AccountId: 011433970860
ContactId: ab829d6b-fd7e-43df-aa20-f465752f2ede
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2091438 ms
Total Talk Time (AGENT): 404734 ms
Total Talk Time (CUSTOMER): 401871 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/ab829d6b-fd7e-43df-aa20-f465752f2ede_20250131T21:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on a claim status.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check on a claim status for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 018.
[CUSTOMER][NEUTRAL] 28796.
[AGENT][POSITIVE] Thank you for that. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][POSITIVE] Thank you so much. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is, uh, just a moment.
[CUSTOMER][NEUTRAL] It's [PII] with charge amount $257 even.
[AGENT][NEUTRAL] Alright, [PII], 1 moment.
[CUSTOMER][NEUTRAL] Would you please spell your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Uh yes. It's uh $136.03.
[CUSTOMER][NEUTRAL] Just deductible.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So it looks like we did receive this claim [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim is processed, this amount has been applied towards the member's $1000 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I have the claim number?
[AGENT][NEUTRAL] 348.
[AGENT][NEUTRAL] 2605.
[CUSTOMER][NEUTRAL] That's it
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 3482605, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK. Is there any option to get the fax the copy of EOB since we are not uh able to get the UB through portal.
[AGENT][NEUTRAL] Yeah, I can send it to you via fax. What is a good fax number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh sorry, sorry. Just a moment. No, no. Uh, I will, uh, it's an incorrect number. It's updated. May I provide you the fax number once again?
[AGENT][NEUTRAL] That is on
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] It's 5, yeah, it's [PII].
[AGENT][NEUTRAL] Right, so that's [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Should we mark that attention to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that is on its way. It should be there in about 5 minutes. Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Yeah, I have 2 more claim for different patients.
[AGENT][NEUTRAL] For different patients, OK, let me just notate this account and then we can check the next one.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] May I have the call reference number for this one?
[AGENT][NEUTRAL] Uh, yeah, absolutely. So call reference is going to be my name with my last initial and then today's date. My last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] How long it will do for the shifting for you?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] How many hours to go for your shift and and weekend?
[AGENT][NEUTRAL] Oh, I have like
[AGENT][NEUTRAL] 3 more hours.
[CUSTOMER][NEUTRAL] OK, OK. May I know maximum how many claims you can assist me on this call?
[AGENT][NEUTRAL] As many as you have.
[CUSTOMER][NEUTRAL] Oh, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's try. I have a few more claims. If you are in, OK, I'm ready with the next patient.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, just some.
[CUSTOMER][NEUTRAL] What's the plan for the weekend?
[AGENT][NEGATIVE] No plans.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] Uh, so complete rest.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Almost that just a moment.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Uh, yeah, the next member ID is 021-91744.
[AGENT][NEUTRAL] Alright, give me just one moment to pull that up here.
[AGENT][NEUTRAL] All right, and so for this plan, can I get patient name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you for that data service.
[CUSTOMER][NEUTRAL] Yeah, date of service is uh [PII] with charge amount $162 even.
[AGENT][NEUTRAL] All right, thank you. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on this one for [PII].
[AGENT][NEUTRAL] It looks like the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied we requested the EOB from the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Since it's not received, right?
[AGENT][NEGATIVE] It has not been received, correct.
[CUSTOMER][NEUTRAL] OK. And uh what's the timely filing to submit the primary UB?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] Claim number is gonna be 3491519.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I have the.
[CUSTOMER][NEUTRAL] Uh, fax number to submit and to submit the primary UB.
[AGENT][NEUTRAL] Mhm absolutely fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you, just a moment, uh, I just close this one and just move on to the next client.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Almost done, sir. Just allow me 2 minutes.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, sir. Uh, may I move on to the next one?
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] Uh, it, it's uh
[CUSTOMER][NEUTRAL] Yeah, the next member ID is 01 02279404.
[AGENT][NEUTRAL] Thank you for that and patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you data service.
[CUSTOMER][NEUTRAL] It's [PII] with charge amount uh $210 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Uh, it's 130.88, 130.88.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Claim is received on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] A payment was sent in the amount of $130.88. This is a single check.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] 348-4091.
[CUSTOMER][NEUTRAL] Thank you. May I know the check number?
[AGENT][NEUTRAL] 186.
[AGENT][NEUTRAL] 4250.
[CUSTOMER][NEUTRAL] Single check, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Issue date and clear date.
[AGENT][NEUTRAL] Issued on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, let me see if the check has been cleared.
[AGENT][POSITIVE] Check still shows outstanding.
