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
(53674, 11056, 45732, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:00', '2021-11-17 17:55:00'),
(53675, 11056, 45732, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:02:58', '2021-11-17 18:02:58'),
(53676, 11056, 45733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:54:12', '2021-11-17 17:54:12'),
(53677, 11056, 45733, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:54:51', '2021-11-17 17:54:51'),
(53678, 11056, 45733, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:03:09', '2021-11-17 18:03:09'),
(53679, 11056, 46715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53680, 11056, 46715, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:28:39', '2021-11-22 09:28:39'),
(53681, 11056, 46715, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:13', '2021-11-22 09:30:13'),
(53682, 11056, 46715, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:09:16', '2021-11-22 10:09:16'),
(53683, 11056, 46716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53684, 11056, 46716, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:28:45', '2021-11-22 09:28:45'),
(53685, 11056, 46716, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:20', '2021-11-22 09:30:20'),
(53686, 11056, 46716, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:09:11', '2021-11-22 10:09:11'),
(53687, 11056, 46717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53688, 11056, 46717, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:28:51', '2021-11-22 09:28:51'),
(53689, 11056, 46717, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:24', '2021-11-22 09:30:24'),
(53690, 11056, 46717, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:09:05', '2021-11-22 10:09:05'),
(53691, 11056, 46718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53692, 11056, 46718, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:28:56', '2021-11-22 09:28:56'),
(53693, 11056, 46718, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:31', '2021-11-22 09:30:31'),
(53694, 11056, 46718, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:09:01', '2021-11-22 10:09:01'),
(53695, 11056, 46719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53696, 11056, 46719, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:03', '2021-11-22 09:29:03'),
(53697, 11056, 46719, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:37', '2021-11-22 09:30:37'),
(53698, 11056, 46719, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:08:55', '2021-11-22 10:08:55'),
(53699, 11056, 46720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53700, 11056, 46720, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:08', '2021-11-22 09:29:08'),
(53701, 11056, 46720, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:43', '2021-11-22 09:30:43'),
(53702, 11056, 46720, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:08:50', '2021-11-22 10:08:50'),
(53703, 11056, 46721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53704, 11056, 46721, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:13', '2021-11-22 09:29:13'),
(53705, 11056, 46721, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:30:58', '2021-11-22 09:30:58'),
(53706, 11056, 46721, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:08:40', '2021-11-22 10:08:40'),
(53707, 11056, 46722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53708, 11056, 46722, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:18', '2021-11-22 09:29:18'),
(53709, 11056, 46722, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:31:03', '2021-11-22 09:31:03'),
(53710, 11056, 46722, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:08:35', '2021-11-22 10:08:35'),
(53711, 11056, 46723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:24:33', '2021-11-22 09:24:33'),
(53712, 11056, 46723, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:24', '2021-11-22 09:29:24'),
(53713, 11056, 46723, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:31:09', '2021-11-22 09:31:09'),
(53714, 11056, 46723, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:08:29', '2021-11-22 10:08:29'),
(53715, 11056, 46724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:27:18', '2021-11-22 09:27:18'),
(53716, 11056, 46724, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:28', '2021-11-22 09:29:28'),
(53717, 11056, 46724, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:31:14', '2021-11-22 09:31:14'),
(53718, 11056, 46724, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021 ', NULL, NULL, '2021-11-22 10:08:24', '2021-11-22 10:08:24'),
(53719, 11056, 46725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-22 09:27:18', '2021-11-22 09:27:18'),
(53720, 11056, 46725, NULL, '2021-11-29 00:00:00.000', 'Initiated', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-22 09:29:34', '2021-11-22 09:29:34'),
(53721, 11056, 46725, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess', NULL, NULL, '2021-11-22 09:31:19', '2021-11-22 09:31:19'),
(53722, 11056, 46725, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com  CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Location is added from 11/4/2021  ', NULL, NULL, '2021-11-22 10:08:07', '2021-11-22 10:08:07'),
(53723, 11056, 46726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 09:15:30', '2021-11-24 09:15:30'),
(53724, 11056, 46726, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to: HumanaHoustonPD@humana.com , pcalupaz@humana.com & JTRENZ@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 09:15:57', '2021-11-24 09:15:57'),
(53725, 11056, 46726, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to: HumanaHoustonPD@humana.com , JTRENZ@humana.com & pcalupaz@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 09:16:09', '2021-11-24 09:16:09'),
(53726, 11056, 46726, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to: HumanaHoustonPD@humana.com , JTRENZ@humana.com & pcalupaz@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 09:16:09', '2021-11-24 09:16:09'),
