AccountId: 011433970860
ContactId: 690abac8-da0a-42e2-aeaa-b4fcceb0a1c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 776719 ms
Total Talk Time (AGENT): 202508 ms
Total Talk Time (CUSTOMER): 367397 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/690abac8-da0a-42e2-aeaa-b4fcceb0a1c7_20250214T19:07_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling for claims.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It is 01565944 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] And a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] Absolutely, it is [PII] and that is direct.
[AGENT][NEUTRAL] OK and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and [PII], you said you're checking claim status?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] And what's the date of service and the build amount?
[CUSTOMER][NEUTRAL] It is for [PII] for $437.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do not show that data service on file for [PII].
[CUSTOMER][NEUTRAL] OK, and then do you mind if I confirm the claims mailing address is it?
[AGENT][NEUTRAL] Mhm, that's fine.
[CUSTOMER][NEUTRAL] Um, is it the [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and then um do you guys have an electronic payer ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can you repeat that? I feel like I typed it 0 in the wrong spot.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you mind repeating that electronic to your ID?
[AGENT][NEUTRAL] Um, 60801.
[CUSTOMER][POSITIVE] OK 01 perfect um.
[CUSTOMER][NEUTRAL] And then these are supplemental to commercial plans, correct?
[AGENT][POSITIVE] Major medical, that is correct.
[CUSTOMER][NEUTRAL] OK, and do you know because I have.
[CUSTOMER][NEUTRAL] 6 claims for another patient. Do you, I'm assuming because I haven't heard of it, but the primaries are not set up to cross over to them like for the claims to cross over to you guys correctly? OK, I just wanted to confirm that because we have a hold in our system that.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] They're crossed like that they don't actually go out pending the primary crossing it over so I just wanted to make sure that maybe that system bug needed to be fixed so thank you I appreciate that thank you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, I think you have to physically submit them to us.
[CUSTOMER][NEUTRAL] Yeah, because there's like a hold on it when they're like that plan type. I don't know if that makes sense, but it like because they're usually a Medicare, so it puts them on hold based on the plan type awesome I appreciate that. Is there a reference number for the call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll use my name in today's date as your reference. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] ONYA.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][POSITIVE] Awesome perfect and are you able to see if one other patient's claims are on file? I'm assuming they're not.
[AGENT][NEUTRAL] OK, and that policy number?
[CUSTOMER][POSITIVE] Yeah, absolutely it is give me one second, sorry.
[CUSTOMER][NEUTRAL] It is 18462997.
[AGENT][NEUTRAL] OK, and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And is this the one you had 6 on?
[CUSTOMER][NEUTRAL] No, that's another one.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] Figured I
[CUSTOMER][NEUTRAL] This one is [PII] for $305.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, I do not show date of service [PII] in the amount of 305 on file for Shawna, but I do need to give you the correct policy number for that range of date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Absolutely OK perfect.
[AGENT][NEUTRAL] Uh, the correct policy number for this data service is 230.
[AGENT][NEUTRAL] 4131.
[CUSTOMER][NEUTRAL] 4131 OK.
[CUSTOMER][NEUTRAL] Perfect, thank you, and I don't think you can, can you check that other patient with those 6 claims? I was gonna just call those back piecemeal.
[AGENT][NEUTRAL] It's a different policy number?
[CUSTOMER][NEUTRAL] Yeah, it's a totally different patient. I've 6 different dates of services. Yeah, absolutely.
[AGENT][NEUTRAL] OK, give me just a second. Mhm.
[CUSTOMER][NEUTRAL] OK, so I was gonna try to get like the ones and twos out and then just call on his like piecemeal.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, sure, no rep who wants to like, you know what I mean, that's why I'm like it, and I would greatly, greatly, greatly appreciate it.
[AGENT][NEUTRAL] Alright, what's the policy number?
[CUSTOMER][NEUTRAL] It is 1227379.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima 7.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] And then that is
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service date of service?
[CUSTOMER][NEUTRAL] Of course they're all for the same build amount of $336 and so the dates are [PII], [PII], [PII], [PII], [PII], and [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do not see the [PII].
[AGENT][NEUTRAL] Or the [PII].
[AGENT][NEUTRAL] Or the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't do not see [PII] or [PII].
