AccountId: 011433970860
ContactId: d65c02a7-785f-49ab-b136-152fb2329208
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671419 ms
Total Talk Time (AGENT): 241921 ms
Total Talk Time (CUSTOMER): 364876 ms
Interruptions: 11
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/d65c02a7-785f-49ab-b136-152fb2329208_20250326T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on a claim status.
[AGENT][POSITIVE] Yeah, it would be my pleasure to assist you with claim status. What is the callback number?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Bri, the policy number for the patient please ma'am?
[CUSTOMER][NEUTRAL] I need.
[CUSTOMER][NEUTRAL] Yes, the policy number is uh
[CUSTOMER][NEUTRAL] 10566168
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 10566168
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] That is gonna be too long for our policy number.
[AGENT][NEUTRAL] Do you have the APL ID card or if you have a claim number, I can look it up by claim number.
[CUSTOMER][NEUTRAL] I don't have the claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't have one. Can you help me with that.
[AGENT][NEUTRAL] What's your name search? what is the patient's last name?
[CUSTOMER][NEUTRAL] Last name is [PII], and the first name is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So how
[AGENT][NEUTRAL] And what is Elba's date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The patient date of birth is uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I did locate a policy for [PII]. I can provide that policy number for you.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The correct policy number is 015.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 66168.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Shall I tell the date of service?
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that claim status. What is that data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] For [PII], I do not have a claim on file for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] May I know the policy effective on termination date?
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] Policy turned on 12-1-2024.
[CUSTOMER][NEUTRAL] [PII] and [PII]. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And may I also the time the filing limit for commit a claim.
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK. And the
[AGENT][NEUTRAL] You can
[CUSTOMER][NEUTRAL] My mailing address please.
[AGENT][NEUTRAL] Mhm. [PII]'s mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can also fax that claim directly to our claims department with the primary EOB.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And our fax number is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] OK, and please spell your name for my documentation purposes.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Again the call reference number for this one.
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and also do you have an electronic pay ID?
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 608 and then
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] I have another one more patient. Could you please assist?
[AGENT][NEUTRAL] I can certainly assist you with another claim status. Let me bear with me just one quick moment.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII], I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Yes, give me a second. The next one is.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK. Thank you so much for your patience. The next ID is
[CUSTOMER][NEUTRAL] 1306681 M as in Mike, L as in Lima 8 number 8.
[AGENT][NEUTRAL] Thank you, [PII]. And that name and date of birth?
[CUSTOMER][NEUTRAL] Last name is [PII] First name is [PII] Date of birth, [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Yes, the rate of service is uh [PII] and the bill amount is $1,037 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm checking, bear with, is that a facility claim B for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] I that.
[AGENT][NEUTRAL] And you said 1000, what was the total bill amount?
[CUSTOMER][NEUTRAL] 371037
[CUSTOMER][POSITIVE] So good.
[AGENT][NEUTRAL] Bear with me just one second.
[CUSTOMER][NEUTRAL] Cleveland Clinic Foundation.
[AGENT][NEUTRAL] What is the name of the facility?
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I'm checking on that claim status for you. Bear with me just one second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], that claim we did receive on [PII] and was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And paid 200, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Yes, sorry for that. But we submitted a claim on [PII] only. But you have stated [PII].
[AGENT][NEUTRAL] Mhm. Let me check.
[CUSTOMER][NEUTRAL] Shall I tell the rendering provider NPA?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hang on just one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The one on what was the bill amount that was submitted?
[CUSTOMER][NEUTRAL] Yes, [PII], 1037 total bill amount and the rendering provider's name is [PII].
[AGENT][NEUTRAL] On [PII], what was that date of service?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that was for a different date of service that we received on [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The one for [PII], let's see, yeah.
[CUSTOMER][NEUTRAL] OK. But that means you're, you'll
[CUSTOMER][NEUTRAL] OK. And it's a no claim on file, right?
[AGENT][NEUTRAL] Oh, we do have that claim for July, I'm sorry, [PII] for Cleveland Clinic Foundation. That claim we received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Same bill amount? $1,037.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me get this claim pulled up.
[CUSTOMER][NEUTRAL] $1,037.
[AGENT][NEUTRAL] Yeah, let me just get
[CUSTOMER][NEUTRAL] And the date of service is [PII], right?
[AGENT][NEUTRAL] That's correct. Let me get the rendering provider name. Hang on just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm getting that claim pulled up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Rendering provider name on this claim is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] So that means no claim on file, is that correct?
[AGENT][NEUTRAL] I'm checking on that. Um, now, the one that we received on.
[AGENT][NEUTRAL] [PII], that one is not for [PII] either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] OK. Please let me know if you have received a claim or not.
[AGENT][NEUTRAL] For that bill amount $1,037 data service 62724.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I do have a claim with CPT 99285.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Rendering provider [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][MIXED] OK, but it's [PII] only.
[AGENT][NEUTRAL] So we don't have that one on file.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. May I know the effective and termination date for this one?
[AGENT][NEUTRAL] Effective date [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And active.
[CUSTOMER][NEUTRAL] And the call reference number for this one?
[AGENT][NEUTRAL] It would be my name and today's date.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] OK. Thank you so much for your kind assistance. Have a great day.
[AGENT][POSITIVE] Well it's been my pleasure to assist you today, [PII]. Thank you for calling APL and have a wonderful day.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.