(53727, 11056, 46726, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Humana has 4 Network Development Regions in Texas. Updates can only be made by the region where the provider’s office resides. Based on your service address, your request for a contract/ existing contract/updates are handled by another Network Development Market. Please remove the HumanaHoustonPD mailbox from your distribution and use the STXNM@humana.com email in its place.     Thank you.     HumanaHoustonPD     Dallas/Fort Worth/North TX/East TX   NTXNM@humana.com    San Antonio/Corpus Christi/South Texas    STXNM@humana.com     Austin/El Paso/Central Texas/BCS/West TX/Panhandle    networkrelationsaustintx@humana.com    Another request has been sent to STXNM@humana.co', NULL, NULL, '2021-11-24 09:16:22', '2021-11-24 09:16:22'),
(53728, 11056, 46726, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  stxnm@humana.com  Sub:  Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 09:16:34', '2021-11-24 09:16:34'),
(53729, 11056, 46726, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Good morning!  Hope this email finds you well. Please find the attached roster for the provider, Leticia Aleman-Listenbee for enrolling and credentialing under the facility.  Furthermore, if any documents and corrections are required please don\'t hesitate in reaching out to me.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-24 09:19:03', '2021-11-24 09:19:03'),
(53730, 11056, 46726, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com   Sub:  Enrollment Query - CBUC & GWMC - Humana  Good afternoon1  Hope this email finds you well. Please provide me with the latest updates regarding the credentialing process of the provider,  Leticia Aleman-Listenbee, and also about the roster which I have submitted to you on 5th of November,2021.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Eagerly, waiting for your response.  Thank you!', NULL, NULL, '2021-12-03 15:48:35', '2021-12-03 15:48:35'),
(53731, 11056, 46726, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub:  Enrollment Query - CBUC & GWMC - Humana  Good morning!  Hope this email finds you well. Please provide the latest updates regarding the enrollment process of the below-mentioned provider under facility TIN  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-17 17:22:22', '2021-12-17 17:22:22'),
(53732, 11056, 46726, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Sub: Enrollment Query - CBUC & GWMC - Humana   Hello,  The request was received and is in the queue.   We are experiencing a large volume of requests. Please allow a minimum of 45 days or longer for processing.   Thank you,   South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741 F 855.461.6048 stxnm@humana.com', NULL, NULL, '2021-12-22 12:49:33', '2021-12-22 12:49:33'),
(53733, 19067, 46726, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||  Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S Hillside, DR STE 4, Beeville, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside, DR STE 4, Beeville, TX 78102-5324    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:47:51', '2022-01-04 12:47:51'),
(53734, 19067, 46726, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Monica Gonzalez was added to the group on 11/22/2021     Leticia Aleman-Listenbee was added to the group on 12/17/2021.   Thank you   Network Operations Coordinator – Provider Contracting     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2022-01-11 13:06:40', '2022-01-11 13:06:40'),
(53735, 19067, 46726, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Greetings!  I am unable to find these providers on Humana\'s provider directory.  Kindly assist me in this matter.  Regards, Hammad.', NULL, NULL, '2022-01-26 13:33:30', '2022-01-26 13:33:30'),
(53736, 19067, 46726, NULL, '2022-03-07 00:00:00.000', 'Approved', 'Email received from: stxnm@humana.com  Monica Gonzalez is loaded with a 1/1/2021 effective date  Leticia Aleman-Listenbee loaded on 11/1/2021', NULL, NULL, '2022-02-28 15:54:33', '2022-02-28 15:54:33'),
(53737, 11056, 46727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 12:47:38', '2021-11-24 12:47:38'),
(53738, 11056, 46727, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub : Enrollment Query - CBUC & GWMC - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Tricare. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 12:48:28', '2021-11-24 12:48:28');
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
(53739, 11056, 46727, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Query - CBUC & GWMC - Tricare  Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-24 12:48:46', '2021-11-24 12:48:46'),
(53740, 11056, 46727, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub : Enrollment Query - CBUC & GWMC - Tricare  Good morning!  Hope this email finds you well. Please also assist regarding a provider having a Nurse Practitioner speciality. I don\'t find a certification form at humanamilitary.com for a Nurse Practitioner specialty.  Kindly, do provide me with the form If you could.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 12:48:58', '2021-11-24 12:48:58'),
(53741, 11056, 46727, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:  Enrollment Query - CBUC & GWMC - Tricare  https://docushare-web.apps.external.pioneer.humana.com/Marketing/docushare-app?file=3301818     Please use the Allied Health professional provider certification application found on humanamilitary.com     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East    The form has been filled and attached.', NULL, NULL, '2021-11-24 12:53:25', '2021-11-24 12:53:25'),
(53742, 11056, 46727, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - CBUC & GWMC - Tricare  Good afternoon!  Hope this email finds you well. Please find the attached form, I had faxed them a week ago. Any updates on it and credentialing process of the provider, Leticia Aleman-Listenbee?  Thank you! Have a great day! ', NULL, NULL, '2021-12-03 15:30:56', '2021-12-03 15:30:56'),
