AccountId: 011433970860
ContactId: 00c0f3be-1e72-4677-b003-c59d16773526
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1310199 ms
Total Talk Time (AGENT): 275905 ms
Total Talk Time (CUSTOMER): 274386 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/00c0f3be-1e72-4677-b003-c59d16773526_20250224T19:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII], and I'm calling to check status on a claim.
[AGENT][NEUTRAL] All right, [PII], happy to check claim status today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 02519236.
[AGENT][NEUTRAL] And then if I can get patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][POSITIVE] Thank you. And data service?
[CUSTOMER][NEUTRAL] Data service is [PII].
[CUSTOMER][NEUTRAL] Now let me give you a little background on this because this was actually paid but it was sent to the incorrect address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I had to send a.
[AGENT][POSITIVE] Corrected.
[CUSTOMER][NEUTRAL] Update of our W-9 to [PII] which I sent by fax on [PII].
[CUSTOMER][NEUTRAL] So I wanna see if that um.
[CUSTOMER][NEUTRAL] If that check has been reissued.
[AGENT][NEUTRAL] Reissued, gotcha.
[AGENT][NEUTRAL] Was the bill amount on this [PII] $1,413?
[CUSTOMER][NEUTRAL] No, $5,792.
[AGENT][NEUTRAL] 5,792. OK.
[AGENT][NEUTRAL] I do see the original claim in the void.
[AGENT][NEUTRAL] Um, that occurred. I'm just trying to see if they reissued. Sorry for the hold here.
[AGENT][NEUTRAL] So I do show that there was a payment then sent on [PII] and that was a single check. Do you need the check number on that one?
[CUSTOMER][NEUTRAL] Well, the check number for that one is um.
[CUSTOMER][NEUTRAL] 2014391 correct?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that that's the one that's supposed to be.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I get stopped and reissued.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me check that check number because that one still shows.
[AGENT][NEUTRAL] So the check ending Monica in [PII] that one on our side shows cash, but you're saying that was the one that was supposed to be voided?
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEGATIVE] that was crushed.
[CUSTOMER][NEUTRAL] What was that cash to cash that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know who might have. Give me one second. Let me just double check these claims and make sure that.
[CUSTOMER][NEGATIVE] This wasn't paid on another.
[CUSTOMER][NEUTRAL] OK, yeah, the 6641.
[CUSTOMER][NEUTRAL] was actually paid to
[CUSTOMER][NEUTRAL] DMA.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Let me see something.
[CUSTOMER][NEUTRAL] OK, so let's scratch all of that because that was for another claim, so this.
[CUSTOMER][NEUTRAL] OK, so for this claim I'm showing that this was processed um back in December.
[CUSTOMER][NEUTRAL] What was the status on that because I'm showing that it was at 0.
[CUSTOMER][NEGATIVE] So nothing was paid. It's denied as a duplicate.
[AGENT][NEUTRAL] Huh
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] Is that for claim number 3531778, is that what you see on your side?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, the only other claims that I see for that date of service are the one that was paid that we, we were like disregard, and then I see the original one that was voided out.
[AGENT][NEUTRAL] Um, and then there's the duplicate one, the one that you had given me, that was the one ending in 1778.
[CUSTOMER][NEUTRAL] I'm wondering if they're denying this as a duplicate against that other claim that paid because that's a different billing provider.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] So it should not be.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Then out of a duplicate.
[AGENT][NEUTRAL] Yeah, because then there's another claim date of service of [PII].
[AGENT][NEUTRAL] Getting all my dates confused now. I'm sorry.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Yeah, the only other things that I see are for the next date then.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Because on the original claim that was voided, the benefit payment looks like was the same, the 6641.
[CUSTOMER][NEUTRAL] 66.
[CUSTOMER][NEUTRAL] Yeah, that one and that one.
[CUSTOMER][NEUTRAL] Hm, OK, so I'm confused because the one for 6641 was applied to digestive medicine associates. That payment was made to a digestive medicine associates, um, which is fine, but.
[CUSTOMER][NEUTRAL] Then I have a claim for the Palmetto Surgery Center that's built on the same date for a different amount but for the same code. Um, usually what happens is they deny insurance companies deny it as a duplicate against the physician's claim. So I'm guessing that's what that's what's happening here. It's being denied as a duplicate against the physician's claim, which is incorrect because it's two different billing providers.
