AccountId: 011433970860
ContactId: 42df790d-4359-49a4-a868-f8f859785d32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 894940 ms
Total Talk Time (AGENT): 228028 ms
Total Talk Time (CUSTOMER): 163816 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/42df790d-4359-49a4-a868-f8f859785d32_20250127T17:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] in Broker Resources. How are you?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] Pretty good. Um, I have got [PII]. She is with the provider's office and she's calling about a couple of claims on policy 2296321 for [PII] and she did verify date of birth. Can I send her over?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You sure can, [PII], thank you.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from Bear Creek Family Dentistry. I'm needing to check status of a couple claims, uh, that are outstanding.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm so sorry your voice broke up if you could repeat your callback number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you so much. And what is the first date of service to check for outstanding claim?
[CUSTOMER][NEUTRAL] It is for [PII] and patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, I have the information and what's the total charge for 6 2020 24?
[CUSTOMER][NEUTRAL] It is $1,905.
[AGENT][POSITIVE] OK, thank you so much. One moment please, [PII].
[AGENT][NEUTRAL] 20th.
[AGENT][NEUTRAL] And if you could also verify the procedure codes bill for the service safety the member.
[CUSTOMER][NEUTRAL] OK, the one for [PII], it's 1502 1043 41 for all four quads and then extractions 7250 for tooth number 3 and 5 7210 for 4 and 14.
[AGENT][NEUTRAL] I'm so sorry I was trying to write all this down. If you could just repeat that for me, I'm just trying to make sure we have that claim on file for you. If you could repeat that for me please. I have 1521043 41 all quads, is that correct?
[CUSTOMER][NEUTRAL] Uh, code 150,210.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4341 all four quads.
[CUSTOMER][NEUTRAL] 7210 for tooth number 4, tooth number 14, and tooth I mean uh procedure 7250 for tooth number 3 and tooth number 5.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The name of the dental provider's office or practice?
[CUSTOMER][NEUTRAL] That would be
[CUSTOMER][NEUTRAL] Buckner Marketplace Dental PA.
[CUSTOMER][NEUTRAL] The providers doctor.
[CUSTOMER][NEUTRAL] Chimp Chimpsey.
[CUSTOMER][NEUTRAL] OK where am I at.
[AGENT][NEUTRAL] Hm
[CUSTOMER][POSITIVE] Exactly
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, OK? Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, got that one.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK, thank you for your patience and uh I did show that we received the claim for [PII].
[AGENT][NEUTRAL] And it was processed and the claim, the check was voided. I'm not sure why it was voided, but I'm about to do some research on that. But to verify the place where the check was sent and what's the name of the dentist again please, the treating dentist?
[CUSTOMER][NEUTRAL] Chimps Chimpsy.
[AGENT][NEUTRAL] Chepy and that, um, OK, and the name of the dental office?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Buckner Marketplace Dental PA [PII].
[AGENT][NEUTRAL] OK, place dental PA. OK, OK, you have the 2nd date of service. What was the second date of service, please, the member.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the total charges?
[CUSTOMER][NEUTRAL] On that one it's $3,225.
[AGENT][NEUTRAL] $25 OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and if you could just verify those procedure codes bill for the service date of [PII].
[CUSTOMER][NEUTRAL] Um, OK, and that's uh.
[CUSTOMER][NEUTRAL] And it is 5211.
[CUSTOMER][NEUTRAL] 2392 and 5212.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, we also received that claim and that check was also voided. Uh, let me just checked as to why it was voided. One moment.
[AGENT][NEGATIVE] OK, return mail.
[AGENT][NEUTRAL] OK OK.
[AGENT][NEUTRAL] And I hate to have to do this to you again, um, and let me place you back on hold, OK? But just again we did receive those claims, both checks were voided. um, I'm not sure if it was because it was undeliverable, but those claims were received and both checks were voided. So let me just look at these two claims that we have in line just to make sure that we are that we have the same claims that need to be reprocessed, OK, if you could just bear with me.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] OK see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you so much for your patience. OK, we will have to reprocess both claims and let me just verify to where the checks were sent to, please, if you just bear with me. They were mailed to Place Dental PA [PII]. Is that correct?
[CUSTOMER][NEUTRAL] That is correct. That's our physical address, but on the claim it also has the option for the PO box where we actually prefer our payments to go to the PO box.
[AGENT][NEUTRAL] On the claim that was submitted it was actually the.
[AGENT][NEUTRAL] The PO box was not listed. It was the physical address, the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and can you tell me how much we're paid on each one?
[AGENT][NEUTRAL] Uh, sure, on the date of service of [PII]. OK, let me go back to that one, just one moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII] $160 was paid $160 was paid for that date of service and for [PII] [PII].
[AGENT][NEUTRAL] Um, bear with me.
[AGENT][NEUTRAL] $1340 was paid.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome and the like I said, the claims will be reprocessed and mailed to the same address for the claim that was committed into us.
[CUSTOMER][NEUTRAL] OK, is there a reference number for this being sent back to we we do this claims over?
[AGENT][NEUTRAL] Um, the reference number will be my name [PII], my last initial is [PII] like [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Anything else I can help you with?
[CUSTOMER][NEUTRAL] That would be it.
[AGENT][POSITIVE] Thank you for calling APL take care bye.
[CUSTOMER][NEUTRAL] Bye bye