(53743, 11056, 46727, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - CBUC & GWMC - Tricare   Good afternoon, Mr. Talha –     A provider cannot be credentialed until their NPI is first CERTIFIED.  The attached application should have been faxed to TRICARE East Certification at 608.221.7535.     The certification process will take at least 90 days.   If you fax a CREDENTIALING packet before the provider is certified, it will not be processed because the provider NPI cannot be found in our system until certification is complete.     Can you advise if her CERTIFICATION application was faxed to the Certification Team? If so, please allow 90 days from faxing for processing.  The NPI can then be checked on the provider portal at humanamilitary.com (see example below from email dated Nov 1, 2021).     Please let me know if I can provide further assistance.  The application has already been provided.', NULL, NULL, '2021-12-17 18:01:28', '2021-12-17 18:01:28'),
(53744, 11056, 46727, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - CBUC & GWMC - Tricare   Good afternoon!  Hope you are having a productive day. Yes, the CERTIFICATION application was faxed to the Certification Team. I am unable to get to the provider portal. Could you please let me know the certification status of the provider, Leticia Aleman-Listenbee?  Looking forward to hearing from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 11:19:06', '2021-12-22 11:19:06'),
(53745, 19067, 46727, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||     Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mocia Gonzalez	1871132811	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663   Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:58:56', '2022-01-04 10:58:56'),
(53746, 19067, 46727, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||   Good Morning Hammad,     This group tax id is not in my area. Celeste Santiago is the Rep for that area. I have include her on this email.  Please reach out to her to assist.  You can also check status by creating a log in on the Provider portal.', NULL, NULL, '2022-01-10 10:12:24', '2022-01-10 10:12:24'),
(53747, 19067, 46727, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com, ywyatt@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Greetings Celeste!  Hope this email finds you well.  Can you look into the request mentioned below?   Have a beautiful day! Hammad Ahmed. ', NULL, NULL, '2022-01-20 20:25:42', '2022-01-20 20:25:42'),
(53748, 19067, 46727, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Hammad,  Thank you for reaching out to me.  I am the new Provider Rep for the Corpus Christi Area, as well as Austin, and Del Rio area.  I have researched your providers you listed and have annotated in RED below  Group Name  Beeville Medical Clinic        Tax ID  81-1890349        Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified Authorized TRICARE Provider-assigned this location     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified Authorized TRICARE Provider-assigned to this location     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location        I have identified an issue for Mercedita Flynn, but that does not impact her as a provider and certification and or credentialing.  That alert has been submitted and is set to be corrected.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 11:35:10', '2022-02-16 11:35:10'),
(53749, 19067, 46727, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: Credentialing for Leticia Aleman    Hammad,  Attached is the credentialing application.  Please ensure the following documents are attached with the application  ·         TSCA- Required  ·         DEA Certificate  ·         DPS Certificate  ·         Other Controlled Dangerous Substance Certificate  ·         Provider’s License  ·         Liability Insurance- needs to list the practitioners name, and effective and term dates of policy.  ·         W9  ·         CLIA Certificate (if applicable)  ·         Radiology Certificate (if applicable)  ·         DD214 (if applicable)        In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  O (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 13:24:46', '2022-02-16 13:24:46'),
(53750, 19067, 46727, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: Credentialing for Leticia Aleman    Hammad,  Attached is the credentialing application.  Please ensure the following documents are attached with the application  ·         TSCA- Required  ·         DEA Certificate  ·         DPS Certificate  ·         Other Controlled Dangerous Substance Certificate  ·         Provider’s License  ·         Liability Insurance- needs to list the practitioners name, and effective and term dates of policy.  ·         W9  ·         CLIA Certificate (if applicable)  ·         Radiology Certificate (if applicable)  ·         DD214 (if applicable)        In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  O (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 14:52:32', '2022-02-16 14:52:32'),
(53751, 19067, 46727, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: Re: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare   Hi Celeste,  Kindly see attachment for the form as per your request, and do not hesitate to contact me if you have any questions or if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-16 14:53:44', '2022-02-16 14:53:44'),
(53752, 19067, 46727, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: RE: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare    Hammad,  The Credentialing application has been uploaded to this providers profile.  I have alerted credentialing for processing.  Note the timeline for this to be processed is 90-120 days.         Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-17 16:20:46', '2022-02-17 16:20:46'),
