AccountId: 011433970860
ContactId: c0bd65db-7feb-4425-8a7d-b2e462c33710
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1021719 ms
Total Talk Time (AGENT): 288076 ms
Total Talk Time (CUSTOMER): 380671 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/c0bd65db-7feb-4425-8a7d-b2e462c33710_20250320T16:51_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient information and the provider information?
[AGENT][POSITIVE] Yes, it would be my pleasure to assist you, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII] and there is a direct line or extension.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It's 02013328 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy, I mean the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Last name is [PII]. It[PII]
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you, and it would be a pleasure to assist you with that claim status. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] Um, no, I don't have a claim number, but the date of service is [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And I'm checking for that data service. I don't see a claim processed for [PII] for 11-19-24. I did just receive some claims, so bear with me just one second. Just gonna check those real quick to see if that's your claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Still checking, bear with me.
[AGENT][NEUTRAL] Yeah, [PII], I do not see a claim on file for 11-19-2024 for [PII].
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can you can you see the claim submitted on [PII]?
[AGENT][NEUTRAL] I don't see a claim submitted on [PII].
[CUSTOMER][NEUTRAL] OK, could you see, uh, could you find the claim with the bill amount?
[AGENT][NEUTRAL] No, I don't have a claim on file for that data service of 11-19-2024.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] OK. Could you please give me the information about is the patient active on date of service?
[AGENT][NEUTRAL] Yes, the effective date on the policy is [PII], and the policy is active.
[AGENT][NEUTRAL] Well, actually, I'm sorry, it turned on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Ah, OK, uh, the effective date is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the term date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just, just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. And could you please give me the information about, are you a primary or secondary?
[AGENT][NEUTRAL] We're secondary to the policyholder's Major Medical.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And uh when was the last coordination of benefits updated?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. And what is your preferred mode of submission?
[AGENT][NEUTRAL] You can fax it or mail it to our claims department.
[CUSTOMER][NEUTRAL] OK, and what is the claim submission timely filing you mean?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and what is the claim submission mailing address?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] You can also fax it directly to us.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and what is the payer ID?
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. Just a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you so much and uh could you please give me the call reference number for this call?
[AGENT][NEUTRAL] The co reference number is my name in today's date, and I spell my name [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And uh it's a request. Could you please assist me with the one more claim?
[AGENT][POSITIVE] It would be my pleasure to assist you with another claim. Bear with me just one second, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And I am ready for the next policy number, [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The next member ID is 02546627.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] Thank you, [PII]. That patient's name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII] Last name is [PII]
[AGENT][NEUTRAL] Thank you. And her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you and what is that data service please?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] I'm so sorry. It's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the policy number you gave me, the effective date is 10-1-2024.
[AGENT][NEUTRAL] I did find a policy that was active for data service 924-24. Can I give you the correct policy number for that data service?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Is the policy number is incorrect?
[AGENT][NEUTRAL] Yes, the policy number you gave me, the effective date was [PII].
[AGENT][NEUTRAL] Now, I do have.
[CUSTOMER][NEUTRAL] They you know they can make.
[AGENT][NEUTRAL] A policy that was active for your September date of service, and I can provide that information.
[AGENT][NEUTRAL] To you.
[CUSTOMER][NEUTRAL] OK, please.
[CUSTOMER][NEUTRAL] OK, please give me the um policy ID for [PII]. Sorry.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, the correct policy number for that data service is 243-318-5.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] OK. It's 243-318-5. Just a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, [PII]. Um
[CUSTOMER][NEUTRAL] The member ID which I gave you which is 02546627. Is there any claim on that member ID?
[AGENT][NEUTRAL] No, ma'am, because the date of service was prior to the effective date of that policy, and that is why I gave you the correct ID number of 243-3185 that was in fact active for that [PII] data service.
[CUSTOMER][NEUTRAL] OK, so that for that member ID there is no claim, right?
[AGENT][NEUTRAL] Not on the one you gave me. Now, I do have a claim on file for 92424 excuse me, 92424 under policy number 243-3185.
[AGENT][NEUTRAL] And I'll be happy to check to see if that's your claim. What is the facility name and the bill amount?
[CUSTOMER][NEUTRAL] OK. Uh, but, um,
[CUSTOMER][NEUTRAL] The, the member ID which I gave you, [PII]. Is there any claim on that member ID?
[AGENT][NEUTRAL] Not for your date of service, that policy did not start until [PII].
[CUSTOMER][NEUTRAL] OK, for, OK, for the another date of service.
[AGENT][NEUTRAL] You have another data service?
[CUSTOMER][NEUTRAL] No, you can find the claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so what is the billed amount on the claim and the facility name?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, facility name is?
[CUSTOMER][NEUTRAL] Campbell County Jacksboro Clinic.
[AGENT][NEUTRAL] And the bill amount, please, ma'am.
[CUSTOMER][NEUTRAL] Yes, sir, just a moment. The bill amount is $266 even.
[AGENT][NEUTRAL] All right, thank you. So that claim was processed under the policy number I gave you.
[AGENT][NEUTRAL] The 243-318-5.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you give me one moment?
[AGENT][NEUTRAL] Sure, and I can give you that claim information if needed.
[CUSTOMER][NEUTRAL] OK, [PII]. Uh sorry for the holding. Um.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Would you like that claim information?
[CUSTOMER][NEUTRAL] OK. Uh, is the patient active on, yes, is the patient active on date of service?
[AGENT][NEUTRAL] Under that policy number I gave you 243-318-5. The patient was active for that data service.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and what is the effective date?
[AGENT][NEUTRAL] Effective date was [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, I'm still active.
[AGENT][NEUTRAL] No, it turned on [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, and are you a primary or secondary?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] And uh when was the last coordination of benefits updated?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Would you like the claim information?
[CUSTOMER][NEUTRAL] And what is the preferred mode of submission if this fax or email, right?
[AGENT][NEUTRAL] We have the claim on file. I can give you the claim information.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what would you like the claim number?
[CUSTOMER][NEUTRAL] So, what is the, uh, what is the status of a claim?
[AGENT][NEUTRAL] It's been processed. I can provide that claim information for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] And it was denied as non-covered.