AccountId: 011433970860
ContactId: c86981a5-70fe-4191-86d5-bb537277d913
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363230 ms
Total Talk Time (AGENT): 63448 ms
Total Talk Time (CUSTOMER): 238804 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/c86981a5-70fe-4191-86d5-bb537277d913_20250505T20:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling for the Pra check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Uh, yes, I can help you with claim status. Can I get your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] my extension is a direct line.
[AGENT][NEUTRAL] And the policy number of the patient, member ID?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's D as in Delta 43,732,860.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Do you have the last name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] OK, I'm sorry, could you spell that again?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I I have the chicken.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment. Hold on.
[AGENT][NEUTRAL] You have a group number?
[CUSTOMER][NEUTRAL] Um, yeah, give me a minute.
[CUSTOMER][NEUTRAL] Yeah, uh, the group number means. OK, I do have one policy certificate number. It starts with 025. It's 02596548.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have 4.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[CUSTOMER][NEUTRAL] When was uh.
[AGENT][NEUTRAL] The date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII], charges will be $157 even.
[AGENT][NEUTRAL] I don't have a claim on file. Can you resubmit that?
[CUSTOMER][NEUTRAL] OK. For the date of service to [PII] and for $1157 the claim is not on file.
[AGENT][NEUTRAL] And you said [PII], is that correct?
[CUSTOMER][NEUTRAL] So you won't be having.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, it looks like this policy was effective [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, OK, so the member is also not act on the data our service and the claim is also not on file.
[AGENT][NEUTRAL] Terminator [PII].
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, could you please help me with the, OK, just a moment. Let me make a note. Give me a minute.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so, um, for this point is the same.
[CUSTOMER][NEUTRAL] OK, you can tell me the effect to date and term rate once again.
[AGENT][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] And then Terminator [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] OK. When was the last coordination of benefits updated?
[AGENT][NEUTRAL] Uh, we don't have anything on file.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] You like.
[CUSTOMER][POSITIVE] good
[CUSTOMER][NEUTRAL] Do you see any other pay payer listed for this patient?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Timely finding to submit the corrected claim.
[AGENT][NEGATIVE] There's no timely filing?
[CUSTOMER][NEUTRAL] What will be the payment's mailing uh sorry uh what will be the mailing uh mailing address to submit the correct claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what will be the appeals timely filing limit?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's 180 days from the process date.
[CUSTOMER][NEUTRAL] like.
[CUSTOMER][NEUTRAL] Mailing address to submit the correct uh appeal.
[AGENT][NEUTRAL] The same address?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is there any specific form for nappy?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] No, there's not
[CUSTOMER][NEUTRAL] What will be the call reference number, your name and date?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] The name.
[CUSTOMER][POSITIVE] OK, thank you, [PII], for your assistance and have a great day. It was a pleasure to have a talk with you.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] I