[AGENT][NEGATIVE] Yeah, cause they're all reading on my side that digestive medicine associates. It's not reading.
[AGENT][NEUTRAL] 75.
[AGENT][NEUTRAL] It's not reading anything different.
[AGENT][NEUTRAL] What are, do you have the procedure codes that you're looking for or?
[CUSTOMER][NEUTRAL] Yeah, the procedure codes, but it's just gonna be the same procedure code for the um.
[CUSTOMER][NEUTRAL] For the, the other one, the digestive medicine.
[CUSTOMER][NEUTRAL] Associates claim it's the same procedure code it's just different billing providers.
[AGENT][NEUTRAL] I just don't, it's not showing me a different provider.
[AGENT][NEUTRAL] Yeah, because when I do a search, you know, for that date of service, the only provider that comes up is the digestive medicine.
[AGENT][NEUTRAL] Histology, I guess is how you pronounce that.
[CUSTOMER][NEUTRAL] Yeah, digestive medicine histology lab, that's a different, um.
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] Alright, so at this point, [PII], would you like me to have the claim like reach out to the examiner to see if they can resubmit the claim or reprocess it because I don't show a different provider.
[CUSTOMER][NEUTRAL] But do you have a claim for 5, let me see, $5,792?
[AGENT][NEUTRAL] OK, so the claim ending in 2075 that was received on [PII], 2024 was the original claim that was received for that specific billed amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the secondary claim then that was received and then I'm showing that was paid was the one ending in the 99.
[AGENT][NEUTRAL] That was the claim received 11-15-24. Claim number ended in 1399.
[CUSTOMER][NEUTRAL] OK, but I'm confused. Is that the claim for the Palmetto Surgery Center?
[CUSTOMER][NEUTRAL] And for the amount that I gave you.
[AGENT][NEUTRAL] It's for the amount that you gave me. It shows providers digestive medicine associates. It does not show anything different.
[CUSTOMER][NEUTRAL] OK, I don't know. I, I'm not sure if you're pulling up the claim and looking at the actual claim or if this is something that's entered in your system because if it's something that's entered in your system, then it's incorrect.
[CUSTOMER][NEUTRAL] Because that amount, that bill amount claim that I gave you is for the Palmetto Surgery Center. It's not for digestive medicine associates.
[CUSTOMER][NEUTRAL] The procedure is performed here in the Palmetto Surgery Center, but we do, um, bill.
[CUSTOMER][NEUTRAL] Off of the same system but would they all go out with their own um.
[CUSTOMER][NEUTRAL] You know their own payer information um.
[CUSTOMER][NEGATIVE] So you should have received three claims for this data service from us. One should have been for $5,792 from the Palmetto Surgery Center. Another one for $2,609 from Digestive Medicine Associates, and one for $630 from the Gulfstream Anesthesia Group.
[CUSTOMER][NEUTRAL] Now I'm showing that Gulfstream anesthesia Group and digestive medicine has processed and paid.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The Palmetto Surgery Center hasn't.
[AGENT][NEUTRAL] Yeah, I don't see anything for the palmetto.
[AGENT][NEUTRAL] Yeah, I don't see anything for like the palmetto. The only thing that I see that matches that amount was the claim that was originally voided and that amount that 5,072 was on that when it was submitted at the top, it just says digestive medicine and associates LLP and then has the um
[AGENT][NEUTRAL] The totals, you know.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So we, I don't see anything in my system that has palmetto on it at all.
[CUSTOMER][NEUTRAL] OK, can I
[CUSTOMER][NEUTRAL] Let me see something.
[CUSTOMER][NEUTRAL] Is there a fax number I can fax this to then?
[AGENT][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 [PII].
[AGENT][NEUTRAL] And then we have a payer ID and mailing address also if you need any of that.
[CUSTOMER][NEUTRAL] OK, so I'm just gonna go ahead and resubmit this, um.
[CUSTOMER][NEUTRAL] And see what happens from there because.
[CUSTOMER][NEUTRAL] I'm not sure what's going on.
[AGENT][NEGATIVE] Yeah, I don't know either because it's just not matching up with the provider and the amount. I like I said, I don't see that provider at all, so.
[CUSTOMER][POSITIVE] OK, I'm gonna go ahead and resubmit this, um, thank you very much.
[AGENT][POSITIVE] No problem, [PII]. Take care.