(53753, 19067, 46727, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: Re: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare    Hammad,  I am missing the providers State License  for the credentialing application.  It was not included.     Respectfully,  Celeste Santiago  TRICARE Community Liaison II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com   ', NULL, NULL, '2022-03-16 10:36:18', '2022-03-16 10:36:18'),
(53754, 19067, 46727, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: Re: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare   Hello,  Kindly see the attachment of State License as per you requested.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 10:44:16', '2022-03-16 10:44:16'),
(53755, 22077, 46727, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject; 	Re: Re: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||  Hi,  Hope this email finds you well,  I would like to know the effective date of the providers mentioned previously,   Looking forward to your kind response. Have a great day!  Thanks & Regards Alex', NULL, NULL, '2022-04-14 08:13:11', '2022-04-14 08:13:11'),
(53756, 22077, 46727, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||  Hi,  Hope this email finds you well,  I would like to know the effective date of the providers mentioned previously,   Looking forward to your kind response. Have a great day!  Thanks & Regards Alex', NULL, NULL, '2022-04-14 08:20:29', '2022-04-14 08:20:29'),
(53757, 19067, 46727, NULL, '2022-04-26 00:00:00.000', 'Approved', 'Email received from: CSantiago20@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Hi,     Group Name  Beeville Medical Clinic        Tax ID  81-1890349        Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified-1/10/2022 Authorized TRICARE Provider-assigned this location-Credentialed as of 04/15/2022     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified-1/10/22 Authorized TRICARE Provider-assigned to this location-Credentialed as of 4/15/2022     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location-01/19/2022     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location 01/19/2022     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location-12/15/2019     ', NULL, NULL, '2022-04-19 16:00:26', '2022-04-19 16:00:26'),
(53758, 11056, 46728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 13:03:20', '2021-11-24 13:03:20'),
(53759, 11056, 46728, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to : providerservices@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Tricare. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 13:04:03', '2021-11-24 13:04:03'),
(53760, 11056, 46728, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from : providerservices@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Hello,     Please e-mail your request to credentialing@triwest.com and reference contract number 121TW62766C01.     Thank you,     Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance  providerservices@triwest.com  www.triwest.com  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)     Remember to now send your claims to PGBA! TriWest has a new claims processor and Payer ID. For more information, visit www.triwest.com/claimsconversion.', NULL, NULL, '2021-11-24 13:05:41', '2021-11-24 13:05:41'),
(53761, 11056, 46728, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  Credentialing@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential     Good Afternoon     The provider cannot be loaded for credentialing as the providers CAQH is not completed.     Please have the provider complete the CAQH process.     If the provider is unable to complete the CAQH please have the provider fill out the attached provider application pages 2-9 and return it along with the required documents that are listed on page 1 of the credentialing packet.     Kind regards,     Nicole Goergen  Provider Credentialing Specialist  TriWest Healthcare Alliance  F: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Choice Contact Center: (866) 606-8198  Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838  www.triwest.com     Follow TriWest:  www.facebook.com/triwest  www.twitter.com/triwest  linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-24 13:05:59', '2021-11-24 13:05:59'),
(53762, 11056, 46728, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: credentialing@triwest.com  Sub:   Enrollment Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Good Afternoon     The provider cannot be loaded for credentialing as the provider\'s CAQH is not completed.     Please have the provider complete the CAQH process.     If the provider is unable to complete the CAQH please have the provider fill out the attached provider application pages 2-9 and return it along with the required documents that are listed on page 1 of the credentialing packet.     Kind regards,     Nicole Goergen  Provider Credentialing Specialist  TriWest Healthcare Alliance  F: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Choice Contact Center: (866) 606-8198  Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838  www.triwest.com     Follow TriWest:  www.facebook.com/triwest  www.twitter.com/triwest  linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-24 13:11:05', '2021-11-24 13:11:05'),
(53763, 11056, 46728, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  credentialing@triwest.com  Sub: Enrollment Query - CBUC & GWMC - Triwest  Good afternoon!  Hope you are doing well. The CAQH of the provider has been updated and attested. Is there any need for the form to be filled out or not?  Please get back to me at your earliest convenience.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 15:36:06', '2021-12-03 15:36:06'),
(53764, 11056, 46728, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub: Enrollment Query - CBUC & GWMC - Triwest  Good morning!  Hope you are doing great. Still waiting for your response. The CAQH of the provider is updated and attested. Is there any need for the form to be filled out or not?  Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-14 16:29:40', '2021-12-14 16:29:40'),
