AccountId: 011433970860
ContactId: 22dc74c2-0c35-4063-8808-1b8f7d552553
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1123079 ms
Total Talk Time (AGENT): 479563 ms
Total Talk Time (CUSTOMER): 247146 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/22dc74c2-0c35-4063-8808-1b8f7d552553_20250513T18:43_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] Hey, my name is [PII]. How are you doing today?
[AGENT][NEUTRAL] I'm good, [PII]. How are you?
[CUSTOMER][NEUTRAL] Good thank you. I am calling from a provider's office. Um, I have a claim for assistant. Um, it looks like, um, from the previous note there was a check that was sent out back in January, um, and it does not look like we have received it yet, so I was wondering if you can check the status of the check.
[AGENT][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] OK, [PII], so you're calling on behalf of a check that it showed we sent out back in January, but it still doesn't, hasn't been received as far as you're aware of?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 02515748
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And her date of birth is um [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's the date of service and total bill amount for that claim, [PII]?
[CUSTOMER][NEUTRAL] Um, it is, um, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Total bill amount was $278.
[AGENT][NEUTRAL] Did you say 278?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and and what again was the bill amount?
[CUSTOMER][NEUTRAL] 278
[AGENT][NEUTRAL] OK, we don't even have a claim for 278.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the name of the provider?
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] Um doctor [PII]
[AGENT][NEUTRAL] What's the
[AGENT][NEUTRAL] Um, what's the, is it, uh, is he with a group or is it just him by himself?
[CUSTOMER][NEUTRAL] With a group.
[AGENT][NEUTRAL] And what's the name of the group?
[CUSTOMER][NEUTRAL] Rabini and Associates Family dentistry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the um give me just a moment. What's the tax uh let me get back to the screen. I'm, I'm talking ahead of what my what's the tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And the address?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[CUSTOMER][NEUTRAL] Olander Drive.
[CUSTOMER][NEUTRAL] Clayton, North Carolina.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so the claim that we have on file for that data service is not the billed amount that you're providing for me.
[CUSTOMER][POSITIVE] Interesting. I have a limited exam, um, panoramic X-ray.
[AGENT][NEUTRAL] Again, you had given me the, you said 278, but that again is not what
[AGENT][NEUTRAL] This claim is for.
[CUSTOMER][NEUTRAL] OK, how, uh how many services are on the claim?
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Weird. Um.
[AGENT][NEUTRAL] Let me and you say 12:16. Yes, I'm looking at the claim, yes.
[CUSTOMER][NEUTRAL] Yeah, I'm showing its limited.
[CUSTOMER][NEUTRAL] But that
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I have um the previous note.
[CUSTOMER][NEUTRAL] The claim a previous representative had said the claim had paid $200 by paper check issued [PII].
[AGENT][NEUTRAL] And we did, but again, if it's for the claim, you put the bills amount.
[CUSTOMER][NEUTRAL] With
[AGENT][NEGATIVE] I'm not sure why they provided that information when you're the billed amount that you're giving me doesn't match the claim for that payment.
[CUSTOMER][NEUTRAL] OK, what do you advise I should do?
[AGENT][NEUTRAL] Well, I need to be able to for you to give me the correct billed amount that we received on this claim.
[CUSTOMER][NEGATIVE] Yeah, the limited exam should have been for $113 and the panoramic X-ray was $165.
[AGENT][NEUTRAL] And neither one of those amounts matched this claim.
[CUSTOMER][NEUTRAL] That's very strange. Um.
[AGENT][NEGATIVE] And the saga continues, but yeah, I'm actually looking at the claim that was sent to us and that information does not match.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What you're providing.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So I would have to say that we don't have a claim on file for your billed amount. So I mean I can't.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, so should I resubmit it or would it deny as a duplicate?
[AGENT][NEGATIVE] Well, you're the the information you're providing for me, um, the charges are definitely not what was submitted.
