INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49425, 1006, 32641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:04', '2021-07-14 09:11:04'),
(49426, 1006, 32641, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:35', '2021-07-14 09:25:35'),
(49427, 1006, 32641, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:24', '2021-08-06 10:44:24'),
(49428, 1006, 32642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:04', '2021-07-14 09:11:04'),
(49429, 1006, 32642, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:28', '2021-07-14 09:25:28'),
(49430, 1006, 32642, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:21', '2021-08-06 10:44:21'),
(49431, 1006, 32643, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:04', '2021-07-14 09:11:04'),
(49432, 1006, 32643, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:25', '2021-07-14 09:25:25'),
(49433, 1006, 32643, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:12', '2021-08-06 10:44:12'),
(49434, 1006, 32644, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:04', '2021-07-14 09:11:04'),
(49435, 1006, 32644, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:22', '2021-07-14 09:25:22'),
(49436, 1006, 32644, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:41:09', '2021-08-06 10:41:09'),
(49437, 1006, 32645, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:04', '2021-07-14 09:11:04'),
(49438, 1006, 32645, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:19', '2021-07-14 09:25:19'),
(49439, 1006, 32645, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:41:03', '2021-08-06 10:41:03'),
(49440, 1006, 32646, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:04', '2021-07-14 09:11:04'),
(49441, 1006, 32646, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:09', '2021-07-14 09:25:09'),
(49442, 1006, 32646, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:40:56', '2021-08-06 10:40:56'),
(49443, 1006, 32647, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:09', '2021-07-14 09:11:09'),
(49444, 1006, 32647, NULL, '2021-07-21 00:00:00.000', 'Initiated', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request.', NULL, NULL, '2021-07-14 09:15:50', '2021-07-14 09:15:50'),
(49445, 1006, 32647, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ :   Sub:   \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\"', NULL, NULL, '2021-08-06 10:05:15', '2021-08-06 10:05:15'),
(49446, 1006, 32648, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49447, 1006, 32648, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:31', '2021-07-14 09:18:31'),
(49448, 1006, 32648, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:37:16', '2021-08-06 10:37:16'),
(49449, 1006, 32649, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49450, 1006, 32649, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:28', '2021-07-14 09:18:28'),
(49451, 1006, 32649, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:37:13', '2021-08-06 10:37:13'),
(49452, 1006, 32650, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49453, 1006, 32650, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:24', '2021-07-14 09:18:24'),
(49454, 1006, 32650, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:37:05', '2021-08-06 10:37:05'),
(49455, 1006, 32651, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49456, 1006, 32651, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:21', '2021-07-14 09:18:21'),
(49457, 1006, 32651, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:36:31', '2021-08-06 10:36:31'),
(49458, 1006, 32652, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49459, 1006, 32652, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:16', '2021-07-14 09:18:16'),
(49460, 1006, 32652, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:36:09', '2021-08-06 10:36:09'),
(49461, 1006, 32653, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49462, 1006, 32653, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:13', '2021-07-14 09:18:13'),
(49463, 1006, 32653, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:33:34', '2021-08-06 10:33:34'),
(49464, 1006, 32654, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49465, 1006, 32654, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:17:44', '2021-07-14 09:17:44'),
(49466, 1006, 32654, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:33:16', '2021-08-06 10:33:16'),
(49467, 1006, 32655, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49468, 1006, 32655, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:17:33', '2021-07-14 09:17:33'),
(49469, 1006, 32655, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:32:38', '2021-08-06 10:32:38'),
(49470, 1006, 32656, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49471, 1006, 32656, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:17:29', '2021-07-14 09:17:29'),
(49472, 1006, 32656, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:32:30', '2021-08-06 10:32:30'),
(49473, 1006, 32657, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:51', '2021-07-14 09:11:51'),
(49474, 1006, 32657, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:17:15', '2021-07-14 09:17:15'),
(49475, 1006, 32657, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:32:24', '2021-08-06 10:32:24'),
(49476, 1006, 32658, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:56', '2021-07-14 09:11:56'),
(49477, 1006, 32658, NULL, '2021-07-21 00:00:00.000', 'Initiated', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request.', NULL, NULL, '2021-07-14 09:15:43', '2021-07-14 09:15:43'),
(49478, 1006, 32658, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ :   Sub:   \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\"', NULL, NULL, '2021-08-06 10:05:11', '2021-08-06 10:05:11'),
(49479, 1006, 32659, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:11', '2021-07-14 09:12:11'),
(49480, 1006, 32659, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:24:30', '2021-07-14 09:24:30'),
(49481, 1006, 32659, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:29:23', '2021-08-06 10:29:23'),
(49482, 1006, 32660, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:11', '2021-07-14 09:12:11'),
(49483, 1006, 32660, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:24:27', '2021-07-14 09:24:27'),
(49484, 1006, 32660, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:34', '2021-08-06 10:28:34'),
(49485, 1006, 32661, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:11', '2021-07-14 09:12:11'),
(49486, 1006, 32661, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:24:23', '2021-07-14 09:24:23'),
(49487, 1006, 32661, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:31', '2021-08-06 10:28:31'),
(49488, 1006, 32662, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:11', '2021-07-14 09:12:11'),
(49489, 1006, 32662, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:24:19', '2021-07-14 09:24:19'),
(49490, 1006, 32662, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:27', '2021-08-06 10:28:27'),
(49491, 1006, 32663, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:11', '2021-07-14 09:12:11'),
(49492, 1006, 32663, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:22:46', '2021-07-14 09:22:46'),
(49493, 1006, 32663, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:23', '2021-08-06 10:28:23'),
(49494, 1006, 32664, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:12', '2021-07-14 09:12:12'),
(49495, 1006, 32664, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:20:18', '2021-07-14 09:20:18'),
(49496, 1006, 32664, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:20', '2021-08-06 10:28:20'),
(49497, 1006, 32665, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:12', '2021-07-14 09:12:12'),
(49498, 1006, 32665, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:20:15', '2021-07-14 09:20:15'),
(49499, 1006, 32665, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:15', '2021-08-06 10:28:15'),
(49500, 1006, 32666, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:12', '2021-07-14 09:12:12'),
(49501, 1006, 32666, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:20:09', '2021-07-14 09:20:09'),
(49502, 1006, 32666, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:11', '2021-08-06 10:28:11'),
(49503, 1006, 32667, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:12', '2021-07-14 09:12:12'),
(49504, 1006, 32667, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:20:05', '2021-07-14 09:20:05'),
(49505, 1006, 32667, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:28:04', '2021-08-06 10:28:04'),
(49506, 1006, 32668, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:12', '2021-07-14 09:12:12'),
(49507, 1006, 32668, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:20:00', '2021-07-14 09:20:00'),
(49508, 1006, 32668, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:27:48', '2021-08-06 10:27:48'),
(49509, 1006, 32669, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:12:15', '2021-07-14 09:12:15'),
(49510, 1006, 32669, NULL, '2021-07-21 00:00:00.000', 'Initiated', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request.', NULL, NULL, '2021-07-14 09:15:27', '2021-07-14 09:15:27'),
(49511, 1006, 32669, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ :   Sub:   \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\"', NULL, NULL, '2021-08-06 10:05:05', '2021-08-06 10:05:05'),
(49512, 1006, 32670, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 14:59:28', '2021-07-14 14:59:28'),
(49513, 1006, 32670, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 15:00:04', '2021-07-14 15:00:04'),
(49514, 1006, 32671, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 14:59:28', '2021-07-14 14:59:28'),
(49515, 1006, 32671, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 15:00:07', '2021-07-14 15:00:07'),
(49516, 1006, 32672, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 14:59:28', '2021-07-14 14:59:28'),
(49517, 1006, 32672, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 15:00:10', '2021-07-14 15:00:10'),
(49518, 1006, 32673, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 14:59:31', '2021-07-14 14:59:31');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49519, 1006, 32673, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 14:59:55', '2021-07-14 14:59:55'),
(49520, 1006, 32674, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-15 16:33:21', '2021-07-15 16:33:21'),
(49521, 1006, 32674, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Request Status - NASA Urgent Care - Wellcare  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status of our group and provider.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-15 16:33:32', '2021-07-15 16:33:32'),
(49522, 11056, 32674, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 11:13:06', '2021-07-28 11:13:06'),
(49523, 11056, 32674, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare   Good morning,  I have reached out to the Contract Negotiators and they said the amendment to add WellCare to their existing Superior HealthPlan agreement will be sent through Adobe for electronic signature.   Have you signed and returned it to be processed?  Thanks Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-17 08:34:19', '2021-08-17 08:34:19'),
(49524, 11056, 32674, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already signed and returned Superior HealthPlan agreement through Adobe .  Practice Details: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider Details: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-26 16:06:26', '2021-08-26 16:06:26'),
(49525, 11056, 32674, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:41:08', '2021-09-15 09:41:08'),
(49526, 11056, 32674, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Urgent Care Inc.  Tax Identification Number 81-3237149  Specialty Internal Medicine  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Urgent Care  NPI 1629418025  CAQH Number 12779522  Medicare Number 738034  Medicaid Number 391190101  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI.  Confirmation email of our application submission.', NULL, NULL, '2021-09-28 15:33:30', '2021-09-28 15:33:30'),
(49527, 11056, 32674, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-08 15:44:12', '2021-10-08 15:44:12'),
(49528, 11056, 32674, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello Macy,  The provider below would like to add an additional location for the provider below.    Talha,   The Prospective Provider box does not need to be included on further emails.  Thank you, Network Development', NULL, NULL, '2021-10-15 16:42:54', '2021-10-15 16:42:54'),
(49529, 11056, 32674, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-     Please see the email attached which I never got a response to…so I do apologize but I have not added the second location.     I will submit a request for the 2nd location and process it as STAT. I’m very sorry for the delay.', NULL, NULL, '2021-10-22 15:55:18', '2021-10-22 15:55:18'),
(49530, 11056, 32674, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good evening Macy!  Hope this email finds you well.  No problem, thank you for the update. There is no need for any apology. Please do add the locations properly as  Practice Name: Primary/ billing Address : 985 NASA Parkway, Houston , TX 77058-3039    I thought so this one is missing.& it is the main location. Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406 .  Please also confirm the effective dates.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:12:44', '2021-11-11 12:12:44'),
(49531, 11056, 32674, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Hi-   Location is added. The update is completed.    Kindest Regards,  Macy Mertens, LL.M. Network Performance Advisor cid:image002.png@01D79E5C.9D608FD0  4888 Loop Central Drive, Suite 300 Houston, Texas 77081 Direct Mobile 281-217-0142', NULL, NULL, '2021-11-19 11:06:15', '2021-11-19 11:06:15'),
(49532, 11056, 32674, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon Macy!  I am very grateful to you. Great, thank you so much!  Please provide me with a welcome letter. Can we send claims on that address?  Take Care!  Have a wonderful day!', NULL, NULL, '2021-12-03 16:55:26', '2021-12-03 16:55:26'),
(49533, 11056, 32674, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Sara.Sanchez@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good morning,     Macy is out of the office but I have pulled a copy of our provider report.  You can see Dr. Adeoye’s effective date, along with other information.  If you scroll right you can see the addresses that are affiliated with the practice.   Please let me know if I can assist with anything else.     Hope this helps!  Have a great day,        Sara Sanchez  Provider Account Manager  1700 N. Zaragoza Ste 140     El Paso, TX 79936  Direct Line: 1.915.856.2502   Mobile: 1.915.801.5226    Fax: 1.915.856.2513  sara.sanchez@wellcare.com   |   https://www.wellcare.com', NULL, NULL, '2021-12-14 18:12:35', '2021-12-14 18:12:35'),
(49534, 11056, 32674, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon!  Hope you are staying healthy. I have already submitted the Online application for it in the past. And again on 15, September 2021. Kindly let me know what to do now, and how many times I have to submit an application for credentialing and enrolling.  Kindly, do us a favor, please figure this out soon. Let this be resolved permanently and properly.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 17:30:25', '2021-12-22 17:30:25'),
(49535, 19067, 32674, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Groups with Wellcare.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway, Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:39:18', '2021-12-30 14:39:18'),
(49536, 19067, 32674, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  This is my Second reminder on the previous mentioned request.  Kindly get in touch as soon as you have time.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:09:03', '2022-01-09 19:09:03'),
(49537, 1006, 32675, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49538, 1006, 32675, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:11:56', '2021-07-16 17:11:56'),
(49539, 1006, 32675, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Group is enrolled as an urgentcare. The contract is attached in the group task.   Eff: 01/15/2018', NULL, NULL, '2021-07-28 12:24:33', '2021-07-28 12:24:33'),
(49540, 1006, 32676, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49541, 1006, 32676, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:03', '2021-07-16 17:12:03'),
(49542, 1006, 32676, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'Pending due to Superior Health.', NULL, NULL, '2021-08-16 10:01:49', '2021-08-16 10:01:49'),
(49543, 11056, 32676, NULL, '2021-09-27 00:00:00.000', 'Initiated', '	 Online form has been submitted. Please see the attachment.', NULL, NULL, '2021-09-20 10:12:51', '2021-09-20 10:12:51'),
(49544, 11056, 32676, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Rep. : Yesenia P  Status:    Mercedita flynn = is in processing & reviewing.  Monica = is in credentialing. Received on 09/28/2021 It will take 100 days.  Secondary location has been listed under the group Tax ID.  Ref : 60964  Contact no : 800-656-4817', NULL, NULL, '2021-09-29 16:05:57', '2021-09-29 16:05:57'),
(49545, 11056, 32676, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : Credentialing@superiorhealthplan.com  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good morning!  Hope you are doing well. Please update me with the enrollment status of below mentioned providers at your earliest opportunity..  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Mercedita Flynn 	1619166188 : for secondary location Monica Gonzalez  	1871132811 : for both locations   If you need any documents or information feel free to contact me.  Thank you!', NULL, NULL, '2021-10-07 13:31:13', '2021-10-07 13:31:13'),
(49546, 11056, 32676, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Credentialing@superiorhealthplan.com  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon,             I am able to locate the following information per the status request below for the providers:  1619166188 - Re-credential date will be 07/31/2022.  1871132811 -I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  Thank you,   Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-14 16:14:56', '2021-10-14 16:14:56'),
(49547, 11056, 32676, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : Credentialing@superiorhealthplan.com>  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon!  Hope this email finds you well. Please respond to the below at your earliest convenience.   TIN - 81-1890349 1619166188 - Are both locations listed under this NPI and also, please do provide the welcome letter.  1871132811 - Please provide the latest updates on this NPI.  Waiting to hear from you soon.  Thank you! Take Care!', NULL, NULL, '2021-10-22 12:30:19', '2021-10-22 12:30:19'),
(49548, 11056, 32676, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: Credentialing@superiorhealthplan.com  Sub: Enrollment Query - CBUC & GWMC - AMBETTER  Good morning,              1619166188 -Please contact your account manager for assistance in obtaining the welcome letter. I have attached the providers approval letter from credentialing team. Please go to https://www.superiorhealthplan.com/ , for providers, and find my account manager, to locate your account manager. Your Account Manager can better assist you with your question and direct your request to the correct Department.      1871132811-I am currently reflecting that this provider is awaiting approval by the medical director. If all goes well, the anticipated effective date will be 12/01/2021', NULL, NULL, '2021-11-09 16:35:30', '2021-11-09 16:35:30'),
(49549, 11056, 32676, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Credentialing@superiorhealthplan.com  Sub:   Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon!  Hope you are doing well. I want to get the latest updates regarding the enrollment process of the following provider under the facility.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you have any questions or concerns feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:31:40', '2021-11-24 13:31:40'),
(49550, 11056, 32676, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email received from: Credentialing@superiorhealthplan.com  Sub:  Enrollment Query - CBUC & GWMC - AMBETTER  Good Afternoon,              I am able to locate the following information per the status request below for the provider:  The providers credentialing is complete, the effective date is 12/01/2021 and the re-credential date is 10/31/2024.  Thank you,     Credentialing Department | Superior Health Plan  5900 E. Ben White Blvd | Austin, TX 78741  Phone: 800-820-5686 |Fax: 866-702-4831  Credentialing@superiorhealthplan.com', NULL, NULL, '2021-12-10 10:17:18', '2021-12-10 10:17:18'),
(49551, 1006, 32677, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49552, 1006, 32677, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:09', '2021-07-16 17:12:09'),
(49553, 1006, 32677, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'Pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 10:03:03', '2021-08-16 10:03:03'),
(49554, 11056, 32677, NULL, '2021-09-27 00:00:00.000', 'Initiated', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good morning!  Hope all is well with you. It had been a long since our email got responded back. We are still waiting to get the latest updates related our enrollment applications for the following providers under the Practice Tax I.D mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  Provider Name: Mercedita N Flynn Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-20 12:19:40', '2021-09-20 12:19:40'),
(49555, 11056, 32677, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good evening!  Hope this email finds you well. Please see the location again. Please note that our facilities are located in BEEVILLE , TX & George West , TX, not in Corpus Christi.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-30 15:35:56', '2021-09-30 15:35:56'),
(49556, 11056, 32677, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good Morning,  Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.   Hi There, those locations are within the Corpus Christi service delivery area, Amerigroup currently does not have membership down in that region.   Those areas are managed by other Medicaid Managed Care Organizations.   Thank you again for your interest.  Sincerely,', NULL, NULL, '2021-10-07 15:35:31', '2021-10-07 15:35:31'),
(49557, 1006, 32678, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49558, 1006, 32678, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:15', '2021-07-16 17:12:15'),
(49559, 1006, 32678, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,   I wanted to get an update regarding this request, please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-28 12:29:33', '2021-07-28 12:29:33'),
(49560, 1006, 32678, NULL, '2021-08-13 00:00:00.000', 'In Process', 'We received the following update from jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Good Morning,  I show that Coastal Bend Urgent Care, LLC And ACS are currently contracted since 7/20/2017. Records indicate that you are due for credentialing.  Please see the attached Re-credentialing Profile.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com\"  Replied with:  \"Hello Jennifer,  Please find the attached information, do let me know if you need anything else.  Thank you. \"', NULL, NULL, '2021-08-06 15:12:08', '2021-08-06 15:12:08'),
(49561, 1006, 32678, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,  I hope you\'re doing well, I just wanted to check in on the status of enrollment for our group. Can you please get back to me on this?  Thank you.\"', NULL, NULL, '2021-08-16 16:07:27', '2021-08-16 16:07:27'),
(49562, 11056, 32678, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.     Recredentialing is complete just waiting on the approval meeting on 9/16.     No further action is necessary.  Claims are still being processing for this provider.     Jennifer Maligaya is no longer with ACS/HealthSmart.     Please continue to use VIPproviders@anci-care.com for updates.     New provider agreements please email me:  patti.davidson@healthsmart.com     Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-23 17:10:52', '2021-08-23 17:10:52'),
(49563, 11056, 32678, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates,effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 14:31:55', '2021-09-03 14:31:55'),
(49564, 11056, 32678, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates, effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-14 14:29:44', '2021-09-14 14:29:44'),
(49565, 11056, 32678, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates, effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-14 14:29:45', '2021-09-14 14:29:45'),
(49566, 11056, 32678, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.  Recredentialing is complete just waiting on the approval meeting on 9/16.  No further action is necessary.  Claims are still being processing for this provider.    Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-09-27 10:32:14', '2021-09-27 10:32:14'),
(49567, 11056, 32678, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Hi.   The provider below is already contracted.  We are only recredentialing the site.     You will receive the recredentialing approval letter from our credentialing department after 2 weeks.', NULL, NULL, '2021-10-06 14:50:10', '2021-10-06 14:50:10'),
(49568, 11056, 32678, NULL, '2021-10-14 00:00:00.000', 'Approved', 'Ancillary contract has been completed.  There is no need of the providers to be credentialed.', NULL, NULL, '2021-10-07 10:56:11', '2021-10-07 10:56:11'),
(49569, 1006, 32679, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49570, 1006, 32679, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:21', '2021-07-16 17:12:21'),
(49571, 1006, 32679, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Submitted enrollment request via Provider Onboarding Process. The form is attached for reference. ', NULL, NULL, '2021-07-28 14:11:22', '2021-07-28 14:11:22'),
(49572, 1006, 32679, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email since no calls can get through to the credentialing department of BCBS @ tx_standard_contracting_team@bcbstx.com & :  Sub: Location Addition || George West Medical Clinic || Group || BCBS || : Case Number - 02533924  \"Hello,   Please get back to me as soon as possible regarding the status of our query as we are unable to reach out to the credentialing department via calls.  Thank you. \"', NULL, NULL, '2021-08-16 16:45:30', '2021-08-16 16:45:30'),
(49573, 11056, 32679, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to : 	TXProviderUpdateSubmission@bcbstx.com, provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Sub : Re: Location Addition || George West Medical Clinic || Group || BCBS || : Case Number - 02533924  Good afternoon!  Hope all is well. Please let me know if you can find the following group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  We wish to add the following secondary address under the above-mentioned group: Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please let me know what is required to get this updated. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-24 15:15:35', '2021-08-24 15:15:35'),
(49574, 11056, 32679, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : tx_standard_contracting_team@bcbstx.com  Sub : Re: Location Addition || George West Medical Clinic || Group || BCBS || : Case Number - 02533924  Thank you for contacting Blue Cross and Blue Shield of Texas.  We have received your email for case number 02533924.  Since case 02533924 is closed, your request can not be processed at this time.  To open a new case for your request or for any questions, contact TX_standard_contracting_team@bcbstx.com.  Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-09-14 16:01:09', '2021-09-14 16:01:09'),
(49575, 11056, 32679, NULL, '2021-09-21 00:00:00.000', 'In Process', '	 New Application no. : 02860897 has opened.', NULL, NULL, '2021-09-14 16:31:55', '2021-09-14 16:31:55'),
(49576, 11056, 32679, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email received from : 	Tx_Network_South_Voicemail &  geraldi_salazar@bcbstx.com  Sub : SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC  Hello,  Your previous case was closed in error, so I will be handling the request myself moving forward. Please email me at the account below if you have questions.  I am writing to confirm your request to add an address to tax id 811890349 (BEEVILLE MEDICAL CLINIC). Please confirm which providers will be practicing at this location (provide a list of who will practice here) and provide the phone and fax for this address as well.   504 A Houston Street, George West, TX 78022-3663   Thank you,  Geraldi Salazar | Manager, Network Management – West Region Blue Cross and Blue Shield of Texas geraldi_salazar@bcbstx.com', NULL, NULL, '2021-09-20 16:34:14', '2021-09-20 16:34:14'),
