AccountId: 011433970860
ContactId: 1eea5aac-e19b-479c-a228-5f449d90bdba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2819360 ms
Total Talk Time (AGENT): 666905 ms
Total Talk Time (CUSTOMER): 1415190 ms
Interruptions: 20
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/1eea5aac-e19b-479c-a228-5f449d90bdba_20250109T21:33_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, hi there, so I'm so sorry I'm having a lot of trouble hearing you.
[CUSTOMER][NEUTRAL] uh yeah.
[CUSTOMER][NEUTRAL] Hello
[AGENT][POSITIVE] And I'm just so sorry. I can hear like a lot of other noise but it sounds like you're really far away.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can find now?
[AGENT][POSITIVE] No, I'm not yet. I'm so sorry.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] What about right now? Is it [PII] right now?
[AGENT][POSITIVE] Uh, yes, that's a little better.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please uh spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh do you have any.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Me.
[AGENT][NEUTRAL] Yes, it's [PII], and if I could also get your first name again, I wasn't able to hear it when you introduced yourself.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] My name is [PII]. I don't have any.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] And I'm so sorry, it's just so hard to hear you over the sounds of everything else in the background.
[CUSTOMER][NEUTRAL] OK. What about right now?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, that was my bad.
[AGENT][POSITIVE] I can hear you so much better, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm so sorry. I hate to ask a third time. Can I have your name one more time, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, of course. My name is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And you, you, I did hear you say you were calling on a recorded line, so I did get that. And um what were you calling for today, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, my name is [PII]. I'm calling for Kids Medical Services INC to check on the payment status. And please be informed that this call is being recorded and monitored for the quality and training purposes.
[AGENT][POSITIVE] OK, perfect, thank you. And do you mind if I get a good call back number from you?
[CUSTOMER][NEUTRAL] Yes, of course, my callback number is [PII].
[AGENT][POSITIVE] Wonderful. And the policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I please, may I place the call on hold for a couple of minutes, please?
[AGENT][POSITIVE] Oh, absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for being on Hall Delhi.
[CUSTOMER][NEUTRAL] And the policy number is 2,443,500.
[AGENT][NEUTRAL] 2,443,500
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and give me a second to get that all pulled up.
[AGENT][NEUTRAL] May I have your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] OK. The patient's name is [PII] and the date of birth of the patient is [PII].
[CUSTOMER][NEUTRAL] that
[AGENT][POSITIVE] All right. Thank you so much.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And do you have the date of service for the claim status you're looking for?
[CUSTOMER][NEUTRAL] Yes, I have the data service and that is [PII].
[AGENT][POSITIVE] Perfect. I'm sorry, one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Total charges is $78 even. And uh
[CUSTOMER][NEUTRAL] Total bill amount is $618 even.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Alright, perfect. And I think I found your claim. Give me one second to verify that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From
[AGENT][NEUTRAL] You said $78 was the total charge after primary?
[CUSTOMER][NEUTRAL] Yes, $78 even is the total charges and the total bill amount is $618 even.
[AGENT][NEUTRAL] OK, hold on, so it might not be the one I was looking at. Let me look again.
[AGENT][NEUTRAL] 042.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Hey I got lost.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, so I'm actually just like going through a couple different claims, um, and so it's just taking me a little more time than.
[AGENT][POSITIVE] The normal, but I'm definitely here with you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I verify them?
[CUSTOMER][NEUTRAL] Group NPI.
[CUSTOMER][NEUTRAL] For you?
[AGENT][NEUTRAL] I wouldn't be able to search anything by that, but.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] There's just a lot of claims on file and none of them off first look match so I'm pulling them all up one by one,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Take your own time.
[AGENT][POSITIVE] Thank you. I'm so sorry. And then.
[AGENT][NEUTRAL] Yeah, I guess actually if it makes it easier what is that ID number and I'll just um use that to help find the facilities as I look at them one by one.
[CUSTOMER][NEUTRAL] Oh, OK. The member ID is 2,443,500.