[AGENT][NEUTRAL] Now, what I, I, yeah, no, what I can do, I mean, because I, technically, I would have to tell you that we don't have a claim on file and you're not able to give me the information, [PII], to match the claim. I have the tax ID number. I'm able to verify that, but the amount that you're giving me or.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Give them to me again.
[AGENT][NEUTRAL] And the code. The two codes?
[CUSTOMER][NEUTRAL] 270
[AGENT][NEUTRAL] Oops, I'm sorry. Go ahead.
[CUSTOMER][NEUTRAL] D. 0
[CUSTOMER][NEUTRAL] Um, D0140 and that was for a limited exam for submitted amount $113 and then D0330 panoramic X-ray was $165.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the codes on the claim that you're giving me.
[AGENT][NEUTRAL] Are the codes that were submitted, but the amounts are not.
[CUSTOMER][POSITIVE] It's so interesting.
[CUSTOMER][NEUTRAL] Um, OK, so should I just resubmit it?
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] I think what I'm gonna do is transfer you over to one of the examiners and if they want to, you know, provide you that information, but again, it's, it's not that I don't want to, but [PII], but
[AGENT][NEUTRAL] In looking at the claim, you're in the bill those billed amounts aren't matching this claim that you were given information on codes do providers do, the amount does not.
[AGENT][NEUTRAL] For the bail charges.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If
[CUSTOMER][NEUTRAL] Um, and what was your name?
[AGENT][NEUTRAL] I'm so sorry. What was your question, [PII]?
[CUSTOMER][NEUTRAL] What did you say your first name was, ma'am?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII], OK, um, and you just have a reference for [PII] before you transfer me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, you would use my name along with today's date.
[AGENT][NEUTRAL] And in the future once we process the claim [PII] we do have a portal that you can check claim status in.
[AGENT][NEUTRAL] Once we have processed a claim and the website for that portal is secured. [PII].
[AGENT][NEUTRAL] And you, so you should also be able to check that [PII]here as well.
[CUSTOMER][NEUTRAL] OK, do you have to create a provider portal?
[AGENT][NEUTRAL] You will, it's a self registering portal and you will set that up, yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect
[AGENT][NEUTRAL] You'll just walk through each screen and gives you the steps.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, well, you're certainly very welcome. So is there anything else that I can help you with before I connect you?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] OK then well thank you again for calling APO Gaby and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling ATO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII].
[AGENT][NEUTRAL] Hi, can you hear me?
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, so this is, um, OK, so I have a provider's office on the line who was calling regarding a check that they say they have not received, and they have been given claim status on before it does Tanya Rivers gave them claim status.
[AGENT][NEGATIVE] But the problem and the reason for the transfer is they still don't have this check and they're wanting to request it to be reissued, however.
[AGENT][NEUTRAL] The bill amount that she's giving me?
[AGENT][NEUTRAL] Is not for the claim that we have on file. It is the same provider. It is the same codes. I verified that information, but she cannot come up.
[AGENT][NEUTRAL] With the billed amount that's actually on the claim form that we received because I'm looking at it.
[CUSTOMER][NEUTRAL] OK, what was the policy number?
[AGENT][NEUTRAL] So the policy number is 251-5748.
[AGENT][NEUTRAL] But [PII]'s note didn't have the sta I mean she doesn't have the amount she just gave her the claim number and the check number.
[AGENT][NEUTRAL] But again,
[AGENT][NEGATIVE] The bill I, I'm not requesting the check to be reissued because I just told her we have a claim for this provider in the same data service and codes but it doesn't match.
[AGENT][NEUTRAL] The amount she's giving me.
[AGENT][NEUTRAL] She says that on code 01 and it's part two, I'm so sorry, part two, and there's only one claim on file.
