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
(4857, 2037, 9090, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 16:46:50', '2020-09-10 16:46:50'),
(4858, 2037, 9090, NULL, '2020-09-17 00:00:00.000', 'Approved', 'The Facility is Contracted with Managed Care Organization holding an Ancillary contract Effective 01/08/2013 With the assigned provider ID# 1177750. Sending approval email to the billing. Copy of the executed contract uploaded in EMRBS.', NULL, NULL, '2020-09-10 16:49:35', '2020-09-10 16:49:35'),
(4859, 1006, 9091, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 16:49:36', '2020-09-10 16:49:36'),
(4860, 1006, 9091, NULL, '2020-09-17 00:00:00.000', 'Initiated', 'Submitted online enrollment request: \"You have successfully submitted your application. Please print a copy of this page for your records. Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273.\"', NULL, NULL, '2020-09-10 16:49:48', '2020-09-10 16:49:48'),
(4861, 1006, 9091, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Received an email from Cigna, stating that as the provider is already enrolled we only need to get her added to the group. Called Cigna behavioral health provider services and requested that the provider be added to the group, it should take a week as per the representative and I can reach out to Samilia Owusu.  Email: samilia.owusu@cigna.com Phone# 952-996-2523 Provider is effective with Cigna as of 10/11/2012  Ref# Stetson S 09/15/2020', NULL, NULL, '2020-09-15 14:39:20', '2020-09-15 14:39:20'),
(4862, 1006, 9091, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent followup email to \"Owusu, Samilia A 46K\" samilia.owusu@cigna.com> regarding status of linkage of the provider. ', NULL, NULL, '2020-09-23 16:55:00', '2020-09-23 16:55:00'),
(4863, 1006, 9091, NULL, '2020-10-01 00:00:00.000', 'Approved', 'Received following approval from Owusu:  \"Good morning Brad,  Provider 4137873 Pandeeswari Raveendran, MD, MD is affiliated with your TIN at 61 Lincoln St Ste 203, Framingham, MA 01702 . The effective date for this location will be the same as his contract date 10/11/2012 since we don’t track separate dates for when new locations are added to a provider’s profile.  Please let me know if you have any further questions.  ConnectedCare PROVIDER OPERATIONS Samilia Owusu Cigna Behavioral Health | Provider Data Management T: 952.996.2523 DC, DE, MA, NJ, NY & RI\"', NULL, NULL, '2020-09-24 10:52:57', '2020-09-24 10:52:57'),
(4864, 2037, 9092, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 16:56:11', '2020-09-10 16:56:11'),
(4865, 2037, 9092, NULL, '2020-09-17 00:00:00.000', 'Approved', 'The Facility is holding an Urgent Care Ancillary Contract with MCO so linkage of any individual provider is not a requirement. any provider billing using the facility\'s TIN and Type 2 NPI will be considered in-network', NULL, NULL, '2020-09-10 17:03:54', '2020-09-10 17:03:54'),
(4866, 1006, 9093, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 18:18:37', '2020-09-10 18:18:37'),
(4867, 1006, 9093, NULL, '2020-09-17 00:00:00.000', 'Initiated', 'Sent email to John \"Chuck\" McGrew to add provider to our TIN. Form is attached.', NULL, NULL, '2020-09-10 18:19:30', '2020-09-10 18:19:30'),
(4868, 1006, 9093, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to John McGrew jmcgrew3@humana.com> regarding the status of group enrollment. ', NULL, NULL, '2020-09-23 17:50:33', '2020-09-23 17:50:33'),
(4869, 1006, 9093, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Received the following update from Chuck McGrew regarding linking:  \"Hi, Brad!  Nope, not yet. That was submitted just over a week ago, and it take at LEAST a couple weeks for anybody in Admin even to look at it. :-\\ Since Spectrum is in-net, I just went ahead and made the affiliation myself, but Admin still has to do some stuff on their end to lock her in.\"', NULL, NULL, '2020-09-24 10:45:16', '2020-09-24 10:45:16'),
(4870, 1006, 9093, NULL, '2020-10-05 00:00:00.000', 'Approved', 'Received following reply from Chuck Mcgrew:  \"Well, they take a while; I wouldn’t expect anything before three weeks, But you should still be able to go ahead and file, I believe. Maybe wait till Monday. :-)\"', NULL, NULL, '2020-09-28 14:04:53', '2020-09-28 14:04:53'),
(4871, 1006, 9094, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 18:18:39', '2020-09-10 18:18:39'),
(4872, 1006, 9094, NULL, '2020-09-17 00:00:00.000', 'Initiated', 'Submitted online request for initiation via the Magellan website. ', NULL, NULL, '2020-09-10 18:19:02', '2020-09-10 18:19:02'),
(4873, 1006, 9094, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Received following email from Magellan/ Jones-Wright, Judith JJonesWright@magellanhealth.com:   Good Day,  CAQH ID: 12084607  If all of the information is showing correctly in the CAQH application, such as the work history and malpractice insurance, then send nothing more.  Judy Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management O 410-953-3537 | F   1-888-656-1598 | E JJonesWright@magellanhealth.com ', NULL, NULL, '2020-09-11 15:39:12', '2020-09-11 15:39:12'),
(4874, 1006, 9094, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a follow-up request to JJonesWright@magellanhealth.com regarding status. ', NULL, NULL, '2020-09-23 17:03:29', '2020-09-23 17:03:29'),
(4875, 1006, 9094, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following update from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  Sub: PANDEESWARI RAVEENDRAN MIS 601280-952  \"The provider has about 2 weeks before they are completed and made active with your group.  Judy\"', NULL, NULL, '2020-09-28 14:49:20', '2020-09-28 14:49:20'),
(4876, 1006, 9094, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a follow-up email to Judith regarding the status of enrollment. ', NULL, NULL, '2020-10-05 16:52:35', '2020-10-05 16:52:35'),
(4877, 1006, 9094, NULL, '2020-10-13 00:00:00.000', 'Approved', 'As per Judith, the provider has been linked to our group effective: 09/28/2020', NULL, NULL, '2020-10-06 10:26:13', '2020-10-06 10:26:13'),
(4878, 2027, 9095, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:16:21', '2020-09-11 12:16:21'),
(4879, 2027, 9095, NULL, '2020-09-18 00:00:00.000', 'Approved', 'This provider is now showing linked under the group contract with the insurance and effective date is 08/10/2020. Welcome packet and executed signed contract is attached.', NULL, NULL, '2020-09-11 12:18:43', '2020-09-11 12:18:43'),
(4880, 2027, 9096, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:37:14', '2020-09-11 12:37:14'),
(4881, 2027, 9096, NULL, '2020-09-18 00:00:00.000', 'Approved', 'This provider is now showing linked under the group contract with the insurance and effective date is 08/10/2020. Welcome packet and executed signed contract is attached.', NULL, NULL, '2020-09-11 12:38:33', '2020-09-11 12:38:33'),
(4882, 2027, 9097, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:42:44', '2020-09-11 12:42:44'),
(4883, 2027, 9097, NULL, '2020-09-18 00:00:00.000', 'Approved', 'This provider is now showing linked under the group contract with the insurance and effective date is 08/10/2020. Welcome packet and executed signed contract is attached.', NULL, NULL, '2020-09-11 12:43:01', '2020-09-11 12:43:01'),
(4884, 2027, 9098, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:45:54', '2020-09-11 12:45:54'),
(4885, 2027, 9098, NULL, '2020-09-18 00:00:00.000', 'Approved', 'This provider is now showing linked under the group contract with the insurance and effective date is 08/10/2020. Welcome packet and executed signed contract is attached.', NULL, NULL, '2020-09-11 12:46:04', '2020-09-11 12:46:04'),
(4886, 2027, 9099, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:49:46', '2020-09-11 12:49:46'),
(4887, 2027, 9099, NULL, '2020-09-18 00:00:00.000', 'Approved', 'This provider is now showing linked under the group contract with the insurance and effective date is 08/10/2020. Welcome packet and executed signed contract is attached.', NULL, NULL, '2020-09-11 12:50:04', '2020-09-11 12:50:04'),
(4888, 2037, 9100, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:52:45', '2020-09-11 12:52:45'),
(4889, 2037, 9100, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Called Triwest provider services @ 866-284-3743 and spoke to Allysa. As per her one location is CCN contracted and the other 2 locations contracting is still under process and will be completed soon.There is no estimated turn around as of now.Below are the details : 500 E CAESAR  KINGSVILLE , TX 78363. CCN Contracted Effective Date: 06/01/2020. ------- Secondary Location: 4042 River Hill Drive Nueces County Corpus Christi TX  78410-5606. -------- Tertiary Location:  6646 S Staples St #122 Nueces County  Corpus Christi TX 78413-5426. Call  Reference #: PH-667741-F4Q4F8', NULL, NULL, '2020-09-11 12:53:04', '2020-09-11 12:53:04'),
(4890, 2037, 9100, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server.', NULL, NULL, '2020-09-11 12:53:16', '2020-09-11 12:53:16'),
(4891, 2037, 9101, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 12:55:24', '2020-09-11 12:55:24'),
(4892, 2037, 9101, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Called Triwest provider services @ 866-284-3743 and spoke to Allysa. As per her one location is CCN contracted and the other 2 locations contracting is still under process and will be completed soon.There is no estimated turn around as of now.Below are the details : 500 E CAESAR  KINGSVILLE , TX 78363. CCN Contracted Effective Date: 06/01/2020. ------- Secondary Location: 4042 River Hill Drive Nueces County Corpus Christi TX  78410-5606. -------- Tertiary Location:  6646 S Staples St #122 Nueces County  Corpus Christi TX 78413-5426. Call  Reference #: PH-667741-F4Q4F8', NULL, NULL, '2020-09-11 12:55:33', '2020-09-11 12:55:33'),
(4893, 2037, 9101, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server.', NULL, NULL, '2020-09-11 12:55:56', '2020-09-11 12:55:56'),
(4894, 2027, 9102, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:17:58', '2020-09-11 13:17:58'),
(4895, 2027, 9102, NULL, '2020-09-18 00:00:00.000', 'Approved', 'This provider is now showing linked under the group contract with the insurance and effective date is 08/10/2020. Welcome packet and executed signed contract is attached.', NULL, NULL, '2020-09-11 13:18:48', '2020-09-11 13:18:48'),
(4896, 2037, 9103, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:31:04', '2020-09-11 13:31:04'),
(4897, 2037, 9103, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server.', NULL, NULL, '2020-09-11 13:32:04', '2020-09-11 13:32:04'),
(4898, 2037, 9104, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:50', '2020-09-11 13:36:50'),
(4899, 2037, 9104, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:39:47', '2020-09-11 13:39:47'),
(4900, 2037, 9105, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:51', '2020-09-11 13:36:51'),
(4901, 2037, 9105, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:39:53', '2020-09-11 13:39:53'),
(4902, 2037, 9106, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:53', '2020-09-11 13:36:53'),
(4903, 2037, 9106, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:40:04', '2020-09-11 13:40:04'),
(4904, 2037, 9107, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:54', '2020-09-11 13:36:54'),
(4905, 2037, 9107, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:40:12', '2020-09-11 13:40:12'),
(4906, 2037, 9108, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:55', '2020-09-11 13:36:55'),
(4907, 2037, 9108, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:40:20', '2020-09-11 13:40:20'),
(4908, 2037, 9109, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:57', '2020-09-11 13:36:57'),
(4909, 2037, 9109, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:40:26', '2020-09-11 13:40:26'),
(4910, 2037, 9110, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:58', '2020-09-11 13:36:58'),
(4911, 2037, 9110, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:40:33', '2020-09-11 13:40:33'),
(4912, 2037, 9111, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:36:59', '2020-09-11 13:36:59'),
(4913, 2037, 9111, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:40:39', '2020-09-11 13:40:39'),
(4914, 2037, 9112, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:46:30', '2020-09-11 13:46:30'),
(4915, 2037, 9112, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:48:01', '2020-09-11 13:48:01'),
(4916, 2037, 9113, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:46:47', '2020-09-11 13:46:47'),
(4917, 2037, 9113, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:48:15', '2020-09-11 13:48:15'),
(4918, 2037, 9114, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:46:53', '2020-09-11 13:46:53'),
(4919, 2037, 9114, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:48:26', '2020-09-11 13:48:26'),
(4920, 2037, 9115, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:46:59', '2020-09-11 13:46:59'),
(4921, 2037, 9115, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:48:37', '2020-09-11 13:48:37'),
(4922, 2037, 9116, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:47:10', '2020-09-11 13:47:10'),
(4923, 2037, 9116, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:49:08', '2020-09-11 13:49:08'),
(4924, 2037, 9117, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:47:17', '2020-09-11 13:47:17'),
(4925, 2037, 9117, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:49:18', '2020-09-11 13:49:18'),
(4926, 2037, 9118, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:47:23', '2020-09-11 13:47:23'),
(4927, 2037, 9118, NULL, '2020-09-18 00:00:00.000', 'New/Not Initiated', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:49:28', '2020-09-11 13:49:28'),
(4928, 2037, 9118, NULL, '2020-10-09 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server.', NULL, NULL, '2020-10-02 15:31:18', '2020-10-02 15:31:18'),
(4929, 2037, 9119, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:47:29', '2020-09-11 13:47:29'),
(4930, 2037, 9119, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:49:40', '2020-09-11 13:49:40'),
(4931, 2037, 9120, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:47:36', '2020-09-11 13:47:36'),
(4932, 2037, 9120, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:49:52', '2020-09-11 13:49:52'),
(4933, 2037, 9121, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:48:44', '2020-09-11 13:48:44'),
(4934, 2037, 9121, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:48:56', '2020-09-11 13:48:56'),
(4935, 2037, 9122, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:54:21', '2020-09-11 13:54:21'),
(4936, 2037, 9122, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server.  ', NULL, NULL, '2020-09-11 13:57:13', '2020-09-11 13:57:13'),
(4937, 2037, 9123, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:55:16', '2020-09-11 13:55:16'),
(4938, 2037, 9123, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:24', '2020-09-11 13:57:24'),
(4939, 2037, 9124, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:55:26', '2020-09-11 13:55:26'),
(4940, 2037, 9124, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:28', '2020-09-11 13:57:28'),
(4941, 2037, 9125, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:55:37', '2020-09-11 13:55:37'),
(4942, 2037, 9125, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:33', '2020-09-11 13:57:33'),
(4943, 2037, 9126, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:55:49', '2020-09-11 13:55:49'),
(4944, 2037, 9126, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:38', '2020-09-11 13:57:38'),
(4945, 2037, 9127, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:56:01', '2020-09-11 13:56:01'),
(4946, 2037, 9127, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:42', '2020-09-11 13:57:42'),
(4947, 2037, 9128, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:56:18', '2020-09-11 13:56:18'),
(4948, 2037, 9128, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:47', '2020-09-11 13:57:47'),
(4949, 2037, 9129, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:56:36', '2020-09-11 13:56:36'),
(4950, 2037, 9129, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:57:53', '2020-09-11 13:57:53'),
(4951, 2037, 9130, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 13:56:48', '2020-09-11 13:56:48'),
(4952, 2037, 9130, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server. ', NULL, NULL, '2020-09-11 13:58:02', '2020-09-11 13:58:02'),
(4953, 2037, 9131, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 16:45:46', '2020-09-11 16:45:46'),
(4954, 2037, 9131, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Initiated enrollment over the TMHP portal.Agreement Signed Electronically. Copy uploaded! Below is the reference email: --------------------- PROD_PEPEmailService@tmhp.com 2:40 AM (2 minutes ago) to rhc  9/11/2020  Dear Provider:  Your signature on the following agreements is required to complete provider enrollment application number 17204878 : HHSC Traditional Medicaid Agreement (Performing)  To sign and complete the agreements, you must log in to your TMHP portal account on the TMHP website at www.tmhp.com.  To access the provider enrollment application number 17204878, you must contact the provider administrator of your TMHP portal account, who is copied on this email.  If you received this email in error, please notify the provider administrator of your TMHP portal account and delete the email.  If you have any general questions about provider applications, please call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.', NULL, NULL, '2020-09-11 16:48:15', '2020-09-11 16:48:15'),
(4955, 2037, 9131, NULL, '2020-09-25 00:00:00.000', 'In Process', 'Received a deficiency letter from TMHP for in-accurate Medicare number. Unable to edit the application from the Web portal. Reported the issue to Medicaid .They will fix the issue and will give a confirmation call by Monday.Ticket#39803336000. Representative : Linoid ', NULL, NULL, '2020-09-18 13:03:38', '2020-09-18 13:03:38'),
(4956, 2037, 9131, NULL, '2020-10-06 00:00:00.000', 'Approved', 'William Francis got approved by Medicaid effective 08/01/2020 TPI: 4144909-02. Welcome letter Attached  and Approval email sent.', NULL, NULL, '2020-09-29 15:50:42', '2020-09-29 15:50:42'),
(4957, 2037, 9132, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 16:50:09', '2020-09-11 16:50:09'),
(4958, 2037, 9132, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Initiated enrollment over the TMHP portal.Agreement Signed Electronically. Copy uploaded! Below is the reference email: --------------------- PROD_PEPEmailService@tmhp.com 2:40 AM (2 minutes ago) to rhc  9/11/2020  Dear Provider:  Your signature on the following agreements is required to complete provider enrollment application number 17204878 : HHSC Traditional Medicaid Agreement (Performing)  To sign and complete the agreements, you must log in to your TMHP portal account on the TMHP website at www.tmhp.com.  To access the provider enrollment application number 17204878, you must contact the provider administrator of your TMHP portal account, who is copied on this email.  If you received this email in error, please notify the provider administrator of your TMHP portal account and delete the email.  If you have any general questions about provider applications, please call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.', NULL, NULL, '2020-09-11 16:50:45', '2020-09-11 16:50:45'),
(4959, 2037, 9132, NULL, '2020-10-06 00:00:00.000', 'Approved', 'William Francis got approved by Medicaid effective 08/01/2020 TPI: 4144909-02. Welcome letter Attached  and Approval email sent.', NULL, NULL, '2020-09-29 16:56:36', '2020-09-29 16:56:36'),
(4960, 2037, 9133, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 16:50:20', '2020-09-11 16:50:20'),
(4961, 2037, 9133, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Initiated enrollment over the TMHP portal.Agreement Signed Electronically. Copy uploaded! Below is the reference email: --------------------- PROD_PEPEmailService@tmhp.com 2:40 AM (2 minutes ago) to rhc  9/11/2020  Dear Provider:  Your signature on the following agreements is required to complete provider enrollment application number 17204878 : HHSC Traditional Medicaid Agreement (Performing)  To sign and complete the agreements, you must log in to your TMHP portal account on the TMHP website at www.tmhp.com.  To access the provider enrollment application number 17204878, you must contact the provider administrator of your TMHP portal account, who is copied on this email.  If you received this email in error, please notify the provider administrator of your TMHP portal account and delete the email.  If you have any general questions about provider applications, please call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.', NULL, NULL, '2020-09-11 16:50:50', '2020-09-11 16:50:50'),
(4962, 2037, 9133, NULL, '2020-10-06 00:00:00.000', 'Approved', 'William Francis got approved by Medicaid effective 08/01/2020 TPI: 4144909-02. Welcome letter Attached  and Approval email sent.', NULL, NULL, '2020-09-29 16:56:58', '2020-09-29 16:56:58'),
(4963, 2037, 9134, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 16:53:19', '2020-09-11 16:53:19'),
(4964, 2037, 9134, NULL, '2020-09-18 00:00:00.000', 'Initiated', 'Reassigning of Benefits request Initiated Via PECOS.', NULL, NULL, '2020-09-11 16:54:12', '2020-09-11 16:54:12'),
(4965, 2037, 9134, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T090220200004521)   Sent: 09/02/2020 18:27 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T090220200004521        NPI: 1457994436        Medicare ID: 1B6508, 1G0803        Name: WILLIAM R FRANCIS          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-09-11 16:54:31', '2020-09-11 16:54:31'),
(4966, 2037, 9134, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Medicare Approved the enrollment application. William Francis is effective 08/01/2020 with the provider ID , P-Tan (1G6537). For RHC all three Locations. Sending approval to the billing department. ', NULL, NULL, '2020-09-11 16:54:55', '2020-09-11 16:54:55'),
(4967, 2037, 9135, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 16:53:24', '2020-09-11 16:53:24'),
(4968, 2037, 9135, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Reassigning of Benefits request Initiated Via PECOS.', NULL, NULL, '2020-09-11 16:54:17', '2020-09-11 16:54:17'),
(4969, 2037, 9135, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T090220200004521)   Sent: 09/02/2020 18:27 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T090220200004521        NPI: 1457994436        Medicare ID: 1B6508, 1G0803        Name: WILLIAM R FRANCIS          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-09-11 16:54:37', '2020-09-11 16:54:37'),
(4970, 2037, 9135, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Medicare Approved the enrollment application. William Francis is effective 08/01/2020 with the provider ID , P-Tan (1G6537). For RHC all three Locations. Sending approval to the billing department. ', NULL, NULL, '2020-09-11 16:55:01', '2020-09-11 16:55:01'),
(4971, 2027, 9136, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 17:09:00', '2020-09-11 17:09:00'),
(4972, 2027, 9136, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid effective date is 11/21/2019 and enrollment date is 09/04/2020. Welcome letter is attached  ', NULL, NULL, '2020-09-11 17:11:19', '2020-09-11 17:11:19'),
(4973, 2027, 9137, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 17:22:48', '2020-09-11 17:22:48'),
(4974, 2027, 9137, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid effective date is 11/21/2019 and enrollment date is 09/04/2020. Welcome letter is attached  ', NULL, NULL, '2020-09-11 17:23:06', '2020-09-11 17:23:06'),
(4975, 1006, 9138, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 17:52:12', '2020-09-11 17:52:12'),
(4976, 1006, 9138, NULL, '2020-09-18 00:00:00.000', 'Initiated', 'Sent an email to CCAContracting@commonwealthcare.org to verify if provider is enrolled and if we can add them to our group. ', NULL, NULL, '2020-09-11 17:53:08', '2020-09-11 17:53:08'),
(4977, 1006, 9138, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Received following update from Heaven Barros hbarros@commonwealthcare.org>:   Sub: Provider Enrollment Query - Pandeeswari Raveendran  \"Hi Brad,  You will need to contact Provide Data Management Department via e-mail PNMDepartment@commonwealthcare.org  Please be sure to attach the HCAS form and w-9 on your e-mail.  Heaven\"', NULL, NULL, '2020-09-14 11:16:49', '2020-09-14 11:16:49'),
(4978, 1006, 9138, NULL, '2020-09-21 00:00:00.000', 'In Process', 'HCAS form filled and sent to PNMDepartment@commonwealthcare.org', NULL, NULL, '2020-09-14 16:05:00', '2020-09-14 16:05:00'),
(4979, 1006, 9138, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Sent a followup email to PNM Department PNMDepartment@commonwealthcare.org> regarding status of enrollment. ', NULL, NULL, '2020-09-23 18:19:55', '2020-09-23 18:19:55'),
(4980, 1006, 9138, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Sent a followup email regarding the status of enrollment to #Credentialing Credentialing@commonwealthcare.org>. ', NULL, NULL, '2020-09-28 14:51:48', '2020-09-28 14:51:48'),
(4981, 1006, 9138, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to credentialing asking to get back to me ASAP regarding the status of enrollment. ', NULL, NULL, '2020-10-05 18:00:37', '2020-10-05 18:00:37'),
(4982, 1006, 9138, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent followup email to #Credentialing Credentialing@commonwealthcare.org> & PNM Department PNMDepartment@commonwealthcare.org>, waiting on response. ', NULL, NULL, '2020-10-13 10:23:21', '2020-10-13 10:23:21'),
(4983, 1006, 9138, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Sent a follow-up email to Provider Relations providerrelations@commonwealthcare.org>, #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding the updated status of enrollment. ', NULL, NULL, '2020-10-20 15:47:48', '2020-10-20 15:47:48'),
(4984, 1006, 9138, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received following update from Provider Relations providerrelations@commonwealthcare.org> @#%@!^%^:  \"Good Morning Brad,  Do you have copies of the paperwork that was submitted for the below providers? If so, are you able to submit the paperwork directly to me  I want to make sure I have the right paperwork and the appropriate information is being reviewed when I reach out to our enrollment team.\"', NULL, NULL, '2020-10-23 11:01:35', '2020-10-23 11:01:35'),
(4985, 1006, 9138, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received following update from CCA @ providerrelations@commonwealthcare.org:    \"Good Afternoon,  Thank you so much for the attached documents. I have reached out internally regarding the enrollment requests and I have asked for them to be expedited.  I will follow up once I have an update.  Thank you, Reed\"', NULL, NULL, '2020-10-23 13:47:52', '2020-10-23 13:47:52'),
(4986, 1006, 9138, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Received following update from :  \"Good Afternoon,  I’ve received confirmation that both Jennifer Ullrich and Jonathan Schubert are effective with CCA and Spectrum Neuro Behavioral Health as of 01/01/2020-  Pandeeswari Raveendran is in the final stages of credentialing and once finalized, the provider will also be effective 01/01/2020.   Thank you, Reed\"', NULL, NULL, '2020-11-03 10:47:09', '2020-11-03 10:47:09'),
(4987, 1006, 9138, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Sent a followup email to Provider Relations providerrelations@commonwealthcare.org>', NULL, NULL, '2020-11-10 18:05:49', '2020-11-10 18:05:49'),
(4988, 1006, 9138, NULL, '2020-11-23 00:00:00.000', 'Approved', 'Received following approval email:  \"November 16, 2020  Pandeeswari Raveendran, MD RE: Status of Credentialing & Enrollment Request  The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 11/13/2020. Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.  Sincerely, CCA Credentialing Department 2 Avenue De Lafayette 5th Floor Boston, MA 02111\" ', NULL, NULL, '2020-11-16 13:13:34', '2020-11-16 13:13:34'),
(4989, 2037, 9139, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 18:12:23', '2020-09-11 18:12:23'),
(4990, 2037, 9139, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Approved. Effective 09/01/2018', NULL, NULL, '2020-09-11 18:14:07', '2020-09-11 18:14:07'),
(4991, 2037, 9140, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 18:12:26', '2020-09-11 18:12:26'),
(4992, 2037, 9140, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Approved. Effective 09/01/2018', NULL, NULL, '2020-09-11 18:14:11', '2020-09-11 18:14:11'),
(4993, 2037, 9141, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-11 18:12:27', '2020-09-11 18:12:27'),
(4994, 2037, 9141, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Approved. Effective 09/01/2018', NULL, NULL, '2020-09-11 18:14:16', '2020-09-11 18:14:16'),
(4995, 1006, 9142, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-11 18:13:02', '2020-09-11 18:13:02'),
(4996, 1006, 9142, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Submitted Provider Address Change Form to add our group for the provider.  ', NULL, NULL, '2020-09-11 18:13:40', '2020-09-11 18:13:40'),
(4997, 1006, 9142, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to MBHP Network Operations MBHPNetworkOperations@beaconhealthoptions.com> regarding group addition request. ', NULL, NULL, '2020-09-23 17:17:46', '2020-09-23 17:17:46'),
(4998, 1006, 9142, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Sent another followup email to MBHP Network Operations MBHPNetworkOperations@beaconhealthoptions.com> & \"Tarpley, Randy\" Randy.Tarpley@beaconhealthoptions.com>.', NULL, NULL, '2020-09-28 15:11:24', '2020-09-28 15:11:24'),
(4999, 1006, 9142, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Request needs to be on-hold until we can send the requested information for the group credentialing request. ', NULL, NULL, '2020-10-15 15:13:18', '2020-10-15 15:13:18'),
(5000, 1006, 9142, NULL, '2020-11-01 00:00:00.000', 'On Hold', NULL, NULL, NULL, '2020-10-15 15:13:27', '2020-10-15 15:13:27'),
(5001, 1006, 9142, NULL, '2020-11-03 00:00:00.000', 'On Hold', 'Received the following email from Miguel: \"Good morning,     For the submitted credentialing application of Pandeeswari Raveendran, MD to MBHP, please submit:  ·         In-network physician or facility to refer to for admitting purposes. (attached)  ·         Demographic data (attached)  ·         MCSR Registration (attached)  ·         Years of clinical and managed care experience (attached)  ·         Malpractice claims information. If there are no claims, mark the ‘N/A’ box. (attached)  ·         The submitted attestation of cultural competency indicates the provider has not participated in a cultural competency training. Complete a cultural competency training and re-submit the attestation. (attached)  ·         Copy of latest Massachusetts renewal application for physician license.  ·         CANS certification (or confirm the provider will only provide medication-management and no psychotherapy)  ·         Updated current resume listing practice with “Spectrum Neuro Behavioral Care”.  ·         The application indicates the provider is not board certified by the ABPN as required by the credentialing criteria. What is the intent of the provider to attain ABPN certification?     Email or fax to my attention: Email: Miguel.Medrano@BeaconHealthOptions.com Fax: 877-390-2324     Thank you,  Miguel Medrano MBHP Network Operations ––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership a Beacon Health Options company 1000 Washington Street, Suite 310 Boston, MA 02118 Email: miguel.medrano@beaconhealthoptions.com Fax: 877.390.2324 www.masspartnership.com\"', NULL, NULL, '2020-11-03 11:07:30', '2020-11-03 11:07:30'),
(5002, 1006, 9142, NULL, '2020-11-11 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-04 17:35:27', '2020-11-04 17:35:27'),
(5003, 1006, 9142, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Sent following email to Miguel: \"Hey Miguel,   Here are the filled applications for the LCSW\'s, I\'ll reply to your email regarding Mahreen, Pandeeswari & Fauzia as soon as I\'m able to.   Thanks. \"', NULL, NULL, '2020-11-12 18:45:20', '2020-11-12 18:45:20'),
(5004, 1006, 9142, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Received another follow-up email from Miguel Medrano regarding the requested info:  For the submitted credentialing application of Mahreen Rashid, PMHNP to MBHP, please submit:  ·         In-network physician or facility to refer to for admitting purposes. (attached)  ·         Demographic data (attached)  ·         MCSR Registration (attached)  ·         Years of clinical and managed care experience (attached)  ·         Malpractice claims information. If there are no claims, mark the ‘N/A’ box. (attached)  ·         The submitted attestation of cultural competency indicates the provider has not participated in a cultural competency training. Complete a cultural competency training and re-submit the attestation. (attached)  ·         CANS certification (or confirm the provider will only provide medication-management and no psychotherapy)  ·         Updated current resume listing practice with “Spectrum Neuro Behavioral Care”.  ·         Collaborative practice agreement with Fauzia Wali-Khan, Psychiatrist.  ', NULL, NULL, '2020-11-19 18:11:49', '2020-11-19 18:11:49'),
(5005, 1006, 9142, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request. ', NULL, NULL, '2020-12-11 17:40:20', '2020-12-11 17:40:20'),
(5006, 1019, 9142, NULL, '2021-06-22 00:00:00.000', 'Initiated', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:33:50', '2021-06-04 15:33:50'),
(5007, 1019, 9142, NULL, '2021-06-29 00:00:00.000', 'Not Eligible', 'Provider is no longer working with SNBCARE.', NULL, NULL, '2021-06-05 11:28:31', '2021-06-05 11:28:31'),
(5008, 1006, 9143, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-14 09:58:56', '2020-09-14 09:58:56'),
(5009, 1006, 9143, NULL, '2020-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com>:  \"Hello,   We wanted to add the following credentialed/contracted provider to our group, the information is as follows: Provider Name: Pandeeswari Raveendran  NPI# 1124247267 Group Name: Spectrum Neuro Behavioral Care LLC  TIN# 83-4482753  Please let me know what else is required to get this information updated ASAP. Thank you!\"', NULL, NULL, '2020-09-14 09:59:46', '2020-09-14 09:59:46'),
(5010, 1006, 9143, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> & Kody Dunnett Kody_Dunnett@tufts-health.com>', NULL, NULL, '2020-09-23 17:55:46', '2020-09-23 17:55:46'),
(5011, 1006, 9143, NULL, '2020-10-08 00:00:00.000', 'In Process', 'Kody requested HCAS form, filled out and sent.', NULL, NULL, '2020-10-01 18:14:16', '2020-10-01 18:14:16'),
(5012, 1006, 9143, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a follow-up email to Kody regarding the status of this email @ Kody Dunnett Kody_Dunnett@tufts-health.com>. ', NULL, NULL, '2020-10-16 10:23:52', '2020-10-16 10:23:52'),
(5013, 1006, 9143, NULL, '2020-10-26 00:00:00.000', 'Approved', '\"Hi   Pandeeswari Raveendran, MD – ID 223592, in network, linked to Spectrum Neuro  Behavioral Care effective 10.8.2020  Thanks\"', NULL, NULL, '2020-10-19 17:41:35', '2020-10-19 17:41:35'),
(5014, 2027, 9144, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-14 10:41:18', '2020-09-14 10:41:18'),
(5015, 2027, 9144, NULL, '2020-09-21 00:00:00.000', 'Initiated', 'Task initiated with medicare details are mentioned below:    Application Tracking ID: T091420200001277        NPI: 1265945125        Medicare ID: 943141        Name: MAYRA ALEJANDRA LOPEZ          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2020-09-14 10:42:14', '2020-09-14 10:42:14'),
(5016, 2027, 9144, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 06/16/2020. Welcome letter is attached', NULL, NULL, '2020-09-18 10:30:38', '2020-09-18 10:30:38'),
(5017, 2027, 9145, NULL, NULL, 'New/Not Initiated', 'Task initiated with medicare and details are mentioned below:    Application Tracking ID: T091420200001277        NPI: 1265945125        Medicare ID: 943141        Name: MAYRA ALEJANDRA LOPEZ          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2020-09-14 10:45:49', '2020-09-14 10:45:49'),
(5018, 1005, 9145, NULL, '2020-10-19 00:00:00.000', 'Approved', 'http://app.emrbs.com/Credentials/Details/3761 - Duplicate task found. Error has been marked.', NULL, NULL, '2020-10-12 14:58:27', '2020-10-12 14:58:27'),
(5019, 2027, 9146, NULL, NULL, 'New/Not Initiated', 'Task initiated with medicare and details are mentioned below:    Application Tracking ID: T091420200001277        NPI: 1265945125        Medicare ID: 943141        Name: MAYRA ALEJANDRA LOPEZ          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ', NULL, NULL, '2020-09-14 10:47:42', '2020-09-14 10:47:42'),
(5020, 2027, 9146, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 06/16/2020. Welcome letter is attached ', NULL, NULL, '2020-09-18 10:45:24', '2020-09-18 10:45:24'),
(5021, 2037, 9147, NULL, NULL, 'New/Not Initiated', 'location Addition.', NULL, NULL, '2020-09-14 12:36:14', '2020-09-14 12:36:14'),
(5022, 2037, 9147, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Added Tertiary Location (Raspberry) : Application Tracking-T091420200001412 Added Address:  2101 Raspberry Lane, Pasadena, Texas 77502-4014  ', NULL, NULL, '2020-09-14 12:38:48', '2020-09-14 12:38:48'),
(5023, 2037, 9147, NULL, '2020-09-24 00:00:00.000', 'Approved', 'Address addition Approval Received from Medicare . Letter Uploaded. Notified the billing department.', NULL, NULL, '2020-09-17 16:53:30', '2020-09-17 16:53:30'),
(5024, 2027, 9148, NULL, NULL, 'New/Not Initiated', 'Task initiated with medicare railroad  and ref# is 20258000928 ', NULL, NULL, '2020-09-14 13:00:11', '2020-09-14 13:00:11'),
(5025, 2027, 9148, NULL, '2020-09-21 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2020-09-14 13:10:58', '2020-09-14 13:10:58'),
(5026, 1005, 9148, NULL, '2020-09-25 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-18 12:14:54', '2020-09-18 12:14:54'),
(5027, 1005, 9148, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-10-12 14:53:01', '2020-10-12 14:53:01'),
(5028, 1006, 9148, NULL, '2020-11-02 00:00:00.000', 'Approved', ' PROVIDER NAME	DIEGO NARANJO NP PROVIDER PTAN	P02530359 PROVIDER NPI	1568929800 EFFECTIVE DATE	11/21/2019 END DATE	', NULL, NULL, '2020-10-26 13:10:56', '2020-10-26 13:10:56'),
(5029, 2037, 9149, NULL, NULL, 'New/Not Initiated', 'Adding location in CBUC\'s Medicaid.', NULL, NULL, '2020-09-14 13:00:17', '2020-09-14 13:00:17'),
(5030, 2037, 9149, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Request submitted via Texas Medicaid Portal to Add Location  : Portal Ticket Number :17208865 ', NULL, NULL, '2020-09-14 13:03:21', '2020-09-14 13:03:21');
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
(5031, 2037, 9149, NULL, '2020-10-15 00:00:00.000', 'Approved', 'Location reflecting over TMHP .Verified and notification sent to the billing', NULL, NULL, '2020-10-08 15:49:30', '2020-10-08 15:49:30'),
(5032, 2027, 9150, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-14 15:05:25', '2020-09-14 15:05:25'),
(5033, 2027, 9150, NULL, '2020-09-21 00:00:00.000', 'Approved', 'Group is showing linked with medicare railroad and effective date is 01/06/2015. Screenshot is attached  ', NULL, NULL, '2020-09-14 15:07:31', '2020-09-14 15:07:31'),
(5034, 2027, 9151, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-14 15:15:19', '2020-09-14 15:15:19'),
(5035, 2027, 9151, NULL, '2020-09-21 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 01/06/2015. Screenshot is attached  ', NULL, NULL, '2020-09-14 15:20:48', '2020-09-14 15:20:48'),
(5036, 2027, 9153, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-14 16:50:47', '2020-09-14 16:50:47'),
(5037, 2027, 9153, NULL, '2020-09-21 00:00:00.000', 'Initiated', 'Medicare railroad for this provider has already initiated and ref# is 20258001611', NULL, NULL, '2020-09-14 16:53:16', '2020-09-14 16:53:16'),
(5038, 1005, 9153, NULL, '2020-09-25 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-18 12:13:32', '2020-09-18 12:13:32'),
(5039, 1005, 9153, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-10-12 14:52:26', '2020-10-12 14:52:26'),
(5040, 1006, 9153, NULL, '2020-11-02 00:00:00.000', 'Approved', 'PROVIDER NAME	VIBITHA JOSEPH NP PROVIDER PTAN	P02530797 PROVIDER NPI	1952931560 EFFECTIVE DATE	02/11/2020 END DATE	', NULL, NULL, '2020-10-26 13:07:10', '2020-10-26 13:07:10'),
(5041, 2027, 9154, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-14 17:07:31', '2020-09-14 17:07:31'),
(5042, 2027, 9154, NULL, '2020-09-21 00:00:00.000', 'Initiated', 'Medicare railroad initiated for this provider and ref# is 20258001636', NULL, NULL, '2020-09-14 17:26:26', '2020-09-14 17:26:26'),
(5043, 1005, 9154, NULL, '2020-09-25 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-18 12:12:55', '2020-09-18 12:12:55'),
(5044, 1005, 9154, NULL, '2020-10-20 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-10-12 14:50:10', '2020-10-12 14:50:10'),
(5045, 1006, 9154, NULL, '2020-11-02 00:00:00.000', 'Approved', 'PROVIDER NAME	MINI P CHENNEMKARA NP PROVIDER PTAN	P02530830 PROVIDER NPI	1841755956 EFFECTIVE DATE	03/06/2020 END DATE	', NULL, NULL, '2020-10-26 15:15:34', '2020-10-26 15:15:34'),
(5046, 2027, 9155, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 09:48:54', '2020-09-15 09:48:54'),
(5047, 2027, 9155, NULL, '2020-09-22 00:00:00.000', 'In Process', 'provider is now in enrollment process with medicare and the details are mentioned below:  Application Tracking ID: T091520200000866        NPI: 1194206490        Medicare ID: 760296, 829002, 857408        Name: GLORY  ABRAHAM          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2020-09-15 09:50:13', '2020-09-15 09:50:13'),
(5048, 2027, 9155, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 06/17/2020. Welcome letter is attached', NULL, NULL, '2020-09-18 15:34:58', '2020-09-18 15:34:58'),
(5049, 2027, 9157, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 10:27:49', '2020-09-15 10:27:49'),
(5050, 2027, 9157, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 08/01/2020. Welcome letter is attached.', NULL, NULL, '2020-09-15 10:28:23', '2020-09-15 10:28:23'),
(5051, 2027, 9158, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 10:35:19', '2020-09-15 10:35:19'),
(5052, 2027, 9158, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 08/01/2020. Welcome letter is attached.', NULL, NULL, '2020-09-15 10:35:52', '2020-09-15 10:35:52'),
(5053, 2027, 9160, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 14:39:16', '2020-09-15 14:39:16'),
(5054, 2027, 9160, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 05/01/2019', NULL, NULL, '2020-09-15 14:43:04', '2020-09-15 14:43:04'),
(5055, 2037, 9161, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-15 14:39:48', '2020-09-15 14:39:48'),
(5056, 2037, 9161, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Received application along with the new agreement to sign .Email sent with attachments to michal.simms@christushealth.org:  ------------------------------- Hello Michal,  Kindly find the attached documents for contracting. Feel free to contact me if you need additional information. Regards:', NULL, NULL, '2020-09-15 15:15:38', '2020-09-15 15:15:38'),
(5057, 2037, 9161, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Got the confirmation of receiving from Christus Health of the agreement sent yesterday. ---------------------------------------------------- Hello Sherry,  Thank you for submitting the signed contract and application.  I have submitted the contract for processing.  Once approved by Credentialing Committee a letter will be mailed to the provider advising the approval date.  The executed contract will be sent thereafter.  Our credentialing verification process is currently taking 120+ days to complete.  Please allow 60 days before following up and please send your request to Credentialing at the mailbox listed below.  I appreciate your help with this process.  Best regards, Michal', NULL, NULL, '2020-09-17 10:07:10', '2020-09-17 10:07:10'),
(5058, 2037, 9161, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Follow up Email sent', NULL, NULL, '2020-10-01 12:10:04', '2020-10-01 12:10:04'),
(5059, 2037, 9161, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Follow up email sent to Michal Simms', NULL, NULL, '2020-10-30 13:34:25', '2020-10-30 13:34:25'),
(5060, 2037, 9161, NULL, '2020-11-24 00:00:00.000', 'In Process', '	 Follow up email sent to Michal Simms', NULL, NULL, '2020-11-02 14:05:12', '2020-11-02 14:05:12'),
(5061, 2037, 9161, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follow up email sent to CHRISTUS.HP.Credentialing@christushealth.org -------------- Greetings, Following up on the credentialing process for the below mentioned group.  Group: Bay Area Quick Care  Billing Address: 9929 South Padre Island Drive                           Suite 109  Corpus Christi , TX 78418-5148 TIN:                   27-1702009. NPI:                   1437481421. ', NULL, NULL, '2020-11-20 17:00:06', '2020-11-20 17:00:06'),
(5062, 2037, 9161, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Follow up email sent to Michal Simms', NULL, NULL, '2020-11-30 14:44:12', '2020-11-30 14:44:12'),
(5063, 2037, 9161, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-22 16:38:05', '2020-12-22 16:38:05'),
(5064, 1006, 9161, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent for credentialing status for group to CHRISTUS.HP.Credentialing@christushealth.org', NULL, NULL, '2021-01-26 15:35:40', '2021-01-26 15:35:40'),
(5065, 1006, 9161, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email received:  This facility still has not been credentialed. We are working on getting facilities credentialed as soon as possible. Due to COVID our processing times are longer than usual. We appreciate the patience.   ', NULL, NULL, '2021-01-27 18:03:23', '2021-01-27 18:03:23'),
(5066, 1006, 9161, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Need to allow more time for this to process, will follow-up next week.', NULL, NULL, '2021-02-02 16:58:53', '2021-02-02 16:58:53'),
(5067, 1006, 9161, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ CHRISTUS.HP.Credentialing@christushealth.org', NULL, NULL, '2021-02-12 14:50:16', '2021-02-12 14:50:16'),
(5068, 3046, 9161, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Enrollment Status || Bay Area Quick Care ||  CHRISTUS HEALTH PLAN   Greetings,  Hope you are doing well. Kindly advise the status of credentialing process for the below mentioned group.  Group: Bay Area Quick Care  Billing Address: 9929 South Padre Island Drive                           Suite 109  Corpus Christi , TX 78418-5148 TIN:                   27-1702009. NPI:                   1437481421.', NULL, NULL, '2021-02-25 13:10:05', '2021-02-25 13:10:05'),
(5069, 3046, 9161, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Enrollment Status || Bay Area Quick Care ||  CHRISTUS HEALTH PLAN  Greetings,  Hope my email finds you in good health.  Kindly note that I am writing this email to follow up for the status of credentialing process for the below mentioned group.  Group: Bay Area Quick Care  Billing Address: 9929 South Padre Island Drive                           Suite 109  Corpus Christi , TX 78418-5148 TIN:                   27-1702009. NPI:                   1437481421. I hope to hear from you soon. Thank you.', NULL, NULL, '2021-03-04 09:34:13', '2021-03-04 09:34:13'),
(5070, 3046, 9161, NULL, '2021-03-25 00:00:00.000', 'Initiated', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org Subject: Enrollment Status || Bay Area Quick Care ||  CHRISTUS HEALTH PLAN   Hello,  I hope my email finds you well.  I would like to request you to kindly advise the status of credentialing process for the below mentioned group.  Group: Bay Area Quick Care Billing Address: 9929 South Padre Island Drive                           Suite 109  Corpus Christi , TX 78418-5148 TIN:                   27-1702009. NPI:                   1437481421.', NULL, NULL, '2021-03-18 09:29:40', '2021-03-18 09:29:40'),
(5071, 3046, 9161, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org Subject: Enrollment Status || Bay Area Quick Care ||  CHRISTUS HEALTH PLAN   Hello,  I hope my email finds you well.  I would like to request you to kindly advise the status of credentialing process for the below mentioned group.  Group: Bay Area Quick Care Billing Address: 9929 South Padre Island Drive                           Suite 109  Corpus Christi , TX 78418-5148 TIN:                   27-1702009. NPI:                   1437481421.', NULL, NULL, '2021-03-18 09:29:51', '2021-03-18 09:29:51'),
(5072, 1006, 9161, NULL, '2021-04-07 00:00:00.000', 'In Process', 'Received the following reply from CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org:  \"Good Afternoon  Looks like facility is missing some documentation so showing profile as incomplete listed below response from coordinator working on profile he is waiting for Certificate of insurance, and Attestation pages.  To complete process.   Thank you  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857 CHRISTUS.HP.Credentialing@christushealth.org\"  Sent reply:  \"Hello,   Could you please let me know which attestation pages are missing? So that we can send them to you.   Thank you. \"', NULL, NULL, '2021-03-31 13:37:06', '2021-03-31 13:37:06'),
(5073, 1006, 9161, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Received the following email with Attestation pages listed from Adams, Hollis E. hollis.adams@christushealth.org:  Sub: Required documents  \"The attestation pages are expired, I have attached new pages to be signed and dated.  Also an updated certificate of insurance is required for application completion.   Thank you,  Hollis Adams Coordinator Credentialing Senior CHRISTUS System CVO 919 Hidden Ridge Irving Tx 75038 (O) 469.282-2746 (F) 210.766-9030 www.christushealth.org\"   Attestation pages were signed and sent back with the updated COI of the group. ', NULL, NULL, '2021-04-16 12:30:38', '2021-04-16 12:30:38'),
(5074, 9057, 9161, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: hollis.adams@christushealth.org, tyesha.sullivan@christushealth.org Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN  Hello, We want to know the current status of the request about enrollment for the following group and its providers:  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details Provider 1 Provider Name: Cynthia Malowitz NPI# 1336173244  Provider 2 Provider Name: Kynda Orsak NPI# 1528553724  Provider 3 Provider Name: William Francis NPI# 1457994436  Provider 4 Provider Name: Melissa Ramsden NPI# 1194376228  Kindly update us as soon as possible.   Thank You', NULL, NULL, '2021-05-27 13:13:34', '2021-05-27 13:13:34'),
(5075, 1006, 9161, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Received the following response from hollis.adams@christushealth.org:  Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN  \"Hi Samuel,  Bay Area Quick Care PLLC has a contract start date of 07.01.2021.  Cynthia Malowitz: n/a  Kynda Orsak: n/a  William Francis: n/a  Melissa Ramsden: Active for both plans CHP/USFHP, next appointment not due until 09.01.2023  Here is the most recent information provided, the other 3 names I don’t have information on right nowexcept they are still in process.  Thank you,  Hollis Adams Credentialing Coordinator CHRISTUS Health (O) 469.282-2746 (F) 210.766-9030 www.christushealth.org\"  Sent f/u email:   \"Hello Hollis,  I appreciate the update regarding the enrollment status for the group and Melissa, could you please let me know if the group effective date also applies for Melissa? Also, if possible please send us a copy of the welcome letter and executed contract as well.   Have there been any new updates regarding the enrollment for the other mentioned providers?  Thank you!\"', NULL, NULL, '2021-06-15 11:31:49', '2021-06-15 11:31:49'),
(5076, 1006, 9161, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Received following approval confirmation email from @ Offord, Tommishia S. tommishia.offord@christushealth.org:  Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN   \"Good morning,  Bay Area Quick Care PLLC is credentialed as a facility and would not require the providers to be credentialed individually. All billing will be under the ancillary agreement. Please reach out to your Network Contractor for an executed contract (Michal Simms). I have attached the Credentialing Approval Welcome Letter that was sent on May 12, 2021 to email address “baqc@claimsmedinc.com”. As stated in the email history, the network effective date will be 7/1/2021. Please let us know if you need anything else. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254\"  Welcome letter is attached for reference.  ', NULL, NULL, '2021-06-16 11:32:23', '2021-06-16 11:32:23'),
(5077, 2027, 9162, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 14:50:42', '2020-09-15 14:50:42'),
(5078, 2027, 9162, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Railroad has been processed and ref# is 20259001211', NULL, NULL, '2020-09-15 15:07:34', '2020-09-15 15:07:34'),
(5079, 1005, 9162, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Request is in process.', NULL, NULL, '2020-10-12 14:33:47', '2020-10-12 14:33:47'),
(5080, 1006, 9162, NULL, '2020-11-02 00:00:00.000', 'Approved', 'PROVIDER NAME	JEENA ABRAHAM PROVIDER PTAN	P02531430 PROVIDER NPI	1467901587 EFFECTIVE DATE	04/22/2017 END DATE	 ', NULL, NULL, '2020-10-26 13:03:19', '2020-10-26 13:03:19'),
(5081, 2027, 9163, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 15:18:48', '2020-09-15 15:18:48'),
(5082, 2027, 9163, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 11/27/2016', NULL, NULL, '2020-09-15 15:26:54', '2020-09-15 15:26:54'),
(5083, 2027, 9164, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 15:33:14', '2020-09-15 15:33:14'),
(5084, 2027, 9164, NULL, '2020-10-09 00:00:00.000', 'Approved', 'This provider is now showing linked with medicare railroad.', NULL, NULL, '2020-10-02 15:32:31', '2020-10-02 15:32:31'),
(5085, 2027, 9165, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-15 15:58:18', '2020-09-15 15:58:18'),
(5086, 2027, 9165, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Railroad has been processed and ref# is 20259001284.', NULL, NULL, '2020-09-15 16:00:37', '2020-09-15 16:00:37'),
(5087, 1005, 9165, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Request is in process.', NULL, NULL, '2020-10-12 14:53:38', '2020-10-12 14:53:38'),
(5088, 1006, 9165, NULL, '2020-11-02 00:00:00.000', 'Approved', ' PROVIDER NAME	ANI STEPHEN NP PROVIDER PTAN	P02531565 PROVIDER NPI	1588959118 EFFECTIVE DATE	02/07/2020 END DATE	', NULL, NULL, '2020-10-26 13:08:48', '2020-10-26 13:08:48'),
(5089, 2037, 9166, NULL, NULL, 'New/Not Initiated', 'Initiated.', NULL, NULL, '2020-09-15 17:05:24', '2020-09-15 17:05:24'),
(5090, 2037, 9166, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Email Sent to info@usamco.com with LOI, W-9 and complete credentials .Below is the reference email. ----------------------  Greetings, Kindly find the attached requested documents to enrol the below mentioned provider in-network: Group: Healing Hands Urgent Care & Telehealth Primary Location & Billing Address : 6911 Twilight Elm Trace                                                                Katy , TX 77493-3392.NPI Type 2 : 1265045660TIN : 85-1449677 Phone Number :  954-649-7377Fax Number :       718-640-2713 Provider Name :  Erline TerrelongeNPI Type 1 : 1699166074 Please do let me know if you need any additional information.', NULL, NULL, '2020-09-15 17:09:38', '2020-09-15 17:09:38'),
(5091, 2037, 9166, NULL, '2020-09-28 00:00:00.000', 'In Process', 'Contract Received Signed and Resubmitted back to Tina @ ProviderMarketingInfo@usamco.com -------------- Greetings Tina, I hope this email finds you well.Kindly find the attached signed agreement along with the required documents mentioned in the checklist.Please note that the practice\'s Medicare enrollment is currently being processed and we will be assigned with the Medicare P-TAN. Feel free to contact me for any additional information if needed.Regards:Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 | sd@claimsmedinc.com', NULL, NULL, '2020-09-21 13:13:46', '2020-09-21 13:13:46'),
(5092, 2037, 9166, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Confirmation of receiving from  Tina (MCO) of the required documents. Reference email as follows: ----------------------------- Perfect, thank you! This completes the agreement and I will forward to be processed. You will receive a welcome email with effective date once it has been executed. ', NULL, NULL, '2020-09-29 13:32:39', '2020-09-29 13:32:39'),
(5093, 2037, 9166, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Received an Email with the effective date of 10/09/2020 waiting for the copy of the executed contract and welcome packet.Reference emails are as follows: -------------------  Tina Pena 1:38 PM (37 minutes ago) to me  Hello Sherry,  I show Healing Hands Urgent Care and Telehealth effective as of 10/9/20. -------------- Tina Pena 2:13 PM (2 minutes ago) to me  It is in the process of going out already. You should receive it shortly from provider relations.', NULL, NULL, '2020-10-15 14:19:49', '2020-10-15 14:19:49'),
(5094, 2037, 9166, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Received an Email with the effective date of 10/09/2020 waiting for the copy of the executed contract and welcome packet.Reference emails are as follows: -------------------  Tina Pena 1:38 PM (37 minutes ago) to me  Hello Sherry,  I show Healing Hands Urgent Care and Telehealth effective as of 10/9/20. -------------- Tina Pena 2:13 PM (2 minutes ago) to me  It is in the process of going out already. You should receive it shortly from provider relations.', NULL, NULL, '2020-10-26 13:46:57', '2020-10-26 13:46:57'),
(5095, 2037, 9166, NULL, '2020-11-13 00:00:00.000', 'Approved', 'Received Welcome group is contracted as an urgent care effective 10/09/2020. Contract uploaded in EMRBS. ------------- Hello Sherry,  Attached is a copy of the Final Packet for Healing Hands Urgent Care and Telehealth.  Please let me know if you have any additional questions.', NULL, NULL, '2020-11-06 17:15:19', '2020-11-06 17:15:19'),
(5096, 2027, 9167, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 09:48:50', '2020-09-16 09:48:50'),
(5097, 2027, 9167, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Group is showing linked with medicare and effective date is 01/01/2014. SS from PD is attached', NULL, NULL, '2020-09-16 09:57:43', '2020-09-16 09:57:43'),
(5098, 2027, 9168, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:03:55', '2020-09-16 10:03:55'),
(5099, 2027, 9168, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 01/05/2015', NULL, NULL, '2020-09-16 10:04:45', '2020-09-16 10:04:45'),
(5100, 2027, 9169, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:08:48', '2020-09-16 10:08:48'),
(5101, 2027, 9169, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 1/22/2020', NULL, NULL, '2020-09-16 10:10:27', '2020-09-16 10:10:27'),
(5102, 2027, 9170, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:14:13', '2020-09-16 10:14:13'),
(5103, 2027, 9170, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 01/29/2020', NULL, NULL, '2020-09-16 10:15:25', '2020-09-16 10:15:25'),
(5104, 2027, 9171, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:18:42', '2020-09-16 10:18:42'),
(5105, 2027, 9171, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 02/11/2020', NULL, NULL, '2020-09-16 10:20:11', '2020-09-16 10:20:11'),
(5106, 2027, 9172, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:24:13', '2020-09-16 10:24:13'),
(5107, 2027, 9172, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 03/06/2020', NULL, NULL, '2020-09-16 10:25:30', '2020-09-16 10:25:30'),
(5108, 1006, 9174, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:40:17', '2020-09-16 10:40:17'),
(5109, 1006, 9174, NULL, '2020-09-25 00:00:00.000', 'Initiated', 'Sent email to Laura Bevin regarding an update for First Health', NULL, NULL, '2020-09-18 16:03:07', '2020-09-18 16:03:07'),
(5110, 1006, 9174, NULL, '2020-09-28 00:00:00.000', 'In Process', 'Received the following reply from Laura Bevin regarding First Health:   \"Good morning,  I am checking with the Network Relations Specialist to see if she is enrolled in First Health. I will let you know when I have more information.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-09-21 14:29:28', '2020-09-21 14:29:28'),
(5111, 1006, 9174, NULL, '2020-09-29 00:00:00.000', 'Approved', 'Received the following email from Laura:   \"Hi,  The effective date for First Health is 09/01/2020.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"  Also attached email as proof of enrollment. ', NULL, NULL, '2020-09-22 10:46:43', '2020-09-22 10:46:43'),
(5112, 2027, 9175, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:42:52', '2020-09-16 10:42:52'),
(5113, 2027, 9175, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 05/01/2019', NULL, NULL, '2020-09-16 10:45:42', '2020-09-16 10:45:42'),
(5114, 2027, 9176, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 10:53:54', '2020-09-16 10:53:54'),
(5115, 2027, 9176, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 10/10/2017', NULL, NULL, '2020-09-16 10:55:03', '2020-09-16 10:55:03'),
(5116, 2027, 9177, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 11:00:01', '2020-09-16 11:00:01'),
(5117, 2027, 9177, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 04/22/2017', NULL, NULL, '2020-09-16 11:01:15', '2020-09-16 11:01:15'),
(5118, 2027, 9178, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 12:05:38', '2020-09-16 12:05:38'),
(5119, 2027, 9178, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is now linked with medicare and effective date is 11/27/2016', NULL, NULL, '2020-09-16 12:08:51', '2020-09-16 12:08:51'),
(5120, 2027, 9179, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 12:12:50', '2020-09-16 12:12:50'),
(5121, 2027, 9179, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 02/07/2020', NULL, NULL, '2020-09-16 12:14:15', '2020-09-16 12:14:15'),
(5122, 2027, 9180, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 12:31:29', '2020-09-16 12:31:29'),
(5123, 2027, 9180, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicaid and effective date is 01/06/2015', NULL, NULL, '2020-09-16 12:35:12', '2020-09-16 12:35:12'),
(5124, 1006, 9180, NULL, NULL, 'Revalidation', 'Received request from Medicaid to revalidate group.   Requests submitted for both Traditional Medicaid and THStep: \"Traditional Medicaid: Application Status   PEP Ticket Number Submitted		         17483731  THSteps: Application Status   PEP Ticket Number Submitted		          17483758\" ', NULL, NULL, '2020-12-30 18:00:09', '2020-12-30 18:00:09'),
(5125, 1006, 9180, NULL, NULL, 'Revalidated', 'Revalidation has been completed, proof attached. ', NULL, NULL, '2021-01-27 18:02:33', '2021-01-27 18:02:33'),
(5126, 2027, 9181, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 12:39:23', '2020-09-16 12:39:23'),
(5127, 2027, 9181, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicaid and effective date is 01/05/2015', NULL, NULL, '2020-09-16 12:40:51', '2020-09-16 12:40:51'),
(5128, 2027, 9182, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 13:59:21', '2020-09-16 13:59:21'),
(5129, 2027, 9182, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid and effective date is 05/01/2019', NULL, NULL, '2020-09-16 14:03:24', '2020-09-16 14:03:24'),
(5130, 2027, 9183, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 14:16:20', '2020-09-16 14:16:20'),
(5131, 2027, 9183, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicaid and effective date is 7/12/2017', NULL, NULL, '2020-09-16 14:20:30', '2020-09-16 14:20:30'),
(5132, 2027, 9184, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 14:26:23', '2020-09-16 14:26:23'),
(5133, 2027, 9184, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicaid and effective date is 4/22/2017', NULL, NULL, '2020-09-16 14:34:05', '2020-09-16 14:34:05'),
(5134, 2027, 9185, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 15:01:35', '2020-09-16 15:01:35'),
(5135, 2027, 9185, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with medicare and effective date is 11/17/2016', NULL, NULL, '2020-09-16 15:13:21', '2020-09-16 15:13:21'),
(5136, 2037, 9186, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 15:44:20', '2020-09-16 15:44:20'),
(5137, 2037, 9186, NULL, '2020-09-23 00:00:00.000', 'Approved', '\"Linkage for an individual is not a requirement as we are holding a facility setup contract Effective 10/15/2015 and we can bill using the facility\'s NPI.  Approval Email sent to billing.', NULL, NULL, '2020-09-16 15:44:47', '2020-09-16 15:44:47'),
(5138, 2037, 9187, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 17:33:02', '2020-09-16 17:33:02'),
(5139, 2037, 9187, NULL, '2020-09-23 00:00:00.000', 'In Process', 'he Facility is in network with Anci-Care.Ref#2021753.Representative: Diane. Effective 02/15/2018. Requested copy of the executed contract from Jennifer maligaya. ', NULL, NULL, '2020-09-16 17:33:35', '2020-09-16 17:33:35'),
(5140, 2037, 9187, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Contract received and uploaded. Sending approval email to the billing.-Reference email as follows: ------------------------- Hi Sherry,     Thank you for the quick turnaround on the consent. Please see the attached provider agreement between BAY AREA QUICK CARE and ACS. Thank you!', NULL, NULL, '2020-09-16 17:36:07', '2020-09-16 17:36:07'),
(5141, 2037, 9188, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 17:33:13', '2020-09-16 17:33:13'),
(5142, 2037, 9188, NULL, '2020-09-23 00:00:00.000', 'In Process', 'he Facility is in network with Anci-Care.Ref#2021753.Representative: Diane. Effective 02/15/2018. Requested copy of the executed contract from Jennifer maligaya. ', NULL, NULL, '2020-09-16 17:33:39', '2020-09-16 17:33:39'),
(5143, 2037, 9188, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Contract received and uploaded. Sending approval email to the billing.-Reference email as follows: ------------------------- Hi Sherry,     Thank you for the quick turnaround on the consent. Please see the attached provider agreement between BAY AREA QUICK CARE and ACS. Thank you!', NULL, NULL, '2020-09-16 17:36:16', '2020-09-16 17:36:16'),
(5144, 2027, 9189, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 17:43:36', '2020-09-16 17:43:36'),
(5145, 2027, 9189, NULL, '2020-09-23 00:00:00.000', 'Initiated', 'Medicaid enrollment initiated and ticket# is 17215690 ', NULL, NULL, '2020-09-16 17:44:14', '2020-09-16 17:44:14'),
(5146, 2027, 9189, NULL, '2020-09-25 00:00:00.000', 'In Process', 'Provider is now showing in process with medicaid ref#17215690', NULL, NULL, '2020-09-18 10:22:14', '2020-09-18 10:22:14'),
(5147, 2027, 9189, NULL, '2020-10-28 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 10/01/2018', NULL, NULL, '2020-10-21 12:31:19', '2020-10-21 12:31:19'),
(5148, 2037, 9190, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-16 17:47:07', '2020-09-16 17:47:07'),
(5149, 2037, 9190, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Blue Choice PPO - Effective: 01-18-2019  Welcome letter will be received within 30 business days.   Ref# Tanillya R 01/25/2019', NULL, NULL, '2020-09-16 17:48:07', '2020-09-16 17:48:07'),
(5150, 2027, 9191, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-17 09:24:00', '2020-09-17 09:24:00'),
(5151, 2027, 9191, NULL, '2020-09-24 00:00:00.000', 'Initiated', 'Medicaid is initiated for this provider and the ref# is 17215774', NULL, NULL, '2020-09-17 09:31:50', '2020-09-17 09:31:50'),
(5152, 1005, 9191, NULL, '2020-09-25 00:00:00.000', 'In Process', 'Current Status: In progress.', NULL, NULL, '2020-09-18 10:29:15', '2020-09-18 10:29:15'),
(5153, 2027, 9191, NULL, '2020-10-28 00:00:00.000', 'Approved', 'Provider is now linked with the insurance and the effective date is 03/06/2020', NULL, NULL, '2020-10-21 10:38:48', '2020-10-21 10:38:48'),
(5154, 2037, 9192, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-17 12:35:38', '2020-09-17 12:35:38'),
(5155, 2037, 9192, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Received COI Confirmation and Hospital Affiliation letter from Multi. Filled/Signed and submitted back to Multi @ appmissinginfo@multiplan.com. ', NULL, NULL, '2020-09-17 12:35:55', '2020-09-17 12:35:55'),
(5156, 2037, 9192, NULL, '2020-10-07 00:00:00.000', 'Approved', 'Welcome Packet received. William Francis effective from 09/08/2020. Approval email sent and attachment Uploaded.', NULL, NULL, '2020-09-30 15:52:21', '2020-09-30 15:52:21'),
(5157, 2037, 9193, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-17 12:35:49', '2020-09-17 12:35:49'),
(5158, 2037, 9193, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Received COI Confirmation and Hospital Affiliation letter from Multi. Filled/Signed and submitted back to Multi @ appmissinginfo@multiplan.com. ', NULL, NULL, '2020-09-17 12:36:03', '2020-09-17 12:36:03'),
(5159, 2037, 9193, NULL, '2020-10-07 00:00:00.000', 'Approved', 'Welcome Packet received. William Francis effective from 09/08/2020. Approval email sent and attachment Uploaded. ', NULL, NULL, '2020-09-30 15:54:52', '2020-09-30 15:54:52'),
(5160, 2037, 9194, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-17 14:16:06', '2020-09-17 14:16:06'),
(5161, 2037, 9194, NULL, '2020-09-24 00:00:00.000', 'New/Not Initiated', 'Initiated enrollment request online. Reference Number: 20253000398 ', NULL, NULL, '2020-09-17 14:16:32', '2020-09-17 14:16:32'),
(5162, 1005, 9194, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-10-02 15:11:06', '2020-10-02 15:11:06'),
(5163, 2037, 9194, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Currently in process. Need to allow more time.', NULL, NULL, '2020-10-08 14:56:10', '2020-10-08 14:56:10'),
(5164, 2037, 9194, NULL, '2020-10-26 00:00:00.000', 'Approved', 'Effective 08/01/2020. Approval letter received and uploaded in the app.', NULL, NULL, '2020-10-19 10:25:18', '2020-10-19 10:25:18'),
(5165, 2037, 9195, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-17 14:16:14', '2020-09-17 14:16:14'),
(5166, 2037, 9195, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Initiated enrollment request online. Reference Number: 20253000398 ', NULL, NULL, '2020-09-17 14:16:41', '2020-09-17 14:16:41'),
(5167, 2037, 9195, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Currently in process. Need to allow more time.', NULL, NULL, '2020-10-02 14:12:58', '2020-10-02 14:12:58'),
(5168, 2037, 9195, NULL, '2020-10-23 00:00:00.000', 'Approved', 'Effective 08/01/2020. Approval letter received and uploaded in the app.', NULL, NULL, '2020-10-16 17:41:49', '2020-10-16 17:41:49'),
(5169, 2037, 9196, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-17 14:16:21', '2020-09-17 14:16:21'),
(5170, 2037, 9196, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Initiated enrollment request online. Reference Number: 20253000398 ', NULL, NULL, '2020-09-17 14:16:46', '2020-09-17 14:16:46'),
(5171, 1005, 9196, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-10-12 14:51:22', '2020-10-12 14:51:22'),
(5172, 2037, 9196, NULL, '2020-10-26 00:00:00.000', 'Approved', 'Effective 08/01/2020. Approval letter received and uploaded in the app.', NULL, NULL, '2020-10-19 10:25:12', '2020-10-19 10:25:12'),
(5173, 1006, 9197, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-21 15:05:25', '2020-09-21 15:05:25'),
(5174, 1006, 9197, NULL, '2020-09-28 00:00:00.000', 'Initiated', 'Reassignment request submitted via PECOS: \"Applicant Name: MELODY L\'ETOILE   Tracking ID: T092120200003287  Submitted Date: MON - SEPTEMBER21 2020 04:04:52 PM EST  Submitted By: Melody L\'Etoile\"', NULL, NULL, '2020-09-21 15:05:42', '2020-09-21 15:05:42'),
(5175, 1006, 9197, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Submitted request is still processing:  \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000088125	 CMS855R Web	 09/21/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-10-05 17:50:48', '2020-10-05 17:50:48'),
(5176, 1005, 9197, NULL, '2020-10-21 00:00:00.000', 'In Process', 'Online status tool is showing the request is currently in process. Stating, allow 3-6 weeks.', NULL, NULL, '2020-10-12 15:08:27', '2020-10-12 15:08:27'),
(5177, 1006, 9197, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Received the same update:   \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000088125	 CMS855R Web	 09/21/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-10-20 14:05:55', '2020-10-20 14:05:55'),
(5178, 1006, 9197, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Request still shows up as in process:  \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000101570	 CMS855I Web	 10/02/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-10-28 17:36:20', '2020-10-28 17:36:20'),
(5179, 1006, 9197, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Disregard previous update! Record has been approved, waiting on finalization: \" CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000088125	 CMS855R Web	 09/21/2020	 10/23/2020 Status:  NGS has approved your enrollment record updates but is still in the process of finalizing your case. You will receive a determination once the case is finalized.\"', NULL, NULL, '2020-10-28 17:37:53', '2020-10-28 17:37:53'),
(5180, 1006, 9197, NULL, '2020-11-06 00:00:00.000', 'Approved', 'The provider has been approved on medicare effective date: 09/01/2020 with PTAN# U400692468. Approval confirmation attached. ', NULL, NULL, '2020-10-30 15:26:42', '2020-10-30 15:26:42'),
(5181, 2027, 9198, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-21 15:09:59', '2020-09-21 15:09:59'),
(5182, 2027, 9198, NULL, '2020-09-28 00:00:00.000', 'Approved', 'Provider is now showing linked with tricare and effective date is 09/14/2020. SS from provider directory is attached', NULL, NULL, '2020-09-21 15:11:35', '2020-09-21 15:11:35'),
(5183, 3040, 9198, NULL, NULL, 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:17:29', '2021-03-26 17:17:29'),
(5184, 3040, 9198, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com   Subject: Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare   Hello Katherine,  Hope you had a great weekend. I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to loaded correctly. Can you please check and advise.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-21 11:00:56', '2021-06-21 11:00:56'),
(5185, 3040, 9198, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare  Hello Katherine,  Hope you had a great weekend. I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to be loaded correctly. Can you please check and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you  ', NULL, NULL, '2021-07-09 11:21:47', '2021-07-09 11:21:47'),
(5186, 3040, 9198, NULL, '2021-09-16 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Re: Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare  Hello Katherine,  I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to be loaded correctly. Can you please check and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks ', NULL, NULL, '2021-09-09 16:19:19', '2021-09-09 16:19:19'),
(5187, 10057, 9198, NULL, '2021-11-12 00:00:00.000', 'Revalidation', 'Email Sent To : KMoten4@humana.com  Sub : Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare  Good Afternoon,  Hope this email finds you well. I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to be loaded correctly. Highlighted locations need to be updated, can you please check and confirm?  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Saavedra, Teresa	1255676151  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 14:31:11', '2021-11-02 14:31:11'),
(5188, 10057, 9198, NULL, '2021-12-08 00:00:00.000', 'Revalidation', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:45', '2021-12-01 16:24:45'),
(5189, 10057, 9198, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good morning,  NPI 1700960556  Not certified.  Please visit humanamilitary.com, click on Provider link, click on Forms. Locate appropriate certification application, complete and fax to WPS at number located on application.  Please allow 90 days for processing  NPI 1225617558 Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice). Please see screenshot below to submit.  NPI 1659919702  Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  NPI 1568929800  Prov credentialing complete effect 8/31/21. Prov is affiliated with three locations listed.  NPI 1730564857  Prov credentialing complete effective 9/28/21. Prov is affiliated with three locations listed.  NPI 1245789502  Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice) and work history. Email request sent 6/9/21  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-09 10:34:53', '2021-12-09 10:34:53'),
(5190, 10057, 9198, NULL, '2021-12-21 00:00:00.000', 'Revalidation', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:47', '2021-12-14 13:39:47'),
(5191, 10057, 9198, NULL, '2021-12-28 00:00:00.000', 'Revalidation', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:52', '2021-12-21 13:39:52'),
(5192, 10057, 9198, NULL, '2022-01-04 00:00:00.000', 'Revalidation', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:41', '2021-12-28 15:29:41'),
(5193, 20067, 9198, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub:  Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Hope this email finds you in good health. I would like to know the enrollment status of the below mentioned providers.  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631  Provider 1: Garcia Homero NPI: 17303564857 Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496  Provider 2: Teresa Saavedra NPI:1255676151 Location 1:  800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Location 2: 101 E. Expressway 83, Suite #170  McAllen, TX 78501-1166  Your early response will be highly appreciated.  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-13 14:19:22', '2022-01-13 14:19:22'),
(5194, 20067, 9198, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2022-01-13 16:36:17', '2022-01-13 16:36:17'),
(5195, 20067, 9198, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Thanks for the update. Can you please provide me with their welcome kits?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-13 16:40:55', '2022-01-13 16:40:55');
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
(5196, 20067, 9198, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:10:06', '2022-01-18 14:10:06'),
(5197, 20067, 9198, NULL, '2022-02-23 00:00:00.000', 'Revalidation', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:31:01', '2022-02-16 17:31:01'),
(5198, 20067, 9198, NULL, '2022-03-09 00:00:00.000', 'Revalidated', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   ood afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East ', NULL, NULL, '2022-03-02 16:44:55', '2022-03-02 16:44:55'),
(5199, 1006, 9201, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-23 09:50:18', '2020-09-23 09:50:18'),
(5200, 1006, 9201, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Check received from Erline, submitted request for Group enrollment:  \"Applicant Name: ERLINE TERRELONGE   Tracking ID: T091820200001358  Reassignment Tracking ID: T092320200000939  Submitted Date: WED - SEPTEMBER23 2020 10:46:59 AM EST  Submitted By: Erline Terrelonge  Contact Email(s): ERLINETERRELONGE2019@GMAIL.COM HHUC@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 as a corporation, professional corporation, professional association, or limited liability company. No reassignment of benefits exists with this enrollment application.\"', NULL, NULL, '2020-09-23 09:50:44', '2020-09-23 09:50:44'),
(5201, 2037, 9201, NULL, '2020-10-19 00:00:00.000', 'In Process', 'As per live call to Medicare the voided check that was submitted needs to have Legal business name mentioned on it thus the application is on development status.Sent an email to Erline for requested voided check. Below is the reference :  Hi Erline,  Hope this email finds you well.  Regarding the voided check that you sent to Brad, Medicare has sent us another development on it as the legal business name is not mentioned on that. Kindly provide us with a voided check with the entity\'s name on urgent basis.  Looking forward to hearing back from you soon. ', NULL, NULL, '2020-10-12 16:57:17', '2020-10-12 16:57:17'),
(5202, 2037, 9201, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Waiting on the voided check with the business name : ------------------------ Hi Erline,  Happy Monday!  Hope your day is off to a good start.   Following up on the copy of the voided check if you\'ve received it.', NULL, NULL, '2020-10-20 17:18:05', '2020-10-20 17:18:05'),
(5203, 2037, 9201, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Waiting on the voided check with the business name :', NULL, NULL, '2020-10-27 14:46:17', '2020-10-27 14:46:17'),
(5204, 2037, 9201, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Check Received -Group enrollment re initiated over PECOS', NULL, NULL, '2020-11-03 11:57:29', '2020-11-03 11:57:29'),
(5205, 2037, 9201, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Application Tracking ID: T110220200000463        NPI: 1265045660        Medicare ID:         Name: Healing Hands Urgent Care & Telehealth        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-11-03 16:53:07', '2020-11-03 16:53:07'),
(5206, 2037, 9201, NULL, '2021-02-28 00:00:00.000', 'On Hold', 'The Voided Check received had inaccurate name and missing \"&\" so another development was received from Medicare. Since the credentialing is put on hold by Erline Terrelonge so task is put on hold.', NULL, NULL, '2020-11-30 15:15:40', '2020-11-30 15:15:40'),
(5207, 1006, 9201, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The provider is no longer with the company. ', NULL, NULL, '2021-08-16 09:12:00', '2021-08-16 09:12:00'),
(5208, 2037, 9202, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-23 13:51:52', '2020-09-23 13:51:52'),
(5209, 2037, 9202, NULL, '2020-09-30 00:00:00.000', 'In Process', '	 Sent below email to Karla for fee schedule comparison between group & urgent care contracts.Below is the reference: ------------------ Hello Karla,  Thank you for your patience.I tried to reach you over the phone but was unable to get a hold of you. As \"Stat Care Minor Emergency Clinic\" is an urgent care.Is it possible to obtain an urgent care contract rather than a group. I also wanted a comparison of fee schedules between a group contract and an urgent care to make sure that the rates are lucrative before proceeding further.  Looking forward to hearing from you soon. Thank You! Hello Karla,  Thank you for your patience.I tried to reach you over the phone but was unable to get a hold of you. As \"Stat Care Minor Emergency Clinic\" is an urgent care.Is it possible to obtain an urgent care contract rather than a group. I also wanted a comparison of fee schedules between a group contract and an urgent care to make sure that the rates are lucrative before proceeding further.  Looking forward to hearing from you soon. Thank You!', NULL, NULL, '2020-09-23 13:52:08', '2020-09-23 13:52:08'),
(5210, 2037, 9202, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received an email from Karla requesting to  sign the group contract.Below is the reference: ------------- Good afternoon,  Please find the attached DHP agreement.  Katherine Rabagos is currently in process of credentialing and we are needing the contract in place to complete the process.  Please email the signature pages back to me promptly to avoid any delays.  I look forward to hearing back from you soon.  Karla Claunch, C.M.A.', NULL, NULL, '2020-09-23 13:53:13', '2020-09-23 13:53:13'),
(5211, 2037, 9202, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received an email from Karla requesting to  sign the group contract.Below is the reference: ------------- Good afternoon,  Please find the attached DHP agreement.  Katherine Rabagos is currently in process of credentialing and we are needing the contract in place to complete the process.  Please email the signature pages back to me promptly to avoid any delays.  I look forward to hearing back from you soon.  Karla Claunch, C.M.A.', NULL, NULL, '2020-09-23 16:55:59', '2020-09-23 16:55:59'),
(5212, 2037, 9202, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Received Email from Karla: ----------- Not an inconvenience at all.  Thank you for the quick response back.  You should be hearing back from me soon with Welcome packet and executed agreement.  Have a great weekend and stay safe!', NULL, NULL, '2020-09-25 10:22:28', '2020-09-25 10:22:28'),
(5213, 2037, 9202, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Still in process. follow up email sent to Karla .', NULL, NULL, '2020-10-08 14:47:49', '2020-10-08 14:47:49'),
(5214, 2037, 9202, NULL, '2020-11-23 00:00:00.000', 'In Process', ' Sherry Deen  1:57 PM (5 minutes ago) to Rabagos, Karla  Hi Karla,  Hope you had a great weekend.  Just wanted to follow up for the Welcome packet and executed agreement for:  Rabagos Health Care LLC dba Statcare Minor Emergency Clinic. Tax ID: 46-0575924.  Thank you! Regards:', NULL, NULL, '2020-10-26 14:08:01', '2020-10-26 14:08:01'),
(5215, 2037, 9202, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Katherine will not be credentialed because of the absence of an In-network supervising physician with Driscoll. And without a Katherine the group/Facility wont be credentialed as well.Reference email is as follows. ------------------------  Karla Claunch Attachments Mon, Oct 26, 2:43 PM to me  Hi Sherry,  Looks like Katherine was withdrawn (see attached letter which should have been sent from credentialing department 10/21/2020.  Until a provider is credentialed, the practice will not be contracted and will be considered out of network.  Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  615 N Upper Broadway Ste 1621  Corpus Christi TX 78401-0764  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org', NULL, NULL, '2020-11-23 12:51:45', '2020-11-23 12:51:45'),
(5216, 1006, 9202, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:10', '2021-04-06 14:56:10'),
(5217, 2037, 9203, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-23 13:51:56', '2020-09-23 13:51:56'),
(5218, 2037, 9203, NULL, '2020-09-30 00:00:00.000', 'In Process', '	 Sent below email to Karla for fee schedule comparison between group & urgent care contracts.Below is the reference: ------------------ Hello Karla,  Thank you for your patience.I tried to reach you over the phone but was unable to get a hold of you. As \"Stat Care Minor Emergency Clinic\" is an urgent care.Is it possible to obtain an urgent care contract rather than a group. I also wanted a comparison of fee schedules between a group contract and an urgent care to make sure that the rates are lucrative before proceeding further.  Looking forward to hearing from you soon. Thank You! Hello Karla,  Thank you for your patience.I tried to reach you over the phone but was unable to get a hold of you. As \"Stat Care Minor Emergency Clinic\" is an urgent care.Is it possible to obtain an urgent care contract rather than a group. I also wanted a comparison of fee schedules between a group contract and an urgent care to make sure that the rates are lucrative before proceeding further.  Looking forward to hearing from you soon. Thank You!', NULL, NULL, '2020-09-23 13:52:15', '2020-09-23 13:52:15'),
(5219, 2037, 9203, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received an email from Karla requesting to  sign the group contract.Below is the reference: ------------- Good afternoon,  Please find the attached DHP agreement.  Katherine Rabagos is currently in process of credentialing and we are needing the contract in place to complete the process.  Please email the signature pages back to me promptly to avoid any delays.  I look forward to hearing back from you soon.  Karla Claunch, C.M.A.', NULL, NULL, '2020-09-23 13:53:18', '2020-09-23 13:53:18'),
(5220, 2037, 9203, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received an email from Karla requesting to  sign the group contract.Below is the reference: ------------- Good afternoon,  Please find the attached DHP agreement.  Katherine Rabagos is currently in process of credentialing and we are needing the contract in place to complete the process.  Please email the signature pages back to me promptly to avoid any delays.  I look forward to hearing back from you soon.  Karla Claunch, C.M.A.', NULL, NULL, '2020-09-23 16:55:48', '2020-09-23 16:55:48'),
(5221, 2037, 9203, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Received Email from Karla: ----------- Not an inconvenience at all.  Thank you for the quick response back.  You should be hearing back from me soon with Welcome packet and executed agreement.  Have a great weekend and stay safe! Have a great weekend and stay safe!', NULL, NULL, '2020-09-25 10:21:57', '2020-09-25 10:21:57'),
(5222, 2037, 9203, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Still in process. follow up email sent to Karla .', NULL, NULL, '2020-10-08 14:48:01', '2020-10-08 14:48:01'),
(5223, 2037, 9203, NULL, '2020-11-23 00:00:00.000', 'In Process', ' Sherry Deen  1:57 PM (5 minutes ago) to Rabagos, Karla  Hi Karla,  Hope you had a great weekend.  Just wanted to follow up for the Welcome packet and executed agreement for:  Rabagos Health Care LLC dba Statcare Minor Emergency Clinic. Tax ID: 46-0575924.  Thank you! Regards:', NULL, NULL, '2020-10-26 14:07:47', '2020-10-26 14:07:47'),
(5224, 2037, 9203, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Katherine will not be credentialed because of the absence of an In-network supervising physician with Driscoll. And without a Katherine the group/Facility wont be credentialed as well.Reference email is as follows. ------------------------  Karla Claunch Attachments Mon, Oct 26, 2:43 PM to me  Hi Sherry,  Looks like Katherine was withdrawn (see attached letter which should have been sent from credentialing department 10/21/2020.  Until a provider is credentialed, the practice will not be contracted and will be considered out of network.  Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  615 N Upper Broadway Ste 1621  Corpus Christi TX 78401-0764  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org', NULL, NULL, '2020-11-23 12:52:04', '2020-11-23 12:52:04'),
(5225, 1006, 9203, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:53:56', '2021-04-06 14:53:56'),
(5226, 2037, 9204, NULL, NULL, 'New/Not Initiated', 'Initiated.', NULL, NULL, '2020-09-23 13:54:36', '2020-09-23 13:54:36'),
(5227, 2037, 9204, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Katherine\'s Re-Credentialing has been initiated. Emal Received from Patricia requesting missing Documents.Below is the reference email: ---------------- Good Morning Credentialing Dept.,  At this time I am working on credentialing provider Katherine C. Rabagos, NP and I am needing additional/missing items to move on to the next phase of credentialing.  Missing/additional items:  ·         Page 5 of application need call coverage should list at least supervising physician (copy of page 5 attached)  ·         Current License  ·         Current DEA  ·         PAA (form attached)  ·         Addendum (form attached)  ·         Attestation pages (forms attached)  ·         Provider Disclosure Statement (form attached)   Please send requested information as soon as possible.  Should you have any questions or concerns please do not hesitate to reach out to me my information is listed below.   Patricia Garcia', NULL, NULL, '2020-09-23 13:57:05', '2020-09-23 13:57:05'),
(5228, 2037, 9204, NULL, '2020-09-30 00:00:00.000', 'In Process', 'All the requested documents for Katherine\'s Re-credentialing forwarded Patricia @ Patricia.Garcia@dchstx.org  along with the forms to add the secondary and tertiary locations.Below is the reference email: -----------------------------  Hello Patricia, Hope this email finds you well.My apologies for the delay as I was waiting on the PAA.  Kindly find all the requested documents along with the state license and DEA to proceed further with the credentialing process of Katherine C. Rabagos.In addition to that kindly find the form as a request to add two additional locations for Stat Care Minor Emergency Clinic. Please feel free to contact me for any additional information if needed.  Regards : Sherry', NULL, NULL, '2020-09-23 14:03:33', '2020-09-23 14:03:33'),
(5229, 2037, 9204, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Katherine Rabagos got removed from the Master provider list with Medicaid as her License got expired.Updated AP License over TMHP Portal for Katherine Rabagos. Request received and is currently being processed .Kintana Number# 7257174. Confirmation of receiving obtained from Melony over the call Ref# 39875911000. Once her status will be reactivated with Medicaid her re credentialing with Driscoll will be resumed.', NULL, NULL, '2020-10-08 14:55:10', '2020-10-08 14:55:10'),
(5230, 2037, 9204, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Patricia Garcia Attachments Wed, Oct 21, 10:03 AM (5 days ago) to me  Good Morning Sherry,  Application for Katherine Rabagos, NP application withdrawn effective today October 21, 2020 due to supervising physician is non par with the Driscoll Health Plan, provider will need to reapply request for contract attached.  Patricia Garcia  Driscoll Health Plan  Credentialing Department  615 N Upper Broadway Ste 1621  Corpus Christi, TX 78401  Phone:  361-694-4802   Fax:  361-808-2182  Email:  patricia.garcia@dchstx.org --------------------------- Facility\'s contracting is in process and Karla is currently working on it.', NULL, NULL, '2020-10-26 14:17:01', '2020-10-26 14:17:01'),
(5231, 2037, 9204, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Katherine wont be credentialed as her supervising physician is OON with Driscoll we do not have general liability coverage for the practice to continue for the facility\'s contracting process. ------------------------------  Karla Claunch Karla.Claunch@dchstx.org Attachments Mon, Oct 26, 2:43 PM to me  Hi Sherry,  Looks like Katherine was withdrawn (see attached letter which should have been sent from credentialing department 10/21/2020.  Until a provider is credentialed, the practice will not be contracted and will be considered out of network.', NULL, NULL, '2020-11-30 09:53:22', '2020-11-30 09:53:22'),
(5232, 1006, 9204, NULL, '2021-04-13 00:00:00.000', 'Rejected', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:53:31', '2021-04-06 14:53:31'),
(5233, 2037, 9205, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-23 14:05:02', '2020-09-23 14:05:02'),
(5234, 2037, 9205, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Katherine\'s Re-Credentialing has been initiated. Emal Received from Patricia requesting missing Documents.Below is the reference email: ---------------- Good Morning Credentialing Dept.,  At this time I am working on credentialing provider Katherine C. Rabagos, NP and I am needing additional/missing items to move on to the next phase of credentialing.  Missing/additional items:  ·         Page 5 of application need call coverage should list at least supervising physician (copy of page 5 attached)  ·         Current License  ·         Current DEA  ·         PAA (form attached)  ·         Addendum (form attached)  ·         Attestation pages (forms attached)  ·         Provider Disclosure Statement (form attached)   Please send requested information as soon as possible.  Should you have any questions or concerns please do not hesitate to reach out to me my information is listed below.   Patricia Garcia', NULL, NULL, '2020-09-23 14:05:29', '2020-09-23 14:05:29'),
(5235, 2037, 9205, NULL, '2020-09-30 00:00:00.000', 'In Process', 'All the requested documents for Katherine\'s Re-credentialing forwarded Patricia @ Patricia.Garcia@dchstx.org  along with the forms to add the secondary and tertiary locations.Below is the reference email: -----------------------------  Hello Patricia, Hope this email finds you well.My apologies for the delay as I was waiting on the PAA.  Kindly find all the requested documents along with the state license and DEA to proceed further with the credentialing process of Katherine C. Rabagos.In addition to that kindly find the form as a request to add two additional locations for Stat Care Minor Emergency Clinic. Please feel free to contact me for any additional information if needed.  Regards : Sherry', NULL, NULL, '2020-09-23 14:05:53', '2020-09-23 14:05:53'),
(5236, 2037, 9205, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Katherine Rabagos got removed from the Master provider list with Medicaid as her License got expired.Updated AP License over TMHP Portal for Katherine Rabagos. Request received and is currently being processed .Kintana Number# 7257174. Confirmation of receiving obtained from Melony over the call Ref# 39875911000. Once her status will be reactivated with Medicaid her re credentialing with Driscoll will be resumed. ', NULL, NULL, '2020-10-08 14:57:32', '2020-10-08 14:57:32'),
