AccountId: 011433970860
ContactId: 81005129-8330-4967-98f1-54f1e8b34d75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1185420 ms
Total Talk Time (AGENT): 370134 ms
Total Talk Time (CUSTOMER): 247634 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/81005129-8330-4967-98f1-54f1e8b34d75_20250304T19:35_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] Good afternoon thank you for response. My name is and I am calling from provider office looking for claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status and the phone was cutting in and out. I missed your name. Can you repeat that for me, please?
[CUSTOMER][NEUTRAL] Yes, my name is spelled as [PII].
[AGENT][NEUTRAL] OK, now may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is
[CUSTOMER][NEUTRAL] 0181305
[CUSTOMER][NEUTRAL] Uh, sorry, from start. It is 01813065 M as in Mary, L as in Lima.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member first name [PII], last name [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bill?
[CUSTOMER][NEUTRAL] Uh, the date of service is.
[CUSTOMER][NEUTRAL] [PII] total bill amount $718 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, so I'm not showing a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Not on file for this state of service.
[AGENT][NEUTRAL] Actually, hold on one moment, because this policy wasn't active on the data service. This policy termed on [PII]. Policy number 25494997 has been active since [PII]. So let me check that one and see if there's a claim on file.
[AGENT][NEUTRAL] And you said it's the total bill was $718?
[CUSTOMER][NEUTRAL] Yes, total bill amount $718.
[AGENT][NEUTRAL] OK, and do you mind if I place you on just a brief hold while I look through these claims?
[CUSTOMER][NEUTRAL] Or.
[CUSTOMER][NEUTRAL] Can you repeat, please? I didn't get you.
[AGENT][NEUTRAL] Yes, do you mind if I place you on a brief hold, so there's several claims for this data service. I'm just trying to locate your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is it alright if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, how do we send you primary pay? Can you, you tell me?
[AGENT][NEUTRAL] Do you need the claim status for the data service that you gave?
[CUSTOMER][NEUTRAL] Yes, but uh I had a specific question.
[AGENT][NEUTRAL] OK, and what was the question that you had? OK.
[CUSTOMER][NEUTRAL] Please allow me a moment.
[CUSTOMER][NEUTRAL] Yes, yes, yes, allow me a moment. I
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, we had
[CUSTOMER][NEUTRAL] Send claim with primary payer EOB and it is duplicate.
[CUSTOMER][NEUTRAL] As
[CUSTOMER][NEUTRAL] Uh, it is denied as duplicate.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So we send this claim, we send this claim on [PII].
[AGENT][NEUTRAL] Let me locate the
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I'm just trying to locate the claim so that I can assist you. Um, so is, do you have the claim number there? Is it 3563463?
[CUSTOMER][NEUTRAL] Have you got that?
[AGENT][NEUTRAL] Because you asked for the claim status. I'm just trying to make sure you have the claim information.
[CUSTOMER][NEUTRAL] Yes, allow me a moment. I am
[CUSTOMER][NEUTRAL] Pulling down for claim number.
[CUSTOMER][NEUTRAL] Just wait, please.
[CUSTOMER][NEGATIVE] System is slow due to some issue.
[AGENT][POSITIVE] Oh, take your time. It's fine.
[CUSTOMER][NEUTRAL] Please bear with me.
[CUSTOMER][NEUTRAL] Uh thank you for your patience. Claim number is 35.
[AGENT][POSITIVE] You're welcome. So.
[CUSTOMER][NEUTRAL] Claim number is 356.
[AGENT][NEUTRAL] So I have
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] 3463.
[AGENT][NEUTRAL] OK, so you were asking about the denied um
[AGENT][NEUTRAL] Codes under this claim number. So these codes were previously submitted under claim 356-8500 and which those codes were paid on. So that's why on this on this claim 3563463, they're denied as duplicates because they have already been paid on.
[CUSTOMER][NEUTRAL] OK, thank you. Allow me a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much. May I have payment information?
[AGENT][NEUTRAL] Sure, so the claim number is 356-8500.
[AGENT][NEUTRAL] Um, the check was a single check in the amount of $248.07.
[AGENT][NEUTRAL] The check number was 2029813.
[AGENT][NEUTRAL] Um, and it was issued on [PII], so, um, you probably haven't received the check yet.
