AccountId: 011433970860
ContactId: c0aa7a82-b7dc-4a26-9678-790170a2d5d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451290 ms
Total Talk Time (AGENT): 146202 ms
Total Talk Time (CUSTOMER): 125477 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/c0aa7a82-b7dc-4a26-9678-790170a2d5d3_20250602T18:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, good afternoon, [PII]. This is [PII] calling from Novi Medical Group. I was calling to get additional information on a claim that denied.
[AGENT][POSITIVE] All right, [PII]. Happy to check a claim. Do we have the policy number, claim number?
[CUSTOMER][NEUTRAL] Um, I have both. Um, the policy number is 02539252.
[AGENT][NEUTRAL] And then [PII] if I can get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, the patient name is.
[CUSTOMER][NEUTRAL] Oh hold on.
[CUSTOMER][NEUTRAL] OK, the first name spelled [PII] Last name is [PII] Date of birth [PII].
[AGENT][NEUTRAL] And the data service.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And then what did you have as a bill amount?
[CUSTOMER][NEUTRAL] Um, yes, $562.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so it looks like we did get a claim for the date of service. It looks like the member's plan is through a temp staff agency and so we were awaiting um information from them just to verify eligibility for the date of service.
[CUSTOMER][NEUTRAL] Oh, OK, so, um, this my policy is through a temp staff agent you say?
[AGENT][NEUTRAL] Right, it's through a staffing agency. And as of right now, the plan shows lapsed as of [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so la.
[CUSTOMER][NEUTRAL] OK, [PII]. OK, but yeah, um, but I reached out to the, um, staff agents just then you say.
[AGENT][NEUTRAL] So we sent a message to them just waiting to see if the member was eligible at the time of service because as of right now we don't show that the member was active.
[CUSTOMER][NEUTRAL] OK, and when did y'all send that request?
[AGENT][NEUTRAL] Let me see what the date was, give me just one moment.
[AGENT][NEUTRAL] Looks like I show the last correspondence sent out was on.
[AGENT][NEUTRAL] [PII] and we haven't heard anything back, so.
[CUSTOMER][NEUTRAL] OK, um, do the stock agent have a name?
[AGENT][NEUTRAL] Oh, I would venture to.
[CUSTOMER][NEUTRAL] Oh go ahead I'm sorry, sir, what you were saying?
[AGENT][NEUTRAL] Oh no, that's OK. I was I was gonna say I'd venture to say they're probably not active anymore, um.
[AGENT][NEUTRAL] The group name is the resource company.
[AGENT][NEUTRAL] And I have a group number if you need that, [PII].
[CUSTOMER][NEUTRAL] OK, what's that group number?
[AGENT][NEUTRAL] 70075.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so I guess, um, mm, now what is your time frame for claims?
[AGENT][NEUTRAL] We don't have, yeah, we don't have a timely filing limit, so.
[CUSTOMER][NEUTRAL] Medical clients.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, because I asked that because I have several other claims for this patient around the same for all of them in January.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Very, uh, that's outstanding on my end, so I guess I called back and I I send a request on the [PII].
[CUSTOMER][NEUTRAL] So do you have that? Is there any way I can get that actual direct number the resource company number?
[AGENT][NEUTRAL] Um, let's see. I can give you.
[AGENT][NEUTRAL] Um, so the number that I have for benefits and a card who manages this through the staffing agency is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4974856
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I would venture to say at this point, [PII], since no communication has been received back that the member was not active on the date of service, so it's gonna be up to the provider facility as far as billing if they want to bill the patient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, well, um.
[AGENT][NEGATIVE] Cause, cause we should have we should have gotten something back right now.
[AGENT][NEUTRAL] Cause it's June already.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you. OK, well, I'll just go ahead and build the, I'm showing that they got Medicaid, so I guess I'll just go ahead and build Medicaid, um, yeah, Medicaid and secondary and see if they'll pick up some of the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, payment just to give us something. Oh, OK then, [PII], let me get a reference number for this call then.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with today's date. My name again is [PII], that is spelled [PII] My last initial is going to be [PII].
[CUSTOMER][POSITIVE] OK, thank you, um, sir, and you enjoy the rest of your day.
[AGENT][NEUTRAL] You too bye bye.