(5237, 2037, 9205, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Patricia Garcia Attachments Wed, Oct 21, 10:03 AM (5 days ago) to me  Good Morning Sherry,  Application for Katherine Rabagos, NP application withdrawn effective today October 21, 2020 due to supervising physician is non par with the Driscoll Health Plan, provider will need to reapply request for contract attached.  Patricia Garcia  Driscoll Health Plan  Credentialing Department  615 N Upper Broadway Ste 1621  Corpus Christi, TX 78401  Phone:  361-694-4802   Fax:  361-808-2182  Email:  patricia.garcia@dchstx.org --------------------------- Facility\'s contracting is in process and Karla is currently working on it.', NULL, NULL, '2020-10-26 14:17:12', '2020-10-26 14:17:12'),
(5238, 2037, 9205, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Katherine wont be credentialed as her supervising physician is OON with Driscoll we do not have general liability coverage for the practice to continue for the facility\'s contracting process. ------------------------------  Karla Claunch Karla.Claunch@dchstx.org Attachments Mon, Oct 26, 2:43 PM to me  Hi Sherry,  Looks like Katherine was withdrawn (see attached letter which should have been sent from credentialing department 10/21/2020.  Until a provider is credentialed, the practice will not be contracted and will be considered out of network.', NULL, NULL, '2020-11-30 09:53:15', '2020-11-30 09:53:15'),
(5239, 1006, 9205, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:15', '2021-04-06 14:56:15'),
(5240, 2037, 9206, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-23 14:05:07', '2020-09-23 14:05:07'),
(5241, 2037, 9206, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Katherine\'s Re-Credentialing has been initiated. Emal Received from Patricia requesting missing Documents.Below is the reference email: ---------------- Good Morning Credentialing Dept.,  At this time I am working on credentialing provider Katherine C. Rabagos, NP and I am needing additional/missing items to move on to the next phase of credentialing.  Missing/additional items:  ·         Page 5 of application need call coverage should list at least supervising physician (copy of page 5 attached)  ·         Current License  ·         Current DEA  ·         PAA (form attached)  ·         Addendum (form attached)  ·         Attestation pages (forms attached)  ·         Provider Disclosure Statement (form attached)   Please send requested information as soon as possible.  Should you have any questions or concerns please do not hesitate to reach out to me my information is listed below.   Patricia Garcia', NULL, NULL, '2020-09-23 14:05:30', '2020-09-23 14:05:30'),
(5242, 2037, 9206, NULL, '2020-09-30 00:00:00.000', 'In Process', 'All the requested documents for Katherine\'s Re-credentialing forwarded Patricia @ Patricia.Garcia@dchstx.org  along with the forms to add the secondary and tertiary locations.Below is the reference email: -----------------------------  Hello Patricia, Hope this email finds you well.My apologies for the delay as I was waiting on the PAA.  Kindly find all the requested documents along with the state license and DEA to proceed further with the credentialing process of Katherine C. Rabagos.In addition to that kindly find the form as a request to add two additional locations for Stat Care Minor Emergency Clinic. Please feel free to contact me for any additional information if needed.  Regards : Sherry', NULL, NULL, '2020-09-23 14:05:47', '2020-09-23 14:05:47'),
(5243, 2037, 9206, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Katherine Rabagos got removed from the Master provider list with Medicaid as her License got expired.Updated AP License over TMHP Portal for Katherine Rabagos. Request received and is currently being processed .Kintana Number# 7257174. Confirmation of receiving obtained from Melony over the call Ref# 39875911000. Once her status will be reactivated with Medicaid her recredentialing with Driscoll will be resumed.', NULL, NULL, '2020-10-08 14:52:01', '2020-10-08 14:52:01'),
(5244, 2037, 9206, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Patricia Garcia Attachments Wed, Oct 21, 10:03 AM (5 days ago) to me  Good Morning Sherry,  Application for Katherine Rabagos, NP application withdrawn effective today October 21, 2020 due to supervising physician is non par with the Driscoll Health Plan, provider will need to reapply request for contract attached.  Patricia Garcia  Driscoll Health Plan  Credentialing Department  615 N Upper Broadway Ste 1621  Corpus Christi, TX 78401  Phone:  361-694-4802   Fax:  361-808-2182  Email:  patricia.garcia@dchstx.org --------------------------- Facility\'s contracting is in process and Karla is currently working on it.', NULL, NULL, '2020-10-26 14:17:29', '2020-10-26 14:17:29'),
(5245, 2037, 9206, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Katherine wont be credentialed as her supervising physician is OON with Driscoll we do not have general liability coverage for the practice to continue for the facility\'s contracting process. ------------------------------  Karla Claunch Karla.Claunch@dchstx.org Attachments Mon, Oct 26, 2:43 PM to me  Hi Sherry,  Looks like Katherine was withdrawn (see attached letter which should have been sent from credentialing department 10/21/2020.  Until a provider is credentialed, the practice will not be contracted and will be considered out of network.', NULL, NULL, '2020-11-30 09:53:08', '2020-11-30 09:53:08'),
(5246, 1006, 9206, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:19', '2021-04-06 14:56:19'),
(5247, 2027, 9207, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-23 14:37:50', '2020-09-23 14:37:50'),
(5248, 2027, 9207, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Medicaid application for this provider is in process and PEP Ticket# is 17230987', NULL, NULL, '2020-09-23 14:39:46', '2020-09-23 14:39:46'),
(5249, 2027, 9207, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid and effective date is 08/01/2020', NULL, NULL, '2020-10-02 17:31:42', '2020-10-02 17:31:42'),
(5250, 2027, 9208, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-23 15:08:16', '2020-09-23 15:08:16'),
(5251, 2027, 9208, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Provider application is in process with medicaid and ref# is 17231434. ', NULL, NULL, '2020-09-23 15:09:30', '2020-09-23 15:09:30'),
(5252, 2027, 9208, NULL, '2020-10-29 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 08/01/2020. Screenshot for provider confirmation is attached.', NULL, NULL, '2020-10-22 09:25:23', '2020-10-22 09:25:23'),
(5253, 1006, 9209, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-24 17:34:21', '2020-09-24 17:34:21'),
(5254, 1006, 9209, NULL, '2020-10-07 00:00:00.000', 'Initiated', 'Submitted the following email to Wendy :  \"Hello Wendy,   Appreciate the update, hopefully, they can get back to me soon.   We now have two more providers that are Rhode Island specific that need  to be enrolled under supervisory protocols, their info is as follows:  Provider Name: Erin Oliva NPI# 1407349632 Provider Name: Melody L\'Etoile NPI# 1942687108 TIN# 83-4482753  Please let me know what is required to process this ASAP.  Thank you!\"', NULL, NULL, '2020-09-24 17:35:26', '2020-09-24 17:35:26'),
(5255, 1006, 9209, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply from Wendy:  \"Hello Brad,   Are these providers going to be in the supervisory role or are the going to be under the provider we have previously established as the supervisor for your RI location?   Thank you,   We at Optum Behavioral Health would like to express our sincere appreciation for the services you are providing to our members during this difficult time.  Please frequently visit Provider Express at the link listed below for the most current COVID19 information and updates on telehealth policies, coding, reimbursement and member resources.  If you require any assistance and have any questions that are not available on the Provider Express Portal please email me. Link to Optum Provider Express:  https://www.providerexpress.com/content/ope-provexpr/us/en/COVID-19_Provider_Updates.html  Providers make it possible. Thank you!  Wendy Hamel Sherzer   Network Manager - Rhode Island   Phone: 401-732-7120  Fax: 1-844-606-9423 Behavioral Network online resources:  www.providerexpress.com  Our United Culture. The way forward.  ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance\"', NULL, NULL, '2020-09-29 11:02:44', '2020-09-29 11:02:44'),
(5256, 1006, 9209, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to Wendy regarding the status of the request. ', NULL, NULL, '2020-10-05 18:08:54', '2020-10-05 18:08:54'),
(5257, 1006, 9209, NULL, '2020-10-20 00:00:00.000', 'Approved', 'Received following update from Wendy regarding the supervisory protocol:  \"Hello Brad  As to the RI if they are being billed under Supervisory Protocol because they are unable to be credentialled do to licensure level limitations they would not be added to the groups roster. You would simply bill under the supervisory protocol and make sure the necessary notes/records are maintained should there be and review/audit of the associated claims.  Thank you,\"', NULL, NULL, '2020-10-13 09:17:43', '2020-10-13 09:17:43'),
(5258, 1006, 9209, NULL, NULL, 'Revalidation', 'Initiated a new request as the provider is now an LICSW. ', NULL, NULL, '2020-11-11 17:34:05', '2020-11-11 17:34:05'),
(5259, 1006, 9209, NULL, NULL, 'Revalidated', 'Provider added as in-network to UBH:  \"I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 11/16/2020.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.\"', NULL, NULL, '2020-11-18 09:55:38', '2020-11-18 09:55:38'),
(5260, 1006, 9210, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-24 17:36:07', '2020-09-24 17:36:07'),
(5261, 1006, 9210, NULL, '2020-10-01 00:00:00.000', 'Initiated', 'Submitted the following email to Wendy :  \"Hello Wendy,   Appreciate the update, hopefully, they can get back to me soon.   We now have two more providers that are Rhode Island specific that need  to be enrolled under supervisory protocols, their info is as follows:  Provider Name: Erin Oliva NPI# 1407349632 Provider Name: Melody L\'Etoile NPI# 1942687108 TIN# 83-4482753  Please let me know what is required to process this ASAP.  Thank you!\"', NULL, NULL, '2020-09-24 17:36:13', '2020-09-24 17:36:13'),
(5262, 1006, 9210, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply from Wendy:  \"Hello Brad,   Are these providers going to be in the supervisory role or are the going to be under the provider we have previously established as the supervisor for your RI location?   Thank you,   We at Optum Behavioral Health would like to express our sincere appreciation for the services you are providing to our members during this difficult time.  Please frequently visit Provider Express at the link listed below for the most current COVID19 information and updates on telehealth policies, coding, reimbursement and member resources.  If you require any assistance and have any questions that are not available on the Provider Express Portal please email me. Link to Optum Provider Express:  https://www.providerexpress.com/content/ope-provexpr/us/en/COVID-19_Provider_Updates.html  Providers make it possible. Thank you!  Wendy Hamel Sherzer   Network Manager - Rhode Island   Phone: 401-732-7120  Fax: 1-844-606-9423 Behavioral Network online resources:  www.providerexpress.com  Our United Culture. The way forward.  ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance\"', NULL, NULL, '2020-09-29 11:02:50', '2020-09-29 11:02:50'),
(5263, 1006, 9210, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to Wendy regarding the status of the request.  ', NULL, NULL, '2020-10-05 18:09:52', '2020-10-05 18:09:52'),
(5264, 1006, 9210, NULL, '2020-10-20 00:00:00.000', 'Approved', 'Received following update from Wendy regarding the supervisory protocol:  \"Hello Brad  As to the RI if they are being billed under Supervisory Protocol because they are unable to be credentialled do to licensure level limitations they would not be added to the groups roster. You would simply bill under the supervisory protocol and make sure the necessary notes/records are maintained should there be and review/audit of the associated claims.  Thank you,\"', NULL, NULL, '2020-10-13 09:18:04', '2020-10-13 09:18:04'),
(5265, 1019, 9210, NULL, '2021-10-06 00:00:00.000', 'Revalidation', 'Application Submitted online through Provider express.', NULL, NULL, '2021-09-29 08:19:47', '2021-09-29 08:19:47'),
(5266, 1006, 9211, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-24 18:12:49', '2020-09-24 18:12:49'),
(5267, 1006, 9211, NULL, '2020-10-01 00:00:00.000', 'Initiated', 'Enrollment initiated:  \"Applicant Name: ERIN OLIVA   Tracking ID: T092420200004019  Reassignment Tracking ID: T092420200004031  Submitted Date: THU - SEPTEMBER24 2020 07:11:31 PM EST  Submitted By: Erin Oliva  Contact Email(s): SNBC@CLAIMSMEDINC.COM ERINOLIVA116@GMAIL.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, '2020-09-24 18:13:10', '2020-09-24 18:13:10'),
(5268, 1006, 9211, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Request is still processing:   \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000091664	 CMS855I Web	 09/24/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-10-05 17:52:51', '2020-10-05 17:52:51'),
(5269, 1005, 9211, NULL, '2020-10-21 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-10-12 15:09:49', '2020-10-12 15:09:49'),
(5270, 1006, 9211, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Request still in process: \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000091664	 CMS855I Web	 09/24/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-10-22 17:59:12', '2020-10-22 17:59:12'),
(5271, 1006, 9211, NULL, '2020-11-03 00:00:00.000', 'Approved', 'Application Tracking ID: T092420200004019   NPI ID: 1407349632   Medicare ID: U400693419   Name: ERIN OLIVA  State: RI   Form Type: 855I  Date: 10/27/2020  Status: APPROVED ', NULL, NULL, '2020-10-27 17:00:26', '2020-10-27 17:00:26'),
(5272, 2037, 9212, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 09:53:14', '2020-09-25 09:53:14'),
(5273, 2037, 9212, NULL, '2020-10-02 00:00:00.000', 'Approved', 'Received group contract with effective date listed.   Effective Date: 08/08/2019', NULL, NULL, '2020-09-25 09:53:44', '2020-09-25 09:53:44'),
(5274, 1006, 9213, NULL, NULL, 'New/Not Initiated', 'Email used to create the request aa@claimsmedinc.com', NULL, NULL, '2020-09-25 10:33:33', '2020-09-25 10:33:33'),
(5275, 1006, 9213, NULL, '2020-10-02 00:00:00.000', 'Initiated', 'Request submitted for enrollment as the provider is not showing up in Beacon\'s system. ', NULL, NULL, '2020-09-25 10:36:08', '2020-09-25 10:36:08'),
(5276, 1006, 9213, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Your application is currently being reviewed by a member of Beacon\'s onboarding team.  You will be contacted in the event that more information is required. Your application was submitted on 09/25/2020 at 11:32:08 AM EST ', NULL, NULL, '2020-10-06 10:09:23', '2020-10-06 10:09:23'),
(5277, 1006, 9213, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Received the following update from Beacon status tool:  \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. Your application was submitted on 09/25/2020 at 11:32:08 AM EST\"', NULL, NULL, '2020-10-20 14:15:27', '2020-10-20 14:15:27'),
(5278, 1006, 9213, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Request update:  \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. Your application was submitted on 09/25/2020 at 11:32:08 AM EST\"', NULL, NULL, '2020-11-02 13:28:23', '2020-11-02 13:28:23'),
(5279, 1006, 9213, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com: \"Hello,   I hope you\'re doing well, I wanted to check in on the status of the following providers as well:   Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me as soon as you\'re able to, thanks.\"', NULL, NULL, '2020-11-16 16:34:42', '2020-11-16 16:34:42'),
(5280, 1006, 9213, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Sent another follow-up email to provider.relations@beaconhealthoptions.com. ', NULL, NULL, '2020-11-30 17:51:28', '2020-11-30 17:51:28'),
(5281, 1006, 9213, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Received following reply from Kayla: \"Good afternoon,   The applications for the below providers are still processing.   Ticket: 8944245  Thank You!   Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632 www.beaconhealthoptions.com\"', NULL, NULL, '2020-12-09 13:36:00', '2020-12-09 13:36:00'),
(5282, 1006, 9213, NULL, '2020-01-08 00:00:00.000', 'In Process', 'Sent follow-up email @ provider.relations@beaconhealthoptions.com: \"Hello,   I need an update regarding the enrollment status of the following providers:   Provider Name: Lynneta Loveland NPI# 1598163602  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2020-12-24 14:07:44', '2020-12-24 14:07:44'),
(5283, 1006, 9213, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:19:50', '2021-02-11 15:19:50'),
(5284, 1006, 9213, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:08:43', '2021-03-03 18:08:43'),
(5285, 1019, 9213, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:44:26', '2021-03-23 10:44:26'),
(5286, 1019, 9213, NULL, '2021-04-14 00:00:00.000', 'In Process', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-07 08:59:11', '2021-04-07 08:59:11'),
(5287, 1019, 9213, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:08:19', '2021-04-14 07:08:19'),
(5288, 1019, 9213, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-04-14 08:11:19', '2021-04-14 08:11:19'),
(5289, 1019, 9213, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:55:37', '2021-04-22 15:55:37');
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
(5290, 1019, 9213, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:47:35', '2021-05-03 12:47:35'),
(5291, 1019, 9213, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:30:31', '2021-05-20 08:30:31'),
(5292, 1019, 9213, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:19:40', '2021-06-05 11:19:40'),
(5293, 1019, 9213, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:03:25', '2021-06-24 08:03:25'),
(5294, 1019, 9213, NULL, '2021-09-02 00:00:00.000', 'Approved', 'Welcome Letter attached, effective date 08/13/2021. ', NULL, NULL, '2021-08-26 10:21:10', '2021-08-26 10:21:10'),
(5295, 2037, 9214, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 13:47:31', '2020-09-25 13:47:31'),
(5296, 2037, 9214, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Linkage Request Sent to Galaxy Health @ mmedina@ghn-mci.com.LOI+W9. ------------------- Greetings, Kindly find the attached requested documents with letter of intent to add the provider \"William Francis\" to an existing group in your network. Do feel free to contact me for any additional information if required.Regards:Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-', NULL, NULL, '2020-09-25 13:49:25', '2020-09-25 13:49:25'),
(5297, 2037, 9214, NULL, '2020-10-02 00:00:00.000', 'Approved', 'We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement.  ALL THREE LOCATIONS ADDED.', NULL, NULL, '2020-09-25 13:51:13', '2020-09-25 13:51:13'),
(5298, 2037, 9215, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 13:48:48', '2020-09-25 13:48:48'),
(5299, 2037, 9215, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Linkage Request Sent to Galaxy Health @ mmedina@ghn-mci.com.LOI+W9. ------------------- Greetings, Kindly find the attached requested documents with letter of intent to add the provider \"William Francis\" to an existing group in your network. Do feel free to contact me for any additional information if required.Regards:Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-', NULL, NULL, '2020-09-25 13:49:30', '2020-09-25 13:49:30'),
(5300, 2037, 9215, NULL, '2020-10-02 00:00:00.000', 'Approved', 'We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement.  ALL THREE LOCATIONS ADDED.', NULL, NULL, '2020-09-25 13:51:17', '2020-09-25 13:51:17'),
(5301, 2037, 9216, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 13:52:19', '2020-09-25 13:52:19'),
(5302, 2037, 9216, NULL, '2020-10-02 00:00:00.000', 'Approved', 'We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement.  ALL THREE LOCATIONS ADDED.', NULL, NULL, '2020-09-25 13:53:12', '2020-09-25 13:53:12'),
(5303, 2037, 9217, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 13:56:55', '2020-09-25 13:56:55'),
(5304, 2037, 9217, NULL, '2020-10-02 00:00:00.000', 'Approved', 'We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement.  ALL THREE LOCATIONS ADDED.', NULL, NULL, '2020-09-25 13:57:09', '2020-09-25 13:57:09'),
(5305, 2037, 9218, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 13:56:56', '2020-09-25 13:56:56'),
(5306, 2037, 9218, NULL, '2020-10-02 00:00:00.000', 'Approved', 'We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement.  ALL THREE LOCATIONS ADDED.', NULL, NULL, '2020-09-25 13:57:16', '2020-09-25 13:57:16'),
(5307, 2037, 9219, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 15:40:32', '2020-09-25 15:40:32'),
(5308, 2037, 9219, NULL, '2020-10-02 00:00:00.000', 'Approved', 'Received Urgent Care Contract for the practice effective 10/01/2020. Placed on the server and uploaded on EMRBS. ', NULL, NULL, '2020-09-25 15:40:39', '2020-09-25 15:40:39'),
(5309, 2037, 9220, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-25 16:50:30', '2020-09-25 16:50:30'),
(5310, 2037, 9220, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Filled out provider enrollment form and emailed to kmoten@humana.com with DEA,COI.', NULL, NULL, '2020-09-25 17:01:49', '2020-09-25 17:01:49'),
(5311, 2037, 9220, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Got the confirmation of receiving over the secure email:  -------------- This application has been submitted for processing. Please allow 90 days.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana', NULL, NULL, '2020-09-28 09:27:55', '2020-09-28 09:27:55'),
(5312, 2037, 9220, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent.', NULL, NULL, '2020-10-22 13:02:20', '2020-10-22 13:02:20'),
(5313, 2037, 9220, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Follow up email sent to K-Moten.Turn around 90 days', NULL, NULL, '2020-10-23 10:35:40', '2020-10-23 10:35:40'),
(5314, 2037, 9220, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent.', NULL, NULL, '2020-11-09 18:02:30', '2020-11-09 18:02:30'),
(5315, 2037, 9220, NULL, '2020-12-03 00:00:00.000', 'In Process', 'Currently in process.Need to allow more time.', NULL, NULL, '2020-11-16 12:53:22', '2020-11-16 12:53:22'),
(5316, 1006, 9220, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Sent a follow-up email to Katherine @ KMoten4@humana.com', NULL, NULL, '2020-12-03 10:42:11', '2020-12-03 10:42:11'),
(5317, 2037, 9220, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Currently being processed', NULL, NULL, '2020-12-11 17:37:49', '2020-12-11 17:37:49'),
(5318, 2037, 9220, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Response received from Katherine Moten. Yes this provider is showing affiliated with that TIN, eff: 10/22/20.However the provider is still in the process of being certified. Need to allow 90 days for the process to be completed. Submitted location addition request to add all three to HGBProviderRosters@humana.com: -------------------------------------- Greetings!  We need to add all three mentioned locations to the below provider exactly the same way they are set up for the below mentioned TIN.Kindly find the attached roster.  Provider Name: Mary Gonzalez NPI# 1952713083 TIN# 46-0575924   1) 500 E Caesar Ave, (Physical & Billing Address) Kingsville, TX 78363 (O)361.516.0800 (F)361.516.0855  2) 4042 River Hill Dr. (Physical Address) Corpus Christi, TX 78410 (O)361.933.5187 (F) 361.933.5189 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  3) 6646 S. Staples #122 (Physical Address) Corpus Christi, TX 78413 (O)361.334.2023 (F) 361.334.2025 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363   Please let me know if you need any further information.', NULL, NULL, '2020-12-17 16:45:58', '2020-12-17 16:45:58'),
(5319, 2037, 9220, NULL, '2021-01-05 00:00:00.000', 'Approved', 'As per live call confirmation Mary is completely certified as of 10/22/2020 with Kingsville and Staples added. Snapshot updated in EMRBS. Welcome letter is in the process to be mailed out.', NULL, NULL, '2020-12-29 15:31:41', '2020-12-29 15:31:41'),
(5320, 1006, 9221, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 17:17:55', '2020-09-25 17:17:55'),
(5321, 1006, 9221, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Submitted online application via online Join The Network application. ', NULL, NULL, '2020-09-25 17:18:22', '2020-09-25 17:18:22'),
(5322, 1006, 9221, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Your application is currently being reviewed by a member of Beacon\'s onboarding team.  You will be contacted in the event that more information is required. Your application was submitted on 09/25/2020 at 06:13:12 PM EST ', NULL, NULL, '2020-10-06 09:50:10', '2020-10-06 09:50:10'),
(5323, 1006, 9221, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Received following status update from Beacon Health Status Tool:  \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. Your application was submitted on 09/25/2020 at 06:13:12 PM EST\" ', NULL, NULL, '2020-10-20 14:24:03', '2020-10-20 14:24:03'),
(5324, 1006, 9221, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Received following update:  \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.\"', NULL, NULL, '2020-10-28 17:40:21', '2020-10-28 17:40:21'),
(5325, 1006, 9221, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com:  \"Hello,   I hope you\'re doing well, I wanted to follow-up on the status of enrollment for the following providers as it\'s been close to 90~120 days since the request for their enrollment was submitted:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Erin Oliva NPI# 1407349632  TIN# 83-4482753  Please get back to me ASAP and expedite the request as we are getting quite a few patients that we aren\'t able to see due to this delay.  Thank you.\"', NULL, NULL, '2020-11-13 18:23:22', '2020-11-13 18:23:22'),
(5326, 1006, 9221, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received following reply from Kayla @ provider.relations@beaconhealthoptions.com:  \"Good afternoon,  Both application for the below providers are still in process. I have provided the number of days this has been in process so far.   Jennifer Ullrich:          75 business days Erin Oliva:                  36 business days  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-11-16 14:52:25', '2020-11-16 14:52:25'),
(5327, 1006, 9221, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received following update from Provider Enrollment website: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.\"', NULL, NULL, '2020-11-25 11:59:15', '2020-11-25 11:59:15'),
(5328, 1006, 9221, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com.  Sub: Provider Enrollment Status - SNBCare', NULL, NULL, '2020-12-18 15:52:17', '2020-12-18 15:52:17'),
(5329, 1006, 9221, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Request is still processing, need to allow more time. Expected time-frame 90 business days but rep said he would get the request re-evaluated as well.  Ref# 12292020-0058739 Rep: John N ', NULL, NULL, '2020-12-29 18:03:54', '2020-12-29 18:03:54'),
(5330, 1006, 9221, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Called Beacon but wasn\'t able to reach anyone, requested a call back from them. ', NULL, NULL, '2021-01-15 17:05:28', '2021-01-15 17:05:28'),
(5331, 1006, 9221, NULL, '2021-02-01 00:00:00.000', 'In Process', 'The request still on day 83, needs to allow more time for processing.  Ref# 01202021-0292859', NULL, NULL, '2021-01-20 13:07:36', '2021-01-20 13:07:36'),
(5332, 1006, 9221, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:20:01', '2021-02-11 15:20:01'),
(5333, 1006, 9221, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:08:49', '2021-03-03 18:08:49'),
(5334, 1019, 9221, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:44:54', '2021-03-23 10:44:54'),
(5335, 1019, 9221, NULL, '2021-04-14 00:00:00.000', 'In Process', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-07 08:47:01', '2021-04-07 08:47:01'),
(5336, 1019, 9221, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:08:10', '2021-04-14 07:08:10'),
(5337, 1019, 9221, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-04-14 08:11:11', '2021-04-14 08:11:11'),
(5338, 1019, 9221, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:55:06', '2021-04-22 15:55:06'),
(5339, 1019, 9221, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:47:02', '2021-05-03 12:47:02'),
(5340, 1019, 9221, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:32:29', '2021-05-20 08:32:29'),
(5341, 1019, 9221, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:19:33', '2021-06-05 11:19:33'),
(5342, 1019, 9221, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:03:19', '2021-06-24 08:03:19'),
(5343, 1019, 9221, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:23:39', '2021-08-24 11:23:39'),
(5344, 1019, 9221, NULL, '2021-09-02 00:00:00.000', 'Approved', 'Welcome Letter Attached, effective date 08/13/2021', NULL, NULL, '2021-08-26 10:24:08', '2021-08-26 10:24:08'),
(5345, 2027, 9222, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 17:49:28', '2020-09-25 17:49:28'),
(5346, 2027, 9222, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Provider is now in enrollment process with medicare it may take 30 days to be completed:   Application Tracking ID: T092520200003038        NPI: 1861914053        Medicare ID: 870959, 887015        Name: DEBORAH  POTTER          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-09-25 17:51:00', '2020-09-25 17:51:00'),
(5347, 2027, 9222, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 09/01/2020', NULL, NULL, '2020-10-02 14:05:56', '2020-10-02 14:05:56'),
(5348, 1006, 9223, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 17:57:05', '2020-09-25 17:57:05'),
(5349, 1006, 9223, NULL, '2020-10-02 00:00:00.000', 'Initiated', 'Submitted enrollment request via Magellan website. ', NULL, NULL, '2020-09-25 17:59:12', '2020-09-25 17:59:12'),
(5350, 1006, 9223, NULL, '2020-10-13 00:00:00.000', 'In Process', 'Sent a follow-up email to Judy for Melody\'s status as well.  ', NULL, NULL, '2020-10-06 10:18:21', '2020-10-06 10:18:21'),
(5351, 1006, 9223, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent another follow-up email to Judith @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> ', NULL, NULL, '2020-10-14 17:45:40', '2020-10-14 17:45:40'),
(5352, 1006, 9223, NULL, '2020-10-22 00:00:00.000', 'In Process', 'The provider is in the credentialing process. They were added to the roster 9/25/2020 and they are in process to be credentialed.  ', NULL, NULL, '2020-10-15 18:09:34', '2020-10-15 18:09:34'),
(5353, 1006, 9223, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> regarding the status of enrollment. ', NULL, NULL, '2020-10-28 17:34:08', '2020-10-28 17:34:08'),
(5354, 1006, 9223, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent another follow-up email to Judy @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> : \"Good morning Judy,   I hope you\'re doing well, I wanted to check in again with you regarding the status of enrollment for the following providers:   Provider Name: Jessica Hartman  NPI# 1326665472  Provider Name: Erin Oliva NPI# 1407349632  Also regarding Melody L\'Etoile, she has her LICSW license now, how can I re-initiate her enrollment request?  Thanks. \"', NULL, NULL, '2020-11-09 10:53:47', '2020-11-09 10:53:47'),
(5355, 1006, 9223, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Received following reply from Judy: \"Please send me a copy of her license and I will attempt to get her started again.\"  License sent to her to re-initiate request. ', NULL, NULL, '2020-11-12 18:49:36', '2020-11-12 18:49:36'),
(5356, 1006, 9223, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Sent a follow-up email to Judy @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com ', NULL, NULL, '2020-11-19 18:06:25', '2020-11-19 18:06:25'),
