AccountId: 011433970860
ContactId: 738cf845-b27d-49ec-9339-756c1881ec99
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551929 ms
Total Talk Time (AGENT): 201888 ms
Total Talk Time (CUSTOMER): 176674 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/738cf845-b27d-49ec-9339-756c1881ec99_20250318T19:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office to check up on a claim status. Also, this call is being recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Hello
[AGENT][NEUTRAL] That is fine. Thank you. And you said your name is [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] spelled as [PII]. Initial to my last name would be [PII]. Also, can you spell out your name for me?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you with that claim status. What is a good callback number?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, it would be 01893411.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am.
[CUSTOMER][NEUTRAL] Yeah, it would be, it, it would be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is, bear with me just one second, let me get that pulled up again.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What is the data service for [PII]?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII] and I do have uh two claims for the same date of service just a different charge amount. The first charge amount would be $500 even and the second one would be $905 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] It's diagnostic Center for Women LLC.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I'm getting those claims pulled up and need you give me just a second.
[CUSTOMER][POSITIVE] Sure, no problem. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh the claim for $500.
[AGENT][NEUTRAL] Actually both of these claims now we received the one for $500 on 217.
[AGENT][NEUTRAL] Under claim number 356-588-6.
[AGENT][NEUTRAL] Um, the other claim for $905 was received on 217.
[AGENT][NEUTRAL] Under claim number 356.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] 896. Both of those claims were processed on 219, and both are pending for the primary EOB.
[AGENT][NEUTRAL] We are secondary.
[CUSTOMER][POSITIVE] OK, sure, no problem. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can submit primary COB. Can you help me with the call reference number for this one? Actually, I do have uh some more claims with me. Can you help me with those claims as well?
[AGENT][NEUTRAL] I can. And now on um.
[AGENT][NEUTRAL] Those EOBs can be faxed directly to our claims department as well.
[CUSTOMER][NEUTRAL] Yeah, I do have fax number.
[AGENT][POSITIVE] OK. I am ready for the next policy.
[CUSTOMER][NEUTRAL] Uh, sure, just give me a moment.
[CUSTOMER][NEUTRAL] Yeah, the next policy number would be 60801.
[AGENT][NEUTRAL] That is our payer ID number.
[AGENT][NEUTRAL] That's not the policy number.
[CUSTOMER][NEUTRAL] Uh, just give me a moment.
[CUSTOMER][NEUTRAL] Oh, I don't have a member ID for this number.
[CUSTOMER][NEUTRAL] Uh, can you check manually with member's name and date of birth?
[AGENT][POSITIVE] Yeah, give me just one second. I can do that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me get to that screen. We'll, we'll pull it up by name.
[AGENT][NEUTRAL] What's the last name of the patient?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] [PII] Thank you. And the first name, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] What is [PII]'s date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service for [PII]?
[CUSTOMER][NEUTRAL] It would be [PII]. Total charge $500 even.
[AGENT][NEUTRAL] Same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That claim we received on 224.
[AGENT][NEUTRAL] And processed on 225.
[AGENT][NEUTRAL] I need for the primary EOB.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And would you like that claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim number 356.
[AGENT][NEUTRAL] 7955.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you also help me with the correct member ID?
[AGENT][NEUTRAL] Oh, I sure can. I apologize. I was just gonna give you that. It is 255.
[AGENT][NEUTRAL] 6494.
[CUSTOMER][NEUTRAL] 2556494. OK, thank you.
[CUSTOMER][NEUTRAL] Can we move to the next number, the last one?
[AGENT][POSITIVE] I'm ready. Yes, ma'am.
[CUSTOMER][NEUTRAL] Thank you. Uh, yeah, it would be 02556457.
[AGENT][NEUTRAL] And that patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and premium, what is that data service?
[CUSTOMER][NEUTRAL] It's [PII]. Total charge $905 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim we received on [PII] and processed on [PII].
[AGENT][NEUTRAL] And you'll never guess what.
[AGENT][NEUTRAL] This claim is pending for.
[AGENT][NEUTRAL] This claim is pending for the primary EOB.
[CUSTOMER][POSITIVE] OK, no problem, thank you so much.
[CUSTOMER][NEUTRAL] Yeah, can you help me with the claim number for this one as well?
[AGENT][NEUTRAL] Absolutely, that claim number is 356-[PII].
[CUSTOMER][NEUTRAL] Thank you. Can you help me with the call reference number for all of the claims?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sure. It's going to be my name and today's date, and I spell my name [PII]rst initial last name, L as in Lima.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your help. Hope you have a wonderful day.
[AGENT][POSITIVE] My pleasure.
[AGENT][POSITIVE] I hope you have a wonderful day as well, and it's been a pleasure to assist you and thank you for calling APL. You take care.
[CUSTOMER][POSITIVE] Bye-bye. Take care. Take care too, yeah.
[AGENT][POSITIVE] Thank you. Bye-bye.