AccountId: 011433970860
ContactId: dc1f8cfe-271f-40ea-b7ca-2270ad942d51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1184150 ms
Total Talk Time (AGENT): 531773 ms
Total Talk Time (CUSTOMER): 279444 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/dc1f8cfe-271f-40ea-b7ca-2270ad942d51_20250604T17:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm a provider. I'm calling from SSM Health Medical Group. I'm calling regarding a claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. The policy number is 02597992.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the name is [PII]. Last name is [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, it is 319 of $25 with a total charge of $1,514.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 514. OK. Now, we received, you want the second one that was paid or the first, the original?
[CUSTOMER][NEUTRAL] Um, well, I know that when I spoke to a rep, uh, the claim was received. I spoke to a rep named [PII]. She stated that the claim was received on [PII], processed on [PII] on claim number 3586541. Um, she stated that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, there was a discrepancy with the taxpayer and um my lead reached out to me to have me reach out to you guys to see um what was the name, like what was the tax ID.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEGATIVE] Or the NPI that you guys had on your end that we was missing on our end.
[AGENT][NEUTRAL] OK, um, OK, so I see what happened. It's all one claim, the, the part that I said was denied, that's what you're speaking in reference to. OK. So you want to confirm the tax ID and the provider name that we have on file here for you all?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, you know what, I don't know if this, so let me check, I just noticed this. OK, so on the one that was, it's all one claim, but it's like two lines. On the first one that was paid, I don't see a tax ID here. They both say SSM Health Medical Group, but the one that was denied that giving you the issues, it shows tax ID 364.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Yes, but that's not on the one that was paid. It's just the one that was denied.
[CUSTOMER][NEUTRAL] OK, so the one that was paid.
[AGENT][NEUTRAL] Wait a minute. Hold on, hold on, hold on. I'm sorry, because I'm looking at it and trying to put it all together right now.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] This is so.
[AGENT][NEUTRAL] This is the same thing because it's the same code, the same build amount. What's the difference between these two? Is it, I don't see a modifier or anything.
[AGENT][NEUTRAL] Cause I'm trying to see if you have to even go through all this because it's already been paid. You see what I'm saying?
[CUSTOMER][NEUTRAL] Yeah, that's what I, that's what I was confused about. Um, let me go back.
[AGENT][NEUTRAL] Let me see, procedure code 2882528825. OK, that's the same.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The charge amount, 1514. OK, that's the same.
[CUSTOMER][NEUTRAL] And then they got a modifier.
[CUSTOMER][NEUTRAL] Do they got the T5 on there for the modifier?
[AGENT][NEUTRAL] Mm, well, let me pull it up like this because I can't see the modifiers. Let me pull up the claim form. Hold on one second.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] And it was.
[AGENT][NEUTRAL] I'm in a different screen. The last four of that claim number was 6541 or 14.
[CUSTOMER][NEUTRAL] 6541.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] Sorry, I was clicking and went to another screen.
[AGENT][NEUTRAL] 44.
[CUSTOMER][NEUTRAL] Oh no, you are fine.
[AGENT][NEUTRAL] The payment of 44 2025. OK, 44.
[AGENT][NEUTRAL] It's probably this one.
[AGENT][NEUTRAL] I'm just waiting for it, yep, on the first try. Hold on one second.
[AGENT][NEUTRAL] This may be an error. Hold on now, wait a minute. Um, do you mind, I'm sorry, do you mind if I place you on just a brief, um, just a brief hold. I'm trying to think through it and I see stuff and I don't want to say anything yet, but it looks like this, this may be an error that I don't think you have to go through all this because even on the claim form, it's just one line, so I don't know why it's 2 here on this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, let me do this.
[CUSTOMER][NEGATIVE] That's what was confusing me too.
[AGENT][NEUTRAL] OK, so we're on the same page. All right.
[AGENT][NEUTRAL] Because I'm like, this is the same exact thing. It's just I don't know where this tax ID came from for the second line, and that's what's giving you all the issues, but it's already been paid. Um, do you mind if I place you on just a brief hold? I'm just gonna reach out the claims and see if what I'm seeing is correct and you possibly could just disregard.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Yes. Hey, [PII], I was hoping I got you. This is [PII] from the canteen. How are you doing?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good. Can you look at this with me? I don't think I need to transfer her to you if what I'm thinking is correct.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Um, it's policy number 259-7992.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's um claim number, oh well, it's for part one.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's claim number 3586541.
[CUSTOMER][NEUTRAL] 3586511
[AGENT][NEUTRAL] 41
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, in lion, there's two lines, but it's the same exact thing. They're getting the B notice error because of this denied one right here. So when I was looking, I was like, wait a minute, this is the same thing, but the first line has a tax ID and the second one doesn't, but the second one was paid. So then I went to Onase to see if it really two things that they're billing for or what. So in Onase it's just one line, so it looks like we paid correctly.
[AGENT][NEGATIVE] Can they just disregard this be notice stuff because I, I don't even know, they don't know that they don't know that tax ID and
[AGENT][NEUTRAL] They were, they, she was calling to see what we had on file so that they can try to fix it with the IRS and once I looked at it, I'm like, wait.
[AGENT][NEUTRAL] We already paid this.
[CUSTOMER][NEUTRAL] OK, did you give her the payment information because that payment information went to the insured actually.
[AGENT][NEUTRAL] What payment information?
[AGENT][NEUTRAL] No, no, I didn't, I just said it was paid. I didn't tell her what.
