AccountId: 011433970860
ContactId: ac13fa71-edaf-43d5-a4fc-938c6c8ae71b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754349 ms
Total Talk Time (AGENT): 291978 ms
Total Talk Time (CUSTOMER): 195515 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/ac13fa71-edaf-43d5-a4fc-938c6c8ae71b_20241231T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh hi, [PII]. This is [PII]. I'm calling from provider's office, checking our claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, OK. I can help you with that. What is your callback number?
[CUSTOMER][NEUTRAL] Callback phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, [PII], how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Only one claim?
[AGENT][NEUTRAL] OK, and what is that member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02355945.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. Date of birth is [PII] sorry, [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $657 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the facility name?
[CUSTOMER][NEUTRAL] Facility name is MD Now Medical Center INC.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received on 10-15-2024.
[AGENT][NEUTRAL] Processed on 10-21-2024.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 9504.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $100.
[AGENT][NEUTRAL] That was paid on single check [PII].
[AGENT][NEUTRAL] And that check has cleared as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you just verify me the check mailing address?
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] This was sent to [PII].
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you provide me the address where it was sent?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] No, that's not the correct address.
[CUSTOMER][NEUTRAL] The address I provided to you is correct.
[AGENT][NEUTRAL] Give me a moment to look at the information on the claim that was received.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's still loading the information.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, well let me, um, what I'm gonna do is connect you over to one of the examiners who reviews this type of claim since this check does show as cleared, [PII], um, you will not have to re-verify any of the information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, I will.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I will provide them that and I'm looking at one more document. Just one moment.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] So this was
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so yes, I will get you connected, but before I do can I help you with anything else today, [PII]?
[CUSTOMER][NEUTRAL] Uh no. Can I get the caller reference number?
[AGENT][NEUTRAL] Sure. It's my name along with today's date, and you probably already have this now. Pardon me?
[CUSTOMER][NEUTRAL] Can I get your name
[CUSTOMER][NEUTRAL] Can I get your name?
[AGENT][NEUTRAL] Again, you need me, do you need me to repeat it?
[CUSTOMER][NEUTRAL] Yeah, can I get your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the initial of your last name?
[AGENT][NEUTRAL] S and your initial?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So, you said the check was cleared on [PII]?
[AGENT][NEUTRAL] Uh-huh. Yes, it was.
[CUSTOMER][NEUTRAL] OK. So the address which I provided to you.
[AGENT][NEUTRAL] It was sent.
[AGENT][NEUTRAL] Yes, it was sent to the MD Now Medical Center. It was remitted on the from the AVMed, that address, the [PII] is what is on there.
[AGENT][NEUTRAL] For the facility.
[CUSTOMER][NEUTRAL] So, you're transferring me to which department?
[AGENT][NEUTRAL] Well, I'm going, it was sent to what is on this remittance from the primary insurance company for the facility.
[CUSTOMER][NEGATIVE] Mm, but that's not the correct address.
[AGENT][NEUTRAL] OK. That's on the, OK, that's the information. I'm just saying that's the information that was submitted to us by the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the explanation of benefits, what is the NPI what is the tax ID number?
[CUSTOMER][NEUTRAL] OK, so you cannot go
[CUSTOMER][NEUTRAL] So you can
[CUSTOMER][NEUTRAL] Tax ID number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that is what was on the information we received with the [PII] address.
[CUSTOMER][NEGATIVE] So you cannot go ahead and reissue a new check as it was sent to the incorrect address.
[AGENT][NEUTRAL] According to what we have on file, that was not the incorrect address.
[CUSTOMER][NEUTRAL] So, what exactly we need to do now?
[AGENT][NEUTRAL] Again, I will transfer you to see what they can say about this as to why it was, but it was issued to the to the address that we received.
[CUSTOMER][NEUTRAL] So, so is there anything we need to submit any WA form or something?
[AGENT][NEUTRAL] I can let me get you connected and if you need a copy of that explanation of benefits sector you can get that from our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, we have the UOB with, I have the UOB with me, but, yeah, yeah.
[AGENT][POSITIVE] OK. Oh, OK. OK. All right. Well, give me just one moment then and if that's all I can help you with, thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Same to you. Bye-bye.
[AGENT][POSITIVE] Thank you, you too. One moment.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey, [PII]'s [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm good, and yourself?
[AGENT][NEUTRAL] I'm all right. I have a provider on the line. His name is [PII].
[AGENT][NEUTRAL] Um, his callback number he gave me is [PII].
[AGENT][NEUTRAL] And he's calling on policy 235-5945.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim in question is 351.
[AGENT][NEUTRAL] 9504.
[CUSTOMER][NEUTRAL] What's the question?
[AGENT][NEUTRAL] Um, he says the claim, the check was issued to the wrong address. This claim and this check shows it's cleared.
[AGENT][NEUTRAL] The address that's on the claim form itself is different. However, one of the two documents, because I just took a glance at it before I transferred, is the address that we sent the check to.
[CUSTOMER][NEUTRAL] Who process to go.
[AGENT][NEUTRAL] I don't have a clue.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So, I mean,
[CUSTOMER][NEUTRAL] I'm pulling up the claim.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So, what are you eating?
[CUSTOMER][NEUTRAL] Why is my own be moving so slow?
[CUSTOMER][NEGATIVE] She used the wrong vendor.
[CUSTOMER][NEUTRAL] But this, it has to be, I don't know it has to be an error document created for this claim.
[CUSTOMER][NEGATIVE] She sent it to the wrong ven she used the wrong vendor.
[CUSTOMER][NEUTRAL] But I'll let him know, but
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you know how to do an error document?
[AGENT][NEUTRAL] I don't. We don't do those.
[CUSTOMER][NEUTRAL] Oh, a hub. So, you have to do it through herb request cause [PII] did one for me one time. It was through her request.
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] Um, no, so this, so the, the, um, the person who processed the claim, you have to do a whole request saying that it's an error. She'll have to request a refund from the wrong provider that she sent the check to being that it was cleared.
[AGENT][NEUTRAL] I don't do.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I'll let them know, but I'll leave the notes on here, but you have to do that through hub request. That's, I can't, I'm not supposed to do that because you found the error, not me.
[CUSTOMER][POSITIVE] But I'll let him know that it's gonna be a refund requested and it'll be reprocessed and the payment will be sent to him.
[CUSTOMER][NEUTRAL] But y'all doing them through herb herb request because [PII] sent me one the other day actually.
[AGENT][NEUTRAL] She sent the hub request. Well, that's OK. So I, I can just tell him that. We'll have to send a hub, yeah, OK.
[CUSTOMER][NEUTRAL] But I'll let them know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That tell them that a refund will be requested and the payment will be sent out to him, but I can tell him that if you want me to.
[AGENT][NEUTRAL] Either way.
[AGENT][NEUTRAL] Either way.
[CUSTOMER][NEUTRAL] No matter. You, you can transfer him. I'll let him know.
[AGENT][NEUTRAL] OK, and
[AGENT][POSITIVE] OK. Well, thank you very much. I appreciate that. I'll take care of this other on the end.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Mhm. Have a good one.
[AGENT][POSITIVE] Alright, you too, thanks.