AccountId: 011433970860
ContactId: b64fd5d5-f11f-4974-8971-13dfa592b929
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 852710 ms
Total Talk Time (AGENT): 245755 ms
Total Talk Time (CUSTOMER): 269688 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/b64fd5d5-f11f-4974-8971-13dfa592b929_20241230T18:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] at Mercy, and I'm sorry I didn't catch your name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling um to see if you all received the claim and if it's processing.
[AGENT][NEUTRAL] OK, I can check that for you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] 02467806
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for that information and you said that you're checking claim status correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] for $2,459.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, Mercy Clinic East Community.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I do show that we received it on.
[AGENT][NEUTRAL] [PII], the claim was processed on [PII]. Um, an explanation of benefits would have been mailed out, um, the next business day. I show that the treatment codes under this policy treatment in a physician's office, whether it's a primary care or specialist, is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a way to get the EOB faxed or emailed to me?
[AGENT][NEUTRAL] Um, I can, um, help you create an online account and you can download it from our online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me know when you're ready for that address.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Uh, first word is secured, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So it's secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And from there.
[CUSTOMER][NEUTRAL] Let me click on there.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's opening, OK, it says log in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It shows that I have a user name and password, but I let me see what happens.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It does? OK, under what tax ID number you see it?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Well, I'm in there.
[AGENT][NEUTRAL] Let me pull up.
[CUSTOMER][NEUTRAL] Where do I find out what tax line number I'm under?
[AGENT][NEUTRAL] It, it's under the claim that was submitted?
[AGENT][NEUTRAL] On the claim form that that was sent to us.
[CUSTOMER][NEUTRAL] OK, I have
[CUSTOMER][NEUTRAL] OK, well I'm in APL and it says quick access.
[AGENT][NEUTRAL] OK, so you are in. OK, so, so the quick access I think it's gonna need the claim our claim number, the patient's first name and date of birth so I can give you the claim number.
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] OK, what's that?
[AGENT][NEUTRAL] It's 351.
[AGENT][NEUTRAL] 6395.
[CUSTOMER][NEUTRAL] OK, 351-6395.
[AGENT][NEUTRAL] Yeah, 351-639-5.
[CUSTOMER][NEUTRAL] 0 claims found.
[AGENT][NEUTRAL] OK, and so what information did you enter other than the claim number?
[CUSTOMER][NEUTRAL] I put her first name in and her date of birth.
[AGENT][NEUTRAL] Mhm. And what do you show as her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how are you spelling her first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, which is what we have. Give me a second.
[AGENT][NEUTRAL] And what it it's gonna depend on the tax ID number because it has to match what's in our system for that claim.
[CUSTOMER][NEUTRAL] Well that's that's that's what I don't know. I don't know what tax ID number I'm under when I put in the website you gave me, it shows that I already have access so I clicked on it and it takes me right to the uh claim status. I don't know how to find out what tax number I'm under.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so I'm gonna pull up the CMS 1500 form that was sent to us and the tax identification.
[CUSTOMER][NEUTRAL] Right, but on on online I don't, it doesn't show me what tax ID number I'm under.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, you probably do statuses for different providers with different tax numbers, is that right?
[CUSTOMER][POSITIVE] Yes, a bunch.
[AGENT][NEUTRAL] So, so then that tells me that the tax ID number that you've checked statuses on before is different than the one that's on this claim because otherwise it would have been found so.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Then what do I do?
[AGENT][NEUTRAL] Do you have a copy of the CMS 1500 form?
[CUSTOMER][NEUTRAL] Yes, I'm looking at it.
[AGENT][NEUTRAL] On box 25
[CUSTOMER][NEUTRAL] So do I have to, do I have to, do I have to sign out and sign in with a new username and password for a different tax ID number?
[AGENT][NEUTRAL] Uh, not necessarily the user password, but the tax ID number needs to be entered.
[CUSTOMER][NEGATIVE] OK, that's what it's not giving me.
[CUSTOMER][NEUTRAL] OK, so I'm, I'm opening the website uh no here.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah, so go back to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm back to the sign in it says online service center view claims uh and then it says log in or new user and my logins already in there, but I don't know.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and it already takes you to the, I got you. OK, so then because this is a different tax identification number, you may need to go in as a new user because it's looking for that tax ID number on that claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's what I was wondering, OK.
[AGENT][NEUTRAL] And I'm thinking it will still allow you to get in since you've already created a user password.
[CUSTOMER][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see if it's gonna let me create a new one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's also looking for the patient account number as well.
[AGENT][NEUTRAL] In box number 26.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, let me, OK, I'm a medical or dental provider, so let's go to next tax ID here we go [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 8 patient account number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's our PSL [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] So now I have to create an account.
[AGENT][NEUTRAL] It is asking you to create a new one?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I'm trying to write all this down so I don't forget.
[AGENT][NEUTRAL] OK, no rush.
[CUSTOMER][NEGATIVE] Oh come on.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] An error occurred during registration. Please try again. Lord have [PII].
[AGENT][NEUTRAL] So we entered the I heard you entering the tax ID number and the patient account number.
[CUSTOMER][NEUTRAL] I did that and it's asked me to create a new account which I'm trying to do. I put in my username password, email, phone numbers.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And I click next and it says an an error occurred during registration please try again if this error persists, please contact customer service.
[AGENT][NEUTRAL] What email address did you use?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what username did you use?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, so I show it is that you're trying to set it up on my end.
[AGENT][NEUTRAL] So there's no identity.
[CUSTOMER][NEUTRAL] Then it won't let me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] 8 characters minimum that might be the problem.
[AGENT][NEUTRAL] Is that your password?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And just use one number and one character.
[CUSTOMER][NEUTRAL] It won't let me.
[CUSTOMER][NEUTRAL] OK, let's try this again. There is my username.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Your account has been successfully created. OK, let me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Try this again at [PII].
[CUSTOMER][NEGATIVE] I had to change all this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Log in.
[CUSTOMER][NEUTRAL] OK, now let's try it again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I think I may have it let me make sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 95 of 24 for $2,459.
[CUSTOMER][NEGATIVE] The service is not covered when performed and I got it.
[AGENT][POSITIVE] OK, very good.
[CUSTOMER][POSITIVE] Yay, thank you so much.
[AGENT][POSITIVE] Yay, you're welcome, [PII]. Any other questions?
[CUSTOMER][NEUTRAL] Yeah, do you have, do you have a reference number for the call?
[AGENT][NEUTRAL] You're gonna use my name in today's state as your reference, uh [PII], first initial last name is [PII]. So if you're checking status and it's for a different provider or a different tax identification number, then you'll have to create another account for that provider.
[AGENT][NEUTRAL] Oh, you know that tax ID, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much and have a happy new year.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You too, [PII] thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.