AccountId: 011433970860
ContactId: 30d1d2d5-a267-4708-be8f-5c1d3d2be2c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 901619 ms
Total Talk Time (AGENT): 360054 ms
Total Talk Time (CUSTOMER): 194388 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/30d1d2d5-a267-4708-be8f-5c1d3d2be2c6_20250313T13:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to know the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, only one claim.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the member's policy number is 02492690.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $216 216.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, so let's included in here.
[AGENT][NEUTRAL] 921396127.
[AGENT][NEUTRAL] So where's the very first.
[AGENT][NEUTRAL] No, that's as I do.
[AGENT][NEUTRAL] So it was this one.
[AGENT][NEUTRAL] But that's what it was paid on.
[AGENT][NEUTRAL] 632.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we received this claim of quite a few times, um, but the original claim that we received was on [PII]. Hold on, one second.
[AGENT][NEUTRAL] This is the one from last year. Hold on one moment.
[AGENT][NEUTRAL] It was [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so we received it on [PII].
[AGENT][NEUTRAL] But it looks like the insured actually submitted this claim.
[AGENT][NEUTRAL] Let me see if there's one that you all as a provider submitted because I can't give you the claim status for the insured and there's several.
[AGENT][NEUTRAL] Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What? So did the insured submit it or the provider?
[AGENT][NEUTRAL] Oh, we
[AGENT][NEUTRAL] Oh Lord.
[AGENT][NEUTRAL] So you want me to verify the tax ID? Let me verify the tax ID.
[AGENT][NEUTRAL] But am I even allowed to, but am I allowed to give it or not because
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's why, because it's all on one. So the insured submitted it and the provider, but they put it all on one claim and paid the insured.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] How does the insured and the
[AGENT][NEUTRAL] Whatever, um.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thanks for holding. I apologize for that wait. So it looks like they're all on, it's all on one claim, so I'll look into that further with my supervisor, but for the parts of the claim that's for the uh the provider, it came back saying that there was a discrepancy with the tax ID number. Can you verify your tax ID number?
[CUSTOMER][NEUTRAL] Yes, sure, the tax ID number is [PII].
[AGENT][NEUTRAL] OK, so that's the correct um that's the correct tax ID that we have on here as well. Um.
[AGENT][NEUTRAL] So I can either have claims give you a call to discuss the claim with you, um.
[AGENT][NEUTRAL] And so that we can get that rectified because it doesn't look like the claim has been processed because of that.
[AGENT][NEUTRAL] Did you want to speak with someone in claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, so I'm gonna go ahead and get a claims representative for you. Before I do that, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah, can I get the call reference please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you so much, Channel.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Hold on one moment.
[CUSTOMER][POSITIVE] Yeah thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, we gotta get some more direction because.
[AGENT][NEUTRAL] How?
[AGENT][NEUTRAL] Whatever.
[AGENT][NEUTRAL] Claim support.
[CUSTOMER][NEUTRAL] Sing
[CUSTOMER][POSITIVE] And thanks for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][NEUTRAL] I'm doing good. Um, I have a provider on the other line. They can you look at this claim with me?
[CUSTOMER][NEUTRAL] Sure. What's the policy number?
[AGENT][NEUTRAL] Um, it's 249-269-0.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Um, uh, claim number 3562058.
[CUSTOMER][NEUTRAL] OK, and this is for the [PII] data service?
[AGENT][NEUTRAL] Yes, so for her, so the insured and her and the providers all on one claim, but for the provider's part, it's one of those B notices, but she has questions more so about the claim and um versus the B notice. I didn't want to send an email to [PII], but
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Am I, how do I handle this? Because when I look in um Lion, it shows the paid, but when I went to the claim, then I saw all the stuff for the provider. So am I allowed to go further or?
[CUSTOMER][NEUTRAL] So, as far, yeah, the benefit was paid to the insured, however, to the provider, they received a notice letting them know that um
[CUSTOMER][NEUTRAL] That based off the discrepancy with their payer tax ID number um that um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Benefits were paid to the insured. So on that EOB it lets them know that remark code which is the DM 6428, lets the provider know that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim was paid to the insured instead of them.
[CUSTOMER][NEUTRAL] So you can share that information with them cause that's what the remark code is to the to the provider letting them know that.
[CUSTOMER][NEUTRAL] There is a discrepancy in our records on their based off their tax ID number and there is a letter that was sent out to them as well instructing them how to resolve that discrepancy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that on this particular claim, the payment of the $50 was paid to the, the insured due to that discrepancy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I just want to make sure because in online it said, you know how when it shows the insured, we can't give the provider information. So I'm like, well, it shows both, so what can I do? So I, I was just making sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's OK in this instance because it was filed by the provider, but due to their, their payer ID tax discrepancy, that's the reason why I was yeah, so yeah, I would just read exactly what it says in that remark code that was sent to them on that EOB.
[AGENT][NEUTRAL] It went to the patient. OK.
[AGENT][POSITIVE] Alrighty, I will do that. Thank you.
[CUSTOMER][POSITIVE] Mhm you're welcome.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So actually, um I just spoke with the claims representative. Do you have a copy of the explanation of benefits from APL?
[CUSTOMER][NEUTRAL] No. No.
[AGENT][NEUTRAL] OK, I can send you a copy of the explanation of benefits on the explanation of benefits. There's a remark code, a decision code, and it says that we're unable to assign benefits to the provider of record due to a discrepancy with the provider's tax ID number.
[AGENT][NEUTRAL] A letter has been mailed um to you, but you said you didn't receive it, so I'll send you um another copy of the explanation of benefits, but there's also a letter that was sent out to resolve the discrepancy. So the claim, um,
[AGENT][NEUTRAL] So the claim was paid to the insured.
[CUSTOMER][NEUTRAL] Yeah, one minute please, um, check that letter. Is there any letter was received or not? One minute please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, one minute please. I'm checking that letter whether we received or not, yeah.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, thanks for being on hold, [PII]. We received that letter on [PII]. We received that letter.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so you did receive the letter?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so once um that discrepancy is resolved, um, claims moving forward, we can then um try to assign benefits to the provider, but for this claim, it was paid to the patient.
[CUSTOMER][POSITIVE] Yeah, it was already paid. Uh, it was ready to pay.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, the claim was already paid to provider, sorry, paid to patient, uh, it was not to pay to patient in now.
[AGENT][NEUTRAL] It, it was paid to the patient.
[CUSTOMER][NEUTRAL] Yeah, may I know the process date, please?
[AGENT][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] Yeah, can I get the claim number please?
[AGENT][NEUTRAL] The claim number is 3562058.
[CUSTOMER][NEUTRAL] Yeah, may I know the allowed amount, please?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The allowed amount was $50.
[CUSTOMER][NEUTRAL] And pay the monthly.
[AGENT][NEUTRAL] $50.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah, is there any check number is available?
[AGENT][NEUTRAL] I can't provide you with that information because that was paid to the insured.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that and call reference is your name and today's date, am I correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, is there any UB is available?
[AGENT][NEUTRAL] Yes, would you like me to fax it to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should that be attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, my
[AGENT][POSITIVE] All right, and I'm sending that over to you now. Was there anything else I can help with?
[CUSTOMER][POSITIVE] Yeah, nothing and thanks a lot and thank you so much for assisting me.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.