AccountId: 011433970860
ContactId: 6178da36-6823-48c2-b92d-d7e0a12e8d39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549239 ms
Total Talk Time (AGENT): 239282 ms
Total Talk Time (CUSTOMER): 148740 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/6178da36-6823-48c2-b92d-d7e0a12e8d39_20250131T18:00_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good afternoon. My name is [PII] and last termination for [PII]. I'm calling from provider's office regarding claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is a good call back number?
[CUSTOMER][NEUTRAL] [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] OK. It's 02252690. M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright, and I understand you're needing claim status for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can help you with that. What is that data service?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge.
[CUSTOMER][NEUTRAL] $1,073 even.
[AGENT][NEUTRAL] 1000
[AGENT][NEUTRAL] $73.
[CUSTOMER][NEUTRAL] Yes, 1073.
[AGENT][NEUTRAL] Thank you. And what is the name of the facility, please, sir?
[CUSTOMER][NEUTRAL] Gastro Health also, sir.
[AGENT][POSITIVE] All right, thank you, and I can help you with that claim status. Let's see.
[AGENT][NEUTRAL] [PII], I am showing that we received that claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim was processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And this claim is pending for the detailed primary EOB. We need an EOB showing what was applied to the deductible, co-pay, or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] OK, so it's required primary, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Claim number is 3531899.
[CUSTOMER][NEUTRAL] OK, may I know the claim TFL limit?
[AGENT][NEGATIVE] No, no honey filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] You can actually fax it to our claims department.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our claims fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3, and that does come straight to our claims department.
[CUSTOMER][NEUTRAL] Yeah, OK, sure.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's move to another client.
[AGENT][NEUTRAL] Oh, you have another claim?
[CUSTOMER][NEGATIVE] Yeah. Totally 3 claims.
[AGENT][NEUTRAL] Different patients
[AGENT][NEUTRAL] Is it a different patient?
[CUSTOMER][NEUTRAL] Yeah, it's a different patient.
[AGENT][POSITIVE] All right, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Uh, one second, it's loading.
[AGENT][NEUTRAL] Also, [PII], while that's loading, we do have a provider portal at [PII] where you have 24/7 access to claim status, EOBs, and you can also submit claim documents as well online.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK, sure. OK, um, that's for the member ID.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Yeah, it's 02408951 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] Uh, both, and the date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you. What is data service for [PII]?
[CUSTOMER][NEUTRAL] It's [PII] and the total charge is $350 even.
[AGENT][NEUTRAL] OK, so bear with me just one moment. The policy number that you gave me actually turned on 9124.
[AGENT][NEUTRAL] I'm checking to see if he has active coverage for that date, so bear with me just a quick second.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] He does have active coverage for that date of service. Can I give you the correct policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] The correct policy number for that data service is 254.
[AGENT][NEUTRAL] 942 2.
[AGENT][NEUTRAL] And again, you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And billed them out with 358.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is it for the same provider?
[AGENT][NEUTRAL] Gastrohealth? OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm getting that claim pulled up.
[AGENT][NEUTRAL] That claim we received on 123.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And processed on 124.
[AGENT][NEUTRAL] And that claim was denied as office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK, and may I know the claim number?
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] The claim number is
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 7188.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm ready, you said you have one more?
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] I'm ready for that next policy number. OK.
[CUSTOMER][NEUTRAL] Just give me a moment, it's loading.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] The next member ID was 202,279,940 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] And that data service.
[CUSTOMER][NEUTRAL] OK. The date of service is [PII] and the total $759 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The same provider.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like we received that claim actually twice, but the original claim.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] We received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And this claim, the 99214 was denied.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] As office visits are not covered when performed, um, office visits are not covered, I'm sorry, and then for the CPT 46,600 services are not covered when performed in the doctor's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and one second.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Claim number 35063553.
[CUSTOMER][NEUTRAL] 3506353, right?
[AGENT][POSITIVE] Yes sir, that's correct.
[CUSTOMER][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 3506253. Yeah. Thank you. And can you please spell your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that claim status. Anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Uh, no, thanks. That's it. Thank you and thank you for giving this information. Have a nice day.
[AGENT][POSITIVE] My pleasure, [PII]. Thank you for calling APL. Hope you have a great day as well and happy weekend.
[CUSTOMER][NEUTRAL] Yeah, same to you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.