(49577, 11056, 32679, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : geraldi_salazar@bcbstx.com & Tx_Network_South_Voicemail@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC  Hello,     Please advise if the 600 South Hillside Dr Address is still an active satellite location or if the 504A Houston Street address will be replacing it under tax id 811890349.     Thank you,   Geraldi Salazar | Manager, Network Management – West Region  Blue Cross Blue Shield of Texas  phone 361-878-1622 | fax 361-852-0624', NULL, NULL, '2021-09-30 15:05:11', '2021-09-30 15:05:11'),
(49578, 11056, 32679, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : geraldi_salazar@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Good afternoon Geraldi!  Hope this email finds you well. We have two locations for our practice under the same Tax ID and NPI, But with different addresses.  301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 is the main & billing location.  504A Houston Street George West , TX 78022-3663 is the secondary location.  If further you have queries or concerns or require documents please let me know.    Thank you!', NULL, NULL, '2021-10-07 15:46:49', '2021-10-07 15:46:49'),
(49579, 11056, 32679, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : geraldi_salazar@bcbstx.com & Angela_Norman@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Hi Angela,     Please submit this address update request. See original request at the bottom of the chain and additional information on 9-30.     Thank you,   Geraldi Salazar | Manager, Network Management – West Region  Blue Cross Blue Shield of Texas  phone 361-878-1622 | fax 361-852-0624   ', NULL, NULL, '2021-10-14 16:24:09', '2021-10-14 16:24:09'),
(49580, 11056, 32679, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : geraldi_salazar@bcbstx.com & Angela_Norman@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Good afternoon Angela and Geraldi!   Hope you both are doing great. Please provide me the update regarding my request of enrollment and updating both addresses under the TIN & providers.  Group Name Coastal Bend Urgent Care, LLC  Tax ID 81-1890349  Group NPI 1427509264  Primary Location 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Secondary Location 504A Houston Street, George West , TX 78022-3663  Provider Name  NPI  Monica Gonzalez  1871132811  Please assist with the above at your earliest opportunity.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-10-22 13:47:42', '2021-10-22 13:47:42'),
(49581, 11056, 32679, NULL, '2021-11-01 00:00:00.000', 'Approved', 'Email received from : Angela_Norman@bcbstx.com & geraldi_salazar@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Hello,   The provider Monica Gonzalez, APN associated with Tax Id# 811890349 is in-network as of 10/15/2021 with the following networks:  Plans: Blue Advantage HMO Blue Choice PPO Blue Essentials Health Select Medicare Advantage HMO Medicare Advantage PPO   Thank you,   Another Email received :   Good Afternoon,  Below you will find the Welcome letter and the locations we have for Monica Gonzalez, APN are listed below.    Physical: 301 S. HILLSIDE DR., STE 4 BEEVILLE, TX 78102 361-226-1126 PHONE 718-640-2713 FAX  Satellite: 504A HOUSTON ST GEORGE WEST, TX 78022 361-226-1219 PHONE 361-542-4076    Please see the attached welcome letter.', NULL, NULL, '2021-10-25 14:25:40', '2021-10-25 14:25:40'),
(49582, 1006, 32680, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49583, 1006, 32680, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:27', '2021-07-16 17:12:27'),
(49584, 1006, 32680, NULL, '2021-08-23 00:00:00.000', 'Approved', 'Received the following approval confirmation email Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Hello Brad,  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – reference # FL01383347.  Thanks, Michal\" ', NULL, NULL, '2021-08-16 16:54:41', '2021-08-16 16:54:41'),
(49585, 1006, 32681, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49586, 1006, 32681, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:33', '2021-07-16 17:12:33'),
(49587, 1006, 32681, NULL, '2021-08-23 00:00:00.000', 'In Process', 'We received the following request from vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  What is the last 4 ss?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with providers last 4 SSN. ', NULL, NULL, '2021-08-16 17:05:19', '2021-08-16 17:05:19'),
(49588, 1006, 32681, NULL, '2021-08-23 00:00:00.000', 'In Process', 'We received the following request from vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  What is the last 4 ss?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with providers last 4 SSN. ', NULL, NULL, '2021-08-16 17:05:31', '2021-08-16 17:05:31'),
(49589, 11056, 32681, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email received from : vicki.guerra@christushealth.org  Sub : Re: Enrollment Request - CBUC/GWMC - Christus Spohn  Hi Brad,     Happy Wednesday!     I do not find the provider did his reappointment paperwork with the Christus hospital facility.     Can the provider be asked if he re-did hospital facility paperwork?     Thanks,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745', NULL, NULL, '2021-08-25 08:16:38', '2021-08-25 08:16:38'),
(49590, 11056, 32681, NULL, '2021-09-27 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-09-20 16:40:37', '2021-09-20 16:40:37'),
(49591, 11056, 32681, NULL, '2021-10-07 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-09-30 13:49:52', '2021-09-30 13:49:52'),
(49592, 11056, 32681, NULL, '2021-10-14 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-10-07 17:01:52', '2021-10-07 17:01:52'),
(49593, 11056, 32681, NULL, '2021-10-25 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-10-18 16:38:30', '2021-10-18 16:38:30'),
(49594, 11056, 32681, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Have emailed them again. Waiting for response.', NULL, NULL, '2021-11-10 09:22:59', '2021-11-10 09:22:59'),
(49595, 11056, 32681, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Have emailed them again. Waiting for response.  It has been along that we get n response from the provider. ', NULL, NULL, '2021-11-15 16:59:09', '2021-11-15 16:59:09'),
(49596, 1006, 32682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49597, 1006, 32682, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:40', '2021-07-16 17:12:40'),
(49598, 1006, 32682, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Initiated enrollment via call.   Application# 12707513 ', NULL, NULL, '2021-07-28 14:57:15', '2021-07-28 14:57:15'),
(49599, 1006, 32682, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Received the following update from discovercigna@information.cigna.com:  Sub: Cigna Credentialing Status Update: Application Received  \"Re:	Reference number 12707513 Application to participate in the Cigna medical network Dear MONICA GONZALEZ,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely, Cigna\"', NULL, NULL, '2021-08-02 08:30:03', '2021-08-02 08:30:03'),
(49600, 1006, 32682, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ PSSCentral@Cigna.com:  Sub: Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  \"Hello,   I wanted to get an update regarding the enrollment status for the following provider under our group:  Group Name: Coastal Bend Urgent Care LLC TIN# 81-1890349  Provider Name: Monica Gonzalez NPI# 1871132811  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-16 17:12:48', '2021-08-16 17:12:48'),
(49601, 11056, 32682, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  PSSCentral@cigna.com, PDMCOGZ@cigna.com & JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  Good Afternoon!  Hope this email finds you well. I want to get an update regarding the enrollment status of the below mentioned provider under the practice.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or queries regarding this or need documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 11:33:51', '2021-08-24 11:33:51'),
(49602, 1006, 32682, NULL, '2021-09-02 00:00:00.000', 'In Process', 'We received the following update from DiscoverCigna@information.cigna.com:  Sub: Cigna Credentialing Status Update: Application Received  \"Reference number 12707513 for MONICA GONZALEZ, MSN Application to participate in the Cigna medical network Dear BRAD ,  Thank you for submitting an application for one of your providers to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely, Cigna\"', NULL, NULL, '2021-08-26 09:55:37', '2021-08-26 09:55:37'),
(49603, 11056, 32682, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Approval Email received from : DiscoverCigna@information.cigna.com  Sub : Welcome to the Cigna network  Dear MONICA GONZALEZ,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management   Your effective date is 09/08/2021. Your provider identification number is‍ ‌8532240.   Please see the attachment.', NULL, NULL, '2021-09-09 08:17:49', '2021-09-09 08:17:49'),
(49604, 1006, 32683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49605, 1006, 32683, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:48', '2021-07-16 17:12:48'),
(49606, 11056, 32683, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', '	 Email received from : lerensa.crain@careallies.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  George West, Texas and Beeville, Texas are not in the Cigna MA medical plan service area.', NULL, NULL, '2021-09-24 13:07:25', '2021-09-24 13:07:25'),
(49607, 1006, 32684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49608, 1006, 32684, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:55', '2021-07-16 17:12:55'),
(49609, 1006, 32684, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference.  ', NULL, NULL, '2021-08-16 10:04:27', '2021-08-16 10:04:27'),
(49610, 1006, 32685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49611, 1006, 32685, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:02', '2021-07-16 17:13:02'),
(49612, 1006, 32685, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 10:05:25', '2021-08-16 10:05:25'),
(49613, 11056, 32685, NULL, '2021-09-24 00:00:00.000', 'Initiated', 'Email sent to : Karla.Claunch@dchstx.org  Sub  : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good evening Karla!  Hope this email finds you well. Here are the forms with attached documents in the Pdf too with W9s, which you requested for in the previous email for enrollment process. Please find the attachments.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# 1164776548  Provider Name: Flynn, Mercedita  Provider NPI# 1619166188  Provider Name: Gonzalez, Monica Provider NPI# 1427509264  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day', NULL, NULL, '2021-09-17 12:20:29', '2021-09-17 12:20:29'),
(49614, 11056, 32685, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  Thank you for these requests but, the disclosure statements were not attached for Monica Gonzalez NP and Katherine Paterson NP.  Please email these directly to me when completed.  They are all now in the credentialing process.  Please allow 60-90 days to complete.  Once complete, you will receive a welcome letter with their effective date.  Thank you  Karla Claunch   ', NULL, NULL, '2021-09-28 16:57:57', '2021-09-28 16:57:57'),
(49615, 11056, 32685, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  My apologies,  I am just noticing that this practice is currently not participating with us.  All providers requested are mid-level who will need a supervising physician.  The physician will also need to be a Driscoll Health Plan participating physician.  If their supervising physician is not already credentialed with us, we will also need to credential them.  We will also need the current PAA or Collaborative agreement between the NP’s and supervising physician.  They should have one on file within the practice.  We are withdrawing these providers  due to not currently having a supervising physician on file for this practice.  We can re-activate them once the remaining, required information is received and they have an established, participating, supervising physician.  We look forward to working with you and eager to hear from you again soon.  Please let me know if you need any further assistance.  Karla Claunch  ', NULL, NULL, '2021-10-06 16:29:40', '2021-10-06 16:29:40'),
(49616, 11056, 32685, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : Karla.Claunch@dchstx.org  Sub : Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Hey Karla!  Hope you had a great weekend. You don\'t need to apologise. We do have a supervising physician for this practice and want to let him participate with Driscoll Health Plan. Please suggest to me the procedure to credential the supervising physician as soon as possible.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-14 15:44:20', '2021-10-14 15:44:20'),
(49617, 11056, 32685, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  I wish the weekend was much longer but, here we are.  We will need the same documents for the supervising physician and he must carry them on his license.  Please send a Request for Contact as well as the DHP addendum and disclosure as below.', NULL, NULL, '2021-10-22 08:49:19', '2021-10-22 08:49:19');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49618, 11056, 32685, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Please find the attached forms for the Supervising physician enrollment with Driscoll. Please accept my apology for the delay. If any corrections are required please let me know.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed day!', NULL, NULL, '2021-11-09 14:33:11', '2021-11-09 14:33:11'),
(49619, 11056, 32685, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Hello,  Thank you for this request.  Before I begin, the addendum needs to be completed with all information.  The disclosure is named and signed by Mercedita Flynn so, we will need his own, signed by him please.  This provider will not be processed until this information is received.  Your prompt attention will avoid delays and withdrawal.  I look forward to hearing from you soon.  Thank you  Karla Claunch   Provided them with their requirement.', NULL, NULL, '2021-11-24 10:01:57', '2021-11-24 10:01:57'),
(49620, 11056, 32685, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good morning!  Hope this email finds you well. Here you go. Please find the corrected one in the attachment.  If anything else is needed feel free to reach out to me.  Take Care!  Thank you!', NULL, NULL, '2021-12-06 16:39:35', '2021-12-06 16:39:35'),
(49621, 11056, 32685, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from:  Karla.Claunch@dchstx.org  Sub:  Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good afternoon,  You only sent one disclosure, it was for Mercedita which I already have.   I am needing one for both of these providers please-Monica Gonzalez NP and Katherine Paterson NP  They are now in process.  Please allow 60-90 days to complete the process.  I am looking forward to hearing back from you soon with these disclosures and all of their PAA/Collaborative Agreements  Thank you', NULL, NULL, '2021-12-17 14:47:08', '2021-12-17 14:47:08'),
(49622, 11056, 32685, NULL, '2021-12-29 00:00:00.000', 'In Process', '	 Email sent to: Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope you are having a blessed day. Please find the attached disclosure for Monica Gonzalez and Katherine Paterson. We will provide you with their PAA/Collaborative Agreements near in the future.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Take Care!  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 11:11:00', '2021-12-22 11:11:00'),
(49623, 19067, 32685, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Kindly do provide me with the recent accomplishments of the credentialing process of the below-mentioned providers under facility TIN.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   Please get back to me soon with the updates and if credentialing is completed do provide me with effective dates and welcome letters.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-12-30 11:00:47', '2021-12-30 11:00:47'),
(49624, 19067, 32685, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Greetings!  Any updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:22:30', '2022-01-09 22:22:30'),
(49625, 19067, 32685, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||    Good morning,  I sent the welcome packet and contract 12/28/2021 to the credentialing contact email we have on file.  I have attached everything to this email for you.    ', NULL, NULL, '2022-01-10 09:24:33', '2022-01-10 09:24:33'),
(49626, 19067, 32685, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    RE:             Monica Del Bosque Gonzalez, NP  NPI #:        1871132811  Tax ID#:    81-890349     Good Morning,  I am currently working on the INITIAL application for Monica Del Bosque Gonzalez, NP for the Driscoll Health  Plan; and I need some additional documentation completed.  (see attached)  ·         PAA Agreement  ·         Attestation  ·         Current Liability Insurance  ·         NP License  ·         W-9 form  ·         Page 1 of TSCA – Place of Birth  ·         Page 2 of TSCA – Work History completed  ·         Page 4-5 of TSCA – Referenced and Call Coverage  ·         Page 6 of TSCA – Check payable To box completed  Please forward all requested information to my attention via email within 5 business days.  Feel free to contact me if you have any questions.      Thank you,  Christine S Rodriguez  Credentialing Specialist  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-4322  Fax: (361) 808-2182  Email: Christine.Rodriguez@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2022-03-01 13:50:38', '2022-03-01 13:50:38'),
(49627, 19067, 32685, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    RE:             Monica Del Bosque Gonzalez, NP  NPI #:        1871132811  Tax ID#:    81-890349     Good Morning,  I am currently working on the INITIAL application for Monica Del Bosque Gonzalez, NP for the Driscoll Health  Plan; and I need some additional documentation completed.  (see attached)  ·         PAA Agreement  ·         Attestation  ·         Current Liability Insurance  ·         NP License  ·         W-9 form  ·         Page 1 of TSCA – Place of Birth  ·         Page 2 of TSCA – Work History completed  ·         Page 4-5 of TSCA – Referenced and Call Coverage  ·         Page 6 of TSCA – Check payable To box completed  Please forward all requested information to my attention via email within 5 business days.  Feel free to contact me if you have any questions.      Thank you,  Christine S Rodriguez  Credentialing Specialist  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-4322  Fax: (361) 808-2182  Email: Christine.Rodriguez@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2022-03-01 16:31:16', '2022-03-01 16:31:16'),
(49628, 19067, 32685, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: christine.rodriguez@dchstx.org  Subject: Re: Monica Del Bosque Gonzalez, NP   Hi Christine!  Kindly see the attachments as per you requested and don\'t hesitate to reach me if you need any document or information.  Regards, Hammad Ahmed', NULL, NULL, '2022-03-01 16:31:51', '2022-03-01 16:31:51'),
(49629, 19067, 32685, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    Good Morning,     Thanks for the information; however the documents are NOT completed.     ·         PAGE 3 needs the CURRENT employer listed on Work History  ·         PAGE 4-5 needs the references completed (address & phone numbers)  ·         PAGE 6 needs the “Check Payable To” and Electronically box checked  ·         PAA Agreement needs to be completed (all the questions answered)  ·            *NOTE*  I have HIGHLIGHTED all the areas that need to be completed.  Please contact me if you have any questions.  This information is needed ASAP.', NULL, NULL, '2022-03-10 16:31:09', '2022-03-10 16:31:09'),
(49630, 19067, 32685, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    Good Morning,     I am still missing the information from the email below.  I need this information  ASAP.  If the information is NOT received by Friday March 11, 2022 the application  will be WITHDRAWN.      Please contact me if you have any questions.         Thank you,', NULL, NULL, '2022-03-10 16:32:06', '2022-03-10 16:32:06'),
(49631, 19067, 32685, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: christine.rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    Hi Christine,  Kindly see the attached.  Thanks', NULL, NULL, '2022-03-10 17:20:59', '2022-03-10 17:20:59'),
(49632, 22077, 32685, NULL, '2022-04-19 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: 	Re: FW: URGENT REQUESTS RE: FW: Monica Del Bosque Gonzalez, NP  Hi,  Attached is the current liability for Monica.  And the names on References we are not familiar with them.  Also, I have updated the name of the supervising physician.  Thanks.', NULL, NULL, '2022-04-12 13:56:00', '2022-04-12 13:56:00'),
(49633, 22077, 32685, NULL, '2022-04-28 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Katherine Paterson, NP & Monica Del Bosque Gonzalez, NP  Good Afternoon Alex,     Sorry for the delay I have been in meetings all morning.  Here is a Request for Contract.  I need a new one for each provider.     I will review all the information you have sent me and let you know if I need anything else.  This will be done tomorrow, since I will be in meetings for the rest of the day.     Have a great day…     Thank you,  Christine S Rodriguez  Credentialing Specialist  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-4322  Fax: (361) 808-2182  Email: Christine.Rodriguez@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2022-04-21 15:40:21', '2022-04-21 15:40:21'),
(49634, 22077, 32685, NULL, '2022-04-28 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: 	Re: Katherine Paterson, NP & Monica Del Bosque Gonzalez, NP  Good Afternoon Christine,  Kindly see the attached application for each provider.  Have a great day,  Thanks & Regards.', NULL, NULL, '2022-04-21 15:41:48', '2022-04-21 15:41:48'),
(49635, 1006, 32686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49636, 1006, 32686, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:09', '2021-07-16 17:13:09'),
(49637, 1006, 32686, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Sent initiation and f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & \"Talasila, Bala M\" TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We are still waiting on the status of our initial request and here is the information for an additional provider, please get back to me as soon as possible.   Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Thank you. \"', NULL, NULL, '2021-07-28 16:27:11', '2021-07-28 16:27:11'),
(49638, 1006, 32686, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \" ', NULL, NULL, '2021-08-16 12:18:25', '2021-08-16 12:18:25'),
(49639, 11056, 32686, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com, \"Sidley, Jeanette\" SidleyJ1@firsthealth.com, PDS Dallas  pdsdallas@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059   Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 17:02:01', '2021-08-23 17:02:01'),
(49640, 11056, 32686, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  Good afternoon!  Hope you are doing well. It has been so long since you haven\'t responded to our emails. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice. Please provide me with the latest updates soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great weekend! ', NULL, NULL, '2021-09-03 14:15:05', '2021-09-03 14:15:05'),
(49641, 11056, 32686, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : DillikarA@aetna.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hi,  Please find the status of below provider as per requested.   S.no  Provider Name  NPI  Cpd Id  TIN  Effective Date  Status  1  Paterson, Katherine D  1164776548  2815476  811890349  -  Tax Id not found  2  Monica Gonzalez  1871132811  811890349  -  Provider not found    Regards, Bharath', NULL, NULL, '2021-09-14 13:22:23', '2021-09-14 13:22:23'),
(49642, 11056, 32686, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : DillikarA@aetna.com  Sub  : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hey Bharath!  Hope this email finds you well. Please guide and assist me regarding how to solve the below highlighted issues.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 12:38:54', '2021-09-28 12:38:54'),
(49643, 11056, 32686, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,  I hope that this email finds you well! I apologize that I have not been able to respond sooner, my son has been ill so I have been in and out of the office.  This is the new group agreement that we established that will become effective 11/1/21. It is still in the implementation stages but will be complete before the effective date. All providers listed on the roster you provided to me will be linked to the new agreement once effective.   I hope that this helps clarify.  Take care!  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-06 15:01:58', '2021-10-06 15:01:58'),
(49644, 11056, 32686, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Ahmed,  I hope that this email finds you well! Thank you for the well wishes, we are hoping he starts to feel better soon.  I have attached a copy of the signed agreement to this email. I apologize if the system did not automatically send it to you when it was signed on our side.  The contract is currently in implementation with our Data Team. I will send over the welcome letter once I have your group ID.  As always, please do not hesitate to reach out if you have any questions or concerns.  Take care! Jeanette', NULL, NULL, '2021-10-14 15:38:44', '2021-10-14 15:38:44'),
(49645, 11056, 32686, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Re: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Jeanette!  Hope this email finds you well. He will feel better soon. He is in my prayers.  Bundle of thanks for your prompt responses. And I am grateful to you for that.  Whenever the implementation is completed, please provide the welcome letter soon.   Thank you! Have a wonderful & blessed weekend ahead!', NULL, NULL, '2021-10-22 12:10:22', '2021-10-22 12:10:22'),
(49646, 11056, 32686, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning Jeanette!  Hope you & your son both are doing great. Please provide me with the latest updates about the implementation as well as on the welcome letters too. Kindly do the needful soon.  Please get back to me soon.  Thank you! Take Care!', NULL, NULL, '2021-11-09 15:27:09', '2021-11-09 15:27:09'),
(49647, 11056, 32686, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sidleyj1@firsthealth.com  Sub:  Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1073945 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,  Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605  Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-24 10:38:42', '2021-11-24 10:38:42'),
(49648, 11056, 32686, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email received from:  SidleyJ1@firsthealth.com  Sub:  RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning,     I hope that this email finds you well!     I have attached the welcome letter that I sent over last Tuesday. I apologize if you did not receive it.     Have a wonderful week!     Take care,     Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605 Phone: 916-374-4876  SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-12-09 14:22:50', '2021-12-09 14:22:50'),
(49649, 11056, 32686, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,     I hope that this email finds you well!     The feedback that I have received on my request to add the providers to the group is:  Mercedita Flynn is already participating under the TIN on an individual agreement effective 12/1/2019. She is now linked to the group and will still show effective as of 12/1/2019. For Monica Gonzalez, they are needing her CAQH number as she is not credentialed through Aetna yet and they handle that part for us in order to link her to the group contract.    Please send over the CAQH number for Monica Gonzalez and I can get her part finalized.     Thank you and take care!  Jeanette', NULL, NULL, '2021-12-22 10:17:30', '2021-12-22 10:17:30'),
(49650, 19067, 32686, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Query || CBUC & GWMC || Providers || First Health ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following provider with First Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 12:39:30', '2021-12-30 12:39:30'),
(49651, 19067, 32686, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers || First Health ||   Greetings!  You have not responded yet.  Kindly give updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 23:03:18', '2022-01-09 23:03:18'),
(49652, 19067, 32686, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers || First Health ||    Greetings!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad.', NULL, NULL, '2022-01-26 15:12:40', '2022-01-26 15:12:40'),
(49653, 20067, 32686, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Call Firsth Health Ref# 244565  Monica Gonzalez is credentialed with effective date of 11/01/2021 Welcome letter has already been send. But we haven\'t received the letters so i request rep to resend the letter at cbuc@claimsmedinc.com', NULL, NULL, '2022-03-07 17:35:29', '2022-03-07 17:35:29'),
