AccountId: 011433970860
ContactId: 9f82df33-68a4-4e07-b115-0b7ecf07bf5d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384829 ms
Total Talk Time (AGENT): 91160 ms
Total Talk Time (CUSTOMER): 103575 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/9f82df33-68a4-4e07-b115-0b7ecf07bf5d_20250506T17:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on a claim status. Also, this call is being recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can help you with claim statusrina. Do you have a good callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, I do have it's [PII].
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah it would be 018.
[CUSTOMER][NEUTRAL] 26,170 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Member's name would be [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] It's [PII] and the total charge would be $3500 even and I need uh primary OB status for this claim.
[AGENT][NEUTRAL] I'm sorry, what was the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the um I'm sorry, the bill charges again?
[CUSTOMER][NEUTRAL] $3500 even.
[AGENT][NEUTRAL] OK, it looks like we received it 3 times. Let me see which one is.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, it looks like we received it 3 times. Um, we needed the primary explanation of benefits.
[AGENT][NEUTRAL] Let me see what we.
[CUSTOMER][NEUTRAL] Actually we have already submitted that.
[AGENT][NEUTRAL] Um, it looks like we, the benefits listed for the dates of service have been paid directly to the provider of service.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Directly to the provider.
[CUSTOMER][NEUTRAL] So do you have any uh payment details with you?
[AGENT][NEUTRAL] Um, I don't know. Let's see, let me see if I can find something else on here. I'm not, I don't understand what that means.
[AGENT][NEUTRAL] Um, can I place you on a brief hold?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[AGENT][NEUTRAL] [PII], this is [PII] on the care team. Can you help me with the claim? I don't understand what, what it means.
[CUSTOMER][NEUTRAL] OK. Do you have a policy number?
[AGENT][NEUTRAL] Policy number is 1,826,170.
[CUSTOMER][NEUTRAL] OK, and part 1, part 2.
[AGENT][NEUTRAL] Or 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, data service is 95-2024 for 3500.
[AGENT][NEGATIVE] We've received 3 claims from the provider.
[AGENT][NEUTRAL] The last one, claim number 3564509.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it says policy benefits for listed date of service have been paid directly to the provider of service.
[AGENT][NEUTRAL] But I don't see a payment on the this date of service. Am I missing it?
[CUSTOMER][NEUTRAL] OK, and so that that CPT code is 19081?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is that correct? OK, so next, um, are you on the search screen on the CLA HQ screen?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, next to the data services a procedure code put in that procedure code.
[CUSTOMER][NEUTRAL] And that would narrow it down.
[AGENT][NEUTRAL] 9081.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it only pulled up claims for that one, so we made a $200 payment under 3541622.
[AGENT][POSITIVE] Oh, I learned something new today. Cool.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Yeah. OK, perfect. OK, thank you so much.
[CUSTOMER][POSITIVE] OK, no problem.