AccountId: 011433970860
ContactId: fbf3f3e8-6fe9-42e4-8e2f-541f79851789
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 942520 ms
Total Talk Time (AGENT): 341617 ms
Total Talk Time (CUSTOMER): 382665 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/fbf3f3e8-6fe9-42e4-8e2f-541f79851789_20250609T13:40_UTC.wav
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[AGENT][NEUTRAL] contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is.
[AGENT][POSITIVE] Good morning. Thank you for contacting.
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Yes, of course, [PII]. What's that policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy, OK, just a second.
[CUSTOMER][NEUTRAL] The policy number is 02566933.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] OK, I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service you're looking for for [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the bill amount is $265.63.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like the claim number for this one.
[AGENT][NEUTRAL] It's 35
[AGENT][NEUTRAL] 83
[AGENT][NEUTRAL] 463.
[AGENT][NEUTRAL] So this is an outpatient surgical claim. Uh it looks like the CPT code is 4.
[AGENT][NEUTRAL] 325 9.
[AGENT][NEUTRAL] And it looks like that check, let me see what I can find here on the check. There there was a check that went out on this.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Um, we received your claim on the [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We process it on the [PII].
[AGENT][NEUTRAL] There was a check
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In the amount of $265.83.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] That check number 203.
[CUSTOMER][NEUTRAL] Uh, things
[AGENT][NEUTRAL] 647-9.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] was sent to a [PII] in [PII].
[AGENT][NEUTRAL] So it looks like the check, it looks like the claim went out. It was received.
[CUSTOMER][NEUTRAL] I I said that.
[AGENT][NEUTRAL] And sent to an address.
[AGENT][NEUTRAL] In, in May.
[CUSTOMER][NEUTRAL] So the claim is being paid, am I right?
[AGENT][POSITIVE] That is right, yes, the claim has been paid.
[CUSTOMER][NEUTRAL] Allowed amount and the paid amount is the same.
[AGENT][NEUTRAL] And it looks like
[AGENT][NEUTRAL] That's right. Now, uh, is the, is the bill is the, uh, address that we send it to [PII], is that correct in [PII]?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And what's the zip code?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, it's right. And could you please help me with the
[CUSTOMER][NEUTRAL] Check number uh
[AGENT][NEUTRAL] Yeah, certainly, um, just let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] It was a check payment, am I right?
[AGENT][NEUTRAL] That is right, a single paper check.
[CUSTOMER][NEUTRAL] Just a second, just a sec.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Uh yeah, I'm ready.
[AGENT][NEUTRAL] Yes, the check number is.
[AGENT][NEUTRAL] 203.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 6479.
[CUSTOMER][NEUTRAL] OK. And do you have the uh claim pay date as well?
[AGENT][NEUTRAL] Yes, it looks like that was on the uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And do you have any clear date with you?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Uh, no, I don't. And so what I was going to do is I'm, I'm just checking to make sure that the address is the same, is, is correct, because what we'll have to do on this one is we will have to reissue the check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what I'm going to do is I'm going to um
[AGENT][NEUTRAL] Take a copy of the check.
[AGENT][NEUTRAL] And then we will reissue it. I just need to make sure that the address is correct, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, it's right. It's right. The address is right.
[AGENT][NEUTRAL] The
[AGENT][POSITIVE] Good OK.
[AGENT][NEUTRAL] OK, well then I'm going to go ahead and have the check reissued. Does that sound right with you?
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] And could you please send me the copy of UB?
[AGENT][NEUTRAL] Uh, yes, what is your fax number, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. In attention to the patient's account number and could you please verify me the patient's account number?
[AGENT][NEUTRAL] Uh yes, I've got 89003.
[AGENT][NEUTRAL] 8 V as in Victor.
[AGENT][NEUTRAL] 262-89.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, in attention to the patient's account number. Could you please fax me the copy of your? Do you want the fax number once again?
[AGENT][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Uh, no, I've got [PII].
[AGENT][NEUTRAL] Uh, and use the account number uh to verify. OK, I can certainly do that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is this the only thing that we need to look at updated? Is there another one that I can help with?
[CUSTOMER][NEUTRAL] Uh, yeah, I do have more to claims.
[AGENT][NEUTRAL] OK, and what is the next, uh, policy number?
[CUSTOMER][NEUTRAL] Yeah, it's.
[CUSTOMER][NEUTRAL] Yeah, it's loading just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And could you please tell me your name?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as our reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next policy number will be 018.
[CUSTOMER][NEUTRAL] 359-977.
