AccountId: 011433970860
ContactId: 94562fea-6cc7-4508-a682-5d34b610fbe6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273380 ms
Total Talk Time (AGENT): 88515 ms
Total Talk Time (CUSTOMER): 82740 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/94562fea-6cc7-4508-a682-5d34b610fbe6_20250623T16:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII] and I am calling from provider's office at Tarrant County Hospital, and I'm needing to get some claim status information on behalf of a patient, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the policy number for that patient?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] Policy 02505608.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] It is uh [PII] [PII] [PII].
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] Um, yes, data service is 123 at $25 and that's gonna be for $472.
[AGENT][NEUTRAL] And that was 123 25?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Was that for an office visit?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Just had an amount of 130 72, so I didn't know if.
[AGENT][NEUTRAL] Is it 99213 is that the CPT code?
[CUSTOMER][NEUTRAL] Uh, 99213, yes, and then there was another one billed labs on here, so the total is $472 on the claim.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] For some reason we just have the office code. It looks like um we received it on.
[AGENT][NEUTRAL] Uh it was received [PII].
[AGENT][NEUTRAL] Uh, process [PII] and
[AGENT][NEUTRAL] So the place of service, um, looks like outpatient treatment benefit provides amount um when performed in emergency room, urgent care facility, physician's office.
[AGENT][NEUTRAL] Or PT or occupational therapy facility.
[AGENT][NEUTRAL] Uh, we show it was in a outpatient hospital setting.
[AGENT][NEGATIVE] So it denied
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it is an outpatient hospital. What is that claim number?
[AGENT][NEUTRAL] The claim number is 3,576,150.
[CUSTOMER][NEUTRAL] OK, that's I don't believe that's our claim. I think that's the doctor's claim.
[AGENT][NEUTRAL] OK, um, that's the only one we have on file for that date, so it looks like we don't have it on file then.
[CUSTOMER][NEUTRAL] Oh, OK, so then you don't have ours on file, yeah, because that would have been the doctor's claim.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] Uh, what is your claim's mailing address?
[AGENT][NEUTRAL] Our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and that was [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, uh, then I will get this updated and we'll get it rebuilt.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][POSITIVE] Thank you very much for your help. That will be it.
[AGENT][POSITIVE] OK, thanks for calling APL have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.