AccountId: 011433970860
ContactId: 8931bdef-e731-41a0-837a-decc30ffee7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1156430 ms
Total Talk Time (AGENT): 278892 ms
Total Talk Time (CUSTOMER): 431483 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/8931bdef-e731-41a0-837a-decc30ffee7d_20250210T13:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I may be in the wrong area. This is [PII] with Baptist Health Medical Group calling on a physician office visit me.
[AGENT][NEUTRAL] OK, I can help you [PII]. What is your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, what is the policy number?
[CUSTOMER][NEUTRAL] D 42016429
[AGENT][NEUTRAL] Excuse me, one moment please, [PII].
[AGENT][NEUTRAL] What is the patient's last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name please?
[CUSTOMER][NEUTRAL] It did um did arrive.
[AGENT][NEUTRAL] [PII], OK, one moment.
[AGENT][NEUTRAL] And verify her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And are you calling, you say it for office visits benefits, is that correct? I'm sorry.
[CUSTOMER][NEUTRAL] Oh well, for a claim, it's an older claim that looks like it's been processed 34.
[AGENT][NEUTRAL] 00 claim status, OK.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I can help you with claim status, and what is that date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] [PII] $172.
[CUSTOMER][NEUTRAL] Our last processing was in January.
[CUSTOMER][NEUTRAL] And it looks like they were
[CUSTOMER][NEUTRAL] Let me get back to my notes something about.
[CUSTOMER][NEUTRAL] He has a limited plan, the medical process number. Let me look again.
[AGENT][NEUTRAL] Which
[CUSTOMER][NEUTRAL] It was very
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, way back [PII] when [PII] spoke to.
[CUSTOMER][NEUTRAL] them
[CUSTOMER][NEUTRAL] Advise patients updated plan to medical service 71, but that some medical was covered through the hospital plan.
[CUSTOMER][NEUTRAL] So that she may not have medical coverage for office visits in March.
[AGENT][NEUTRAL] OK, I'm sorry, let me just look. I'm trying to find the claim for release. I'm sorry, but I was listening to you. OK, so [PII] charges $172 [PII].
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] OK thank you now you said that someone spoke to.
[AGENT][NEUTRAL] What what was the last update that you received on your, your end?
[CUSTOMER][NEUTRAL] Uh let me get back over there so.
[CUSTOMER][NEUTRAL] OK, [PII] spoke to.
[CUSTOMER][NEUTRAL] [PII] on [PII].
[CUSTOMER][NEUTRAL] And she had stated that
[AGENT][NEUTRAL] [PII]? OK.
[CUSTOMER][NEUTRAL] At [PII] [PII] she has.
[AGENT][NEUTRAL] Oh [PII], OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now I do not show a claim on file for [PII] for $172.
[AGENT][NEUTRAL] And the reason why I, I wanted you to, I asked if you would spell the patient's name is that we have a different policy number than what you provided at the beginning of the call, but.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As far as the date of service, I do not show a claim on file and let me provide you with the policy number, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the policy number is 2442882.
[CUSTOMER][NEUTRAL] OK, and is that for the medical that would pay office visits?
[AGENT][NEUTRAL] That's for the policy number that she had with us as far as medical, yes ma'am.
[CUSTOMER][NEUTRAL] OK, and that other one I guess was hers.
[AGENT][NEUTRAL] Well, the one that you provided me is her member ID number. We have different numbers, so, um, yes ma'am.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] And how is this to be billed? Does it go to multiple plans? Does it go to benefits in the car?
[AGENT][NEUTRAL] CD 420 and if you would provide me with that member ID number again please um [PII].
[CUSTOMER][NEUTRAL] The previous one or the one you gave me?
[AGENT][NEUTRAL] The the one that you provided me.
[CUSTOMER][NEUTRAL] D 42016429
[AGENT][NEUTRAL] OK, yes, and that is the policy number. They actually are the same, so the member ID number you provide me does relate to or correlate with the policy number that I provide you and we do not have the claim on file. Now you wanted to know if it needs to go to benefits in the card? Yes ma'am, it does because we do not have it on file.
[CUSTOMER][NEUTRAL] OK, and that address being let me get back over here.
[AGENT][POSITIVE] Actually it's IMA I apologize.
[CUSTOMER][NEUTRAL] We have people.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that's where it went and again when we call when [PII] called previously, the claims were there this claims processed already and [PII] had said.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The medical didn't start until July, so is this policy number you gave me maybe not effective until [PII]?
[AGENT][NEUTRAL] OK, now the policy number I provided you.
[AGENT][NEUTRAL] It showed effective as of [PII], but it turned as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I guess it's well so the claims that I, I don't know what to do with this one. The claim's been billed and.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] With the call to [PII] she.
[CUSTOMER][NEUTRAL] Had indicated the claims were on file and they had been processed at that time.
[CUSTOMER][NEUTRAL] And she stated patient was active.
[AGENT][NEUTRAL] Well did she provide a claim number?
[CUSTOMER][NEUTRAL] Yeah, OK, give me just a second. Let me see if it's a no claim active effective 12-1123, but advised the updated plan to medical did not start until [PII]. Some medical was covered through the hospital plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And advised to resubmit the claim, so it was resubmitted again [PII].
[CUSTOMER][NEUTRAL] Originally processed [PII] claim number 202408191486 and that process does not cover patient responsibility.
[AGENT][NEUTRAL] OK, and that's not one of our policy, excuse me, that's not one of our claim numbers, the 202.
[AGENT][NEUTRAL] Um, that may be an IMA or 90 degree benefit claim number that but that is not one of our claim numbers.
[CUSTOMER][NEUTRAL] OK, and although it went to the.
[CUSTOMER][NEGATIVE] Address that you gave me it still didn't process.