(5357, 1006, 9223, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received following update from Judith:  \"The provider is in process, She will not be completed in this month. I also noticed that the malpractice insurance will expire soon can you send the updated malpractice if you have it. That will create another hesitation in getting the provider completed.\"', NULL, NULL, '2020-11-20 09:22:03', '2020-11-20 09:22:03'),
(5358, 1006, 9223, NULL, '2020-12-07 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-30 15:28:38', '2020-11-30 15:28:38'),
(5359, 1006, 9223, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent an email to Judith with the updated malpractice attached. ', NULL, NULL, '2020-11-30 16:36:34', '2020-11-30 16:36:34'),
(5360, 1006, 9223, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Sent a follow-up to Judith regarding the updated status. ', NULL, NULL, '2020-12-07 17:17:08', '2020-12-07 17:17:08'),
(5361, 1006, 9223, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Received following reply from Judith:  \"Good Afternoon,  The providers record is being reviewed by committee. The provider should be completed in about 2 weeks.\"', NULL, NULL, '2020-12-08 17:31:37', '2020-12-08 17:31:37'),
(5362, 1006, 9223, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com ', NULL, NULL, '2020-12-21 14:59:35', '2020-12-21 14:59:35'),
(5363, 1006, 9223, NULL, '2020-12-28 00:00:00.000', 'Approved', 'Received following reply from Judith: \"The provider has been linked to your group effective date 12/9/2020.\"', NULL, NULL, '2020-12-21 17:18:45', '2020-12-21 17:18:45'),
(5364, 1006, 9224, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-25 18:05:01', '2020-09-25 18:05:01'),
(5365, 1006, 9224, NULL, '2020-10-02 00:00:00.000', 'Initiated', 'Request initiated via Magellan website.', NULL, NULL, '2020-09-25 18:05:18', '2020-09-25 18:05:18'),
(5366, 1006, 9224, NULL, '2020-10-13 00:00:00.000', 'In Process', 'Sent a follow-up email to Judith regarding status of enrollment. ', NULL, NULL, '2020-10-06 10:15:54', '2020-10-06 10:15:54'),
(5367, 1006, 9224, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent another follow-up email to Judith @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> ', NULL, NULL, '2020-10-14 17:45:30', '2020-10-14 17:45:30'),
(5368, 1006, 9224, NULL, '2020-10-22 00:00:00.000', 'In Process', 'The provider has to go through the credentialing process.  The only time you would be waiting up to 30 days is if the provider was already credentialed. The provider was not credentialed when added to the roster.  The process for initial credentialing can be anywhere from 90-180 days.  ', NULL, NULL, '2020-10-15 18:09:47', '2020-10-15 18:09:47'),
(5369, 1006, 9224, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> regarding the status of enrollment. ', NULL, NULL, '2020-10-28 17:34:15', '2020-10-28 17:34:15'),
(5370, 1006, 9224, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent another follow-up email to Judy @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> : \"Good morning Judy,   I hope you\'re doing well, I wanted to check in again with you regarding the status of enrollment for the following providers:   Provider Name: Jessica Hartman  NPI# 1326665472  Provider Name: Erin Oliva NPI# 1407349632  Also regarding Melody L\'Etoile, she has her LICSW license now, how can I re-initiate her enrollment request?  Thanks. \"', NULL, NULL, '2020-11-09 10:53:37', '2020-11-09 10:53:37'),
(5371, 1006, 9224, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Received following reply from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  \"Good Morning,   Provider Name: Erin Oliva: This provider has been linked to our group effective date 10/26/2020 NPI# 1407349632\" ', NULL, NULL, '2020-11-09 13:00:34', '2020-11-09 13:00:34'),
(5372, 1006, 9225, NULL, NULL, 'New/Not Initiated', 'You have successfully submitted your application. Please print a copy of this page for your records. Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273.  ', NULL, NULL, '2020-09-28 18:07:50', '2020-09-28 18:07:50'),
(5373, 1006, 9225, NULL, '2020-10-05 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2020-09-28 18:07:54', '2020-09-28 18:07:54'),
(5374, 1006, 9225, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent a follow-up email to Behavioral Contracting BehavioralContracting@Cigna.com> regarding status inquiry. ', NULL, NULL, '2020-10-06 13:32:08', '2020-10-06 13:32:08'),
(5375, 1006, 9225, NULL, '2020-10-14 00:00:00.000', 'In Process', 'Received following reply:  \"Hello,  Thank you for applying to the Cigna Behavioral Network of practitioners - The online screening form has been received. A Cigna recruiter, will contact the credentialing email address to assist with completing the remaining steps of our onboarding process via email/phone within 20 business days from your submission date.  Next steps in the onboarding process will include:  · CAQH Account Verification: all data must be current and valid (see below for more information on CAQH account requirements)  · Electronic Onboarding Packet/Agreement: Completion of our electronic onboarding packet (this will be sent to you via email after I confirm that your CAQH account is current)\"', NULL, NULL, '2020-10-07 09:47:50', '2020-10-07 09:47:50'),
(5376, 1006, 9225, NULL, '2020-10-16 00:00:00.000', 'Rejected', 'Dear Melody L\'Etoile, Thank you for your interest in Cigna\'s behavioral provider network. Although Cigna\'s network is always open to new providers, we develop specialized networks for our participants. At present, network needs are based upon multiple criteria including: 1) the demographics of current membership in your area; 2) potential new business growth; and 3) our contracting and credentialing requirements.  After a thorough assessment, you do not meet our minimum requirements.  Thank you again for your interest in Cigna,  Sincerely, Cigna Behavioral Credentialing ', NULL, NULL, '2020-10-09 10:52:20', '2020-10-09 10:52:20'),
(5377, 1006, 9225, NULL, NULL, 'Revalidation', NULL, NULL, NULL, '2021-02-01 12:05:21', '2021-02-01 12:05:21'),
(5378, 1006, 9225, NULL, NULL, 'Revalidated', 'Executed Contract received from Cigna, provider has been enrolled under SNBC-RI. ', NULL, NULL, '2021-02-01 12:06:11', '2021-02-01 12:06:11'),
(5379, 1006, 9226, NULL, NULL, 'New/Not Initiated', 'You have successfully submitted your application. Please print a copy of this page for your records. Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273.', NULL, NULL, '2020-09-28 18:19:03', '2020-09-28 18:19:03'),
(5380, 1006, 9226, NULL, '2020-10-08 00:00:00.000', 'Rejected', 'Received following email from Cigna (behPWS@cigna.com):  \"Dear Erin Oliva, Thank you for your interest in Cigna\'s behavioral provider network. Although Cigna\'s network is always open to new providers, we develop specialized networks for our participants. At present, network needs are based upon multiple criteria including: 1) the demographics of current membership in your area; 2) potential new business growth; and 3) our contracting and credentialing requirements.  After a thorough assessment, you do not meet our minimum requirements.  Thank you again for your interest in Cigna,  Sincerely, Cigna Behavioral Credentialing\"', NULL, NULL, '2020-10-01 17:29:07', '2020-10-01 17:29:07'),
(5381, 1019, 9226, NULL, '2021-10-06 00:00:00.000', 'Revalidation', '\'Summited Online Application through Cigna Portal.', NULL, NULL, '2021-09-29 09:33:39', '2021-09-29 09:33:39');
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
(5382, 11056, 9226, NULL, '2021-12-09 00:00:00.000', 'Revalidation', 'Email received from: Romelyn.Lucar@evernorth.com  Sub: Fwd: Evernorth Behavioral Health - Erin Oliva  Dear Erin Oliva,  CAQH ID#: 14282970  Thank you for your interest in joining the Evernorth Behavioral Health network of providers. At this time, the process is on hold because your Council for Affordable Quality Healthcare (CAQH) application is missing the following highlighted documentation.  ·         NEW USERS -  o    To create your application: https://proview.caqh.org/  o    For quick reference guide: https://proview.caqh.org/Login/Download?filename=PR-QuickRef.v2.pdf  o    For all other questions call the CAQH Helpdesk - 1.888.600.9802 or navigate to: https://www.caqh.org/solutions/caqh-proview-resources for all other available resources.  ·         AUTHORIZE ACCESS – CAQH is reporting that you have not granted Evernorth access to view your CAQH account. You must grant Evernorth permission to access your information before we can continue the credentialing process. To complete this requirement, follow these steps:  1.        On the “Authorize” page, you have two options to select which listed organization(s) you would like to receive your information.  2.        Select one and click “Save” to proceed to the next step.  3.        Click “Review & Attest”.  4.        Proceed to “Next Steps – All Users” on the next page.  ***You must re-attest anytime you have updated any information on your CAQH profile.  ·         APPLICATION RELEASE (Mandatory for all new users) - all providers new to CAQH must submit a signed copy of the “Application Release Form”. CAQH requires a signed copy to keep on file. To complete this requirement, follow these steps:  1.        Select “Documents”  2.        Under section titled “Mandatory Attestation Documents” you will find the “Application Release Form”.  3.        Click “Download”  4.        Print, sign, and upload to your CAQH profile.  5.        A how-to video is also available for assistance - https://www.youtube.com/watch?v=mKQ6Q1PImig&t=4s  ·         EXPIRED ATTESTATION – Every 120 days (180 for IL providers) you will receive a notification from CAQH Proview to re-attest that all information in your profile is still correct.  Ø  Expired Attestation Date: ************  o    To complete this requirement, follow these steps:  1.        Log in.  2.        At the home page, select “Review & Attest.”  3.        Review and update your data as needed.  4.        Click on “Attest.”  5.        Upload any applicable supporting documents.  ·         PROFESSIONAL LICENSE and DEA/CDS (Prescribers Only) – Current expiration date must be at least 60 days from the receipt of this communication.  Ø  State License expiration date: ***********  Ø  DEA expiration date: ***********  ·         EDUCATION MISSING - Evernorth requires ALL Graduate education information be completed in CAQH. Must include the following:    o    Highest Level of Education –including School Name, Degree, Start date & End date  o    Prescribers – Must include Internship/Residency/Fellowship information.  o    Specialty Information – including Primary Specialty  ·         PROFESSIONAL LIABILITY INSURANCE - Current expiration date must be at least 60 days from the receipt of this communication.  Ø  Professional Liability expiration date: 12/01/21  ·         WORK HISTORY GAP - to be compliant with Evernorth\'s credentialing standards you must demonstrate the following:  o    Five years of consecutive work history with no gaps of more than 6 months. Education can substitute for work history, if appropriate.  o    An explanation must be included in the Work Gap Explanation field for any work history gaps more than 6 months.  Ø  Work History Gap showing in CAQH - ************  ·         Resume and CV  o    Work history and Education can be accepted via CV/Resume as long as it is dated within the last 2 years.  You must complete the above to continue the credentialing process with Evernorth. If you have any questions about the application, contact CAQH directly at 1.888.600.9802.   Thank you,        +  ROMELYN LUCAR  Provider Relations Associate Analyst, Behavioral Health  EVERNORTH.COM', NULL, NULL, '2021-12-02 17:48:41', '2021-12-02 17:48:41'),
(5383, 11056, 9226, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Rep: Marisa M  Status:  The address is updated will take 30 business days. Asked the rep to email us the location update.  Ref code: marisam12082021', NULL, NULL, '2021-12-09 10:34:31', '2021-12-09 10:34:31'),
(5384, 19067, 9226, NULL, '2022-02-11 00:00:00.000', 'Revalidated', 'Spoke with Nick @800-926-2273. Got the effective date as of 12/28/2021. See attachment for provides directory. Ref# NichH02042022', NULL, NULL, '2022-02-04 11:43:10', '2022-02-04 11:43:10'),
(5385, 2037, 9227, NULL, NULL, 'New/Not Initiated', 'Initiated!', NULL, NULL, '2020-09-29 14:31:26', '2020-09-29 14:31:26'),
(5386, 2037, 9227, NULL, '2020-10-20 00:00:00.000', 'In Process', ' Submitted new application to get the Group on board with S&W.Submission identifier is: 1bb8bfe6-7a46-4c0a-974a-c282e3e61564', NULL, NULL, '2020-09-29 14:32:12', '2020-09-29 14:32:12'),
(5387, 2037, 9227, NULL, '2021-05-31 00:00:00.000', 'On Hold', 'Received response from Scott & White stating that the application will not be considered for group on-boarding at  this time based on the current network needs and suggested to re apply after six months. Reference email as follows. ------------------------ Dear Best Health Urgent Care & Clinic  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 09/28/2020,  SWHP and FirstCare regretfully declines to contract with Best Health Urgent Care & Clinic  at 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,', NULL, NULL, '2020-10-07 09:43:12', '2020-10-07 09:43:12'),
(5388, 2037, 9227, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'Received response from Scott & White stating that the application will not be considered for group on-boarding at  this time based on the current network needs and suggested to re apply after six months. ', NULL, NULL, '2020-10-09 09:23:13', '2020-10-09 09:23:13'),
(5389, 1006, 9227, NULL, '2021-06-28 00:00:00.000', 'On Hold', 'We cannot proceed with this enrollment until Dr. Segun has been enrolled with Scott & White, as he is the supervising physician for the group.  ', NULL, NULL, '2021-06-21 09:39:14', '2021-06-21 09:39:14'),
(5390, 2037, 9228, NULL, NULL, 'New/Not Initiated', 'Re-credentialing Initiated.', NULL, NULL, '2020-09-30 11:03:43', '2020-09-30 11:03:43'),
(5391, 2037, 9228, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received request for Re-credentialing for Jennifer Tudor from Multi Plan. Filled the application packet received from Kristy along with the CAQH state application and submitted back to registrar@multiplan.com.', NULL, NULL, '2020-09-30 11:05:08', '2020-09-30 11:05:08'),
(5392, 2037, 9228, NULL, '2020-10-07 00:00:00.000', 'In Process', 'reference Email: Greetings, Kindly find the attached completed re-credentialing application for the below mentioned provider along with the CAQH State application form. Jennifer M Tudor MultiPlan ID# 13627725301 S HILLSIDE DR STE 4 County BEE BEEVILLE , TX 78102-5324  Feel free to contact me for any additional information.', NULL, NULL, '2020-09-30 11:06:46', '2020-09-30 11:06:46'),
(5393, 2037, 9228, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Case # 7372885.', NULL, NULL, '2020-09-30 11:48:44', '2020-09-30 11:48:44'),
(5394, 2037, 9228, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Per live call to Multiplan  the application  is currently being processed with no further requirements as of yet. Rep: Jane', NULL, NULL, '2020-10-29 10:01:19', '2020-10-29 10:01:19'),
(5395, 2037, 9228, NULL, '2020-12-23 00:00:00.000', 'In Process', 'As per the live call the re-credentialing is still in process need to allow more time Case # 7372885.', NULL, NULL, '2020-11-23 13:26:16', '2020-11-23 13:26:16'),
(5396, 2037, 9228, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-23 17:15:07', '2020-12-23 17:15:07'),
(5397, 2037, 9228, NULL, '2021-01-06 00:00:00.000', 'Approved', 'As per live call to Multi Jennifer\'s re credentialing has been approved and effective as of 12/11/2020. Next re credentialing will be 09/10/2023', NULL, NULL, '2020-12-30 13:53:14', '2020-12-30 13:53:14'),
(5398, 1006, 9228, NULL, NULL, 'Revalidation', 'For notation purposes, as this is a re-validation request as the provider was already credentialed.', NULL, NULL, '2020-12-30 16:51:42', '2020-12-30 16:51:42'),
(5399, 1006, 9228, NULL, NULL, 'Revalidated', 'For notation purposes, as this is a re-validation request as the provider was already credentialed. Eff: 12/11/2020', NULL, NULL, '2020-12-30 16:52:02', '2020-12-30 16:52:02'),
(5400, 1006, 9229, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-30 16:03:06', '2020-09-30 16:03:06'),
(5401, 1006, 9229, NULL, '2020-10-07 00:00:00.000', 'Initiated', 'Hello,  Please find the attached applications for enrollments for the two providers, please let me know if you have any questions or if anything else is needed. Thanks. ', NULL, NULL, '2020-09-30 16:03:26', '2020-09-30 16:03:26'),
(5402, 1006, 9229, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent a followup email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> regarding status. ', NULL, NULL, '2020-10-07 18:14:02', '2020-10-07 18:14:02'),
(5403, 1006, 9229, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Sent a followup email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com>:  \"Hello,   I want to get an update regarding the credentialing/contracting status for the above-mentioned providers, please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2020-10-20 14:30:08', '2020-10-20 14:30:08'),
(5404, 1006, 9229, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received following update from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com>:  \"incident number - PPO0068471   Hello Brad,   We apologize for the delay in responding to your email. Due to a backlog, the applications for Erin Oliva and Melody L\'etoile were received on 10/15/2020 and are in process. We ask to allow at least 30-45 business days to process the applications.  Thank you so much for your patience.\"', NULL, NULL, '2020-10-27 10:29:47', '2020-10-27 10:29:47'),
(5405, 1006, 9229, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Received following reply from Allison Morris Allison_Morris@tufts-health.com: \"Hi Brad,  We received the provider application for Melody L’Etoile, LCSW. Unfortunately we cannot extend a contract for this provider as we can only contract with LICSWs.   Thank you, _____________________________________ Allison Morris Associate Contract Specialist, Behavioral Health Services Allied Health Contracting Tufts Health Plan 705 Mt. Auburn Street, MS 84 Watertown, MA 02472 P: 617-972-9400 ext 56009 | F: 617-673-0909\"  Sent reply to her:  \"Hey Allison,   Would we be able to set-up a supervisory protocol for our provider or something else during the pandemic that would allow our LCSW\'s to provide their services?  Thank you. \"', NULL, NULL, '2020-11-02 15:27:38', '2020-11-02 15:27:38'),
(5406, 1006, 9229, NULL, '2020-11-10 00:00:00.000', 'Rejected', 'Received following reply from Allison: \"Hi Brad,  I checked with the contract manager and unfortunately we cannot make an exception or create a special arrangement.   Thank you, _____________________________________  Allison Morris Associate Contract Specialist, Behavioral Health Services Allied Health Contracting Tufts Health Plan 705 Mt. Auburn Street, MS 84 Watertown, MA 02472 P: 617-972-9400 ext 56009 | F: 617-673-0909\"', NULL, NULL, '2020-11-03 13:04:42', '2020-11-03 13:04:42'),
(5407, 1006, 9229, NULL, NULL, 'Revalidation', 'The provider has been enrolled: \"incident number - PPO0074495   Hello   Melody L\'Etoile, LICSW is all set, effective 12.31.2020.  ID 648533   Thank you Provider Operations Ref:MSG6380204\"', NULL, NULL, '2021-01-18 13:30:16', '2021-01-18 13:30:16'),
(5408, 1006, 9229, NULL, NULL, 'Revalidated', 'The provider has been enrolled: \"incident number - PPO0074495   Hello   Melody L\'Etoile, LICSW is all set, effective 12.31.2020.  ID 648533   Thank you Provider Operations Ref:MSG6380204\"', NULL, NULL, '2021-01-18 13:30:22', '2021-01-18 13:30:22'),
(5409, 1006, 9230, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-30 16:03:07', '2020-09-30 16:03:07'),
(5410, 1006, 9230, NULL, '2020-10-07 00:00:00.000', 'Initiated', 'Hello,  Please find the attached applications for enrollments for the two providers, please let me know if you have any questions or if anything else is needed. Thanks. ', NULL, NULL, '2020-09-30 16:03:30', '2020-09-30 16:03:30'),
(5411, 1006, 9230, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent a followup email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> regarding status. ', NULL, NULL, '2020-10-07 18:14:08', '2020-10-07 18:14:08'),
(5412, 1006, 9230, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Sent a followup email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com>:  \"Hello,   I want to get an update regarding the credentialing/contracting status for the above-mentioned providers, please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2020-10-20 14:30:02', '2020-10-20 14:30:02'),
(5413, 1006, 9230, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received following update from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com>:  \"incident number - PPO0068471   Hello Brad,   We apologize for the delay in responding to your email. Due to a backlog, the applications for Erin Oliva and Melody L\'etoile were received on 10/15/2020 and are in process. We ask to allow at least 30-45 business days to process the applications.  Thank you so much for your patience.\"', NULL, NULL, '2020-10-27 10:28:26', '2020-10-27 10:28:26'),
(5414, 1006, 9230, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent a follow-up email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> regarding updated status. ', NULL, NULL, '2020-11-03 18:13:04', '2020-11-03 18:13:04'),
(5415, 1006, 9230, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Received following email from Tufts: \"Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.     If you make any changes to the contract document we will not be able to process your contract for you.     You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591     Once we are in receipt of your completed contract, the credentialing process will begin.       Thank you\"', NULL, NULL, '2020-11-10 18:01:49', '2020-11-10 18:01:49'),
(5416, 1006, 9230, NULL, '2020-11-18 00:00:00.000', 'In Process', 'The contract signed and sent back to Tufts Credentialing. Attached copy for reference. ', NULL, NULL, '2020-11-11 17:49:51', '2020-11-11 17:49:51'),
(5417, 1006, 9230, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received following email from Tufts: \"incident number - PPO0072609   Hi,   I show that a contract was sent on 11/4 via email. Once returned credentialing will begin and it typically takes 2-3 weeks.   Thank you   Ref:MSG6110176\"', NULL, NULL, '2020-11-12 11:37:26', '2020-11-12 11:37:26'),
(5418, 1006, 9230, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received email from Tufts requesting sign of Provider, sent signed document:  \"Here you go. How long will it take to get the provider added?   Thanks. \"', NULL, NULL, '2020-11-18 17:50:57', '2020-11-18 17:50:57'),
(5419, 1006, 9230, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent a followup email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com: \"Hello,   I wanted to check in on this request and to know what the expected time-frame is for the enrollment?  Thanks.\" ', NULL, NULL, '2020-11-25 17:08:45', '2020-11-25 17:08:45'),
(5420, 1006, 9230, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Received following reply from Tufts: \"Hi Brad   I would check in with us in about a 1-2 weeks for a status on Erin Olivia.   Thanks   Provider Operations\"', NULL, NULL, '2020-12-04 18:03:17', '2020-12-04 18:03:17'),
(5421, 1006, 9230, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com. ', NULL, NULL, '2020-12-17 16:52:50', '2020-12-17 16:52:50'),
(5422, 1006, 9230, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Sent another follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com ', NULL, NULL, '2020-12-24 14:01:13', '2020-12-24 14:01:13'),
(5423, 1006, 9230, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com', NULL, NULL, '2020-12-29 11:00:53', '2020-12-29 11:00:53'),
(5424, 1006, 9230, NULL, '2021-01-07 00:00:00.000', 'Rejected', 'Received following reply from Tufts @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com: \"incident number - PPO0072768   Hello   Erin Olivia, LICSW\'s application was discontinued due to not holding the required LICSW, per the Cred Specialist.   Thank you Provider Operations   Ref:MSG6318672\" ', NULL, NULL, '2020-12-31 10:19:00', '2020-12-31 10:19:00'),
(5425, 2037, 9232, NULL, NULL, 'New/Not Initiated', 'initiated', NULL, NULL, '2020-10-01 15:40:18', '2020-10-01 15:40:18'),
(5426, 2037, 9232, NULL, '2020-10-30 00:00:00.000', 'In Process', 'We are holding an Urgent Care Contract with Humana with two locations added (Kingsville & Staples) Request to add the (Callalen location) initiated back in August was disregarded as per live call to Humana as proper procedure was not followed. Submitted completed credentialing application for secondary location addition and submitted back to stxnm@humana.com.', NULL, NULL, '2020-10-01 15:43:56', '2020-10-01 15:43:56'),
(5427, 2037, 9232, NULL, '2020-10-16 00:00:00.000', 'Approved', 'Secondary Locations added.', NULL, NULL, '2020-10-09 14:29:43', '2020-10-09 14:29:43'),
(5428, 2037, 9233, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-01 16:52:20', '2020-10-01 16:52:20'),
(5429, 2037, 9233, NULL, '2020-10-08 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183. (LOCATION ADDED)', NULL, NULL, '2020-10-01 16:53:37', '2020-10-01 16:53:37'),
(5430, 19067, 9233, NULL, '2022-04-25 00:00:00.000', 'Approved', 'Sent fax to Humana for revalidation. ', NULL, NULL, '2022-04-18 11:32:41', '2022-04-18 11:32:41'),
(5431, 2037, 9234, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:41:30', '2020-10-01 17:41:30'),
(5432, 2037, 9234, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI: 353308509 eff: 07/20/2018', NULL, NULL, '2020-10-01 17:42:24', '2020-10-01 17:42:24'),
(5433, 2037, 9235, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:41:47', '2020-10-01 17:41:47'),
(5434, 2037, 9235, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI: 353308509 eff: 07/20/2018 (Location Added)', NULL, NULL, '2020-10-01 17:45:16', '2020-10-01 17:45:16'),
(5435, 2037, 9236, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:46:53', '2020-10-01 17:46:53'),
(5436, 2037, 9236, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI# 285068703 (Location Added)', NULL, NULL, '2020-10-01 17:48:06', '2020-10-01 17:48:06'),
(5437, 2037, 9237, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:47:09', '2020-10-01 17:47:09'),
(5438, 2037, 9237, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI# 285068703 (Location Added)', NULL, NULL, '2020-10-01 17:48:21', '2020-10-01 17:48:21'),
(5439, 2037, 9238, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:51:32', '2020-10-01 17:51:32'),
(5440, 2037, 9238, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI: 286629506 eff: 10/31/2018 (Location Added)', NULL, NULL, '2020-10-01 17:52:33', '2020-10-01 17:52:33'),
(5441, 2037, 9239, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:51:50', '2020-10-01 17:51:50'),
(5442, 2037, 9239, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI: 286629506 eff: 10/31/2018 (Location Added)', NULL, NULL, '2020-10-01 17:53:04', '2020-10-01 17:53:04'),
(5443, 2037, 9240, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:55:25', '2020-10-01 17:55:25'),
(5444, 2037, 9240, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI: 372356105 (Location Added)', NULL, NULL, '2020-10-01 17:56:43', '2020-10-01 17:56:43'),
(5445, 2037, 9241, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-01 17:55:45', '2020-10-01 17:55:45'),
(5446, 2037, 9241, NULL, '2020-10-08 00:00:00.000', 'Approved', 'TPI: 372356105 (Location Added)', NULL, NULL, '2020-10-01 17:56:47', '2020-10-01 17:56:47'),
(5447, 2037, 9242, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 09:09:43', '2020-10-02 09:09:43'),
(5448, 2037, 9242, NULL, '2020-10-09 00:00:00.000', 'Approved', 'TPI: 384883002  eff: 06/08/2018 (Location Added)', NULL, NULL, '2020-10-02 09:10:39', '2020-10-02 09:10:39'),
(5449, 2037, 9243, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 09:09:44', '2020-10-02 09:09:44'),
(5450, 2037, 9243, NULL, '2020-10-09 00:00:00.000', 'Approved', 'TPI: 384883002  eff: 06/08/2018 (Location Added)', NULL, NULL, '2020-10-02 09:10:45', '2020-10-02 09:10:45'),
(5451, 2037, 9244, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 09:22:40', '2020-10-02 09:22:40'),
(5452, 2037, 9244, NULL, '2020-10-09 00:00:00.000', 'Approved', 'TPI: 407035101  eff: 10/10/2019 (Location Added)', NULL, NULL, '2020-10-02 09:25:11', '2020-10-02 09:25:11'),
(5453, 2037, 9245, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 09:22:51', '2020-10-02 09:22:51'),
(5454, 2037, 9245, NULL, '2020-10-09 00:00:00.000', 'Approved', 'TPI: 407035101  eff: 10/10/2019 (Location Added)', NULL, NULL, '2020-10-02 09:25:17', '2020-10-02 09:25:17'),
(5455, 2037, 9246, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 09:26:43', '2020-10-02 09:26:43'),
(5456, 2037, 9246, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Ticket # 17019727 Status: Approved. (Location Added)', NULL, NULL, '2020-10-02 09:30:04', '2020-10-02 09:30:04'),
(5457, 2037, 9247, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 09:27:02', '2020-10-02 09:27:02'),
(5458, 2037, 9247, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Ticket # 17019727 Status: Approved. (Location Added)', NULL, NULL, '2020-10-02 09:30:10', '2020-10-02 09:30:10'),
(5459, 1006, 9248, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 10:54:58', '2020-10-02 10:54:58'),
(5460, 1006, 9248, NULL, '2020-10-09 00:00:00.000', 'Initiated', '  Application Tracking ID: T100220200001233        NPI: 1326665472        Medicare ID:         Name: JESSICA  HARTMAN          State: RI        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149', NULL, NULL, '2020-10-02 10:55:13', '2020-10-02 10:55:13'),
(5461, 1006, 9248, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Received following status update from NGS:  \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000101570	 CMS855I Web	 10/02/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-10-15 18:07:51', '2020-10-15 18:07:51'),
(5462, 1006, 9248, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Request still shows up as in process:  \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000101570	 CMS855I Web	 10/02/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\" ', NULL, NULL, '2020-10-28 17:36:51', '2020-10-28 17:36:51'),
(5463, 1006, 9248, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Received following email from Medicare:  \"To:  jlh6690@gmail.com,snbc@claimsmedinc.com   Subject:  Request for Corrections for Medicare Enrollment Application (Tracking ID: T100220200001233)  Date:   11/06/2020 12:06 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 T100220200001233. The information provided below indicates areas of your application requiring corrections as determined by your fee-for-service contractor.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T100220200001233   NPI ID: 1326665472   Medicare ID:    Name: JESSICA HARTMAN   State: RI  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Other Comments  **Please upload a copy of the provider\'s Master\'s or Doctor\'s degree/diploma.\"  Sent Master Degree via PECOS online attachment. ', NULL, NULL, '2020-11-06 13:37:33', '2020-11-06 13:37:33'),
(5464, 1006, 9248, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Received the following email from Medicare:  \"Application Tracking ID: T100220200001233   NPI ID: 1326665472   Medicare ID: U400697000   Name: JESSICA HARTMAN  State: RI   Form Type: 855I  Date: 11/09/2020  Status: APPROVED\"', NULL, NULL, '2020-11-09 09:29:58', '2020-11-09 09:29:58'),
(5465, 2027, 9249, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 13:10:29', '2020-10-02 13:10:29'),
(5466, 2027, 9249, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now re-credentialed with the insurance in all three locations of VMUC.  The effective date is 10/01/2020', NULL, NULL, '2020-10-02 13:25:33', '2020-10-02 13:25:33'),
(5467, 2027, 9250, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 13:50:10', '2020-10-02 13:50:10'),
