AccountId: 011433970860
ContactId: 6eb87b7c-b4b2-4583-a8a7-2d42dac238a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 484350 ms
Total Talk Time (AGENT): 159619 ms
Total Talk Time (CUSTOMER): 158536 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/6eb87b7c-b4b2-4583-a8a7-2d42dac238a3_20250103T14:32_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the um provider's office to check the status of the claim.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, my, uh, member ID number was just give me a second and I'm sorry I couldn't catch your name. Uh, may I know your name, please?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] If I can get the policy number, please?
[CUSTOMER][POSITIVE] OK, thank you, [PII].
[CUSTOMER][NEUTRAL] Yeah, and the member ID number is 1462936.
[AGENT][POSITIVE] Thank you and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII] and it's a direct line with an extension number.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Thank you for holding, [PII]. Can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And you said the patient's first name is?
[CUSTOMER][NEUTRAL] [PII]. It's uh spelled like [PII], yes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, thank you, and you were checking claim status?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK, can you provide the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the total charge amount is $120 even.
[AGENT][NEUTRAL] 1:30.
[CUSTOMER][NEUTRAL] 120, 120.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said [PII] 4 $30?
[CUSTOMER][NEUTRAL] $120. [PII] $120 even.
[AGENT][NEUTRAL] OK, 120. OK, I do not show the claim um for that date of service on file. [PII] 4 $20.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah. Actually, uh, we have submitted the claim for the mailing address of uh [PII].
[AGENT][NEUTRAL] That is correct. When was it submitted?
[CUSTOMER][NEUTRAL] Uh, yeah, it was submitted on.
[CUSTOMER][NEUTRAL] [PII] uh sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK, I see where you called for the status of that claim on that day. I don't show that the claim has been received. That is the correct mailing address. I can also provide you with the payer ID number and the fax number if you would like.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, uh, actually, may I have the pay ID number and the fax number?
[AGENT][NEUTRAL] Payer ID number is 608.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 01
[AGENT][NEUTRAL] The fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me confirm the payer ID number. It's uh 60801 and the fax number is [PII], right?
[AGENT][NEUTRAL] Attention claims.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then no cover it is, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, to submit the claim, do we need to add any cover sheet for that along with the claim form?
[AGENT][NEUTRAL] OK, I'm not understanding the question. I didn't understand what you said. Along with the claim form, submit, are you submitting the itemized bill?
[CUSTOMER][NEUTRAL] Uh, like,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, no, actually, uh, we didn't submit the bill.
[AGENT][NEUTRAL] I mean the itemized bill and the primary EOB is required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it thank you so much for the information.
[CUSTOMER][NEUTRAL] And uh may I have the time you find limit to submit the claim?
[AGENT][NEGATIVE] There is no timely to submit a claim.
[CUSTOMER][POSITIVE] OK. Got it. Thank you so much for the information. And uh may I have the member policy effective on the termination date?
[AGENT][NEUTRAL] So the policy effective date is [PII]. I show the policy is currently active. And is this, I'm what is the name of this office?
[CUSTOMER][NEUTRAL] It's South Central Medical and Resource Center.
[AGENT][NEUTRAL] OK, so I see a claim for date of service September 1624. Is the 120 charge for an office visit?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, yeah, actually it is for the office visit, but it is for the data service of uh [PII]:15 of [PII]. I was looking.
[AGENT][NEUTRAL] Hold on a second. Let me pull up the claim.
[AGENT][NEUTRAL] Yeah, this claim has [PII]. OK, so this claim was just recently processed on the [PII], so this could have been the one submitted, uh, you said on [PII]?
[AGENT][NEUTRAL] We received it on [PII].
[CUSTOMER][NEUTRAL] Yeah, we have some
[AGENT][NEUTRAL] But not, it's not for data service 8:15 it's for data service 9-16 from South Central Medical.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so your claim is not on file.
[CUSTOMER][NEUTRAL] Uh-huh. OK. Thank you so much for that. But actually, we have to, OK. Got it.
[AGENT][NEUTRAL] I was gonna say you can also check your claim status on our online service center at [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. Uh, we can also submit the claim through portal, right?
[AGENT][NEUTRAL] Any other questions?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information as well. And uh yeah, can I have the call reference number?
[AGENT][NEUTRAL] My name in today's date, first initial, last name is [PII]. First name is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have an account created an online account created already?
[CUSTOMER][NEUTRAL] Uh, for the photo.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, actually, no.
[AGENT][NEUTRAL] Do you want to create an account while we're on the phone?
[CUSTOMER][POSITIVE] Uh, actually, uh, uh, we can do that another time. Thank you so much for that. And, uh, thank you so much for your assistance today. Have a good day. Stay safe. Bye for now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you for, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too. Have a good day. Bye for now.