AccountId: 011433970860
ContactId: f1b7a7ae-02a9-4198-a904-15bc3292c4bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681049 ms
Total Talk Time (AGENT): 127336 ms
Total Talk Time (CUSTOMER): 207762 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/f1b7a7ae-02a9-4198-a904-15bc3292c4bd_20250421T16:30_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and the first to my last name is [PII]. I'm calling from Norton Hospital to check on a claim status.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] The callback number is [PII]. And it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, one moment, let me check.
[CUSTOMER][NEUTRAL] The policy number is 024497552.
[AGENT][NEUTRAL] OK, thank you. And patient name and date of birth?
[CUSTOMER][NEUTRAL] The member name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what's that date of service?
[CUSTOMER][NEUTRAL] Let me, one moment, um, before, before that, could you please spell out your name for the documentation purpose?
[AGENT][NEUTRAL] It's [PII], it's [PII]
[CUSTOMER][NEUTRAL] initiate your last name, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you for providing your name.
[CUSTOMER][NEUTRAL] And the date of, do you want the date of service, right? The date of services.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $4,949 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just one moment pulling that up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Looks like we were requesting an explanation of benefits, but let me see, we received another claim. Let me see if that was attached.
[CUSTOMER][POSITIVE] Oh yeah, take your time.
[AGENT][NEUTRAL] And what was the total bill charges again?
[CUSTOMER][NEUTRAL] The total bill amount is $494,900.49.
[AGENT][NEUTRAL] Uh, it looks like we, we haven't received the facility claim. The claim I'm referencing is for the physician. I don't have a claim on file for that amount.
[CUSTOMER][NEUTRAL] Um, there is no claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For the date of services, [PII] and the total bill amount is $4900.49.
[AGENT][NEUTRAL] Yes, I don't show that billed amount.
[AGENT][NEUTRAL] Got a claim for that date, but not that bill amount. Who is the provider?
[CUSTOMER][NEUTRAL] The provider name is
[CUSTOMER][NEUTRAL] Not a Women's and Children's Hospital?
[AGENT][NEUTRAL] I don't, I don't show that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] May I know the effective date and termination date?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Uh, effective date is [PII] and the looks like the policy is
[AGENT][NEUTRAL] Well he's active, there's no term date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Like,
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Yes, and zip code is [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What are the last four digits of the ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the payer ID?
[AGENT][NEUTRAL] Pay ID is 60801.
[CUSTOMER][NEUTRAL] 60801. Mm.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Upon checking in my system, the claim was sent to the
[CUSTOMER][NEUTRAL] Mailing address [PII]. Is it valid mailing address?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Give me some time.
[CUSTOMER][NEUTRAL] But we received the payment for the pay to address of the mailing address of [PII].
[AGENT][NEUTRAL] I don't, I don't know what address that is.
[AGENT][NEUTRAL] You're saying you received a payment?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You have a claim number?
[CUSTOMER][NEUTRAL] Mm, one moment, let me check. It is a, it is a PB claim from.
[AGENT][NEUTRAL] What a what claim?
[CUSTOMER][NEUTRAL] Is the physician willing claim.
[AGENT][NEUTRAL] What was the payment amount?
[CUSTOMER][NEUTRAL] The payment amount is $247.99.
[CUSTOMER][NEUTRAL] For the same member, for the date of service of [PII], we received payment for the same mailing address.
[AGENT][NEUTRAL] OK, I, I mean, I see that payment. Is that what you're wanting claim status on because it didn't match the bill charges.
[CUSTOMER][NEUTRAL] No, I don't want that. Um, but we received payment for that mailing address, but you're seeing different mailing address now.
[AGENT][NEUTRAL] That's our claims mailing address that I gave you.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It's our claims mailing address, the address that I gave you?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I, the, the claim that you're asking about, I don't show on file. I see this one for 24799, that's a physician claim and it doesn't match the.
[AGENT][NEUTRAL] Billed amount. Are you checking on the hospital claim?
[CUSTOMER][NEUTRAL] Yeah, I'm checking on the hospital claim, but that physician billing claim got paid to submit on the same mailing address.
[AGENT][NEUTRAL] Right, I, I understand, but I don't have the claim that you're referencing.
[AGENT][NEUTRAL] So can you resubmit it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah. Uh, to this mailing address, right? It's [PII] [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Pay ID is 60801, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. May I know the attention?
[AGENT][NEUTRAL] That's claims.
[CUSTOMER][NEUTRAL] OK. Claims
[CUSTOMER][NEUTRAL] Mm, may I know the timely filing limit to submit the claim?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment, let me check whether I got all the information or not. One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, OK, that's all from my end. May I know the call reference number?
[AGENT][NEUTRAL] It's my name, [PII], and then today's date.
[CUSTOMER][POSITIVE] [PII] and this. Thank you for your help, [PII]. Have a great day. Bye for now.
[AGENT][POSITIVE] OK, thanks for calling APLU as well.