[AGENT][NEUTRAL] Correct, we do not have it on file.
[CUSTOMER][NEUTRAL] OK, where did it go going to that address then?
[AGENT][NEUTRAL] Um, I'm not sure. I'm sorry, but we do not have it on file.
[AGENT][NEUTRAL] I can provide you with a payer ID as well.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Just a second, let me see if we can.
[CUSTOMER][NEUTRAL] Let me look at our clearing house, see if we have ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I tell you when some of them process they process crazy for so long.
[CUSTOMER][NEUTRAL] And yeah it looks like all of the processing one well starting with 20 the date so the processed 20243 times and then 20.
[CUSTOMER][NEUTRAL] 25 it's processed once already. Let me see what we got.
[CUSTOMER][NEUTRAL] I apologize, clearing house is a little slow today.
[AGENT][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK, yeah, looks like this one.
[CUSTOMER][NEUTRAL] When a few different places.
[CUSTOMER][NEUTRAL] We had a payer ID of Z96149.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the correct but again they were, you know, all of them did have that address I guess it went out electronically to the wrong payer ID. What was the correct payer ID?
[AGENT][NEUTRAL] 645-556.
[CUSTOMER][NEUTRAL] 645-556 and is it past timely filing now for consideration or?
[AGENT][NEGATIVE] No, there's no timely filing with APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me check one other thing to make sure I've got everything I need here.
[AGENT][NEUTRAL] PSB.
[CUSTOMER][NEUTRAL] OK, yeah, it looks to see that was the only how would we have known what ID number to bill under because all it had it has employee ID the one I gave you D42016429 on her card and that's the only ID number on there.
[CUSTOMER][NEUTRAL] So what
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What will we have gone by?
[AGENT][NEUTRAL] You would have gone by the member ID number. It's just that our number is different, so it was, it's just the member ID number and our policy number they're different. However, I was able to verify the member ID number that you provided me. That's why I want you to repeat it.
[AGENT][NEUTRAL] But when we look up claims we look up by a policy number.
[CUSTOMER][NEUTRAL] Right, but
[CUSTOMER][NEUTRAL] OK, my question is how would we as an employer as a provider know what number to put because the card says employee ID D42016429 that other number is nowhere on the card.
[AGENT][NEUTRAL] And I'm saying that you would have put the number of this on the card.
[CUSTOMER][NEUTRAL] That's what we put and it's.
[AGENT][NEUTRAL] You will put the member ID number.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Alright, let me put the member ID number on the card D42016429.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me look I'm totally confused now.
[CUSTOMER][NEUTRAL] But you said the ID that should have been billed was 2442882?
[AGENT][NEUTRAL] I was not able to locate the member ID number as you read to me, so I was able to look up the member by the name, but then I uh gave you our policy number. This is how we look up the member in our system.
[CUSTOMER][NEUTRAL] Oh, OK, OK, but still bill under the employee ID number we billed it correctly under the right ID number.
[AGENT][NEUTRAL] But the member
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But I do need to make note of the policy number for future calls.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, your name again please?
[AGENT][NEUTRAL] Of course. My name is [PII]. My last initial is [PII]. Is there anything else I can assist you with, please, [PII]?
[CUSTOMER][NEUTRAL] No, it's call reference just your name and today's.
[AGENT][POSITIVE] That is correct. Thank you.
[CUSTOMER][NEUTRAL] OK, yes, I will get that. Um, do you have a claim on file for [PII] by chance?
[AGENT][NEUTRAL] I'm sorry, what was that date again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] More time.
[CUSTOMER][NEUTRAL] Because it was both dates that can.
[AGENT][NEUTRAL] And the total charges?
[CUSTOMER][NEUTRAL] That one is.
[CUSTOMER][NEUTRAL] 4 excuse me, $416.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Which
[CUSTOMER][NEUTRAL] So hopefully if I just change the payer ID they should come OK if you don't have this one already.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $116.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It looks like the processing on this one came back from 90 degree benefits.
[AGENT][NEUTRAL] 2416.
[AGENT][NEUTRAL] And what procedure codes were billed for the.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let's see, we've got.
[CUSTOMER][NEUTRAL] 205-52.
[CUSTOMER][NEUTRAL] Looks like it's on there twice for $122 each and then 99213 for $172.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And it looks like one of 205-52's paid.
[CUSTOMER][NEUTRAL] Well it looks like we've got a payment on all of them.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Excuse me, OK, so [PII].
[AGENT][NEUTRAL] It does show a payment from [PII]. It shows for those procedure codes, um, a payment of $125 was made.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] And again that looks the processing on our remit shows 90 degree benefits.
[AGENT][NEUTRAL] 346 4 464.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is a strange one, but I will get the other one.
[CUSTOMER][NEUTRAL] And it went out the very same way that address with the Z 96149 payer ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her coverage has totally turned [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, yeah, since it's already turned, we, I.
[CUSTOMER][NEGATIVE] Stress too much over how those others did and I'll just get that one resubmitted that we don't have on file.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now can that be faxed or is it best to just change the electronic payer ID?
[AGENT][NEUTRAL] It can be faxed. I can give you a fax number for APL when you're ready for that.
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] OK, it is 877.
[AGENT][NEUTRAL] 3659423.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, now it's gonna say benefits in the card instead of APL is that OK?
[CUSTOMER][NEUTRAL] The claim itself.
[AGENT][POSITIVE] That is correct. That is OK.
[CUSTOMER][POSITIVE] OK, uh, terrific. I will get that faxed and hopefully that will get that taken care of and again that was [PII].
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] OK, I thank you so much for all your help, [PII]. You have a wonderful day.
[AGENT][POSITIVE] You as well, [PII], and thank you for calling APL. Have a good one. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.