(5468, 2027, 9250, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now re-credentialed with the insurance in all three locations of VMUC.  The effective date is 10/01/2020', NULL, NULL, '2020-10-02 13:50:49', '2020-10-02 13:50:49'),
(5469, 2027, 9251, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 13:52:51', '2020-10-02 13:52:51'),
(5470, 2027, 9251, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now re-credentialed with the insurance in all three locations of VMUC.  The effective date is 10/01/2020', NULL, NULL, '2020-10-02 13:53:20', '2020-10-02 13:53:20'),
(5471, 2027, 9252, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 14:18:48', '2020-10-02 14:18:48'),
(5472, 2027, 9252, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 09/01/2020', NULL, NULL, '2020-10-02 14:19:05', '2020-10-02 14:19:05'),
(5473, 2027, 9253, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 14:22:34', '2020-10-02 14:22:34'),
(5474, 2027, 9253, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 09/01/2020', NULL, NULL, '2020-10-02 14:22:58', '2020-10-02 14:22:58'),
(5475, 2027, 9254, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 17:44:40', '2020-10-02 17:44:40'),
(5476, 2027, 9254, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid and effective date is 08/01/2020 ', NULL, NULL, '2020-10-02 17:45:03', '2020-10-02 17:45:03'),
(5477, 2027, 9255, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-02 17:48:56', '2020-10-02 17:48:56'),
(5478, 2027, 9255, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid and effective date is 08/01/2020 ', NULL, NULL, '2020-10-02 17:49:12', '2020-10-02 17:49:12'),
(5479, 2027, 9256, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-05 12:14:10', '2020-10-05 12:14:10'),
(5480, 2027, 9256, NULL, '2020-10-12 00:00:00.000', 'In Process', 'From: KMoten4@humana.com   The following provider is not showing certified in our system. Please complete the certification process with WPS.  Thank you.  Respectfully, Katherine Moten', NULL, NULL, '2020-10-05 13:47:33', '2020-10-05 13:47:33'),
(5481, 2027, 9256, NULL, '2020-10-12 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Please find the required documents attached in this email for tricare certification of Moses Campos.  Thanks.', NULL, NULL, '2020-10-05 13:48:09', '2020-10-05 13:48:09'),
(5482, 2027, 9256, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent Certification application and other documents also by fax to (608) 221-7535 (Tricare)', NULL, NULL, '2020-10-05 13:50:57', '2020-10-05 13:50:57'),
(5483, 2027, 9256, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Campos, Moses)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,  May I know the current status of the below mentioned provider: Provider Name: Campos, Moses Provider NPI# 1558680009 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-11-02 12:17:21', '2020-11-02 12:17:21'),
(5484, 2027, 9256, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 11:01:40', '2020-11-09 11:01:40'),
(5485, 2027, 9256, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hello Katherine,  May I know the current enrollment status for all three locations of (Valley Med Urgent Care) of this below mentioned provider: Provider Name: Campos, Moses Provider NPI# 1558680009 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-11-16 10:26:18', '2020-11-16 10:26:18'),
(5486, 2027, 9256, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Please find the credentialing application attached in this email for the below mentioned provider: Provider Name: Campos, Moses   Provider NPI# 1558680009   Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-11-16 15:26:37', '2020-11-16 15:26:37'),
(5487, 2027, 9256, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  Please confirm if this below mentioned provider is showing in network in all three locations of (Valley Med Urgent Care). Provider Name: Campos, Moses Provider NPI# 1558680009 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-23 09:42:17', '2020-11-23 09:42:17'),
(5488, 2027, 9256, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Please confirm if this below mentioned provider is showing in network in all three locations of (Valley Med Urgent Care). Provider Name: Campos, Moses Provider NPI# 1558680009 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-30 15:39:48', '2020-11-30 15:39:48'),
(5489, 2037, 9256, NULL, '2020-12-17 00:00:00.000', 'In Process', 'May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1) Group Name: Columbus Urgent Care PA     Group Tax-ID: 471914151       Provider Name: Jose, Julie                Provider NPI# 1447883061     --------------------------------------- 2)  Group Name: Valley Med Urgent Care (All three locations)      Group Tax-ID: 81-5123542     Provider Name: Rodriguez, Cynthia     Provider NPI# 1124282553      Provider Name: Campos, Moses                Provider NPI# 1558680009      Provider Name: Wright, Larry Donald                Provider NPI# 1033769765', NULL, NULL, '2020-12-08 15:09:37', '2020-12-08 15:09:37'),
(5490, 3040, 9256, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 14:19:20', '2020-12-17 14:19:20'),
(5491, 3040, 9256, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Form request sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare |   Greetings,  Hope you doing well. We already sent the spreadsheet on the email that you provide.  Kindy send me the credentialing application form for Campos, Moses.  Please feel free to email me if you need anything else from my end. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-18 09:51:20', '2020-12-18 09:51:20'),
(5492, 3040, 9256, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks ', NULL, NULL, '2020-12-18 15:34:24', '2020-12-18 15:34:24'),
(5493, 3040, 9256, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks ', NULL, NULL, '2020-12-18 15:34:58', '2020-12-18 15:34:58'),
(5494, 3040, 9256, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks ', NULL, NULL, '2020-12-18 15:35:11', '2020-12-18 15:35:11'),
(5495, 3040, 9256, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Email sent to : kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||   Greetings,  Hope you are doing well.   I just wanted to know that Martin sent you the credential application form for Moses Campos on 11/16/2020. Kindly advise me the status of that request.   I really appreciate all your help. If you need further information kindly contact me or email me.   Thanks ', NULL, NULL, '2020-12-21 09:39:13', '2020-12-21 09:39:13'),
(5496, 3040, 9256, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  The Application for Moses Campos was submitted on 12/18/2020 for processing. Please allow 90 days for review. ', NULL, NULL, '2020-12-28 12:19:56', '2020-12-28 12:19:56'),
(5497, 3040, 9256, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Still in process.   The Application for Moses Campos was submitted on 12/18/2020 for processing. Please allow 90 days for review. ', NULL, NULL, '2021-01-04 10:08:01', '2021-01-04 10:08:01'),
(5498, 3040, 9256, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Follow up Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-11 14:43:49', '2021-01-11 14:43:49'),
(5499, 3040, 9256, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com,   HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-18 13:54:56', '2021-01-18 13:54:56'),
(5500, 3040, 9256, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. The two providers are already certified and the dates are mentioned below.  Practice Detail: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Can you please advise that did you received the credentialing application for below provider.  Provider 3: Provider Name: Wright, Larry Donald Provider NPI# 1033769765   Please feel free to email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:36:02', '2021-01-25 13:36:02'),
(5501, 3040, 9256, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:33:26', '2021-02-01 15:33:26'),
(5502, 3040, 9256, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:53:27', '2021-02-08 13:53:27'),
(5503, 3040, 9256, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-02-15 13:38:04', '2021-02-15 13:38:04'),
(5504, 3040, 9256, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks  ', NULL, NULL, '2021-02-22 13:35:33', '2021-02-22 13:35:33'),
(5505, 3040, 9256, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Still in process.  ', NULL, NULL, '2021-03-01 16:53:09', '2021-03-01 16:53:09'),
(5506, 3040, 9256, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-08 15:27:25', '2021-03-08 15:27:25'),
(5507, 3040, 9256, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 13:55:06', '2021-03-16 13:55:06'),
(5508, 3040, 9256, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 13:55:10', '2021-03-16 13:55:10'),
(5509, 3040, 9256, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:38', '2021-04-15 08:07:38'),
(5510, 3040, 9256, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 2: Provider Name: Campos, Moses - eff: 3/16/2021 (showing under all 3 locations) Provider NPI# 1558680009', NULL, NULL, '2021-04-15 10:26:28', '2021-04-15 10:26:28'),
(5511, 2027, 9257, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-05 15:14:33', '2020-10-05 15:14:33'),
(5512, 2027, 9257, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Medicaid is in process for this provider and the PEP Ticket# is 17262844.', NULL, NULL, '2020-10-05 15:15:32', '2020-10-05 15:15:32'),
(5513, 2027, 9257, NULL, '2020-10-23 00:00:00.000', 'New/Not Initiated', 'Provider is now linked with medicaid in all three locations of (VMUC) and effective date is 09/01/2020. Welcome letter is attached', NULL, NULL, '2020-10-16 17:42:27', '2020-10-16 17:42:27'),
(5514, 2027, 9257, NULL, '2020-10-23 00:00:00.000', 'Approved', 'Provider is now linked with medicaid in all three locations of (VMUC) and effective date is 09/01/2020. Welcome letter is attached', NULL, NULL, '2020-10-16 17:42:48', '2020-10-16 17:42:48'),
(5515, 2027, 9258, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-05 16:48:57', '2020-10-05 16:48:57'),
(5516, 2027, 9258, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Medicare railroad has been initiated for this provider and the ref# is 20269000445 ', NULL, NULL, '2020-10-05 16:50:39', '2020-10-05 16:50:39'),
(5517, 2027, 9258, NULL, '2020-11-06 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare railroad and effective date is 08/01/2020', NULL, NULL, '2020-10-30 13:14:24', '2020-10-30 13:14:24'),
(5518, 2027, 9259, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-05 16:56:50', '2020-10-05 16:56:50'),
(5519, 2027, 9259, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Medicare Railroad for this provider has been initiated and the ref# is 20279001546', NULL, NULL, '2020-10-05 16:58:05', '2020-10-05 16:58:05'),
(5520, 1005, 9259, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-10-12 14:34:36', '2020-10-12 14:34:36'),
(5521, 2027, 9259, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Request is still in process need more time to be completed.', NULL, NULL, '2020-11-02 09:32:00', '2020-11-02 09:32:00'),
(5522, 2027, 9259, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 08/01/2020. Welcome letter is attached', NULL, NULL, '2020-11-09 13:22:24', '2020-11-09 13:22:24');
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
(5523, 2027, 9260, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-06 13:24:30', '2020-10-06 13:24:30'),
(5524, 2027, 9260, NULL, '2020-10-13 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Hi Martin,     This provider is showing certified.     Please provide me a credentialing application with the following documents: DEA, License, Malpractice Insurance, CV     Thank you.', NULL, NULL, '2020-10-06 13:25:44', '2020-10-06 13:25:44'),
(5525, 2027, 9260, NULL, '2020-10-13 00:00:00.000', 'In Process', 'To: Please find the requested documents to start the credentialing process.', NULL, NULL, '2020-10-06 13:26:19', '2020-10-06 13:26:19'),
(5526, 2027, 9260, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Wright, Larry Donald)-(Valley Med Urgent Care)-(Tricare)  Hi Katherine, May I know the current enrollment status of the below mentioned provider: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542 Thanks.', NULL, NULL, '2020-11-02 13:27:51', '2020-11-02 13:27:51'),
(5527, 2027, 9260, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 17:33:15', '2020-11-09 17:33:15'),
(5528, 2027, 9260, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Katherine, May I know the current enrollment status of this below mentioned provider for all three locations of (Valley Med Urgent Care) Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542 Thanks.', NULL, NULL, '2020-11-16 10:34:12', '2020-11-16 10:34:12'),
(5529, 2027, 9260, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  Please confirm if this below mentioned provider is showing in network in all three locations of (Valley Med Urgent Care). Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542 Thanks.', NULL, NULL, '2020-11-23 09:45:54', '2020-11-23 09:45:54'),
(5530, 2027, 9260, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  Please confirm if this below mentioned provider is showing in network in all three locations of (Valley Med Urgent Care). Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542 Thanks.', NULL, NULL, '2020-11-30 15:41:43', '2020-11-30 15:41:43'),
(5531, 2037, 9260, NULL, '2020-12-17 00:00:00.000', 'In Process', 'May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1) Group Name: Columbus Urgent Care PA     Group Tax-ID: 471914151       Provider Name: Jose, Julie                Provider NPI# 1447883061     --------------------------------------- 2)  Group Name: Valley Med Urgent Care (All three locations)      Group Tax-ID: 81-5123542     Provider Name: Rodriguez, Cynthia     Provider NPI# 1124282553      Provider Name: Campos, Moses                Provider NPI# 1558680009      Provider Name: Wright, Larry Donald                Provider NPI# 1033769765', NULL, NULL, '2020-12-08 15:10:10', '2020-12-08 15:10:10'),
(5532, 3040, 9260, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 14:21:24', '2020-12-17 14:21:24'),
(5533, 3040, 9260, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.', NULL, NULL, '2020-12-18 16:39:38', '2020-12-18 16:39:38'),
(5534, 3040, 9260, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.', NULL, NULL, '2020-12-18 16:40:14', '2020-12-18 16:40:14'),
(5535, 3040, 9260, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2020-12-28 12:27:48', '2020-12-28 12:27:48'),
(5536, 3040, 9260, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Email sent to: 	HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the update on the enrollment status of below mentioned providers. We already sent the credential application form for Moses Campos.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-04 16:46:38', '2021-01-04 16:46:38'),
(5537, 3040, 9260, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Follow up Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-11 14:44:13', '2021-01-11 14:44:13'),
(5538, 3040, 9260, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com,   HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-18 13:55:36', '2021-01-18 13:55:36'),
(5539, 3040, 9260, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. The two providers are already certified and the dates are mentioned below.  Practice Detail: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Can you please advise that did you received the credentialing application for below provider.  Provider 3: Provider Name: Wright, Larry Donald Provider NPI# 1033769765   Please feel free to email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:36:17', '2021-01-25 13:36:17'),
(5540, 3040, 9260, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:34:20', '2021-02-01 15:34:20'),
(5541, 3040, 9260, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:53:32', '2021-02-08 13:53:32'),
(5542, 3040, 9260, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-02-15 13:38:20', '2021-02-15 13:38:20'),
(5543, 3040, 9260, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks  ', NULL, NULL, '2021-02-22 13:35:41', '2021-02-22 13:35:41'),
(5544, 3040, 9260, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please note the I checked the provider enrollment status on Tricare portal for below mentioned providers its shows the credentialing is completed but on Tricare provider directory its not showing up. Can you please check and advise.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Cynthia Rodriguez PA Provider NPI# 1124282553  Provider Name: Larry D Wright NP Provider NPI# 1033769765  Also I checked the provider enrollment status for the below mentioned provider its only showing in 02 locations in-process. In McAllen location provider is not showing up. Can you please check this and advise.   Provider Name: Deborah Potter NP Provider NPI# 1861914053  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 16:52:35', '2021-03-01 16:52:35'),
(5545, 3040, 9260, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Need to check the contract status from Kmoten4@humana.com.', NULL, NULL, '2021-03-08 15:20:59', '2021-03-08 15:20:59'),
(5546, 3040, 9260, NULL, '2021-03-19 00:00:00.000', 'In Process', 'still in process ', NULL, NULL, '2021-03-12 17:21:42', '2021-03-12 17:21:42'),
(5547, 3040, 9260, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Provider enrolled in Tricare.   Please see attachment. ', NULL, NULL, '2021-03-18 08:59:19', '2021-03-18 08:59:19'),
(5548, 1006, 9261, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-07 10:46:35', '2020-10-07 10:46:35'),
(5549, 1006, 9261, NULL, '2020-10-14 00:00:00.000', 'Initiated', 'Thank you for your enrollment request. Within four business days of the submission of this form, you should receive an email that will serve to confirm receipt of your request. The email will also include an attachment that contains a packet of important forms such as a provider agreement, W9, EFT instructions, etc., as well as information that will help guide you through the initial credentialing process. Those forms should be completed and returned to Database.Credentialing@bcbsri.org as soon as possible. It is important to note that your application will not be considered complete until all of the required documents have been returned. Additionally, BCBSRI utilizes the CAQH application to credential providers. It is very important to ensure that you have made your CAQH accessible to BCBSRI and updated and attested to the information in CAQH within the last 120 days. If you do not receive an email response within two days after submitting this form please email Database.Credentialing@bcbsri.org to confirm the status of your submission and request that the packet be resent to you. We appreciate your interest in joining the BCBSRI network and will work to begin prompt processing of your request. However, please note the credentialing process may be discontinued if we are unable to access your CAQH application or if your CAQH application is not updated and attested to in the required timeframe, or if you do not return the provider agreement and required forms.  ', NULL, NULL, '2020-10-07 10:46:48', '2020-10-07 10:46:48'),
(5550, 1006, 9261, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Received following email from Database Credentialing:  \"Good Morning,  Request you to return back the signed contracts & W9 form ASAP to database.Credentialing@bcbsri.org or you can fax it to 401-459-1369. Thank You  Regards Pavithra S\"', NULL, NULL, '2020-10-14 17:56:27', '2020-10-14 17:56:27'),
(5551, 1006, 9261, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Sent following email @Database Credentialing Database.Credentialing@bcbsri.org> with the requested documents:  \"Hello,   Please find the requested information and do let me know what the expected time-frame is for completion of this request?  Thank you.\"', NULL, NULL, '2020-10-20 13:06:59', '2020-10-20 13:06:59'),
(5552, 1006, 9261, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Received following update from BCBS @ Database Credentialing Database.Credentialing@bcbsri.org> :  \"Dear Provider,  Thank you for your recent request to become a participating Provider in the Blue Cross & Blue Shield of Rhode Island (BCBSRI) provider network.    Your application for participation is currently in process. we  will outreach to you directly for any information required to complete the process.  If you have, any questions please feel free to email us at Database.Credentialing@BCBSRI.org. Thank you for your cooperation.  Sincerely, BCBSRI Credentialing Department\"', NULL, NULL, '2020-10-22 15:19:15', '2020-10-22 15:19:15'),
(5553, 1006, 9261, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Received following update from Database Credentialing Database.Credentialing@bcbsri.org>:  \"Dear Provider,  Thank you for your recent request to become a participating Provider in the Blue Cross & Blue Shield of Rhode Island (BCBSRI) provider network.    Your application for participation is currently pending with the BCBSRI Credentialing Committee. Our next committee is scheduled for 11/10/2020 and we will advise you on the status once a decision has been made.  If you have any questions please feel free to email us at Database.Credentialing@BCBSRI.org.Thank you for your cooperation.  Sincerely, BCBSRI Credentialing Department\"', NULL, NULL, '2020-10-30 14:44:55', '2020-10-30 14:44:55'),
(5554, 1006, 9261, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Received following update from BCBSRI:  \"Dear Provider,  Thank you for your recent request to become a participating Provider in the Blue Cross & Blue Shield of Rhode Island (BCBSRI) provider network.    Your application for participation is currently pending with the BCBSRI Credentialing Committee. Our next committee is scheduled for 11/10/2020 and we will advise you on the status once a decision has been made.  If you have any questions please feel free to email us at Database.Credentialing@BCBSRI.org.Thank you for your cooperation.  Sincerely, BCBSRI Credentialing Department\"', NULL, NULL, '2020-11-06 16:33:23', '2020-11-06 16:33:23'),
(5555, 1006, 9261, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Sent follow-up email to Database.Credentialing@bcbsri.org regarding status of the committee. ', NULL, NULL, '2020-11-12 18:26:21', '2020-11-12 18:26:21'),
(5556, 1006, 9261, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following update from BCBS: \"Good morning,  The BCBSRI Credentialing Committee has approved your request for Participation and we are currently in the process of adding your information to our systems. You can expect to receive a welcome letter with additional information by 11/23/2020.  Regards, Loganathan R\"', NULL, NULL, '2020-11-13 11:02:02', '2020-11-13 11:02:02'),
(5557, 1006, 9261, NULL, '2020-11-23 00:00:00.000', 'Approved', '\"Good Morning..     Provider set up done in our system and Please find the attached Welcome Letter  for Provider Jessica Hartman ,NP  with signed agreements, instructions to generate Web PIN and contact sheet.     Please send email to ProvDB@BCBSRI.org of any questions or clarifications.     Thank You,  Backiyalakshmi\"', NULL, NULL, '2020-11-16 13:52:03', '2020-11-16 13:52:03'),
(5558, 2027, 9262, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-07 12:28:19', '2020-10-07 12:28:19'),
(5559, 2027, 9262, NULL, '2020-10-14 00:00:00.000', 'In Process', 'Provider is not certified yet so I have sent the certification application to the WPS by fax at (608-221-7535)', NULL, NULL, '2020-10-07 12:30:05', '2020-10-07 12:30:05'),
(5560, 2027, 9262, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Potter, Deborah)-(Valley Med Urgent Care)-(Tricare)  Hi Katherine, May I know the current enrollment status of the below mentioned provider: Provider Name: Potter, Deborah Provider NPI# 1861914053 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Thanks. ', NULL, NULL, '2020-11-02 12:47:15', '2020-11-02 12:47:15'),
(5561, 2027, 9262, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 15:53:41', '2020-11-09 15:53:41'),
(5562, 2027, 9262, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Katherine, May I know the current enrollment status of the below mentioned provider for all three locations of (Valley Med Urgent Care). Provider Name: Potter, Deborah Provider NPI# 1861914053 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Thanks. ', NULL, NULL, '2020-11-16 10:38:54', '2020-11-16 10:38:54'),
(5563, 2027, 9262, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  Please confirm if this below mentioned provider is showing in network in all three locations of (Valley Med Urgent Care). Provider Name: Potter, Deborah Provider NPI# 1861914053 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Thanks. ', NULL, NULL, '2020-11-23 09:50:02', '2020-11-23 09:50:02'),
(5564, 2027, 9262, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  Please confirm if this below mentioned provider is showing in network in all three locations of (Valley Med Urgent Care). Provider Name: Potter, Deborah Provider NPI# 1861914053 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Thanks. ', NULL, NULL, '2020-11-30 15:42:03', '2020-11-30 15:42:03'),
(5565, 2037, 9262, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent to Katherine -------------- Hello! May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1)                Group Name: Valley Med Urgent Care (All three locations)                    Group Tax-ID: 81-5123542    Provider Name: Potter, Deborah     Provider NPI# 1861914053     Provider Name: Lopez, Mayra Alejandra                   Provider NPI# 1265945125', NULL, NULL, '2020-12-08 15:27:29', '2020-12-08 15:27:29'),
(5566, 1006, 9262, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent follow-up email to Katherine Moten @ \"KMoten4@humana.com\" :  \"Hello Katherine,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider: Provider Name: Deborah Potter NPI# 1861914053 TIN# 81-5123542  Please get back to me as soon as you\'re able to.   Thanks.\" ', NULL, NULL, '2020-12-15 17:06:18', '2020-12-15 17:06:18'),
(5567, 3040, 9262, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Potter Deborah.  Kindly advise me the time frame of the enrollment process.  For further assistance please feel free to contact me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2020-12-21 14:13:20', '2020-12-21 14:13:20'),
(5568, 3040, 9262, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: 	ywyatt@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Potter Deborah.  Kindly advise me the time frame of the enrollment process.  For further assistance please feel free to contact me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2020-12-23 10:00:20', '2020-12-23 10:00:20'),
(5569, 3040, 9262, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  I hope you had a great weekend. I just wanted to know if Deborah Potter is certified?  The documents that you requested from me in your previous email are required for her credentialing process?  Please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2020-12-28 14:05:04', '2020-12-28 14:05:04'),
(5570, 3040, 9262, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Please resubmit the application with all documents: CV, DEA, Malpractice Insurance, License, W9.', NULL, NULL, '2020-12-28 17:14:12', '2020-12-28 17:14:12'),
(5571, 3040, 9262, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  I hope you had a great weekend. I just wanted to know if Deborah Potter is certified?  The documents that you requested from me in your previous email are required for her credentialing process?  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-28 17:14:51', '2020-12-28 17:14:51'),
(5572, 3040, 9262, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Yes she is certified, but now she needs to be credentialed and I need all those documents to credential this provider with Humana Military.  Need to send the requested documents. Only Resume is missing. We already requested waiting for the email.  ', NULL, NULL, '2021-01-04 15:18:29', '2021-01-04 15:18:29'),
(5573, 3040, 9262, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached the requested documents for Deborah Potter.  If you anything else please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-07 15:56:31', '2021-01-07 15:56:31'),
(5574, 3040, 9262, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  This application has been submitted for processing, please allow 90 days for review. ', NULL, NULL, '2021-01-08 15:32:05', '2021-01-08 15:32:05'),
(5575, 3040, 9262, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Potter, Deborah Provider NPI# 1861914053  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-22 14:53:33', '2021-01-22 14:53:33'),
(5576, 3040, 9262, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Good Morning,  Deborah Potter is still in the credentialing process. Please allow 90 days for processing. ( Application was submitted for processing on 1/8/2021)  ', NULL, NULL, '2021-01-25 13:54:16', '2021-01-25 13:54:16'),
(5577, 3040, 9262, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:36:04', '2021-02-01 15:36:04'),
(5578, 3040, 9262, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:53:39', '2021-02-08 13:53:39'),
(5579, 3040, 9262, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-02-15 13:38:37', '2021-02-15 13:38:37'),
(5580, 3040, 9262, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks  ', NULL, NULL, '2021-02-22 13:35:47', '2021-02-22 13:35:47'),
(5581, 3040, 9262, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please note the I checked the provider enrollment status on Tricare portal for below mentioned providers its shows the credentialing is completed but on Tricare provider directory its not showing up. Can you please check and advise.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Cynthia Rodriguez PA Provider NPI# 1124282553  Provider Name: Larry D Wright NP Provider NPI# 1033769765  Also I checked the provider enrollment status for the below mentioned provider its only showing in 02 locations in-process. In McAllen location provider is not showing up. Can you please check this and advise.   Provider Name: Deborah Potter NP Provider NPI# 1861914053  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 16:52:50', '2021-03-01 16:52:50'),
(5582, 3040, 9262, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-08 15:31:33', '2021-03-08 15:31:33'),
(5583, 3040, 9262, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 13:55:23', '2021-03-16 13:55:23'),
(5584, 3040, 9262, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:48', '2021-04-15 08:07:48'),
(5585, 3040, 9262, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 4: Provider Name: Potter, Deborah - eff: 4/13/2021 (showing under all 3 locations) Provider NPI# 1861914053 ', NULL, NULL, '2021-04-15 11:15:48', '2021-04-15 11:15:48'),
(5586, 1006, 9263, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-07 18:07:18', '2020-10-07 18:07:18'),
(5587, 1006, 9263, NULL, '2020-10-19 00:00:00.000', 'Initiated', 'Submitted online enrollment request, attached copy. ', NULL, NULL, '2020-10-07 18:08:02', '2020-10-07 18:08:02'),
(5588, 1006, 9263, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. ', NULL, NULL, '2020-10-20 13:47:13', '2020-10-20 13:47:13'),
(5589, 1006, 9263, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Request still shows as in-process: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. Your application was submitted on 10/20/2020 at 02:45:59 PM EST\"', NULL, NULL, '2020-11-02 13:29:02', '2020-11-02 13:29:02'),
(5590, 1006, 9263, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com: \"Hello,   I hope you\'re doing well, I wanted to check in on the status of the following providers as well:   Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me as soon as you\'re able to, thanks.\"', NULL, NULL, '2020-11-16 16:34:49', '2020-11-16 16:34:49'),
(5591, 1006, 9263, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Sent another follow-up email to provider.relations@beaconhealthoptions.com. ', NULL, NULL, '2020-11-30 17:51:36', '2020-11-30 17:51:36'),
(5592, 1006, 9263, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Received the following reply from Kayla: \"Good afternoon,   The applications for the below providers are still processing.   Ticket: 8958707  Thank You!   Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632 www.beaconhealthoptions.com\"', NULL, NULL, '2020-12-09 13:36:33', '2020-12-09 13:36:33'),
(5593, 1006, 9263, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent follow-up email @ provider.relations@beaconhealthoptions.com: \"Hello,   I need an update regarding the enrollment status of the following providers:   Provider Name: Lynneta Loveland NPI# 1598163602  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2020-12-24 14:07:18', '2020-12-24 14:07:18'),
(5594, 1006, 9263, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Called Beacon but wasn\'t able to reach anyone, requested a call back from them. ', NULL, NULL, '2021-01-15 17:05:36', '2021-01-15 17:05:36'),
(5595, 1006, 9263, NULL, '2021-02-01 00:00:00.000', 'In Process', 'The request still on day 66, need to allow more time.   Request still on day 66, need to allow more time. ', NULL, NULL, '2021-01-20 13:07:56', '2021-01-20 13:07:56'),
(5596, 1006, 9263, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:20:06', '2021-02-11 15:20:06'),
(5597, 1006, 9263, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:09:00', '2021-03-03 18:09:00'),
(5598, 1019, 9263, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:45:25', '2021-03-23 10:45:25'),
(5599, 1019, 9263, NULL, '2021-04-14 00:00:00.000', 'In Process', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-07 09:19:16', '2021-04-07 09:19:16'),
(5600, 1019, 9263, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:07:58', '2021-04-14 07:07:58'),
(5601, 1019, 9263, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-04-14 08:11:05', '2021-04-14 08:11:05'),
(5602, 1019, 9263, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Resent the CAQH application by fax at (866) 612-7790', NULL, NULL, '2021-04-14 08:13:51', '2021-04-14 08:13:51'),
(5603, 1019, 9263, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:54:31', '2021-04-22 15:54:31');
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
(5604, 1019, 9263, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:46:40', '2021-05-03 12:46:40'),
(5605, 1019, 9263, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:24:13', '2021-05-20 08:24:13'),
(5606, 1019, 9263, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:19:25', '2021-06-05 11:19:25'),
(5607, 1019, 9263, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:03:13', '2021-06-24 08:03:13'),
(5608, 1019, 9263, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello, Can you please let me know about the enrollment status for the following providers under our group. Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Individual NPI: Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767. Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767. Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767. Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767. Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767. Lynetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767. Cemetrice Muhammed NPI: 1548843410 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Regards, Alex', NULL, NULL, '2021-08-24 11:16:29', '2021-08-24 11:16:29'),
(5609, 11056, 9263, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email received from:  provider.relations@beaconhealthoptions.com  Sub:  JESSICA HARTMAN Beacon  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you        Dan Haller  Provider Network Consultant  Northeast Provider Relations  Beacon Health Options', NULL, NULL, '2021-12-02 16:49:18', '2021-12-02 16:49:18'),
(5610, 11056, 9263, NULL, '2021-12-10 00:00:00.000', 'Not Eligible', 'Due to ANCC certification.  Jessica Hartman – Missing ANCC certification and the application has been denied. ', NULL, NULL, '2021-12-03 13:02:58', '2021-12-03 13:02:58'),
(5611, 2027, 9264, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 12:33:40', '2020-10-09 12:33:40'),
(5612, 2027, 9264, NULL, '2020-10-16 00:00:00.000', 'In Process', 'Request submitted to add the location of longpoint with an existing group by sending LOI and W9 to CHC.Contracting@communityhealthchoice.org', NULL, NULL, '2020-10-09 12:35:18', '2020-10-09 12:35:18'),
(5613, 2027, 9264, NULL, '2020-10-16 00:00:00.000', 'In Process', 'From: CHC.Contracting@communityhealthchoice.org  Good Afternoon ,   Thank you for providing the requested documentation. We are in receipt of the request and will proceed with processing the demographic update. Should you need further assistance, please feel free to contact us.  Have a great weekend! J Contracting Dept. ', NULL, NULL, '2020-10-09 15:45:20', '2020-10-09 15:45:20'),
(5614, 2037, 9264, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-26 16:57:35', '2020-10-26 16:57:35'),
(5615, 2037, 9264, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Follow up email sent to CHC Contracting CHC.Contracting@communityhealthchoice.org --------------(Group)-(Normandy Urgent Care Center)-(Community Health Choice)  Greetings, This is to follow up on a request to add a secondary service location address to the below mentioned group. Group: Normandy Urgent Care Center Address: 779 Normandy St Ste 114                  Houston , TX 77015-3441. TIN: 27-0796429 NPI: 1407171077  Secondary Location: Imperial Valley Urgent Care Center Address: 16272 IMPERIAL VALLEY DR STE K,                 Houston , TX 77060 Billing Address:16272 IMPERIAL VALLEY DR STE K,                             Houston , TX 77060  ', NULL, NULL, '2020-11-18 14:15:55', '2020-11-18 14:15:55'),
(5616, 2037, 9264, NULL, '2020-12-07 00:00:00.000', 'In Process', 'coordinating with Rajika Ried for the location addition of LPMC under Normandy. Rajika.Reid@communityhealthchoice.org', NULL, NULL, '2020-11-30 10:22:50', '2020-11-30 10:22:50'),
(5617, 2037, 9264, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent to Rajika.Reid@communityhealthchoice.org as he was double checking the TIN situation with the internal team.', NULL, NULL, '2020-12-08 12:42:35', '2020-12-08 12:42:35'),
(5618, 1006, 9264, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a follow-up email @ Rajika.Reid@communityhealthchoice.org regarding updated status. ', NULL, NULL, '2020-12-15 18:03:01', '2020-12-15 18:03:01'),
(5619, 2037, 9264, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent:', NULL, NULL, '2020-12-29 10:43:25', '2020-12-29 10:43:25'),
(5620, 1006, 9264, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing of this group to Rajika.Reid@communityhealthchoice.org ', NULL, NULL, '2021-01-27 13:23:29', '2021-01-27 13:23:29'),
(5621, 1006, 9264, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Sent another follow-up email @ CHC Contracting CHC.Contracting@communityhealthchoice.org requesting update on status.  ', NULL, NULL, '2021-02-03 10:28:32', '2021-02-03 10:28:32'),
(5622, 3040, 9264, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Location Addition Update - LPMC  Greetings,  Hope you are doing well. Please advise me the status of a location addition for the below group.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-03-01 15:39:46', '2021-03-01 15:39:46'),
(5623, 3040, 9264, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Location Addition Update - LPMC  Greetings,  Please find the attached information that was requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-02 10:22:09', '2021-03-02 10:22:09'),
(5624, 3040, 9264, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: CHC.Contracting@communityhealthchoice.org  Subject:   Good Morning,  After review, I show that an ancillary profile form was previously requested to assist you process the demographic change for the group. Please assist in providing the completed Ancillary Network Interest Profile Form for the demographic change to assist with your request in a timely manner. Make sure to provide a W-9 dated in 2021 along with the profile form.  Kindest regards, Contracting Team', NULL, NULL, '2021-03-02 10:36:07', '2021-03-02 10:36:07'),
(5625, 3040, 9264, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Location Addition Update - LPMC  Greetings,   This is a follow up email regarding the status of a location addition for the below group.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-19 14:00:32', '2021-03-19 14:00:32'),
(5626, 3040, 9264, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:02:50', '2021-05-26 14:02:50'),
(5627, 3040, 9264, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good Morning Miss Rajika,  Please follow up on request #3399 and advise if additional information is needed to process additional service locations for Normandy Urgent Care Center providers.  Thank you   ', NULL, NULL, '2021-06-14 09:51:32', '2021-06-14 09:51:32'),
(5628, 3040, 9264, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. I wanted to follow up regarding the location addition status for below mentioned group. Also can you please send the copy of contract. I wanted to know if we have an ancillary contract do we need to enroll the providers separately or it will billed under the facility TIN?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 10:49:13', '2021-06-14 10:49:13'),
(5629, 3040, 9264, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-05 09:24:13', '2021-07-05 09:24:13'),
(5630, 3040, 9264, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-26 13:55:11', '2021-07-26 13:55:11'),
(5631, 11056, 9264, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     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, '2021-08-09 10:36:11', '2021-08-09 10:36:11'),
(5632, 3040, 9264, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Email rcvd from: Kris.Olier@communityhealthchoice.org  Subject: RE: FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  The request for load has been submitted please allow 10 days for load to be completed.   ', NULL, NULL, '2021-08-17 13:47:38', '2021-08-17 13:47:38'),
(5633, 2037, 9265, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 13:58:38', '2020-10-09 13:58:38'),
(5634, 2037, 9265, NULL, '2020-10-16 00:00:00.000', 'In Process', 'As per live call to Humana the request for location addition was disregarded as proper procedure was not followed. Submitted completed credentialing application for secondary location addition and submitted back to stxnm@humana.com.', NULL, NULL, '2020-10-09 13:59:15', '2020-10-09 13:59:15'),
(5635, 2037, 9265, NULL, '2020-10-16 00:00:00.000', 'Approved', 'Urgent Care Contract-Location Added to the Facility.', NULL, NULL, '2020-10-09 14:02:19', '2020-10-09 14:02:19'),
(5636, 2037, 9266, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 13:58:40', '2020-10-09 13:58:40'),
(5637, 2037, 9266, NULL, '2020-10-16 00:00:00.000', 'In Process', 'As per live call to Humana the request for location addition was disregarded as proper procedure was not followed. Submitted completed credentialing application for secondary location addition and submitted back to stxnm@humana.com.', NULL, NULL, '2020-10-09 13:59:23', '2020-10-09 13:59:23'),
(5638, 2037, 9266, NULL, '2020-10-16 00:00:00.000', 'Approved', 'Urgent Care Contract-Location Added to the Facility.', NULL, NULL, '2020-10-09 14:02:25', '2020-10-09 14:02:25'),
(5639, 2037, 9267, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 14:59:12', '2020-10-09 14:59:12'),
(5640, 2037, 9267, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:02:39', '2020-10-09 15:02:39'),
(5641, 2037, 9268, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 14:59:20', '2020-10-09 14:59:20'),
(5642, 2037, 9268, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:02:44', '2020-10-09 15:02:44'),
(5643, 2037, 9269, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 14:59:27', '2020-10-09 14:59:27'),
(5644, 2037, 9269, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:02:50', '2020-10-09 15:02:50'),
(5645, 2037, 9270, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 14:59:31', '2020-10-09 14:59:31'),
(5646, 2037, 9270, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:02:33', '2020-10-09 15:02:33'),
(5647, 2037, 9271, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:25', '2020-10-09 15:11:25'),
(5648, 2037, 9271, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:12:40', '2020-10-09 15:12:40'),
(5649, 2037, 9272, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:27', '2020-10-09 15:11:27'),
(5650, 2037, 9272, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:12:46', '2020-10-09 15:12:46'),
(5651, 2037, 9273, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:29', '2020-10-09 15:11:29'),
(5652, 2037, 9273, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:12:52', '2020-10-09 15:12:52'),
(5653, 2037, 9274, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:30', '2020-10-09 15:11:30'),
(5654, 2037, 9274, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:12:57', '2020-10-09 15:12:57'),
(5655, 2037, 9275, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:32', '2020-10-09 15:11:32'),
(5656, 2037, 9275, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:13:01', '2020-10-09 15:13:01'),
(5657, 2037, 9276, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:34', '2020-10-09 15:11:34'),
(5658, 2037, 9276, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:13:07', '2020-10-09 15:13:07'),
(5659, 2037, 9277, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:36', '2020-10-09 15:11:36'),
(5660, 2037, 9277, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:13:12', '2020-10-09 15:13:12'),
(5661, 2037, 9278, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:11:37', '2020-10-09 15:11:37'),
(5662, 2037, 9278, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All three locations added.', NULL, NULL, '2020-10-09 15:13:16', '2020-10-09 15:13:16'),
(5663, 2037, 9279, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:00', '2020-10-09 15:21:00'),
(5664, 2037, 9279, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:05', '2020-10-09 15:23:05'),
(5665, 2037, 9280, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:01', '2020-10-09 15:21:01'),
(5666, 2037, 9280, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:31', '2020-10-09 15:23:31'),
(5667, 2037, 9281, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:03', '2020-10-09 15:21:03'),
(5668, 2037, 9281, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:37', '2020-10-09 15:23:37'),
(5669, 2037, 9282, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:04', '2020-10-09 15:21:04'),
(5670, 2037, 9282, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:42', '2020-10-09 15:23:42'),
(5671, 2037, 9283, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:05', '2020-10-09 15:21:05'),
(5672, 2037, 9283, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:48', '2020-10-09 15:23:48'),
(5673, 2037, 9284, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:07', '2020-10-09 15:21:07'),
(5674, 2037, 9284, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:52', '2020-10-09 15:23:52'),
(5675, 2037, 9285, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:09', '2020-10-09 15:21:09'),
(5676, 2037, 9285, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:23:57', '2020-10-09 15:23:57'),
(5677, 2037, 9286, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 15:21:11', '2020-10-09 15:21:11'),
(5678, 2037, 9286, NULL, '2020-10-16 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.All Three Locations Added.', NULL, NULL, '2020-10-09 15:24:03', '2020-10-09 15:24:03'),
(5679, 2037, 9287, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-09 16:51:59', '2020-10-09 16:51:59'),
(5680, 2037, 9287, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Apex Standard roster filled out and submitted @ stxnm@humana.com to add   301 S HILLSIDE DR STE 4 County BEE BEEVILLE , TX 78102-5324  to the provider\'s profile.', NULL, NULL, '2020-10-09 16:54:39', '2020-10-09 16:54:39'),
(5681, 2037, 9287, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-02 15:47:46', '2020-11-02 15:47:46'),
(5682, 2037, 9287, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to stxnm@humana.com', NULL, NULL, '2020-11-18 14:21:34', '2020-11-18 14:21:34'),
(5683, 2037, 9287, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Follow up email sent to : nvidad@humana.com', NULL, NULL, '2020-11-25 12:48:05', '2020-11-25 12:48:05'),
(5684, 1006, 9287, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent follow-up email @ nvidad@humana.com', NULL, NULL, '2020-12-02 17:57:54', '2020-12-02 17:57:54'),
(5685, 2037, 9287, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent follow-up email @ nvidad@humana.com', NULL, NULL, '2020-12-11 13:23:49', '2020-12-11 13:23:49'),
(5686, 2037, 9287, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent to noel vidad', NULL, NULL, '2020-12-29 10:45:25', '2020-12-29 10:45:25'),
(5687, 2037, 9287, NULL, '2021-01-06 00:00:00.000', 'Approved', 'As per live call the location has been added successfully effective 12/28/2020.Call interaction number: 2000162006984', NULL, NULL, '2020-12-30 13:28:08', '2020-12-30 13:28:08'),
(5688, 1006, 9288, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-09 18:28:43', '2020-10-09 18:28:43'),
(5689, 1006, 9288, NULL, '2020-10-16 00:00:00.000', 'Initiated', 'Request submitted online via providerxpress portal. ', NULL, NULL, '2020-10-09 18:28:57', '2020-10-09 18:28:57'),
(5690, 1006, 9288, NULL, '2020-10-21 00:00:00.000', 'In Process', 'Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Jessica Hartman has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services ', NULL, NULL, '2020-10-12 09:10:41', '2020-10-12 09:10:41'),
(5691, 1006, 9288, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Received following update from \"Gentile, Richard C\" richard_c_gentile_@optum.com>:  \"Good morning!  I’ve just submitted this request to credentialing.  Once the application reaches the Credentialing Department, it will take approximately 60 days to process.  As a new fuction, if your application was submitted online,  you may check the status of your application during this time on our Provider Express site here, and you should receive a confirmation packet with an effective date once the process is complete.  Please note that we cannot review for Telehealth at this point. ZOOM requires a Business Associate Agreement (BAA) be submitted to us for review.  You may return directly that form directly to me vial email. Once I receive, I will update the request, asking them to review for Telehealth.  Thanks, Rich   Richard Gentile Network Associate, Behavioral Network Services Richard_C_Gentile_@optum.com 950 Winter Street Suite 2200/3800 Waltham, Ma.  02451 Phone: 781-472-8537 Fax:     844-481-2861 Optum l United Behavioral Health\"', NULL, NULL, '2020-10-20 13:42:08', '2020-10-20 13:42:08'),
(5692, 1006, 9288, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received the following update from UBH stating that the provider is unable to be enrolled due to lacking Psychiatric/Mental Health education:  \"10/22/2020 Attn:  Brad Peterson, Credentialing Contact snbc@claimsmedinc.com RE: Network Participation – Jessica Hartman  Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your request, but are unable to extend an invitation for participation at this time. Your Nurse license does not meet Optum credentialing standards.   - Does not list psychiatric/mental health  We encourage you to visit providerexpress.com for updates regarding network need and to review credentialing criteria specific to your area. If you have any questions, please contact our Provider Services Line at (877) 614-0484.  Sincerely,   Optum Specialty Network Services\"', NULL, NULL, '2020-10-23 10:43:17', '2020-10-23 10:43:17'),
(5693, 1006, 9288, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Sent a followup email to UBH: \"Hello,   Appreciate the update, regarding the provider not being Psychiatric/Mental Health. She is quite experienced with mental health services and is also currently attending Maryville University for her PMHNP currently.   Please let me know what we can do to get her enrolled or we can set up a meeting to go over this as well.   Please get back to me ASAP.  Thank you. \"', NULL, NULL, '2020-10-27 11:03:51', '2020-10-27 11:03:51'),
(5694, 1006, 9288, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Resubmitted application to UBH with FNP information listed. Attached. ', NULL, NULL, '2020-11-05 14:37:48', '2020-11-05 14:37:48'),
(5695, 1006, 9288, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Sent a follow-up email to Optum Behavioral Health bhcredentialing@optum.com> regarding status.', NULL, NULL, '2020-11-12 18:43:20', '2020-11-12 18:43:20'),
(5696, 1006, 9288, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Need to contact UBH @ 877-614-0484. Since emails aren\'t going through. ', NULL, NULL, '2020-11-12 19:01:34', '2020-11-12 19:01:34'),
(5697, 1006, 9288, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Left a VM, waiting on call back. ', NULL, NULL, '2020-11-13 18:24:03', '2020-11-13 18:24:03'),
(5698, 1006, 9288, NULL, '2020-11-23 00:00:00.000', 'In Process', 'As per the rep, this request was rejected again stating that the provider does not meet the licensing requirements and that we should talk to the network manager as soon as we receive the rejection email.  Rep: Jay', NULL, NULL, '2020-11-16 17:50:18', '2020-11-16 17:50:18'),
(5699, 1006, 9288, NULL, '2021-01-25 00:00:00.000', 'On Hold', 'As per my discussion with Furquan, he suggested we resubmit this request a few months from now and submit claims under rendering until then. ', NULL, NULL, '2020-12-08 17:47:13', '2020-12-08 17:47:13'),
(5700, 2037, 9289, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-12 09:30:30', '2020-10-12 09:30:30'),
(5701, 2037, 9289, NULL, '2020-10-19 00:00:00.000', 'Approved', 'The below mentioned location has been successfully added: 301 S HILLSIDE DR STE 4 County BEE BEEVILLE , TX 78102-5324', NULL, NULL, '2020-10-12 09:56:04', '2020-10-12 09:56:04'),
(5702, 2027, 9290, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-12 09:40:08', '2020-10-12 09:40:08'),
(5703, 2027, 9290, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: Katherine,  Hope you are doing well, I want to add this below mentioned provider in the other two locations of (Normandy Urgent Care Center) i am also mentioning the locations below where I want to add this provider. Location (1) (Normandy Urgent Care Center  9504 LONG POINT RD STE E, Houston , TX 77055)  Location (2) (Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX  77060)  Details of the provider: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: (Normandy Urgent Care Center)    Group Tax-ID: 270796429  Thanks.', NULL, NULL, '2020-10-12 09:41:12', '2020-10-12 09:41:12'),
(5704, 1006, 9290, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Received an update from Katherine listing all addresses under NUCC group but no update for provider specific query, left her a voice message @ 502-318-5250 as well as Yvonne Wyatt @ (502) 318-5409. Waiting on response.   ', NULL, NULL, '2020-10-26 11:07:04', '2020-10-26 11:07:04'),
(5705, 2027, 9290, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (George, Jeemol)-(Imperial Valley Urgent Care Center)-(Tricare)  Please confirm if this below mentioned provider is enrolled in all requested locations of (Normandy Urgent Care Center) Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: (Normandy Urgent Care Center)   Group Tax-ID: 270796429  Thanks. ', NULL, NULL, '2020-11-02 12:34:10', '2020-11-02 12:34:10'),
(5706, 2027, 9290, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  May I know the current status of this request.  Thanks.', NULL, NULL, '2020-11-09 15:27:39', '2020-11-09 15:27:39'),
(5707, 2037, 9290, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Follow up email sent to K-Moten for Location Addition', NULL, NULL, '2020-11-16 12:59:03', '2020-11-16 12:59:03'),
(5708, 1006, 9290, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up @ KMoten4@humana.com', NULL, NULL, '2020-12-02 18:02:44', '2020-12-02 18:02:44'),
(5709, 2037, 9290, NULL, '2020-12-15 00:00:00.000', 'Approved', 'Received confirmation email from K morten with the effective date 12/01/2020. Confirmation email uploaded.', NULL, NULL, '2020-12-08 17:48:30', '2020-12-08 17:48:30'),
(5710, 2037, 9291, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-12 09:43:09', '2020-10-12 09:43:09'),
(5711, 2037, 9291, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Market Apex roster received! filled out and submitted back to stxnm@humana.com to add the below mentioned location : ------------------------ 504A Houston Street Live Oak County George West , TX 78022-3663 ----------------------------', NULL, NULL, '2020-10-12 09:51:29', '2020-10-12 09:51:29'),
(5712, 2037, 9291, NULL, '2020-11-17 00:00:00.000', 'In Process', 'In Process', NULL, NULL, '2020-10-28 12:41:47', '2020-10-28 12:41:47'),
(5713, 2037, 9291, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to stxnm@humana.com', NULL, NULL, '2020-11-18 14:21:30', '2020-11-18 14:21:30'),
(5714, 2037, 9291, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Follow up email sent to : nvidad@humana.com', NULL, NULL, '2020-11-25 12:48:11', '2020-11-25 12:48:11'),
(5715, 1006, 9291, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent follow-up email @ nvidad@humana.com ', NULL, NULL, '2020-12-02 17:58:20', '2020-12-02 17:58:20'),
(5716, 2037, 9291, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Sent follow-up email @ nvidad@humana.com', NULL, NULL, '2020-12-11 13:22:40', '2020-12-11 13:22:40'),
(5717, 3040, 9291, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC  Greetings,  Hope you are doing well. I just wanted to follow up regarding the location addition for the below mentioned providers.   Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-03 13:30:41', '2021-02-03 13:30:41'),
(5718, 3040, 9291, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC  Greetings,  Hope you are doing well. I just wanted to follow up regarding the location addition for the below mentioned providers.   Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-03 13:30:42', '2021-02-03 13:30:42'),
(5719, 3040, 9291, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Follow up email sent to: 	nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC  Greetings,  This is a follow up email regarding the location addition for the below mentioned providers.   Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Please get to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:33:18', '2021-02-10 12:33:18'),
(5720, 3040, 9291, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Follow up email sent to: nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC.  Greetings,  I just wanted to follow up regarding the location addition for the below mentioned providers. Has there been any update??  Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Please get to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-17 09:31:25', '2021-02-17 09:31:25'),
(5721, 3046, 9291, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC.  Greetings,  Hope my email finds you in good health.  I would like to request for the updates for the request of \"Location Addition\" for the below mentioned providers.  Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Kindly reply at your earliest convenience.', NULL, NULL, '2021-02-25 12:59:18', '2021-02-25 12:59:18');
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
(5722, 3046, 9291, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC.  Greetings,  Hope my email finds you in good health.  Kindly note that this is a soft reminder for my previous request for the updates of location addition for the below mentioned providers.  Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Your quick response in this regard will be highly appreciated. Thank you', NULL, NULL, '2021-03-04 09:58:05', '2021-03-04 09:58:05'),
(5723, 3046, 9291, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC. Hello, Hope you are doing well.   I would like to give you a soft reminder for the location addition for below mentioned providers. Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI#: 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI#: 1952376345  I hope to hear from you soon. Thank you.', NULL, NULL, '2021-03-10 15:33:17', '2021-03-10 15:33:17'),
(5724, 3046, 9291, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC.  Hello, Kindly advise if there are any updates for the location addition for the below mentioned providers: Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Kindly reply at your earliest convenience.', NULL, NULL, '2021-03-19 12:51:52', '2021-03-19 12:51:52'),
(5725, 1006, 9291, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com> & S TX Network Mgmt stxnm@humana.com>:  Sub: Enrollment Query - CBUC/GWMC - Humana  \"Hello,   I wanted to verify if the following group and providers were enrolled under the mentioned addresses with Humana:   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: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-06-09 10:59:31', '2021-06-09 10:59:31'),
(5726, 1006, 9291, NULL, '2021-07-06 00:00:00.000', 'In Process', 'We received the following response from S TX Network Mgmt stxnm@humana.com:  \"Hello Brad,   The provider is not active  on the group contract. I’m unable to locate the original request to add the provider.  Please forward the original email and all documents to further research and/or fill out the attached provider add template.  Thank you Network Operations Coordinator /Provider Contracting 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\"  Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub; APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,   I hope you\'re doing well, can you please get back to me on the status of this request?  Thank you. \"', NULL, NULL, '2021-06-29 17:10:35', '2021-06-29 17:10:35'),
(5727, 1006, 9291, 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 12:03:38', '2021-08-09 12:03:38'),
(5728, 11056, 9291, 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 15:29:18', '2021-08-18 15:29:18'),
(5729, 11056, 9291, 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 08:36:59', '2021-08-25 08:36:59'),
(5730, 11056, 9291, 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 13:21:45', '2021-09-22 13:21:45'),
(5731, 11056, 9291, 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 17:11:48', '2021-10-01 17:11:48'),
(5732, 11056, 9291, NULL, '2021-10-14 00:00:00.000', 'Approved', 'Email received from : MLacastesantos@humana.com  Sub : {Humcrypt} Participation status_Interaction number 2000204033304  Hi Ahmed,  This provider NPI: 1619166188: Flynn Mercedita N b is in networks under your TIN: 811890349 and provider is in network with Humana HMO, Medicare PPO, Medicare PFFS, Humana PPO, ChoiceCare PPO effective date 11/1/2017. Provider is set to Not to Print means provider is not showing on the web directory.   Service address on file for this provider are:  301 S Hillside Dr Ste 4 Beeville, TX 78102-5324 eff date 11/1/2017  504A Houston St George West, TX 78022-3663 effective date 12/28/2020  Regards,  Jean Mary Jean Lacastesantos Network Specialist | Provider Relations  Humana HGS Manila  T 800-626-2741 F 000-000-0000 E mlacastesantos@humana.com  Humana.com', NULL, NULL, '2021-10-07 16:54:34', '2021-10-07 16:54:34'),
(5733, 2037, 9292, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-12 10:00:36', '2020-10-12 10:00:36'),
(5734, 2037, 9292, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Market Apex roster received! filled out and submitted back to stxnm@humana.com to add the below mentioned location : ------------------------ 504A Houston Street Live Oak County George West , TX 78022-3663 ----------------------------', NULL, NULL, '2020-10-12 10:00:45', '2020-10-12 10:00:45'),
(5735, 2037, 9292, NULL, '2020-11-17 00:00:00.000', 'In Process', 'In Process', NULL, NULL, '2020-10-28 12:41:56', '2020-10-28 12:41:56'),
(5736, 2037, 9292, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to stxnm@humana.com', NULL, NULL, '2020-11-18 14:21:36', '2020-11-18 14:21:36'),
(5737, 2037, 9292, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Follow up email sent to : nvidad@humana.com', NULL, NULL, '2020-11-25 12:48:17', '2020-11-25 12:48:17'),
(5738, 1006, 9292, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent follow-up email @ nvidad@humana.com ', NULL, NULL, '2020-12-02 17:58:24', '2020-12-02 17:58:24'),
(5739, 2037, 9292, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Sent follow-up email @ nvidad@humana.com', NULL, NULL, '2020-12-11 13:22:50', '2020-12-11 13:22:50'),
