AccountId: 011433970860
ContactId: d6103fb9-5ac4-4f16-9387-e3e197e8449c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1331020 ms
Total Talk Time (AGENT): 361012 ms
Total Talk Time (CUSTOMER): 470952 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/d6103fb9-5ac4-4f16-9387-e3e197e8449c_20250207T20:57_UTC.wav
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[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. Good afternoon. This is [PII], uh, calling from provider's office to check members claim.
[AGENT][NEUTRAL] [PII], I can help you with that claim status this afternoon. What is a good callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What is the policy number for the patient?
[CUSTOMER][NEUTRAL] Sure, the policy number I have 02494077.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Alright thank you and I can help you with that claim status for [PII]. Let me get it pulled up real quick, please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for your patience, [PII]. I have the policy pulled up. What is that data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is this for dental clean?
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is the provider name?
[CUSTOMER][NEUTRAL] Sure, the doctor name I have is
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], I am showing that we did receive that claim on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it was processed and paid on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, I have uh one question regarding one code. It is 2392 to number 31. Did you pay for that one?
[AGENT][NEUTRAL] 2392.
[CUSTOMER][NEUTRAL] Yeah, to number 31.
[AGENT][NEUTRAL] Now, I'm seeing a charge for tooth number 20.
[AGENT][NEUTRAL] For the 2393.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, because there is, uh, number 30 and 31 which was billed. So I believe we received payment for one.
[CUSTOMER][NEUTRAL] 2393, that is for 176. But the other two number is not listed on the EOB or
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see that. Let me check the claim real quick, bear with me just one moment. Let's make sure it was listed on the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm sure.
[AGENT][NEUTRAL] Let me just get that pulled up real quick.
[AGENT][NEUTRAL] OK, I do see that listed on the claim. What I'm going to do, [PII] is to send that back to our claims department.
[AGENT][NEUTRAL] To review for reprocessing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that particular CPT code.
[CUSTOMER][NEUTRAL] OK, so it's not processed yet, right, on that, uh, for this code.
[AGENT][NEUTRAL] Not for the 2:31.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, was there any separate claim number for that just for that particular procedure or the same?
[AGENT][NEUTRAL] No, sir. I, it's the same claim number.
[CUSTOMER][NEUTRAL] Same thing. Because if I use the same claim number, uh, on the UB it's not listed. So I'm not sure if you are generating a new claim number or not.
[AGENT][NEUTRAL] Once it goes to claims and it's reprocessed, it will have a different claim number for that.
[AGENT][NEUTRAL] She's number 31.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] How many days we need to wait like 30, 15 days, sir?
[AGENT][NEUTRAL] Uh, 7 to 10 business days.
[CUSTOMER][NEUTRAL] Any reference number on this request or?
[AGENT][NEUTRAL] There's, you can use my name in today's date.
[AGENT][NEUTRAL] And I spell my name [PII]
[AGENT][NEUTRAL] First initial last name, [PII]. And [PII], if you don't mind holding just one moment while I submit this request, would that be OK?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you. I'll put you on a brief hold and I'll be back with you shortly.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII] that request has been sent to our claims department.
[CUSTOMER][POSITIVE] Outstanding
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] And I, I appreciate your patience while I did that.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh yeah, yeah, I like I have uh uh like how many more claims you can assist uh if I have.
[AGENT][NEUTRAL] How many of you need, [PII], bear with me just one second. Let me notate this account?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Like 2.
[AGENT][POSITIVE] And I can help you with more claims.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Just give me just a second.
[CUSTOMER][POSITIVE] Take your time. No worries.
[CUSTOMER][NEUTRAL] 12.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] 21307.
[AGENT][NEUTRAL] I have to put specifics in the notes, so bear with me just a second.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] People that fine or anything.
[CUSTOMER][NEUTRAL] 5000.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And you said you had another
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Claim status, correct?
[CUSTOMER][NEUTRAL] Yes, I have 2 more. Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] Hang on just a second.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] have.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, [PII], I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Sure, the next policy number I have.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is that a social?
[CUSTOMER][NEUTRAL] Yeah, I believe it's social.
[AGENT][NEUTRAL] OK, let me get to that screen. Bear with me just a second because I'll have to.
[AGENT][NEUTRAL] Look it up a different way. What is that social again, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the patient's name?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] And allowed amount is also $250.
[AGENT][NEUTRAL] Alright thank you and what is that data service?
[CUSTOMER][NEUTRAL] Date of service I have [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And what is that dental provider name?
[CUSTOMER][NEUTRAL] Sure, the doctor name I have [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking, so bear with me just one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 50
[CUSTOMER][NEUTRAL] 96
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, I had to find the, the paid claim for that one. It looks like there was some duplicates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that original claim.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] We received on 64-24.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on 6-12-24.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And there was a payment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got the phone last night
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Of 19,540 to the dental provider.
[CUSTOMER][POSITIVE] Perfect. When it was made?
[AGENT][NEUTRAL] Um, 6, 1224.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Can I get the uh cash date when it was cleared?
