AccountId: 011433970860
ContactId: ae8ada70-ecfa-44f3-961f-df0fb0b0532a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602359 ms
Total Talk Time (AGENT): 110539 ms
Total Talk Time (CUSTOMER): 210437 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ae8ada70-ecfa-44f3-961f-df0fb0b0532a_20250509T19:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. I'm [PII] calling from provider's office regarding our claims.
[AGENT][NEUTRAL] OK, [PII], can I get your callback number?
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] [PII] with an extension of [PII].
[AGENT][NEUTRAL] OK, you have the policy number for the patient? May I know that's D as in Delta.
[CUSTOMER][NEUTRAL] May I know the the last name [PII]?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Thank you. The policy ID is 02295955 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is going to be uh.
[CUSTOMER][NEUTRAL] It's [PII]. The last name is [PII] and the date of birth is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And date of service the bill charges?
[CUSTOMER][NEUTRAL] The data service is uh [PII] with the bill amount of $542 even.
[AGENT][NEUTRAL] I don't show that claim on file. Can you resubmit?
[CUSTOMER][NEUTRAL] OK, you're stating that the claim is not on file for date of service [PII] with the bill amount of 542. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, could you please tell me the payer ID of yours?
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] OK, 608.
[AGENT][NEUTRAL] Yes, 01.
[CUSTOMER][NEUTRAL] 60801 got it got it. Could you please tell me the mailing address of yours, please?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII]. Am I right? Got it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please, what is the timely filing limit to submit the claim?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] Could you please tell me the member effective date and time of your policy?
[AGENT][NEUTRAL] Effective date is [PII]. Policy is active, no term date.
[CUSTOMER][NEUTRAL] Sure, could you please tell me the qualificence for this claim and I do have a uh.
[CUSTOMER][NEGATIVE] Like 3 more claims it's for 3 different numbers.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Call reference is my name is [PII], and today's date.
[CUSTOMER][NEUTRAL] Thank you, [PII]. Uh, OK, shall we move to another, another number?
[AGENT][NEUTRAL] What's the policy ID?
[CUSTOMER][NEUTRAL] I mean another policy ID.
[CUSTOMER][POSITIVE] Yeah, sure, just give me a second, please don't mind.
[CUSTOMER][NEUTRAL] Yeah, the policy ID is 1480435 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure, patient's first name is going to be [PII] and the last name is [PII]. Uh-huh.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Yeah. Date of birth is going to be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] D of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, so that the service is going to be [PII]. Uh-huh. With the bill amount of
[CUSTOMER][NEUTRAL] $237 even.
[AGENT][NEUTRAL] That claim was received 48-2025. Process 4-10-2025.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Oh, sorry.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Office
[CUSTOMER][NEGATIVE] We just are not covered under this policy.
[CUSTOMER][NEUTRAL] Got it. Could you please tell me the member's plan name as well?
[AGENT][NEUTRAL] My name is [PII] [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] SSN, am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, got it. In this case, can you send me a copy of your through fax, please?
[AGENT][NEUTRAL] What's your facts?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 61615-7777.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] 3536
[AGENT][NEUTRAL] 352 6.
[CUSTOMER][NEUTRAL] 3536.
[AGENT][NEUTRAL] 36.
[AGENT][NEUTRAL] OK, um, can you hold on one moment?
[CUSTOMER][NEUTRAL] of course take your time. You are on hold.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, sorry about that. OK. And um what was the next policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah, sure. Yes, give me a second. I will help with that information also, please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, just give me a second, ma'am. I'll help you with that. The next policy number is going to be uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 000.
[CUSTOMER][NEUTRAL] 25921.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is going to be uh.
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Uh, that policy number you gave me didn't pull up that name. What, what was the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is actually I can see it's 2591. That's it.
[AGENT][NEUTRAL] It's just 4 numbers.
[AGENT][NEUTRAL] 2591.
[CUSTOMER][NEUTRAL] Yes, if you want, I can, yeah, 259-1. Let me check in the patient box. Just give me a second please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh my god, ma'am, upon checking, I don't see any of the patient documents as well for this number.
[AGENT][NEUTRAL] What's the
[CUSTOMER][NEUTRAL] Is there any possibility of checking like verifying first name and the last name numbers?
[AGENT][NEUTRAL] Yeah, what's the last name?
[CUSTOMER][NEUTRAL] Last name spelled as [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] What's the first name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My first name is going to be, it's [PII].
[AGENT][NEUTRAL] OK, I'm not pulling up that name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. In this case, I will build to question. Mhm. Got it.
[CUSTOMER][NEUTRAL] OK, should we move to the last claim, ma'am. I do have one more claim. It's a different number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Number.
[CUSTOMER][NEUTRAL] Yeah, the next number ID is going to be 0021.
[CUSTOMER][NEUTRAL] 4510.
[AGENT][NEUTRAL] So 00214510?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm pulling up that policy number. What's the last name?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Last name is, my first name is, I'm sorry, my last name is [PII].
[AGENT][NEUTRAL] What, um, how do you spell the last name?
[AGENT][NEUTRAL] OK.