AccountId: 011433970860
ContactId: be1fcc06-dfd8-4a78-a8f6-46cbfb3487f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1523689 ms
Total Talk Time (AGENT): 390187 ms
Total Talk Time (CUSTOMER): 378693 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/be1fcc06-dfd8-4a78-a8f6-46cbfb3487f2_20250401T20:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling you from provider's office, checking on claim status.
[AGENT][NEUTRAL] Hey, [PII], I can help you with claim status. Can I please get your callback number?
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Could you please repeat once again?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Could you please repeat once again, your, yeah, I can hear you now better.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 24 the policy number is 02496781.
[CUSTOMER][NEUTRAL] And the patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] total charge $4,436 even.
[AGENT][NEUTRAL] OK, and then what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah, just give me one second.
[CUSTOMER][NEUTRAL] Yeah. The charges is 1,531 dollars.34 cents.
[AGENT][NEUTRAL] OK, and the name of the facility you're calling from [PII]?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I will be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No, that ain't it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I have the claim number for you. The claim number is 357-712-0. The claim is pending eligibility from the primary from the insured's uh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Employer, once we get that eligibility in we will repro the process the claim automatically.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, you mean that the claim is pending for primary EOB, am I right?
[AGENT][NEUTRAL] No, it's pending for eligibility from the employer. Once we get the eligibility from the employer, then we will reprocess the claim automatically.
[CUSTOMER][NEUTRAL] Yeah, just give me one second. I'm checking on it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know who is the employer?
[AGENT][NEUTRAL] The employer is.
[AGENT][NEUTRAL] A law it's a law firm.
[AGENT][NEUTRAL] We're waiting for
[AGENT][NEUTRAL] Eligibility.
[CUSTOMER][NEUTRAL] OK. You mean uh the patient need to update cop information, I'm right?
[AGENT][NEUTRAL] I'm not sure what all entails. We're just waiting eligibility.
[AGENT][NEUTRAL] For the patient, and then once we get that we will reprocess the claim automatically.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the claim received date?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] The claim was received on.
[AGENT][NEUTRAL] [PII] and the claim was processed on [PII].
[CUSTOMER][NEUTRAL] And the claim has been pending for eligibility information, I'm right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can I get the policy effective date?
[AGENT][NEUTRAL] Yes, the policy effective date is [PII].
[CUSTOMER][NEUTRAL] Still active, I'm right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, so we need to contact to the patient and tell to contact to customer to call to customer service department of APL to the patient.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, the patient doesn't need to call us.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] OK. From which end you are waiting for this information?
[AGENT][NEUTRAL] We're just waiting eligibility to process the claim, the.
[AGENT][NEUTRAL] The documents to for that have already been assigned to the correct people. We're just waiting for a response back.
[CUSTOMER][NEUTRAL] OK, so we need to allow more time. I'm I right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. And uh can we check, just one second, same patient or different date of service, can we check?
[AGENT][NEUTRAL] You check you repeat the que.
[AGENT][NEUTRAL] Can you repeat the question?
[CUSTOMER][NEUTRAL] Same patient for another date of service.
[CUSTOMER][NEUTRAL] Can we have a look on that one?
[AGENT][NEUTRAL] Same patient different date of service, is that correct? Is that what you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, sir. What is the date, what is the date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, the date of service is.
[CUSTOMER][NEUTRAL] [PII], total charge $403 even.
[AGENT][NEUTRAL] OK. And then what is the name of the facility?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, and what's the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, this.
[CUSTOMER][NEUTRAL] Yeah, the leftover balance is $14.02.
[CUSTOMER][NEUTRAL] 20 cents, sorry, $14.20.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you for holding for me.
[AGENT][NEUTRAL] I do have the claim number for you. The claim number is 357-7125.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim was paid $14.20.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] And the check is still outstanding as it was just sent in March to Holy Cross Medical Group, [PII], zip code is [PII].
[CUSTOMER][NEUTRAL] OK, this one was a single check amount. I'm right?
[AGENT][NEUTRAL] The check amount was $14.20.
[CUSTOMER][NEUTRAL] OK. And can I get the claim received it?
[AGENT][NEUTRAL] Yes, sir. Let me look that up.