[AGENT][NEUTRAL] Sure, let me check that for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[AGENT][POSITIVE] Uh, looks like it's still outstanding. It went to [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] This was like finally for [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] So it's still outstanding?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Like, uh, do you have any reason like why it's still outstanding?
[AGENT][NEGATIVE] I don't have that information. I just does not appear to have cleared.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What we can do on this one now, uh.
[AGENT][NEUTRAL] Is that the correct address?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, actually, for the provider, I have a different, uh, you know, billing address, that's the rendering address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] Let me get this claim pulled up as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 17.
[AGENT][NEUTRAL] And let me check that for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] I I've been
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] What hard pressed.
[AGENT][NEUTRAL] That is the address we have on file for.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] On the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] And so we have to go by whatever's on the claim.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Now you can send an updated claim.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] With the corrected billing address?
[AGENT][NEUTRAL] And state that you never received the payment for claim number 3467966, so I can give you that claim number again.
[AGENT][NEUTRAL] And we can have that voided and reissued to the correct address if we, but we'll have to have a claim form with the updated address.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I believe we have already uh did that one as well.
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] OK, did you send the email form to update the address by mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm looking at the last claim received, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was denied as a duplicate. Let me check that for you.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] The last claim we received still has that address on it.
[CUSTOMER][NEUTRAL] 197
[CUSTOMER][NEUTRAL] number
[AGENT][NEUTRAL] The same billing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, you can only reissue to the same address which is listed in your end, right?
[AGENT][NEUTRAL] Um, and it's on the claim and that [PII].
[CUSTOMER][NEUTRAL] Same, OK.
[CUSTOMER][NEUTRAL] In
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the correct address?
[CUSTOMER][NEUTRAL] Uh, the, uh, billing address which I have here is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We don't have that on file.
[CUSTOMER][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just let me just uh check one more thing here.
[AGENT][NEUTRAL] And if you can send the corrected uh copy of the W-9 with the updated address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just to get it.
[AGENT][POSITIVE] And you can actually fax that to us.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Need to get a valid, because they are saying need to get a valid fax number because the fax number which I have [PII] is not uh correct.
[AGENT][NEGATIVE] Yeah, that's not right.
[AGENT][NEUTRAL] That's not correct. I can give you the, yes, sir. I can give you that. The correct fax number is 877.
[CUSTOMER][NEUTRAL] OK. Do you have a valid like?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Attention to uh Alisa or?
[AGENT][NEUTRAL] Claims.
[CUSTOMER][NEUTRAL] OK, dental theme, uh, just a claim, right? Attention.
[AGENT][NEUTRAL] Right, and that's right, and I can give you the claim number and if y'all will put on there please see updated claim with corrected um provider address and then put on there that you never received that payment for claim number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And I can give you the claim number.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 346-796-6 is the claim number.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Ok.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 877365-3659423.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I got here. 942-3. OK. [PII].
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][POSITIVE] Perfect. Now, can they, uh,
[CUSTOMER][NEUTRAL] I actually, I have one more uh claims to check. Just one small question for the last one.
[AGENT][NEUTRAL] Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] Uh, to different patients actually.
[AGENT][NEUTRAL] OK, I'm ready for that policy number.
[CUSTOMER][NEUTRAL] Sure. The policy number I have here is 02277598.
[AGENT][NEUTRAL] And that name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. And do you have that claim number or date of service?
[CUSTOMER][NEUTRAL] Yeah, I have the both claim numbers. The date of service I have [PII], where the claim number is 3552432.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. And that provider name?
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Sure, this provider name I have [PII].
[CUSTOMER][NEUTRAL] And I just have a, uh, one question, sir, regarding this claim.
[AGENT][NEUTRAL] What, what is the, oh, [PII] Bs, got it.
[AGENT][NEUTRAL] OK, I've got that claim pulled up. [PII], how can I help you?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK. Uh, actually, uh, we got a payment on this claim regarding the uh D0120 and D1120. Uh, was this process at 100%, like, uh, the, for the allowed amount or how, how it was paid?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on this policy, let me get that.
[AGENT][NEUTRAL] 00120.
[AGENT][NEUTRAL] Now we pay at a percentage of the usual customary rate.
[AGENT][NEUTRAL] So that is preventive services, so we paid 100% of the usual customary rate, which is $75.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, uh, so it's paid at 100.
[CUSTOMER][NEUTRAL] 100%, right, of your UCR fees.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, I'll just mention that.
[CUSTOMER][NEUTRAL] So there is no in-network or out of network, right? There is only UCR fees.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, that was paid at.
[CUSTOMER][POSITIVE] paid at 100%.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] and the safe.
[CUSTOMER][NEUTRAL] Yeah, perfect. So this is the only uh information I was looking for this policy.
[CUSTOMER][POSITIVE] So, uh, thank you so much for your patience and help. Uh, I hope you have a lovely weekend ahead.
[AGENT][POSITIVE] Well, [PII], it has been such a pleasure to assist you and thank you for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Same here.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.