(49654, 22077, 32686, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: 	Re: Urgent || Demographic Update || Providers || First Health  Hi,  Any updates on the request mentioned previously?  Thanks.', NULL, NULL, '2022-04-13 14:05:23', '2022-04-13 14:05:23'),
(49655, 1006, 32687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49656, 1006, 32687, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:16', '2021-07-16 17:13:16'),
(49657, 11056, 32687, NULL, '2021-09-24 00:00:00.000', 'Initiated', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good afternoon Daniel!  Hope this email finds you well. Here is the filled Physician agreement form for the provider Monica Gonzalez, to add her with Galaxy under the Coastal Bend Urgent Care Group agreement. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-17 16:24:31', '2021-09-17 16:24:31'),
(49658, 11056, 32687, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hi Ahmed,  I am sorry, however, the below statement that Dr. Flynn is under a personal agreement shows to be incorrect. I show this provider, Dr. Flynn  is under a group agreement.  To confirm I do not show Katherine Paterson as presently participating with Galaxy under the Coastal Bend Urgent Care Group agreement. If the group wishes to add Katherine Paterson to their existing agreement then please see the attached.  If your company wishes a copy of the group agreement you will need to fax written authorization signed by an authorized signatory of the CBUS group stating your company Claims Med Inc is representing the group and that Galaxy is authorized to send you a copy of their agreement. That can be faxed to 817-633-5729.   Further, I show that the same information above on how to obtain a copy of the group agreement was sent to Mr. Brad Peterson who is with you company and he may already have a copy of the group agreement.', NULL, NULL, '2021-09-29 12:51:40', '2021-09-29 12:51:40'),
(49659, 11056, 32687, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good afternoon Daniel!  Hope this email finds you well. Here is the filled Physician agreement form for the provider Katherine Paterson, to add her with Galaxy under the Coastal Bend Urgent Care Group agreement. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-07 15:05:11', '2021-10-07 15:05:11'),
(49660, 11056, 32687, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good morning!  Hope this email finds you well.  Please provide us with the latest updates regarding the following providers under the below mentioned practice with Galaxy health as soon as possible.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-18 16:45:53', '2021-10-18 16:45:53'),
(49661, 11056, 32687, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : kavalos@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hello please,     provide providers specialty, phone/fax number effective date you will like.     Thanks;     Karen A  Have provided them with details', NULL, NULL, '2021-11-09 12:15:28', '2021-11-09 12:15:28'),
(49662, 11056, 32687, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good afternoon Karen!  Hope this email finds you well. Please find the information below which you have requested.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name & Specialities	NPI  & COntact & Fax no.  Katherine Paterson  (FNP)	1164776548           Ph # : 361-226-1126          fax no. : 361 542-4076 Mercedita Flynn (FNP)	1619166188          Ph # : 361-226-1126          fax no. : 361 542-4076 Monica Gonzalez (FNP)	1871132811          Ph # : 361-226-1126          fax no. : 361 542-4076  If you have any additional questions or need documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:54:08', '2021-11-24 13:54:08'),
(49663, 11056, 32687, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-06 15:31:47', '2021-12-06 15:31:47'),
(49664, 11056, 32687, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Enrollment Status Query - Galaxy Health - CBUC/GWMC   Is this eff date is for all of the providers or not? Provide me with welcome letters too.', NULL, NULL, '2021-12-17 14:25:54', '2021-12-17 14:25:54'),
(49665, 11056, 32687, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Enrollment Status Query - Galaxy Health - CBUC/GWMC  Enrollment Query - CBUC & GWMC - Galaxy Health   Good evening Karen!  Hope this email finds you well. Please list the highlighted location under the following provider as soon as possible. And also list all of the providers with both locations on your provider directory. I am unable to find the providers, I only found Mercedita Flynn. I have attached the SS for your concerns.    Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name & Specialities	NPI  & COntact & Fax no.  Katherine Paterson  (FNP)	1164776548              Unable to find provider on the directory Mercedita Flynn (FNP)	1619166188               Only Primary location is listed Monica Gonzalez (FNP)	1871132811              Unable to find provider on the directory  If you have any additional questions or need documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 10:10:20', '2021-12-23 10:10:20'),
(49666, 19067, 32687, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Hello!  Hope you\'re doing well,  I would like to know the enrollment status of the following Providers & Groups with Galaxy Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:24:22', '2021-12-30 13:24:22'),
(49667, 19067, 32687, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, kavalos@ghn-mci.com, dmarley@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Greetings!  You haven\'t responded yet.  Still waiting to get the updates about the previously mentioned request.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:28:22', '2022-01-09 22:28:22'),
(49668, 19067, 32687, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Good Morning!  Hope this email finds you well.  This is my SECOND REMINDER on the below mentioned request. Kindly look into this.  Kindly respond as per your convenience.   Regards, Hammad.', NULL, NULL, '2022-01-26 11:09:43', '2022-01-26 11:09:43'),
(49669, 1019, 32687, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Hello,  Can you please send me a copy of their welcome letters.     Regards, Alex', NULL, NULL, '2022-02-02 13:33:09', '2022-02-02 13:33:09'),
(49670, 19067, 32687, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||    Hello Ahmed;     There is no welcome letters this is not a personal agreement.', NULL, NULL, '2022-02-21 16:26:21', '2022-02-21 16:26:21'),
(49671, 20067, 32687, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Good Afternoon!  Hope you had a great weekend. I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663  Eagerly waiting to hear from you.  Thank you, ', NULL, NULL, '2022-03-07 16:55:33', '2022-03-07 16:55:33'),
(49672, 22077, 32687, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Hi,  I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Waiting to hear from you soon.  Thanks. Alex', NULL, NULL, '2022-04-13 14:25:22', '2022-04-13 14:25:22'),
(49673, 1006, 32688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49674, 1006, 32688, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:23', '2021-07-16 17:13:23'),
(49675, 1006, 32688, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Sent enrollment request @ pr.south@healthsmart.com:  Sub: Enrollment Request - CBUC/GWMC - Health Smart  \"Hello,   We want to enroll the following provider under the mentioned group and given addresses:   Group Name: Coastal Bend Urgent Care, LLC TIN# 81-1890349 Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663   Provider Name: Monica Gonzalez NPI# 1871132811 CAQH# 14624355  Please let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-08-16 10:12:09', '2021-08-16 10:12:09'),
(49676, 11056, 32688, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment Request - CBUC/GWMC - Health Smart  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  *Gonzalez, Monica Del Bosque NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :85450)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-08-24 08:52:12', '2021-08-24 08:52:12'),
(49677, 11056, 32688, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com    Sub : Enrollment Status Updates - CBUC/GWMC - Health Smart  & Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,  1. Our system has been updated as requested.  * The locations below have been added.  Provider \"FLYNN, MERCEDITA N\" effective date is \" 09/01/2017 \".  2. Below provider not found in the system please fill out the attached CAQH Access form and send W9 so that we can process your request.   * Katherine Paterson.  3. Provider \" Gonzalez, Monica Del Bosque NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :85450)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-09-01 14:54:30', '2021-09-01 14:54:30'),
(49678, 11056, 32688, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,  -Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status Paterson, Katherine D NP  -Provider \" Gonzalez, Monica Del Bosque NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81433)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-09-14 12:36:39', '2021-09-14 12:36:39'),
(49679, 11056, 32688, NULL, '2021-10-04 00:00:00.000', 'In Process', '', NULL, NULL, '2021-09-27 10:49:49', '2021-09-27 10:49:49'),
(49680, 11056, 32688, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Good morning!  Hope you had a great and safe weekend. Please assist with the below at your earliest opportunity.  (Inventory Log ID : 85450)  01- Provider \" Monica D Gonzalez, NP \" is effective date \" 10/01/2021 \": Please provide us with the welcome letter for the provider  02- Provider \" Paterson, Katherine D NP \" : Provide the latest updates on the credentialing process of the provider.  If you need any documents or information or have any concerns please do not hesitate to contact me.   Thank you! Have a blessed day!', NULL, NULL, '2021-10-06 14:36:09', '2021-10-06 14:36:09'),
(49681, 11056, 32688, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : mdiprsupport@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart   Good morning!  Hope you had a great and safe weekend. Please assist with the below at your earliest opportunity.  (Inventory Log ID : 85450)  01- Provider \" Monica D Gonzalez, NP \" is effective date \" 10/01/2021 \": Please provide us with the welcome letter for the provider  02- Provider \" Paterson, Katherine D NP \" : Provide the latest updates on the credentialing process of the provider.  If you need any documents or information or have any concerns please do not hesitate to contact me.   Thank you! Have a blessed day!', NULL, NULL, '2021-10-14 14:48:34', '2021-10-14 14:48:34'),
(49682, 11056, 32688, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Welcome letters have not been completed for the providers effective 10/1. Please allow 2-3 weeks.    Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions 6303 Commerce Drive | Suite 180 | Irving, TX 75039 pr.south@healthsmart.com | www.HealthSmart.com  ', NULL, NULL, '2021-10-22 09:07:06', '2021-10-22 09:07:06'),
(49683, 11056, 32688, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Welcome letters will be generated and go out this week.     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039', NULL, NULL, '2021-11-09 14:01:49', '2021-11-09 14:01:49'),
(49684, 11056, 32688, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  pr.south@healthsmart.com  Sub: Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,   Provider \" Monica D Gonzalez, NP \" is  effective date \" 10/01/2021 \".   It has been 2 months after requesting and demanding the welcome letters not been received yet. ALthough found them in the provider directory.  Please see the attachment. ', NULL, NULL, '2021-11-24 10:17:58', '2021-11-24 10:17:58'),
(49685, 11056, 32688, NULL, '2021-12-01 00:00:00.000', 'Approved', 'Email received from:  pr.south@healthsmart.com  Sub: Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,   Provider \" Monica D Gonzalez, NP \" is  effective date \" 10/01/2021 \".   It has been 2 months after requesting and demanding the welcome letters not been received yet. ALthough found them in the provider directory.  Please see the attachment.', NULL, NULL, '2021-11-24 10:18:25', '2021-11-24 10:18:25'),
(49686, 1006, 32689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49687, 1006, 32689, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:29', '2021-07-16 17:13:29'),
(49688, 1006, 32689, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Sent enrollment request @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment Request - Monica Gonzalez - Humana  \"Hello,  Please find the attached roster for our provider that we wish to add to our group, do let me know if you have anything else is required to proceed with this request. Thank you.\"  Attached for reference. ', NULL, NULL, '2021-07-28 16:50:01', '2021-07-28 16:50:01'),
(49689, 1006, 32689, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment & Location Status - CBUC/GWMC   \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment & location status for the following group and providers:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Are both of the addresses listed under both the group and mentioned providers?  Thank you!\"', NULL, NULL, '2021-08-16 12:19:56', '2021-08-16 12:19:56'),
(49690, 11056, 32689, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Still waiting for the  Updated MALPRACTICE : Frank Dehnisch  Updated  AANP Certification : Mercedita Flynn  by Ryan.', NULL, NULL, '2021-08-24 17:09:28', '2021-08-24 17:09:28'),
(49691, 11056, 32689, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to : stxnm@humana.com, mduffee@humana.com  Sub : Enrollment & Location Status - CBUC/GWMC  Good morning!  Hope this email finds you well. I want to inquire about the enrollment & location status of the following providers and practice. Are both of the addresses listed under both the group and mentioned providers?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice TIN# 81-1890349 Practice Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Practice Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Mercedita Flynn Provider NPI#: 1619166188  Provider Name: Monica Gonzalez Provider NPI#: 1871132811  If you require any further information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-25 08:36:40', '2021-08-25 08:36:40'),
(49692, 11056, 32689, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Rep : Dean L  Ref code : 2000201690399  -Monica out  of network. Roster has been resubmitted at mlacastesantos@humana.com & Hmaleon@humana.com  -Mercedita in network. secondary location is on file and in process for loading  Contact no. : 8006262741', NULL, NULL, '2021-09-22 13:20:58', '2021-09-22 13:20:58'),
(49693, 11056, 32689, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email sent to : mlacastesantos@humana.com. & 	Hmaleon@humana.com  Sub : MONICA GONZALEZ & test email  Hey Lance!  Hope this email finds you well. You haven\'t responded to my query yet. Please assist with the below at your earliest opportunity.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI & Enrollment Status Monica Gonzalez	1871132811 : with both locations  Mercedita Flynn	1619166188 :  the secondary location listed or not?   If you have any questions or require additional information or documents please let me know.   Thank you! Have a great weekend! ', NULL, NULL, '2021-10-01 17:10:49', '2021-10-01 17:10:49'),
(49694, 11056, 32689, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Rep : Jean L  Status : MONICA is in process . This request has been provided to the contractor. 45 days will be needed. The contracting dept will contact us soon.  Ref  code : 2000204032187', NULL, NULL, '2021-10-07 16:56:40', '2021-10-07 16:56:40'),
(49695, 11056, 32689, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Ritch M  Status :Monica Gonzalez is still out of network. She is gonna to escalate our application to contracting depart.  Ref code: 2000205673540  Contact no. : (800) 626-2741', NULL, NULL, '2021-10-18 16:32:05', '2021-10-18 16:32:05'),
(49696, 11056, 32689, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Rep : Jessie T  Status:  Send them the roster for Monica Gonzalez again. Escalated the request. Going to send us the roster for leticia.  Ref code: 2000208916781  Contact no. : (800) 626-2741 ', NULL, NULL, '2021-11-04 16:05:54', '2021-11-04 16:05:54');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49697, 11056, 32689, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  VCervantes2@humana.com  Sub:  Roster for Monica Gonzalez  Good Morning,     Your request was received.  However we are unable to process due to the following reasons:     ·        There cannot be two (2) remit to addresses for one tax ID number. The remit to address listed for your group is:  o   301 Hillside Drive, Suite 4, Beeville, TX 78102     Billing #: (361) 226-1126.     Please resubmit your request with the appropriate remit address.  No additional action can be taken at this time.  This request is now considered closed.     Thank you,     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741  F 855.461.6048  stxnm@humana.com     Learn more about our Bold Goal  #MoreHealthyDays  #startwithhealthy   ', NULL, NULL, '2021-11-24 09:53:12', '2021-11-24 09:53:12'),
(49698, 11056, 32689, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  vcervantes2@humana.com  Sub:  Roster for Monica Gonzalez  Good morning!  Hope this email finds you well. Yes, this one is the main and correct address for the billing.  Billing & Primary Address: 301 Hillside Drive, Suite 4, Beeville, TX 78102     Billing #: (361) 226-1126.  Please see the attached roster. The correction has been made.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 16:46:35', '2021-12-06 16:46:35'),
(49699, 11056, 32689, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Rep: Adrian I   Status: Unprocessed yet. An email has been sent for escalation. Delay from the credentialing side of Humana   Refcode: 2000216735787', NULL, NULL, '2021-12-17 17:09:13', '2021-12-17 17:09:13'),
(49700, 11056, 32689, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Sub: Roster for Monica Gonzalez  Your answer to our question was received and is in the queue to be worked on.  Please allow more time for the completion of your requests.   You will receive an email notification once your request has been completed.    Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 F 855.461.6048 stxnm@humana.com', NULL, NULL, '2021-12-22 12:56:04', '2021-12-22 12:56:04'),
(49701, 19067, 32689, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||  Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S Hillside, DR STE 4, Beeville, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside, DR STE 4, Beeville, TX 78102-5324    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:48:10', '2022-01-04 12:48:10'),
(49702, 19067, 32689, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Monica Gonzalez was added to the group on 11/22/2021     Leticia Aleman-Listenbee was added to the group on 12/17/2021.   Thank you   Network Operations Coordinator – Provider Contracting     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2022-01-11 13:06:56', '2022-01-11 13:06:56'),
(49703, 19067, 32689, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Greetings!  I am unable to find these providers on Humana\'s provider directory.  Kindly assist me in this matter.  Regards, Hammad.', NULL, NULL, '2022-01-26 13:33:37', '2022-01-26 13:33:37'),
(49704, 19067, 32689, NULL, '2022-03-07 00:00:00.000', 'Approved', 'Email received from: stxnm@humana.com  Monica Gonzalez is loaded with a 1/1/2021 effective date  Leticia Aleman-Listenbee loaded on 11/1/2021', NULL, NULL, '2022-02-28 15:54:48', '2022-02-28 15:54:48'),
(49705, 1006, 32690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49706, 1006, 32690, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:36', '2021-07-16 17:13:36'),
(49707, 1006, 32690, NULL, '2021-08-23 00:00:00.000', 'Approved', 'We received the following approval confirmation email from ProviderMarketingInfo ProviderMarketingInfo@usamco.com:   Sub: Enrollment Status/Request - CBUC/GWMC - MCO  \"Hi Brad,  I show that there is an active agreement with TIN 81-1890349 since 2/22/17 under the name Beeville Medical Clinic and the two DBA’s Coastal Bend Urgent Care LLC and Coastal Bend Long Term Care.  I show two addresses under this agreement, 600 S Hillside Dr and 301 S Hillside Dr Ste 4.  I have CC’ed our Provider Relations department on this email and they will be able to add the 504 A Houston St address below.  With regards to the providers, as the agreement is as an Ancillary group, you do not need to add/credential new providers. Any provider billing under the TIN and one of the addresses on file will be counted as in-network.  Please let me know if you have any further questions.  Sarah Cozzetto Lead Network Development Coordinator\"', NULL, NULL, '2021-08-16 10:13:17', '2021-08-16 10:13:17'),
(49708, 1006, 32691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49709, 1006, 32691, NULL, '2021-07-23 00:00:00.000', 'Initiated', 'Applicant Name: MONICA GONZALEZ  Tracking ID: T071620210001167  Reassignment Tracking ID: T071620210002107  Submitted Date: FRI - JULY 16 2021 03:03:26 PM EST  Submitted By: Monica Gonzalez  Contact Email(s): MXG4797@GMAIL.COM CBUC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is enrolling in the Medicare program for the first time to bill for Part B services. A reassignment of benefits may exist. ', NULL, NULL, '2021-07-16 14:04:45', '2021-07-16 14:04:45'),
(49710, 1006, 32691, NULL, '2021-07-30 00:00:00.000', 'In Process', 'We received the following correction request:  \"To:  mxg4797@gmail.com,cbuc@claimsmedinc.com   Subject:  Request for Corrections for Medicare Enrollment Application (Tracking ID: T071620210001167)  Date:   07/21/2021 20:15 PM  This message is in response to your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T071620210001167. The information provided below indicates areas of your application requiring corrections as determined by your fee-for-service contractor.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T071620210001167   NPI ID: 1871132811   Medicare ID:    Name: MONICA GONZALEZ   State: TX  Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Other Comments  Please provide a copy of the master\'s degree.    Thank you for your cooperation.  After you have resubmitted your corrections through the Internet-based PECOS application, you may electronically sign or upload the certification statement for the corrections or if you prefer, please fax a new signed and dated certification statement(s) to my attention at: 904-361-0614; Fax to Image 877-439-5479.  Once you have submitted the corrections or if you have any questions about this request, please call me at 570-912-8376. JUSTINE GARDNER DCN: 3211970759 Novitas Solutions, Inc. Provider Enrollment Services Please note, we may reject your application if you do not furnish the complete information within 30 days from the date of this letter pursuant to 42 CFR 424.525. \"  Corrected.', NULL, NULL, '2021-07-23 11:02:07', '2021-07-23 11:02:07'),
(49711, 1006, 32691, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Application Tracking ID: T071620210001167   NPI ID: 1871132811   Medicare ID: 1R9771   Name: MONICA GONZALEZ  State: TX   Form Type: 855I  Date: 07/26/2021  Status: APPROVED ', NULL, NULL, '2021-07-27 09:23:19', '2021-07-27 09:23:19'),
(49712, 1006, 32691, NULL, '2021-08-04 00:00:00.000', 'Approved', '', NULL, NULL, '2021-07-28 10:23:16', '2021-07-28 10:23:16'),
(49713, 1006, 32691, NULL, '2021-08-13 00:00:00.000', 'Approved', '', NULL, NULL, '2021-08-06 09:14:23', '2021-08-06 09:14:23'),
(49714, 1006, 32692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49715, 1006, 32692, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:42', '2021-07-16 17:13:42'),
(49716, 1006, 32692, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Submitted enrollment request: Reference Number: 21228000546 Please allow three business days for the activation of this newly assigned PTAN', NULL, NULL, '2021-08-16 10:52:06', '2021-08-16 10:52:06'),
(49717, 1006, 32692, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Approval letter received and is attached.  PTAN: Q00116068 Eff: 05/01/2021', NULL, NULL, '2021-08-30 16:26:07', '2021-08-30 16:26:07'),
(49718, 1006, 32693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49719, 1006, 32693, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:49', '2021-07-16 17:13:49'),
(49720, 1006, 32693, NULL, '2021-08-05 00:00:00.000', 'Not Eligible', 'We received  the following denial notification from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"At this time, the cities listed below are out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"', NULL, NULL, '2021-07-29 13:34:12', '2021-07-29 13:34:12'),
(49721, 1006, 32694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49722, 1006, 32694, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:58', '2021-07-16 17:13:58'),
(49723, 1006, 32694, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment. ', NULL, NULL, '2021-08-16 12:24:47', '2021-08-16 12:24:47'),
(49724, 11056, 32694, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-09-24 11:47:07', '2021-09-24 11:47:07'),
(49725, 11056, 32694, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-06 12:37:12', '2021-10-06 12:37:12'),
(49726, 11056, 32694, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-10-14 15:47:31', '2021-10-14 15:47:31'),
(49727, 11056, 32694, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-10-22 10:21:27', '2021-10-22 10:21:27'),
(49728, 11056, 32694, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-09 14:11:17', '2021-11-09 14:11:17'),
(49729, 11056, 32694, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-11-24 12:13:28', '2021-11-24 12:13:28'),
(49730, 11056, 32694, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 17:01:38', '2021-12-06 17:01:38'),
(49731, 11056, 32694, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 17:01:38', '2021-12-06 17:01:38'),
(49732, 11056, 32694, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Please see the attachment', NULL, NULL, '2021-12-21 17:39:05', '2021-12-21 17:39:05'),
(49733, 1006, 32695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49734, 1006, 32695, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:05', '2021-07-16 17:14:05'),
(49735, 1006, 32695, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment. ', NULL, NULL, '2021-08-16 12:24:53', '2021-08-16 12:24:53'),
(49736, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Email sent to: david.balli@molinahealthcare.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Molina Health||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Molina Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-12-21 17:43:01', '2021-12-21 17:43:01'),
(49737, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'We received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Coastal Bend Urgent Care, LLC  \"Good Afternoon,  Happy Wednesday! Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Coastal Bend Urgent Care, LLC ) to contract under TAX ID number (81-1890349).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below: EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com 888-562-5442 x200249   Have a wonderful day! Thank you, Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"', NULL, NULL, '2021-12-21 17:43:34', '2021-12-21 17:43:34'),
(49738, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'We received the following update from Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Monday!!  Hope you are doing well.  I am following up to my previous email. Please be advised unless all forms are returned, we will not be able to continue contracting process.  any assistance will be greatly appreciated.  Thank you in advance  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Replied with the requested information:  \"Hello Juliana,   I apologize for the delay, here\'s the requested information hopefully it suffices. We also have a secondary location and the address is as follows: 504A Houston Street, George West, TX 78022-3663  Do let me know if anything else is required to proceed.\"', NULL, NULL, '2021-12-21 17:44:08', '2021-12-21 17:44:08'),
(49739, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good evening!  Hope all is well. Please provide me with the latest updates of the enrollment status of following providers & practice and the secondary location too. Kindly also update me about the applications and forms submitted to you regarding enrollment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Furthermore,if documents and information is needed please let me know. Please don\'t hesitate to contact me directly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-12-21 17:44:34', '2021-12-21 17:44:34'),
(49740, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope all is well. Here is the filled contract request form for the secondary service location 504-A, Houston Street. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Furthermore, if any additional information is required please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-21 17:45:10', '2021-12-21 17:45:10'),
