AccountId: 011433970860
ContactId: d8a98092-9629-453f-ac1b-05d08d0ea2ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 999390 ms
Total Talk Time (AGENT): 267511 ms
Total Talk Time (CUSTOMER): 423055 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/d8a98092-9629-453f-ac1b-05d08d0ea2ad_20250428T13:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APM. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hey, [PII], it's [PII]. Good morning. How are you?
[AGENT][POSITIVE] Good morning. I'm good thanks how are you?
[CUSTOMER][NEUTRAL] I'm all right thank you. I have a dental provider's office on the line.
[CUSTOMER][NEUTRAL] That I need um for you to speak with I've tried to decipher this claim the best that I can.
[CUSTOMER][NEUTRAL] The policy number, [PII] is 256.
[CUSTOMER][NEUTRAL] 831 9.
[CUSTOMER][NEUTRAL] And the lady's name that I have on the on the line is [PII].
[CUSTOMER][NEUTRAL] She's calling about date of service [PII].
[CUSTOMER][NEUTRAL] OK, so for this data service there's two claims on file. Well, the they had called in January and ED gave them the information on the claim number ending in 358.
[CUSTOMER][NEUTRAL] But that's
[CUSTOMER][NEUTRAL] That's a totally different provider.
[AGENT][NEUTRAL] OK, I'm sorry, you said what's the data service?
[CUSTOMER][NEUTRAL] The tax ID.
[CUSTOMER][NEUTRAL] 1217 of 24.
[AGENT][NEUTRAL] Hm, I'm not getting, finding that date. Let's see.
[CUSTOMER][NEUTRAL] Really?
[AGENT][NEUTRAL] What was the claim number?
[AGENT][NEUTRAL] Is it under part one?
[CUSTOMER][NEUTRAL] Yeah, there's only one part on this [PII].
[AGENT][NEUTRAL] OK, and what was the claim number?
[CUSTOMER][NEUTRAL] Well, I that, OK, the two that are on file for this data service is 354-535-8.
[CUSTOMER][NEUTRAL] And 354-6599.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the claims information that they have been given when they called for status was the one ending in 58.
[CUSTOMER][NEUTRAL] However,
[CUSTOMER][NEUTRAL] That's not their claim.
[CUSTOMER][NEGATIVE] [PII] just mistakenly gave them that claims information.
[CUSTOMER][NEUTRAL] It's what I'm, I'm gathering from what she's saying.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then the other claim ending in 99.
[CUSTOMER][NEUTRAL] The provider name matches, the tax ID matches the address matches for the provider, but the billed amount on the claim we received is more than what she initially gave me so because everything else matched, I did tell her in the same codes. I mean the codes that are on the claim are the ones that she gave me as well.
[CUSTOMER][NEUTRAL] So she thinks that what happened was they used the wrong fee amounts initially and which is why the claims is for 435 instead of.
[CUSTOMER][NEUTRAL] 395.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Their claim ending in 99 was denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEGATIVE] Very confusing.
[CUSTOMER][NEUTRAL] Or for me it is.
[CUSTOMER][NEUTRAL] I don't know why we denied their claim as a duplicate when they had not submitted one claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, it's, it's just odd.
[AGENT][NEGATIVE] So they're saying that they should have gotten paid more?
[CUSTOMER][NEUTRAL] And the first claim number?
[CUSTOMER][NEGATIVE] Well, they didn't get paid at all. They haven't been paid at all because their claim was denied as a duplicate and it looks like we paid.
[CUSTOMER][NEUTRAL] The claims information that EV gave her, it was to a different provider under a different tax ID number.
[CUSTOMER][NEUTRAL] And all of that.
[CUSTOMER][NEUTRAL] I don't really know what happened.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But we denied all three of the codes on claim number 99 ending in 99 as duplicates.
[CUSTOMER][NEUTRAL] But I don't even see the 0110.
[CUSTOMER][NEUTRAL] It sounds like he went to 2 providers the same day, 2 different providers.
[AGENT][NEUTRAL] So the provider you have on the other line is from the comfortable care dental.