[CUSTOMER][NEUTRAL] February issued on
[AGENT][NEUTRAL] It was mailed to 6
[CUSTOMER][NEUTRAL] Issued on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII]?
[AGENT][NEUTRAL] And it was mailed to [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thank you. Uh, may I have you be through fax?
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Fax number is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is his attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, extension [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes this is correct.
[AGENT][NEUTRAL] And are you requesting for the
[AGENT][NEUTRAL] Claim with the paid codes to be sent or both?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Both
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So I'll go ahead and fax these over to you now. And was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, [PII]ow uh much the time uh the fax will take and uh you have also another data service of the same member.
[AGENT][POSITIVE] OK, so the fax, um, we usually say to give it about an hour, um, because it is a fax. If you haven't received it by the end of day today, um, just give us a call and we'll be more than happy to resend it for you.
[AGENT][NEUTRAL] And um I'll go ahead and send, you're welcome to send the explanation of benefits at the end. Will you need an explanation of benefits for the next data service as well?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, uh, but, uh, the call, the call reference will be same for in all or the different.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, it'll be the same for the entire call, which is my name and today's date.
[CUSTOMER][NEUTRAL] Your name please can you spell your name for me?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're very welcome. And may I have the next date of service for the member?
[CUSTOMER][NEUTRAL] Yes, next date of services.
[CUSTOMER][NEUTRAL] [PII] and total charge amount $624 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It really
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, hold on one moment. It looks like this one was processed under the old policy. Hold on one second.
[AGENT][NEUTRAL] So, it's probably.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Uh, yes, sir, uh, I want to discuss denialism on this claim also.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, yes, I have a claim number.
[CUSTOMER][NEUTRAL] Are you ready for claim number?
[AGENT][NEUTRAL] Yes, I'm ready for the claim number.
[CUSTOMER][NEUTRAL] OK. The claim number is 356-524-4.
[AGENT][NEUTRAL] 244. OK. All right, hold on one moment, OK?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][POSITIVE] Yes, yes, thank you.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So this claim is the same as the previous claim. It's denied as a duplicate because these codes were paid under the um 356-8500.
[AGENT][NEUTRAL] They're the same codes.
[CUSTOMER][NEGATIVE] Uh, the same case previously this claim was paid and we again resubmit this claim because this is, uh, denied.
[AGENT][NEUTRAL] Sort code [PII] and J 0935 was submitted for.
[AGENT][NEUTRAL] Claim number 356-524-4.
[AGENT][NEUTRAL] And it was submitted for 356-8500. It was paid on this claim. So just like the other claim, you submitted it twice, you submitted it three times, and it was denied twice and paid once.
[CUSTOMER][POSITIVE] OK, thank you, thank you for confirmation, uh.
[CUSTOMER][NEUTRAL] Uh, may I have also the payment details for this member or this data of service?
[AGENT][NEUTRAL] So it was paid from the same claim, so that was claim 3,568,500?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That's check number 2029831.
[CUSTOMER][NEUTRAL] 9831 total paid amount?
[AGENT][NEUTRAL] Um, it's the same as the claim we just went over. Um, hold on one moment, I can get it for you again.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] It's the same check.
[AGENT][NEUTRAL] OK, so hold on one moment.
[AGENT][NEUTRAL] OK, so it's check number 2029813.
[AGENT][NEUTRAL] In the amount of $248.07.
[AGENT][NEUTRAL] It was mailed on [PII].
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK, thank you. Thank you. Uh, can I have also you be through fax for this member also.
[AGENT][NEUTRAL] So it'll just be one EOB, it's the same claim, so it'll just be one explanation of benefits.
[AGENT][NEUTRAL] Are you saying you want to denied explanation of benefits?
[CUSTOMER][POSITIVE] Yes, thank you. Now I got the part.
[AGENT][NEUTRAL] I'm asking for clarity to make sure I send you the correct thing. Are you saying you need the duplicate or the paid claim?
[CUSTOMER][NEUTRAL] I need paid claim EOB.
[AGENT][NEUTRAL] OK, so you'll just receive one because it's the same paid claim for both of the denied claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, thank you. That's it for today.
[AGENT][POSITIVE] Alrighty, well thank you so much for calling APL and I hope you have a good day, [PII].
[CUSTOMER][POSITIVE] Thank you, same to you. Bye.
[AGENT][POSITIVE] You're welcome thank you bye bye.