(49741, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-12-21 17:45:33', '2021-12-21 17:45:33'),
(49742, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-12-21 17:45:57', '2021-12-21 17:45:57'),
(49743, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-12-21 17:46:29', '2021-12-21 17:46:29'),
(49744, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-12-21 17:50:04', '2021-12-21 17:50:04'),
(49745, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-21 17:50:43', '2021-12-21 17:50:43'),
(49746, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-12-21 17:50:56', '2021-12-21 17:50:56'),
(49747, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-21 17:51:18', '2021-12-21 17:51:18'),
(49748, 11056, 32695, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Please see the attachment', NULL, NULL, '2021-12-21 17:51:46', '2021-12-21 17:51:46'),
(49749, 1006, 32696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:27', '2021-07-16 10:06:27'),
(49750, 1006, 32696, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:11', '2021-07-16 17:14:11'),
(49751, 1006, 32696, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent following request @ registrar@multiplan.com:  Sub: Practitioner Application - CBUC/GWMC - Multiplan  \"Hello,   Please find the attached information for our providers, do let me know if anything else is required to proceed.  Thank you. \" ', NULL, NULL, '2021-08-11 11:01:36', '2021-08-11 11:01:36'),
(49752, 11056, 32696, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Updates - CBUC/GWMC - Multiplan  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 15:15:50', '2021-08-18 15:15:50'),
(49753, 11056, 32696, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com, pif@multiplan.com  &  ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Good morning!  Hope this email finds you well. Here are the Group Cover Sheet for Practitioner Applications for the enrollment of the below mentioned providers under the practice in Multiplan.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 11:55:03', '2021-08-24 11:55:03'),
(49754, 11056, 32696, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email received from : ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Hello,  Thank you for contacting our Service Department at MultiPlan/PHCS.  Unfortunately the email box you have submitted your request to providerservices@multiplan.com does not process these types of requests.  You may contact us at our Customer Service department by calling 800-950-7040 or you may visit our website at https://custservice.multiplan.com (note there is no www. for the link) to request service online.  As a reminder under the MultiPlan and/or PHCS provider agreement, MultiPlan does not make determinations with respect to benefits or eligibility or pay claims. For these types of inquiries please contact the patient\'s insurance company.  **Please do not reply back to this email. We will not be able to process your request.**  Thank you,  Service Operations', NULL, NULL, '2021-09-03 14:59:36', '2021-09-03 14:59:36'),
(49755, 11056, 32696, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : 	appmissinginfo@multiplan.com  Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760  Good evening!  Hope all is well with you. Here is the Filled form for the provider Gonzalez Monica. Please find the attachment below.  Practice Details: Practice/ Group Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Furthermore, If anything is required by you please let me know without any hesitation.  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-20 12:38:09', '2021-09-20 12:38:09'),
(49756, 11056, 32696, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760 Regarding Paterson, Katherine D., MSN\'s MultiPlan Application – Reference: APP0008265762   Good afternoon!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment status of the following providers under the Facility TIN. Are both locations listed below the TIN and providers too?  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Monica Gonzalez	1871132811  If you need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 16:23:38', '2021-09-29 16:23:38'),
(49757, 11056, 32696, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760  Rep. : Dann G  Monica is in process Malpractice & Hospital affiliations issue.  Ref code : 7711003  Contact : (800) 950-7040 ', NULL, NULL, '2021-10-04 10:37:06', '2021-10-04 10:37:06'),
(49758, 11056, 32696, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760  Rep. : Dann G  Monica is in process Malpractice & Hospital affiliations issue.  Ref code : 7711003  Contact : (800) 950-7040 ', NULL, NULL, '2021-10-04 10:37:07', '2021-10-04 10:37:07'),
(49759, 11056, 32696, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Rep :  Natasha C  Status : Participation completed. Credentialing is completed  Soon they gonna send the letter in 8-10 business days  Eff date : 10/04/2021  Ref code : 7711003  Contact : (800) 950-7040', NULL, NULL, '2021-10-14 12:26:31', '2021-10-14 12:26:31'),
(49760, 11056, 32696, NULL, '2021-10-25 00:00:00.000', 'Approved', 'Email received from :welcomepackets@multiplan.com  Sub : SECURE: MultiPlan Network Participation (13939691-9933249)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Gonzalez, Monica D., MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information   Eff dates : 10/4/2021   Please see the attachment. Welcome letter is attached.', NULL, NULL, '2021-10-18 10:25:47', '2021-10-18 10:25:47'),
(49761, 1006, 32697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49762, 1006, 32697, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:18', '2021-07-16 17:14:18'),
(49763, 11056, 32697, NULL, '2021-09-02 00:00:00.000', 'Not Eligible', 'Email received from : cresta.smith@careallies.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  These providers are not in the renaissance service area. We are only in the greater Houston area.     Thanks  Cresta', NULL, NULL, '2021-08-25 14:21:21', '2021-08-25 14:21:21'),
(49764, 1006, 32698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49765, 1006, 32698, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:24', '2021-07-16 17:14:24'),
(49766, 1006, 32698, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'We received the following Network Denial/Rejection email from Scott & White:   Sub: New Contract Request  \"Tax ID#: 811890349  RE: Network Denial  Dear Katherine  D Paterson  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 03/03/2021, SWHP and FirstCare regretfully declines to contract with Katherine  D Paterson this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.   Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\" ', NULL, NULL, '2021-08-16 12:27:18', '2021-08-16 12:27:18'),
(49767, 1006, 32699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49768, 1006, 32699, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:32', '2021-07-16 17:14:32'),
(49769, 1006, 32699, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'Pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 10:02:29', '2021-08-16 10:02:29'),
(49770, 11056, 32699, NULL, '2021-09-27 00:00:00.000', 'Initiated', 'Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.   Online form has been submitted. Please see the attachment.', NULL, NULL, '2021-09-20 08:36:24', '2021-09-20 08:36:24'),
(49771, 11056, 32699, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good afternoon,  The record is showing provider Regarding provider MONICA GONZALEZ, the application packet was received 09/28/2021 and is currently in process.     Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2021-09-29 16:58:57', '2021-09-29 16:58:57'),
(49772, 11056, 32699, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good morning!  Hope this email finds you well. I want to get an update regarding the enrollment process of the following provider under this TIN with Superior HealthPlan. Please provide the updates soon.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811    If you need any additional information or documents please let me know. Waiting for your reply.  Thank you! Have a great day! ', NULL, NULL, '2021-10-12 15:33:29', '2021-10-12 15:33:29'),
(49773, 11056, 32699, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub  : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good morning  My apologies for the delay in response   For the Provider Monica Gonzalez NPI#1871132811 under TID#811890349 is under credentialing status with a TAT of 12 business days   Have a great day   Veronica Botello Rocha  Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-10-22 08:30:41', '2021-10-22 08:30:41'),
(49774, 11056, 32699, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188   Good morning,     After reviewing the application status for the provider below, I see the application is under Make PAR status. At This time, our Network Development Team is validating provider information to be uploaded into our system.     Provider projected effective date shows to be 12/1/2021, however, until our system reflects the Provider Completed Status, then we are unable to provide you with an actual effective date.     Please allow a bit more time for this to be completed.', NULL, NULL, '2021-11-09 16:27:38', '2021-11-09 16:27:38'),
(49775, 11056, 32699, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good morning!  Hope this email finds you well. I want to get an update regarding the enrollment process of the following provider under this TIN with Superior HealthPlan. Please provide the updates soon.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811    If you need any additional information or documents please let me know. Waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:26:36', '2021-11-24 13:26:36'),
(49776, 11056, 32699, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email received from:  AM.CorpusChristi@superiorhealthplan.com   Sub:  REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good afternoon Ahmed,  Provider has an effective date of 12/1/2021, meaning you will get a Welcome letter for provider before end of this month or on by effective date.  Our department does not issue Welcome Letters for providers. Please allow for that information to be sent out by our ECM team. If you do not receive it by providers effective date,  you may reach out to them by beginning of next month contacting them at the following email address.   ECMExecutionTeam@superiorhealthplan.com  Thank you,   Yesenia Prado Provider Account Manager Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Phone: (800) 656-4817  Option 1 /English Option 3 for Account Management Fax: (866) 683-5630   AM.CorpusChristi@Superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 ext. 87391', NULL, NULL, '2021-12-10 10:14:33', '2021-12-10 10:14:33'),
(49777, 1006, 32700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49778, 1006, 32700, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:38', '2021-07-16 17:14:38'),
(49779, 1006, 32700, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment.', NULL, NULL, '2021-08-16 12:28:07', '2021-08-16 12:28:07'),
(49780, 11056, 32700, NULL, '2021-09-24 00:00:00.000', 'Initiated', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP   Good morning!  Hope all is well. Please find the attached application for the below mentioned provider under the following practice for both locations.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name : Monica Gonzalez Provider NPI# :  1871132811  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-17 13:09:30', '2021-09-17 13:09:30'),
(49781, 11056, 32700, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Hello,  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.   Thank you  Liz Ramirez Contract Specialist Texas Children’s Health Plan', NULL, NULL, '2021-09-28 09:44:57', '2021-09-28 09:44:57'),
(49782, 11056, 32700, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : tchpnetworkmanagement@texaschildrens.org & bxgupta@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Group- Coastal Bend Urgent Care, LLC   Katherine Paterson         1164776548 Please see attached denial letter  20211001038052743     Mercedita Flynn               1619166188 Please see attached denial letter  20210930038036249     Monica Gonzalez             1871132811 Please see attached denial letter  20210930038036263   No TCHP does not work with BEE county. Our apologies.  You can also check yourself on website at texaschildrens.org yourself which county TCHP serves. ', NULL, NULL, '2021-10-07 10:35:59', '2021-10-07 10:35:59'),
(49783, 1006, 32701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49784, 1006, 32701, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:45', '2021-07-16 17:14:45'),
(49785, 1006, 32701, NULL, '2021-08-17 00:00:00.000', 'In Process', 'As per my discussion with TRPN we need to send a provider update form to them, requested a copy, and sent it to trpndataentry@trpnppo.com:  Sub: Provider Update Form - CBUC/GWMC - TRPN  \"Hello,   Please find the attached provider update forms for our providers. Please let me know if anything else is required to continue.   Thank you!\"  Attached for reference in provider tasks. ', NULL, NULL, '2021-08-10 12:45:13', '2021-08-10 12:45:13'),
(49786, 11056, 32701, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Status Updates - CBUC/GWMC - TRPN  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:08:00', '2021-08-18 14:08:00'),
(49787, 11056, 32701, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  trpndataentry@trpnppo.com, providerrelations@trpnppo.com   & AVasquez@trpnppo.com  Sub : Provider Update Form - CBUC/GWMC - TRPN   Good afternoon!  Hope this email finds you well. Please inform me with the latest updates regarding enrollment status of the following providers under the practice in TRPN. Please also inform me about the provider\'s update forms.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 13:32:24', '2021-08-24 13:32:24'),
(49788, 11056, 32701, NULL, '2021-09-09 00:00:00.000', 'Approved', 'Approval Email received from : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status Updates - CBUC/GWMC - TRPN  Hi,     This request is completed,     Provider Mercedita Flynn is Active, effective date 01/01/2017,  Provider Katherine Paterson is Active, effective date 01/01/2017,  Provider Monica Gonzalez is Active, effective date 01/01/2021.    Please see the attachment', NULL, NULL, '2021-09-01 16:07:17', '2021-09-01 16:07:17'),
(49789, 1006, 32702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49790, 1006, 32702, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:51', '2021-07-16 17:14:51'),
(49791, 11056, 32702, NULL, '2021-09-27 00:00:00.000', 'Initiated', '	 I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for the certification process and the form has been faxed at 608-221-7535   Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 15:57:05', '2021-09-20 15:57:05'),
(49792, 11056, 32702, NULL, '2021-09-27 00:00:00.000', 'Initiated', '	 I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for the certification process and the form has been faxed at 608-221-7535   Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 15:57:07', '2021-09-20 15:57:07');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49793, 11056, 32702, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com & ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning  Ahmed,     Katherine, has taken another position.  This address location do not appear in my area. I will assist you with this question but any additional questions please reach out to Jacqueline Trenz. I have include her on this email.  You do not need to include me on the emails for this area    Provider Details: Provider Name: Flynn, Mercedita N  Provider NPI# 1619166188 - Show affiliated with this group tax id but is not display on the portal a request was submitted to update. Allow up to five business days to process.   Provider Name: Katherine Paterson- Show affiliated with this group tax id and is displayed  Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811 - Do not appear in our system as TRICARE certified. Below is the link to the certification application for you to complete and fax to WPS.', NULL, NULL, '2021-09-30 15:51:17', '2021-09-30 15:51:17'),
(49794, 11056, 32702, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon!  Hope all is well with you. Please assist with the below at your earliest opportunity.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI & Queries Katherine Paterson	1164776548 : Please provide eff date & Please update the main                           location with proper address on your director  Mercedita Flynn	1619166188 : Latest updates on this application Monica Gonzalez	1871132811 : We have faxed the certification and credentialing                                      application to Tricare.  If you have any questions or require additional information or documents please don\'t hesitate in contacting me. Please see the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-07 16:15:09', '2021-10-07 16:15:09'),
(49795, 11056, 32702, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Please allow 90 days for processing of Ms. Gonzalez.  Application was faxed 9/20/2021.      Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-14 16:01:12', '2021-10-14 16:01:12'),
(49796, 11056, 32702, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Hello Jacqueline!  Hope you are doing great. Please help me out with the issue mentioned below:  Katherine Paterson - The main location is not appearing in your directory.  Mercedita Flynn - The secondary location is not appearing in your directory.  Please also see the attachments related to this. Kindly sort this out for me as soon as possible.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-22 10:35:47', '2021-10-22 10:35:47'),
(49797, 11056, 32702, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub:  Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning,     The correct locations are showing up in my systems, so I have to send this the my provider administration team for a review.  Please email  a copy of the W-9 for the group so I can send my request.   Have provided them with their demands.', NULL, NULL, '2021-11-09 15:46:46', '2021-11-09 15:46:46'),
(49798, 11056, 32702, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  ywyatt@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon Ahmed,     You can check the status and effective dates on a provider by creating a log-in on the Provide Portal using the links listed below. This address location is not in my area. You do not need to include me on the email for Coastal Bend unless there is a location in Houston Texas.     https://infocenter.humana-military.com/provider/service/Account/Login  Katherine Paterson is listed as network the effective date is listed on the Provider Portal    Mercedita Flynn is listed as network the effective date is listed on the Provider Portal  Monica Gonzalez- certification faxed to WPS can take up to 120 days to process. WPS will send you a letter once the application is complete. I do not have access to WPS system to give you the status. You can call 1800 444 5445 and ask to speak to the certification unit to check status.', NULL, NULL, '2021-11-24 12:43:14', '2021-11-24 12:43:14'),
(49799, 11056, 32702, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Jacqueline!  Hope this email finds you well. Any update on the location listing in the provider directory? Have the locations been updated?  For Katherine : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  For Mercedita : 504A Houston Street, George West , TX 78022-3663  Take Care! Have a wonderful week ahead!', NULL, NULL, '2021-12-10 13:04:07', '2021-12-10 13:04:07'),
(49800, 11056, 32702, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon!  Hope this email finds you well. Please update me with the certification & credentialing process of the below-mentioned provider at your earliest convenience.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you require any further information or documents please let me know.  Thank you!', NULL, NULL, '2021-12-17 17:53:32', '2021-12-17 17:53:32'),
(49801, 11056, 32702, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning Jacqueline!  Hope you had a wonderful week yet. Please respond to the below query soon. I am still waiting to get the latest updates regarding the provider, Monica\'s certification, and credentialing with Tricare.  Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 13:18:54', '2021-12-22 13:18:54'),
(49802, 19067, 32702, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||     Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mocia Gonzalez	1871132811	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663   Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:59:15', '2022-01-04 10:59:15'),
(49803, 19067, 32702, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||   Good Morning Hammad,     This group tax id is not in my area. Celeste Santiago is the Rep for that area. I have include her on this email.  Please reach out to her to assist.  You can also check status by creating a log in on the Provider portal.', NULL, NULL, '2022-01-10 10:12:41', '2022-01-10 10:12:41'),
(49804, 19067, 32702, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com, ywyatt@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Greetings Celeste!  Hope this email finds you well.  Can you look into the request mentioned below?   Have a beautiful day! Hammad Ahmed.', NULL, NULL, '2022-01-20 20:27:32', '2022-01-20 20:27:32'),
(49805, 19067, 32702, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the following email from: CSantiago20@humana.com    Hammad,  Thank you for reaching out to me.  I am the new Provider Rep for the Corpus Christi Area, as well as Austin, and Del Rio area.  I have researched your providers you listed and have annotated in RED below  Group Name  Beeville Medical Clinic   Tax ID  81-1890349    Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified Authorized TRICARE Provider-assigned this location     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified Authorized TRICARE Provider-assigned to this location     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location        I have identified an issue for Mercedita Flynn, but that does not impact her as a provider and certification and or credentialing.  That alert has been submitted and is set to be corrected.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 12:00:20', '2022-02-16 12:00:20'),
(49806, 1006, 32703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49807, 1006, 32703, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:57', '2021-07-16 17:14:57'),
(49808, 1006, 32703, NULL, '2021-08-23 00:00:00.000', 'In Process', 'The request is in-process in group task as Triwest only enrolls urgent care centers, not individual providers. ', NULL, NULL, '2021-08-16 12:30:42', '2021-08-16 12:30:42'),
(49809, 11056, 32703, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : credentialing@triwest.com, providerservices@triwest.com, jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I am still waiting to get an update regarding the status of enrollment for our group and providers mentioned below. Please respond to me as soon as possible.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 10:41:16', '2021-08-24 10:41:16'),
(49810, 11056, 32703, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening Jess!  Hope this email finds you well. Thank you so much for the prompt response. Please provide me with the welcome or approval letters for the below mentioned providers and practice as soon as possible.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-03 14:43:27', '2021-09-03 14:43:27'),
(49811, 11056, 32703, NULL, '2021-10-01 00:00:00.000', 'In Process', 'mail received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-09-24 14:51:22', '2021-09-24 14:51:22'),
(49812, 11056, 32703, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-10-06 12:57:06', '2021-10-06 12:57:06'),
(49813, 11056, 32703, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : providerdataupdate@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates regarding the providers and facility credentialing applications mentioned below under Tax I.D and both locations. And still waiting for the welcome letters for the providers.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663  Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   If you have any questions or concerns or require any information or documents please let me know. Eagerly, waiting for the response.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-14 15:55:50', '2021-10-14 15:55:50'),
(49814, 11056, 32703, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential   Talha,  I removed Michelle from the email as she is no longer in the same department.   We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.  The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548        Cecilia Carroll Direct Contract Manager TriWest Healthcare Alliance  O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com', NULL, NULL, '2021-10-22 12:03:02', '2021-10-22 12:03:02'),
(49815, 11056, 32703, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential     Talha,     Reminder, Michelle is no longer in this department.      See below status of your urgent care and providers in question.     We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.     The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548              Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance  O:  (623) 435-3343  F:  (866) 549-4618  ccarroll@triwest.com  www.triwest.com', NULL, NULL, '2021-11-09 11:14:32', '2021-11-09 11:14:32'),
(49816, 11056, 32703, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sbachman@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Julie,  Please process the provider in Pending status and provider the effective dates for all three providers.     Group Name  Coastal Bend Urgent Care, LLC  Tax ID  81-1890349  Group NPI  1427509264  Primary Location  301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Secondary Location  504A Houston Street, George West , TX 78022-3663  Provider Name  NPI  Katherine Paterson  1164776548  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Sincerely,  Sandra Bachman  Team Lead, Provider Data Ops / TriWest Healthcare Alliance  P: 1 (855) 722-2838  F: (866) 589-7693  www.triwest.com', NULL, NULL, '2021-11-24 13:02:19', '2021-11-24 13:02:19'),
(49817, 11056, 32703, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  	jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest   Good morning Julie!  Hope this email finds you well. Please respond to this query at your earliest convenience. Provide us with the effective dates and welcome letters for all three providers soon.  Eagerly, waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 18:02:30', '2021-12-06 18:02:30'),
(49818, 11056, 32703, NULL, '2021-12-21 00:00:00.000', 'Approved', 'Email received from: jmonson@triwest.com & Credentialing@triwest.com & sdevi@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  Talha,  Coastal Bend Urgent Care LLC, 301 S Hillside Dr, Ste 4 Beeville TX – 78102 and NPI: 1427509264 credentialed as of date 09/27/2019.  The location has been added. Effective 7/26/2021.  Here is the provider information that you have requested  Providers - Effective dates   Patterson – 10.15.21  Flynn – 9.29.21  Gonzalez – 10.5.21  Thank you.  Sailaja Devi Provider Credentialing Specialist TriWest Healthcare Alliance  Ph: (480) 530 4403 Fax: (866) 549-4610 Sdevi@triwest.com www.triwest.com', NULL, NULL, '2021-12-14 15:39:54', '2021-12-14 15:39:54'),
(49819, 1006, 32704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49820, 1006, 32704, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:15:04', '2021-07-16 17:15:04'),
(49821, 1006, 32704, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Submitted enrollment request via RFP portal. Attached for reference. ', NULL, NULL, '2021-08-16 14:03:28', '2021-08-16 14:03:28'),
(49822, 11056, 32704, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - CBUC / GWMC - United HealthCare  Good afternoon!  Hope all is well. I would like to request you that I am sending you this email in regards to the enrollment update status for below mentioned provider under the practice.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name : Gonzalez, Monica Provider NPI# : 1871132811  If you have any questions or concerns or need additional information or documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 15:25:17', '2021-08-24 15:25:17'),
(49823, 11056, 32704, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub :  Secure Message from brian_k_autio@uhc.com  Good afternoon,  Thank you for contacting the Network Management Resource Team. The provider, Monica Gonzalez, is linked to the Tax ID 811890349, but is not contracted yet. There is a request, PR-6102116, in process to get the group contract loaded. Please allow some additional time for the request to get completed.  Please let us know if we can assist further via email. All responses must only be sent to networkhelp@uhc.com, so we don’t receive duplicate emails. Any emails sent to my personal email will be deleted.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Brian K. Autio  Associate Network Contractor United Healthcare Network Management Resource Team (NMRT)    For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.    For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.', NULL, NULL, '2021-09-02 10:24:58', '2021-09-02 10:24:58'),
