AccountId: 011433970860
ContactId: cc7627b9-13c2-4a31-9b16-67747206ef5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318329 ms
Total Talk Time (AGENT): 88918 ms
Total Talk Time (CUSTOMER): 129277 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/cc7627b9-13c2-4a31-9b16-67747206ef5b_20250212T20:31_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from the provider's office to check on the claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Yes, it would be [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yes, give me one second. It would be 01741604 Mike Lima number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient's first name is [PII]. Last name is [PII], and the date of birth would be on [PII].
[AGENT][NEUTRAL] And what is the data service?
[CUSTOMER][NEUTRAL] Yes, data service is on [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] It looks like we received this claim.
[AGENT][NEUTRAL] Twice.
[AGENT][NEUTRAL] OK, uh, we ask for a detailed explanation of benefits.
[AGENT][NEGATIVE] And we never got it.
[AGENT][NEGATIVE] So the second time it denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, so the first time it was denied for explanation of benefits, is that right, ma'am?
[AGENT][NEUTRAL] Detailed. We got an explanation of benefits, but it wasn't clear what the patient responsibility is, where they applied any to the deductible, co-pay or co-insurance. So we needed a detailed EOB.
[CUSTOMER][NEUTRAL] OK, so can we like resubmit the claim with the UB or just fax the
[CUSTOMER][NEUTRAL] It will be to you.
[AGENT][NEUTRAL] Um, you can just send the, um, detailed EOB faxed.
[CUSTOMER][NEUTRAL] OK. Could you like provide me with the fax number for that?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] Sure, I understand. Thank you for that. And could you provide me with the claim status for the first one, like what would be the received and the claim number for that one?
[AGENT][NEUTRAL] We received the claim [PII], claim denied [PII], and claim number is 352-8512.
[CUSTOMER][NEUTRAL] Sure, thank you for that. And is there any timely filing for this?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK, I understand. Thank you for that and we just need to submit the.
[CUSTOMER][NEUTRAL] Uh, you'll be for this one, right?
[AGENT][NEUTRAL] A detailed EOB if you see in the same one that you've been sending, we're gonna keep denying it as a duplicate.
[CUSTOMER][NEUTRAL] Yes, I understand. Thank you for that information and that would be this for this one, ma'am. What would be the policy number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Yes, I do have one more claim with me, [PII], if you can assist me with that.
[AGENT][NEUTRAL] Same, same, um, member or different member?
[CUSTOMER][NEUTRAL] Different member.
[AGENT][NEUTRAL] And what's that policy number?
[CUSTOMER][NEUTRAL] Yes, give me 1 2nd.
[CUSTOMER][NEUTRAL] OK, it would be
[CUSTOMER][NEUTRAL] 20991.
[AGENT][NEGATIVE] That don't sound right.
[AGENT][NEUTRAL] That might be the group number, but that's not the policy number.
[CUSTOMER][NEUTRAL] OK, you like, give me one moment, let me verify with the member's ID card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, [PII], can you like try to verify the patient using his name and date of birth because he didn't provide us with any member ID card for this one.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] Yes, first name is [PII], last name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, [PII]
[AGENT][NEUTRAL] OK, we don't have anyone in our system by that name.
[CUSTOMER][POSITIVE] OK, I understand, no problem with that.
[CUSTOMER][POSITIVE] And yes, then if you can't find a member, that would be it. Thanks for your assistance for today, [PII], and I hope you have a great day ahead. Bye bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you.