AccountId: 011433970860
ContactId: ca13de34-9454-4ac0-a305-4973ec29420e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376070 ms
Total Talk Time (AGENT): 141316 ms
Total Talk Time (CUSTOMER): 132803 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/ca13de34-9454-4ac0-a305-4973ec29420e_20250206T20:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for the provider's office to check on a claim verification. Please be informed the call is being recorded and monitored for quality and training purpose. I recorded for a claim clarification, [PII], this is [PII].
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and from my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII] with the last initial letter of [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] 01986343.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And I'll just confirm the bill a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And double the amount will be, it is $198.92.
[AGENT][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] And it was $198.92.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So I'm not sure we have a claim on file with your total bills. Um there is a claim on file for that data service, but it's a different total bills. What is the name of the provider on your claim?
[CUSTOMER][NEUTRAL] And does your provider name will be [PII]?
[AGENT][NEUTRAL] Oh no, this is a different provider as well, so there's no claim on file.
[CUSTOMER][NEUTRAL] OK, I'll just confirm the bill amount one second. Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK. So upon checking, do you have the amount of $264.57?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, I apologize for that one. That is multiple pages was this. I apologize for that.
[AGENT][NEUTRAL] OK, and the name of the provider's office on this claim?
[CUSTOMER][NEUTRAL] It belongs to?
[CUSTOMER][NEUTRAL] It is Medvise LLC.
[AGENT][NEUTRAL] OK, um, so I'm showing that this claim was received.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1208.
[AGENT][NEUTRAL] And on [PII], the claim was denied. Hold on one moment, I'm getting that denial reason for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, in order for us to continue processing the claim, um, we'll need the explanation of benefits that matches the claim information. The wrong explanation of benefits was provided with the claim information.
[CUSTOMER][NEUTRAL] OK. I just want to confirm the primary base is Blue Cross of Blue Shield of Oklahoma.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So, upon checking with this claim, so we submitted that EOB, the primary BCBS Oklahoma EOB. It was attached to the last page of the claim form. Did you receive that one?
[AGENT][NEUTRAL] So it's not saying that we didn't receive the the explanation of benefits. The charges that are on the explanation of benefits that we received does not match the um claim form and what's being.
[AGENT][NEUTRAL] Claims. So we just need the explanation of benefits that goes with what you're claiming.
[CUSTOMER][NEUTRAL] OK. So the UOB was received but it was mismatched with the claim form. So you need the correct primary UOB to process it, is it right?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Thank you for the valid information. And what about the mailing address and timeifying name at the Summit andqui UB?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So there's no timely filing limit. Um, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, thank you. So it is [PII]. Is it right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And there is no time defining limit. And for this one, you required only the U and no additional document required, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you for the valid information. So it was received on [PII] and was processed on [PII]. And the claim number 3551208. So the claim for the primary EOB. Thank you for the valid information. What about the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Again, that's [PII] my [PII] is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, [PII]. I have only one time to verify with you and thank you for assisting me patiently and have a nice day.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.