AccountId: 011433970860
ContactId: a5517797-434a-4492-8aa9-12376f45a2e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390619 ms
Total Talk Time (AGENT): 94575 ms
Total Talk Time (CUSTOMER): 160406 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/a5517797-434a-4492-8aa9-12376f45a2e2_20250407T13:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey there, this is [PII] calling for the from the provider's office to check on a claim. I'm sorry I just missed out on your name. Can you help me with that, please?
[AGENT][NEUTRAL] Yes, uh, my name is [PII]. And what was your name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] OK, I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEGATIVE] And there will be no extension to that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have the policy number of the picture?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, I've got that. Just a moment let me check that out for you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So, here you go. The policy number is 02419348 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] That's going to be [PII]. And the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] That's for [PII] for the charge amount $610 even.
[AGENT][NEUTRAL] OK, and you said 229-2024, is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like we paid 386 52.
[AGENT][NEUTRAL] And that was on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 41 2025.
[CUSTOMER][NEUTRAL] OK, then just a moment, I would need the information on it.
[CUSTOMER][NEUTRAL] Claim is paid, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And also the allowed amount and paid amount you mentioned earlier.
[AGENT][NEUTRAL] Uh, we paid 38652.
[CUSTOMER][NEUTRAL] Got that. is there any patient responsibility on it?
[AGENT][NEUTRAL] Um, this is a secondary policy, so we don't determine patient responsibilities.
[CUSTOMER][NEUTRAL] Got that. Uh, can you help me with the claim number, please?
[AGENT][NEUTRAL] Claim number is 3583121.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Great. Thank you for that. And can you help me with the payment details as well, and when the claim was received as well?
[AGENT][NEUTRAL] A claim was received 328-25 paid for 125.
[AGENT][NEUTRAL] And that is check number single check 2036466.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got that. I do have another date of service as well for the same patient. Can you help me with that as well, please?
[AGENT][NEUTRAL] OK, what is the data service?
[CUSTOMER][NEUTRAL] That's going to be from [PII] and the total charge amount is $250 even.
[AGENT][NEUTRAL] And it was for 250 even, is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Uh, I don't show that claim on file.
[CUSTOMER][NEUTRAL] Oh, that's it. Let me just check that then. Well, actually we have sent this on the same day, the one we sent it earlier for.
[CUSTOMER][NEUTRAL] On [PII] to the same payer ID 60801.
[CUSTOMER][NEUTRAL] Oh, are you still not able to see that?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Who is the provider?
[CUSTOMER][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] Uh, you mean the billing provider or the doctor?
[AGENT][NEUTRAL] Yes, the billing provider.
[CUSTOMER][NEUTRAL] That's Pediatrics Medical Group.
[AGENT][NEUTRAL] And it was the same patient, correct?
[CUSTOMER][NEUTRAL] Correct, that's the same patient but a different date of service.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect, that's right.
[AGENT][NEUTRAL] OK, yeah, I only have one claim on file for that date. It's not for the amount that you gave me.
[AGENT][NEUTRAL] Um, and it's not for that provider.
[CUSTOMER][NEUTRAL] Isn't it for 250?
[AGENT][NEUTRAL] I don't have a claim.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, then is it possible if you can rebuild the team again?
[AGENT][NEUTRAL] You, you can resubmit the claim is that is that what you said?
[CUSTOMER][NEUTRAL] Yes, that's what I'm asking.
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] OK, got that. And what will be the time frame for this?
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Uh, perfect then, uh, so you just to summarize what you said, you couldn't find a claim for [PII] for $250 even, right? But we have to bill it on [PII] as well. So is it not possible that you can see in your back end maybe the claim is in process there.
[AGENT][NEUTRAL] Uh, I don't show it on file at all, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got that, no problem. uh, great then, thank you so much for assisting me with this. Can I get your caller reference number for this, please?
[AGENT][NEUTRAL] Uh, call reference number is my first name [PII] and last or first initial last name [PII] and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much for assisting me with this, [PII]. I hope you have a really amazing day and a blessed week ahead. Take care and bye-bye for now.
[AGENT][POSITIVE] Thanks for calling APL you as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye.