AccountId: 011433970860
ContactId: 97f9e624-0668-49f3-ba77-fc639a6d5b78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 543020 ms
Total Talk Time (AGENT): 213336 ms
Total Talk Time (CUSTOMER): 264616 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/97f9e624-0668-49f3-ba77-fc639a6d5b78_20250331T21:34_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hello, [PII]. This is [PII]. First letter to my initials is [PII] calling from the business office of Saint Anne Hospital. This call may be monitored and recorded for quality assurance. Calling to check on the claim status, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. uh, [PII], can I get a good call back number from me first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that is [PII]. And may I have the first letter to your initials, [PII], please?
[AGENT][NEUTRAL] Sure, it's [PII] Uh my first name is spelled [PII]
[AGENT][NEUTRAL] And then did you have that policy number, [PII]?
[CUSTOMER][NEUTRAL] So your name is [PII]. Is that correct? [PII] and the first letter of your initials, I'm sorry.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][POSITIVE] [PII] as well thank you so much. Yes, I have here the member's ID number that would be 02583467.
[AGENT][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Sure, Member's name is [PII]. Last name would be [PII], with the date of birth of [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that [PII]. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Sure, data service that would be [PII].
[AGENT][NEUTRAL] OK, and do you have that bill amount?
[CUSTOMER][NEUTRAL] Yes, I have as well, billed amount of $3530.54.
[AGENT][NEUTRAL] OK, let's.
[CUSTOMER][NEUTRAL] That is the total charge.
[AGENT][NEUTRAL] OK, do you have the amount after major medical pay the remaining balance? Oh no, I'm sorry, this was.
[AGENT][NEUTRAL] Different but I'm sorry, I thought this was a different kind of policy OK and then what was the, uh, do you have the tax ID for this provider?
[CUSTOMER][NEUTRAL] Sure, I have. That is [PII].
[AGENT][NEUTRAL] OK. And if you would, could you give me that build them out one more time? I apologize.
[CUSTOMER][NEUTRAL] No problem. That would be $3530.54.
[AGENT][NEUTRAL] Got it. OK, so we did not receive this claim, [PII], um, I've only got one claim on file for this number. It is from a different provider and for a different amount.
[CUSTOMER][NEUTRAL] Oh alright so for this claim there is no claim on file, is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All right, one moment please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me just check that here on my end.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Alright, so as per checking here, uh, we send and billed the claim on [PII] through paper. It was submitted to our MAINC, is that correct?
[AGENT][NEUTRAL] Um, I'm, I'm not quite sure. I can verify the mailing address that uh we've got.
[AGENT][NEUTRAL] Or our mailing address?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Is it uh the [PII] I I want oh all right.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No ma'am, yeah, that is a different address, yes, of course let me know when you're ready I can give you that correct one.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] And I've also got a fax ID.
[CUSTOMER][NEGATIVE] So incorrect mailing address?
[AGENT][NEUTRAL] Yes, I've also got a fax number and a payer ID if you'd like.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Mhm.
[CUSTOMER][NEUTRAL] Yes, um, but first, is there any other claim received for the same date of service?
[AGENT][NEUTRAL] Yes, uh, but it is for from a different provider and a different build amount.
[CUSTOMER][NEUTRAL] So there is a.
[CUSTOMER][NEGATIVE] Other claim received for the same date of service.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Different build amount and provider as well.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And how long will it take the payer to receive the claim?
[AGENT][NEUTRAL] Uh, it really depends on how um how you send it. um, if you send it by mail, I would give it at least a couple of weeks, um, if it's through our, uh, online, if you use the payer ID, if you do it electronically, it does get it to us pretty quickly um fax can take about a couple of days.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Where it's processed
[CUSTOMER][NEUTRAL] But through mail or, I'm sorry. Yeah, thank you so much. But through mail or paper, how long, how long will it take?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] I would say I would give it at least a couple of weeks. It really does depend on the postal service.
[CUSTOMER][NEUTRAL] Um, is it 2 weeks?
[AGENT][NEUTRAL] I, I couldn't give you an accurate, um, it's just as the mail is a bit unpredictable. I would say to if you were to send it allow two weeks from the send date I would think that would be, yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 2 weeks, 2 weeks.
[AGENT][NEUTRAL] That's what I would say.
[CUSTOMER][NEUTRAL] Yes, 2 weeks from the sending date, is that correct?
[AGENT][NEUTRAL] Yeah, that's what I would, I would think so. And then, of course, it could, uh, that could be for us receiving it, once it's been received, it can take about 7 to 10 business days for it to process.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7 to 10 business days to be processed once you receive.
[AGENT][POSITIVE] Correct. That's correct.
[CUSTOMER][POSITIVE] Thank you so much. And then, is there any patients eligibility on that? Is the uh patient active?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh yes, um, this policy's effective date was [PII] and it is currently active.
[CUSTOMER][NEUTRAL] So we actually are.
[CUSTOMER][NEUTRAL] [PII] and it is currently active.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It's [PII], and yes, it is currently active.
[CUSTOMER][NEUTRAL] 23. 0, all right. I see. Thank you so much. And yes, I just need the correct billing address as well as your payer ID.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, so our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] so sorry.
[AGENT][NEUTRAL] And that is in Oklahoma City, Oklahoma.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much and I just need the electronic payer ID please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] [PII] is the epayer ID.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And your fax number, please?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much attention to claims department, is that correct?
[AGENT][POSITIVE] Correct, yes, yes.
[CUSTOMER][POSITIVE] Thank you so much. And may I know the uh timely filing limit, please?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][POSITIVE] Thank you so much and.
[CUSTOMER][NEUTRAL] Yes, I just need the call reference number for this call, please.
[AGENT][NEUTRAL] Sure. Reference number would just be my first name, last initial, and today's date. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] That would be.
[CUSTOMER][NEUTRAL] Yes, that would be [PII] and then the dates today is [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright, and one moment so this is under commercial generic, is that correct?
[AGENT][NEUTRAL] Uh, this is a, um, limited indemnity medical plan that is through their employer.
[CUSTOMER][NEUTRAL] Oh, all right, but, uh, do you see the member's uh name [PII] under this policy?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] All right, perfect. Thank you so much. Yes, I think I got all the information here on my end and yes, thank you so much for assisting me, [PII]. You have a great day. Thank you so much. Appreciate it.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Have a great day bye bye.
[AGENT][POSITIVE] You too. Thank you. Bye-bye.