AccountId: 011433970860
ContactId: c0db8af0-6e39-4496-b89f-2ca050453167
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413899 ms
Total Talk Time (AGENT): 110912 ms
Total Talk Time (CUSTOMER): 103280 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/c0db8af0-6e39-4496-b89f-2ca050453167_20250402T16:15_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] In the 8
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I would like to share the claim status, please.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK, OK, I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, the policy number is gonna be 02518924.
[AGENT][NEUTRAL] Yes, that's
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what's that date of service?
[CUSTOMER][NEUTRAL] Their service was in [PII].
[CUSTOMER][NEUTRAL] For the bill amount $7400.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I would like to know if you process the the claim I needed the the check number please.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, let me see what we.
[AGENT][NEUTRAL] Uh, it looks like we received it several times. Let me see what's going on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that's so duplicate.
[AGENT][NEUTRAL] 16
[CUSTOMER][NEUTRAL] Maybe the only beach I was um sorry 2400.
[AGENT][NEUTRAL] OK, looks like.
[AGENT][NEUTRAL] Sorry, we got 44 claims on file same claim. Let's see.
[CUSTOMER][NEUTRAL] Mhm if you want I can give you the CPT code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I've, I've got the claims. I'm just, there's 4 different claims, so I'm looking at each one to see what, what was going on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So it looks like we received the incorrect EOB um.
[AGENT][NEUTRAL] In order to for us to process the claim, we need the explanation of benefits that matches the claim information.
[CUSTOMER][NEGATIVE] But the last one letter that I can see here I received today the the claim was denied but mm for duplicate.
[CUSTOMER][NEUTRAL] And I would like to know how, how do you pay?
[AGENT][NEUTRAL] Well, we haven't paid. Did you submit a corrected EOB?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Cause
[CUSTOMER][POSITIVE] OK, yes, we send that with the correct information.
[AGENT][NEUTRAL] OK, let me see if we just missed it or what happened.
[AGENT][NEGATIVE] Yeah, the EOB attached, the bill charges don't match what is being billed on the claims.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] So there's an EOB attached that has 5000 as the billed amount, but you're only billing for 2400 on the claim.
[AGENT][NEUTRAL] So we have to have something that matches.
[CUSTOMER][NEUTRAL] Let me check because I sent.
[AGENT][NEUTRAL] We corrected claim.
[CUSTOMER][NEUTRAL] We send them many times. Give me one second.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] 62
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I can give you the INC number because I have here too I I need uh what is the right so can you help me with that?
[AGENT][NEUTRAL] Give me, give them what number?
[CUSTOMER][NEUTRAL] ICN number?
[AGENT][NEUTRAL] Well, I have the correct I have the EOB pulled up for this claim, so we received a claim with bill charges of 2400.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the EOB that's attached has billed charges of 5000.
[AGENT][NEGATIVE] So it doesn't match.
[AGENT][NEUTRAL] It has to match for us to consider the processing.
[CUSTOMER][NEUTRAL] OK, I'm gonna check OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna check and I'm gonna send it again.
[CUSTOMER][NEUTRAL] With the right claim, OK?
[AGENT][NEUTRAL] OK, yeah, if you can send a corrected claim because those $2 amounts, they have to match exactly.
[AGENT][NEUTRAL] Or else we won't be able to process.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else I can help with today?
[CUSTOMER][POSITIVE] No, no thank you I appreciate it.
[AGENT][POSITIVE] OK, well thank you for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] Bye bye bye.
[AGENT][NEUTRAL] Bye.