AccountId: 011433970860
ContactId: 980cf320-0283-4345-92c4-bcd7825eb9f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1723229 ms
Total Talk Time (AGENT): 396737 ms
Total Talk Time (CUSTOMER): 324656 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/980cf320-0283-4345-92c4-bcd7825eb9f0_20250401T13:54_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sir. My name is [PII]. I'm calling you from provider's office, checking on claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from?
[AGENT][NEUTRAL] For the provider?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02496781.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient name is.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $403 even.
[AGENT][NEUTRAL] OK, thank you. OK, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII] and we send a benefit amount of $14.20 to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, uh, you mean the claim was allowed and paid for $14.20 I'm I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And uh may I know the mode of payment?
[AGENT][NEUTRAL] Is a check, paper check, single check?
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] Yes, it's 203-364-4.
[CUSTOMER][NEUTRAL] And when was the check issue done?
[AGENT][NEUTRAL] The same day that it was processed, [PII].
[CUSTOMER][NEUTRAL] [PII]. Can you please verify me the check paper to address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one was sent to [PII].
[CUSTOMER][NEUTRAL] OK. Uh, this one was a single check or bulk check amount?
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] OK. And uh can you check for the next member?
[AGENT][NEUTRAL] OK, I have to notate this one. I cannot move forward until I notate this one. You need any other information on this one?
[AGENT][NEUTRAL] Mr. [PII], do we need any other information on this policy for this member?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] Mm, I'm ready for the next one.
[CUSTOMER][NEUTRAL] Yeah, one second. Yeah, the next member ID is.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 02540135
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] total charge.
[CUSTOMER][NEUTRAL] $455 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, it's gonna be one more minute.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK. So it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The amount is a little bit different. Can you verify that amount just, just to make sure because it's a little bit different from the one you're giving me.
[CUSTOMER][NEUTRAL] Yeah, it is $455 even.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] If there is any charge amount of $438 even at your end?
[AGENT][NEUTRAL] OK, yeah, that's the one we have 4:38. Is that OK?
[CUSTOMER][NEUTRAL] Yeah, uh, we have split the two claims. OK, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I got the 4:38, which it was processed on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $21.44 for this one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And the office visit is not covered, so the 99213 was not covered.
[AGENT][NEUTRAL] And the claim number on this one is 357.
[AGENT][NEUTRAL] 7560.
[CUSTOMER][NEUTRAL] 3,577,560. Am I right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK, sure. Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check for the.
[CUSTOMER][NEUTRAL] Next member, I'm done. I'm done with this number. Can you check for the next member?
[AGENT][NEUTRAL] You're done. OK, bear with me just a second. I need to make a note on this one.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Down.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] Yeah, the next member ID is.
[CUSTOMER][NEUTRAL] 01578526 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] total charge $590 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment, waiting on the EOB.
[AGENT][NEUTRAL] OK, um, we processed this one on [PII].
[AGENT][NEGATIVE] And this one was denied. And the reason for this denial is
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] And this one doesn't have a.
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] Sure. Claim number is 3577851.
[CUSTOMER][NEUTRAL] 357
[CUSTOMER][NEUTRAL] 7851. Am I right?
[AGENT][NEUTRAL] 78
[AGENT][NEUTRAL] 51. Yes, mhm.
[CUSTOMER][NEUTRAL] OK, and uh uh you were stating something this one doesn't have.
[AGENT][NEGATIVE] This one didn't pay and this one doesn't have any office procedures benefits so it was denied completely. There's no service that is covered on the office setting.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK. Thank you. I got it. And uh I'm done with this patient. Can we check for the next member?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] One moment, let me make a note.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, the member ID is 02555046.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $288 even. And I have a specific concern regarding this claim.
[AGENT][NEUTRAL] OK, bear with me, let me pull the EOB, OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So how may I assist you with this one?
[CUSTOMER][NEUTRAL] Uh, this claim was allowed and paid for $53.89 but the claim has paid to incorrect address. So the representative has suggested to send the W9 form and we have faxed the W9 form on [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mm OK. Let me check the notes because that goes to a different department. OK, one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What is the correct address?
[CUSTOMER][NEUTRAL] Yeah, the correct address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basically the one I mentioned in the beginning. OK, give me just a second, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I will have to put you on hold on this one because I, I see that it's been reissued, but it was reissued to the other address again, and this is um the last call I got here on [PII] from [PII] is indicating that it was um reissued.
[AGENT][NEUTRAL] So I'm not
[AGENT][NEGATIVE] Not sure what's going on. This is the reissued check. This is the original check which she was voided.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And you said they send the W-9 in [PII], but I don't see any changes in the address.
[AGENT][NEUTRAL] Um, you think they can send that W9 1 more time because I don't see any changes.
[CUSTOMER][NEUTRAL] Mm, but, uh, on [PII] has just stated one of your representative has stated they have received the fax on [PII] and they have updated the address to their finance team.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] I don't see that in the notes and I don't see that in the system. Let me check. Um, I'll have to put you on hold, OK, one moment.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, um, the representative is not in right now so I will have to send her an email and have her call you OK?
[CUSTOMER][NEUTRAL] OK. And uh before that, have you received the W9 form which we have faxed?
[AGENT][NEUTRAL] Again, I don't see that information and this will have to be um going to the person who gave you that information. So I will have to send her an email and have you have her to call you back. She's not in right now.
[CUSTOMER][NEUTRAL] OK, sure. Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just 1 2nd.
[CUSTOMER][NEUTRAL] OK, yeah, I uh, I'm done with this number. Can we check for the next member?
[AGENT][NEUTRAL] OK, how many more do you have?
[CUSTOMER][NEUTRAL] I think more 3 members.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Let me send a message to my supervisor, bear with me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so this is the phone number. OK, what is the next policy number?
[CUSTOMER][NEUTRAL] 0160233
[CUSTOMER][NEUTRAL] Number 9, M as in Lima. I apologize. The member ID is 01602339 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is
[CUSTOMER][NEUTRAL] [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Can you verify that date of birth one more time for [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, yeah, that's right. OK. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $661 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And uh for this one.
[CUSTOMER][NEUTRAL] We have faxed the primary EOB and claim form.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEGATIVE] OK, Mr. [PII], are you sure about that data service you just gave me? Because the one you gave me prior is pulling something, but the one you're giving me now is not pulling anything. Can you verify the date of service one more time?
[CUSTOMER][NEUTRAL] Yeah, the date of services.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it is not [PII], it's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this one was originally uh processed because there's another one, but it was the process is a duplicate. So this is the original claim. The original claim was processed on [PII].
[AGENT][NEGATIVE] And the claim was denied. The reason for this denial is that office visits are not covered by the policy. Service rendered in the office is not covered by the policy.
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[AGENT][NEUTRAL] That is 3562067.
[CUSTOMER][NEUTRAL] No, OK. And may I have your name spell, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK. And what will be the call reference?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you wouldn't like.
[CUSTOMER][POSITIVE] OK, sure. Uh thanks for assisting me. Have a good day. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Bye bye.