AccountId: 011433970860
ContactId: a95f5a9a-6dad-4268-8578-21f330d18e14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331890 ms
Total Talk Time (AGENT): 151498 ms
Total Talk Time (CUSTOMER): 114957 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/a95f5a9a-6dad-4268-8578-21f330d18e14_20250115T17:17_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Palmetto Primary Care Physicians. I was calling to check the status of a claim for a few patients.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with that claim status, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] It is [PII], no extension.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] I have 02446513.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] I'm getting that pulled up. Bear with me just one second, and it would be a pleasure to help you with that claim status. What is the date of service?
[CUSTOMER][NEUTRAL] Date of service [PII].
[AGENT][NEUTRAL] And the bill amount please, ma'am.
[CUSTOMER][NEUTRAL] $180.80.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said it was for primary care physicians. I can help you with that.
[CUSTOMER][NEUTRAL] Yes, Palm Palmetto. Mhm.
[AGENT][NEUTRAL] Correct. I'm sorry, I just skipped over that word.
[AGENT][NEUTRAL] All right. We, we did receive that claim on [PII].
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] It was processed on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEGATIVE] And it was denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK, this is not covered. Can I get that claim number, please?
[AGENT][POSITIVE] Absolutely. Claim number is.
[AGENT][NEUTRAL] 353-295-0.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] And I don't know if you're aware, [PII], but we do have a provider portal at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK. Do I have to register for that?
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] It is a self-registration using the tax ID number and the patient's account number listed in box 26 on the HIPA. That just gives you access to um claim status and EOBs as well as claim submission online.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I will register after this. Uh, would you be able to help me with two more claims for different patients?
[AGENT][POSITIVE] Yes, ma'am. It would be my pleasure and I am ready for the next policy number whenever you are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] And what is that name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And that data service for [PII]?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Same bill amount?
[CUSTOMER][NEUTRAL] It is, uh, was it $180.89?
[AGENT][POSITIVE] Perfect, yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And get that claim pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] This claim we received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEGATIVE] And it was denied for the same reason, office visit not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. If I could just get that claim number, please.
[AGENT][NEUTRAL] And that claim number is 351.
[AGENT][NEUTRAL] 784 4.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] And I'm ready for the next one.
[CUSTOMER][NEUTRAL] All right, I'm putting the claim number in and then I'll be able to give you that member ID. It's going super slow. OK.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] 02446513
[CUSTOMER][NEUTRAL] For [PII]. [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And [PII]'s data service?
[CUSTOMER][NEUTRAL] It is [PII]. Bill amount is the same $180 with 89 cents.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEGATIVE] Denied for the same reason.
[AGENT][NEGATIVE] Office is not covered.
[AGENT][NEUTRAL] And that claim number?
[AGENT][NEUTRAL] Is 353.
[AGENT][NEUTRAL] Um, 353 2950. Sorry about that.
[CUSTOMER][POSITIVE] That's OK. All right. OK. Um, that's everything I need for now.
[AGENT][POSITIVE] It's been such a pleasure to assist you with those claims, [PII]. Thank you for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.