AccountId: 011433970860
ContactId: fb821280-6c74-463a-8df0-5789c7ef9037
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691390 ms
Total Talk Time (AGENT): 174808 ms
Total Talk Time (CUSTOMER): 196801 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/fb821280-6c74-463a-8df0-5789c7ef9037_20250221T16:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to get the gender claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII], and do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and that number is?
[CUSTOMER][NEUTRAL] 01659835 M. Mike L. Lima 7.
[AGENT][NEUTRAL] OK, thank you. And a moment. Do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, that's gonna be [PII] and it's a direct line.
[AGENT][NEUTRAL] OK. Thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Sure, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's gonna be [PII], and the date of birth gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Sure, that's gonna be.
[CUSTOMER][NEUTRAL] It's a date range that starts from [PII] with billed amount of $240 even $240. And before proceeding it further, do you mind spelling out your name for me?
[AGENT][NEUTRAL] Sure, it's [PII], and I apologize, Ms. [PII], you said the date of service was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was that date range again? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually, it's the same, [PII].
[AGENT][NEUTRAL] OK, so the date of service [PII] in the amount of $240.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I don't show we received that claim and also that policy number you gave is no longer active, so I can give you the current policy number when you're ready.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, the current policy number is 2505749.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Effective [PII] and I show the policy is active.
[CUSTOMER][NEUTRAL] Let me just
[CUSTOMER][NEUTRAL] No term date.
[AGENT][NEUTRAL] No, ma'am, I'm sure the policy is active. And can you verify the mailing address the claim was submitted to?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, that's gonna be 15.
[CUSTOMER][NEUTRAL] [PII]. And there is no claim on file.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Correct, and that is not our mailing address for claims. So when you're ready, I can give that to you as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And before that, before providing the mailing address, can you verify whether this claim was rejected?
[AGENT][NEGATIVE] We hadn't received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And there is no other claim for the same date of service with different bill amount?
[AGENT][NEUTRAL] No, we have not received the claim.
[CUSTOMER][NEUTRAL] Yeah, and the effective dates you provided me was [PII] to no term date.
[AGENT][NEUTRAL] [PII], correct.
[CUSTOMER][NEUTRAL] Yeah, and the member was active at the time of the service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And we need to resubmit the claim, right?
[AGENT][NEUTRAL] Yes. Can I give you the correct mailing address because the number or the address you gave is incorrect.
[CUSTOMER][NEUTRAL] OK, you can proceed that.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII], [PII], and it's OK [PII], OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Let me just verify the mailing address you provided me. That's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII]. Am I right?
[AGENT][NEUTRAL] It's [PII] and it's [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK. And how about the timely filing limit to submitted?
[AGENT][NEUTRAL] Uh, there's no time limit.
[CUSTOMER][NEUTRAL] Then how about the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. Just a moment, almost done.
[CUSTOMER][NEUTRAL] And the policy, current policy ID you provided me for the number was 25057449. Am I right?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. In that case, OK, OK, can you proceed with the call reference number so that we can go ahead with the next claim under the same number?
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. You may use my name is [PII].
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] So, can you proceed with the next member?
[AGENT][NEUTRAL] You said it was on the same patient or different patient?
[CUSTOMER][NEUTRAL] A different patient under the same provider.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. It is, yeah, and it is, and that this.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's that next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's, let me just tell it the member ID but it's for a different provider. So that's gonna be 9667068471.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Do you have a patient's name, date of birth?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, that's gonna be [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And you said the patient's name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What state is she from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] And do you have a copy of her card?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm not finding this patient in the system.
[AGENT][NEUTRAL] And you say you do not have a copy of the card?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have a copy of their
[AGENT][NEUTRAL] Uh, do you have the social?
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So in that case, you need to contact the member, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. That's all for today.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL Lisa. Bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.