(53765, 11056, 46728, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: smiguel@triwest.com  Sub: Credentialing Application Approval re: Leticia Aleman-Listenbee FNP  TriWest Classification: Confidential   Hello, Dear Leticia Aleman-Listenbee, FNP:  I am pleased to inform you that on 12/6/2021, the TriWest Healthcare Alliance Credentialing Committee reviewed and approved your credentialing application for participation as a TriWest network provider.  Please find the attached approval letter for the above provider.   We value your participation and commitment to providing quality health care services!   Shannael Miguel Provider Credentialing Spec  TriWest Healthcare Alliance smiguel@triwest.com  www.triwest.com', NULL, NULL, '2021-12-20 12:34:25', '2021-12-20 12:34:25'),
(53766, 11056, 46729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 13:55:13', '2021-11-24 13:55:13'),
(53767, 11056, 46729, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to : mmedina@ghn-mci.com & Kavalos@ghn-mci.com  Sub : Enrollment Query - CBUC & GWMC - Galaxy Health  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 13:55:33', '2021-11-24 13:55:33'),
(53768, 11056, 46729, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:kavalos@ghn-mci.com  Sub : Enrollment Query - CBUC & GWMC - Galaxy Health   please provide Dr. title, specialty. Effective date and phone/fax number for the practice location.  Thanks;  Karen A  Have provided with the details.', NULL, NULL, '2021-11-24 13:55:42', '2021-11-24 13:55:42'),
(53769, 11056, 46729, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health   Good evening Karen!  Hope you had a great weekend. Here it is. If anything else is needed please feel free to reach out to me.  Provider Name: Leticia Aleman-Listenbee           Effective date: 09/01/2021 Degree :  MSN                                                          Title: FNP Practice contact no. # : 361-226-1126                      fax no. : 361 542-4076   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:55:53', '2021-11-24 13:55:53'),
(53770, 11056, 46729, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Hello Ahmed;     This is all we need to for the update allow 60-90 days for the update to be completed.     Thanks;     Karen A', NULL, NULL, '2021-11-24 13:59:18', '2021-11-24 13:59:18'),
(53771, 11056, 46729, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Kavalos@ghn-mci.com  Sub: Enrollment Query - CBUC & GWMC - Galaxy Health  Good morning Karen!  Hope you are doing great. Any update on the credentialing process of the provider, Leticia Aleman-Listenbee?  Are you in need of any information or document? Please let me know.  Take Care of yourself!  Thank you! Have a wonderfully blessed day!', NULL, NULL, '2021-12-03 15:39:06', '2021-12-03 15:39:06'),
(53772, 11056, 46729, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Enrollment Status Query - Galaxy Health - CBUC/GWMC   Is this eff date is for all of the providers or not? Provide me with welcome letters too.', NULL, NULL, '2021-12-17 14:26:11', '2021-12-17 14:26:11'),
(53773, 11056, 46729, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - CBUC & GWMC - Galaxy Health    Hello Ahmed;     Update completed effective date is 11/1/2021 Malanie from Galaxy already send you an email confirming this.     Sincerely:  Karen Avalos  Provider Relations  Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497', NULL, NULL, '2021-12-23 10:12:00', '2021-12-23 10:12:00'),
(53774, 19067, 46729, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Hello!  Hope you\'re doing well,  I would like to know the enrollment status of the following Providers & Groups with Galaxy Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:24:07', '2021-12-30 13:24:07'),
(53775, 19067, 46729, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, kavalos@ghn-mci.com, dmarley@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Greetings!  You haven\'t responded yet.  Still waiting to get the updates about the previously mentioned request.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:28:07', '2022-01-09 22:28:07'),
(53776, 19067, 46729, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Good Morning!  Hope this email finds you well.  This is my SECOND REMINDER on the below mentioned request. Kindly look into this.  Kindly respond as per your convenience.   Regards, Hammad.', NULL, NULL, '2022-01-26 11:09:36', '2022-01-26 11:09:36'),
(53777, 19067, 46729, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||    Hello Ahmed;     There is no welcome letters this is not a personal agreement.', NULL, NULL, '2022-02-21 16:26:05', '2022-02-21 16:26:05'),
(53778, 20067, 46729, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Good Afternoon!  Hope you had a great weekend. I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663  Eagerly waiting to hear from you.  Thank you, ', NULL, NULL, '2022-03-07 16:55:09', '2022-03-07 16:55:09'),
(53779, 22077, 46729, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Hi,  I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Waiting to hear from you soon.  Thanks. Alex', NULL, NULL, '2022-04-13 14:25:03', '2022-04-13 14:25:03'),
(53780, 11056, 46730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 14:09:34', '2021-11-24 14:09:34'),
(53781, 11056, 46730, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921K0S   Email received from : donotreply@multiplan.com  Sub : Provider Nomination  Dear Leticia Aleman-Listenbee:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-11-24 14:10:01', '2021-11-24 14:10:01'),
(53782, 11056, 46730, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep :Lania R  Status: Still in process. Application has been received yesterday. 90- 120 days. nomination is processing.   Ref code: 102921K0S', NULL, NULL, '2021-11-24 14:10:09', '2021-11-24 14:10:09'),
(53783, 11056, 46730, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-24 14:10:18', '2021-11-24 14:10:18'),