[CUSTOMER][NEUTRAL] Let's see, [PII], the one matching the 99 information so.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Provider Victor Key, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm ready to transfer them over and what was their um callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And again her name is [PII].
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Alright, [PII], well thank you for your help have a great day.
[AGENT][POSITIVE] Thanks you too.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Thank you for holding, this is [PII].
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII].
[CUSTOMER][NEUTRAL] And um I got transferred for a case that we're trying to look into.
[AGENT][POSITIVE] Uh yes, ma'am. Uh, how can I help you today?
[CUSTOMER][NEUTRAL] Um, yes, so it looks like either are we sent a claim and the amount.
[CUSTOMER][NEGATIVE] Is um not.
[CUSTOMER][NEUTRAL] Is not coming up as what we have so I think we sent a claim.
[CUSTOMER][NEGATIVE] And then we sent another one with different fees possibly.
[CUSTOMER][NEGATIVE] And then now I now my fees don't match the fees that we sent because they're less so I'm wondering if we had a mix up on our fee scheduling.
[CUSTOMER][NEUTRAL] And we finally got it corrected with the right fee schedule?
[CUSTOMER][NEUTRAL] And that could possibly be it.
[AGENT][NEUTRAL] OK. Um, let's see.
[AGENT][NEUTRAL] Do you have a claim number?
[AGENT][NEUTRAL] Or the date that you submitted the claim.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I, yes, well, I don't have have a reference number and what's funny is that we were told.
[CUSTOMER][NEUTRAL] That a check was sent to another office?
[CUSTOMER][NEGATIVE] Yeah I don't believe we're connected to.
[CUSTOMER][NEGATIVE] So it's kind of a mess.
[CUSTOMER][NEUTRAL] Um, would you like the reference number?
[AGENT][NEUTRAL] Um, well, we don't have reference numbers, so I'm
[CUSTOMER][NEUTRAL] What's the name and and.
[AGENT][NEGATIVE] How furious
[AGENT][POSITIVE] Oh, I'm sorry?
[CUSTOMER][NEUTRAL] It's a reference to like get somebody's name it looks like the date.
[AGENT][NEUTRAL] Yeah, that's probably when you guys someone had called in and you spoke to someone, um, I was referring to like the claim number of when you sent in the claim and it was processed and it, so you did initially send in a claim, was that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We did looks like there were 2 claims according to the last representative that helped me out.
[AGENT][NEUTRAL] OK, and do you have those claim numbers or the dates that those claims were sent in?
[CUSTOMER][NEUTRAL] Uh, so they were sent on [PII].
[CUSTOMER][NEUTRAL] Um, let me see if anything pops up over here.
[AGENT][NEUTRAL] And what was the the provider name on that claim?
[CUSTOMER][NEUTRAL] So it's gonna be Victor. Last name is [PII]
[AGENT][NEUTRAL] OK, and what was the total fee amount?
[CUSTOMER][NEUTRAL] So what we have is 395, but what you have is 435.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Looks like our comprehensive and our um FMX was sent at um a different amount.
[CUSTOMER][NEUTRAL] The prophy was the same 124.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or the code 1110.
[AGENT][NEUTRAL] So you think that we we received the wrong information for that claim?
[CUSTOMER][NEUTRAL] I'm thinking that's what happened and maybe we had the wrong fee schedule and then we sent the wrong we sent the wrong fee schedule to you now but the fee is actually a little bit lower, um, because maybe we have the new, I don't not for sure what happened.
[AGENT][NEUTRAL] OK, were you wanting to resubmit the claim to us or we review?
[CUSTOMER][NEUTRAL] But that's the only thing I can think of.
[CUSTOMER][NEUTRAL] I do. I just don't want it to get denied because looks like what I was told that you already have.
[CUSTOMER][NEUTRAL] Two claims for the same date for the same thing.
[CUSTOMER][NEUTRAL] Just different amounts.
[CUSTOMER][NEGATIVE] So I just don't want this 3rd 1 to get denied.
[CUSTOMER][NEUTRAL] So do I just put corrective claims wrong fee schedule was attached?
