AccountId: 011433970860
ContactId: 838c736b-eb2f-4500-b6a0-eed30d650a9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220429 ms
Total Talk Time (AGENT): 82689 ms
Total Talk Time (CUSTOMER): 100136 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/838c736b-eb2f-4500-b6a0-eed30d650a9d_20250224T14:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for providersur and PC to check an additional information about claim that has been denied. Please note this call will be monitored and recorded for the quality and training purpose. I have already checked EOB and I need clarification on this denial.
[AGENT][NEUTRAL] It would be my pleasure to assist you with that claim denial reason, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] Callback number, it's going to be [PII], and there is no extension. It's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the claim number please, sir?
[CUSTOMER][NEUTRAL] Uh just a moment, the claim number it's going to be 3560045.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Oh yes, the member name is going to be [PII], and the date of birth, it's going to be [PII].
[AGENT][NEUTRAL] Alright, thank you and this is for data service 13125?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, thank you and I can help you with that denial reason. Do you mind verifying the facility name?
[CUSTOMER][NEUTRAL] Yes, the facility name it's going to be.
[CUSTOMER][NEUTRAL] Resurgence PC.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And [PII], that this claim was denied as a non-covered service. This policy does not cover.
[AGENT][NEUTRAL] Physical therapy, occupational therapy, speech thera therapy, or any other types of therapy?
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] Is this uh non-core services as per the provider contract or the patient members contract?
[AGENT][NEUTRAL] The patient's plan.
[CUSTOMER][NEUTRAL] So it means it was known called Aspay.
[CUSTOMER][NEUTRAL] Patient plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yes, and could you please help me with the uh corrected claim filing limit and corrected claim mailing address?
[AGENT][NEGATIVE] There's no timely filing.
[AGENT][NEUTRAL] And the claims address is [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Oklahoma City.
[AGENT][NEUTRAL] Oklahoma.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the ZIP code is going to be [PII]. Is it right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And could you please help me with the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] [PII], I need it. Uh, thank you so much and have a nice day. Bye-bye.
[AGENT][POSITIVE] It's been my pleasure to help you with that claim denial reason, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, you just uh help me with the, uh, actually, have I, I the only one claim and that you help me with that. And I really appreciate for your patience and have a nice day. Bye-bye.
[AGENT][NEUTRAL] Mm.