AccountId: 011433970860
ContactId: e42fc35e-c843-4ed7-b8ff-e38d9b0364ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303519 ms
Total Talk Time (AGENT): 115988 ms
Total Talk Time (CUSTOMER): 180070 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/e42fc35e-c843-4ed7-b8ff-e38d9b0364ed_20241230T15:20_UTC.wav
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[AGENT][NEUTRAL] [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] [PII], hi, this is [PII]. How are you?
[AGENT][POSITIVE] I'm great, Ms. [PII]. How are you doing?
[CUSTOMER][NEUTRAL] Good. I have a dental question.
[CUSTOMER][NEUTRAL] Do you want me to see if I can get somebody else?
[AGENT][NEUTRAL] Mm, I can see if I can help you, but I don't process them, so what's the policy number?
[CUSTOMER][NEUTRAL] I don't think
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, no, but this is the dental cue, so you're it.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It is 255.
[CUSTOMER][NEUTRAL] 5870 and it's for part two.
[AGENT][NEUTRAL] I tell what [PII] did, babe. Hey, is it a client?
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] Yeah, I think [PII] did this one yeah it is it's the only claim that he has.
[CUSTOMER][NEUTRAL] And let me ask you this question. I think you may know it so you know the profies, the, the tropical fluoride that includes the prophy and there's a code without it. Our schedule, the ADA codes are not updated. Mhm and usually when we get one that they're using the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It's not updated.
[CUSTOMER][NEUTRAL] The new code
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We denied it, but it is actually the, the correct code and I know [PII] usually kind of catches those, but we denied it, it's not covered.
[AGENT][NEUTRAL] What's the 12:06, um, it's.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And so the 1206 replaced the 1203.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Yeah, cause it's covered. It falls on the preventative services.
[CUSTOMER][NEUTRAL] Right. And you
[AGENT][NEUTRAL] Unless it's varnished, is it varnished though?
[CUSTOMER][NEUTRAL] It's not, he, so he had that they built for the um the prophy, the cleaning with the fluoride application.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so what they did was they built the 1120, they build the the the cleaning under the 1120.
[CUSTOMER][NEUTRAL] And then they built for the fluoride application without the trophy or the cleaning.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2 hours.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which is the 12:03.
[CUSTOMER][NEUTRAL] On our schedule but he billed it as the 1206, which is the most current procedure code.
[AGENT][NEGATIVE] Schedule. I wanna know why they don't update those.
[CUSTOMER][NEUTRAL] I know it.
[AGENT][NEUTRAL] And I it's just a little bit less frustrating.
[CUSTOMER][NEUTRAL] Uh no, it would be.
[CUSTOMER][NEUTRAL] And so usually when Angela pro, you know, she usually kind of.
[AGENT][NEUTRAL] It it the system normally would change like I know when I processed dental, the codes weren't updated, but the system will still pay it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so,
[AGENT][NEUTRAL] So she needs to reprocess claim.
[CUSTOMER][NEUTRAL] Do you show that it was [PII]? Is that [PII] or [PII]'s initials?
[AGENT][NEUTRAL] I ain't no [PII] process claims, but let me, I mean dental claims, but let me make sure.
[CUSTOMER][NEUTRAL] And may maybe I'm wrong. [PII] Let me see who that is. OK, I thought that was her initials.
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] I don't know on the process on the [PII].
[CUSTOMER][NEUTRAL] And when was it processed? She was probably.
[CUSTOMER][NEUTRAL] OK, just recently she probably was back up or something like that.
[AGENT][NEUTRAL] It's processed on the [PII] it just processed a couple of week last week or week before last.
[CUSTOMER][NEUTRAL] Just recently. Mhm.
[CUSTOMER][NEGATIVE] She must have been back
[AGENT][NEUTRAL] Oh that's probably why, but it normally would pay it though when I processed it, it would pay it because it was.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just caught it. I don't know.
[CUSTOMER][NEUTRAL] Yeah, and I, I looked at her own team she's out, so that's why I called the queue. I was gonna reach out to her.
[AGENT][NEUTRAL] So somebody needs to reprocess it.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I'll send it through. Is [PII] here?
[CUSTOMER][NEUTRAL] Uh, she's away.
[CUSTOMER][NEUTRAL] I'll, I'll reach out to you.
[AGENT][NEUTRAL] uh, so are you gonna send an error document or?
[CUSTOMER][NEUTRAL] Well, I don't know. I'll send it through team. I'll I'll do a hub request.
[AGENT][NEUTRAL] Do you know how to spin it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A help request.
[AGENT][NEUTRAL] Oh, OK. I think they, they changed it some kind of way. You know how when we used to get an error, they send the error document.
[AGENT][NEUTRAL] Somewhere I got a new way to do it now.
[CUSTOMER][NEUTRAL] But I don't think
[CUSTOMER][NEUTRAL] Our roles have kind of changed so we can't go in and do that part anymore because it's a claim function we just have to send a hub request, but I'm gonna reach out to [PII] before I do that.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because she just kind of go back in and reprocess it.
[AGENT][NEUTRAL] If she only look like just the one line she needs to reprocess, but.
[CUSTOMER][NEUTRAL] Right. Right.
[AGENT][NEUTRAL] I don't know why the system didn't change it. It normally would change it.
[CUSTOMER][NEUTRAL] Yeah, um, but I'm, I wish we could get our schedule updated because it's that code, it's two codes that we need to update.
[AGENT][NEUTRAL] Yeah, well I.
[CUSTOMER][NEUTRAL] Well, it's just the fluoride, but it's the child and the adult both of those need to be updated.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, I agree.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] All right, Ms. [PII], thank you.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. It was nice hearing from you. Have a good one and happy [PII]'s if I don't talk to you again.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] OK, same to you.
[AGENT][POSITIVE] Thank you. Bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye.