AccountId: 011433970860
ContactId: b134c7da-7cb9-408b-bd6f-7e521e3efd8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472859 ms
Total Talk Time (AGENT): 141621 ms
Total Talk Time (CUSTOMER): 131962 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/b134c7da-7cb9-408b-bd6f-7e521e3efd8d_20250320T18:33_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling on behalf of provider's office regarding claim.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] Policy number of the member?
[CUSTOMER][NEUTRAL] Uh, the policy number is 01611631 M like Mike L like Lima 8.
[AGENT][NEUTRAL] Thank you. Could you verify the patient's name and date of birth that you're checking status of a claim for?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And I apologize. What was your name?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] Could you provide me with the spelling of it?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Could you provide me the date of service that you're checking the status of the claim for?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] [PII]. What is your procedure called?
[CUSTOMER][NEUTRAL] It is 99213.
[AGENT][NEUTRAL] There was no payment made on this claim?
[AGENT][NEUTRAL] Because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And may I have the date?
[AGENT][NEUTRAL] [PII] we received the claim [PII]. Would you like the claim number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 34595888
[CUSTOMER][NEUTRAL] 958-8, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And the process that is at [PII]. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right. Could you please fax me a copy of the UB?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, what is your fax number?
[CUSTOMER][NEUTRAL] It's 513.
[CUSTOMER][NEUTRAL] 9937441.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] 7441.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] I do have 2 more accounts for different members. So how long does it take to get the UB?
[AGENT][NEUTRAL] I'm not sure how long it will take. I just will fax it over for you.
[CUSTOMER][POSITIVE] All right. Thank you so much. And I do have 2 more accounts.
[CUSTOMER][NEUTRAL] So are you ready for the next one account?
[AGENT][NEUTRAL] Give me a moment please. I will request that as soon as I'm done doing what I have to do with this member. If you don't mind, could you give me a moment? Thank you.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] No problem. Take your time.
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] And the next one is 01740502 and Mike Lima number 7.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth that you're checking the status of a claim for?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're checking the status of a claim for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's no claim on file for this member.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] No, I apologize. Uh, the date service is [PII], not [PII].
[AGENT][NEUTRAL] What is your procedure called?
[CUSTOMER][NEUTRAL] 99213
[AGENT][NEUTRAL] There was no payment made on this claim because office visits are not covered and the denied claim was processed on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I have the claim number?
[AGENT][NEUTRAL] 3556447
[CUSTOMER][NEUTRAL] All right, could you please fax me a copy of the UB?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is your next policy number?
[CUSTOMER][NEUTRAL] 01852088 and [PII] number 8.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the first name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is your date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Total charge amount is $465.60.
[AGENT][NEUTRAL] What is your procedure called?
[CUSTOMER][NEUTRAL] 76,870.
[AGENT][NEUTRAL] It's only one procedure code?
[CUSTOMER][NEUTRAL] No, there are two procedure codes. Uh the other one is 93976.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim, and the reason why there was no payment is because we are requesting.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, we're requesting a um
[AGENT][NEUTRAL] A more detailed EOB to be sent in to us and you guys have not sent that in yet.
[CUSTOMER][POSITIVE] For the primary care, you'll be right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] A detailed EOB.
[CUSTOMER][NEUTRAL] All right, so just give me a moment.
[CUSTOMER][NEUTRAL] And may I have the claim number for this one?
[AGENT][NEUTRAL] Claim number is 3485446.
[CUSTOMER][POSITIVE] All right, thank you so much. May I have the call reference number?
[AGENT][NEUTRAL] We don't provide those, however, you can use my name in today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] Yeah, how do you spell your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII] and have good day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.