AccountId: 011433970860
ContactId: 6f5129ef-326d-4325-b00b-bdfb4c6cacb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408750 ms
Total Talk Time (AGENT): 173422 ms
Total Talk Time (CUSTOMER): 161362 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/6f5129ef-326d-4325-b00b-bdfb4c6cacb7_20250116T15:24_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] calling for Kid Medical Service INC to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. Thank you.
[AGENT][NEUTRAL] I can help you.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number and a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Policy number is 02273057. callback number [PII] direct line.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for verifying that information, [PII], and we're checking claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the date of service and build them out?
[CUSTOMER][NEUTRAL] So the date is [PII]. 1 moment for the bill amount.
[CUSTOMER][NEUTRAL] $1,546 even.
[AGENT][NEUTRAL] OK, what are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] 99464.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You show the claim was received [PII], processed on [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Showing a payment in the amount of $1,236.80 was issued, and I'll give you the claim number. Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It's 354.
[AGENT][NEUTRAL] 1252.
[AGENT][NEUTRAL] And you can also check your status on our online service center at [PII]. And did you have any other questions I can help out with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A loud amount?
[AGENT][NEUTRAL] OK, that information is gonna be on the primary ELB that was submitted with the claim.
[CUSTOMER][NEUTRAL] OK. So the remaining is 1 $1,236.80. So you paid full, allowed and paid is full with no patient responsibility.
[AGENT][NEUTRAL] We do not determine patients responsibility, so you would refer to the primary EOB. It indicates what the patient owes, and then we pay the 1,236.80.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, remaining. Uh, it was paid through check EFT or BCC?
[AGENT][NEUTRAL] It's an individual check, the check number.
[AGENT][NEUTRAL] It's 201850-08.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Check has not been cashed yet.
[CUSTOMER][NEUTRAL] Bulk or single?
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] Of 1,236 and 80 cents.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Do you have the issue date?
[AGENT][NEUTRAL] The date that it was processed.
[AGENT][NEUTRAL] The [PII]. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, pay to address?
[AGENT][NEUTRAL] It's the address on your claim. Can you verify that billing address, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] That's where it was mailed to.
[CUSTOMER][NEUTRAL] Thank you. And can you verify with the patient account number?
[AGENT][NEUTRAL] OK, if you, you have it on your claim, you give me that information, I can confirm it for you.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else? That's what I'm showing what's on your claim.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, can, huh.
[CUSTOMER][NEUTRAL] Uh, requested, can you, uh, just requesting the UB through fax or mail. Can you fax or mail the UB?
[AGENT][NEUTRAL] It's already been mailed, so the check is attached to the explanation of benefits.
[CUSTOMER][NEUTRAL] You can't, uh, fax now?
[AGENT][NEUTRAL] Um, I can give you our online service center and you you can use the claim number provided to request a copy or download a copy of the explanation of benefits. Let me know when you're ready for that, um, web address.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] It's secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] In network out of network provider can uh access the portal?
[AGENT][NEUTRAL] You will have to enter some security information, the tax identification number, and the patient account number on your claim will need to be entered.
[AGENT][NEUTRAL] We verified.
[CUSTOMER][NEUTRAL] Tax ID claim number and patient account number.
[AGENT][NEUTRAL] So the verification is gonna be the provider's tax identification number and the patient account number that's on your claim.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So it's not our policy number, it's that patient account number that you asked for.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, yes, that's what I told. Tax ID patient account number, and claim number. I told, do we need to attach or do we need to enter the claim number I asked?
[AGENT][NEUTRAL] It's not gonna ask you for the claim number at that point, just those two pieces of information, and then you'll have to create a username and password to get you into the site at which time you can use that claim number, the patient's first name.
[CUSTOMER][POSITIVE] OK, no issues. Thank you.
[CUSTOMER][NEUTRAL] A reference number?
[AGENT][NEUTRAL] And the data service to download the EOB. You'll use my name in today's date as your reference, [PII] First initial last name is [PII]. Did you have any other questions I can assist with today?
[CUSTOMER][NEUTRAL] Yes. Can you help me for the different number?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Member ID is 30736699661.
[AGENT][NEUTRAL] Hey, that's not our policy number, [PII].
[CUSTOMER][NEUTRAL] Sorry, 9961.
[AGENT][NEUTRAL] That's not our policy number.
[CUSTOMER][NEUTRAL] I'll just repeat it.
[AGENT][NEUTRAL] That's not our policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Medicaid supplement.
[CUSTOMER][NEUTRAL] OK. Your policy number starts from 00.
[AGENT][NEUTRAL] That's not our policy number, [PII].
[CUSTOMER][NEUTRAL] I got that.
[CUSTOMER][NEUTRAL] Just checking with the different one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have one more, 2402042836.
[AGENT][NEUTRAL] That's not our policy number either.
[CUSTOMER][POSITIVE] That is very good one. OK, then no issues. Thank you. Thank you so much for your assistance and have a great day. Bye-bye.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][POSITIVE] You too. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mm bye.