AccountId: 011433970860
ContactId: a8657e97-147e-4224-bf63-07f195f0bf47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338359 ms
Total Talk Time (AGENT): 135813 ms
Total Talk Time (CUSTOMER): 104935 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/a8657e97-147e-4224-bf63-07f195f0bf47_20250317T13:01_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII]. I'm calling from I was checking on a client, sorry, eligibility status of a member.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with eligibility. What is a good callback number?
[CUSTOMER][NEUTRAL] Uh, callback number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and the policy number for the patient, please?
[CUSTOMER][NEUTRAL] I shall
[CUSTOMER][NEUTRAL] Policy number I have here.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That is our payer ID number. Do you have a policy, a policy er number?
[CUSTOMER][NEUTRAL] Uh, actually, I don't have, but I have the member details, patient name and date of birth, and the SSN number and everything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me get to that screen. Bear with me just one second.
[AGENT][NEUTRAL] What's the social? What's you have the full social?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What is the patient's last name?
[CUSTOMER][NEUTRAL] The patient's last name. Give me one second.
[CUSTOMER][NEUTRAL] The patient's last name [PII].
[AGENT][NEUTRAL] And what is the first name of the patient?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII], sorry, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just one second. And what state does [PII] live in?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] Data birth I have [PII].
[AGENT][POSITIVE] All right thank you.
[AGENT][NEUTRAL] Like I did locate her policy. Can I give you the correct policy number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Her policy number is 233.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4378.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I can help you with eligibility for [PII]. I'm showing that her policy is active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] 21 is done.
[AGENT][NEUTRAL] No termination date on file.
[CUSTOMER][NEUTRAL] Uh, are you primary or secondary to this member?
[AGENT][NEUTRAL] Were secondary to the policyholder's major medical.
[CUSTOMER][NEUTRAL] Secondary to
[CUSTOMER][NEUTRAL] OK, can I get the, I mean, even we submitted claim for one data service. Could you please help me on that?
[AGENT][NEUTRAL] Sure, what's the data service?
[CUSTOMER][NEUTRAL] What's that
[CUSTOMER][NEUTRAL] It's a 6-12 [PII].
[AGENT][NEUTRAL] 6 12 2023.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. What is the bill amount?
[CUSTOMER][NEUTRAL] Build amount I have 1 $32,800.25.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Facility name I have here PH Green Memorial Hospital.
[AGENT][NEUTRAL] You said 32,825?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is that Prisma Health Upstate?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we did receive the claim on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mm-hmm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Because outpatient outpatient benefits.
[AGENT][NEUTRAL] Has been met for the calendar year.
[CUSTOMER][NEUTRAL] Has been
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, can we bill the patient?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] That would be determined by the provider. We're not major medical, so we can't determine if you can bill the patient or not.
[CUSTOMER][NEUTRAL] That would be
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, could you please send this it would be to my fax.
[AGENT][NEUTRAL] EOBs are obtainable on our provider portal at [PII] and that is a simple self-registration.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] Claim number is 333.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8715.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII]
[CUSTOMER][NEUTRAL] my
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you. Have a great day, bye.
[AGENT][POSITIVE] It's been my, my pleasure to assist you with that claim status.
[CUSTOMER][NEUTRAL] My