[AGENT][NEUTRAL] Claim was received on [PII] and processed on [PII].
[CUSTOMER][POSITIVE] OK. Thank you. No problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we check for the next patient?
[AGENT][NEUTRAL] OK, let me put my notes in and we'll move on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number is 01602339 M as in Mike, L as in Lima, number 8, and the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy number.
[AGENT][NEUTRAL] OK, and then what is the data service, the charge amount?
[CUSTOMER][NEUTRAL] Yeah. The date of service is.
[CUSTOMER][NEUTRAL] [PII] total charge $661 even.
[AGENT][NEUTRAL] OK, and that was September, what was the day again, please?
[CUSTOMER][NEUTRAL] Sure, it is [PII] for $661 even.
[AGENT][NEUTRAL] OK, and what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah, it is $21.91.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I'm back with you again. Uh, let me give you the good policy number this claim is under.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] The good policy number is 237-032-5.
[AGENT][NEUTRAL] The claim number is 3562067.
[AGENT][NEUTRAL] The claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under the policy, I'm right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Uh, can you please send a copy of your retro fax?
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Attention to [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm gonna put you on a quick hold while I get that faxed over to you. I'll be right back, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh can we check for the next patient?
[AGENT][NEUTRAL] How many patients do you have?
[CUSTOMER][NEUTRAL] Uh, just give me one second.
[CUSTOMER][NEUTRAL] Uh, I, this is the last patient at my end, I think so, yeah.
[AGENT][NEUTRAL] OK. All right. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02555046.
[CUSTOMER][NEUTRAL] And the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $288 even and I have the specific concern regarding this claim.
[AGENT][NEUTRAL] OK, and what's the charges after the primary paid their part?
[CUSTOMER][NEUTRAL] Yeah, one second. Yeah, the address is
[CUSTOMER][NEUTRAL] $53.89.
[AGENT][NEUTRAL] OK. And since you have specific questions, do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, I have the claim number. Just give me one second.
[AGENT][NEUTRAL] What is that, please?
[CUSTOMER][NEUTRAL] Yeah. The claim number at my end is 356-053-3.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, the claim was paid $53.89 with check number 2026498.
[AGENT][NEUTRAL] Let me look up the check.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Check was issued on [PII].
[AGENT][POSITIVE] And I'm showing that it's still outstanding.
[CUSTOMER][NEUTRAL] Uh, uh, yeah, and, uh, for that reason, the check has been sent to incorrect address which is
[CUSTOMER][NEUTRAL] [PII], which is incorrect. And uh the representative has suggested us to send the W-9 form, and we have submitted the W-9 form through fax and the fax number which we have submitted the W9 is 8773659423. Have you received the W9 form at your end?
[AGENT][NEUTRAL] OK, so the fax number that you sent that to.
[AGENT][NEUTRAL] Is the claims fax number. Let me give you the work fax number.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh wait, let's see, what I'm sorry, [PII].
[AGENT][NEUTRAL] 807.
[AGENT][NEUTRAL] 0911.
[CUSTOMER][NEUTRAL] Just to confirm, it's [PII]. I'm right?
[AGENT][NEUTRAL] Yeah, yes, that's correct that's the fax number that you should have sent it to.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Which fax number is this? This is the appeals fax number?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Or fax it's not for claims it's the general fax number.
[CUSTOMER][NEUTRAL] OK. This is the general fax number. OK.
[AGENT][NEUTRAL] Right, the one that you sent it to was for processing claims only.
[CUSTOMER][NEUTRAL] OK, that was the claim processing fax number. One second, I will update this information.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Passing. So I need to resend again the W9 form. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the address which I gave you, the address, the address was incorrect. I'm I right?
[AGENT][NEUTRAL] Uh, I'm not
[CUSTOMER][NEUTRAL] Where the check has been issued.
[AGENT][NEUTRAL] The check has been issued. You're saying it's incorrect, but that's what we have on file. Um, let me give you a um email address too just so you can email that in also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII]. I'm right?
[AGENT][NEUTRAL] Yes, yes, sir.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Sure. I will send you the WI and what will be the call reference?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] I date.
[CUSTOMER][POSITIVE] OK, sure, sir. Thanks for assisting me. Have a good day. Bye-bye.