(49824, 11056, 32704, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub  : Secure Message from corin_lett@uhc.com  Thank you for  contacting Network Management Resource Team.  The provider is not contracted ot the tax ID, and I show the request is in proccess under case reference PR-6102116.  Please allow time to process.   Thank You. Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-24 10:29:11', '2021-09-24 10:29:11'),
(49825, 11056, 32704, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Emails received from :  networkhelp@uhc.com  Sub : Secure Message from corin_lett@uhc.com  Thank you for  contacting Network Management Resource Team.  The provider’s contracting is in process and can take 30-60 business days.  We thank you for your patience.   Provider Name : Gonzalez, Monica Provider NPI# : 1871132811  Thank You.  Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-06 13:27:50', '2021-10-06 13:27:50'),
(49826, 11056, 32704, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from barbara_jordan@uhc.com  Good afternoon!  Hope all is well with you. I want to get an update regarding the credentialing process of the following provider with UHC under the facility Tax ID and both locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you have any queries or concerns feel free to contact me. I will be happy to assist.  Thank you!', NULL, NULL, '2021-10-12 17:05:26', '2021-10-12 17:05:26'),
(49827, 11056, 32704, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from barbara_jordan@uhc.com  Hello  Thank you for contacting the Network Management Resource Team. PR-6102116 is in process to add the hospital based provider to TIN  811890349.  I apologize for the delay is getting the provider added, the request has been escalated.   GONZALEZ, MONICA  - 7777102   If you have any other questions or need additional assistance, please do not hesitate to contract us.    Kind Regards   Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-20 13:57:20', '2021-10-20 13:57:20'),
(49828, 11056, 32704, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from barbara_jordan@uhc.com  Good afternoon!   Hope this email finds you well. Please provide me with the latest updates regarding the provider, Monica Gonzalez\'s Enrollment with UHC at your earliest convenience.   Eagerly, waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-11-09 12:44:53', '2021-11-09 12:44:53'),
(49829, 11056, 32704, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: barbara_jordan@uhc.com  Sub:  RE: Secure Message from barbara_jordan@uhc.com  Hello Thank you for contacting the Network Management Resource Team.   GONZALEZ, MONICA  - 7777102   TIN 811890349 Effective 08/16/2021   If you have any other questions or need additional assistance, please do not hesitate to contract us.   Kind Regards   Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-24 11:01:36', '2021-11-24 11:01:36'),
(49830, 11056, 32704, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Secure Message from barbarajordan@uhc.com  Good afternoon!   Hope all is well with you. Could you please confirm about the locations because the provider is providing services at bot locations:   Primary & Billing Location:  301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location:           504A Houston Street, George West, TX 78022-3663   Kindly, provide me with the welcome letter and plan roster for the provider as soon as possible. Please list the provider on the provider directory of UHC.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 16:47:11', '2021-12-10 16:47:11'),
(49831, 11056, 32704, NULL, '2021-12-24 00:00:00.000', 'Approved', 'Email received from:   barbara_jordan@uhc.com    &  networkhelp@uhc.com  Sub:  Secure Message from barbara_jordan@uhc.com    Hello  Thank you for contacting the Network Management Resource Team.   GONZALEZ, MONICA  - 7777102   TIN 811890349 Effective 08/16/2021   If you have any other questions or need additional assistance, please do  not hesitate to contact us.   Kind Regards   Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)  Please see the attached.', NULL, NULL, '2021-12-17 13:29:23', '2021-12-17 13:29:23'),
(49832, 1006, 32705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:28', '2021-07-16 10:06:28'),
(49833, 1006, 32705, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:15:10', '2021-07-16 17:15:10'),
(49834, 1006, 32705, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 15:42:29', '2021-08-16 15:42:29'),
(49835, 11056, 32705, NULL, '2021-10-06 00:00:00.000', 'Initiated', 'Email sent to : TERESA.Argueta@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   Good afternoon!  Hope all is well with you. I want to get the latest update regarding the enrollment status of the below mentioned providers under the facility TIN with Wellcare.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  If you have any questions or concerns feel free to reach out to me soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 13:24:37', '2021-09-29 13:24:37'),
(49836, 11056, 32705, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   We are in process of loading the contract and provider.   We will let you know once complete.   Signed contract was sent to configuration to load to WellCare 9.10.2021.   Thanks  Network Development', NULL, NULL, '2021-10-07 14:55:31', '2021-10-07 14:55:31'),
(49837, 11056, 32705, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good afternoon!  Hope this email finds you well. Yes, this request is to add an additional provider highlighted below. And add a secondary location for an already approved provider with the main address.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188 : Please list the secondary location below this provider.  If you have any questions or require additional information or documents please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-10-14 16:48:52', '2021-10-14 16:48:52'),
(49838, 11056, 32705, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good Afternoon,   To add an additional provider please submit all requests via our website. Also, this inbox is for contract change requests only. If you need to update demographic or location information, please reach out to your Account Manager.    https://www.wellcare.com/en/Texas/Become-a-Provider', NULL, NULL, '2021-10-22 09:21:08', '2021-10-22 09:21:08'),
(49839, 11056, 32705, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Thank you for the information.  We have already submitted an online application for the provider, Monica Gonzalez.  Please see the attachment.  Thank you!  Application has been submitted and attached.', NULL, NULL, '2021-11-09 16:44:54', '2021-11-09 16:44:54'),
(49840, 11056, 32705, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC   Good morning!  Hope all is well with you. Please let us know the credentialing status of the below-mentioned providers with Wellcare.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188:  Please list the secondary location below this provider in your systems.  Please let us know the Account Manager of our area. And do provide his email & contact no. too.  Thank you! Have a great weekend!', NULL, NULL, '2021-11-24 14:07:59', '2021-11-24 14:07:59'),
(49841, 11056, 32705, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   This provider is still being processed. You will be notified once completed.     Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-12-06 17:43:43', '2021-12-06 17:43:43'),
(49842, 11056, 32705, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC   Hello,   The provider below is PAR effective 10/18/2021.   Please see the attachments.', NULL, NULL, '2021-12-21 17:11:19', '2021-12-21 17:11:19'),
(49843, 1006, 32706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49844, 1006, 32706, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:11:52', '2021-07-16 17:11:52'),
(49845, 1006, 32706, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Group is enrolled as an urgentcare. The contract is attached in the group task.   Eff: 01/15/2018 ', NULL, NULL, '2021-07-28 12:24:45', '2021-07-28 12:24:45'),
(49846, 1006, 32707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49847, 1006, 32707, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:00', '2021-07-16 17:12:00'),
(49848, 1006, 32707, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'Pending due to Superior Health.', NULL, NULL, '2021-08-16 10:01:56', '2021-08-16 10:01:56'),
(49849, 11056, 32707, NULL, '2021-09-27 00:00:00.000', 'Initiated', 'Online form has been submitted. Please see the attachment.', NULL, NULL, '2021-09-20 10:12:36', '2021-09-20 10:12:36'),
(49850, 11056, 32707, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Rep. : Yesenia P  Status:    Mercedita flynn = is in processing & reviewing.  Monica = is in credentialing. Received on 09/28/2021 It will take 100 days.  Secondary location has been listed under the group Tax ID.  Ref : 60964  Contact no : 800-656-4817', NULL, NULL, '2021-09-29 16:05:49', '2021-09-29 16:05:49'),
(49851, 11056, 32707, NULL, '2021-10-06 00:00:00.000', 'In Process', 'REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188', NULL, NULL, '2021-09-29 16:14:10', '2021-09-29 16:14:10'),
(49852, 11056, 32707, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : Credentialing@superiorhealthplan.com  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good morning!  Hope you are doing well. Please update me with the enrollment status of below mentioned providers at your earliest opportunity..  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Mercedita Flynn 	1619166188 : for secondary location Monica Gonzalez  	1871132811 : for both locations   If you need any documents or information feel free to contact me.  Thank you!', NULL, NULL, '2021-10-07 13:36:04', '2021-10-07 13:36:04'),
(49853, 11056, 32707, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Credentialing@superiorhealthplan.com  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon,             I am able to locate the following information per the status request below for the providers:  1619166188 - Re-credential date will be 07/31/2022.  1871132811 -I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  Thank you,   Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-14 16:14:13', '2021-10-14 16:14:13'),
(49854, 11056, 32707, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : Credentialing@superiorhealthplan.com>  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon!  Hope this email finds you well. Please respond to the below at your earliest convenience.   TIN - 81-1890349 1619166188 - Are both locations listed under this NPI and also, please do provide the welcome letter.  1871132811 - Please provide the latest updates on this NPI.  Waiting to hear from you soon.  Thank you! Take Care!', NULL, NULL, '2021-10-22 12:28:44', '2021-10-22 12:28:44'),
(49855, 11056, 32707, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: Credentialing@superiorhealthplan.com  Sub: Enrollment Query - CBUC & GWMC - AMBETTER  Good morning,              1619166188 -Please contact your account manager for assistance in obtaining the welcome letter. I have attached the providers approval letter from credentialing team. Please go to https://www.superiorhealthplan.com/ , for providers, and find my account manager, to locate your account manager. Your Account Manager can better assist you with your question and direct your request to the correct Department.      1871132811-I am currently reflecting that this provider is awaiting approval by the medical director. If all goes well, the anticipated effective date will be 12/01/2021', NULL, NULL, '2021-11-09 16:35:07', '2021-11-09 16:35:07'),
(49856, 11056, 32707, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Credentialing@superiorhealthplan.com  Sub:   Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon!  Hope you are doing well. I want to get the latest updates regarding the enrollment process of the following provider under the facility.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you have any questions or concerns feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:31:27', '2021-11-24 13:31:27'),
(49857, 11056, 32707, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email received from: Credentialing@superiorhealthplan.com  Sub:  Enrollment Query - CBUC & GWMC - AMBETTER  Good Afternoon,              I am able to locate the following information per the status request below for the provider:  The providers credentialing is complete, the effective date is 12/01/2021 and the re-credential date is 10/31/2024.  Thank you,     Credentialing Department | Superior Health Plan  5900 E. Ben White Blvd | Austin, TX 78741  Phone: 800-820-5686 |Fax: 866-702-4831  Credentialing@superiorhealthplan.com', NULL, NULL, '2021-12-10 10:16:57', '2021-12-10 10:16:57'),
(49858, 1006, 32708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49859, 1006, 32708, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:06', '2021-07-16 17:12:06'),
(49860, 1006, 32708, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'Pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 10:03:00', '2021-08-16 10:03:00'),
(49861, 11056, 32708, NULL, '2021-09-27 00:00:00.000', 'Initiated', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good morning!  Hope all is well with you. It had been a long since our email got responded back. We are still waiting to get the latest updates related our enrollment applications for the following providers under the Practice Tax I.D mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  Provider Name: Mercedita N Flynn Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-20 12:19:25', '2021-09-20 12:19:25'),
(49862, 11056, 32708, NULL, '2021-10-06 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good Morning,     Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.      Those areas are managed by other Medicaid Managed Care Organizations.     Thank you again for your interest.     Sincerely,', NULL, NULL, '2021-09-29 16:43:40', '2021-09-29 16:43:40'),
(49863, 11056, 32708, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good evening!  Hope this email finds you well. Please see the location again. Please note that our facilities are located in BEEVILLE , TX & George West , TX, not in Corpus Christi.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-30 15:35:26', '2021-09-30 15:35:26'),
(49864, 11056, 32708, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good Morning,  Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.   Hi There, those locations are within the Corpus Christi service delivery area, Amerigroup currently does not have membership down in that region.   Those areas are managed by other Medicaid Managed Care Organizations.   Thank you again for your interest.  Sincerely,', NULL, NULL, '2021-10-07 15:34:45', '2021-10-07 15:34:45'),
(49865, 1006, 32709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49866, 1006, 32709, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:12', '2021-07-16 17:12:12'),
(49867, 1006, 32709, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,   I wanted to get an update regarding this request, please get back to me as soon as possible.  Thank you!\" ', NULL, NULL, '2021-07-28 12:31:15', '2021-07-28 12:31:15'),
(49868, 1006, 32709, NULL, '2021-08-13 00:00:00.000', 'In Process', 'We received the following update from jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Good Morning,  I show that Coastal Bend Urgent Care, LLC And ACS are currently contracted since 7/20/2017. Records indicate that you are due for credentialing.  Please see the attached Re-credentialing Profile.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com\"  Replied with:  \"Hello Jennifer,  Please find the attached information, do let me know if you need anything else.  Thank you. \"', NULL, NULL, '2021-08-06 15:12:05', '2021-08-06 15:12:05'),
(49869, 1006, 32709, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,  I hope you\'re doing well, I just wanted to check in on the status of enrollment for our group. Can you please get back to me on this?  Thank you.\"', NULL, NULL, '2021-08-16 16:07:21', '2021-08-16 16:07:21'),
(49870, 11056, 32709, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.     Recredentialing is complete just waiting on the approval meeting on 9/16.     No further action is necessary.  Claims are still being processing for this provider.     Jennifer Maligaya is no longer with ACS/HealthSmart.     Please continue to use VIPproviders@anci-care.com for updates.     New provider agreements please email me:  patti.davidson@healthsmart.com     Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-23 17:10:58', '2021-08-23 17:10:58'),
(49871, 11056, 32709, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates,effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 14:25:18', '2021-09-03 14:25:18'),
(49872, 11056, 32709, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates, effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-14 14:29:21', '2021-09-14 14:29:21'),
(49873, 11056, 32709, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.  Recredentialing is complete just waiting on the approval meeting on 9/16.  No further action is necessary.  Claims are still being processing for this provider.    Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-27 10:34:01', '2021-09-27 10:34:01'),
(49874, 11056, 32709, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Hi.   The provider below is already contracted.  We are only recredentialing the site.     You will receive the recredentialing approval letter from our credentialing department after 2 weeks.', NULL, NULL, '2021-10-06 14:47:37', '2021-10-06 14:47:37'),
(49875, 11056, 32709, NULL, '2021-10-14 00:00:00.000', 'Approved', 'Ancillary contract has been completed.  There is no need of the providers to be credentialed.', NULL, NULL, '2021-10-07 10:55:40', '2021-10-07 10:55:40'),
(49876, 1006, 32710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49877, 1006, 32710, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:18', '2021-07-16 17:12:18'),
(49878, 1006, 32710, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Submitted enrollment request via Provider Onboarding Process. Form is attached for reference. ', NULL, NULL, '2021-07-28 14:11:11', '2021-07-28 14:11:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49879, 1006, 32710, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email since no calls can get through to the credentialing department of BCBS @ tx_standard_contracting_team@bcbstx.com & :  Sub: Location Addition || George West Medical Clinic || Group || BCBS || : Case Number - 02533924  \"Hello,   Please get back to me as soon as possible regarding the status of our query as we are unable to reach out to the credentialing department via calls.  Thank you. \"', NULL, NULL, '2021-08-16 16:45:33', '2021-08-16 16:45:33'),
(49880, 11056, 32710, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to : 	TXProviderUpdateSubmission@bcbstx.com, provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Sub : Re: Location Addition || George West Medical Clinic || Group || BCBS || : Case Number - 02533924  Good afternoon!  Hope all is well. Please let me know if you can find the following group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  We wish to add the following secondary address under the above-mentioned group: Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please let me know what is required to get this updated. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-24 15:15:19', '2021-08-24 15:15:19'),
(49881, 11056, 32710, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : tx_standard_contracting_team@bcbstx.com  Sub : Re: Location Addition || George West Medical Clinic || Group || BCBS || : Case Number - 02533924  Thank you for contacting Blue Cross and Blue Shield of Texas.  We have received your email for case number 02533924.  Since case 02533924 is closed, your request can not be processed at this time.  To open a new case for your request or for any questions, contact TX_standard_contracting_team@bcbstx.com.  Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-09-14 16:00:48', '2021-09-14 16:00:48'),
(49882, 11056, 32710, NULL, '2021-09-21 00:00:00.000', 'In Process', 'New Application no. : 02860897 has opened.', NULL, NULL, '2021-09-14 16:31:38', '2021-09-14 16:31:38'),
(49883, 11056, 32710, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email received from : 	Tx_Network_South_Voicemail &  geraldi_salazar@bcbstx.com  Sub : SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC  Hello,  Your previous case was closed in error, so I will be handling the request myself moving forward. Please email me at the account below if you have questions.  I am writing to confirm your request to add an address to tax id 811890349 (BEEVILLE MEDICAL CLINIC). Please confirm which providers will be practicing at this location (provide a list of who will practice here) and provide the phone and fax for this address as well.   504 A Houston Street, George West, TX 78022-3663   Thank you,  Geraldi Salazar | Manager, Network Management – West Region Blue Cross and Blue Shield of Texas geraldi_salazar@bcbstx.com ', NULL, NULL, '2021-09-20 16:33:55', '2021-09-20 16:33:55'),
(49884, 11056, 32710, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : geraldi_salazar@bcbstx.com & Tx_Network_South_Voicemail@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC  Hello,     Please advise if the 600 South Hillside Dr Address is still an active satellite location or if the 504A Houston Street address will be replacing it under tax id 811890349.     Thank you,   Geraldi Salazar | Manager, Network Management – West Region  Blue Cross Blue Shield of Texas  phone 361-878-1622 | fax 361-852-0624', NULL, NULL, '2021-09-30 15:05:00', '2021-09-30 15:05:00'),
(49885, 11056, 32710, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : geraldi_salazar@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Good afternoon Geraldi!  Hope this email finds you well. We have two locations for our practice under the same Tax ID and NPI, But with different addresses.  301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 is the main & billing location.  504A Houston Street George West , TX 78022-3663 is the secondary location.  If further you have queries or concerns or require documents please let me know.    Thank you!', NULL, NULL, '2021-10-07 15:47:28', '2021-10-07 15:47:28'),
(49886, 11056, 32710, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : geraldi_salazar@bcbstx.com & Angela_Norman@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Hi Angela,     Please submit this address update request. See original request at the bottom of the chain and additional information on 9-30.     Thank you,   Geraldi Salazar | Manager, Network Management – West Region  Blue Cross Blue Shield of Texas  phone 361-878-1622 | fax 361-852-0624', NULL, NULL, '2021-10-14 16:26:14', '2021-10-14 16:26:14'),
(49887, 11056, 32710, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : geraldi_salazar@bcbstx.com & Angela_Norman@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Good afternoon Angela and Geraldi!   Hope you both are doing great. Please provide me the update regarding my request of enrollment and updating both addresses under the TIN & providers.  Group Name Coastal Bend Urgent Care, LLC  Tax ID 81-1890349  Group NPI 1427509264  Primary Location 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Secondary Location 504A Houston Street, George West , TX 78022-3663  Provider Name  NPI  Monica Gonzalez  1871132811  Please assist with the above at your earliest opportunity.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-10-22 13:44:25', '2021-10-22 13:44:25'),
(49888, 11056, 32710, NULL, '2021-11-01 00:00:00.000', 'Approved', 'Email received from : Angela_Norman@bcbstx.com & geraldi_salazar@bcbstx.com  Sub : RE: SECURE - BCBSTX - ADDRESS UPDATE REQUEST - BEEVILLE MEDICAL CLINIC -- TIN 811890349  Hello,   The provider Monica Gonzalez, APN associated with Tax Id# 811890349 is in-network as of 10/15/2021 with the following networks:  Plans: Blue Advantage HMO Blue Choice PPO Blue Essentials Health Select Medicare Advantage HMO Medicare Advantage PPO   Thank you,   Another Email received :   Good Afternoon,  Below you will find the Welcome letter and the locations we have for Monica Gonzalez, APN are listed below.    Physical: 301 S. HILLSIDE DR., STE 4 BEEVILLE, TX 78102 361-226-1126 PHONE 718-640-2713 FAX  Satellite: 504A HOUSTON ST GEORGE WEST, TX 78022 361-226-1219 PHONE 361-542-4076    Please see the attached welcome letter.', NULL, NULL, '2021-10-25 14:27:14', '2021-10-25 14:27:14'),
(49889, 1006, 32711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49890, 1006, 32711, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:24', '2021-07-16 17:12:24'),
(49891, 1006, 32711, NULL, '2021-08-23 00:00:00.000', 'Approved', 'Received the following approval confirmation email Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Hello Brad,  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – reference # FL01383347.  Thanks, Michal\" ', NULL, NULL, '2021-08-16 16:49:56', '2021-08-16 16:49:56'),
(49892, 1006, 32712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49893, 1006, 32712, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:30', '2021-07-16 17:12:30'),
(49894, 1006, 32712, NULL, '2021-08-23 00:00:00.000', 'In Process', 'We received the following request from vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  What is the last 4 ss?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with providers last 4 SSN. ', NULL, NULL, '2021-08-16 17:05:36', '2021-08-16 17:05:36'),
(49895, 11056, 32712, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email received from : vicki.guerra@christushealth.org  Sub : Re: Enrollment Request - CBUC/GWMC - Christus Spohn  Hi Brad,     Happy Wednesday!     I do not find the provider did his reappointment paperwork with the Christus hospital facility.     Can the provider be asked if he re-did hospital facility paperwork?     Thanks,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745', NULL, NULL, '2021-08-25 08:17:38', '2021-08-25 08:17:38'),
(49896, 11056, 32712, NULL, '2021-09-27 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-09-20 16:40:23', '2021-09-20 16:40:23'),
(49897, 11056, 32712, NULL, '2021-10-07 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-09-30 13:49:45', '2021-09-30 13:49:45'),
(49898, 11056, 32712, NULL, '2021-10-14 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-10-07 17:01:46', '2021-10-07 17:01:46'),
(49899, 11056, 32712, NULL, '2021-10-25 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-10-18 16:38:37', '2021-10-18 16:38:37'),
(49900, 11056, 32712, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Have emailed them again. Waiting for response.', NULL, NULL, '2021-11-10 09:22:46', '2021-11-10 09:22:46'),
(49901, 11056, 32712, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Have emailed them again. Waiting for response.  It has been along that we get n response from the provider.', NULL, NULL, '2021-11-15 16:59:38', '2021-11-15 16:59:38'),
(49902, 1006, 32713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49903, 1006, 32713, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:37', '2021-07-16 17:12:37'),
(49904, 1006, 32713, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Initiated enrollment via call.   Application# 12707513 ', NULL, NULL, '2021-07-28 14:57:10', '2021-07-28 14:57:10'),
(49905, 1006, 32713, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Received the following update from discovercigna@information.cigna.com:  Sub: Cigna Credentialing Status Update: Application Received  \"Re:	Reference number 12707513 Application to participate in the Cigna medical network Dear MONICA GONZALEZ,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely, Cigna\"', NULL, NULL, '2021-08-02 08:30:12', '2021-08-02 08:30:12'),
(49906, 1006, 32713, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ PSSCentral@Cigna.com:  Sub: Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  \"Hello,   I wanted to get an update regarding the enrollment status for the following provider under our group:  Group Name: Coastal Bend Urgent Care LLC TIN# 81-1890349  Provider Name: Monica Gonzalez NPI# 1871132811  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-16 17:12:53', '2021-08-16 17:12:53'),
(49907, 11056, 32713, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  PSSCentral@cigna.com, PDMCOGZ@cigna.com & JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  Good Afternoon!  Hope this email finds you well. I want to get an update regarding the enrollment status of the below mentioned provider under the practice.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or queries regarding this or need documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 11:32:42', '2021-08-24 11:32:42'),
