AccountId: 011433970860
ContactId: 62393f59-b02b-48b2-995b-f4fa00e67cfd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1203760 ms
Total Talk Time (AGENT): 275928 ms
Total Talk Time (CUSTOMER): 511905 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/62393f59-b02b-48b2-995b-f4fa00e67cfd_20250320T17:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient information and the provider information?
[AGENT][POSITIVE] Yes, I'm happy to check on a claim for you today, [PII]. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's 1069988.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And do you have a good call back number just in case we're disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, sure. My callback number is [PII]. And there is direct line no extension.
[AGENT][NEUTRAL] Thank you. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] It's [PII] Last name is [PII]
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Thank you. Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you and the bill amount?
[CUSTOMER][NEGATIVE] Yes, the bill amount is $190 even it's $190.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for your patience and waiting on this, [PII]. So it looks like we did receive a claim for this state of service. Let me pull this up here. Apologize. One moment.
[AGENT][NEUTRAL] Uh, looks like the claim was denied.
[AGENT][NEUTRAL] The services were rendered after the date, um, after the policy was active.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so the patient is not active on date of service.
[AGENT][POSITIVE] Correct. The patient was terminated.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you please give me the received date?
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the denial date?
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] And it's for the patient is not active on date of service, right? Could you please give me the effective date?
[AGENT][NEUTRAL] Uh, yes, one moment. The effective date is [PII].
[CUSTOMER][NEUTRAL] And the term date?
[AGENT][NEUTRAL] And the termination date is [PII].
[CUSTOMER][NEUTRAL] OK. And when was the last coordination of benefits updated?
[AGENT][NEGATIVE] There is no coordination of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you see any other pair listed for this patient?
[AGENT][NEUTRAL] We do not show any other active policy for the member at this time.
[CUSTOMER][NEUTRAL] OK. What is the timely filing limit to submit the corrected claim?
[AGENT][NEGATIVE] No timely filings.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] The mailing address to submit the corrected claim.
[AGENT][NEUTRAL] Claims mailing address would be [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, it's [PII] [PII] sorry [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the timely filing limit to an appeal?
[AGENT][NEUTRAL] 180 days within the decision date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the uh uh and the mailing address is [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Is there any specific form for a bill?
[AGENT][NEUTRAL] Uh, it must be in writing.
[AGENT][NEUTRAL] They need to state why they're appealing the decision.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] There's nothing I can
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK. So is there any form for a bill? Yes or no?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, ah, could you please give me the claim number?
[AGENT][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] 9.
[AGENT][NEUTRAL] 9354.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And what is the call reference number for this call?
[AGENT][NEUTRAL] Call references my name with my last initials and today's date. My name again is [PII], last initial [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you, [PII]. And could you please assist me with one more claim?
[AGENT][NEUTRAL] Mhm. Absolutely. Let me just notate this member's policy. Give me one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][POSITIVE] All right, and I'm ready for that next policy number when you are.
[CUSTOMER][NEUTRAL] OK, [PII], the next member ID is 02100475.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Patient's name is [PII]. It's first name is [PII] Last name is [PII].
[CUSTOMER][POSITIVE] Living good. It's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then data service?
[CUSTOMER][NEUTRAL] like.
[CUSTOMER][NEUTRAL] of services [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, no claims on file for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $11,300 even.
[AGENT][NEUTRAL] We don't have any claims on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me the information about is the patient active on data of service.
[AGENT][NEUTRAL] Uh, yes. Patient is active. The effective date is [PII]. Patient is still active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, uh, the effective date is [PII] and the patient is still active.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. And are you a primary or secondary?
[AGENT][NEUTRAL] Uh, we are the secondary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. When was the last coordination of benefits updated?
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is the preferred mode of submission?
[AGENT][NEUTRAL] I'm sorry, what is the, can you ask that again?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] What is the preferred mode of claim submission?
[AGENT][NEUTRAL] Claims can be submitted electronically, via fax or mail.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what is the claim submission timely filing limit?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what is the claim submission mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. And what is the payer ID?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. And what is the call reference number for this call?
[AGENT][NEUTRAL] Call references my name with my last initial and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] And could you assist me with one more claim? It's the last claim I have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, what's the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02.
[CUSTOMER][NEUTRAL] 323-553.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and patient's name and date of birth.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, I'm so sorry, [PII]. Uh, I just have one question from the previous claim, uh, the which is the claim is denied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I just have a question. Uh, do you require the denial copy of you before that denial claim?
[AGENT][NEUTRAL] The previous one that we checked, [PII], there was no claim on file.
[CUSTOMER][NEUTRAL] OK, but not that claim which is denied for the patient is not active on date of service.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Do you require the denial copy of COB?
[AGENT][NEUTRAL] No, we, we can send you a copy if you need it, but we don't require it. I mean, we do send one.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, and, uh, from where I, uh, we can get the copy of COB from portal.
[AGENT][NEUTRAL] You can get it from the portal or we can send it to you via fax if you would like us to.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] And what is the name of the portal?
[AGENT][NEUTRAL] Our web address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, um, just, just allow me a moment, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII]. Sorry for the holding and uh
[CUSTOMER][NEUTRAL] Do you get the next member ID?
[AGENT][NEUTRAL] Yes, I need the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you. And date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the build amount?
[CUSTOMER][NEUTRAL] The bill amount is $295 even.
[CUSTOMER][NEUTRAL] then you're off.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is that.
[AGENT][NEUTRAL] So it looks like we did receive a claim for the state of service. claim was received [PII].
[AGENT][NEUTRAL] The claim was denied. Uh, we requested a copy of the primary insurance explanation of benefits.
[AGENT][NEUTRAL] Claim was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. OK, sir, just a moment.
[CUSTOMER][NEUTRAL] How do you require the denied copy of EOB um with the corrected claim or with the fresh claim?
[AGENT][NEUTRAL] Uh, you can just send the explanation of benefits or corrected claim either.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Um, the claim is received on [PII], right? And the process on [PII].
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And the claim denial date?
[AGENT][NEUTRAL] Was [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And what is the timely filing limit to submit the corrected claim?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] And the mailing address is the same which we discussed in the previous claim, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is there any time requiring to submit an RPG?
[AGENT][NEUTRAL] 180 days from the decision date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the appeal mailing address is the same, right?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] And there is no specific form for a pill?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] 344-6442.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you so much, [PII], and the claim, claim reference number will be the same. It is [PII] and today's date, right?
[AGENT][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate your patience and thank you so much for the information, [PII], and have a good day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] OK.