[CUSTOMER][NEUTRAL] But the claim
[CUSTOMER][NEUTRAL] OK, let me get the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And she's asking, she, she resubmit a claim. Well, I don't want to get denied as a duplicate, but I'm not gonna send a a check request. I mean, if you're comfortable with doing that, but I, because she can't tell me what the billed amount on this claim is because what she's giving me is less than what the claim was for.
[CUSTOMER][NEUTRAL] OK and then I'll be ready.
[AGENT][NEUTRAL] Yeah, yeah, you're fine. I'm still working on my night.
[CUSTOMER][NEUTRAL] OK, what was the provider's name?
[AGENT][NEUTRAL] Um, the lady on the line, her name is [PII].
[AGENT][NEUTRAL] And her callback number, [PII], is [PII].
[AGENT][NEUTRAL] 633.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again, I did not tell her how much the claim that we have on file is for. I just told her that her amounts.
[AGENT][NEUTRAL] You know, so I, I'm not sending a request to have a check reissued because I can't fully verify that that's the claim.
[AGENT][NEUTRAL] I mean [PII] had given her their check number. Yeah, [PII] had mean she had the check number, the check issue date, but.
[CUSTOMER][NEUTRAL] Just tell her the
[CUSTOMER][NEUTRAL] You said that you didn't give her the the check amount or the total amount of the.
[AGENT][NEUTRAL] I did not, no, [PII] had, no, [PII] had given her the check amount and check date and all that, but I didn't give her any of that because, again, she's saying the total billed amount is 278.
[AGENT][NEUTRAL] And the claim we have on file is for 316.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] She says, so I don't know how to handle that.
[CUSTOMER][NEUTRAL] OK. Well, I can go ahead and help her.
[AGENT][NEUTRAL] Yeah, OK, perfect. Will you let me know how this one turns out? I mean, to not hold up the phone line but and keep her on hold, but I'm curious as to how.
[AGENT][NEUTRAL] This would need to be handled moving forward in this scenario.
[CUSTOMER][NEUTRAL] Well, in, in my opinion, if, if what she's giving us is not the is not matching on the claim that we received, I'm just gonna ask her to resend it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can just, I can tell her that, [PII], if, if it's just to resubmit the claim.
[CUSTOMER][NEUTRAL] So that we can review.
[AGENT][NEUTRAL] I'll tell her to do that. I just didn't want her to get denied as a duplicate.
[CUSTOMER][NEUTRAL] Yeah, and then.
[CUSTOMER][NEUTRAL] Well, I'll notify the adjuster just to look out for it and kind of let her know kind of what's going on, but I'll just let I, I would just say, you know, we're gonna have to review your claim because if it's not matching up then it it's not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It may not be the same because.
[CUSTOMER][NEUTRAL] Why would the amount be different?
[AGENT][NEUTRAL] OK. I'll just tell her that, to, yes, to send it, um, just to resubmit the claim then.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yeah, you're welcome, [PII], and I appreciate you helping me with that, OK? Yeah, there's no need for me to transfer her to you. OK, thanks. All right, bye-bye.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK. All right, sounds good. You're welcome. Bye-bye.
[AGENT][NEUTRAL] Hi, [PII], this is still [PII]. OK, so just go ahead.
[AGENT][NEUTRAL] And um resubmit the claim since the claims and amounts that you're giving me versus the claim that we received doesn't match, yes, just resubmit the claim.
[CUSTOMER][NEUTRAL] OK, do I have to provide any like reference number or anything in the remarks of the claim or just resubmit it?
[AGENT][NEGATIVE] No, you can resubmit it because again the charges you're giving me versus the charges that we initially received they're not the same.
[CUSTOMER][POSITIVE] OK, I will go ahead and resubmit it then. Thank you.
[AGENT][POSITIVE] OK, [PII]. Well, you're very welcome. So could I help you with anything else today?
[CUSTOMER][POSITIVE] No, that was it. You have a good day.
[AGENT][POSITIVE] Well, thank you. You too and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] OK.