AccountId: 011433970860
ContactId: d996b64a-da30-4490-b479-9bcd1e190d72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396299 ms
Total Talk Time (AGENT): 214978 ms
Total Talk Time (CUSTOMER): 121725 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/d996b64a-da30-4490-b479-9bcd1e190d72_20250212T21:06_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi um I am calling from a provider's office. I was wanting to follow up on a claim.
[AGENT][NEUTRAL] I can help with the claim and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], thank you. What is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Um, it is, sorry, one second.
[CUSTOMER][NEUTRAL] Um, it is 02410980.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and her date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number, [PII], I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, um, it is [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for um [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is [PII] of last year.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. We had a cleaning.
[AGENT][NEUTRAL] Um, X-rays, periodical examination. Does that sound right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like that uh was um
[AGENT][NEUTRAL] Send out uh it.
[AGENT][NEUTRAL] The um
[AGENT][NEUTRAL] Claim went out in the mail on October, excuse me, I'm sorry, [PII]. Uh, it looks like um a check for $110 was
[AGENT][NEUTRAL] Sent and I'm just going to check that uh check number is 2019676 and it looks like it was cashed on [PII].
[AGENT][NEUTRAL] So, um, the, uh, claim number.
[AGENT][NEUTRAL] For this.
[AGENT][NEUTRAL] Uh, let me just check here. It's uh 354-418-6.
[AGENT][NEUTRAL] Um, check, uh, number 2019676. It looks like this was cash in January.
[CUSTOMER][NEUTRAL] Um, yes, uh, we, we did receive it, but, um, on the claim, the, the bite wing, uh, code that we sent and the, uh, pro fee code that we sent, the fee that um is listed on the EOB that we got back was not what we submitted, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I called on [PII] and the lady I spoke with said that whoever entered the claim just entered it wrong and she was sending it back through to be reprocessed and she said it was supposed to take 8 to 10 days. I was following up on that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what we're having, what we, you have a question about is the bite wing, the, the code for the bite wings, which, let me just, I'll just have to go back to here. Give me just a second, [PII], I'm sorry.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's 0027 excuse me, 00274.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and the other one was the oral examination, is that correct?
[CUSTOMER][NEUTRAL] The profi the D1110.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] 111. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like that was sent back into us, um, and, and, uh, for whatever reason they, they listed it as being a duplicate. So I'm, I'm gonna take it out of that status. I'm gonna send it back in as a correction. I, I don't know why it was listed as a duplicate to begin with, um, but, uh, but it was, and that's what the problem is. So we did the, it was reviewed but it was reviewed as a duplicate. Um, so what we're gonna, I'll go ahead and, and uh have the um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] You all this up first.
[AGENT][NEUTRAL] Just a second here.
[AGENT][NEUTRAL] And it was the uh coding that uh you felt that there, you feel that there's more uh more should have been paid on it. Is that
[CUSTOMER][NEUTRAL] Well, the, the, no, the fee for each code is not correctly listed on the charged amount on the EOB. It's not what we sent in, um, so for example, the bye wings that are listed on the EOB, it says that we build them out for $24 but we actually build them out for $65.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the pro fee it lists that it's a $21 fee.
[AGENT][NEUTRAL] $90 yeah.
[CUSTOMER][NEUTRAL] Yeah, well we build 90.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So the fees were I guess entered wrong is what the lady said last time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um, let me go ahead and send this back to the examiner and uh it's, um, for whatever reason they, they were listing this is is just being a duplicate. So let me go ahead and, and, uh, send this back and uh I can have the, the, um, examiner uh.
[AGENT][NEUTRAL] Uh, look at it again. Um, let's just see, make sure I've got the right one,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], I'll go ahead and do that. I'll go ahead and send it back, um.
[AGENT][NEUTRAL] And let them know that it's not a duplicate, that what it is is that we need to look at those two specific codes that's being reprocessed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now is this the only claim that we need to look at? Is there anything else at all that we need to?
[CUSTOMER][NEUTRAL] Uh, nope, that's the only one.
[AGENT][POSITIVE] OK, OK. Well, I, I apologize for the inconvenience, so I'll go ahead and send it back and we'll see what we can do by getting this resolved.
[CUSTOMER][NEUTRAL] OK, and then about how long should that take?
[AGENT][NEUTRAL] Well, it usually it's, um, I'm sending it back today. I would hope that she would be able to look at it tomorrow, um, uh, to have that done. And usually you, you will receive uh an EOB from us. Um, it's usually about 3 to 4 business days. We're working on the claims that were received on the [PII], so it's um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it usually doesn't take that [PII]g for us to get this processed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, that's all I needed thank you.
[AGENT][POSITIVE] OK, thanks for contacting HP. Have a good day.