AccountId: 011433970860
ContactId: 7028fc65-a8fe-47dd-8c46-dd600412cc7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 589369 ms
Total Talk Time (AGENT): 132499 ms
Total Talk Time (CUSTOMER): 98853 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/7028fc65-a8fe-47dd-8c46-dd600412cc7a_20250501T16:23_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling you from the provider office. I just want to know the claim status. Can you please help me?
[AGENT][POSITIVE] Sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name of the facility you're calling from for my notation?
[CUSTOMER][POSITIVE] Proper oncology, a good parent.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mm one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is 02296604 M as in Mary, L as in Lima, B as in Bravo.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Member's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] bill amount is $1,298 even.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim, and that's November [PII], correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you spell out your name, please?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and Mr. um [PII], we do not have that claim on file. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. And you said your name is [PII], right?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, and as you said no claim on file on the date of service, so we need to rebuild the claim, right sir?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and uh what is the member effective date and the termination date?
[AGENT][NEUTRAL] OK, the effective date on this one is, let me.
[AGENT][NEUTRAL] We have effective [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And what is the
[CUSTOMER][NEUTRAL] Mailing address?
[AGENT][NEUTRAL] Mailing address to submit claims is [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Mhm, yes, that's correct.
[CUSTOMER][NEUTRAL] What is the PR ID number?
[AGENT][NEUTRAL] OK, the payer ID number is 60801. Again, that's 60801. Now, um, we need this claim to be fax or mail because this is a secondary, we need the primary EOB attached to it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what is the fax number?
[AGENT][NEUTRAL] OK, the fax number is [PII].
[CUSTOMER][NEUTRAL] Can you repeat one more time? 187.
[AGENT][NEUTRAL] 1877365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the call reference number so for this one?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah and what is the timely filing limit to submit the appeal?
[AGENT][NEUTRAL] For an appeal, once you submit the claim, if it's denied and you need to submit an appeal, it's 180 days from the decision date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need any other information on this one?
[CUSTOMER][POSITIVE] No, all I have done. Thank you so much for giving me the information. Have a good day.
[AGENT][POSITIVE] You're welcome. You as well thank you for calling APR. Have a good day. Bye-bye, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.