AccountId: 011433970860
ContactId: b27f6b59-6846-4c45-9d9c-c6766ca66a79
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468640 ms
Total Talk Time (AGENT): 129736 ms
Total Talk Time (CUSTOMER): 130378 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/b27f6b59-6846-4c45-9d9c-c6766ca66a79_20250606T20:25_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, my [PII]. I'm calling from Nicholas Children's Hospital provider office. I'm looking for claim status.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII]. Please spell out your name.
[AGENT][NEUTRAL] Yes, my name is [PII]. It's spelled [PII] Last initial [PII].
[CUSTOMER][NEUTRAL] Thank you again. And callback number is [PII] extension is [PII].
[AGENT][NEUTRAL] OK, and please spell your name one more time.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And please say your name?
[CUSTOMER][NEUTRAL] Sorry? [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, 019.
[CUSTOMER][NEUTRAL] 36591.
[AGENT][NEUTRAL] That was 01986591.
[CUSTOMER][NEUTRAL] 01936591.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, your name is uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Charge is $1,599.18.
[AGENT][NEUTRAL] OK. And that date of service was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that date of service for [PII]. Um, how was the claim submitted?
[AGENT][NEUTRAL] Hello, [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yeah, I can hear you now.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you now.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I'm not showing that claim.
[CUSTOMER][NEUTRAL] March
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It not fine.
[AGENT][NEUTRAL] Right, no claim on file, but the claim can be resubmitted.
[CUSTOMER][NEUTRAL] OK. Actually, claim is submitted [PII].
[AGENT][NEUTRAL] Do you have a
[CUSTOMER][NEUTRAL] They said the claim is not on file, so.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Right, there's no claim on file.
[CUSTOMER][NEUTRAL] Patient is active on that of service?
[AGENT][NEUTRAL] Yes, ma'am. There's no claim on file, but the claim can be resubmitted.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can?
[CUSTOMER][NEUTRAL] Give me a call reference number. I have, I have one more claim.
[AGENT][NEUTRAL] Is it for the same number?
[CUSTOMER][NEUTRAL] No. Patient is different provider.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] OK, I'm ready for the next policy number, please.
[CUSTOMER][NEUTRAL] Next policy.
[CUSTOMER][NEUTRAL] 01066938.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim, please?
[CUSTOMER][NEUTRAL] Date of service, [PII], arrange [PII]. Charges.
[CUSTOMER][NEUTRAL] Uh this is $40,515.35.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3.
[CUSTOMER][NEUTRAL] Mhm. claim number?
[AGENT][NEUTRAL] Yes, ma'am. The claim number is 358-829-1.
[AGENT][NEUTRAL] And this claim is denied because the primary carrier's ELB that was sent along with the claim does not match the claim information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So, you received the OB or not?
[AGENT][NEUTRAL] We received it, but it doesn't match the claim information. That's why the claim denied. So the claim would need to be resubmitted with the, with the correct EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] I'll.
[CUSTOMER][POSITIVE] Give me a call reference number. Thank you so much.
[AGENT][NEUTRAL] Yes, ma'am. The call reference number is my name and today's date. Um, my name is spelled [PII] My last initial is [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yeah, thank you, [PII] for calling ATL. You have a great weekend. Mm bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.