[CUSTOMER][NEUTRAL] The $100.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, so that's why, because they were having an issue with the B notice so we paid the insured.
[CUSTOMER][NEUTRAL] Mhm, yeah, whenever there's an issue with it and they should, it should stay on the EOB that the payment uh went to the insured or something to that nature.
[AGENT][NEUTRAL] Yes, I do remember a code or something like that. OK. So, all I gave her was the tax ID that I saw versus what wasn't on the paid one. So, I'm OK to tell, well, I already gave it to her. I'm OK to tell her the tax ID that we're showing in the provider name because that's what she wanted so that they can try to correct it, I guess.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Hold on, my own base is moving slow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, yeah, you can give and that's the provider on the phone, is that correct?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so you can let her know what the tax ID that tax ID number is.
[AGENT][NEUTRAL] OK, OK, I gave you a tax ID and a provider name. OK, well, thank you for um clearing this up for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] Alright, no problem.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. So I, we figured out what's going on. So it's not that, um, so basically it was paid to the insured because of the issues we were having with the tax ID. So it is a true error or issue. Um, so the tax ID number, did you need me to give that to you again or you got it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Was it the [PII] or is it a new one?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, so that's the tax ID that came over and the provider show at SSM Health Medical Group.
[CUSTOMER][NEUTRAL] I wonder what the um tax, I mean what the discrepancy is because that's what I have on the claim form.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let me do this. Let me get you to an examiner so they can look further into it because I'm not sure how it all works and I don't want to give you any wrong information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Before I get a claims rep on the line, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL and hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Oh wait, wait a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] Doing well [PII] thank you how are you?
[AGENT][NEUTRAL] I'm doing OK. Um, I have a provider on the other line that wants to speak with you or somebody because she, um, they had a B notice error and she's trying to figure out what we, what the discrepancy is so they can correct it because what they entered is what's on the claim form, or what we're showing online is what's on the claim form and it's correct.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Who am I gonna speak to?
[AGENT][NEUTRAL] You know what?
[AGENT][NEUTRAL] Hold on one second. Let me look at Guru for a second. I just thought of this. I'm sorry.
[CUSTOMER][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Because they're changing it so much. I don't, I just wanna make sure.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] Uh, personal assistant.
[AGENT][NEUTRAL] OK, no, I'm sorry, let me send this over to [PII].
[AGENT][NEUTRAL] And [PII] can call her back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, if you need me just call me back now.
[AGENT][NEUTRAL] All right
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEGATIVE] The person you are trying to reach is currently unavailable.
[CUSTOMER][NEUTRAL] Please leave a message after the tone.
[CUSTOMER][NEUTRAL] When you have finished, please hang up or press the pound key for more options.
[CUSTOMER][NEUTRAL] This is [PII]. Can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] from the care team. How are you?
[CUSTOMER][POSITIVE] I'm doing fine, thank you.
[AGENT][NEUTRAL] You're welcome. I have a provider on the other line who has some B notice issues. Um, she's what we confirmed, I confirmed the tax ID with her and the provider name that that we have, and she said it's correct, but she, she's trying to figure out what the discrepancy is.
[AGENT][NEGATIVE] And I don't know how else to help her.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I don't, I don't know what to be here.
[AGENT][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEGATIVE] I don't understand what you're asking me. I don't know what a B notice is.
[AGENT][NEUTRAL] A be notice like.
[AGENT][NEUTRAL] Oh, OK. I'm sorry, they have you on the groove to reach you. Um, the B notice is like when the there's something that comes back with a discrepancy with the tax ID or the provider name and we end up paying the insured until they fix the provider fixes the issue with the IRS.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and so it's a claim?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they're OK, uh, I'm not sure what direction to point you in, um.
[CUSTOMER][NEUTRAL] [PII] sets up our vendors.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In the system. So,
[CUSTOMER][NEUTRAL] I'm showing her red right now, but I don't know if that means.
[CUSTOMER][NEUTRAL] If she's just on a phone call, um, she's probably a better person to tell you who to reach out to.
[AGENT][NEUTRAL] OK, I can send an email.
[CUSTOMER][NEUTRAL] And what
[CUSTOMER][NEUTRAL] Yeah, I think I would do that and I would get their name and number so they're not on hold the whole time and tell them that someone will be back with them very shortly or something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. Well, thank you very much.
[CUSTOMER][POSITIVE] OK. You're welcome, honey. Thank you. Bye bye.
[AGENT][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I'm so sorry for um for making you wait. I was trying to get someone on the claims team, but I couldn't get anyone. Um, I will, if you're OK with it, I can see, we have a um
[AGENT][NEUTRAL] What this is called is B notice. We have a Bno representative, um, and I tried to call her also, but it went to her voicemail, so I can send her an email to give you a call back so she can kind of go more in detail and maybe we can figure out what the disconnect is so we can get it corrected, yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Discrepancy is, yeah.
[AGENT][NEUTRAL] Is that right? OK, so, um,
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Hold on, let me see what I need to put in this email.
[AGENT][NEUTRAL] What's the best, well, I have your phone number. Do you prefer, I'll put both. What's a good email address for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, so I'm gonna go ahead and send this over. Her name is [PII], um, so that's who will be giving you a call back and I'm sending this email over for you now, OK?
[CUSTOMER][NEUTRAL] OK, and if you don't mind, um, can I get your name one more time and a reference number if not a reference number I can just use today's date.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, um, so there's no call reference number, but you can use my name [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alrighty well thank you and I appreciate your help.
[AGENT][POSITIVE] You're very welcome and thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.