AccountId: 011433970860
ContactId: 70cb2b3f-a835-4896-83c7-33c56e131e8e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454250 ms
Total Talk Time (AGENT): 162048 ms
Total Talk Time (CUSTOMER): 171586 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/70cb2b3f-a835-4896-83c7-33c56e131e8e_20250325T21:53_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, [PII]. My name is [PII] and I'm calling from provider's office and I'm checking on claims.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, [PII], can I get a good call back number from me first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, that would be [PII].
[AGENT][NEUTRAL] Thank you, do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, I have, give me a moment and you said your name is [PII]?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] [PII], got it. And um yeah, I can help you with the uh member's ID it's 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 465
[CUSTOMER][NEUTRAL] 04
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Sure, that would be for [PII]. One moment, it's sorry, it's [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, that would be on [PII].
[CUSTOMER][NEUTRAL] And the total charges, uh, one moment, it's $420 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that was [PII] for $420 even.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][POSITIVE] Got it. OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I'm sorry, again just to clarify that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing that we've received any claims for that date of service for this number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Got it and um.
[CUSTOMER][NEUTRAL] Yeah, was the member active on the date of service?
[AGENT][NEUTRAL] Yes, this policy's effective date was [PII] and it is currently active.
[CUSTOMER][NEUTRAL] And what is the timely funding limit to some of the client?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Oh, for the secondary claims as well, right?
[AGENT][NEUTRAL] Yes, this is their secondary medical policy.
[CUSTOMER][NEUTRAL] OK, um, one moment, let me check. I have a few more data services and let me check if that has been, uh, sent to you. Give me a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, for the same member correct?
[CUSTOMER][NEUTRAL] Um, yeah, but, uh, give me a moment. Let me check my system if this, uh, claims was sent out, uh, because I found that the first claim was not sent out from, yeah, one has been sent, um, yeah, can I help you with the next date of service?
[AGENT][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, I, uh, just to verify, I'm sorry, this was for the same member.
[CUSTOMER][NEUTRAL] Yes, the same.
[AGENT][NEUTRAL] OK, yes, you can go ahead and give me that next data of service.
[CUSTOMER][NEUTRAL] Yeah, that would be on [PII] for uh $131 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] OK, I do believe we've received that one.
[AGENT][NEUTRAL] Was this, uh, is it Palmetto Primary Care? Is that the physician's office?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The provider is that Palmetto Primary Care?
[CUSTOMER][NEUTRAL] Um, no, this is for, um, Coastal Carolina podiatric.
[AGENT][NEUTRAL] OK, well, maybe we haven't received this one. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, no, I did find it. OK, we did receive this claim, uh, so for this one we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Office visit is not covered and the member's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please help me the receive date and the denial date on this claim.
[AGENT][NEUTRAL] Yes, uh, we've received this claim [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Got it. And could you please help me the claim number?
[AGENT][NEUTRAL] Yes, that is 3454633.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 633 got it and um actually what is the name of the member's plan? Do you have that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry. Uh, well, this is their secondary medical.
[CUSTOMER][NEUTRAL] Got it, thank you for that information, and I do have one more data of service for the same number. Could you please help me with that? This is the last one.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Sure, go ahead, yeah, of course.
[CUSTOMER][NEUTRAL] Yeah, that, that would be on [PII].
[AGENT][NEUTRAL] OK, [PII], yes.
[CUSTOMER][NEUTRAL] And uh the total charge.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, uh, [PII]. I'm sorry, it's [PII] for one, yeah, it's $131 even.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] That was 151?
[CUSTOMER][NEUTRAL] 31131.
[AGENT][NEUTRAL] 31, OK.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, uh, we received this one as well, um, that denial reason is the same as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] So is that the uh patient's responsibility?
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Got it. And um could you please help me with the received it and the denial it.
[AGENT][NEUTRAL] Yes, uh, this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And could you please send me the claim number?
[AGENT][NEUTRAL] Yes, that is 346-839-7.
[CUSTOMER][NEUTRAL] Got it. Thanks for your help, [PII], and uh I just want to confirm the uh payer ID for this uh claims which we have not sent. So is that 98999.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, um, our payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801. OK one moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, got it. Thank you for that information and uh could you please help me the reference number for this conversation?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Got it. Thanks for helping, uh, [PII], and that is all for the day and enjoy the rest of your day and stay safe. Bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, yes, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Yeah bye.