(53784, 11056, 46730, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November,2021. in process.  Ref code: 102921K0S', NULL, NULL, '2021-11-24 14:51:15', '2021-11-24 14:51:15'),
(53785, 11056, 46730, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:09:01', '2021-11-29 13:09:01'),
(53786, 11056, 46730, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021   Refcode: 102921K0S', NULL, NULL, '2021-12-14 14:01:40', '2021-12-14 14:01:40'),
(53787, 11056, 46730, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:22:23', '2021-12-20 17:22:23'),
(53788, 11056, 46730, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Rep:  Maegan K   Leticia: Contracting is in process. Need more time to be credentialed.   Ref code: 12232021maegank', NULL, NULL, '2021-12-23 10:39:52', '2021-12-23 10:39:52'),
(53789, 19067, 46730, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Called @ 800-950-7040 Spoke with Marie. Leticia got effective on 12/17/2021. I asked her for the Welcome kit. Ref# 7864837', NULL, NULL, '2022-01-04 11:52:23', '2022-01-04 11:52:23'),
(53790, 19067, 46730, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Secure email received from: welcomepackets@multiplan.com  Subject: SECURE: MultiPlan Network Participation (13982165-9933249)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Aleman Listenbee, Leticia A., MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  NOTICE OF CONFIDENTIALITY: Information included in and/or attached to this transmission may be confidential. This transmission is intended for the addressee(s) only. Any unauthorized disclosure, reproduction, or distribution of and /or any unauthorized action taken in reliance on the information in this transmission is prohibited. If you believe that you received this transmission in error, please notify the sender by reply transmission and destroy the transmission without copying or disclosing it. We may also need to contact you for additional information as required by HIPAA or state law.  This message was secured by Zix(R).', NULL, NULL, '2022-01-11 13:14:20', '2022-01-11 13:14:20'),
(53791, 19067, 46730, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Demographics Update || GWMC || Leticia || Multi Plan ||    Greetings!   I would like to enroll the mentioned provider in a secondary location.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Primary & Billing Location	301 S Hillside DR STE 4, Beeville, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider	NPI Leticia Aleman-Listenbee	1154999654  Kindly see the attachment of the W9 for the secondary location.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 14:32:29', '2022-01-12 14:32:29'),
(53792, 19067, 46730, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Demographics Update || GWMC || Leticia || Multi Plan ||  Greetings!  Any updates on the below mentioned request?   Thanks, Hammad.', NULL, NULL, '2022-01-26 14:26:58', '2022-01-26 14:26:58'),
(53793, 22077, 46730, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Demographics Update || GWMC || Leticia || Multi Plan ||  Hi,  Any updates on the below-mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 07:05:59', '2022-04-14 07:05:59'),
(53794, 22077, 46730, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Demographics Update || GWMC || Leticia || Multi Plan ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-27 11:06:11', '2022-04-27 11:06:11'),
(53795, 11056, 46731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:14:28', '2021-11-24 15:14:28'),
(53796, 11056, 46731, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921KOM', NULL, NULL, '2021-11-24 15:16:39', '2021-11-24 15:16:39'),
(53797, 11056, 46731, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Dear Elsa Pearce:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-11-24 15:17:09', '2021-11-24 15:17:09'),
(53798, 11056, 46731, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Rep :Lania R  Status: Still in process. The application has been received yesterday. 90- 120 days. Nomination is processing.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:17:38', '2021-11-24 15:17:38'),
(53799, 11056, 46731, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-24 15:18:02', '2021-11-24 15:18:02'),
(53800, 11056, 46731, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November 2021. in process.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:18:25', '2021-11-24 15:18:25'),
(53801, 11056, 46731, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:10:30', '2021-11-29 13:10:30'),
(53802, 11056, 46731, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021   Refcode: 102921KOM', NULL, NULL, '2021-12-14 14:02:57', '2021-12-14 14:02:57'),
(53803, 11056, 46731, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:23:10', '2021-12-20 17:23:10'),
(53804, 11056, 46731, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from:  appmissinginfo@multiplan.com  Sub: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838   Dear Provider,  We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Supriya U  Provider Data Management  appmissinginfo@multiplan.com     MultiPlan, Inc  16 Crosby Drive  Bedford, MA 01730  Fax: 781-487-8257     Reference: APP0008351838  Please see the atatched', NULL, NULL, '2021-12-23 09:59:13', '2021-12-23 09:59:13'),
(53805, 19067, 46731, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: fax7814878257@multiplan.com  Subject: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838    Good morning!  Hope you are doing great. Here is the information you requested and I have faxed as well at 781-487-8257. Please see the attachment.  Furthermore, If any documents or information is needed feel free to contact me.  Thank you! Have a wonderful day!', NULL, NULL, '2022-01-12 16:33:11', '2022-01-12 16:33:11'),
(53806, 19067, 46731, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:25:16', '2022-01-12 17:25:16'),
(53807, 19067, 46731, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:24', '2022-01-26 17:28:24'),