[AGENT][NEUTRAL] Oh no, I'm so sorry, the tax ID for the.
[CUSTOMER][NEUTRAL] OK, the tax ID is [PII].
[AGENT][NEUTRAL] Facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I verify the provider name also?
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Guillermo de Anglo.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the facility name that I could see is Kids Medical Services INC.
[AGENT][NEUTRAL] Sorry, um, there are 3 more claims left for me to just pull up and check.
[AGENT][NEUTRAL] So let me
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 309.
[CUSTOMER][NEUTRAL] That's OK, [PII].
[AGENT][POSITIVE] Sorry, I like it when it's so fast and easy to find. I do believe I found it for you though, um.
[AGENT][NEUTRAL] Let me open up this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you want the provider NPI number?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't believe I need that. I'm just going to verify the total charge on the claim.
[CUSTOMER][NEUTRAL] May I verify that also?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like the claim I'm looking at, it shows the total charge at $62.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is that
[AGENT][NEGATIVE] That's not correct though, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] No, the $62 is not correct because upon checking, I could see that uh the paid amount is $78 even and the bill amount is $618 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So then, what was the procedure code?
[CUSTOMER][NEUTRAL] OK, actually I have 3 procedure codes for this 1 May I verify those 3?
[CUSTOMER][NEUTRAL] 3 codes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. The first one is 36416 and 99213 and 85025.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's definitely not this claim. All right, so I'm gonna go to the.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Next claim on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Hey, I appreciate your patience so much. I am so sorry it's taking me so long. I'm usually, I mean, maybe not really fast, but a lot faster than this.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][POSITIVE] Perfect so I this is what I believe is your claim and I'm going to, it matches all those codes that you just gave me, so.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 437. I show that your claim was received [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim was processed [PII], and that the claim number is 3534537.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I show that this claim had benefits payable of the full $78 and that was paid with a single check. The check number is 2015833.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I can give you the check details in just a second. Let me pull them up.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] How you
[AGENT][NEUTRAL] All right, and those that check was made payable to Kids Medical Services Inc. The check was issued [PII], and it looks like the check cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please help me with the process type of this claim, that is, may I know whether this process as primary or secondary?
[AGENT][NEUTRAL] It was a
[AGENT][NEUTRAL] Yes, we are their secondary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, upon checking, I received two payments in which you pay twice the same amounts that are $75 even and $3 even. For the CPT codes that is 99213 and 85025.
[CUSTOMER][NEUTRAL] And the check number and claim number for that payment are different.
[CUSTOMER][NEUTRAL] So could you please verify that for me?
[AGENT][NEUTRAL] OK, um, we did have an error where we were, uh, one day we accidentally sent duplicate checks and so if you do have duplicate checks, I would, uh, highly recommend destroying one of them.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, but let me also look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, anything else we have paid out?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the other check number that you have?
[CUSTOMER][POSITIVE] Definitely I will provide that to you.
[CUSTOMER][NEUTRAL] And the other check number that I have is 2,011,190. And may I verify the claim number for that one?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] Yes, what is the claim number for that one?
[CUSTOMER][NEUTRAL] The claim number is 352403524506.
[AGENT][NEUTRAL] 506.
[CUSTOMER][NEUTRAL] So, could you please verify that information for me? I just want to know.
[AGENT][NEUTRAL] Yes, and will you reread me that claim number? I wasn't able to find it under her policy.
[CUSTOMER][NEUTRAL] OK. The
[AGENT][NEUTRAL] The 5061.
[CUSTOMER][NEUTRAL] Uh, the claim number, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That is 352-450-6.
[CUSTOMER][NEUTRAL] Actually, I just want to know that uh whether you made a payment in this.
[CUSTOMER][NEUTRAL] Both check numbers as well as in the both claim numbers.
