AccountId: 011433970860
ContactId: c3d7bc88-a8aa-4897-aacc-b5ef7fa89ec6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347480 ms
Total Talk Time (AGENT): 142965 ms
Total Talk Time (CUSTOMER): 149204 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/c3d7bc88-a8aa-4897-aacc-b5ef7fa89ec6_20241230T22:08_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, hi [PII], this is [PII] calling for provider Mark Way. Please be informed that this call would be recorded and monitored for quality and training purposes, and.
[AGENT][NEUTRAL] Mhm. And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] And I was calling to check on a claim clarification.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Your callback number is [PII] and his direct line?
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number for the patient is 02215238.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The name of the patient is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII] and the bill amount is $130 even.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me see if I can find this claim. And for future, you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it looks like it was processed twice. The most recent one was a duplicate, so I'm gonna give you information about the original claim, OK?
[CUSTOMER][NEUTRAL] Yeah, just help me to receive it for the duplicate one if you can.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] The received date was [PII] and it was processed [PII].
[CUSTOMER][NEUTRAL] OK. [PII] and [PII], right?
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] You're welcome. Uh, the original one was received on [PII], processed [PII], and it was denied indicating that we have not received the premium, therefore benefits are not payable and see the policy terminated [PII].
[CUSTOMER][NEGATIVE] So you have not received the premium.
[AGENT][NEUTRAL] Yes, the policy has terminated. Mhm.
[CUSTOMER][NEUTRAL] So when was this policy terminated?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] So member was not active on data service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] My name is and I'm calling for the provider. Just tell me a quick second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, sorry for the long wait.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Really appreciate for your time and patience.
[AGENT][POSITIVE] You're welcome. Is, is there anything else I may help you with today? Any other questions or any other?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, just uh, just, uh, just help me the information like the policy effective date for this member, effective and termination date. You just, yeah.
[AGENT][NEUTRAL] Sure. The effective date was [PII]. Again, that's [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] OK, thank you, sir. [PII], you stated, right?
[AGENT][NEUTRAL] Yes, [PII] is the effective date.
[CUSTOMER][NEUTRAL] And is do you know when was the last coordination of benefits updated?
[AGENT][NEUTRAL] We don't coordinate benefits on this one, this one is a limited policy.
[CUSTOMER][NEUTRAL] people
[CUSTOMER][NEUTRAL] Not an issue. And do you know is there any other payer listed for this patient?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] None that I can see.
[CUSTOMER][NEUTRAL] OK, just a quick second here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Really appreciate you. OK. And could you please just tell me the time finding limit to submit corrected, please.
[AGENT][NEUTRAL] We don't have timely filing limits for corrected claims.
[CUSTOMER][NEUTRAL] OK, so there is no timely filing limit to submit corrected claim.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And is there any mailing address to submit corrected please?
[AGENT][NEUTRAL] PO Box.
[AGENT][NEUTRAL] Um, let me see this one is.
[AGENT][NEUTRAL] This one is in [PII].
[AGENT][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Family filing limit for an appeal is there or not? 5 recall.
[AGENT][NEUTRAL] 180 days from the decision day for any appeals.
[CUSTOMER][NEUTRAL] So timely filing limit is 180 days from denial date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the mailing address for nothing?
[AGENT][NEUTRAL] In the same address.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Same address and may I know is there any specific form for an IP?
[AGENT][NEUTRAL] No, just a letter appealing the decision.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, thank you for that. There is no specific form for an appeal.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And call reference number for today's call.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, not an issue. Thank you for that. Thank you for your assistance and have a great day. Bye.
[AGENT][POSITIVE] You're welcome. You as well and thank you for calling APL. Bye bye, Mr. [PII].