AccountId: 011433970860
ContactId: 98e6ae2d-1ad2-4d1a-9b09-f32468eaa396
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734890 ms
Total Talk Time (AGENT): 201360 ms
Total Talk Time (CUSTOMER): 257353 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/98e6ae2d-1ad2-4d1a-9b09-f32468eaa396_20250428T18:35_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh hello. Good afternoon. This is [PII] calling from provider office Jackson Memorial Hospital. Actually, I'm looking for a patient eligibility details.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] So it is 02313050. M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 7.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, did, did they go by any other name besides [PII]?
[CUSTOMER][NEUTRAL] Mm just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. All right, so the policy number you provided to me is, is terminated. It was effective from [PII].
[AGENT][NEUTRAL] And let me see if I got a new one bear with me.
[AGENT][NEUTRAL] OK, looks like I do have a new policy.
[CUSTOMER][NEUTRAL] Uh, February, uh, policy terminate on [PII], right?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and let me know when you're ready for the new number.
[CUSTOMER][NEUTRAL] Um, just a moment.
[AGENT][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] Uh, may I have your name, please, one second.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Kindly go ahead with the new policy number.
[AGENT][NEUTRAL] OK, new policy number is 0246.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7677.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And it is effective from?
[AGENT][NEUTRAL] [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Effective from [PII].
[CUSTOMER][NEUTRAL] And still active.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please help me with the claim timely filing limit?
[AGENT][NEUTRAL] We don't have family family limits.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, OK, tell me for a minute. OK. uh OK, mailing address, please, Sol.
[AGENT][NEUTRAL] The mailing address to submit claims is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's [PII] uh.
[AGENT][NEUTRAL] [PII]. Correct. Uh-huh.
[CUSTOMER][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Yes. The zip code, let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah, I am, please go ahead.
[AGENT][NEUTRAL] OK, zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. And the electronic payer ID please?
[AGENT][NEUTRAL] OK, for this one is 60801. Again, that's 60801. Now this one is best to send it by fax or mail because we need the primary EOB attached to it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, uh, kindly help me with the fax number also.
[AGENT][NEUTRAL] OK, fax number is [PII].
[CUSTOMER][NEUTRAL] 942-3, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And primary GOP.
[CUSTOMER][NEUTRAL] In order to process this thing.
[CUSTOMER][NEUTRAL] So just to submit the claim by mail or fax.
[CUSTOMER][NEUTRAL] OK. I'm done with this one, So, and uh, I have one more patient. I need that patient eligibility details actually.
[AGENT][NEUTRAL] OK, so it's a different member?
[CUSTOMER][NEUTRAL] Hey you.
[CUSTOMER][NEUTRAL] Different number.
[AGENT][NEUTRAL] OK, bear with me just a minute. Let me go ahead and make a note on this one so we can move forward to the next one.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Uh-huh, that's correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, just want to confirm with you, uh, Sol, can you please check and confirm me, have you received any claim for the previous patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, what's the date of service?
[CUSTOMER][NEUTRAL] Uh, the previous patient date of service was?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] How much is the total charge of the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it is for 5 $50,080.10.
[AGENT][NEUTRAL] So it's [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, we have not received that claim.
[CUSTOMER][NEUTRAL] OK. For the previous patient, you haven't received any claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. So let me go ahead and provide you the next member ID. So, the next member ID is 020497. Sure, sure, sure.
[AGENT][NEUTRAL] Bear with me just a second. Bear with me just a second because I have to go back to it. OK. Um, go ahead now. OK, it's OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] It is 02049775 [PII] [PII].
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient name is, uh it's [PII], I'm sorry, it's [PII] Avi and date of birth is [PII].
[AGENT][NEUTRAL] OK. So for the policy you provided to me, um, we have an effective date of [PII].
[AGENT][NEUTRAL] And it terminated on [PII].
[AGENT][NEUTRAL] And I also have a new policy for this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please go ahead with the new policy number.
[AGENT][NEUTRAL] OK, the new policy number is 02.
[AGENT][NEUTRAL] 259-979.
[CUSTOMER][POSITIVE] I'm sorry, I'm sorry.
[CUSTOMER][NEUTRAL] It's 022599.
[AGENT][NEUTRAL] 022599979.
[CUSTOMER][NEUTRAL] Got it. And this policy effective in the termination date, please?
[AGENT][NEUTRAL] The effective date is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] [PII], right you're still active. And just want to confirm with you, so, uh, for this patient, have you received any claim for
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] for the total bill amount, $7,983.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] No claims on file for [PII].
[CUSTOMER][NEUTRAL] Mhm. OK. So, uh, that's all I need. I believe the mailing address and the fax number is the same, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. OK. Uh, you guys don't have the
[CUSTOMER][NEUTRAL] Uh, family family limit also, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. That's all I need. So thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.