[AGENT][NEUTRAL] OK, thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] and the date of birth will be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I do appreciate that. Is there a particular date of service for [PII]?
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yes, and the bill amount will be $985.71.
[AGENT][NEUTRAL] OK, I don't have anything for that data service, so we'll go over that again.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I don't have any
[AGENT][NEUTRAL] Yeah, I don't have anything at all for, for that date for even for that month for [PII]. Now this policy uh was in effect in [PII]. It's just that I don't have your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So, um, as with the other, uh, services, um,
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] The uh
[AGENT][NEUTRAL] Claims can be sent in to our PO box address.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII]. Uh, it will be the same as, as with the other, uh, with the other information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Assistant for whatever reason I don't have your yeah.
[CUSTOMER][NEUTRAL] Yeah, just a second, just.
[CUSTOMER][NEUTRAL] Just a second, [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the member's effective date and the term date as well?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes, absolutely. The policy went into effect on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] And it is still active as of today, so the, the policy is active. There's not a problem with that at all.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's just that I, for whatever reason, I don't have your uh.
[AGENT][NEUTRAL] I don't have your claim.
[CUSTOMER][NEUTRAL] OK. And
[AGENT][NEUTRAL] I just said it to him.
[CUSTOMER][NEUTRAL] Are you primary or secondary for the member?
[AGENT][NEUTRAL] This is secondary insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh OK. Do you have any updates regarding COB? Do you, when was the last coordination of benefits updated?
[AGENT][NEUTRAL] Uh, the last coordination of benefits that was, that was updated was in [PII]. Now nothing's been changed since then.
[CUSTOMER][NEUTRAL] January, uh, do you have any date?
[CUSTOMER][NEUTRAL] January date.
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] It's [PII]. I, I've got that [PII] so that's the last time that so he doesn't have another policy with this. It's not that there's another policy or no other coordination of benefits, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And for
[CUSTOMER][NEUTRAL] If, what will be the claim submission time, timely filing limit?
[AGENT][NEUTRAL] I you
[AGENT][NEUTRAL] You can file this at any time. This isn't an appeal, so you can file it at any time, [PII], just any time you want to.
[CUSTOMER][NEUTRAL] OK and the address will be the same.
[AGENT][POSITIVE] Absolutely the same. That's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just what, do you have any pay ID? What will be the pay ID?
[AGENT][NEUTRAL] It's 60
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] And the preferred mode prefer mode of submission will be either mail or electronic, am I right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yeah, just a second, shall we move to the last claim, [PII], could you please help me with the last claim?
[AGENT][POSITIVE] I could do one more, absolutely. What is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The next policy number is 1116824.
[AGENT][NEUTRAL] OK thank you and the patient's name and date of birth please.
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for uh R?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the bill amounts please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the bill amount is for
[CUSTOMER][NEUTRAL] $255.91.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, uh, I don't have that on file again our mailing address is at [PII] that I've given you before, um, yeah.
[CUSTOMER][NEUTRAL] And uh yeah, yeah, yeah, just.
[CUSTOMER][NEUTRAL] I'm looking for an appeal status for this one.
[AGENT][NEUTRAL] Oh dear, I don't have it. I don't have anything like that. So the last time, let me, let's go over the last thing that we have with [PII], OK? So the, the last thing that I have, I have 11 thing, 11 day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]. I don't have anything else.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] If you send in an appeal for anything, it doesn't look like I got it.
[CUSTOMER][NEUTRAL] OK, OK. Just a second. So what will be the original claim timely filing limit?
[AGENT][NEGATIVE] For the original one, there is no timely filing.
[AGENT][NEUTRAL] If you're doing an a.
[CUSTOMER][NEUTRAL] OK, and for the app is
[AGENT][NEUTRAL] Yeah, 180 days.
[CUSTOMER][NEUTRAL] It's 10 days from the denial date.
[AGENT][NEUTRAL] That's right, uh-huh.
[CUSTOMER][NEGATIVE] OK. No timely filing.
[CUSTOMER][NEUTRAL] Let me just a second, [PII]. I will not take more time.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] PO Box.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And [PII], just the last question, are you there?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, denied you be is required for submitting an appeal.
[AGENT][POSITIVE] Uh, yes, I would send that in, please. Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] It is. Is there any specific attention to the appeals?
[AGENT][NEUTRAL] If you would send it to appeal please.
[CUSTOMER][NEUTRAL] Attention to pieces. There is no specific form. Am I right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, and the call reference number will be your name and today's date.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, [PII], thanks for your assistance, [PII]. I hope you have a wonderful day.
[AGENT][POSITIVE] OK, thanks for contacting AP have a good day.