AccountId: 011433970860
ContactId: ccc43efd-6c0d-45e8-89ad-f53aa83e9c14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 699900 ms
Total Talk Time (AGENT): 235795 ms
Total Talk Time (CUSTOMER): 249231 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/ccc43efd-6c0d-45e8-89ad-f53aa83e9c14_20250127T19:41_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling for provider office. I'm looking for client status. Could you help with that?
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Sure. 02544110.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, um, patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information [PII], and you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the date of service in charge and I can help you?
[CUSTOMER][NEUTRAL] Yes, date of service is [PII]. Bill amount is $277 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received [PII]. Proceed [PII]. Um, it was denied for a copy of the.
[CUSTOMER][NEUTRAL] Oh, hold on.
[CUSTOMER][NEUTRAL] Just, just, uh, one second, uh, uh, I'm just talk. Hold on. I have the receipt it one second.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, process done.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. Claim number, please.
[AGENT][NEUTRAL] It was denied needing the primary explanation of benefits. The claim number is 352.
[AGENT][NEUTRAL] 4049.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can also check your status online at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any other questions, [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 352-404-9 is the claim number, right?
[AGENT][NEUTRAL] Mhm. 352.
[AGENT][NEUTRAL] 4049.
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] Got it. We need reason once again, please.
[CUSTOMER][NEUTRAL] Primary yogi, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] So, our API is secondary.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I know when was CO be updated?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] COB when was updated by patient. May I know the date, last updated date?
[AGENT][NEUTRAL] The date of the effective date [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm asking about the coordination of benefitsin was upgraded.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh, OK. Thank you.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Could you send the COV through fax?
[AGENT][NEUTRAL] It was mailed when the claim was processed on [PII]. It's now available to download on our online service center at [PII]. Let me know when you're ready and I can assist you with creating the account to download your EOB.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The web address is secured [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, uh,
[CUSTOMER][NEUTRAL] I'm getting slow. One second, just I refresh it one moment. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It's secured secured.
[CUSTOMER][POSITIVE] Yes, I'm ready now, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the welcome page or the home page will say online service center welcome.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][NEUTRAL] OK, and so you're gonna click on the new.
[CUSTOMER][NEUTRAL] I was asking you, you, sir.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then select which role best describes you.
[CUSTOMER][NEUTRAL] Yes, medical or dental, I'm a medical provider.
[AGENT][NEUTRAL] Right, and then it.
[CUSTOMER][NEUTRAL] And it's asking the tax ID?
[AGENT][NEUTRAL] If you can verify that out, out loud, please.
[CUSTOMER][NEUTRAL] Yeah, yeah, it was asking like tax ID number.
[AGENT][NEUTRAL] That's what it's requesting and if you can verify the provider's tax ID out loud please because it has to match what's in our system.
[CUSTOMER][NEUTRAL] 5, OK. [PII], yes, [PII].
[AGENT][NEUTRAL] Do you have that number?
[CUSTOMER][NEUTRAL] [PII] is the tax ID number.
[AGENT][NEUTRAL] Do you have a copy of the claim that was sent to us?
[AGENT][NEUTRAL] The tax ID number is different on that claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, that, that tax ID only provided [PII].
[CUSTOMER][NEUTRAL] And it's asking patient account number as well. I mentioned it.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is this what's the name of the provider?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The provider, is it a hospital?
[CUSTOMER][NEUTRAL] Uh, it's uh individual provider. It's a physician claim.
[AGENT][NEUTRAL] OK, then if it's a physician's claim.
[AGENT][NEUTRAL] This, this claim is not your claim then you said the total charge was 277?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, 2 277 is my.
[AGENT][NEUTRAL] What are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] 99214.
[AGENT][NEUTRAL] OK, I do not show that claim on file.
[AGENT][NEUTRAL] And give me the
[CUSTOMER][NEUTRAL] But you provided the status for that?
[AGENT][NEUTRAL] Yeah, this is a hospital claim with the same date of service and the same charge that we received. It's not a professional fee it's from a hospital so it's not your claim so that that claim number is not your claim number. So if you could remove that please.
[CUSTOMER][NEUTRAL] Oh, OK, that's fin[PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So your claim, if it's a professional charge, give me the doctor's name again.
[AGENT][NEUTRAL] For the practice?
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[CUSTOMER][NEUTRAL] It's [PII] G U.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Spell the last name again for me please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I do not show a claim from this provider on file. Did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you help me to create the portal as well?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] But I don't have the tax identification number that you have, so go ahead and enter the tax ID number. If, if we don't have it on file, you're not going to see it online.
[CUSTOMER][NEUTRAL] Mm. Before that, just hold on.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And we've not received it yet, but you would, but you would go ahead and create a username password, but you've got to pass those two security questions first, and because we do not have the claim, it's not gonna match anything in our system because we've not received the claim from this provider.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Oh yes, that's right. Because if I'm facing issue to create that, using that. That's OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm, I will try another one if in future I got same our claim. That's OK. And may I, could you verify that for me? I, we was submitted through paper.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, what did you ask me to verify?
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] On [PII], we submitted the claim as paper claim.
[CUSTOMER][NEUTRAL] To our address [PII]. OK. [PII]. This is the address we submitted.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] May I know the member's policy effective on the date?
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The policy effective date is [PII]. The policy is active at this time.
[CUSTOMER][NEUTRAL] [PII] still active. OK. May I know the timely filing limit?
[AGENT][NEUTRAL] No timely filing limit in which to submit the claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes. Um, may I have the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801. Yes, thank you. May I have your name spelling, please?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call [PII].
[CUSTOMER][NEUTRAL] Finally,
[AGENT][NEUTRAL] [PII] first initial of my last name is [PII], did you have any other questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Not done yet. Thank you so much for patiently providing this information to your A. Have a great day. Take care. Bye for now.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] It is like