AccountId: 011433970860
ContactId: 6d84c141-0149-4535-b6aa-816f14ef8540
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 747940 ms
Total Talk Time (AGENT): 256779 ms
Total Talk Time (CUSTOMER): 140974 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/6d84c141-0149-4535-b6aa-816f14ef8540_20250512T12:46_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is easy. How can I help you?
[CUSTOMER][NEUTRAL] Yes, uh, this is [PII] with Northeast Georgia Physicians Group. Need to get some claim status, please.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Direct line with no [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the policy number, please?
[CUSTOMER][NEUTRAL] The first one, I have two different patients, but the first one is 02564459.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] is [PII].
[AGENT][NEUTRAL] OK. And the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] 107 of 24 $510.
[AGENT][NEUTRAL] OK, and I'm still waiting on my system. One moment, please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this claim um was actually be processed to pay out to the members, so the member um can pay you directly because we received the um notice from the IRS um regarding your tax ID number and your name. Um, there was a discrepancy in that and until that's um resolved, um, we'll be paying the member directly.
[CUSTOMER][NEUTRAL] So what is the discrepancy?
[AGENT][NEUTRAL] Um, we just received the uh discrepancy notice, um, saying that your name, the provider's name does not match the tax ID number. That's the notice that we received from the IRS regarding your office.
[CUSTOMER][NEUTRAL] Is there any way that we could get a copy of that so I can get it to the right people?
[AGENT][NEUTRAL] Um, yes, ma'am. We sent you guys a letter in the mail regarding this.
[CUSTOMER][NEUTRAL] Can you fax it to me?
[AGENT][NEUTRAL] Um, yes, ma'am. What's your fax number, please?
[CUSTOMER][NEUTRAL] Uh, direct, uh, uh, [PII]. So do you have Northeast Georgia Physicians group?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. That's what we show on the claim, but on the actual um notice that we received from the IRS I don't have access to that. Um, I would have to send this to another department so they can get that um information sent to you.
[CUSTOMER][NEUTRAL] Uh because, I mean, this is, you're not the only one because we do Northeast Georgia physicians group with the tax ID [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. And that's what we're showing on the claim, but that's also what they received the um discrepancy on. And so that's the information. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, there shouldn't be a discrepancy. That's why I'm requesting a copy. So how long do you think I'll get a copy?
[AGENT][NEUTRAL] Um, please allow 3 to 5 business days, but you should have already received the copy. I apologize. Let's see when this was sent out.
[AGENT][NEUTRAL] Yeah, I'm showing that a copy was sent to your office around [PII].
[AGENT][NEUTRAL] So, but yes, ma'am. I can send a request to have um a copy of this letter sent to you.
[CUSTOMER][NEUTRAL] OK. At the 4153, uh, last four digit, right?
[AGENT][NEUTRAL] Yes, ma'am, and I'll have them to attention it to Gail.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the patient was paid for this.
[AGENT][NEUTRAL] Yes, ma'am. The patient was paid directly.
[CUSTOMER][NEUTRAL] Uh, can you give me how much?
[AGENT][NEUTRAL] Yes, ma'am. That was a payment for $431.60.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I have one other patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm ready for that policy number.
[CUSTOMER][NEUTRAL] 02564437.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges on this claim?
[CUSTOMER][NEUTRAL] The first one is 121 of 25, 235.
[AGENT][NEUTRAL] OK, I'm showing that we received this claim on [PII]. It processed on [PII]. And this claim is denying because office visits is not covered under the policy.
[AGENT][NEUTRAL] And do you need?
[CUSTOMER][NEUTRAL] And patient responsible.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Do I need one now?
[AGENT][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] Um, the claim number is 3,572,570.
[CUSTOMER][NEUTRAL] OK, and what the same patient data of service 23-25-20105.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, this one, also the same issue with the B notice.
[AGENT][NEUTRAL] Um, let's see. The payment was made to the patient for $750 which is the benefit maximum on this policy for outpatient services. And you guys also received a B notice for um this claim as well. Do you need a copy of this um letter also?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you showing a contractual of 86,370?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing the contractual payment was $1,241.30.
[AGENT][NEUTRAL] And the claim paid out $750 because under this policy for outpatient services, we cover up to $750 per day.
[CUSTOMER][NEUTRAL] And so what is the patient's responsibility?
[AGENT][NEUTRAL] Um, the remaining balance from the, um, 1200, let's see.
[AGENT][NEUTRAL] Yeah, the patient responsibility is $491.30.
[CUSTOMER][NEGATIVE] Send me that EOR if you don't care, please.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK. And again, you should receive it in about 3 to 5 business days. Is ther[PII] anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um, do you mind checking one last one on him or her? I have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. We received this claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3582238.
[AGENT][NEGATIVE] And this one is denying because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, and do I, may I get a call reference and then we're through if you don't mind just getting those faxes to me then.
[AGENT][NEUTRAL] Yes, ma'am. I'll get those faxed to you and the call reference number is my name and today's date. My name is [PII] um it's spelled [PII] Last initial is [PII], and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Not at this time, thank you.
[AGENT][POSITIVE] OK. Thank you, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Mm thank you.