[AGENT][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] OK, I assumed perfect and do you have, um, do you, I don't know if you know it, but do you have your timely filing limit for claim submission?
[AGENT][NEGATIVE] Yeah, there's no timely filing limit.
[CUSTOMER][POSITIVE] Oh, there isn't awesome perfect thank you I appreciate that, [PII]. Thank you so much.
[AGENT][NEUTRAL] No, you're welcome and [PII], you can also check status online at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, we were, oh.
[CUSTOMER][NEUTRAL] Secure, can you repeat that because we were told by somebody else that there isn't a portal.
[AGENT][NEUTRAL] You would have to
[AGENT][NEUTRAL] There is a portal to check claim status.
[CUSTOMER][POSITIVE] 00 awesome, can you repeat that so I can write that down that would be.
[AGENT][NEUTRAL] You want me to help you set that account up?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Sure, if you can, that would be great.
[AGENT][NEUTRAL] I have time.
[AGENT][NEUTRAL] Just let me know when you you've arrived to the home page.
[CUSTOMER][NEUTRAL] I do you mind repeating that again what it was I had secured.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh. [PII]
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, give me one quick second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right, I am there.
[AGENT][NEUTRAL] And so you should see online service center welcome.
[CUSTOMER][NEUTRAL] Yes, and then log in or new user.
[AGENT][NEUTRAL] Mhm, if you've not created an account, you would be a new user.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And then you'll select which role that best describes you.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the patient account number, would that be ours or am I using the patient ID number?
[AGENT][NEUTRAL] Yeah, it's gonna be the patient account number. I think there's instructions at the bottom. Patient account number can be found in the following locations are you billing on a CMS 1500?
[CUSTOMER][NEUTRAL] Yes, but for us, like our internal, like we, they're called the patient account numbers for us, like our invoice numbers, so that's what they they like start with a piece. I wasn't sure because it just says it would match what you submitted on the claim form and we have both on there. I don't know if that makes any sense, um.
[AGENT][NEUTRAL] So it's gonna be the patient account number that's housed in box number 26 on the CMS 1500 form.
[CUSTOMER][POSITIVE] OK perfect that's what I wanted to make sure because I'm like if I don't wanna go.
[AGENT][NEUTRAL] And out of curiosity, do you see the instructions on that page in that box?
[CUSTOMER][NEUTRAL] Yes, and it, but it and it says the patient account number must match and it says.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like the number you listed on the submitted claim form, so that's where I just wasn't sure.
[CUSTOMER][NEUTRAL] Where it was because it says in box 26 which is our invoice OK, that's what you said right? the 26 that's what I wanted to check, OK.
[AGENT][NEUTRAL] No, for
[CUSTOMER][NEUTRAL] Perfect, yeah, because I thought I was doing something wrong because I keep getting a oops there seems to be a problem. That's why I was like maybe I'm reading wrong and the information has changed.
[AGENT][NEUTRAL] And you know what, you know what, um, you may be getting the message because we've not received any of these claims, so it's looking for the tax ID number and the account number that you're entering and it's not there, so that could be the problem.
[CUSTOMER][NEUTRAL] But yeah, I.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][POSITIVE] OK, because it doesn't mean. OK, that, OK, that's where I was like, I swear I was like, I swear I can read. I promise. It just kept telling me oops, and then I was like maybe I'm wrong. Yeah, no, I was like maybe you're wrong. No, no, no. OK, perfect. No, I appreciate that, [PII]. Thank you so much.
[AGENT][NEUTRAL] Oh, I didn't think about that, but that's probably why.
[AGENT][NEUTRAL] Alright and just so you know let's say you have several claims for a provider with one tax ID and then you may have other claims and it's a totally different tax identification number, you'll have to create an account for each tax ID.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Oh, OK, OK, perfect. That's good to know thank you. I, while you were talking, you probably think I'm, I was trying to take notes for our team because this is a new payer for us, so that's where I was trying to type it like type it out and like in different spots. That's why I'm like I'm gonna make sure I'm not like, you know, all over the place so I appreciate that. Thank you so much thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Anything else, [PII].
[CUSTOMER][NEUTRAL] Nope, that was it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][NEUTRAL] Bye-bye.