(49908, 1006, 32713, NULL, '2021-09-02 00:00:00.000', 'In Process', 'We received the following update from DiscoverCigna@information.cigna.com:  Sub: Cigna Credentialing Status Update: Application Received  \"Reference number 12707513 for MONICA GONZALEZ, MSN Application to participate in the Cigna medical network Dear BRAD ,  Thank you for submitting an application for one of your providers to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely, Cigna\"', NULL, NULL, '2021-08-26 09:55:31', '2021-08-26 09:55:31'),
(49909, 11056, 32713, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  HI Ahmed,     May you follow up with the email listed on your letter of interest.     Thank you,     Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-09-02 10:44:36', '2021-09-02 10:44:36'),
(49910, 11056, 32713, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  HI Ahmed,     May you follow up with the email listed on your letter of interest.     Thank you,     Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-09-02 10:51:44', '2021-09-02 10:51:44'),
(49911, 11056, 32713, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : 9PSSCENT@cigna.com , PDM COGZ  PDMCOGZ@cigna.com, DiscoverCigna@information.cigna.com  Sub : Enrollment Status - CBUC/GWMC - Cigna - Ref# 12707513  Good Afternoon!  Hope this email finds you well. I am still waiting to get the latest updates regarding the enrollment status of the following provider under the practice.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or queries regarding this or need documents or information please let me know. Eagerly ,waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-24 11:00:23', '2021-09-24 11:00:23'),
(49912, 11056, 32713, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Rep : Ariana B  Status:  Have to send an email with details & W-9 at intake_pdm@cigna .com  Contacting  no. of the dept. : 800-981-9114  Ref code : araina10072021', NULL, NULL, '2021-10-07 09:19:11', '2021-10-07 09:19:11'),
(49913, 11056, 32713, NULL, '2021-10-18 00:00:00.000', 'Approved', 'Email received from : PDMCOGZ@cigna.com  Sub : Completion Notification - W202110071942293  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. This request has been completed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # (W202110071942293)  PID  : 8532240  HCP Name : Monica Gonzalez  Effective date : 10/05/2021    Sincerely, PDM .', NULL, NULL, '2021-10-11 14:26:27', '2021-10-11 14:26:27'),
(49914, 1006, 32714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49915, 1006, 32714, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:43', '2021-07-16 17:12:43'),
(49916, 11056, 32714, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', 'Email received from : lerensa.crain@careallies.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  George West, Texas and Beeville, Texas are not in the Cigna MA medical plan service area.', NULL, NULL, '2021-09-24 13:07:09', '2021-09-24 13:07:09'),
(49917, 1006, 32715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:32', '2021-07-16 10:06:32'),
(49918, 1006, 32715, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:51', '2021-07-16 17:12:51'),
(49919, 1006, 32715, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference.  ', NULL, NULL, '2021-08-16 10:04:32', '2021-08-16 10:04:32'),
(49920, 1006, 32716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(49921, 1006, 32716, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:12:57', '2021-07-16 17:12:57'),
(49922, 1006, 32716, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The request is pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 10:05:29', '2021-08-16 10:05:29'),
(49923, 1006, 32716, NULL, '2021-08-23 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-08-16 10:05:38', '2021-08-16 10:05:38'),
(49924, 11056, 32716, NULL, '2021-09-24 00:00:00.000', 'Initiated', 'Email sent to : Karla.Claunch@dchstx.org  Sub  : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good evening Karla!  Hope this email finds you well. Here are the forms with attached documents in the Pdf too with W9s, which you requested for in the previous email for enrollment process. Please find the attachments.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# 1164776548  Provider Name: Flynn, Mercedita  Provider NPI# 1619166188  Provider Name: Gonzalez, Monica Provider NPI# 1427509264  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day', NULL, NULL, '2021-09-17 12:21:06', '2021-09-17 12:21:06'),
(49925, 11056, 32716, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  Thank you for these requests but, the disclosure statements were not attached for Monica Gonzalez NP and Katherine Paterson NP.  Please email these directly to me when completed.  They are all now in the credentialing process.  Please allow 60-90 days to complete.  Once complete, you will receive a welcome letter with their effective date.  Thank you  Karla Claunch   ', NULL, NULL, '2021-09-28 16:58:43', '2021-09-28 16:58:43'),
(49926, 11056, 32716, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  My apologies,  I am just noticing that this practice is currently not participating with us.  All providers requested are mid-level who will need a supervising physician.  The physician will also need to be a Driscoll Health Plan participating physician.  If their supervising physician is not already credentialed with us, we will also need to credential them.  We will also need the current PAA or Collaborative agreement between the NP’s and supervising physician.  They should have one on file within the practice.  We are withdrawing these providers  due to not currently having a supervising physician on file for this practice.  We can re-activate them once the remaining, required information is received and they have an established, participating, supervising physician.  We look forward to working with you and eager to hear from you again soon.  Please let me know if you need any further assistance.  Karla Claunch    ', NULL, NULL, '2021-10-06 16:28:38', '2021-10-06 16:28:38'),
(49927, 11056, 32716, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : Karla.Claunch@dchstx.org  Sub : Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Hey Karla!  Hope you had a great weekend. You don\'t need to apologise. We do have a supervising physician for this practice and want to let him participate with Driscoll Health Plan. Please suggest to me the procedure to credential the supervising physician as soon as possible.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-14 15:43:35', '2021-10-14 15:43:35'),
(49928, 11056, 32716, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  I wish the weekend was much longer but, here we are.  We will need the same documents for the supervising physician and he must carry them on his license.  Please send a Request for Contact as well as the DHP addendum and disclosure as below.', NULL, NULL, '2021-10-22 08:46:28', '2021-10-22 08:46:28'),
(49929, 11056, 32716, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Please find the attached forms for the Supervising physician enrollment with Driscoll. Please accept my apology for the delay. If any corrections are required please let me know.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed day!', NULL, NULL, '2021-11-09 14:32:51', '2021-11-09 14:32:51'),
(49930, 11056, 32716, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Hello,  Thank you for this request.  Before I begin, the addendum needs to be completed with all information.  The disclosure is named and signed by Mercedita Flynn so, we will need his own, signed by him please.  This provider will not be processed until this information is received.  Your prompt attention will avoid delays and withdrawal.  I look forward to hearing from you soon.  Thank you  Karla Claunch', NULL, NULL, '2021-11-24 10:01:19', '2021-11-24 10:01:19'),
(49931, 11056, 32716, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Hello,  Thank you for this request.  Before I begin, the addendum needs to be completed with all information.  The disclosure is named and signed by Mercedita Flynn so, we will need his own, signed by him please.  This provider will not be processed until this information is received.  Your prompt attention will avoid delays and withdrawal.  I look forward to hearing from you soon.  Thank you  Karla Claunch', NULL, NULL, '2021-11-24 10:01:20', '2021-11-24 10:01:20'),
(49932, 11056, 32716, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good morning!  Hope this email finds you well. Here you go. Please find the corrected one in the attachment.  If anything else is needed feel free to reach out to me.  Take Care!  Thank you! ', NULL, NULL, '2021-12-06 16:39:21', '2021-12-06 16:39:21'),
(49933, 11056, 32716, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from:  Karla.Claunch@dchstx.org  Sub:  Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good afternoon,  You only sent one disclosure, it was for Mercedita which I already have.   I am needing one for both of these providers please-Monica Gonzalez NP and Katherine Paterson NP  They are now in process.  Please allow 60-90 days to complete the process.  I am looking forward to hearing back from you soon with these disclosures and all of their PAA/Collaborative Agreements  Thank you', NULL, NULL, '2021-12-17 14:46:32', '2021-12-17 14:46:32'),
(49934, 11056, 32716, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope you are having a blessed day. Please find the attached disclosure for Monica Gonzalez and Katherine Paterson. We will provide you with their PAA/Collaborative Agreements near in the future.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Take Care!  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 11:10:43', '2021-12-22 11:10:43'),
(49935, 19067, 32716, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Kindly do provide me with the recent accomplishments of the credentialing process of the below-mentioned providers under facility TIN.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   Please get back to me soon with the updates and if credentialing is completed do provide me with effective dates and welcome letters.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-12-30 11:00:52', '2021-12-30 11:00:52'),
(49936, 19067, 32716, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Greetings!  Any updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:22:24', '2022-01-09 22:22:24'),
(49937, 19067, 32716, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||    Good morning,  I sent the welcome packet and contract 12/28/2021 to the credentialing contact email we have on file.  I have attached everything to this email for you.    ', NULL, NULL, '2022-01-10 09:24:22', '2022-01-10 09:24:22'),
(49938, 19067, 32716, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    RE:             Monica Del Bosque Gonzalez, NP  NPI #:        1871132811  Tax ID#:    81-890349     Good Morning,  I am currently working on the INITIAL application for Monica Del Bosque Gonzalez, NP for the Driscoll Health  Plan; and I need some additional documentation completed.  (see attached)  ·         PAA Agreement  ·         Attestation  ·         Current Liability Insurance  ·         NP License  ·         W-9 form  ·         Page 1 of TSCA – Place of Birth  ·         Page 2 of TSCA – Work History completed  ·         Page 4-5 of TSCA – Referenced and Call Coverage  ·         Page 6 of TSCA – Check payable To box completed  Please forward all requested information to my attention via email within 5 business days.  Feel free to contact me if you have any questions.      Thank you,  Christine S Rodriguez  Credentialing Specialist  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-4322  Fax: (361) 808-2182  Email: Christine.Rodriguez@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2022-03-01 13:50:30', '2022-03-01 13:50:30'),
(49939, 19067, 32716, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    RE:             Monica Del Bosque Gonzalez, NP  NPI #:        1871132811  Tax ID#:    81-890349     Good Morning,  I am currently working on the INITIAL application for Monica Del Bosque Gonzalez, NP for the Driscoll Health  Plan; and I need some additional documentation completed.  (see attached)  ·         PAA Agreement  ·         Attestation  ·         Current Liability Insurance  ·         NP License  ·         W-9 form  ·         Page 1 of TSCA – Place of Birth  ·         Page 2 of TSCA – Work History completed  ·         Page 4-5 of TSCA – Referenced and Call Coverage  ·         Page 6 of TSCA – Check payable To box completed  Please forward all requested information to my attention via email within 5 business days.  Feel free to contact me if you have any questions.      Thank you,  Christine S Rodriguez  Credentialing Specialist  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-4322  Fax: (361) 808-2182  Email: Christine.Rodriguez@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2022-03-01 16:31:25', '2022-03-01 16:31:25'),
(49940, 19067, 32716, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: christine.rodriguez@dchstx.org  Subject: Re: Monica Del Bosque Gonzalez, NP   Hi Christine!  Kindly see the attachments as per you requested and don\'t hesitate to reach me if you need any document or information.  Regards, Hammad Ahmed', NULL, NULL, '2022-03-01 16:31:58', '2022-03-01 16:31:58'),
(49941, 19067, 32716, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    Good Morning,     Thanks for the information; however the documents are NOT completed.     ·         PAGE 3 needs the CURRENT employer listed on Work History  ·         PAGE 4-5 needs the references completed (address & phone numbers)  ·         PAGE 6 needs the “Check Payable To” and Electronically box checked  ·         PAA Agreement needs to be completed (all the questions answered)  ·            *NOTE*  I have HIGHLIGHTED all the areas that need to be completed.  Please contact me if you have any questions.  This information is needed ASAP.', NULL, NULL, '2022-03-10 16:31:18', '2022-03-10 16:31:18'),
(49942, 19067, 32716, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Christine.Rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    Good Morning,     I am still missing the information from the email below.  I need this information  ASAP.  If the information is NOT received by Friday March 11, 2022 the application  will be WITHDRAWN.      Please contact me if you have any questions.         Thank you,', NULL, NULL, '2022-03-10 16:32:12', '2022-03-10 16:32:12'),
(49943, 19067, 32716, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: christine.rodriguez@dchstx.org  Subject: Monica Del Bosque Gonzalez, NP    Hi Christine,  Kindly see the attached.  Thanks', NULL, NULL, '2022-03-10 17:21:07', '2022-03-10 17:21:07'),
(49944, 22077, 32716, NULL, '2022-04-19 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: 	Re: FW: URGENT REQUESTS RE: FW: Monica Del Bosque Gonzalez, NP  Hi,  Attached is the current liability for Monica.  And the names on References we are not familiar with them.  Also, I have updated the name of the supervising physician.  Thanks.', NULL, NULL, '2022-04-12 13:56:17', '2022-04-12 13:56:17'),
(49945, 1006, 32717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(49946, 1006, 32717, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:05', '2021-07-16 17:13:05'),
(49947, 1006, 32717, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Sent initiation and f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & \"Talasila, Bala M\" TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We are still waiting on the status of our initial request and here is the information for an additional provider, please get back to me as soon as possible.   Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Thank you. \"', NULL, NULL, '2021-07-28 16:27:02', '2021-07-28 16:27:02'),
(49948, 1006, 32717, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-09 10:29:27', '2021-08-09 10:29:27'),
(49949, 1006, 32717, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \" ', NULL, NULL, '2021-08-16 12:18:17', '2021-08-16 12:18:17'),
(49950, 11056, 32717, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com, \"Sidley, Jeanette\" SidleyJ1@firsthealth.com, PDS Dallas  pdsdallas@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059   Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 17:01:43', '2021-08-23 17:01:43'),
(49951, 11056, 32717, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  Good afternoon!  Hope you are doing well. It has been so long since you haven\'t responded to our emails. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice. Please provide me with the latest updates soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great weekend! ', NULL, NULL, '2021-09-03 14:16:08', '2021-09-03 14:16:08'),
(49952, 11056, 32717, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : DillikarA@aetna.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hi,  Please find the status of below provider as per requested.   S.no  Provider Name  NPI  Cpd Id  TIN  Effective Date  Status  1  Paterson, Katherine D  1164776548  2815476  811890349  -  Tax Id not found  2  Monica Gonzalez  1871132811  811890349  -  Provider not found    Regards, Bharath', NULL, NULL, '2021-09-14 13:21:36', '2021-09-14 13:21:36'),
(49953, 11056, 32717, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : DillikarA@aetna.com  Sub  : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hey Bharath!  Hope this email finds you well. Please guide and assist me regarding how to solve the below highlighted issues.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 12:40:07', '2021-09-28 12:40:07'),
(49954, 11056, 32717, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,  I hope that this email finds you well! I apologize that I have not been able to respond sooner, my son has been ill so I have been in and out of the office.  This is the new group agreement that we established that will become effective 11/1/21. It is still in the implementation stages but will be complete before the effective date. All providers listed on the roster you provided to me will be linked to the new agreement once effective.   I hope that this helps clarify.  Take care!  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-06 15:01:44', '2021-10-06 15:01:44'),
(49955, 11056, 32717, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Ahmed,  I hope that this email finds you well! Thank you for the well wishes, we are hoping he starts to feel better soon.  I have attached a copy of the signed agreement to this email. I apologize if the system did not automatically send it to you when it was signed on our side.  The contract is currently in implementation with our Data Team. I will send over the welcome letter once I have your group ID.  As always, please do not hesitate to reach out if you have any questions or concerns.  Take care! Jeanette', NULL, NULL, '2021-10-14 15:36:59', '2021-10-14 15:36:59'),
(49956, 11056, 32717, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Re: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Jeanette!  Hope this email finds you well. He will feel better soon. He is in my prayers.  Bundle of thanks for your prompt responses. And I am grateful to you for that.  Whenever the implementation is completed, please provide the welcome letter soon.   Thank you! Have a wonderful & blessed weekend ahead!  ', NULL, NULL, '2021-10-22 12:10:00', '2021-10-22 12:10:00'),
(49957, 11056, 32717, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning Jeanette!  Hope you & your son both are doing great. Please provide me with the latest updates about the implementation as well as on the welcome letters too. Kindly do the needful soon.  Please get back to me soon.  Thank you! Take Care! ', NULL, NULL, '2021-11-09 15:26:47', '2021-11-09 15:26:47'),
(49958, 11056, 32717, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sidleyj1@firsthealth.com  Sub:  Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1073945 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,  Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605  Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-24 10:38:25', '2021-11-24 10:38:25'),
(49959, 11056, 32717, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email received from:  SidleyJ1@firsthealth.com  Sub:  RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning,     I hope that this email finds you well!     I have attached the welcome letter that I sent over last Tuesday. I apologize if you did not receive it.     Have a wonderful week!     Take care,     Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605 Phone: 916-374-4876  SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-12-09 14:22:55', '2021-12-09 14:22:55'),
(49960, 11056, 32717, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,     I hope that this email finds you well!     The feedback that I have received on my request to add the providers to the group is:  Mercedita Flynn is already participating under the TIN on an individual agreement effective 12/1/2019. She is now linked to the group and will still show effective as of 12/1/2019. For Monica Gonzalez, they are needing her CAQH number as she is not credentialed through Aetna yet and they handle that part for us in order to link her to the group contract.    Please send over the CAQH number for Monica Gonzalez and I can get her part finalized.     Thank you and take care!  Jeanette   ', NULL, NULL, '2021-12-22 10:17:12', '2021-12-22 10:17:12'),
(49961, 19067, 32717, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Query || CBUC & GWMC || Providers || First Health ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following provider with First Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 12:39:22', '2021-12-30 12:39:22'),
(49962, 19067, 32717, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers || First Health ||   Greetings!  You have not responded yet.  Kindly give updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 23:03:23', '2022-01-09 23:03:23'),
(49963, 19067, 32717, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers || First Health ||    Greetings!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad.', NULL, NULL, '2022-01-26 15:12:45', '2022-01-26 15:12:45'),
(49964, 20067, 32717, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Sub: Urgent || Demographic Update || Providers || First Health  Good Evening!  Hope you had a great weekend. I would like to add the secondary location of the listed providers. Attach is the W9 of the location  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663  Thank you,', NULL, NULL, '2022-03-07 17:33:19', '2022-03-07 17:33:19'),
(49965, 22077, 32717, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: 	Re: Urgent || Demographic Update || Providers || First Health  Hi,  Any updates on the request mentioned previously?  Thanks.', NULL, NULL, '2022-04-13 14:05:36', '2022-04-13 14:05:36'),
(49966, 22077, 32717, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email received from: BharathB@aetna.com  Subject: RE: [EXTERNAL] Re: Urgent || Demographic Update || Providers || First Health Case Number : 28606866  Hi Alex,     The below request is processed.     Regards,  Bharath', NULL, NULL, '2022-04-25 12:28:48', '2022-04-25 12:28:48'),
(49967, 22077, 32717, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com  Subject: Re: [EXTERNAL] Re: Urgent || Demographic Update || Providers || First Health Case Number : 28606866  Hi,  Can I get the effective date for the providers for the mentioned locations?  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 14:38:53', '2022-04-25 14:38:53');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49968, 1006, 32718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(49969, 1006, 32718, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:13', '2021-07-16 17:13:13'),
(49970, 11056, 32718, NULL, '2021-09-24 00:00:00.000', 'Initiated', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good afternoon Daniel!  Hope this email finds you well. Here is the filled Physician agreement form for the provider Monica Gonzalez, to add her with Galaxy under the Coastal Bend Urgent Care Group agreement. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-17 16:24:11', '2021-09-17 16:24:11'),
(49971, 11056, 32718, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hi Ahmed,  I am sorry, however, the below statement that Dr. Flynn is under a personal agreement shows to be incorrect. I show this provider, Dr. Flynn  is under a group agreement.  To confirm I do not show Katherine Paterson as presently participating with Galaxy under the Coastal Bend Urgent Care Group agreement. If the group wishes to add Katherine Paterson to their existing agreement then please see the attached.  If your company wishes a copy of the group agreement you will need to fax written authorization signed by an authorized signatory of the CBUS group stating your company Claims Med Inc is representing the group and that Galaxy is authorized to send you a copy of their agreement. That can be faxed to 817-633-5729.   Further, I show that the same information above on how to obtain a copy of the group agreement was sent to Mr. Brad Peterson who is with you company and he may already have a copy of the group agreement.', NULL, NULL, '2021-09-29 12:52:30', '2021-09-29 12:52:30'),
(49972, 11056, 32718, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good afternoon Daniel!  Hope this email finds you well. Here is the filled Physician agreement form for the provider Katherine Paterson, to add her with Galaxy under the Coastal Bend Urgent Care Group agreement. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-07 15:05:35', '2021-10-07 15:05:35'),
(49973, 11056, 32718, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good morning!  Hope this email finds you well.  Please provide us with the latest updates regarding the following providers under the below mentioned practice with Galaxy health as soon as possible.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day! ', NULL, NULL, '2021-10-18 16:45:36', '2021-10-18 16:45:36'),
(49974, 11056, 32718, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : kavalos@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hello please,     provide providers specialty, phone/fax number effective date you will like.     Thanks;     Karen A  Have provided them with details', NULL, NULL, '2021-11-09 12:15:14', '2021-11-09 12:15:14'),
(49975, 11056, 32718, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good afternoon Karen!  Hope this email finds you well. Please find the information below which you have requested.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name & Specialities	NPI  & COntact & Fax no.  Katherine Paterson  (FNP)	1164776548           Ph # : 361-226-1126          fax no. : 361 542-4076 Mercedita Flynn (FNP)	1619166188          Ph # : 361-226-1126          fax no. : 361 542-4076 Monica Gonzalez (FNP)	1871132811          Ph # : 361-226-1126          fax no. : 361 542-4076  If you have any additional questions or need documents please let me know.  Thank you! Have a great day! ', NULL, NULL, '2021-11-24 13:53:15', '2021-11-24 13:53:15'),
(49976, 11056, 32718, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to:  Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-10 17:10:22', '2021-12-10 17:10:22'),
(49977, 11056, 32718, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Enrollment Status Query - Galaxy Health - CBUC/GWMC   Is this eff date is for all of the providers or not? Provide me with welcome letters too.', NULL, NULL, '2021-12-17 14:26:00', '2021-12-17 14:26:00'),
(49978, 11056, 32718, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Enrollment Status Query - Galaxy Health - CBUC/GWMC  Enrollment Query - CBUC & GWMC - Galaxy Health   Good evening Karen!  Hope this email finds you well. Please list the highlighted location under the following provider as soon as possible. And also list all of the providers with both locations on your provider directory. I am unable to find the providers, I only found Mercedita Flynn. I have attached the SS for your concerns.    Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name & Specialities	NPI  & COntact & Fax no.  Katherine Paterson  (FNP)	1164776548              Unable to find provider on the directory Mercedita Flynn (FNP)	1619166188               Only Primary location is listed Monica Gonzalez (FNP)	1871132811              Unable to find provider on the directory  If you have any additional questions or need documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 10:10:11', '2021-12-23 10:10:11'),
(49979, 19067, 32718, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Hello!  Hope you\'re doing well,  I would like to know the enrollment status of the following Providers & Groups with Galaxy Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:24:17', '2021-12-30 13:24:17'),
(49980, 19067, 32718, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, kavalos@ghn-mci.com, dmarley@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Greetings!  You haven\'t responded yet.  Still waiting to get the updates about the previously mentioned request.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:28:17', '2022-01-09 22:28:17'),
