AccountId: 011433970860
ContactId: da059590-b993-4cb5-94de-33e3a72fd14d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356269 ms
Total Talk Time (AGENT): 199347 ms
Total Talk Time (CUSTOMER): 143772 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/da059590-b993-4cb5-94de-33e3a72fd14d_20250225T14:27_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII] I calling, and I'm calling as a provider and I was trying to log in, um, set up a new user on the website so that we can submit a claim for one of our patients and it's giving me an error saying no user was found with the information that was entered, um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But I have just, I just called a little while ago and verified uh his benefits and that so.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEGATIVE] I know it's a valid number. I just don't know why it's stuck here.
[AGENT][NEUTRAL] OK, um, are you putting the patient's account number as your patient's account number or our patient's account number like the policy number?
[CUSTOMER][NEUTRAL] Your patient, your account number.
[AGENT][NEUTRAL] OK. So that will be incorrect. That will be your patient's account number. Um, let me have your name and the callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, sure. First name is [PII], last name is [PII]
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] And number here is 864.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 263-739-0.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. And do you have a policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, you mean your patient's policy, your member's number? OK, sure, it is 0233437373.
[AGENT][NEUTRAL] Yes, yes, yes, our member's number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. And you said you're calling, what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Oh, I'm with Zone Physical therapy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me check into a couple of things before we continue, OK.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] His first name is [PII]. Last name is [PII], [PII], and his date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. All right, Miss [PII], have you received any explanation of benefits from us?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] No. So, um,
[CUSTOMER][NEUTRAL] Well, I mean, I called earlier and they did say that he does not have a deductible and has up to 3000 per year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. um, but in, um, in general, in general, for any, any, any patients you have seen, have you received an explanation of benefits?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] No, so, OK, the reason I'm asking this is.
[CUSTOMER][NEUTRAL] You mean from from APL or from?
[AGENT][NEUTRAL] From APL from APL.
[CUSTOMER][POSITIVE] OK, no, this was, this is our very first one, so I'm kind of, um, I'm agreeing to it all.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, OK, so it's not gonna, it's not gonna let you register this is the first time, OK, um, the reason for that is because it needs to be recorded in our system that, um, ID needs to be recorded in our system in order for our system to recognize the provider. So, um, until you receive.
[CUSTOMER][NEUTRAL] So we're starting.
[AGENT][NEUTRAL] an explanation of benefits for any of your patients that you have one explanation of benefits at least then you can register. Um, if not, it's just not gonna let you register because um it just asked for a specific ID number and it has to be registered in our system, OK? Um.
[CUSTOMER][NEUTRAL] I see. OK, so how do I go about that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right now you have two options to send in a claim. The first one is by mail, the second one is by fax.
[CUSTOMER][NEUTRAL] OK, so we have to submit 2 claims before it will allow you to be registered as as online? Just one, OK.
[AGENT][NEUTRAL] No, just one.
[AGENT][NEUTRAL] Just one, just one, and it could be either denied or paid as long as you receive at least one explanation of benefits, then you can go ahead and create your account and what you're gonna use is the patient's account number that you have for that member, which is usually I think it's in box 2626 if I'm not mistaken, that long number that you create for the member when you do the claim.
[CUSTOMER][NEUTRAL] I see. OK, it does say it's shown in box 26 on the uh CMS CMS 1500 form.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, so, um, when we're submitting a claim by mail.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, we just need to print out the claim form.
[CUSTOMER][NEUTRAL] That basically just ask for really the patient information right and the insured insured's name.
[AGENT][NEUTRAL] If you're gonna
[CUSTOMER][NEUTRAL] And then you just attach the rest.
[AGENT][NEUTRAL] If you're gonna just submit a regular claim, um, which is the 1500 form, I'm not sure if you, that's what you use, but if that's what you use, that's all we're gonna need and then the copy of the explanation of benefits from the primary insurance.
[CUSTOMER][POSITIVE] I see, OK, OK, that's easy enough. I can do that.
[AGENT][NEUTRAL] Yeah, so we don't need a claim form or anything like that. It's just a 1500 form and the copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK and copy of extension of.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I will uh get that in in the works here and get it over to you then.
[AGENT][NEUTRAL] All right. And do you need the fax number or any other information?
[CUSTOMER][POSITIVE] Uh, if you have the fax number, um, handy, that would be great.
[AGENT][POSITIVE] Excellent.
[AGENT][NEUTRAL] Yes, yes. Um, the number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] All right, um, that's what I need. I thank you very much for your help today.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][POSITIVE] You're welcome, Miss [PII]. Thank you for calling APL. You have a good day, OK.
[CUSTOMER][POSITIVE] OK thank you you too.
[AGENT][POSITIVE] You're welcome thank you bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.