(5740, 3040, 9292, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC  Greetings,  Hope you are doing well. I just wanted to follow up regarding the location addition for the below mentioned providers.   Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-03 13:30:48', '2021-02-03 13:30:48'),
(5741, 3040, 9292, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Follow up email sent to: 	nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC  Greetings,  This is a follow up email regarding the location addition for the below mentioned providers.   Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Please get to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:33:24', '2021-02-10 12:33:24'),
(5742, 3040, 9292, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Follow up email sent to: nvidad@humana.com  Subject: Location Addition Request: CBUC/GWMC.  Greetings,  I just wanted to follow up regarding the location addition for the below mentioned providers. Has there been any update??  Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Please get to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-17 09:31:30', '2021-02-17 09:31:30'),
(5743, 3046, 9292, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC.   Greetings,  Hope my email finds you in good health.  I would like to request for the updates for the request of \"Location Addition\" for the below mentioned providers.  Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Kindly reply at your earliest convenience. ', NULL, NULL, '2021-02-25 13:02:32', '2021-02-25 13:02:32'),
(5744, 3046, 9292, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC.  Greetings,  Hope my email finds you in good health.  Kindly note that this is a soft reminder for my previous request for the updates of location addition for the below mentioned providers.  Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Your quick response in this regard will be highly appreciated. Thank you', NULL, NULL, '2021-03-04 10:07:44', '2021-03-04 10:07:44'),
(5745, 3046, 9292, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC. Hello, Hope you are doing well.   I would like to give you a soft reminder for the location addition for below mentioned providers. Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI#: 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI#: 1952376345  I hope to hear from you soon. Thank you.', NULL, NULL, '2021-03-10 15:32:23', '2021-03-10 15:32:23'),
(5746, 3046, 9292, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: nvidad@humana.com Subject: Location Addition Request: CBUC/GWMC.  Hello, Kindly advise if there are any updates for the location addition for the below mentioned providers: Practice Detail: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Mercedita N Flynn Provider NPI# 1619166188  Provider 2:   Provider Name:  Frank R Dehnisch Provider NPI# 1952376345  Kindly reply at your earliest convenience.', NULL, NULL, '2021-03-19 12:52:08', '2021-03-19 12:52:08'),
(5747, 1006, 9292, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com> & S TX Network Mgmt stxnm@humana.com>:  Sub: Enrollment Query - CBUC/GWMC - Humana  \"Hello,   I wanted to verify if the following group and providers were enrolled under the mentioned addresses with Humana:   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: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-06-09 10:59:25', '2021-06-09 10:59:25'),
(5748, 1006, 9292, NULL, '2021-07-06 00:00:00.000', 'In Process', 'We received the following response from S TX Network Mgmt stxnm@humana.com:  \"Hello Brad,   The provider is not active  on the group contract. I’m unable to locate the original request to add the provider.  Please forward the original email and all documents to further research and/or fill out the attached provider add template.  Thank you Network Operations Coordinator /Provider Contracting 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\"  Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub; APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,   I hope you\'re doing well, can you please get back to me on the status of this request?  Thank you. \"', NULL, NULL, '2021-06-29 17:10:32', '2021-06-29 17:10:32'),
(5749, 1006, 9292, NULL, '2021-08-16 00:00:00.000', 'Not Eligible', 'No need to separately enroll MD. ', NULL, NULL, '2021-08-09 12:02:33', '2021-08-09 12:02:33'),
(5750, 2037, 9293, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-12 13:16:40', '2020-10-12 13:16:40'),
(5751, 2037, 9293, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Linkage Request with W-9 Sent to hpdemo@uhc.com. Reference email attached: ------------------------- Greetings, Kindly find the attached Letter with the intention to link an individual provider to the existing group TIN.Details are mentioned in the letter along with the W-9 Form. Do feel free to contact me for additional information if required.', NULL, NULL, '2020-10-12 13:17:21', '2020-10-12 13:17:21'),
(5752, 2037, 9293, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Follow up email sent to networkhelp@uhc.com ----------------- Greetings, If I may have the current status of the request to link William Francis to Stat Care Minor Emergency Clinic.Attached is the initial request with letter of intent submitted on 09/03/2020. Looking forward to hearing back from you soon. Thank you.', NULL, NULL, '2020-10-12 13:17:36', '2020-10-12 13:17:36'),
(5753, 2037, 9293, NULL, '2020-10-19 00:00:00.000', 'Approved', 'As per Live call William Francis Linked to RHC-All Three Locations- Proof Uploaded on EMRBS and placed on the Server.Effective Date: 08/24/2020Reference: 01879197.', NULL, NULL, '2020-10-12 17:10:31', '2020-10-12 17:10:31'),
(5754, 2037, 9294, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-12 13:17:06', '2020-10-12 13:17:06'),
(5755, 2037, 9294, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Linkage Request with W-9 Sent to hpdemo@uhc.com. Reference email attached: ------------------------- Greetings, Kindly find the attached Letter with the intention to link an individual provider to the existing group TIN.Details are mentioned in the letter along with the W-9 Form. Do feel free to contact me for additional information if required.', NULL, NULL, '2020-10-12 13:17:17', '2020-10-12 13:17:17'),
(5756, 2037, 9294, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Follow up email sent to networkhelp@uhc.com ----------------- Greetings, If I may have the current status of the request to link William Francis to Stat Care Minor Emergency Clinic.Attached is the initial request with letter of intent submitted on 09/03/2020. Looking forward to hearing back from you soon. Thank you.', NULL, NULL, '2020-10-12 13:17:31', '2020-10-12 13:17:31'),
(5757, 2037, 9294, NULL, '2020-10-19 00:00:00.000', 'Approved', 'As per Live call William Francis Linked to RHC-All Three Locations- Proof Uploaded on EMRBS and placed on the Server.Effective Date: 08/24/2020Reference: 01879197.', NULL, NULL, '2020-10-12 17:10:25', '2020-10-12 17:10:25'),
(5758, 1006, 9295, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-12 15:03:20', '2020-10-12 15:03:20'),
(5759, 1006, 9295, NULL, '2020-10-22 00:00:00.000', 'Initiated', 'Initiated request via magellan website. ', NULL, NULL, '2020-10-12 15:08:57', '2020-10-12 15:08:57'),
(5760, 1006, 9295, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> regarding the status of enrollment. ', NULL, NULL, '2020-10-28 17:33:58', '2020-10-28 17:33:58'),
(5761, 1006, 9295, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent another follow-up email to Judy @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> : \"Good morning Judy,   I hope you\'re doing well, I wanted to check in again with you regarding the status of enrollment for the following providers:   Provider Name: Jessica Hartman  NPI# 1326665472  Provider Name: Erin Oliva NPI# 1407349632  Also regarding Melody L\'Etoile, she has her LICSW license now, how can I re-initiate her enrollment request?  Thanks. \"', NULL, NULL, '2020-11-09 10:53:53', '2020-11-09 10:53:53'),
(5762, 1006, 9295, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Received following reply from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  \"Good Morning,  Provider Name: Jessica Hartman MIS 601482-506-This provider has been linked to our group effective date 10/26/2020.  NPI# 1326665472\"', NULL, NULL, '2020-11-09 12:55:00', '2020-11-09 12:55:00'),
(5763, 1006, 9296, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-12 17:29:28', '2020-10-12 17:29:28'),
(5764, 1006, 9296, NULL, '2020-10-19 00:00:00.000', 'Initiated', 'Asked Chuck McGrew if we need to send in a certification request for Jessica Hartman. Also filled out a certification form, in case we need to send one. ', NULL, NULL, '2020-10-12 17:31:11', '2020-10-12 17:31:11'),
(5765, 1006, 9296, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Chuck replied stating that we need to submit application for enrollment. The application he suggested is for FNP providers, so we aren\'t able to go for PMHNP enrollment with Tricare. Attached the application that was faxed to (608) 221-7535. ', NULL, NULL, '2020-10-13 16:53:34', '2020-10-13 16:53:34'),
(5766, 1006, 9296, NULL, '2020-11-12 00:00:00.000', 'In Process', '\"Hey Chuck,  I hope you\'re doing well, I wanted to check in on the status of enrollment for the following provider: Provider Name: Jessica Hartman NPI# 1326665472 TIN# 83-4482753  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2020-11-02 13:44:02', '2020-11-02 13:44:02'),
(5767, 1006, 9296, NULL, '2020-11-25 00:00:00.000', 'In Process', 'As per Chuck the initial certification takes quite a while, sent another follow-up email to him.', NULL, NULL, '2020-11-12 18:35:04', '2020-11-12 18:35:04'),
(5768, 1006, 9296, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Received following reply from Chuck: \"Hi, Brad!  Looks like her cert popped a couple days ago, but they somehow didn’t attach her to anything. :-\\ Let me have a copy of her app and I’ll push it over to WPS to get that done.  Thanks!\"  Sent filled out application to him again. ', NULL, NULL, '2020-11-13 09:43:54', '2020-11-13 09:43:54'),
(5769, 1006, 9296, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following email from Chuck: \"Morning, Brad!  WPS is asking for Jessica’s RN and NP license.  Thanks!\"  Sent RN & NP license copy to Chuck. ', NULL, NULL, '2020-11-16 11:03:26', '2020-11-16 11:03:26'),
(5770, 1006, 9296, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent follow-up email to Chuck regarding the status for the providers.', NULL, NULL, '2020-11-23 18:21:01', '2020-11-23 18:21:01'),
(5771, 1006, 9296, NULL, '2020-12-10 00:00:00.000', 'In Process', 'As per my discussion with Chuck, the request is still in-process. Need to allow more time as they are initial enrollments. ', NULL, NULL, '2020-11-30 17:25:25', '2020-11-30 17:25:25'),
(5772, 1006, 9296, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Received following update from Chuck: \"Morning, Brad!  OK, they’ve got Jessica all straightened out; if we want her to show in the directory and as referral-available, then I’ll need a credentialing packet for her.  Thanks!\"', NULL, NULL, '2020-12-01 14:37:09', '2020-12-01 14:37:09'),
(5773, 1006, 9296, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Received credentialing application, filled out and sent to Chuck: \"Hello Chuck,   Huh, that would make sense. Here\'s the filled out credentialing application, let me know if there\'s anything else that\'s needed.  Also, Jessica should still be able to see Tricare patients, right? At least for certain plans?  Thanks.\"', NULL, NULL, '2020-12-02 11:58:27', '2020-12-02 11:58:27'),
(5774, 1006, 9296, NULL, '2020-12-09 00:00:00.000', 'Approved', 'Received following approval confirmation from Chuck, confirmation attached as well: \" Hi, Brad!    Actually, she can see any patient that wanders in. Since the tax ID is network, all claims should process fine; we don’t care so much about the individual rendering as we do the TIN. She personally just won’t be available for referrals until her cred processes.\"  \"I show her effective 10/1/20, as per her app.  Chuck McGrew Tricare Community Liaison II Servicing provider relations matters in the following areas: RI / CT / Western MA  Humana Military  T 502-313-9524 F 806-517-2809 jmcgrew3@humana.com  www.humanamilitary.com\"', NULL, NULL, '2020-12-02 16:32:20', '2020-12-02 16:32:20'),
(5775, 1006, 9297, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-12 17:58:21', '2020-10-12 17:58:21'),
(5776, 1006, 9297, NULL, '2020-10-19 00:00:00.000', 'Initiated', 'Initiated enrollment request via online cigna behavioral health portal. Attached copy of letter.  \"You have successfully submitted your application. Please print a copy of this page for your records. Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273.\"', NULL, NULL, '2020-10-12 17:58:44', '2020-10-12 17:58:44'),
(5777, 1006, 9297, NULL, '2020-10-27 00:00:00.000', 'In Process', 'The request is still in process and we\'re waiting on the Cigna recruiter to check back with us, should allow another week.   Ref# Paia X 10/20/2020', NULL, NULL, '2020-10-20 13:55:24', '2020-10-20 13:55:24'),
(5778, 1006, 9297, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent a follow-up email regarding status @ Behavioral Contracting BehavioralContracting@Cigna.com>.', NULL, NULL, '2020-10-28 17:48:20', '2020-10-28 17:48:20'),
(5779, 1006, 9297, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Received contract for enrollment, signed and sent back to Theresa Garrett @ theresa.garrett@cigna.com. Attached copy of the contract.  ', NULL, NULL, '2020-11-05 13:19:50', '2020-11-05 13:19:50'),
(5780, 1006, 9297, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Sent follow-up email to Behavioral Contracting BehavioralContracting@cigna.com> regarding updated status. ', NULL, NULL, '2020-11-12 18:29:23', '2020-11-12 18:29:23'),
(5781, 1006, 9297, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following reply from BehavioralContracting@cigna.com:  SUB: Provider Enrollment Status - Jessica Hartman  \"Thank you for contacting Cigna Behavioral. Or records indicate that the following recruiter has been assigned to you. To accurately continue the on-boarding process, please reach out to you assigned recruiter listed below, who is familiar with your specific on-boarding process. I have looped them into this email for any questions you might have.    Assigned Recruiter  •          Theresa Garrett •          Email: Theresa.Garrett@cigna.com  Thank you,  ConnectedCare PROVIDER OPERATIONS  Julie Perkins Cigna Behavioral Health NCU | Provider Relations Analyst  P: 903.361.4513  | F: 1.860.697.6085\"', NULL, NULL, '2020-11-16 13:01:11', '2020-11-16 13:01:11'),
(5782, 1006, 9297, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent follow-up email to \"Garrett, Theresa      244\" Theresa.Garrett@cigna.com', NULL, NULL, '2020-11-23 18:10:55', '2020-11-23 18:10:55'),
(5783, 1006, 9297, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Received following reply: \"I will be out of the office Monday, Nov. 23rd to Friday, Nov. 27th. Thank you and warm wishes.     Thank you,  ConnectedCare PROVIDER OPERATIONS  Theresa Garrett  Cigna Behavioral Health | National Contracting Unit | Provider Relations Associate Analyst  T: 903-337-2650 | F: 860-457-4937  theresa.garrett@cigna.com\"', NULL, NULL, '2020-11-24 11:45:15', '2020-11-24 11:45:15'),
(5784, 1006, 9297, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Received following email from Theresa: \"Jessica Hartman  CAQH ID#: 14979113     Thank you for your interest in joining the Cigna Behavioral Health network. At this time, I will need to place your on-boarding process on hold due to your Council for Affordable Quality Healthcare (CAQH) application needing action for the following highlighted documentation, see below. Please update and reattest what is needed for the on-boarding process to continue.  · PROFESSIONAL LIABILITY INSURANCE - Current expiration date must be at least 60 days from the receipt of this communication.  Ø Professional Liability expiration date: 12/1/2020\"  CAQH Updated and informed Theresa. ', NULL, NULL, '2020-11-30 17:37:59', '2020-11-30 17:37:59'),
(5785, 1006, 9297, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Garrett, Theresa 244\" Theresa.Garrett@cigna.com. ', NULL, NULL, '2020-12-07 14:49:32', '2020-12-07 14:49:32'),
(5786, 1006, 9297, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a f/u email @ \"Garrett, Theresa 244\" Theresa.Garrett@cigna.com', NULL, NULL, '2020-12-17 17:00:14', '2020-12-17 17:00:14'),
(5787, 1006, 9297, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Received following reply from Theresa: \'Jessica Hartman     Thank you for completing your Onboarding Packet through DocuSign. I have verified that your CAQH is presently up to date and I have submitted your packet to our credentialing team, they will begin verifying your credentials.  Please note the credentialing process may take up to 90 days depending on the response time of the institutions they contact for this purpose.  While they are verifying your credentials you will be considered a non-participating provider.  During the credentialing process your CAQH must remain up to date, if not,  your processing will be placed on hold until the information is updated and CAQH attested.   No further action is needed from you at this time.  Should I or the credentialing team need additional information we will contact you by means listed on your Cigna Behavioral Provider Application.  Once your credentials have been verified, we will send an email, which will include a copy of your final agreement. The subject line of this email will begin with “Status Update: Completed.” The agreement will include Cigna\'s countersignature and your effective date as a contracted provider  with Cigna Behavioral Health.  We look forward to working with you and helping you realize your professional goals.     Thank you,  Theresa Garrett  Cigna Behavioral Health | National Contracting Unit | Provider Relations Associate Analyst  T: 903-337-2650 | F: 860-457-4937  theresa.garrett@cigna.com\"', NULL, NULL, '2020-12-18 18:07:07', '2020-12-18 18:07:07'),
(5788, 1006, 9297, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Application is in-processing, need to allow more time for the application to process.  Application# CBP-0000178562  Ref# Izzy L 12/29/2020', NULL, NULL, '2020-12-29 14:43:14', '2020-12-29 14:43:14'),
(5789, 1006, 9297, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Garrett, Theresa      244\" theresa.garrett@cigna.com', NULL, NULL, '2021-01-15 18:17:48', '2021-01-15 18:17:48'),
(5790, 1006, 9297, NULL, '2021-02-03 00:00:00.000', 'In Process', 'The request is still in review, need to allow more time.  Ref# Nick H 01/27/2021', NULL, NULL, '2021-01-27 12:03:18', '2021-01-27 12:03:18'),
(5791, 1006, 9297, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a f/u email @ Behavioral Contracting BehavioralContracting@Cigna.com', NULL, NULL, '2021-02-12 16:43:32', '2021-02-12 16:43:32'),
(5792, 1006, 9297, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Congratulations! You are now a fully credentialed and contracted provider in the Cigna Behavioral Health network. You may access your signed agreement by clicking on the “Completed Documented” box below. No further action is required of you at this time. ', NULL, NULL, '2021-02-18 15:30:34', '2021-02-18 15:30:34'),
(5793, 1019, 9297, NULL, NULL, 'Revalidation', 'Sir, As per my discussion with the Rep at Cigna (Megan), Jessica Hartman DEA was not updated in Cigna because of that her fee schedule would not pay for Office Visits, I have updated her DEA information with them, it will take upto 10 business days to show on her Demographics and then we\'ll have to asked Jessica Border in Contracting to Revised Jessica Hartman fees schedule once this process is completed will be able reimburse our claims. (Ref # Megan 04/05/2021). Let me know if you have any questions. Jessica Borders 770 2611162 jessica.borders@cigna.com  Regards, Alex', NULL, NULL, '2021-04-05 16:17:27', '2021-04-05 16:17:27'),
(5794, 11056, 9297, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Rep: Marisa M  Status:  The address is updated will take 30 business days. Asked the rep to email us the location update.  Ref code: marisam12082021', NULL, NULL, '2021-12-09 10:34:19', '2021-12-09 10:34:19'),
(5795, 19067, 9297, NULL, '2022-02-11 00:00:00.000', 'Revalidated', 'Spoke with Nick @800-926-2273. Got the effective date as of 02/04/2021. See attachment for provides directory. Ref# NichH02042022', NULL, NULL, '2022-02-04 11:42:37', '2022-02-04 11:42:37'),
(5796, 2037, 9298, NULL, NULL, 'New/Not Initiated', 'Received a request for Dehnisch, Frank\'s Malpractice Face-sheet via fax.I have attached Frank\'s COI and faxed back to Mulitiplan @ 844-835-5544 for re-credentialing process.Document uploaded to CAQH aswell with the Expiry date of 07-20-2021. ', NULL, NULL, '2020-10-13 15:03:41', '2020-10-13 15:03:41'),
(5797, 2037, 9298, NULL, '2020-10-20 00:00:00.000', 'In Process', 'As per live call the professional liability insurance for Fran was received and the  re credentialing is currently being processed. Case#7381635.The file will be updated Within 10 Business days. Sam.R', NULL, NULL, '2020-10-13 15:03:54', '2020-10-13 15:03:54'),
(5798, 2037, 9298, NULL, '2020-10-20 00:00:00.000', 'Approved', 'Received a confirmation fax from Multiplan notifying the successful re credentialing of Frank effective 09/17/2020. Multiplan & PHCS.Notification Sent to the billing', NULL, NULL, '2020-10-13 15:04:08', '2020-10-13 15:04:08'),
(5799, 2037, 9299, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-13 15:24:59', '2020-10-13 15:24:59'),
(5800, 2037, 9299, NULL, '2020-10-20 00:00:00.000', 'Approved', 'CBUC is having a group contract with all the three providers linked to the tax ID. Both Lines of business . Multiplan & PHCS effective : 12/1/17.Request to add George West location over the phone call. Case#7387345. Turn around 10 business days.Task created in George West medical Center.', NULL, NULL, '2020-10-13 15:27:46', '2020-10-13 15:27:46'),
(5801, 2037, 9300, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-13 15:29:00', '2020-10-13 15:29:00'),
(5802, 2037, 9300, NULL, '2020-10-20 00:00:00.000', 'In Process', 'CBUC is having a group contract with all the three providers linked to the tax ID. Both Lines of business . Multiplan & PHCS effective : 12/1/17.Request to add George West location over the phone call. Case#7387345. Turn around 10 business days.', NULL, NULL, '2020-10-13 15:29:53', '2020-10-13 15:29:53'),
(5803, 2037, 9300, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Case#7387345. In process', NULL, NULL, '2020-10-19 10:57:16', '2020-10-19 10:57:16'),
(5804, 2037, 9300, NULL, '2020-11-03 00:00:00.000', 'In Process', 'The request has been processed and the address has been added got a confirmation over the phone call.Request submitted for updated roaster with demographic details .Will be receiving it withing 5 business days.Case#7387345.', NULL, NULL, '2020-10-27 14:32:04', '2020-10-27 14:32:04'),
(5805, 2037, 9300, NULL, '2020-11-10 00:00:00.000', 'Approved', 'Roster received for confirmation of location addition Uploaded on EMRBS.', NULL, NULL, '2020-11-03 11:29:30', '2020-11-03 11:29:30'),
(5806, 2037, 9301, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-13 15:31:03', '2020-10-13 15:31:03'),
(5807, 2037, 9301, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Only primary service location added. Requested to add George west Location over the call. 7387345#Case. Turn around 10 business days.', NULL, NULL, '2020-10-13 15:39:38', '2020-10-13 15:39:38'),
(5808, 2037, 9301, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Only primary service location added. Requested to add George west Location over the call. 7387345#Case. Turn around 10 business days.', NULL, NULL, '2020-10-13 15:40:20', '2020-10-13 15:40:20'),
(5809, 2037, 9301, NULL, '2020-10-27 00:00:00.000', 'In Process', '7387345#Case.In process', NULL, NULL, '2020-10-19 10:57:29', '2020-10-19 10:57:29'),
(5810, 2037, 9301, NULL, '2020-11-03 00:00:00.000', 'In Process', 'The request has been processed and the address has been added got a confirmation over the phone call.Request submitted for updated roaster with demographic details .Will be receiving it withing 5 business days.Case#7387345.', NULL, NULL, '2020-10-27 14:32:01', '2020-10-27 14:32:01'),
(5811, 2037, 9301, NULL, '2020-11-10 00:00:00.000', 'Approved', 'Roster received for confirmation of location addition Uploaded on EMRBS.', NULL, NULL, '2020-11-03 11:29:23', '2020-11-03 11:29:23'),
(5812, 2037, 9302, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-13 15:36:35', '2020-10-13 15:36:35'),
(5813, 2037, 9302, NULL, '2020-10-20 00:00:00.000', 'Approved', 'Provider is linked to the TIN effective 12/1/17 Multiplan and PHCS . Only primary service location added. Requested to add george west Location over the call. 7387345#Case', NULL, NULL, '2020-10-13 15:38:01', '2020-10-13 15:38:01'),
(5814, 2027, 9303, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-13 17:33:12', '2020-10-13 17:33:12'),
(5815, 2027, 9303, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Application has been submitted for this provider for enrollment in medicaid. PEP ticket SS is attached. ', NULL, NULL, '2020-10-13 17:33:48', '2020-10-13 17:33:48'),
(5816, 1006, 9303, NULL, '2020-11-02 00:00:00.000', 'In Process', 'The request still shows up as in-process on the TMHP provider portal with no other requirements noted. ', NULL, NULL, '2020-10-26 16:41:02', '2020-10-26 16:41:02'),
(5817, 2027, 9303, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-02 12:38:52', '2020-11-02 12:38:52'),
(5818, 2027, 9303, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-09 15:50:32', '2020-11-09 15:50:32'),
(5819, 2027, 9303, NULL, '2020-11-23 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid in all three locations of (VMUC). Screenshot is attached.', NULL, NULL, '2020-11-16 10:13:07', '2020-11-16 10:13:07'),
(5820, 2027, 9304, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-13 17:34:50', '2020-10-13 17:34:50'),
(5821, 2027, 9304, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Application has been submitted for this provider for enrollment in medicaid. PEP ticket SS is attached. ', NULL, NULL, '2020-10-13 17:34:57', '2020-10-13 17:34:57'),
(5822, 1006, 9304, NULL, '2020-11-02 00:00:00.000', 'In Process', 'The request still shows up as in-process on the TMHP provider portal with no other requirements noted. ', NULL, NULL, '2020-10-26 16:41:10', '2020-10-26 16:41:10'),
(5823, 2027, 9304, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-02 12:39:27', '2020-11-02 12:39:27'),
(5824, 2027, 9304, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-09 15:51:25', '2020-11-09 15:51:25'),
(5825, 2027, 9304, NULL, '2020-11-23 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid in all three locations of (VMUC). Screenshot is attached.', NULL, NULL, '2020-11-16 10:15:25', '2020-11-16 10:15:25'),
(5826, 2027, 9305, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-14 11:01:48', '2020-10-14 11:01:48'),
(5827, 2027, 9305, NULL, '2020-10-21 00:00:00.000', 'Approved', '	 Provider is showing linked with the insurance and effective date is 2/28/2018', NULL, NULL, '2020-10-14 11:02:10', '2020-10-14 11:02:10'),
(5828, 2027, 9306, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-16 14:28:36', '2020-10-16 14:28:36'),
(5829, 2027, 9306, NULL, '2020-10-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Hernandez, Eder Francisco)-(Valley Med Urgent Care )-(Tricare)  Please find the requested documents attached in this email to start the credentialing process for this provider.  Thanks.', NULL, NULL, '2020-10-16 14:30:08', '2020-10-16 14:30:08'),
(5830, 2027, 9306, NULL, '2020-10-23 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Thank you, This application has been submitted for processing. Please allow 90 days.        Respectfully,  Katherine Moten', NULL, NULL, '2020-10-16 15:45:35', '2020-10-16 15:45:35'),
(5831, 1006, 9306, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Sent a follow-up email to KMoten4@humana.com:  \"Hello,   I wanted to get an update regarding the status of enrollment for the following providers under our group:   Provider Names: Eder Francisco Hernandez NPI# 1386956852 Provider Name: Cynthia Rodriguez NPI# 1124282553  Both of these providers should be coming up under three locations under the given TIN# 81-5123542. Please let me know if you need any additional information.  Thank you. \"', NULL, NULL, '2020-10-23 18:11:41', '2020-10-23 18:11:41'),
(5832, 2027, 9306, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hi Katherine, Hope you are doing well, I have sent a request for this below mentioned provider to add in all three locations of (Valley Med Urgent Care) with (Tricare). May I know the current status of this request: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852   Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-11-03 13:45:59', '2020-11-03 13:45:59'),
(5833, 2027, 9306, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-10 13:31:51', '2020-11-10 13:31:51'),
(5834, 2027, 9306, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 10:23:39', '2020-11-18 10:23:39'),
(5835, 2027, 9306, NULL, '2020-12-02 00:00:00.000', 'In Process', 'The request is still in process.', NULL, NULL, '2020-11-25 10:58:56', '2020-11-25 10:58:56'),
(5836, 2027, 9306, NULL, '2020-12-09 00:00:00.000', 'In Process', 'The request is still in process', NULL, NULL, '2020-12-02 12:55:08', '2020-12-02 12:55:08'),
(5837, 2027, 9306, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:20:57', '2020-12-10 13:20:57'),
(5838, 3040, 9306, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well.  Please update me regarding the status for the below provider.    Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852   Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks      ', NULL, NULL, '2020-12-17 12:49:27', '2020-12-17 12:49:27'),
(5839, 3040, 9306, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks', NULL, NULL, '2020-12-17 15:43:45', '2020-12-17 15:43:45'),
(5840, 3040, 9306, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks ', NULL, NULL, '2020-12-24 10:39:18', '2020-12-24 10:39:18'),
(5841, 3040, 9306, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-31 13:21:28', '2020-12-31 13:21:28'),
(5842, 3040, 9306, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  I am inquiring on what information is missing, once I receive a response, I will let you know.  Thank you.', NULL, NULL, '2021-01-04 15:20:54', '2021-01-04 15:20:54'),
(5843, 3040, 9306, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Good Afternoon,  Hope you are doing well. Disregard the previous form page no 7 that was mistakenly submitted. Please find the attached the new Consent and Release form for Eder Francisco Hernandez.  If you need the further information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-05 15:01:53', '2021-01-05 15:01:53'),
(5844, 3040, 9306, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from : KMoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Good Morning,  Please look at page 7 on the cred app. Our credentialing department needs an explanation for answering YES to DEA Registration.  Please provide me that explanation along with a new signed Consent and Release Form. ', NULL, NULL, '2021-01-05 15:03:07', '2021-01-05 15:03:07'),
(5845, 3040, 9306, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Thank you.  This has been submitted for review; please allow 30 days. ', NULL, NULL, '2021-01-12 09:52:02', '2021-01-12 09:52:02'),
(5846, 3040, 9306, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Please find the attached the page 7 that you requested.  If you anything else please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-12 09:53:38', '2021-01-12 09:53:38'),
(5847, 3040, 9306, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Application is still in process.', NULL, NULL, '2021-01-19 11:08:44', '2021-01-19 11:08:44'),
(5848, 3040, 9306, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of below mentioned provider.  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-26 10:45:49', '2021-01-26 10:45:49');
