AccountId: 011433970860
ContactId: bd31ea28-9564-4e6e-9a3c-5c26876fc9f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315959 ms
Total Talk Time (AGENT): 143387 ms
Total Talk Time (CUSTOMER): 97303 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/bd31ea28-9564-4e6e-9a3c-5c26876fc9f2_20250305T20:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And you said [PII]?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hi, I was calling to check status on a claim please.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, I can help you. What's your name and the policy number?
[CUSTOMER][NEUTRAL] OK. My name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the policy number that I have is, and I'm not sure what type of policy this is, but I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02464125
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that information, [PII], and you're checking claim status for what day?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have 11:15 to 24.
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] 226.
[AGENT][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] And what's, did you tell me the provider's name is?
[CUSTOMER][NEUTRAL] Moses Cone Memorial Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the date of service of [PII] is after the policy termination date, which was [PII], so it was denied for that reason.
[AGENT][NEUTRAL] Under claim number.
[AGENT][NEUTRAL] 353-341-1. Uh this claim was processed on [PII] and the explanation was mailed out to the uh billing address at that time. It's now available to them.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Load on our online service center.
[CUSTOMER][NEUTRAL] Uh, I was gonna ask you.
[CUSTOMER][NEUTRAL] Oh OK there's no way you can fax it to me?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I can, um, but I could also show you how to download it from the website, so like 3 simple steps to do that.
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Um, the web address is [PII]. [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Have you set up an account with us before, Jo [PII]?
[CUSTOMER][NEUTRAL] in public
[CUSTOMER][NEUTRAL] No, I haven't. OK, I'm here, so I would have to set up an account.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, cause it's a yeah, it's a secured site. And then you would be a medical dental or dental provider.
[CUSTOMER][NEUTRAL] New user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That last one and then you would just enter the tax ID on your claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing [PII] on the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what do you show for the the patient account number on the claim?
[CUSTOMER][NEUTRAL] Oh, OK, would be the.
[CUSTOMER][NEUTRAL] All right. So it would be the
[AGENT][NEUTRAL] Starts with an E.
[CUSTOMER][NEUTRAL] E H
[AGENT][NEUTRAL] I'm showing EP.
[CUSTOMER][NEUTRAL] EP
[AGENT][NEUTRAL] Uh, I think it's box, uh, upper right corner of that UBO4. Let me see.
[CUSTOMER][NEUTRAL] Is it the, OK, so I, I, I show EH, but is it EP 41,051,167,100?
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me pull up the UBL4 that we received and I can verify that.
[AGENT][POSITIVE] And actually this would be the professional charge.
[AGENT][NEUTRAL] Um, so it's gonna be in box number 26 of the CMS 1500 form.
[AGENT][NEUTRAL] And I'm showing
[CUSTOMER][NEUTRAL] OK. Well this
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, you know what, Tanya, this is a facility claim. This is a UBO4 claim.
[AGENT][NEUTRAL] Just me.
[AGENT][NEUTRAL] Yeah, I'm looking at the document that we received and it was built on a HIPA.
[CUSTOMER][NEUTRAL] And he.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me just confirm the uh the, the, the, because I'm not showing that. OK, so there were two procedure codes billed, uh, the 87491 and the 87591, that must be the.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Patient.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On the professional side. Mhm.
[AGENT][NEUTRAL] OK, so then this is the professional charge that we have. I don't see.
[CUSTOMER][NEUTRAL] That's what it is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me double check again to see if I have a facility charge. I don't believe I do. Yeah, I don't show the facility charge for 11:15.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. I will take a reference number if you have one.
[AGENT][NEUTRAL] My name and today's date, [PII] and first initial last name is [PII].
[CUSTOMER][POSITIVE] I appreciate it.
[CUSTOMER][POSITIVE] OK, thank you for all your help. You have a good day.