AccountId: 011433970860
ContactId: e58ecb8e-38ea-4c07-b017-4ce62aba297e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1176180 ms
Total Talk Time (AGENT): 274977 ms
Total Talk Time (CUSTOMER): 167777 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e58ecb8e-38ea-4c07-b017-4ce62aba297e_20250311T20:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from providers office checking on claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and can you spell your name?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you and may I have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] Yes, 024.
[CUSTOMER][NEUTRAL] 92,690.
[AGENT][NEUTRAL] Thank you. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes. Patient's first name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII], total charge amount, $216 payment.
[AGENT][NEUTRAL] OK, I didn't get the month. Can you repeat the month?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] January, OK.
[AGENT][NEUTRAL] Thank you. OK, let me see if I can find this claim for you. For future, you can check claim status online through our website at [PII] and that's just optional and.
[AGENT][NEUTRAL] What is the procedure code?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Procedure code is 99213. Another one is 96127.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 6126. All right, let me pull this here for you one moment.
[AGENT][NEUTRAL] I'm waiting on the system, one moment.
[AGENT][NEUTRAL] It's for Saint [PII].
[CUSTOMER][NEUTRAL] Yes, Saint Joseph Physician Network.
[AGENT][NEUTRAL] OK. Looks like we um processed a claim on [PII].
[AGENT][NEUTRAL] And the claim was denied, um, the denial reason on this claim is, let's see.
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, um, bear with me.
[AGENT][NEUTRAL] OK, based on the explanation of benefits, um,
[AGENT][NEUTRAL] Looks like
[AGENT][NEUTRAL] The charges have been sent to the insured.
[AGENT][NEUTRAL] And due to a discrepancy on the provider's um tax ID number.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] OK, I'm just gonna read this prevailingly because I'm not really sure what's going on. One moment. It says we're unable to sign benefits to the provider or records due to a discrepancy with the provider's tax ID number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You still slowly I will drop out.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please speak uh slowly, I will drop the notes.
[AGENT][NEUTRAL] OK, we're unable to assist or I'm sorry, we're unable to assign, we're unable to assign benefits to the provider of records due to a discrepancy with the provider's tax ID number.
[CUSTOMER][NEUTRAL] No, ma'am. Unable to find the benefit?
[AGENT][NEGATIVE] We're unable to assign.
[CUSTOMER][NEUTRAL] Fine. OK, one moment.
[CUSTOMER][NEUTRAL] OK, unable to assign.
[AGENT][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of record.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Due to a discrepancy.
[CUSTOMER][NEUTRAL] It's due to
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Due to a discrepancy.
[CUSTOMER][NEUTRAL] OK, due to discrepancy?
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] With the providers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Tax ID.
[AGENT][NEUTRAL] Number.
[AGENT][NEUTRAL] A letter has been mailed to the provider.
[CUSTOMER][NEUTRAL] Sorry, ma'am?
[AGENT][NEUTRAL] A letter has been mailed to the provider.
[CUSTOMER][NEUTRAL] May I know the claim number on this?
[AGENT][NEUTRAL] Sure, the claim number is 356.
[AGENT][NEUTRAL] 2058.
[CUSTOMER][NEUTRAL] OK, what is the received on?
[CUSTOMER][NEUTRAL] Received it.
[AGENT][NEUTRAL] OK, let me check on that, one moment.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] was received on [PII].
[CUSTOMER][NEUTRAL] 1 [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Could you please, uh, being on hold one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, could you please send you with the fax?
[AGENT][NEUTRAL] Mhm. What is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 233
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII] to your attention.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. One moment, let me put you on a brief hold while I send this uh fax to you, OK? One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am. I have one question from my side. Uh, uh, you have to send a letter to provider?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] May I know the date, uh,
[AGENT][NEUTRAL] It's gonna be the same day that we process the claim.
[CUSTOMER][NEUTRAL] You send the
[CUSTOMER][NEUTRAL] You'll send the letter to the provider through mail, is right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] Um, let me go back to the claim. One moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, ma'am. Yeah, yeah.
[CUSTOMER][NEUTRAL] You get any response for that uh letter?
[AGENT][NEUTRAL] I have to check the records, um, that goes to the claims department, but I, I went ahead and send you the copy of the EOB and it's gonna be all explained in the back of that EOB. Um, one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I don't see any follow ups. I see that the letter went out, um.
[AGENT][NEGATIVE] The same day we process the claim, but I don't see any response back from the provider.
[CUSTOMER][NEGATIVE] OK, no response received from the provider service right, uh.
[AGENT][NEGATIVE] Incorrect.
[CUSTOMER][NEUTRAL] Um, chance, any, any chance to send a second letter to?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] It looks like it was sent a 2nd time on the [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yeah, we send it again on [PII], so we have sent it on [PII] and [PII]. Uh, we received a call from a provider to reasons and we send it again. So, um, this is the second time that we have sent that over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] But there is no response and second thing is also.
[AGENT][NEUTRAL] I don't see anything here.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEGATIVE] There is no response from the provider side uh right the second time also.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need any other information?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, ma'am. One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for being on hold, ma'am. Uh, if any chance, uh, send a letter to provider for my side.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, send a letter to provider for my site.
[AGENT][NEUTRAL] I cannot send you a copy of the letter. I can only send you the copy of the EOB which I already did.
[CUSTOMER][NEUTRAL] If any chance
[CUSTOMER][NEUTRAL] Uh, ma'am. Thank you for being on hold, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, could you please spell your name and your reference.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[AGENT][NEUTRAL] And we don't have a reference number. You can use my name in today's day.
[CUSTOMER][POSITIVE] OK, thank you, ma'am. Thank you for assisting me. Have a nice day.
[AGENT][POSITIVE] Yes sir, thank you for calling APL. Bye bye.