AccountId: 011433970860
ContactId: 886d6252-6290-4e6e-b909-5de4612653f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454859 ms
Total Talk Time (AGENT): 150532 ms
Total Talk Time (CUSTOMER): 127106 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/886d6252-6290-4e6e-b909-5de4612653f6_20250423T19:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and I'm calling for provider to check on an additional information about your claim that has been denied. Please note this call will be monitored and recorded for quality and training purpose. If you don't mind, can you please spell out your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII], and I need a callback number just in case we get disconnected, Miss Miss [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line?
[AGENT][NEUTRAL] OK, and you're calling from which facility for my notation?
[CUSTOMER][NEUTRAL] Yes, the facility name, it's gonna be Rural Health Services.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah. The patient's policy number for this one, it's gonna be, yeah.
[CUSTOMER][NEUTRAL] 021906667.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name, um, sorry, the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] $272.04.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let's see, let me pull this EOB OK one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm still waiting on the system. One moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] And for this one, we submitted the claim on
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and we received an EOB, it was stating that the time limit for filing has expired. If you don't mind, can you please help out the when was the claim was received and processed?
[AGENT][NEUTRAL] OK, do you have a claim number?
[CUSTOMER][NEUTRAL] I'm checking that one. Thank you. Yeah, the claim number, it's gonna be 3583351.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, so we were waiting to confirm eligibility from benefits of card. On the [PII], we processed the claim.
[AGENT][NEUTRAL] And we send a benefit amount, the benefit amount was 80, let me pull that amount.
[AGENT][NEUTRAL] $88.20.
[CUSTOMER][NEUTRAL] And for before that, when was the claim?
[CUSTOMER][NEUTRAL] When was the claim was received and processed?
[AGENT][NEUTRAL] It was processed twice. So let me give you the date that we received the claim. One moment.
[AGENT][NEUTRAL] All right, let me see when it was received the first time.
[AGENT][NEUTRAL] One moment, I'm waiting on the paperwork.
[AGENT][NEUTRAL] So it looks like it was received on [PII].
[CUSTOMER][NEUTRAL] Process
[AGENT][NEUTRAL] The first time that it was processed was [PII].
[AGENT][NEUTRAL] And it was reprocessed on [PII] once we received the information authorization.
[CUSTOMER][NEUTRAL] And why
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thanks. And when, what, why this claim was denied?
[AGENT][NEUTRAL] It was not denied, it was waiting to confirm eligibility with benefits in a card.
[AGENT][NEUTRAL] The employer.
[CUSTOMER][NEUTRAL] It is still in process, right?
[AGENT][NEUTRAL] No, it was processed on [PII] and we send a benefit amount of $88.20.
[CUSTOMER][NEUTRAL] How much of the allowed amount?
[AGENT][NEUTRAL] We process and paid $88.20.
[CUSTOMER][NEUTRAL] $88.20 $88.20. Allowed and paid the same, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. It was to pay through check or EFT?
[AGENT][NEUTRAL] It was a check, single check, paper check?
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] 2,036,940.
[CUSTOMER][POSITIVE] I thank you so much. And uh this one was paid on [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for that information. Can you please verify the patient account number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm waiting on the system.
[AGENT][NEUTRAL] Patient's account number is [PII].
[CUSTOMER][NEUTRAL] Can you also help us to address?
[AGENT][NEUTRAL] Yes, let me pull that.
[AGENT][NEUTRAL] It was sent to [PII].
[CUSTOMER][NEUTRAL] Yeah, wait for one minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for being on hold, and can I get the reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date if you will. You need the spelling again or any other information?
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][POSITIVE] Your name and today's date, right? Thank you so much for that information and that's it for today. Have a great day. Bye-bye. Thank you.
[AGENT][NEUTRAL] Sorry.