AccountId: 011433970860
ContactId: 5eb42c96-bd6d-471d-84fc-9950acc9ebe1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 925119 ms
Total Talk Time (AGENT): 301842 ms
Total Talk Time (CUSTOMER): 261914 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/5eb42c96-bd6d-471d-84fc-9950acc9ebe1_20250428T16:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office calling you know about the claim status.
[AGENT][NEUTRAL] I'm sure [PII], I can assist you with claim status. Um, first, I'll need a callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah. The callback number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02044897.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient name is uh
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Ms [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and um bill charges on the claim.
[CUSTOMER][NEUTRAL] Yeah, the date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what are the bill charges?
[CUSTOMER][NEUTRAL] Stay on the line.
[CUSTOMER][NEUTRAL] It's 65.
[CUSTOMER][NEUTRAL] $65.11.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Paper claim
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm not showing a claim on [PII] for $65.11.
[CUSTOMER][NEUTRAL] OK. This uh for $508.
[AGENT][NEUTRAL] OK, $508. Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 3552154.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And this claim is the dying because office visits and services provided in office are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we move to the next, uh, sorry, uh, I have another a different date of service with the same patient.
[AGENT][NEUTRAL] Um, yes, ma'am. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's the next date of service, please?
[CUSTOMER][NEUTRAL] Yeah, the next date of service is [PII].
[AGENT][NEUTRAL] OK. And again, the date of service is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm not showing that.
[CUSTOMER][NEUTRAL] The bill amount is 95.
[AGENT][NEUTRAL] Well, I'm not showing a claim on file with that date of service.
[CUSTOMER][NEUTRAL] OK. This is printed claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] This is paper claim.
[AGENT][NEUTRAL] Yeah, I'm not showing a claim on file.
[CUSTOMER][NEUTRAL] Uh, could you check the
[CUSTOMER][NEUTRAL] Uh, OK, yeah, the total will be.
[AGENT][NEUTRAL] And also
[CUSTOMER][NEUTRAL] OK. Yeah, please tell me.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, also, when the claim is filed, um, you guys will need to file the claim under the new policy number. Um, as of [PII], this member does have a new policy number. Would you like that information, the new policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. The new policy number is 023.
[AGENT][NEUTRAL] 074.
[AGENT][NEUTRAL] 29.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the uh timely filing limit?
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] OK. What is the payer ID?
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh you accept the paper for electronic claim also?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Or only pay claim.
[AGENT][NEUTRAL] Yes, we'll accept electric claims um through the payer ID and claims can also be faxed in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you please confirm me your fax ID and with attention?
[AGENT][NEUTRAL] Um, yes, the fax number is [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] The mailing address is
[CUSTOMER][NEUTRAL] Could you please confirm me the billing address?
[AGENT][NEUTRAL] Yes, ma'am. The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK. Yeah, I have another date of service.
[CUSTOMER][NEUTRAL] The same patient.
[AGENT][NEUTRAL] OK, and the date of service.
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Still, I need to rebuild the claim with the new policy?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And are the details will be same, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah, I have more data service with a different patient.
[AGENT][NEUTRAL] OK. And what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 02044897.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Payment
[CUSTOMER][NEUTRAL] Yeah, it's uh
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[CUSTOMER][NEUTRAL] [PII] and uh
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yeah. The date of service is [PII]. And the bill amount is $303 even.
[AGENT][NEUTRAL] OK, thank you. And I'm not showing that claim on file either. And also for this patient.
[AGENT][NEUTRAL] This patient has the same policy number and when the claim is filed, it would need to be refiled under um that new policy number, the 02307.
[CUSTOMER][NEUTRAL] OK. What is the new policy number?
[AGENT][NEUTRAL] OK, it is 023.
[AGENT][NEUTRAL] 07.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 429.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Member is active on date of service.
[AGENT][NEUTRAL] Um, yes, and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the policy is still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the details are the same, right?
[AGENT][NEUTRAL] Yes, ma'am, they are.
[CUSTOMER][NEUTRAL] OK. Uh, I have another data service with the same patient.
[AGENT][NEUTRAL] Yes, ma'am. What's the date of service?
[CUSTOMER][NEUTRAL] Yeah, it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] And the bill amount is $95.
[AGENT][NEUTRAL] OK, and I'm still waiting on my system. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's that date of service one more time?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And what are the bill charges?
[CUSTOMER][NEUTRAL] $95 even.
[AGENT][NEUTRAL] OK, yes, we received this claim on [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the claim number is 3551267.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim is denying because um office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] I have another data of service.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK. And this is also for [PII]?
[CUSTOMER][NEUTRAL] Yeah, same patient.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that date of service.
[CUSTOMER][NEUTRAL] $95 even.
[AGENT][NEUTRAL] Yeah, there's no claim on file with that date of service.
[CUSTOMER][NEUTRAL] And the date of service is uh [PII].
[AGENT][NEUTRAL] OK, for [PII].
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 3551273.
[AGENT][NEUTRAL] And the claim is denying because office visits is not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, I have uh another date of service is [PII] with the same patient.
[AGENT][NEUTRAL] Please repeat the date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] And total bill amount is
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's 8192024. $135 even. OK. Uh, could you please confirm me, uh, patient is active on date of service or not?
[AGENT][NEUTRAL] Um, yes, ma'am. The patient was active on the date of service.
[CUSTOMER][NEUTRAL] OK. So, I need to review this claim with the same policy or another policy number.
[AGENT][NEUTRAL] Um, you would need to rebuild the claim under the policy number 023-07429.
[CUSTOMER][NEUTRAL] you would be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And others for the details is the same, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, another date of service is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need to rebuild with the
[CUSTOMER][NEUTRAL] Sample, OK. Uh, could you please confirm me the call reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] My last initial is [PII] and today's date. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No. Thanks a lot.
[AGENT][POSITIVE] OK. I thank you, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Bye-bye.