AccountId: 011433970860
ContactId: a17f2205-ab47-4adc-a9b0-8bfffbfd7395
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221660 ms
Total Talk Time (AGENT): 84337 ms
Total Talk Time (CUSTOMER): 93626 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/a17f2205-ab47-4adc-a9b0-8bfffbfd7395_20250502T15:06_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, good afternoon, [PII], I'm calling from a provider's office and I guess I need to check eligibility because it looks like we received a claim back that we had submitted for a patient.
[AGENT][NEUTRAL] OK, I can check eligibility for you. um, can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Yes, [PII], last name initial is [PII] and my number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Prisma Health Urgent Care of South Carolina.
[AGENT][NEUTRAL] OK, and may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um yes, the patient's name is [PII]
[CUSTOMER][NEUTRAL] Last name [PII] Date of birth is uh [PII].
[AGENT][NEUTRAL] OK, and then what is the policy number that you have for [PII]?
[CUSTOMER][NEUTRAL] And that is 02537820.
[AGENT][NEUTRAL] OK let me look that up real quick and check eligibility for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think what it was, I think this claim was submitted with her maiden name, and then I think her spouse is listed on the actual ID card, so I think it may be the spouse's policy so I think that's why the claim rejected so we're trying to get the information correct so we can resubmit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, I understand, and she does have an active policy. They do have couple coverage effective [PII].
[AGENT][NEUTRAL] You're right, it is her husband's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But she's also on there as the spouse.
[CUSTOMER][NEUTRAL] Will they accept if we correct her last name information, will they accept the claim or would I also need to list him as a subscriber in the plan so that shows up on the claim as well because I don't think she listed his date of birth on any of the documents she registered.
[AGENT][NEUTRAL] Oh, OK. Um, no, you can just submit it um under Makina.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And she's part two on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do we need it to add an identifier to the end of the ID or anything or just leave the ID as it appears on the card?
[AGENT][NEUTRAL] You just um leave the, leave the ID as it appears on the card. Um there's no identifier needed because once it gets here we can see that it's couple coverage and that she is on the policy.
[CUSTOMER][NEUTRAL] OK, got you. Alright, that's all I needed and do you give call reference numbers?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] OK, sounds good thank you so much I appreciate your help today.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is that everything I can help you with before we go?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][POSITIVE] Alright, well, you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] You