AccountId: 011433970860
ContactId: 8e539806-5e7b-4e07-86dc-6ea0d6590ab8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437630 ms
Total Talk Time (AGENT): 102481 ms
Total Talk Time (CUSTOMER): 125530 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/8e539806-5e7b-4e07-86dc-6ea0d6590ab8_20250429T18:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. Good afternoon. My name is [PII] and last termination for [PII]. I'm calling from provider's office regarding the claim status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you today. May I please have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The first member ID is 02458464 M for Mary, L for Lima, [PII].
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And may I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEGATIVE] And the total charge $348 even.
[AGENT][NEUTRAL] OK, so it looks like we did receive this claim a couple times. Claim was received initially [PII], denied [PII]. Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK. And may I know the claim number?
[AGENT][NEUTRAL] Claim number is going to be 352.
[AGENT][NEUTRAL] 2928.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you. And let's move on that claim.
[AGENT][NEUTRAL] One moment, let me just finish notating this.
[CUSTOMER][POSITIVE] Yeah, sure, sure. Take you on time.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the next member ID?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID is 20691.
[AGENT][NEUTRAL] 20691 is not coming up as a valid member ID.
[CUSTOMER][NEUTRAL] OK. Uh, I can provide the patient name and date of birth. Can you please check it once?
[AGENT][NEUTRAL] What's the patient's last name?
[CUSTOMER][NEUTRAL] Yeah, I can spell the name. Uh, it's [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII], sorry, and the middle name.
[AGENT][NEUTRAL] What state does the insured live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 01 2nd. I got the member ID, valid member ID. So, can I see that?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] All right, thank you for that. And then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $237 even.
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Not showing any claims on file for that date of service.
[CUSTOMER][NEUTRAL] OK, there is no payment for. Thank you so much. And can you please provide the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 608
[AGENT][NEUTRAL] 01
[CUSTOMER][NEUTRAL] Thank you. And can you please provide the number of activate and termination date?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Patient is still active, effective date [PII].
[CUSTOMER][NEUTRAL] Still acting.
[CUSTOMER][NEUTRAL] And when the timely filing limit to submit the claim?
[AGENT][NEGATIVE] No timely filing filing limit.
[CUSTOMER][NEUTRAL] No TFL limit, right?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][POSITIVE] Thank you so much. And can you please spell your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][POSITIVE] Yeah, thank you and thank you for giving this information. May I know the call reference number?
[AGENT][NEUTRAL] Call reference is going to be my name with my last initial then today's date, [PII] today's date.
[CUSTOMER][POSITIVE] Yeah, thank you. Thank you for giving this information. Have a nice day.
[AGENT][POSITIVE] You're welcome bye bye.