[CUSTOMER][NEUTRAL] OK, since it's past 180 days, would you please, uh, make a request to issue the
[CUSTOMER][NEUTRAL] Can you check
[AGENT][NEUTRAL] Let me just verify the mailing address this was sent to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh, no, actually, uh, billing address is different.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll I'll need to look at the claim if that was the address submitted on the claim, then we'll need a new claim filed.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So it looks like that was the billing information provided to us so if that's incorrect, then we'll need a corrected claim submitted to us.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Thank you. May I have the call reference number?
[AGENT][NEUTRAL] A call reference number is going to be my name with my last initial and then just today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you for that. Uh, just a moment, I will close this one and just move on to the next thing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, sir. I may want to the last one.
[CUSTOMER][NEUTRAL] So, next one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 01879207.
[AGENT][NEUTRAL] Alright, and then if I could get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and then date of service?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. The charge on $132 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] So we did receive this claim [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied [PII]. Services were rendered after the policy lapsed.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] Claim number is 352-878-6.
[CUSTOMER][NEUTRAL] May I know the effective date and the date?
[AGENT][NEUTRAL] Effective date was [PII]. Term date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Just a moment, I just close this one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's the lunch, sir?
[AGENT][NEUTRAL] Oh, I already had lunch and uh I just had a sandwich.
[CUSTOMER][NEUTRAL] What special?
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] What's special menu?
[AGENT][NEUTRAL] Oh yeah, nothing special, just a turkey sandwich.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, sir. I may want to the next one?
[AGENT][POSITIVE] Yeah, I'm ready when you are.
[CUSTOMER][NEUTRAL] Yeah, the next one is 017.
[CUSTOMER][NEUTRAL] 92144.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you, data service.
[CUSTOMER][NEUTRAL] Yeah, date of services, uh, uh.
[CUSTOMER][NEUTRAL] [PII], the charge about $184 even.
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] The claim is received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] Mhm claim number is 3,486,490.
[CUSTOMER][POSITIVE] Thank you. Just a moment.
[CUSTOMER][NEUTRAL] Yeah, would you please fax a copy of COB?
[AGENT][NEUTRAL] Mhm, yeah, I sure can do that. One moment.
[AGENT][NEUTRAL] Right, EOB is on its way, should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] OK, sir. Just a moment.
[CUSTOMER][NEUTRAL] Is there any issue with portal because most of the clients are not uh available in portal.
[AGENT][POSITIVE] I haven't heard of any issues with the portal as far as any problems, no.
[CUSTOMER][NEUTRAL] OK. Since I'm not uh
[CUSTOMER][NEUTRAL] Get any of the claims with hotels only ask.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, just a moment I just close this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, sir. Just a moment.
[AGENT][POSITIVE] Yeah, no problem. I'm just finishing up my notes.
[CUSTOMER][POSITIVE] OK, OK. Take your time.
[AGENT][POSITIVE] Alright [PII], I'm ready for the next one when you are.
[CUSTOMER][NEUTRAL] Yeah, almost done, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just allow me 2 minutes, sir.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, actually, it's for the same patient, IN status, sorry.
[AGENT][NEUTRAL] Oh, OK, what was the data service for this one?
[CUSTOMER][NEUTRAL] It's [PII]. The charge amount $129 even.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] [PII]. Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied on [PII].
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] Claim number for this is going to be 3241242.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, for this also you please, uh, fax a copy of COB.
[AGENT][NEUTRAL] Mhm. Absolutely.
[AGENT][NEUTRAL] That's on its way. It should be there in about 5 minutes, [PII].
[CUSTOMER][POSITIVE] OK, sure. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just just.
[CUSTOMER][NEGATIVE] Yeah, for this patient it's over. I just want to the last patient.
[AGENT][POSITIVE] OK, I'm ready for the policy when you are.
[CUSTOMER][NEUTRAL] Yeah, yeah, just
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the last member ID is 010.
[CUSTOMER][NEUTRAL] Yeah, it's uh 001, it's 02467806.
[AGENT][NEUTRAL] Thank you. And then patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you data service.
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII]. The charge amount $141 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim is denied [PII]. Of visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. May I have the claim number?
[AGENT][NEUTRAL] 3473685
[CUSTOMER][NEUTRAL] Thank you. Uh, for this also, you please fax a copy of your your.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This EOB is on its way. It should be there in about 5 minutes also.
[CUSTOMER][NEUTRAL] OK. Sure. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's uh next claim, it's for the same patient.
[AGENT][NEUTRAL] OK, what's the data service?
[CUSTOMER][NEUTRAL] Uh, it's uh [PII] with charge amount $78 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim is denied [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] 347-761-0.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, for this also, would you please fax a copy of EUB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Alright, that one's on its way to you as well.
[CUSTOMER][POSITIVE] So, thanks for the kind assistance, uh, sir. I appreciate your assistance, sir. Uh thanks a lot once again. Bye. Have a great day. Happy weekend.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] Yeah bye.