AccountId: 011433970860
ContactId: ef3eb086-2e8e-4953-af6d-a0be920db14b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406920 ms
Total Talk Time (AGENT): 150265 ms
Total Talk Time (CUSTOMER): 137433 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/ef3eb086-2e8e-4953-af6d-a0be920db14b_20250123T20:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. My name is [PII]. Thank you for calling APL. How may I assist you today?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the office checking on the game status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, actually only one.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, it's [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And may I have the member's policy?
[CUSTOMER][NEUTRAL] Yeah, actually.
[CUSTOMER][NEUTRAL] Yeah, I do have 22 clients for the same patient.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 024-91434 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The number's first name is
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the dates of service and the um total bill for each data service?
[CUSTOMER][NEUTRAL] Yeah, sure. For the first month, the first set of services on [PII] and uh.
[CUSTOMER][NEUTRAL] Charge amount is $1720 even.
[CUSTOMER][NEUTRAL] So can you check that game status?
[AGENT][NEUTRAL] OK, right. You said they're they're both for the same person, right?
[CUSTOMER][NEUTRAL] OK, you want another one too? I edit it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, sure. No problem. And the next one is on the same day.
[CUSTOMER][NEUTRAL] On [PII] for $2,862 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's Gastro Health LLC.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Alright, so we've um processed two claims for that data service, however, only one belongs to your provider. Um, so we received it on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's claim number 354.
[AGENT][NEUTRAL] 2646.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Another reason.
[AGENT][NEGATIVE] Um, it's, hold on one second. Um, it's denied requesting a detailed explanation of benefits that shows the amounts applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was no claim on file for the other amount of $2,862.
[CUSTOMER][NEUTRAL] Let me check. Just give me a second.
[CUSTOMER][NEUTRAL] Just give me a minute.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Actually for this one,
[CUSTOMER][NEUTRAL] The claim has been uh sent to the primary payer like in like as a split payment we got a split payment for this one.
[CUSTOMER][NEUTRAL] Uh, just give me a moment.
[CUSTOMER][NEUTRAL] Yeah, do you have a UOB like the primary will be, right, but there is no specific information about the.
[CUSTOMER][NEUTRAL] Deductible, right?
[AGENT][NEUTRAL] Are you speaking of the claim that we've processed or the other claim?
[CUSTOMER][NEUTRAL] Yeah, that process OK.
[AGENT][NEUTRAL] For the claim that we processed, we did receive the explanation of benefits, but on those um columns, it shows 0, so we'll just need the, we'll need the detailed explanation of benefits that shows the charges for deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so like, uh, how to send that you will be.
[AGENT][NEUTRAL] Um, you can fax it, you can mail it or you can send it electronically. Um, which one do you prefer? I can give you the information for.
[CUSTOMER][NEUTRAL] Uh, yeah, can you provide me the electronic way and the fax number too just for the in case like it's for the chance.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so the payer ID is 60.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, thanks for that. Just give me a second. Let me verify.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks for that.
[AGENT][POSITIVE] You're very welcome. Um, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, and I just want to confirm about the other claim. Just give me a second, let me open it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so as you mentioned, there is no claim for the charge on $2,862 right?
[AGENT][NEUTRAL] Right, there's no claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Patient is active for the data service as he got the payments and what's the timely filing limit to submit a claim as you are the secondary payer.
[AGENT][NEUTRAL] Um, so there's no
[AGENT][NEUTRAL] There's no timely filing. You can file the claim at any time as long as the policy was active on the data service.
[CUSTOMER][POSITIVE] OK, thanks for that and thanks for assistance and I just want the call reference number.
[AGENT][NEUTRAL] Um, so the call, there's no call reference number, but you can use my name in today's date. So that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks for that and thanks for your assistance and have a great day ahead.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.