AccountId: 011433970860
ContactId: 16f3b6f9-fbce-4b8f-b0a7-20635e20f410
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320480 ms
Total Talk Time (AGENT): 145625 ms
Total Talk Time (CUSTOMER): 41865 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/2025/04/23/16f3b6f9-fbce-4b8f-b0a7-20635e20f410_20250423T17:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], my name is [PII]. I'm calling from the Northeast Georgia physicians group and I'm trying to check on the status of a claim for a patient.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], so you have one claim that you're needing to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is your call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Um, I have it as 02455086.
[AGENT][POSITIVE] OK, thank you, [PII]. Give me a couple of moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What place to get the member's information pulled up.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the dates in total build up?
[CUSTOMER][NEUTRAL] Uh, [PII] and it was for $157.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim has been received multiple times, um, the most
[AGENT][NEUTRAL] Recent received claim, [PII], that claim number is 7.
[AGENT][NEUTRAL] 2579.
[AGENT][NEUTRAL] Uh, the office visit charge it's, let's see, this has got two denial remarks on it. One of them is a duplicate of previously submitted expenses. The other is regarding a um.
[AGENT][NEUTRAL] Let me pull up this information, just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so there is also a note on here regarding um.
[AGENT][NEUTRAL] A B notice it says that we're unable to accept assignment of benefits for the claim filed due to a discrepancy reported to us by the IRS.
[AGENT][NEUTRAL] That is a combination of the name and taxpayer identification number on your account.
[AGENT][NEUTRAL] Please visit the IRS website for additional information on how to resolve this issue.
[AGENT][NEGATIVE] And just to stop the backup with whole.
[AGENT][NEUTRAL] Holding and once this issue is resolved with the IRS, please send information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so is this a problem for the patient?
[AGENT][NEUTRAL] No, this has to do with the um the provider.
[CUSTOMER][NEUTRAL] OK, I, I guess I don't understand. Can you go through that again with me?
[AGENT][NEUTRAL] There's some type of discrepancy that was reported.
[AGENT][NEUTRAL] Yes, it states that we're OK, so we're unable to accept the assignment of benefits for the claim filed due to a discrepancy reported to us.
[AGENT][NEUTRAL] Us by the IRS that is a combination of the taxpayer identification number on your account.
[AGENT][NEUTRAL] Please visit the IRS website for additional information on how to resolve this issue to stop back up withholding. Once this issue is resolved with the IRS, please send APLA copy.
[AGENT][NEUTRAL] Copy of the updated information.
[CUSTOMER][NEUTRAL] OK, um, can I just have a reference number from you, [PII]?
[AGENT][POSITIVE] Absolutely. So you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you for your help have a great day.