[CUSTOMER][NEUTRAL] Um, something like that in the note.
[AGENT][NEUTRAL] Yes, I, I would just note that information that like this is um the basically an addendum for the last for the previous claim and maybe also the um referred to that pre previous claim number that was previously processed and denied and send that that this is a an addendum to that claim because it you guys sent the wrong fee schedule.
[AGENT][NEUTRAL] So it could be re-reviewed.
[CUSTOMER][NEUTRAL] OK, did the wrong seat schedule, OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Schedule OK, um, now would I be able to get a claim number so I can attach that?
[AGENT][NEUTRAL] So it looks like that claim that was received, the claim number was 3546599.
[CUSTOMER][NEUTRAL] OK, and, and should I put that same claim number onto this addendum?
[AGENT][NEUTRAL] I would just reference that that was the claim number that the original was processed on and that it needs to be re-reviewed.
[AGENT][NEUTRAL] Because the wrong information was sent, it just kind of indicating that so that we that the adjuster knows that this is a replacement of that claim and not just a duplicate.
[AGENT][NEUTRAL] With the same dates of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, alright, I will definitely do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that's it for yeah, that was it. Um, may I get a reference number I know I know you said you don't have reference number or?
[AGENT][NEUTRAL] Uh, sure, you're free to use my name and today's date and my name is [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][POSITIVE] Great, OK.
[CUSTOMER][POSITIVE] All right [PII], thank you so much I appreciate it.
[AGENT][NEUTRAL] Not sure I needro, was there anything else I could do to help you today?
[CUSTOMER][NEUTRAL] No, no, that was it. I'm gonna resend that in. I think I'm figuring that's what happened and we just had the wrong schedule the schedule, and somehow it got adjusted.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Sure, well, I'll also note the adjuster to, to look out for the claim as well and um I have your callback number as [PII].
[CUSTOMER][NEUTRAL] Hopefully that'll fix it.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and so if they have any other further questions that they can reach out to you and just to make sure that you know we're all on the same page regarding the processing of that claim.
[CUSTOMER][POSITIVE] OK perfect they can speak to anyone here in the office I'll make a note um so anyone can pop up and read it, so I appreciate that.
[AGENT][NEUTRAL] Oh sure, I need to, I'm sorry, can I put you on hold for just one second? I'm gonna take one more quick look at something, OK?
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] OK sounds great thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh, good morning. How are you doing?
[AGENT][NEUTRAL] 00, can you hear me?
[AGENT][NEUTRAL] Oh, OK. Uh, yes, OK, so I'll be honest, I'm a little confused at what the provider was saying for this claim, um.
[AGENT][NEUTRAL] So, so you do see to where we have to, we need to reprocess that one claim for the, the provider keys.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so the one that we did as a duplicate was that with the, the total bill was at 435?
[AGENT][NEUTRAL] Oh, I just wanna make sure I was looking at the right bill. So the bill that has that total fee of the 435, that's the one that you're gonna reprocess, right?
[AGENT][NEUTRAL] Right, OK, OK, so I'll just let her know because she was gonna, she thought maybe that they sent over the wrong fee schedule or something she kept saying and that that was why it was denied, but I'll just let her know that they don't have to resend anything that we'll just go ahead and reprocess it, is that right?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK. OK, thank you so much.
[AGENT][POSITIVE] I think you have a good day.
[AGENT][NEUTRAL] Mm bye bye.
[AGENT][NEUTRAL] OK, I'm sorry about that. Um, [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. So I just spoke to the adjuster and we're gonna go ahead and go ahead and reprocess what we have now for you. So don't, don't worry about resending in that the new claim information. We'll go ahead and reprocess this and then you, you should receive a response from us, um. It should be released today, but you should receive that response in the next couple of days, OK?
[CUSTOMER][POSITIVE] OK great I appreciate you doing that that is awesome.
[AGENT][POSITIVE] Uh, sure, no problem. Is there anything else I could do to help you today?
[CUSTOMER][POSITIVE] Oh no ma'am, that was, that is awesome I appreciate that.
[AGENT][POSITIVE] You're very welcome. Thanks for calling AP. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.