(49981, 19067, 32718, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Good Morning!  Hope this email finds you well.  This is my SECOND REMINDER on the below mentioned request. Kindly look into this.  Kindly respond as per your convenience.   Regards, Hammad.', NULL, NULL, '2022-01-26 11:09:50', '2022-01-26 11:09:50'),
(49982, 19067, 32718, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||    Hello Ahmed;     There is no welcome letters this is not a personal agreement.', NULL, NULL, '2022-02-21 16:26:16', '2022-02-21 16:26:16'),
(49983, 20067, 32718, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Good Afternoon!  Hope you had a great weekend. I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663  Eagerly waiting to hear from you.  Thank you, ', NULL, NULL, '2022-03-07 16:55:22', '2022-03-07 16:55:22'),
(49984, 22077, 32718, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Hi,  I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Waiting to hear from you soon.  Thanks. Alex', NULL, NULL, '2022-04-13 14:25:36', '2022-04-13 14:25:36'),
(49985, 1006, 32719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(49986, 1006, 32719, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:19', '2021-07-16 17:13:19'),
(49987, 1006, 32719, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Sent enrollment request @ pr.south@healthsmart.com:  Sub: Enrollment Request - CBUC/GWMC - Health Smart  \"Hello,   We want to enroll the following provider under the mentioned group and given addresses:   Group Name: Coastal Bend Urgent Care, LLC TIN# 81-1890349 Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663   Provider Name: Monica Gonzalez NPI# 1871132811 CAQH# 14624355  Please let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-08-16 10:12:15', '2021-08-16 10:12:15'),
(49988, 11056, 32719, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment Request - CBUC/GWMC - Health Smart  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  *Gonzalez, Monica Del Bosque NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :85450)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-08-24 09:07:20', '2021-08-24 09:07:20'),
(49989, 11056, 32719, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Updates - CBUC/GWMC - Health Smart  Hi,  1. Our system has been updated as requested.  * The locations below have been added.  Provider \"FLYNN, MERCEDITA N\" effective date is \" 09/01/2017 \".  2. Below provider not found in the system please fill out the attached CAQH Access form and send W9 so that we can process your request.   * Katherine Paterson.  3. Provider \" Gonzalez, Monica Del Bosque NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :85450)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-09-01 14:52:43', '2021-09-01 14:52:43'),
(49990, 11056, 32719, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com    Sub : Enrollment Status Updates - CBUC/GWMC - Health Smart  & Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,  1. Our system has been updated as requested.  * The locations below have been added.  Provider \"FLYNN, MERCEDITA N\" effective date is \" 09/01/2017 \".  2. Below provider not found in the system please fill out the attached CAQH Access form and send W9 so that we can process your request.   * Katherine Paterson.  3. Provider \" Gonzalez, Monica Del Bosque NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :85450)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-09-01 14:54:52', '2021-09-01 14:54:52'),
(49991, 11056, 32719, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,  -Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status Paterson, Katherine D NP  -Provider \" Gonzalez, Monica Del Bosque NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81433)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-09-14 12:37:35', '2021-09-14 12:37:35'),
(49992, 11056, 32719, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart   Hi,  01- Provider \" Monica D Gonzalez, NP \" is effective date \" 10/01/2021 \".  02- Provider \" Paterson, Katherine D NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 85450)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-09-27 10:48:13', '2021-09-27 10:48:13'),
(49993, 11056, 32719, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Good morning!  Hope you had a great and safe weekend. Please assist with the below at your earliest opportunity.  (Inventory Log ID : 85450)  01- Provider \" Monica D Gonzalez, NP \" is effective date \" 10/01/2021 \": Please provide us with the welcome letter for the provider  02- Provider \" Paterson, Katherine D NP \" : Provide the latest updates on the credentialing process of the provider.  If you need any documents or information or have any concerns please do not hesitate to contact me.   Thank you! Have a blessed day!', NULL, NULL, '2021-10-06 14:39:33', '2021-10-06 14:39:33'),
(49994, 11056, 32719, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : mdiprsupport@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart   Good morning!  Hope you had a great and safe weekend. Please assist with the below at your earliest opportunity.  (Inventory Log ID : 85450)  01- Provider \" Monica D Gonzalez, NP \" is effective date \" 10/01/2021 \": Please provide us with the welcome letter for the provider  02- Provider \" Paterson, Katherine D NP \" : Provide the latest updates on the credentialing process of the provider.  If you need any documents or information or have any concerns please do not hesitate to contact me.   Thank you! Have a blessed day!', NULL, NULL, '2021-10-14 14:49:39', '2021-10-14 14:49:39'),
(49995, 11056, 32719, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Welcome letters have not been completed for the providers effective 10/1. Please allow 2-3 weeks.    Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions 6303 Commerce Drive | Suite 180 | Irving, TX 75039 pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-10-22 09:04:59', '2021-10-22 09:04:59'),
(49996, 11056, 32719, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Welcome letters will be generated and go out this week.     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039', NULL, NULL, '2021-11-09 14:01:33', '2021-11-09 14:01:33'),
(49997, 11056, 32719, NULL, '2021-12-01 00:00:00.000', 'Approved', 'Email received from:  pr.south@healthsmart.com  Sub: Fwd: Fw: Enrollment Status - CBUC/GWMC - Health Smart  Hi,   Provider \" Monica D Gonzalez, NP \" is  effective date \" 10/01/2021 \".   It has been 2 months after requesting and demanding the welcome letters not been received yet. ALthough found them in the provider directory.  Please see the attachment.  ', NULL, NULL, '2021-11-24 10:17:35', '2021-11-24 10:17:35'),
(49998, 1006, 32720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(49999, 1006, 32720, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:26', '2021-07-16 17:13:26'),
(50000, 1006, 32720, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Sent enrollment request @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment Request - Monica Gonzalez - Humana  \"Hello,  Please find the attached roster for our provider that we wish to add to our group, do let me know if you have anything else is required to proceed with this request. Thank you.\"  Attached for reference. ', NULL, NULL, '2021-07-28 16:50:09', '2021-07-28 16:50:09'),
(50001, 1006, 32720, NULL, '2021-08-04 00:00:00.000', 'Initiated', '', NULL, NULL, '2021-07-28 16:50:53', '2021-07-28 16:50:53'),
(50002, 1006, 32720, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment & Location Status - CBUC/GWMC   \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment & location status for the following group and providers:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Are both of the addresses listed under both the group and mentioned providers?  Thank you!\"', NULL, NULL, '2021-08-09 12:03:42', '2021-08-09 12:03:42'),
(50003, 11056, 32720, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment & Location Status - CBUC/GWMC   \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment & location status for the following group and providers:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Are both of the addresses listed under both the group and mentioned providers?  Thank you!\"', NULL, NULL, '2021-08-18 15:28:29', '2021-08-18 15:28:29'),
(50004, 11056, 32720, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Still waiting for the  Updated MALPRACTICE : Frank Dehnisch  Updated  AANP Certification : Mercedita Flynn  by Ryan.', NULL, NULL, '2021-08-24 17:09:21', '2021-08-24 17:09:21'),
(50005, 11056, 32720, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to : stxnm@humana.com, mduffee@humana.com  Sub : Enrollment & Location Status - CBUC/GWMC  Good morning!  Hope this email finds you well. I want to inquire about the enrollment & location status of the following providers and practice. Are both of the addresses listed under both the group and mentioned providers?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice TIN# 81-1890349 Practice Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Practice Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Mercedita Flynn Provider NPI#: 1619166188  Provider Name: Monica Gonzalez Provider NPI#: 1871132811  If you require any further information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-25 08:36:22', '2021-08-25 08:36:22'),
(50006, 11056, 32720, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Rep : Dean L  Ref code : 2000201690399  -Monica out  of network. Roster has been resubmitted at mlacastesantos@humana.com & Hmaleon@humana.com  -Mercedita in network. secondary location is on file and in process for loading  Contact no. : 8006262741', NULL, NULL, '2021-09-22 13:21:30', '2021-09-22 13:21:30'),
(50007, 11056, 32720, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email sent to : mlacastesantos@humana.com. & 	Hmaleon@humana.com  Sub : MONICA GONZALEZ & test email  Hey Lance!  Hope this email finds you well. You haven\'t responded to my query yet. Please assist with the below at your earliest opportunity.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI & Enrollment Status Monica Gonzalez	1871132811 : with both locations  Mercedita Flynn	1619166188 :  the secondary location listed or not?   If you have any questions or require additional information or documents please let me know.   Thank you! Have a great weekend!', NULL, NULL, '2021-10-01 17:12:02', '2021-10-01 17:12:02'),
(50008, 11056, 32720, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Rep : Jean L  Status : MONICA is in process . This request has been provided to the contractor. 45 days will be needed. The contracting dept will contact us soon.  Ref  code : 2000204032187', NULL, NULL, '2021-10-07 16:56:47', '2021-10-07 16:56:47'),
(50009, 11056, 32720, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Ritch M  Status :Monica Gonzalez is still out of network. She is gonna to escalate our application to contracting depart.  Ref code: 2000205673540  Contact no. : (800) 626-2741', NULL, NULL, '2021-10-18 16:31:45', '2021-10-18 16:31:45'),
(50010, 11056, 32720, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Rep : Jessie T  Status:  Send them the roster for Monica Gonzalez again. Escalated the request. Going to send us the roster for leticia.  Ref code: 2000208916781  Contact no. : (800) 626-2741', NULL, NULL, '2021-11-04 16:06:58', '2021-11-04 16:06:58'),
(50011, 11056, 32720, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  VCervantes2@humana.com  Sub:  Roster for Monica Gonzalez  Good Morning,     Your request was received.  However we are unable to process due to the following reasons:     ·        There cannot be two (2) remit to addresses for one tax ID number. The remit to address listed for your group is:  o   301 Hillside Drive, Suite 4, Beeville, TX 78102     Billing #: (361) 226-1126.     Please resubmit your request with the appropriate remit address.  No additional action can be taken at this time.  This request is now considered closed.     Thank you,     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741  F 855.461.6048  stxnm@humana.com     Learn more about our Bold Goal  #MoreHealthyDays  #startwithhealthy   ', NULL, NULL, '2021-11-24 09:52:49', '2021-11-24 09:52:49'),
(50012, 11056, 32720, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  vcervantes2@humana.com  Sub:  Roster for Monica Gonzalez  Good morning!  Hope this email finds you well. Yes, this one is the main and correct address for the billing.  Billing & Primary Address: 301 Hillside Drive, Suite 4, Beeville, TX 78102     Billing #: (361) 226-1126.  Please see the attached roster. The correction has been made.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 16:46:21', '2021-12-06 16:46:21'),
(50013, 11056, 32720, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Rep: Adrian I   Status: Unprocessed yet. An email has been sent for escalation. Delay from the credentialing side of Humana   Refcode: 2000216735787', NULL, NULL, '2021-12-17 17:08:59', '2021-12-17 17:08:59'),
(50014, 11056, 32720, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Sub: Roster for Monica Gonzalez  Your answer to our question was received and is in the queue to be worked on.  Please allow more time for the completion of your requests.   You will receive an email notification once your request has been completed.    Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 F 855.461.6048 stxnm@humana.com', NULL, NULL, '2021-12-22 12:53:06', '2021-12-22 12:53:06'),
(50015, 19067, 32720, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||  Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S Hillside, DR STE 4, Beeville, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside, DR STE 4, Beeville, TX 78102-5324    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:48:06', '2022-01-04 12:48:06'),
(50016, 19067, 32720, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Monica Gonzalez was added to the group on 11/22/2021     Leticia Aleman-Listenbee was added to the group on 12/17/2021.   Thank you   Network Operations Coordinator – Provider Contracting     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2022-01-11 13:06:51', '2022-01-11 13:06:51'),
(50017, 19067, 32720, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Greetings!  I am unable to find these providers on Humana\'s provider directory.  Kindly assist me in this matter.  Regards, Hammad.', NULL, NULL, '2022-01-26 13:33:43', '2022-01-26 13:33:43'),
(50018, 19067, 32720, NULL, '2022-03-07 00:00:00.000', 'Approved', 'Email received from: stxnm@humana.com  Monica Gonzalez is loaded with a 1/1/2021 effective date  Leticia Aleman-Listenbee loaded on 11/1/2021', NULL, NULL, '2022-02-28 15:54:44', '2022-02-28 15:54:44'),
(50019, 1006, 32721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50020, 1006, 32721, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:32', '2021-07-16 17:13:32'),
(50021, 1006, 32721, NULL, '2021-08-23 00:00:00.000', 'Approved', 'We received the following approval confirmation email from ProviderMarketingInfo ProviderMarketingInfo@usamco.com:   Sub: Enrollment Status/Request - CBUC/GWMC - MCO  \"Hi Brad,  I show that there is an active agreement with TIN 81-1890349 since 2/22/17 under the name Beeville Medical Clinic and the two DBA’s Coastal Bend Urgent Care LLC and Coastal Bend Long Term Care.  I show two addresses under this agreement, 600 S Hillside Dr and 301 S Hillside Dr Ste 4.  I have CC’ed our Provider Relations department on this email and they will be able to add the 504 A Houston St address below.  With regards to the providers, as the agreement is as an Ancillary group, you do not need to add/credential new providers. Any provider billing under the TIN and one of the addresses on file will be counted as in-network.  Please let me know if you have any further questions.  Sarah Cozzetto Lead Network Development Coordinator\"', NULL, NULL, '2021-08-16 10:13:21', '2021-08-16 10:13:21'),
(50022, 1006, 32722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50023, 1006, 32722, NULL, '2021-07-23 00:00:00.000', 'Initiated', 'Applicant Name: MONICA GONZALEZ  Tracking ID: T071620210001167  Reassignment Tracking ID: T071620210002107  Submitted Date: FRI - JULY 16 2021 03:03:26 PM EST  Submitted By: Monica Gonzalez  Contact Email(s): MXG4797@GMAIL.COM CBUC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is enrolling in the Medicare program for the first time to bill for Part B services. A reassignment of benefits may exist. ', NULL, NULL, '2021-07-16 14:04:40', '2021-07-16 14:04:40'),
(50024, 1006, 32722, NULL, '2021-07-30 00:00:00.000', 'In Process', 'We received the following correction request:  \"To:  mxg4797@gmail.com,cbuc@claimsmedinc.com   Subject:  Request for Corrections for Medicare Enrollment Application (Tracking ID: T071620210001167)  Date:   07/21/2021 20:15 PM  This message is in response to your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T071620210001167. The information provided below indicates areas of your application requiring corrections as determined by your fee-for-service contractor.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T071620210001167   NPI ID: 1871132811   Medicare ID:    Name: MONICA GONZALEZ   State: TX  Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Other Comments  Please provide a copy of the master\'s degree.    Thank you for your cooperation.  After you have resubmitted your corrections through the Internet-based PECOS application, you may electronically sign or upload the certification statement for the corrections or if you prefer, please fax a new signed and dated certification statement(s) to my attention at: 904-361-0614; Fax to Image 877-439-5479.  Once you have submitted the corrections or if you have any questions about this request, please call me at 570-912-8376. JUSTINE GARDNER DCN: 3211970759 Novitas Solutions, Inc. Provider Enrollment Services Please note, we may reject your application if you do not furnish the complete information within 30 days from the date of this letter pursuant to 42 CFR 424.525. \"  Corrected.', NULL, NULL, '2021-07-23 11:02:12', '2021-07-23 11:02:12'),
(50025, 1006, 32722, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Application Tracking ID: T071620210001167   NPI ID: 1871132811   Medicare ID: 1R9771   Name: MONICA GONZALEZ  State: TX   Form Type: 855I  Date: 07/26/2021  Status: APPROVED ', NULL, NULL, '2021-07-27 09:23:35', '2021-07-27 09:23:35'),
(50026, 1006, 32722, NULL, '2021-08-13 00:00:00.000', 'Approved', '', NULL, NULL, '2021-08-06 09:14:31', '2021-08-06 09:14:31'),
(50027, 1006, 32723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50028, 1006, 32723, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:39', '2021-07-16 17:13:39'),
(50029, 1006, 32723, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Submitted enrollment request: Reference Number: 21228000546 Please allow three business days for the activation of this newly assigned PTAN', NULL, NULL, '2021-08-16 10:52:02', '2021-08-16 10:52:02'),
(50030, 1006, 32723, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Approval letter received and is attached.  PTAN: Q00116068 Eff: 05/01/2021', NULL, NULL, '2021-08-30 16:26:10', '2021-08-30 16:26:10'),
(50031, 1006, 32724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50032, 1006, 32724, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:45', '2021-07-16 17:13:45'),
(50033, 1006, 32724, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'We received  the following denial notification from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"At this time, the cities listed below are out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\" ', NULL, NULL, '2021-08-16 11:04:21', '2021-08-16 11:04:21'),
(50034, 1006, 32725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50035, 1006, 32725, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:13:54', '2021-07-16 17:13:54'),
(50036, 1006, 32725, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment. ', NULL, NULL, '2021-08-16 12:24:42', '2021-08-16 12:24:42'),
(50037, 11056, 32725, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-09-24 11:46:46', '2021-09-24 11:46:46'),
(50038, 11056, 32725, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-06 12:36:40', '2021-10-06 12:36:40'),
(50039, 11056, 32725, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-10-14 15:48:24', '2021-10-14 15:48:24'),
(50040, 11056, 32725, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-10-22 10:19:35', '2021-10-22 10:19:35'),
(50041, 11056, 32725, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-09 14:11:03', '2021-11-09 14:11:03'),
(50042, 11056, 32725, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-11-24 12:13:09', '2021-11-24 12:13:09'),
(50043, 11056, 32725, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 16:59:30', '2021-12-06 16:59:30'),
(50044, 11056, 32725, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 17:01:26', '2021-12-06 17:01:26'),
(50045, 11056, 32725, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts', NULL, NULL, '2021-12-21 17:28:29', '2021-12-21 17:28:29'),
(50046, 19067, 32725, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Subject: Enrollment Query || Providers & Group || GWMC || Molina Health ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:01:24', '2022-01-04 12:01:24'),
(50047, 19067, 32725, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Subject: Enrollment Query || Providers & Group || GWMC || Molina Health ||    Good afternoon,  Happy Monday!!  Hope you are doing well. per information on our system, TIN 81-1890349 is loaded into network billing system with effective date 12/15/2021.  Since contract on file is for urgent care clinic, we will not be able to link individual providers to group.  Facility is contracted already.  Should you have any additional questions, please reach out to your provider service representative directly at MHTXProviderServices@MolinaHealthCare.Com.  Thank you in advance, hope you have a great day.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (972)346-0603', NULL, NULL, '2022-01-11 13:10:36', '2022-01-11 13:10:36'),
(50048, 19067, 32725, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Subject: Re: Enrollment Query || Providers & Group || GWMC || Molina Health ||   Greetings!  Can you please confirm the location, it is 504A Houston Street, Live Oak County, George West, TX 78022.   Regards, Hammad.', NULL, NULL, '2022-01-26 15:04:57', '2022-01-26 15:04:57'),
(50049, 19067, 32725, NULL, '2022-02-22 00:00:00.000', 'Approved', 'Received the following email from: Juliana.Mata@molinahealthcare.com  Subject: RE: Enrollment Query || Providers & Group || GWMC || Molina Health ||   Good afternoon,  Happy Monday!!  Hope you are doing well. per information on our system, TIN 81-1890349 is loaded into network billing system with effective date 12/15/2021.  Since contract on file is for urgent care clinic, we will not be able to link individual providers to group.  Facility is contracted already.  Should you have any additional questions, please reach out to your provider service representative directly at MHTXProviderServices@MolinaHealthCare.Com.  Thank you in advance, hope you have a great day.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (972)346-0603', NULL, NULL, '2022-02-15 13:11:38', '2022-02-15 13:11:38'),
(50050, 1006, 32726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50051, 1006, 32726, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:01', '2021-07-16 17:14:01'),
(50052, 1006, 32726, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment. ', NULL, NULL, '2021-08-16 12:24:50', '2021-08-16 12:24:50'),
(50053, 1006, 32727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50054, 1006, 32727, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:08', '2021-07-16 17:14:08'),
(50055, 1006, 32727, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent following request @ registrar@multiplan.com:  Sub: Practitioner Application - CBUC/GWMC - Multiplan  \"Hello,   Please find the attached information for our providers, do let me know if anything else is required to proceed.  Thank you. \" ', NULL, NULL, '2021-08-11 11:01:45', '2021-08-11 11:01:45'),
(50056, 11056, 32727, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Updates - CBUC/GWMC - Multiplan  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 15:15:28', '2021-08-18 15:15:28'),
(50057, 11056, 32727, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com, pif@multiplan.com  &  ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Good morning!  Hope this email finds you well. Here are the Group Cover Sheet for Practitioner Applications for the enrollment of the below mentioned providers under the practice in Multiplan.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 11:54:43', '2021-08-24 11:54:43'),
(50058, 11056, 32727, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : 	appmissinginfo@multiplan.com  Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760  Good evening!  Hope all is well with you. Here is the Filled form for the provider Gonzalez Monica. Please find the attachment below.  Practice Details: Practice/ Group Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Furthermore, If anything is required by you please let me know without any hesitation.  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-20 12:37:45', '2021-09-20 12:37:45');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(50059, 11056, 32727, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : Regarding Paterson, Katherine D., MSN\'s MultiPlan Application – Reference: APP0008265762  Good afternoon!  Hope all is well with you.Here is the Malpractice for the provider Katherine Paterson. Please find the attachment below.  Practice Details: Practice/ Group Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Furthermore, If anything is required by you please let me know without any hesitation.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 16:24:22', '2021-09-29 16:24:22'),
(50060, 11056, 32727, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760  Rep. : Dann G  Monica is in process Malpractice & Hospital affiliations issue.  Ref code : 7711003  Contact : (800) 950-7040', NULL, NULL, '2021-10-04 10:37:36', '2021-10-04 10:37:36'),
(50061, 11056, 32727, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Rep :  Natasha C  Status : Participation completed. Credentialing is completed  Soon they gonna send the letter in 8-10 business days  Eff date : 10/04/2021  Ref code : 7711003  Contact : (800) 950-7040', NULL, NULL, '2021-10-14 12:26:53', '2021-10-14 12:26:53'),
(50062, 11056, 32727, NULL, '2021-10-25 00:00:00.000', 'Approved', 'Email received from :welcomepackets@multiplan.com  Sub : SECURE: MultiPlan Network Participation (13939691-9933249)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Gonzalez, Monica D., MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information   Eff dates : 10/4/2021   Please see the attachment. Welcome letter is attached.', NULL, NULL, '2021-10-18 10:24:53', '2021-10-18 10:24:53'),
(50063, 1006, 32728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50064, 1006, 32728, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:14', '2021-07-16 17:14:14'),
(50065, 11056, 32728, NULL, '2021-09-02 00:00:00.000', 'Not Eligible', 'Email received from : cresta.smith@careallies.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  These providers are not in the renaissance service area. We are only in the greater Houston area.     Thanks  Cresta', NULL, NULL, '2021-08-25 14:17:44', '2021-08-25 14:17:44'),
(50066, 1006, 32729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50067, 1006, 32729, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:21', '2021-07-16 17:14:21'),
(50068, 1006, 32729, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'We received the following Network Denial/Rejection email from Scott & White:   Sub: New Contract Request  \"Tax ID#: 811890349  RE: Network Denial  Dear Katherine  D Paterson  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 03/03/2021, SWHP and FirstCare regretfully declines to contract with Katherine  D Paterson this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.   Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\" ', NULL, NULL, '2021-08-16 12:27:23', '2021-08-16 12:27:23'),
(50069, 1006, 32730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50070, 1006, 32730, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:28', '2021-07-16 17:14:28'),
(50071, 1006, 32730, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'Pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 10:02:25', '2021-08-16 10:02:25'),
(50072, 11056, 32730, NULL, '2021-09-27 00:00:00.000', 'Initiated', 'Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.   Online form has been submitted. Please see the attachment.', NULL, NULL, '2021-09-20 08:35:56', '2021-09-20 08:35:56'),
(50073, 11056, 32730, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good afternoon,  The record is showing provider Regarding provider MONICA GONZALEZ, the application packet was received 09/28/2021 and is currently in process.     Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development  ', NULL, NULL, '2021-09-29 16:58:42', '2021-09-29 16:58:42'),