[AGENT][NEUTRAL] OK, so it looks like that check number was put under a different um name, so it looks like they have the same policy number. The first check was for [PII] and then that second check was for her brother [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Were both claims supposed to be, were they, were they different patients?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, may I place the call on hold for a couple of minutes, please, to verify those details? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you for being on Hall Valley.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK. Actually, upon checking, I could see that the claim number that ends with 537.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Um, the patient is for the patient that, that is [PII].
[AGENT][NEUTRAL] Yeah, it looks like we accidentally processed the claim twice, um, yes, can you, um, I need you to send back the check ending in 190, the, the check, the other one I gave you that other claim information, that one is correct, that one was processed under [PII], but it looks like we accidentally reprocessed the same claim under her brother and cut another check and that's that 190.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so could you, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so you're saying.
[CUSTOMER][NEUTRAL] You will reprocess the claim that ends with the
[CUSTOMER][NEUTRAL] Number that is 506, right?
[AGENT][NEUTRAL] Yeah, so I pulled up the claim that ends in 506 and I'm like looking at the claim form you sent us, and that claim is the same it's the same as the previous one for [PII].
[CUSTOMER][NEUTRAL] You just.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like we processed her claim twice.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, so I have the 1st 10, hold on, I'm looking at.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I need to pull it up on my screen again. I'm sorry, hang tight with me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is fun. OK, so we want.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] 57.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] All right, perfect. So I'm looking at.
[AGENT][NEUTRAL] Both the claims now the 356 and then the 537506 and 537.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And it looks like they are the.
[AGENT][NEUTRAL] Same claims.
[AGENT][NEUTRAL] With the same diagnosis codes and the same procedure codes.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, that is correct. When, but when it comes to the patient name that are different. You made the payment uh for [PII] in the claim number that is 3534537. And uh we also, we also
[CUSTOMER][NEUTRAL] have that information.
[CUSTOMER][NEUTRAL] Actually, you shouldn't uh uh pay for [PII]. So could you please uh give reason for that payment.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And also a resolution.
[AGENT][NEUTRAL] Yes. Do you mind if I put you on a quick hold and I um look into this further?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, [PII], one more minute, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] The first, uh, claim that is, the claim in which the claim number ends with 537 is correct. You made correct payment, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that one, that claim we got, it looks like was for [PII]. The payment is for [PII].
[CUSTOMER][NEUTRAL] OK, but when
[AGENT][POSITIVE] And that one's all correct.
[CUSTOMER][NEUTRAL] OK. And you, and you processed the task correctly, right?
[AGENT][NEUTRAL] It to me looks correct, but I don't process claims, which is why I wanna try to put you on a hold and get on the phone with someone who does process claims because I don't personally process them and I wanna make sure you're getting the right information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And uh one more thing, [PII], and when it comes to the next one, that is the claim number that ends with 506 Nicolas Bestad and uh you made the payment accidentally, accidentally, right?
[AGENT][NEUTRAL] To me it looks like that payment was made by mistake because they're both the same claim when I pull them up they both say [PII] on them so it looks like we accidentally double played the claim and put a different name on it, but again I don't process claims so I really wanna get confirmation from someone who does.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No I don't think I.
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so could you please verify that for me?
[AGENT][NEUTRAL] Yes, let me put you on just a quick hold, Miss [PII], and I will make sure that all the information I give you is correct, OK?
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][POSITIVE] Perfect. One moment, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I know I don't call you but
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] with the care team. How you doing?
[CUSTOMER][POSITIVE] I'm good [PII] how are you doing?
[AGENT][POSITIVE] Hey, I'm doing great, and I have a feeling that maybe I should have like looked up the someone's little digits and
[AGENT][NEUTRAL] Called somebody. I have no idea what I'm doing, um.
[AGENT][NEUTRAL] Hey, I have a claim and it looks like we paid it twice and we put it under somebody else's name the second time we paid it.
[CUSTOMER][NEUTRAL] OK, what is the policy number?
[AGENT][NEUTRAL] Policy number is 2,443,500.
