AccountId: 011433970860
ContactId: ed81f48e-64c2-4797-8336-f0bb5742eef7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 536940 ms
Total Talk Time (AGENT): 171390 ms
Total Talk Time (CUSTOMER): 175338 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/ed81f48e-64c2-4797-8336-f0bb5742eef7_20250620T14:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning [PII] how are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] Good, my name is [PII]. I'm calling to check the status of a claim please for a patient.
[AGENT][NEUTRAL] I can help you with claim status [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] see.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] I have 02283218.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII] was [PII] Romeo [PII].
[AGENT][NEUTRAL] Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] 3 1925.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed the next day on [PII].
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] Give me one moment. That is a duplicate. It looks like it was submitted twice.
[AGENT][NEUTRAL] So give me just one moment.
[CUSTOMER][NEGATIVE] Yeah, that's what they told me when I called on [PII] and then they, they said OK we're gonna resend it back to review and it takes 5 business days, but 5 business days since [PII] it's been more than what we are right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let me see what's going on here.
[AGENT][NEUTRAL] And real quick so I can see if I found uh the duplicate. Um, I'm showing 3 procedure codes that were done that day. Um, do you happen to have those procedure codes so I can verify that this is the correct one.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It was a 01200274.
[CUSTOMER][NEUTRAL] And 868-0.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what happened was just to put you in the contest um.
[CUSTOMER][NEUTRAL] When you guys thought it was a duplicate is because of the 36 like 10 days before 13 days before she did the lower.
[CUSTOMER][NEUTRAL] Arch and then for the 319 she's been doing the upper arch.
[AGENT][NEUTRAL] Yeah, and that's that's what I'm saying.
[AGENT][NEUTRAL] Yeah, and that's what I'm seeing because I'm seeing the same procedure code at 868-0.
[AGENT][NEUTRAL] That was done on the [PII]. Let me see if I can get someone from claim support to look into this, OK? And I'll, uh, give me just one moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][POSITIVE] Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII]. I have [PII] from a dentist office on the line. Um, we were checking claim status and I was seeing for the claim for policy number 22.
[AGENT][NEUTRAL] 83218.
[CUSTOMER][NEUTRAL] And the data service.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] It's for [PII] and it shows that it was denied because it was a duplicate.
[AGENT][NEUTRAL] Cover whenever I looked at it, um, the only duplicate that I found because I just checked by a procedure code is the very next or the, the claim number that's right below it ending in 7864, and she said that one was for the lower and then the claim number 1881 was supposed to be for the upper.
[AGENT][NEUTRAL] Um, so it's, it's not a duplicate, but I was wondering if you could, if you could check in on that cause there's only one procedure code that was duplicated and that's because it was a separate part of the mouth. But I wasn't able to find anything else. No, um,
[CUSTOMER][NEUTRAL] Is it for the same data service though?
[AGENT][NEUTRAL] There there isn't any duplicate for the data service of 3-19 uh 25.
[AGENT][NEUTRAL] That's why I was confused and so I just decided to look it up by a procedure code.
[AGENT][NEUTRAL] And um
[CUSTOMER][NEUTRAL] No, we only, if, if it's a duplicate, it's gotta be the same day, same everything, so if it's not, then we just need to get that claim reprocess. Give me one second while I pull it up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Come on, on these.
[AGENT][NEGATIVE] Yeah, my on base has been real tricky today.
[CUSTOMER][NEUTRAL] 319.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like all of our computers go off the weekend early and then Monday they're too tired to work.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK, OK, let me check your records. OK, so she just needs to get that reprocessed.
[CUSTOMER][NEUTRAL] OK, you can, you can either tell her or you can send her over and I'll let her know that we'll get it reprocessed.
[AGENT][NEUTRAL] OK, I'll go ahead and send her to you just so that she knows um one moment and I'll I'll uh I'll introduce you.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] All right, [PII], I have [PII] from claims and she's going to uh talk you through that, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, but you explained to him that this is not the first time that we call, we call on [PII] and they said it was gonna take the review for 5 business days.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] You can send her on over. I got her I got her. Thank you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How are you?
[CUSTOMER][NEUTRAL] Hi [PII] how are you? Good morning. I'm doing well, thanks for asking. OK, she stated that um you're calling about the claim for 319-2025 and uh the client denied for being a duplicate.
[CUSTOMER][NEGATIVE] And so I looked at it and I do not see that we have processed these charges previously so what I can do is go ahead and have this claim sent back for review. That's what they told me when I called on [PII] they were gonna send it back to review and it was gonna take 5 business days and we are in [PII]. It's been more than 5 business days.
[CUSTOMER][POSITIVE] All right, I do apologize for that.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So they didn't do anything since I called on [PII]?
[CUSTOMER][NEUTRAL] No ma'am, it looks like it has not been reprofit.
[CUSTOMER][NEUTRAL] Uh, I have the reference number if you want to.
[CUSTOMER][NEUTRAL] Uh, I won't be able to locate it with the reference number. Uh, I'm gonna go ahead and send it over and we're gonna try to get it expedited on today, um, and if you wanna check back.