AccountId: 011433970860
ContactId: c441118d-66ae-4a6e-b5de-b50555c799d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 699640 ms
Total Talk Time (AGENT): 237507 ms
Total Talk Time (CUSTOMER): 218731 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c441118d-66ae-4a6e-b5de-b50555c799d6_20250206T17:38_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on a claim. Please spell your name for me, please?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah, got it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, and you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, I have two claims.
[AGENT][NEUTRAL] OK, are your two clients for the same patient or different patients?
[CUSTOMER][NEUTRAL] Yes. No, that's for the same patient but different claims.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh, sure, I see. That will be [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] Yeah. That is 0204939, M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, one moment. You said 0204939. Was that the first part of that number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it's 02049395 and the ML 7.
[AGENT][NEUTRAL] 5. Is there a 5 after the 9?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII] any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. Also, if you need a call reference number for our call today, you will use my name along with today's date.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file [PII] and you need a copy of the explanation of benefits, you may go to our portal and print that and our portal website that you would go to is [PII].
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]. Yeah, got it. Thank you so much, [PII].
[AGENT][NEUTRAL] And yes, ma'am. You're welcome. And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh yeah. The patient's first name is [PII], which is [PII] and the last name was [PII], which is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] Yeah, the first date of service is [PII] with the amount of $760 even.
[AGENT][NEUTRAL] And you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Uh, no, [PII].
[AGENT][NEUTRAL] Of [PII] for 760. Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we received a claim on 9-23-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3510003.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That it.
[CUSTOMER][NEUTRAL] So, OK. And may I know about the reason?
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] It states information received from provider incomplete cannot process until additional correct information is received from the provider.
[CUSTOMER][NEUTRAL] Oh, OK, could you please specify what kind of information that you guys need so we can submit it?
[AGENT][NEUTRAL] Give me one moment, uh, [PII] to see if I can provide that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So just what I'm looking at some notes.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so it appears that on the claim form we received.
[AGENT][NEUTRAL] The patient's name.
[AGENT][NEUTRAL] Is different than what you're giving me, so we need to have corrected information reflecting the correct patient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. Oh, I'm sorry, that, OK. Yes, it, uh, that [PII] was the subscriber. I think the patient name is [PII]. Is that right?
[AGENT][NEUTRAL] I'm, I'm sorry, what is the name and date of birth for the patient?
[CUSTOMER][NEUTRAL] [PII] My last name is [PII], which is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] OK. May what?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so the information that we have on file for that member does not match what you are giving me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, and also on [PII], we also send the claim. Could you please also check that what is the status for that?
[AGENT][NEUTRAL] We do not have, OK, for which patient?
[CUSTOMER][NEUTRAL] Uh, for the same patient. OK, the patient is the problem. OK, OK. uh, [PII], uh, sorry, [PII], uh, yeah, you can go ahead. Sorry to interrupt you.
[AGENT][NEUTRAL] OK, you've given me two different names. Mhm.
[AGENT][NEUTRAL] The patient is
[AGENT][NEUTRAL] No, ma'am. The claims information submitted versus the information you're providing, including the date of birth, do not match what, what we have on record.
[CUSTOMER][NEUTRAL] OK, just give me a minute and just verify that is, OK, there's also noted one.
[CUSTOMER][NEUTRAL] Uh, OK. Sorry to interrupt you again. Uh, can I just put you on for a hold, [PII]?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][POSITIVE] Just for a minute. Thank you so much.
[CUSTOMER][NEUTRAL] Yes, [PII]. Thank you so much for waiting. I'm sorry for making you wait. And uh OK, as you said, the patient name is matching. We can contact the patient to update the details. And also for the another date of service, uh, [PII]. Could you please also verify that also?
[AGENT][POSITIVE] Yes, you're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so because the pay you're giving me [PII] as the patient, is that correct?
[CUSTOMER][NEUTRAL] I'm very sorry, but I have [PII] in the claim form, but in the software that is JC.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] So you're saying that for the 531 data service it's for [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] And that is $634 even.
[AGENT][NEUTRAL] OK. So that claim was also received on [PII] it was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number is 3510002.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was denied for the same reason. In information received from provider incomplete cannot process until additional corrected information is received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm sorry to ask you. Uh, OK. Could you please also verify, uh, [PII], sorry to ask you, what is the correct information that needed from for that, uh, we can, yeah, we can contact the patient.
[AGENT][NEUTRAL] We need the correct paper and date of birth, corrected claim with correct patient information and date of birth.
[CUSTOMER][NEUTRAL] We should do
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Because what we've received does not.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] So, yes, [PII], that's my question for today. And you said your call reference was your name and today's date, right?
[AGENT][POSITIVE] Yes, ma'am, [PII], that is correct. Mhm.
[CUSTOMER][POSITIVE] OK, got that. So yeah, that's my questions for today, [PII]. Thank you so much for assisting me today. Hope you have a good day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you for calling APL. I hope that you have a very nice afternoon, [PII].
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.