[CUSTOMER][NEUTRAL] OK, and for which part?
[AGENT][NEUTRAL] Alright, I'm looking at part 3 and part 4. there's the same claim under both names.
[AGENT][NEUTRAL] I think I don't actually, I feel really confident in what I'm saying, but I do not process claims, so that's why I called.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem, just waiting on my computer.
[CUSTOMER][NEUTRAL] OK, part 3 and part 4.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I have both claim numbers when you're ready, but no rush cause you know, we're both paid by the hour.
[CUSTOMER][NEUTRAL] Correct, thank you. So what's your claim number for part 3?
[AGENT][NEUTRAL] OK, the claim number for part three is 3534537.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this one should be the correct claim like the claim matches the insured's name on this one.
[CUSTOMER][NEUTRAL] OK, that's for [PII], OK, and the other claim number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yep, uh, for part four, the claim number is 352-4506.
[CUSTOMER][NEUTRAL] OK, so both same dates of service.
[CUSTOMER][NEUTRAL] OK, OK, I have that pulled up. OK, so, OK, so you're saying that they are one is processed incorrectly under the wrong part's name, is that correct?
[AGENT][NEUTRAL] Yes, when I went into OnBase and I pulled up the claim, the claim name is [PII], and they're the same dates of service, same diagnosis codes, same CPT codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, so someone processed it incorrectly. OK, let me look here.
[CUSTOMER][NEUTRAL] OK, so since you've already gone to on base, which one is it processed incorrectly? The one for [PII]? OK, so that's processed incorrectly.
[AGENT][NEUTRAL] The 506, mhm, yeah, it's [PII]'s name on the file and or on the claim, but his name on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0, 22 hm, interesting, OK.
[AGENT][NEUTRAL] The reason I pulled it up was because I thought the providers were pulling one over and submitting two claims, you know what I mean?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I was just like, oh, I'm gonna flag that for.
[CUSTOMER][NEUTRAL] OK, so these are two separate, uh, different, um, examiners. OK, so, OK, um, well, we will have to.
[CUSTOMER][NEUTRAL] Request a refund just to make sure so OK so you have a provider on the phone?
[AGENT][NEUTRAL] I do have a provider on the phone and she just wants like further information on what she needs to do.
[CUSTOMER][NEUTRAL] OK, and what is her name, please?
[AGENT][MIXED] Her name is [PII], and she is so sweet, but her background noise is really loud.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, do you have a callback number for [PII] or is it the number on the screen? OK.
[AGENT][NEUTRAL] I do. It is not, oh, you know what? It is the number on the screen. Yeah, the same. And I'm so sorry, I should have taken this down, but what was your name? [PII].
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, it came back to me.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you mind if I introduce you when we join calls?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] I do not mind at all. Ay, go right ahead.
[AGENT][NEUTRAL] And then do you mind if I listen in just so I can, I wanna be prepared, you know what I mean if I get this again.
[CUSTOMER][NEUTRAL] Well, let me first pull up the claim, but just to go off what you said, the one that'll pay correctly is the 453 7.
[AGENT][NEUTRAL] Yes, and then the incorrect one is the 506.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 29 3474.
[CUSTOMER][NEUTRAL] And it processed under part 4, but it should also be part 3, is that correct?
[AGENT][NEUTRAL] Yes, it is, it belongs to part 3, and it's the same claim we just paid.
[CUSTOMER][NEUTRAL] OK, so let me
[CUSTOMER][NEUTRAL] OK, so we are gonna have to request it. OK, so with this process. Give me one second. I'll change.
[CUSTOMER][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] we have 1 pages.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me first get my
[CUSTOMER][NEUTRAL] On base up give me one sec.
[AGENT][POSITIVE] Take your time. I'm in a rush.
[CUSTOMER][NEUTRAL] 1234.
[AGENT][NEUTRAL] I mean once you hit 5:[PII] I'll be in a rush, but like we got time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, come on.