(50074, 11056, 32730, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Good morning!  Hope this email finds you well. I want to get an update regarding the enrollment process of the following provider under this TIN with Superior HealthPlan. Please provide the updates soon.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811    If you need any additional information or documents please let me know. Waiting for your reply.  Thank you! Have a great day! ', NULL, NULL, '2021-10-12 15:32:49', '2021-10-12 15:32:49'),
(50075, 11056, 32730, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good morning!  Hope this email finds you well. I want to get an update regarding the enrollment process of the following provider under this TIN with Superior HealthPlan. Please provide the updates soon.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811    If you need any additional information or documents please let me know. Waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 15:33:46', '2021-10-12 15:33:46'),
(50076, 11056, 32730, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub  : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good morning  My apologies for the delay in response   For the Provider Monica Gonzalez NPI#1871132811 under TID#811890349 is under credentialing status with a TAT of 12 business days   Have a great day   Veronica Botello Rocha  Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-10-22 08:30:23', '2021-10-22 08:30:23'),
(50077, 11056, 32730, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188   Good morning,     After reviewing the application status for the provider below, I see the application is under Make PAR status. At This time, our Network Development Team is validating provider information to be uploaded into our system.     Provider projected effective date shows to be 12/1/2021, however, until our system reflects the Provider Completed Status, then we are unable to provide you with an actual effective date.     Please allow a bit more time for this to be completed.', NULL, NULL, '2021-11-09 16:27:23', '2021-11-09 16:27:23'),
(50078, 11056, 32730, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good morning!  Hope this email finds you well. I want to get an update regarding the enrollment process of the following provider under this TIN with Superior HealthPlan. Please provide the updates soon.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811    If you need any additional information or documents please let me know. Waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:26:31', '2021-11-24 13:26:31'),
(50079, 11056, 32730, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email received from:  AM.CorpusChristi@superiorhealthplan.com   Sub:  REF # 60964 _ MERCEDITA FLYNN_NPI_1619166188  Good afternoon Ahmed,  Provider has an effective date of 12/1/2021, meaning you will get a Welcome letter for provider before end of this month or on by effective date.  Our department does not issue Welcome Letters for providers. Please allow for that information to be sent out by our ECM team. If you do not receive it by providers effective date,  you may reach out to them by beginning of next month contacting them at the following email address.   ECMExecutionTeam@superiorhealthplan.com  Thank you,   Yesenia Prado Provider Account Manager Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Phone: (800) 656-4817  Option 1 /English Option 3 for Account Management Fax: (866) 683-5630   AM.CorpusChristi@Superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 ext. 87391', NULL, NULL, '2021-12-10 10:13:55', '2021-12-10 10:13:55'),
(50080, 1006, 32731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50081, 1006, 32731, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:35', '2021-07-16 17:14:35'),
(50082, 1006, 32731, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment.', NULL, NULL, '2021-08-16 12:28:02', '2021-08-16 12:28:02'),
(50083, 11056, 32731, NULL, '2021-09-24 00:00:00.000', 'Initiated', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP   Good morning!  Hope all is well. Please find the attached application for the below mentioned provider under the following practice for both locations.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name : Monica Gonzalez Provider NPI# :  1871132811  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-17 13:11:18', '2021-09-17 13:11:18'),
(50084, 11056, 32731, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Hello,  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.   Thank you  Liz Ramirez Contract Specialist Texas Children’s Health Plan', NULL, NULL, '2021-09-28 09:46:19', '2021-09-28 09:46:19'),
(50085, 11056, 32731, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : tchpnetworkmanagement@texaschildrens.org & bxgupta@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Group- Coastal Bend Urgent Care, LLC   Katherine Paterson         1164776548 Please see attached denial letter  20211001038052743     Mercedita Flynn               1619166188 Please see attached denial letter  20210930038036249     Monica Gonzalez             1871132811 Please see attached denial letter  20210930038036263   No TCHP does not work with BEE county. Our apologies.  You can also check yourself on website at texaschildrens.org yourself which county TCHP serves.', NULL, NULL, '2021-10-07 10:37:29', '2021-10-07 10:37:29'),
(50086, 1006, 32732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50087, 1006, 32732, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:42', '2021-07-16 17:14:42'),
(50088, 1006, 32732, NULL, '2021-08-17 00:00:00.000', 'In Process', 'As per my discussion with TRPN we need to send a provider update form to them, requested a copy, and sent it to trpndataentry@trpnppo.com:  Sub: Provider Update Form - CBUC/GWMC - TRPN  \"Hello,   Please find the attached provider update forms for our providers. Please let me know if anything else is required to continue.   Thank you!\"  Attached for reference in provider tasks. ', NULL, NULL, '2021-08-10 12:45:17', '2021-08-10 12:45:17'),
(50089, 11056, 32732, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Status Updates - CBUC/GWMC - TRPN  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:05:57', '2021-08-18 14:05:57'),
(50090, 11056, 32732, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  trpndataentry@trpnppo.com, providerrelations@trpnppo.com   & AVasquez@trpnppo.com  Sub : Provider Update Form - CBUC/GWMC - TRPN   Good afternoon!  Hope this email finds you well. Please inform me with the latest updates regarding enrollment status of the following providers under the practice in TRPN. Please also inform me about the provider\'s update forms.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 13:32:01', '2021-08-24 13:32:01'),
(50091, 11056, 32732, NULL, '2021-09-09 00:00:00.000', 'Approved', 'Approval Email received from : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status Updates - CBUC/GWMC - TRPN  Hi,     This request is completed,     Provider Mercedita Flynn is Active, effective date 01/01/2017,  Provider Katherine Paterson is Active, effective date 01/01/2017,  Provider Monica Gonzalez is Active, effective date 01/01/2021.    Please see the attachment', NULL, NULL, '2021-09-01 16:07:40', '2021-09-01 16:07:40'),
(50092, 1006, 32733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50093, 1006, 32733, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:49', '2021-07-16 17:14:49'),
(50094, 11056, 32733, NULL, '2021-09-27 00:00:00.000', 'Initiated', 'I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for the certification process and the form has been faxed at 608-221-7535  Mercedita - is credentialed and in network  Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 15:56:23', '2021-09-20 15:56:23'),
(50095, 11056, 32733, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com & ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning  Ahmed,     Katherine, has taken another position.  This address location do not appear in my area. I will assist you with this question but any additional questions please reach out to Jacqueline Trenz. I have include her on this email.  You do not need to include me on the emails for this area    Provider Details: Provider Name: Flynn, Mercedita N  Provider NPI# 1619166188 - Show affiliated with this group tax id but is not display on the portal a request was submitted to update. Allow up to five business days to process.   Provider Name: Katherine Paterson- Show affiliated with this group tax id and is displayed  Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811 - Do not appear in our system as TRICARE certified. Below is the link to the certification application for you to complete and fax to WPS. ', NULL, NULL, '2021-09-30 15:50:37', '2021-09-30 15:50:37'),
(50096, 11056, 32733, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon!  Hope all is well with you. Please assist with the below at your earliest opportunity.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI & Queries Katherine Paterson	1164776548 : Please provide eff date & Please update the main                           location with proper address on your director  Mercedita Flynn	1619166188 : Latest updates on this application Monica Gonzalez	1871132811 : We have faxed the certification and credentialing                                      application to Tricare.  If you have any questions or require additional information or documents please don\'t hesitate in contacting me. Please see the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-07 16:15:56', '2021-10-07 16:15:56'),
(50097, 11056, 32733, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Please allow 90 days for processing of Ms. Gonzalez.  Application was faxed 9/20/2021.      Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-14 16:05:51', '2021-10-14 16:05:51'),
(50098, 11056, 32733, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Hello Jacqueline!  Hope you are doing great. Please help me out with the issue mentioned below:  Katherine Paterson - The main location is not appearing in your directory.  Mercedita Flynn - The secondary location is not appearing in your directory.  Please also see the attachments related to this. Kindly sort this out for me as soon as possible.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-22 10:35:53', '2021-10-22 10:35:53'),
(50099, 11056, 32733, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub:  Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning,     The correct locations are showing up in my systems, so I have to send this the my provider administration team for a review.  Please email  a copy of the W-9 for the group so I can send my request.', NULL, NULL, '2021-11-09 15:46:11', '2021-11-09 15:46:11'),
(50100, 11056, 32733, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  ywyatt@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon Ahmed,     You can check the status and effective dates on a provider by creating a log-in on the Provide Portal using the links listed below. This address location is not in my area. You do not need to include me on the email for Coastal Bend unless there is a location in Houston Texas.     https://infocenter.humana-military.com/provider/service/Account/Login  Katherine Paterson is listed as network the effective date is listed on the Provider Portal    Mercedita Flynn is listed as network the effective date is listed on the Provider Portal  Monica Gonzalez- certification faxed to WPS can take up to 120 days to process. WPS will send you a letter once the application is complete. I do not have access to WPS system to give you the status. You can call 1800 444 5445 and ask to speak to the certification unit to check status.      ', NULL, NULL, '2021-11-24 12:42:38', '2021-11-24 12:42:38'),
(50101, 11056, 32733, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Jacqueline!  Hope this email finds you well. Any update on the location listing in the provider directory? Have the locations been updated?  For Katherine : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  For Mercedita : 504A Houston Street, George West , TX 78022-3663  Take Care! Have a wonderful week ahead!', NULL, NULL, '2021-12-10 13:02:10', '2021-12-10 13:02:10'),
(50102, 11056, 32733, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon!  Hope this email finds you well. Please update me with the certification & credentialing process of the below-mentioned provider at your earliest convenience.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you require any further information or documents please let me know.  Thank you!', NULL, NULL, '2021-12-17 17:54:05', '2021-12-17 17:54:05'),
(50103, 11056, 32733, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning Jacqueline!  Hope you had a wonderful week yet. Please respond to the below query soon. I am still waiting to get the latest updates regarding the provider, Monica\'s certification, and credentialing with Tricare.  Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 13:18:38', '2021-12-22 13:18:38'),
(50104, 19067, 32733, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||     Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mocia Gonzalez	1871132811	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663   Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:59:06', '2022-01-04 10:59:06'),
(50105, 19067, 32733, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||   Good Morning Hammad,     This group tax id is not in my area. Celeste Santiago is the Rep for that area. I have include her on this email.  Please reach out to her to assist.  You can also check status by creating a log in on the Provider portal.', NULL, NULL, '2022-01-10 10:12:36', '2022-01-10 10:12:36'),
(50106, 19067, 32733, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com, ywyatt@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Greetings Celeste!  Hope this email finds you well.  Can you look into the request mentioned below?   Have a beautiful day! Hammad Ahmed.', NULL, NULL, '2022-01-20 20:27:22', '2022-01-20 20:27:22'),
(50107, 19067, 32733, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the following email from: CSantiago20@humana.com    Hammad,  Thank you for reaching out to me.  I am the new Provider Rep for the Corpus Christi Area, as well as Austin, and Del Rio area.  I have researched your providers you listed and have annotated in RED below  Group Name  Beeville Medical Clinic   Tax ID  81-1890349    Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified Authorized TRICARE Provider-assigned this location     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified Authorized TRICARE Provider-assigned to this location     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location        I have identified an issue for Mercedita Flynn, but that does not impact her as a provider and certification and or credentialing.  That alert has been submitted and is set to be corrected.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 12:00:14', '2022-02-16 12:00:14'),
(50108, 1006, 32734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50109, 1006, 32734, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:14:54', '2021-07-16 17:14:54'),
(50110, 1006, 32734, NULL, '2021-08-23 00:00:00.000', 'In Process', 'The request is in-process in group task as Triwest only enrolls urgent care centers, not individual providers. ', NULL, NULL, '2021-08-16 12:30:46', '2021-08-16 12:30:46'),
(50111, 11056, 32734, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : credentialing@triwest.com, providerservices@triwest.com, jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I am still waiting to get an update regarding the status of enrollment for our group and providers mentioned below. Please respond to me as soon as possible.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 10:40:59', '2021-08-24 10:40:59'),
(50112, 11056, 32734, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening Jess!  Hope this email finds you well. Thank you so much for the prompt response. Please provide me with the welcome or approval letters for the below mentioned providers and practice as soon as possible.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-03 14:44:16', '2021-09-03 14:44:16'),
(50113, 11056, 32734, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-09-24 14:44:06', '2021-09-24 14:44:06'),
(50114, 11056, 32734, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-10-06 12:57:13', '2021-10-06 12:57:13'),
(50115, 11056, 32734, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : providerdataupdate@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates regarding the providers and facility credentialing applications mentioned below under Tax I.D and both locations. And still waiting for the welcome letters for the providers.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663  Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   If you have any questions or concerns or require any information or documents please let me know. Eagerly, waiting for the response.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-14 15:54:57', '2021-10-14 15:54:57'),
(50116, 11056, 32734, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential   Talha,  I removed Michelle from the email as she is no longer in the same department.   We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.  The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548        Cecilia Carroll Direct Contract Manager TriWest Healthcare Alliance  O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com', NULL, NULL, '2021-10-22 10:41:16', '2021-10-22 10:41:16'),
(50117, 11056, 32734, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential     Talha,     Reminder, Michelle is no longer in this department.      See below status of your urgent care and providers in question.     We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.     The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548              Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance  O:  (623) 435-3343  F:  (866) 549-4618  ccarroll@triwest.com  www.triwest.com', NULL, NULL, '2021-11-09 11:14:42', '2021-11-09 11:14:42'),
(50118, 11056, 32734, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sbachman@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Julie,  Please process the provider in Pending status and provider the effective dates for all three providers.     Group Name  Coastal Bend Urgent Care, LLC  Tax ID  81-1890349  Group NPI  1427509264  Primary Location  301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Secondary Location  504A Houston Street, George West , TX 78022-3663  Provider Name  NPI  Katherine Paterson  1164776548  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Sincerely,  Sandra Bachman  Team Lead, Provider Data Ops / TriWest Healthcare Alliance  P: 1 (855) 722-2838  F: (866) 589-7693  www.triwest.com   ', NULL, NULL, '2021-11-24 13:01:53', '2021-11-24 13:01:53'),
(50119, 11056, 32734, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  	jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest   Good morning Julie!  Hope this email finds you well. Please respond to this query at your earliest convenience. Provide us with the effective dates and welcome letters for all three providers soon.  Eagerly, waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 18:02:15', '2021-12-06 18:02:15'),
(50120, 11056, 32734, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Good Morning,  Please direct all credentialing questions, data updates and issues to the Credentialing team.  The urgent care facility below is not found in our data at this point, you will need to request info from the Credentialing team for this one.     The individual providers below have been processed out to all systems, eff Oct 2021.           Thank You,     Julie Miller  Provider Data & Credentialing Specialist  TriWest Healthcare Alliance  P: (602) 564-2024  F: (866) 589-7693  Contact Center (855) 722-2838  www.triwest.com', NULL, NULL, '2021-12-14 16:40:53', '2021-12-14 16:40:53'),
(50121, 11056, 32734, NULL, '2021-12-24 00:00:00.000', 'Approved', 'Email received from:  jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Good Morning,  The two providers below have been processed for the second address, 504A Houston Street, George West, TX 78022-3663   Here is the provider information that you have requested  Providers - Effective dates   Flynn – 9/29/21  - 504A Houston Street, George West  Gonzalez – 10/5/21 - 504A Houston Street, George West  Thank you.    Julie Miller Provider Data & Credentialing Specialist TriWest Healthcare Alliance  P: (602) 564-2024 F: (866) 589-7693 Contact Center (855) 722-2838 www.triwest.com  Please see the attachments.', NULL, NULL, '2021-12-17 10:15:56', '2021-12-17 10:15:56'),
(50122, 1006, 32735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50123, 1006, 32735, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:15:01', '2021-07-16 17:15:01'),
(50124, 1006, 32735, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Submitted enrollment request via RFP portal. Attached for reference. ', NULL, NULL, '2021-08-16 14:03:16', '2021-08-16 14:03:16'),
(50125, 1006, 32735, NULL, '2021-08-23 00:00:00.000', 'Initiated', 'Submitted enrollment request via RFP portal. Attached for reference. ', NULL, NULL, '2021-08-16 14:03:19', '2021-08-16 14:03:19'),
(50126, 11056, 32735, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - CBUC / GWMC - United HealthCare  Good afternoon!  Hope all is well. I would like to request you that I am sending you this email in regards to the enrollment update status for below mentioned provider under the practice.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name : Gonzalez, Monica Provider NPI# : 1871132811  If you have any questions or concerns or need additional information or documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 15:24:02', '2021-08-24 15:24:02'),
(50127, 11056, 32735, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub :  Secure Message from brian_k_autio@uhc.com  Good afternoon,  Thank you for contacting the Network Management Resource Team. The provider, Monica Gonzalez, is linked to the Tax ID 811890349, but is not contracted yet. There is a request, PR-6102116, in process to get the group contract loaded. Please allow some additional time for the request to get completed.  Please let us know if we can assist further via email. All responses must only be sent to networkhelp@uhc.com, so we don’t receive duplicate emails. Any emails sent to my personal email will be deleted.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Brian K. Autio  Associate Network Contractor United Healthcare Network Management Resource Team (NMRT)    For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.    For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.', NULL, NULL, '2021-09-02 10:24:39', '2021-09-02 10:24:39'),
(50128, 11056, 32735, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub  : Secure Message from corin_lett@uhc.com  Thank you for  contacting Network Management Resource Team.  The provider is not contracted ot the tax ID, and I show the request is in proccess under case reference PR-6102116.  Please allow time to process.   Thank You. Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-24 10:28:57', '2021-09-24 10:28:57'),
(50129, 11056, 32735, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Emails received from :  networkhelp@uhc.com  Sub : Secure Message from corin_lett@uhc.com  Thank you for  contacting Network Management Resource Team.  The provider’s contracting is in process and can take 30-60 business days.  We thank you for your patience.   Provider Name : Gonzalez, Monica Provider NPI# : 1871132811  Thank You.  Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-06 13:13:55', '2021-10-06 13:13:55'),
(50130, 11056, 32735, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from barbara_jordan@uhc.com  Good afternoon!  Hope all is well with you. I want to get an update regarding the credentialing process of the following provider with UHC under the facility Tax ID and both locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you have any queries or concerns feel free to contact me. I will be happy to assist.  Thank you!', NULL, NULL, '2021-10-12 17:06:06', '2021-10-12 17:06:06'),
(50131, 11056, 32735, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from barbara_jordan@uhc.com  Hello  Thank you for contacting the Network Management Resource Team. PR-6102116 is in process to add the hospital based provider to TIN  811890349.  I apologize for the delay is getting the provider added, the request has been escalated.   GONZALEZ, MONICA  - 7777102   If you have any other questions or need additional assistance, please do not hesitate to contract us.    Kind Regards   Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-20 13:57:02', '2021-10-20 13:57:02'),
(50132, 11056, 32735, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from barbara_jordan@uhc.com  Good afternoon!   Hope this email finds you well. Please provide me with the latest updates regarding the provider, Monica Gonzalez\'s Enrollment with UHC at your earliest convenience.   Eagerly, waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-11-09 12:44:35', '2021-11-09 12:44:35'),
(50133, 11056, 32735, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: barbara_jordan@uhc.com  Sub:  RE: Secure Message from barbara_jordan@uhc.com  Hello Thank you for contacting the Network Management Resource Team.   GONZALEZ, MONICA  - 7777102   TIN 811890349 Effective 08/16/2021   If you have any other questions or need additional assistance, please do not hesitate to contract us.   Kind Regards   Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-24 11:01:21', '2021-11-24 11:01:21'),
(50134, 11056, 32735, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Secure Message from barbarajordan@uhc.com  Good afternoon!   Hope all is well with you. Could you please confirm about the locations because the provider is providing services at bot locations:   Primary & Billing Location:  301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location:           504A Houston Street, George West, TX 78022-3663   Kindly, provide me with the welcome letter and plan roster for the provider as soon as possible. Please list the provider on the provider directory of UHC.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 16:47:05', '2021-12-10 16:47:05'),
(50135, 11056, 32735, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to:  networkhelp@uhc.com  Sub: RE: Secure Message from CAROL.LEE-BRYANT@uhc.com  Good afternoon!  Hope this email finds you well. Please find the attached Demographic-Change-Request-Form for adding a location under Provider, Monica Gonzalez NPI: 1871132811 under the facility, Coastal Bend Urgent Care LLC TIN: 81-1890349.  Please also list the location under provider in UHC. Also, keep me updated when it is completed.  Thank you! Have a great day!', NULL, NULL, '2021-12-17 13:48:19', '2021-12-17 13:48:19'),
(50136, 11056, 32735, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: United_Healthcare_Provider_Operations@uhc.com   Sub:  Secure message from United_Healthcare_Provider_Operations@uhc.com    UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6376342  Received On: Dec 20, 2021 2:30:45 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations  *--SecureDelivery--*', NULL, NULL, '2021-12-20 10:32:27', '2021-12-20 10:32:27'),
(50137, 19067, 32735, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || GWMC || Monica Gonzalez || UHC ||   Hello!   Hope you\'re doing well.  I would like to know the credentialing status of the following Provider with UHC.   Group Name	George West Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:31:32', '2021-12-29 15:31:32'),
(50138, 19067, 32735, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || CBUC & GWMC || Leticia & Monica || UHC ||    Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers with United HealthCare.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Waiting for your response.  Thanks & Regards, Hammad Ahmed. ', NULL, NULL, '2022-01-04 10:41:09', '2022-01-04 10:41:09'),
(50139, 19067, 32735, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Subject: Enrollment Query CBUC & GWMC Leticia & Monica UHC - [ref:_02646667:ref]   Hello,   Thank you for contacting the UnitedHealthcare Network Management Resource Team. In response to your request, I’m sending you the product roster showing the demographic information, lines of business and effective dates for MONICA GONZALEZ. Leticia Aleman-Listenbee is not in our system. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts. · Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   · Submit your request through the RFP portal at https://ncc-optum.secure.force.com/rfp     Questions? We’re here to help   If we can further assist you, please respond to this email.     Sincerely,  UnitedHealthcare Network Management Resource Team', NULL, NULL, '2022-01-05 13:27:16', '2022-01-05 13:27:16'),
(50140, 19067, 32735, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Query || CBUC & GWMC || Leticia & Monica || UHC ||   Greetings!  Any updates on the following request?   Regards, Hammad Ahmed', NULL, NULL, '2022-01-12 14:50:05', '2022-01-12 14:50:05');
