AccountId: 011433970860
ContactId: 6f8ab0e8-f881-43d1-9892-7b05a65bcf7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 164259 ms
Total Talk Time (AGENT): 85901 ms
Total Talk Time (CUSTOMER): 71705 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/6f8ab0e8-f881-43d1-9892-7b05a65bcf7d_20250313T13:52_UTC.wav
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[AGENT][POSITIVE] And thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How you doing?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] I'm doing good. Um, I have a provider on the other line. They're can you look at this claim with me?
[AGENT][NEUTRAL] Sure, what's the policy number?
[CUSTOMER][NEUTRAL] Um, it's 249-269-0.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. Um, uh, claim number 3562058.
[AGENT][NEUTRAL] OK, and this is for the [PII] data service?
[CUSTOMER][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
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][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?
[AGENT][NEUTRAL] So, as far as, yeah, the benefit was paid to the insured. However, to the provider, they received a notice letting them know that um
[AGENT][NEUTRAL] That based off the discrepancy with their payer tax ID number um that um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][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.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was paid to the insured instead of them.
[AGENT][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.
[AGENT][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.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that on this particular claim, the payment of the $50 was paid to the, the insured due to that discrepancy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I just wanted to make sure cause 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.
[AGENT][NEUTRAL] Yeah.
[AGENT][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 every remark code that was sent to them on that EOB.
[CUSTOMER][NEUTRAL] It went to the patient. OK.
[CUSTOMER][POSITIVE] All righty. I will do that. Thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] All right, bye-bye.
[AGENT][NEUTRAL] Bye.