[CUSTOMER][NEUTRAL] OK, so this is processed on [PII] and that has cleared. OK, I request that.
[CUSTOMER][NEUTRAL] And here you go this is for [PII]. OK, so that's good for [PII], OK.
[CUSTOMER][NEUTRAL] So that is for for you, OK, so what we'll actually, OK, I'm ready, go ahead.
[AGENT][NEUTRAL] OK, I'm gonna join. I'll introduce you and then I'll be quiet.
[AGENT][NEUTRAL] Hi Miss [PII], are you still there with us?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Hey, thank you so much for your patience I have [PII] on the phone and she's with our claims team. She's gonna take the call over from here, but she should be able to provide you further direction, OK?
[CUSTOMER][NEUTRAL] OK, so could you please help me with the call reference number?
[AGENT][NEUTRAL] Oh, you bet you. Um my call reference number was [PII], first initial last name [PII] in today's date.
[CUSTOMER][NEUTRAL] Uh, could you please repeat that for me, please?
[AGENT][NEUTRAL] Yeah, you betcha. It's [PII], [PII] like boy, and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII], hi, hi, my name is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling. Hi [PII].
[CUSTOMER][NEUTRAL] Yes, Miss [PII] I gave all the information. It appears that we processed a claim twice.
[CUSTOMER][NEUTRAL] And we will have to since the check, yes, since the check has cleared, we will have to request a refund in the amount of $78.
[CUSTOMER][NEUTRAL] All right. OK. May I place the call on hold for a couple of minutes, please, [PII]?
[CUSTOMER][NEUTRAL] OK, go ahead, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thank you for being on hold, [PII], and uh could you please repeat that information for me?
[CUSTOMER][NEUTRAL] Certainly
[CUSTOMER][NEUTRAL] We process it a claimed twice for the same participant for the same member and that claim processed incorrectly as 352-4506.
[CUSTOMER][NEGATIVE] We will have to request a refund in the amount of $78 because that is what we paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you made both of the payments, correct?
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] And you are ready to refund the $78 even, right? A request will be sent? Yes.
[CUSTOMER][NEUTRAL] For refund of the card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you need that claim information just for your documentation as to which one I will be, well, excuse me, which one the adjuster will be requesting the refund? Would you need that claim number? Yes, yes, do you have the, oh, OK, OK. Are you ready for the claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yes, I'm ready for the claim number.
[CUSTOMER][NEUTRAL] OK, the claim number is 352-450-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now would you also need that check number as well for your documentation?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Check, OK, the check number shows 2,011,190.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claim number ends with 506 is.
[CUSTOMER][NEUTRAL] Correct. And the claim number ends with 537 is.
[CUSTOMER][NEUTRAL] You will refund $78 from this one, right? The claim number that ends with 573.
[CUSTOMER][NEUTRAL] No, we will request a refund from the claim number that ends in 506.
[CUSTOMER][NEUTRAL] OK. So the refund is happening in this, the, in the claim number that is 506.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So what about the next one?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What about the next claim number that ends with 537?
[CUSTOMER][NEUTRAL] Because actually we made payment, uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, uh, that was my bad. The claim number that ends with 537 is correct and uh you will, you are ready to refund $78 in the claim number that ends with 506. Is that right?
[CUSTOMER][NEUTRAL] I'm sorry, you will excuse me, the provider will refund us the amount of $78.
[CUSTOMER][POSITIVE] OK, I'm so sorry that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I have a few more questions. Could you please help me with that also?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes. Am I audible?
[CUSTOMER][NEUTRAL] Yes, I can hear you, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it possible for take back from your side?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is it possible for a takeback?
[CUSTOMER][NEUTRAL] What is a take back?
[CUSTOMER][NEGATIVE] Um, it takes back from your side instead of refund.
[CUSTOMER][POSITIVE] No, we paid the claim incorrectly, so we've paid this particular price actually.
[CUSTOMER][NEUTRAL] And we need to a refund on this particular claim, yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] It is not possible for equipment, right?
