AccountId: 011433970860
ContactId: 8e467935-c5fa-4f1a-b119-6c5cc04d6d66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438359 ms
Total Talk Time (AGENT): 185289 ms
Total Talk Time (CUSTOMER): 171388 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/8e467935-c5fa-4f1a-b119-6c5cc04d6d66_20250310T18:33_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII], you're calling from provider office to look on a claims initial to my name [PII].
[AGENT][NEUTRAL] OK, and you said your first name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, my first name was [PII], initial to my name, [PII]. And your name you said [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you, [PII]. Well, actually, the last letter of my first name is an [PII]
[AGENT][NEUTRAL] And the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] And [PII], what is your callback number? Oh, you're welcome.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[CUSTOMER][NEUTRAL] My callback number will be [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you and how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] One claim [PII].
[AGENT][NEUTRAL] OK. OK, yes, I can help you with that. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Uh, member policy number will be 02541649.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] Take your time, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] [PII], with the date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Most welcome.
[AGENT][NEUTRAL] And the date of service and total bill amount.
[CUSTOMER][NEUTRAL] The date of service will be [PII] and the bill charge amount will be $212.12 dollars. And actually, this is a medi uh this is a crossover claim of Cigna. So could you please check?
[AGENT][NEUTRAL] OK, so the date of service is [PII], is that correct?
[CUSTOMER][NEUTRAL] Correct. [PII] for the charge amount 212.
[AGENT][NEUTRAL] And what was
[AGENT][NEUTRAL] [PII]. OK, thank you. One moment.
[CUSTOMER][POSITIVE] E, right. Most welcome. Yeah, sure.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII]?
[AGENT][NEUTRAL] The claim number is 3563967.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEGATIVE] It states we are unable to assign benefits to the provider record due to a discrepancy with the provider provider's tax ID.
[AGENT][NEUTRAL] A letter has been mailed to the provider with instructions resolving the discrepancy.
[AGENT][NEUTRAL] The provider will need to resolve the discrepancy with our office to resume claims processing decisions and benefits payments. Our claim decision, including any payable benefits for this charge, have been sent to the insured, please contact our office with questions.
[CUSTOMER][NEUTRAL] OK, so the insured, the claim was denied for some information of provider regarding the claim or regarding the tax ID?
[AGENT][NEUTRAL] Tax ID
[AGENT][NEUTRAL] And that there was information sent to the provider in regards to that.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] I do see here that uh for the Georgia and the tax ID that we billed for provider [PII] and that tax ID was correct and upon checking on the NPPS NPI registry as well, there is uh no incorrectly or not a mistaken in the claim form or in any tax ID. So, [PII], I do have one more request to you if you are able to send the claim back for review because the tax ID was correct.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, no, sir. We will have to have those forms completed along with the instructions that were included.
[CUSTOMER][NEUTRAL] OK. Can you please repeat it one more time, then I'll wrote it down in my notes then transfer this to some department who can help you.
[AGENT][NEUTRAL] Uh, again, there's nothing that can be verbally done over the phone. This would be something that they would have to.
[CUSTOMER][NEUTRAL] Uh no, actually I'm not asking for the verbally. I'm asking for the.
[AGENT][NEUTRAL] Oh, I'm sorry. I thought you said that you were going to transfer me.
[AGENT][NEUTRAL] And I don't need to be transferred. OK.
[CUSTOMER][NEUTRAL] Uh, no, no, my claim. No, no, I got your point. Uh, actually, my point will be I transferred the claim to some department who can work on this.
[AGENT][NEUTRAL] Uh, OK, so again if you need a copy of this explanation of benefits with all of that because that's a lot of wording, you can print that [PII] by going to our portal.
[CUSTOMER][NEUTRAL] Yeah. So can you please
[AGENT][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] OK, thank you so much, [PII]. And [PII], could you please uh help me that document which insurance need regarding the tax ID?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't have that information that was included in what was mailed.
[CUSTOMER][NEUTRAL] OK, and when it was mailed, could you please help me with the date?
[AGENT][NEUTRAL] It was mailed when the on the process, it would have been the day after the process date that I provided for you.
[CUSTOMER][NEUTRAL] So it's mean the claim process on [PII] and the document was mailed on [PII], right?
[AGENT][NEGATIVE] I believe the [PII] was on the weekends, and no, sir, it would not have been mailed the very next day. The [PII] was on a Friday, so it would not have been mailed out until [PII] [PII].
[CUSTOMER][POSITIVE] Uh, OK, great. Thank you so much for helping me with the date.
[AGENT][NEUTRAL] OK. Well, you're welcome. And is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes. Actually, I wanted, uh, one more question that is there any time frame to submit the document to insurance?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] No? OK, thank you so much. And [PII], could you please help me with the reference number for our conversation?
[AGENT][NEUTRAL] Yes, my name and today's date.
[CUSTOMER][NEUTRAL] [PII] and today's date will be [PII], or [PII], sorry.
[AGENT][NEUTRAL] Hi. Mhm.
[AGENT][NEUTRAL] [PII]. Yes, sir.
[CUSTOMER][POSITIVE] Oh yeah, thank you so much, yeah. Have a great day, [PII].
[AGENT][POSITIVE] You're welcome. Yes, sir, you too. And if that is all I can help you with, thank you again for calling APL [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a good day.
[AGENT][POSITIVE] You're welcome. Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.