AccountId: 011433970860
ContactId: c1bff17b-e980-40dc-84ac-6f5e4fc71960
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349480 ms
Total Talk Time (AGENT): 115158 ms
Total Talk Time (CUSTOMER): 93356 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/c1bff17b-e980-40dc-84ac-6f5e4fc71960_20250324T12:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I would like to check the status of a claim. Can you help me with that?
[AGENT][POSITIVE] It would be my pleasure to assist you with that, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][POSITIVE] [PII]. Thank you.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] The patient's primary insurance policy ID is Alpha 6,014,516,200.
[AGENT][NEUTRAL] That is not our policy number. Do you have the APL policy certificate number?
[CUSTOMER][NEUTRAL] Actually, I haven't been provided with that information.
[AGENT][NEUTRAL] What is the patient's last name?
[CUSTOMER][NEUTRAL] The patient's last name is [PII].
[AGENT][NEUTRAL] Can you spell that?
[CUSTOMER][NEUTRAL] Sure, it's Bay spelled Bravo, Alpha, Yankee.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] The patient's first name is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You're welcome. Can you tell me the status of the claim for the date of service [PII]?
[AGENT][NEUTRAL] Bear with me just one moment. I need to verify [PII]'s date of birth, please.
[CUSTOMER][NEUTRAL] The patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and what is the bill amount for November the?
[AGENT][NEUTRAL] 1 2024.
[CUSTOMER][NEUTRAL] The claim billed amount for [PII] is $150.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the facility name?
[CUSTOMER][NEUTRAL] The facility name is TestMed Clinic.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], I do have that claim on file.
[CUSTOMER][NEUTRAL] Your
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And that claim was denied as
[CUSTOMER][NEUTRAL] To confirm the claim.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] To confirm, the claim was received on [PII], processed on [PII], and was denied.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Can I have the claim number please?
[AGENT][NEUTRAL] Claim number is 352-837-0.
[CUSTOMER][NEUTRAL] Thank you. Can I get the specific denial reason for each code billed on the claim?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Code 99204 was denied as office visits are not covered under the patient's plan.
[CUSTOMER][POSITIVE] Thank you for that information.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] What is the corrected claim timely filing?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] What is the
[CUSTOMER][NEUTRAL] Would you mind saying that again?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Thank you for the information. What is the corrected claim timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Would you mind saying that again?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] None
[CUSTOMER][NEUTRAL] Thank you. What's the mailing address or fax number for appeals?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] To confirm, I have [PII], is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Can I have the reference number for this call?
[AGENT][NEUTRAL] My name in today's date, it will be [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] My pleasure to assist you with that claim status. Anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] It seems like I'm all set. Thanks and have a good one.
[AGENT][POSITIVE] Thank you for calling APL. Hope you have a great day as well. Take.