[CUSTOMER][NEGATIVE] We will be requesting a refund in the amount of $78 for for claim number ending in 506. The claim was paid incorrectly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh the reason for the incorrect payment is you made
[CUSTOMER][NEUTRAL] Payment twice incorrectly, right? That is correct. The payment was actually the claim was filed in a different participant's name. So therefore, again we will have to request a refund.
[CUSTOMER][NEUTRAL] Because we have already paid that for that particular date of service for this particular member which is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim is processed as primary, right?
[CUSTOMER][NEUTRAL] No, we are secondary. OK, I'm sorry, sorry, uh, the claim is processed as secondary and, uh, it is not possible for uh recruitment from your side, right?
[CUSTOMER][NEUTRAL] We will be requesting a refund in the amount of $78. OK, and uh may I know the refund mailing address, please?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, the refund mailing address?
[CUSTOMER][NEUTRAL] We will send a letter to the provider of service for the refund, so we will be sending a letter of a refund request to the provider.
[CUSTOMER][NEUTRAL] OK. And the refund amount is $78 right?
[CUSTOMER][NEUTRAL] That is correct. $78 even, right? OK. And will there be any interest applied?
[CUSTOMER][NEUTRAL] I'm not certain if any interest will be applied.
[CUSTOMER][NEUTRAL] OK, so no interest.
[CUSTOMER][NEUTRAL] And the CPT code for this payment is 36416 and 99213 and 85025. Is that right?
[CUSTOMER][NEUTRAL] Those are the procedure codes listed on the claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was that, uh, that is what I met and uh the paid amount is.
[CUSTOMER][NEUTRAL] $78 even and uh correct. OK. And the payment number is 2015833.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] And so sorry, can you repeat? I'm sorry, [PII], can you repeat that information? OK, the, the payment number is 2015833, right?
[CUSTOMER][NEUTRAL] Are you asking me what the check number was? Is that what you're asking me?
[CUSTOMER][NEUTRAL] Uh, the mode of payment is via EFT, right? And it is a single EFT.
[CUSTOMER][NEUTRAL] No, the mode of payment was, no, the mode of payment was a single paper check and that check number is 24 was 2,011,190.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But they actually checking upon the check number, that is the participant name is [PII].
[CUSTOMER][NEUTRAL] That is correct and the claim was processed incorrectly in his name. So again we will be requesting that refund in the amount $8.
[CUSTOMER][NEUTRAL] OK. So the payment number is 2,011,190, right? And uh
[CUSTOMER][NEUTRAL] It is transaction is via check. It is a single check.
[CUSTOMER][NEUTRAL] And could you please provide the amount also?
[CUSTOMER][NEUTRAL] We paid $78.
[CUSTOMER][NEUTRAL] 78.00 was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] Yes, I'm here. I have a few more questions. Anything else I can help you, OK, yeah, yes, yes. OK, so.
[CUSTOMER][NEUTRAL] Uh, could you, uh, please provide the time frame for the recruitment?
[CUSTOMER][NEUTRAL] For the refund request, um, I would have to send a request to the adjuster who processed the claim. Please allow at least 5 to 7 business days. It may be sooner.
[CUSTOMER][NEUTRAL] But please allow at least 5 to 7 business days for processing. OK. OK. And the amount is $78 even and there is no interest applied, right?
[CUSTOMER][NEUTRAL] Again, I'm sorry, so I'm not sure if any interest will be applied. I do not know that at this moment, but definitely we will be requesting that refund of $78.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So could you please help me with your call reference number also?
[CUSTOMER][NEUTRAL] Um, we do not provide call reference numbers. You can use my name [PII], that is [PII]
[CUSTOMER][NEUTRAL] My last initial is [PII] and today's date please [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a great day, [PII].
[CUSTOMER][POSITIVE] And you as well and thank you so much [PII] for calling ATL. Take care bye. Thank you so much bye bye.
[CUSTOMER][NEUTRAL] Mm