(53808, 19067, 46731, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:35:54', '2022-02-11 14:35:54'),
(53809, 19067, 46731, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:27', '2022-02-23 14:28:27'),
(53810, 19067, 46731, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:46', '2022-03-15 16:19:46'),
(53811, 11056, 46732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:14:42', '2021-11-24 15:14:42'),
(53812, 11056, 46732, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921KOM', NULL, NULL, '2021-11-24 15:16:45', '2021-11-24 15:16:45'),
(53813, 11056, 46732, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Dear Elsa Pearce:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-11-24 15:17:16', '2021-11-24 15:17:16'),
(53814, 11056, 46732, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Rep :Lania R  Status: Still in process. The application has been received yesterday. 90- 120 days. Nomination is processing.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:17:42', '2021-11-24 15:17:42'),
(53815, 11056, 46732, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-24 15:18:06', '2021-11-24 15:18:06'),
(53816, 11056, 46732, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November 2021. in process.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:18:31', '2021-11-24 15:18:31'),
(53817, 11056, 46732, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:10:24', '2021-11-29 13:10:24'),
(53818, 11056, 46732, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021   Refcode: 102921KOM', NULL, NULL, '2021-12-14 14:02:51', '2021-12-14 14:02:51'),
(53819, 11056, 46732, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:23:02', '2021-12-20 17:23:02'),
(53820, 11056, 46732, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from:  appmissinginfo@multiplan.com  Sub: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838   Dear Provider,  We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Supriya U  Provider Data Management  appmissinginfo@multiplan.com     MultiPlan, Inc  16 Crosby Drive  Bedford, MA 01730  Fax: 781-487-8257     Reference: APP0008351838  Please see the atatched', NULL, NULL, '2021-12-23 09:59:09', '2021-12-23 09:59:09'),
(53821, 19067, 46732, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: fax7814878257@multiplan.com  Subject: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838    Good morning!  Hope you are doing great. Here is the information you requested and I have faxed as well at 781-487-8257. Please see the attachment.  Furthermore, If any documents or information is needed feel free to contact me.  Thank you! Have a wonderful day!', NULL, NULL, '2022-01-12 16:33:05', '2022-01-12 16:33:05'),
(53822, 19067, 46732, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:25:11', '2022-01-12 17:25:11'),
(53823, 19067, 46732, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:16', '2022-01-26 17:28:16'),
(53824, 19067, 46732, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:35:49', '2022-02-11 14:35:49'),
(53825, 19067, 46732, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:32', '2022-02-23 14:28:32'),
(53826, 19067, 46732, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:51', '2022-03-15 16:19:51'),
(53827, 11056, 46733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:15:00', '2021-11-24 15:15:00');
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
(53828, 11056, 46733, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921KOM', NULL, NULL, '2021-11-24 15:16:50', '2021-11-24 15:16:50'),
(53829, 11056, 46733, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Dear Elsa Pearce:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-11-24 15:17:22', '2021-11-24 15:17:22'),
(53830, 11056, 46733, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Rep :Lania R  Status: Still in process. The application has been received yesterday. 90- 120 days. Nomination is processing.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:17:47', '2021-11-24 15:17:47'),
(53831, 11056, 46733, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-24 15:18:11', '2021-11-24 15:18:11'),
(53832, 11056, 46733, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November 2021. in process.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:18:36', '2021-11-24 15:18:36'),
(53833, 11056, 46733, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:10:18', '2021-11-29 13:10:18'),
(53834, 11056, 46733, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021   Refcode: 102921KOM', NULL, NULL, '2021-12-14 14:02:44', '2021-12-14 14:02:44'),
(53835, 11056, 46733, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:22:57', '2021-12-20 17:22:57'),
(53836, 11056, 46733, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from:  appmissinginfo@multiplan.com  Sub: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838   Dear Provider,  We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Supriya U  Provider Data Management  appmissinginfo@multiplan.com     MultiPlan, Inc  16 Crosby Drive  Bedford, MA 01730  Fax: 781-487-8257     Reference: APP0008351838  Please see the atatched', NULL, NULL, '2021-12-23 09:59:04', '2021-12-23 09:59:04'),
(53837, 19067, 46733, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: fax7814878257@multiplan.com  Subject: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838    Good morning!  Hope you are doing great. Here is the information you requested and I have faxed as well at 781-487-8257. Please see the attachment.  Furthermore, If any documents or information is needed feel free to contact me.  Thank you! Have a wonderful day!', NULL, NULL, '2022-01-12 16:32:57', '2022-01-12 16:32:57'),
(53838, 19067, 46733, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:25:07', '2022-01-12 17:25:07'),
(53839, 19067, 46733, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:11', '2022-01-26 17:28:11'),
(53840, 19067, 46733, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:35:44', '2022-02-11 14:35:44'),
