AccountId: 011433970860
ContactId: 2d7b8c23-02cd-4630-8f85-d0bde9acfcff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 175949 ms
Total Talk Time (AGENT): 83319 ms
Total Talk Time (CUSTOMER): 90051 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/2d7b8c23-02cd-4630-8f85-d0bde9acfcff_20250108T16:34_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good, [PII], thanks for asking. How are you?
[CUSTOMER][NEUTRAL] Doing well thank you so I've got a provider on the line calling about a claim um it denied as stating that the date of service was prior to the effective date and she said that the date of service is incorrect um looks like it might have just been input wrong so I don't know if it might need to be reprocessed.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02563566.
[AGENT][NEUTRAL] For what part?
[CUSTOMER][NEUTRAL] Uh, part one, and there's just the one claim on file. It's the one, ending in 647.
[AGENT][NEUTRAL] This is for dental
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me verify, pull up the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she said that the correct date of service was [PII].
[AGENT][NEUTRAL] Do you know how to do an error document?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Do you do er do herbs.
[CUSTOMER][NEUTRAL] No, I do not, um, but yeah, if you wouldn't mind telling I.
[AGENT][POSITIVE] Great, it's supposed to be about.
[CUSTOMER][NEUTRAL] Sorry, what was that?
[AGENT][NEUTRAL] 121 24168 because if it is incorrect, it's supposed to be an error documents sent to the adjuster who processed the claim.
[CUSTOMER][NEUTRAL] OK, is that something that I'm able to do?
[AGENT][NEUTRAL] Yes, because I received the error, an error from um [PII] saying that I had processed the claim incorrect and I needed to reprocess it. It came from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You guys, but it was through herb.
[CUSTOMER][POSITIVE] Got you OK um.
[AGENT][NEUTRAL] Let me see. 1212.
[CUSTOMER][NEUTRAL] All right, I've not had one like this before.
[AGENT][POSITIVE] Uh, it's not incorrect. That's not, it's not incorrect. She processed it right.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1212 24 is the date of service, right?
[CUSTOMER][NEUTRAL] Yes, um, on the EOB though and on the EOBI it does say 121 2024.
[AGENT][NEUTRAL] This
[AGENT][NEUTRAL] They do like 121, 2024 on the claim service date.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] Yep, it is incorrect.
[AGENT][NEGATIVE] I can let her know, but you have to make a request for it to be um for error.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine um
[CUSTOMER][NEUTRAL] Sure, how do I just put in the user code um on Teams and that's where I see who processed it?
[AGENT][NEUTRAL] Yep, the, um, the person who processed it is [PII]. She processes claims. I mean, um, [PII] processes dental, and yep, it was her.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, OK, that's fine. Alright, I appreciate you letting me know.
[AGENT][NEGATIVE] Now, I don't know how you do it through her cause I've never done it before.
[CUSTOMER][POSITIVE] I haven't either, but we, that's fine I appreciate it. I just wanted to touch base with you because again I've not encountered that before, um, so I appreciate your help. uh, I will figure out the hub.
[AGENT][POSITIVE] OK, well, thanks for calling. Have a good day here.
[CUSTOMER][POSITIVE] Yeah, I appreciate your help thank you bye bye.
[AGENT][NEUTRAL] You well.