AccountId: 011433970860
ContactId: adb5beee-7dff-4c05-8481-110ba05f1cab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341850 ms
Total Talk Time (AGENT): 167732 ms
Total Talk Time (CUSTOMER): 129567 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/adb5beee-7dff-4c05-8481-110ba05f1cab_20250116T16:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey, um, my name is [PII] and I'm with McCloud Regional Medical Center, and I needed to check status on a claim, please.
[AGENT][NEUTRAL] Sure, [PII], I can help you with the claim status. May I please have your call back number in case we get disconnected and I can call you back please.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] Well, I'm trying to give you my cell phone number. Hang on a minute, [PII].
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And what's the policy certificate or member ID please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02052175.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And just give me one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And may I please have you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and her date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for the claim status, can you tell me the date of service and the amount on the claim, please?
[CUSTOMER][NEUTRAL] Data service is [PII] and the um bill amount was $6,993.
[AGENT][NEUTRAL] And this was for [PII], is that correct? [PII]?
[CUSTOMER][POSITIVE] Oh, yes, I'm sorry. Yes, yes, I'm sorry.
[AGENT][POSITIVE] OK, that's OK, thank you.
[AGENT][NEUTRAL] Just making sure.
[AGENT][NEUTRAL] OK, so let me just check some information.
[AGENT][NEUTRAL] And would this have been the uh facility charge for that data service? [PII]? OK, I do not show that claim on file. Would you like to verify any information?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this is my um I really didn't think you'd find it because it actually electronically rejected back to us.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For a duplicate claim which I have 3 similar that are similar different patients, but doing this and I was just wondering if you could maybe tell me why it might rejecting as a duplicate claim, especially when you don't even see a claim yet.
[CUSTOMER][NEUTRAL] And whether we should be billing this as secondary.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because that's how we did build it we billed it secondary to Cigna.
[AGENT][NEUTRAL] OK, so yes, this policy is a um supplemental, it's a limited medical supplemental benefit expense plan now um.
[AGENT][NEUTRAL] Can you verify like what's the payer ID you use?
[CUSTOMER][NEUTRAL] Uh, the, well, the payer ID, yes, hang on just a sec.
[CUSTOMER][NEUTRAL] I have payer ID.
[CUSTOMER][NEUTRAL] 57,080.
[AGENT][NEUTRAL] Yeah, that's not our payer ID I can provide you our.
[CUSTOMER][POSITIVE] Uh, that's what I can. OK, good.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Because normally um in that situation yeah we would not reject it I don't think um if it came through our correct payer ID it wouldn't reject as a duplicate being that it's um uh a secondary it does need to be um you know it does get reviewed so um I wouldn't think that you know that would be the situation so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, good. OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, so that payer ID, uh, the correct payer ID will be 608.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 01
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then our claims address I'll go ahead and and get that to you as well so that uh claims address will be addressed to [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, um, yeah.
[CUSTOMER][NEUTRAL] OK, and just to um verify that payer ID if I could, I've got 60801.
[AGENT][NEUTRAL] That is correct. I also have a claims fax, [PII], if you'd like to fax the claim to us.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] OK, and what is that?
[AGENT][NEUTRAL] That uh fax number is gonna be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that would be just attention claims?
[AGENT][NEUTRAL] And then be sure to include that primary insurance explanation of benefits.
[CUSTOMER][POSITIVE] Right, OK, OK, awesome and.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Got it and uh what was your name again?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][POSITIVE] Last initial is [PII].
[CUSTOMER][POSITIVE] OK, wonderful.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Use my name and today's date is your call reference.
[CUSTOMER][POSITIVE] OK, that sounds wonderful. Hey, I really appreciate your help, [PII].
[AGENT][NEUTRAL] You're welcome, [PII]. Did you have any other questions?
[CUSTOMER][POSITIVE] That's all for now, thanks.
[AGENT][POSITIVE] You're welcome thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Hey, you too. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.