AccountId: 011433970860
ContactId: 06689ece-82b3-4ba8-be34-d7ff1663b739
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545960 ms
Total Talk Time (AGENT): 153898 ms
Total Talk Time (CUSTOMER): 97762 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/06689ece-82b3-4ba8-be34-d7ff1663b739_20250514T15:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm a provider. I'm calling from SSM Health and Medical Group. I'm calling regarding a claim for a patient.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today, [PII]. What's your policy number?
[CUSTOMER][NEUTRAL] It is 02597992.
[AGENT][NEUTRAL] All right, let me pull that up. One moment.
[AGENT][NEUTRAL] And then if I could please have patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the name is [PII]. Last name is [PII] or [PII] [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And then what's the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the total charge $1,514.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] OK, so I appreciate your patience on that, [PII]. Uh, looks like we did receive a claim for that date of service. claim was originally received on [PII]. It was processed [PII]. It looks like there was a benefit payment and.
[AGENT][NEUTRAL] But let's see, hold on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like.
[AGENT][NEUTRAL] There was an issue sending payment to providers, so the payment was sent to the insured.
[CUSTOMER][NEUTRAL] Um, you said that it was a payment with, um, it was an issue, um, with sending the payment to the provider, so the payment was sent to the insurer.
[AGENT][NEUTRAL] Yeah, it looks like there's like a discrepancy or something with a taxpayer ID number. So it was processed and paid the benefit payment was sent to the insured though.
[CUSTOMER][NEUTRAL] And you said there was a discrepancy with the taxpayer?
[AGENT][NEUTRAL] Mhm, with the identification on the account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Um, so question, what is the solution?
[AGENT][NEUTRAL] So it looks like it says that we're unable to accept assignment of benefits for the claim filed due to a discrepancy reported by the IRS with a combination of the name and taxpayer identification. Please visit the IRS website for additional information on how to resolve the issue. Once this is resolved, please send APL a copy of the updated information.
[CUSTOMER][NEUTRAL] Now, if you don't mind, [PII], is there any way I can get that faxed to me so I can forward these details over to my lead?
[AGENT][NEUTRAL] Let me see if I, I should be able to send you a provider EOB on this. Give me just a second. Let me pull it up here if you guys don't have one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just a second here, [PII], because he had quite a few claims processed that day, so I'm gonna have to pull a few EOPs to make sure it's the right one.
[CUSTOMER][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, what is a good fax number that I can send this over to you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, just to confirm that was [PII]?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] All right. And should I mark attention to you on this?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alright, so give it about 5 minutes. You should have it. Is there anything else that I can help you with here today?
[CUSTOMER][NEUTRAL] Um, no, just wanna be clear that there was a benefit payment sent, but there was an issue with sending the payment to the providers, to the provider, so the payment was sent to the insurer.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] Alrighty. Oh, my last thing, I need two things a claim number and a reference number. If not a reference number, I could just use today's date.
[AGENT][NEUTRAL] Yeah, absolutely. So the claim number is gonna be 358.
[AGENT][NEUTRAL] 6541.
[AGENT][NEUTRAL] And then call reference will be my name with my last initial and then today's date. My name again is [PII], that's [PII] and then last initial is [PII].
[CUSTOMER][POSITIVE] All [PII]. Well, thank you for that, [PII]. I appreciate your help. I hope you enjoy the rest of your day.
[AGENT][POSITIVE] You too. Take care.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.