AccountId: 011433970860
ContactId: f71780c4-1a7c-42e3-b876-e72af53cbb1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288250 ms
Total Talk Time (AGENT): 96515 ms
Total Talk Time (CUSTOMER): 165397 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/f71780c4-1a7c-42e3-b876-e72af53cbb1c_20241231T13:46_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good morning Ms. [PII]. My name is [PII]. I'm calling from Reef Kids Dental. You were kind enough to leave us a message yesterday returning Doctor [PII]'s phone call about a patient.
[CUSTOMER][NEUTRAL] Um, just had a quick question, um, if you would.
[AGENT][NEUTRAL] OK, I can barely hear you.
[CUSTOMER][NEUTRAL] OK, is this better?
[AGENT][NEUTRAL] That's better and give me your name again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII]. it's [PII]
[AGENT][NEUTRAL] OK, and it's regarding the what policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is 02555870.
[AGENT][NEUTRAL] OK, what's a good uh callback number angry in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy number.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK thank you alright so uh yes I left a voice message on yesterday.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, oh,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, Doctor [PII] wanted me to call to ask, um, if it would be.
[CUSTOMER][NEUTRAL] Possible, um, there's a code that was on the fax that we received for the 1203, which is, um, topical application of fluoride, um, but it says profy not included um can we send um send a mailed claim with that code and would it perhaps be covered that way?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What do you mean, mean a bill claim?
[CUSTOMER][NEUTRAL] Like, send it, um, we usually send our claims electronically, but our software does not allow us to add the 1203 so if we sent a paper claim with that code, would it be covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With the 1203 code?
[CUSTOMER][NEUTRAL] Yes, for that same date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd, let me look at the schedule.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, that is on the schedule of benefits.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] When it's in parentheses where it says the pro fee is not included, does that mean that the patient has to come in on a separate date just to have the fluoride application?
[CUSTOMER][NEUTRAL] Or can we bill that code even though they had a pro fee on the same day?
[AGENT][NEUTRAL] But he built the trophy separately under the D 1120.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So, uh, 1201, which is an older code 2 I believe, that includes the fluoride and the profy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so if we.
[AGENT][NEUTRAL] For the for the child, so it looks like he billed the the 1120 he billed them out separately for some reason.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm, because that's how our um our um software with the electronic claims it was that that's how the way.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the prophy was covered under the D 1120.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so
[AGENT][NEUTRAL] So basically all he would need to bill for is the fluoride and it's gonna be it's, it doesn't include the pro fee because we've already paid the pro fee otherwise he would be using 1201.
[CUSTOMER][NEUTRAL] OK, so we can bill the 12:03 and it should get covered, OK.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][POSITIVE] All right, um, yes ma'am, thank you for for clarifying that um OK so we'll do that for that patient.
[AGENT][NEUTRAL] Let me see, let me look at the history really quick, yeah.
[CUSTOMER][NEUTRAL] Sure thing.
[AGENT][NEUTRAL] And so yes, so you have to print, uh, do a manual in order for it to take the 1203.
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So what um is it OK if we send that via mail?
[AGENT][NEUTRAL] Yes, but that would be fine.
[AGENT][NEUTRAL] That would be fine.
[CUSTOMER][NEUTRAL] OK, may I confirm the the just the claims mailing address is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] This, that's correct.
[CUSTOMER][POSITIVE] All right fantastic. OK, we'll do that. I really appreciate your help.
[AGENT][POSITIVE] Oh, you're welcome [PII]. Anything else I can help out with today?
[CUSTOMER][POSITIVE] That was all. Have a great day.
[AGENT][POSITIVE] OK, thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.