AccountId: 011433970860
ContactId: 02d8d3f6-84c1-434d-b776-23fc5866d469
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279510 ms
Total Talk Time (AGENT): 141794 ms
Total Talk Time (CUSTOMER): 88124 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/02d8d3f6-84c1-434d-b776-23fc5866d469_20250107T13:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from provider's office. I would like to check on a claims status [PII].
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with claim status. What is the callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, it is 02295286.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and the date of birth is [PII], which is [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with eligibility. I am showing that [PII]'s policy is active and this is for dental coverage, correct?
[CUSTOMER][NEUTRAL] All right, and I, by the way, I would like to check on a claim status for the date of service [PII].
[AGENT][NEUTRAL] [PII] and I can help you with that claim status as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the name of the dental office?
[CUSTOMER][NEUTRAL] Uh, it is Chroma Dental.
[AGENT][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] [PII], I'm showing that we did receive that claim.
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII].
[AGENT][NEUTRAL] With the payment of $450 to Chroma Dental.
[CUSTOMER][NEUTRAL] Um, [PII], I do see that, uh, the total bill amount for this claim is uh $50 which is $50.
[CUSTOMER][NEUTRAL] And there is only one procedure code which is uh D1.
[AGENT][NEUTRAL] OK. And what is,
[AGENT][NEUTRAL] Yeah, the 1206. What is the pro provider name? It's a different name.
[CUSTOMER][NEUTRAL] Uh it is uh yeah, the first name is spelled as [PII]
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] And do you need the last.
[AGENT][NEUTRAL] Now we did receive that claim. I'm sorry, go ahead. Is that [PII]?
[CUSTOMER][POSITIVE] Yes, it does perfect [PII].
[AGENT][POSITIVE] OK, thank you, and I do apologize we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was denied?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That is not a covered procedure according to the
[AGENT][NEUTRAL] Schedule of benefits.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. What about the providers network status is the provider in or out network?
[AGENT][NEUTRAL] This policy with, with this policy network participation is not required.
[AGENT][NEUTRAL] It does participate in the.
[AGENT][NEUTRAL] Carrington PPO fee schedule uh network, but it's not required, so.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It does not affect the processing of our claim.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's why it doesn't deny it, right?
[AGENT][NEUTRAL] That's correct. It's a non-covered procedure.
[CUSTOMER][NEUTRAL] And then what about the patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, alright, and what about the claim number?
[AGENT][NEUTRAL] Claim number 353-3804.
[CUSTOMER][NEUTRAL] Alright, and I need the UOB to be faxed. Could you please do that?
[AGENT][NEUTRAL] EOBs are obtainable on our portal at [PII] and it is a simple self-registration.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, and you're not able to fax that you'll be right.
[AGENT][NEUTRAL] Uh, I can, but it's quicker to do it on the website.
[CUSTOMER][NEUTRAL] All right. What about the call options?
[AGENT][NEUTRAL] Cade reference number is my name and today's date, and I spell my name [PII].
[AGENT][POSITIVE] It has been a pleasure to assist you with that claim status, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Nothing, [PII], thank you so much have a great day bye.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a great day as well. Take care.
[CUSTOMER][NEUTRAL] Bye