think I found her.
[CUSTOMER][NEUTRAL] The number
[CUSTOMER][NEUTRAL] Refund?
[AGENT][NEUTRAL] I, I think I did, yes, sir.
[AGENT][POSITIVE] Alright, I tried a different way and founder, you're welcome.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] OK, what is her data service and charge amount?
[CUSTOMER][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is 1950. After the primary, it is 296.11.
[AGENT][NEUTRAL] OK, and for the same facility, is that correct?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, brief hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 598
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have this information for you.
[AGENT][NEUTRAL] The claim number is 3603265.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was paid $296.11 with check number 2045355 on [PII] and the check is still outstanding.
[CUSTOMER][NEUTRAL] OK. And uh you said that it is uh paid for 296.11. So it is allowed for SIM?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Yes, that's the allowable amount, yes sir.
[CUSTOMER][NEUTRAL] OK, so the loan amount and paid amount is the same.
[CUSTOMER][NEUTRAL] Anything else. OK. Can you send us the ID of your fax?
[AGENT][NEUTRAL] Yes, I can send the EOB and the same fax number, sir.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Brief hold.
[CUSTOMER][NEUTRAL] Attention, patient's name.
[AGENT][NEUTRAL] Oh, OK, yes, I'll do that. Hold on real quick.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me and.