AccountId: 011433970860
ContactId: bca67aa8-eb44-4345-bbe3-4194366f10de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 669250 ms
Total Talk Time (AGENT): 133104 ms
Total Talk Time (CUSTOMER): 195338 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/bca67aa8-eb44-4345-bbe3-4194366f10de_20250516T20:22_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII]. My name is [PII] calling from provider's office booking status. Please be advised this call is being recorded for quality and training purpose.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] OK, thank you. And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It is 02295896. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] [PII] and the amount is $2,461 even.
[AGENT][NEUTRAL] Uh, that claim was received 12-16-2024, processed 12-18-2024.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Need a copy of the primary explanation of benefits?
[CUSTOMER][NEUTRAL] OK. We have submitted that the primary uh UP uh through fax, ma'am, once you can provide the fax number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Is this right?
[AGENT][NEGATIVE] Yes, that's right. We haven't received it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. We have sent on uh [PII], ma'am. You have not received yet.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] We need to submit one through fax only, right, ma'am?
[AGENT][NEUTRAL] Yes, uh, fax or mail or uh um payer ID.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Could you please uh help me out with the payer ID and the mailing address, ma'am?
[AGENT][NEUTRAL] Payer ID is 60801.
[AGENT][NEUTRAL] And our mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. [PII], right, ma'am?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you, ma'am. And what is the time? OK. What is the time if I need to res uh to submit the ma'am, time?
[AGENT][NEUTRAL] There's there's no timely filing limit you could submit any time.
[CUSTOMER][NEUTRAL] OK, thank you, ma'am. And can I have the expiration, ma'am?
[CUSTOMER][NEUTRAL] And claim number, please?
[AGENT][NEUTRAL] Uh, the claim number is 3,542,300.
[CUSTOMER][NEUTRAL] Yes, ma'am. Can you go to the next station?
[AGENT][NEUTRAL] OK, what's the number?
[CUSTOMER][NEUTRAL] It is 1452972. M as in, sorry, M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] Day of service and bill charges.
[CUSTOMER][NEUTRAL] Uh, data services [PII] and the amount is uh $2,461 even.
[AGENT][NEUTRAL] This was received 1125 24, processed 1126 24.
[AGENT][NEUTRAL] we need a copy of the primary EOB.
[CUSTOMER][NEUTRAL] OK, we can um send it through electronically right now to the payer ID it's 0801, right?
[AGENT][NEUTRAL] Yes, and just reference claim number.
[AGENT][NEUTRAL] 353-518-1.
[CUSTOMER][NEUTRAL] 81. OK. And uh
[CUSTOMER][NEUTRAL] second, ma'am.
[CUSTOMER][NEUTRAL] You know the next patient.
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It is 182.
[CUSTOMER][NEUTRAL] 583 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] D of service and bill charges.
[CUSTOMER][NEUTRAL] [PII]. And the amount is $2,583 even.
[AGENT][NEUTRAL] I don't have that claim on file.
[AGENT][NEUTRAL] Remit.
[CUSTOMER][NEUTRAL] Uh, may I know
[CUSTOMER][NEUTRAL] OK. Uh, may I know the patient's eligibility, ma'am?
[AGENT][NEUTRAL] Effective [PII] and active, current, no term date.
[CUSTOMER][NEUTRAL] Do you see any rejection on this claim, ma'am?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And uh what is the time you're filing to submit the uh claim?
[AGENT][NEUTRAL] There's no timely filing limit. You can file anytime.
[CUSTOMER][NEUTRAL] Uh, to the summit also, ma'am, for the original name.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] To resubmit the new claim also, there is no timely filing?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, once again, ma'am. And the uh mailing address and the pay ID is the same, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK. Can I ask the next question, ma'am?
[AGENT][NEUTRAL] Uh, yeah, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] Uh, one second, ma'am.
[CUSTOMER][NEUTRAL] 01475788 ML 7.
[AGENT][NEUTRAL] Your name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] One second, ma'am.
[CUSTOMER][NEUTRAL] Uh [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, could you give me that number one more time? I think I missed a number.
[CUSTOMER][NEUTRAL] Yes, ma'am. It is um
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 475788 ML 7
[AGENT][NEUTRAL] OK, it looks like that's an old policy number. Um, what was the date of service?
[CUSTOMER][NEUTRAL] It is 1 1217 2023. Amount is $2,461 even.
[AGENT][NEUTRAL] OK, can you hold on one moment?
[CUSTOMER][NEUTRAL] Sure, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, sorry about that. Uh, let me get that pulled up.
[CUSTOMER][NEUTRAL] It's a.
[AGENT][NEUTRAL] OK, and what was the bill charges? 2,461, is that right?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, that was received 9-18-2024, process 9-23-2024.
[AGENT][NEUTRAL] And we need a copy of the maximum benefit payable for this date of service has been met.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] The whole amount this patient's responsibility, ma'am.
[AGENT][NEUTRAL] Uh, we can't instruct on patient responsibility because we're a secondary policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, can you please help out with the call reference number, ma'am?
[AGENT][NEUTRAL] Oh reference is, my name is [PII].
[AGENT][NEUTRAL] Uh, first initial to last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, [PII], for assisting me. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.