(53841, 19067, 46733, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:36', '2022-02-23 14:28:36'),
(53842, 19067, 46733, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:56', '2022-03-15 16:19:56'),
(53843, 11056, 46734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:15:10', '2021-11-24 15:15:10'),
(53844, 11056, 46734, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921KOM', NULL, NULL, '2021-11-24 15:16:55', '2021-11-24 15:16:55'),
(53845, 11056, 46734, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Dear Elsa Pearce:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-11-24 15:17:27', '2021-11-24 15:17:27'),
(53846, 11056, 46734, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Rep :Lania R  Status: Still in process. The application has been received yesterday. 90- 120 days. Nomination is processing.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:17:52', '2021-11-24 15:17:52'),
(53847, 11056, 46734, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-24 15:18:16', '2021-11-24 15:18:16'),
(53848, 11056, 46734, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November 2021. in process.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 15:18:41', '2021-11-24 15:18:41'),
(53849, 11056, 46734, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:09:08', '2021-11-29 13:09:08'),
(53850, 11056, 46734, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021   Refcode: 102921KOM', NULL, NULL, '2021-12-14 14:02:33', '2021-12-14 14:02:33'),
(53851, 11056, 46734, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:22:53', '2021-12-20 17:22:53'),
(53852, 11056, 46734, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from:  appmissinginfo@multiplan.com  Sub: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838   Dear Provider,  We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Supriya U  Provider Data Management  appmissinginfo@multiplan.com     MultiPlan, Inc  16 Crosby Drive  Bedford, MA 01730  Fax: 781-487-8257     Reference: APP0008351838  Please see the atatched  ', NULL, NULL, '2021-12-23 09:58:52', '2021-12-23 09:58:52'),
(53853, 19067, 46734, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: fax7814878257@multiplan.com  Subject: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838    Good morning!  Hope you are doing great. Here is the information you requested and I have faxed as well at 781-487-8257. Please see the attachment.  Furthermore, If any documents or information is needed feel free to contact me.  Thank you! Have a wonderful day!', NULL, NULL, '2022-01-12 16:32:53', '2022-01-12 16:32:53'),
(53854, 19067, 46734, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:25:02', '2022-01-12 17:25:02'),
(53855, 19067, 46734, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:05', '2022-01-26 17:28:05'),
(53856, 19067, 46734, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:35:37', '2022-02-11 14:35:37'),
(53857, 19067, 46734, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:41', '2022-02-23 14:28:41'),
(53858, 19067, 46734, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:20:01', '2022-03-15 16:20:01'),
(53859, 11056, 46735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:35:42', '2021-11-24 15:35:42'),
(53860, 11056, 46735, NULL, '2021-12-01 00:00:00.000', 'In Process', '	 Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 15:36:31', '2021-11-24 15:36:31'),
(53861, 11056, 46735, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:   Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-24 15:39:06', '2021-11-24 15:39:06'),
(53862, 11056, 46735, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-03 16:01:40', '2021-12-03 16:01:40'),
(53863, 11056, 46735, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-13 17:48:09', '2021-12-13 17:48:09'),
(53864, 11056, 46735, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope you are having a wonderful day. Please find the attached Texas Credentialing Application for certification and credentialing of the below-mentioned provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please get back to me soon with the latest updates on the credentialing process of the provider.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-20 17:25:18', '2021-12-20 17:25:18'),
(53865, 11056, 46735, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good evening –     A request to update this provider to network has been submitted. Please allow up to 60 days for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-12-23 15:41:32', '2021-12-23 15:41:32'),
(53866, 19067, 46735, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Greetings!   Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:32:43', '2022-01-10 17:32:43'),
(53867, 19067, 46735, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:35', '2022-01-26 17:34:35'),
(53868, 19067, 46735, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:57:53', '2022-02-11 16:57:53'),
(53869, 19067, 46735, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:44:50', '2022-02-21 17:44:50'),
(53870, 19067, 46735, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:46', '2022-03-15 17:58:46'),
(53871, 22077, 46735, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:07:26', '2022-04-08 11:07:26'),
(53872, 22077, 46735, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:00:51', '2022-04-25 08:00:51'),
(53873, 11056, 46736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:35:51', '2021-11-24 15:35:51'),
(53874, 11056, 46736, NULL, '2021-12-01 00:00:00.000', 'In Process', '	 Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 15:36:36', '2021-11-24 15:36:36'),
(53875, 11056, 46736, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:   Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-24 15:39:13', '2021-11-24 15:39:13'),
(53876, 11056, 46736, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-03 16:01:35', '2021-12-03 16:01:35'),
(53877, 11056, 46736, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-13 17:47:59', '2021-12-13 17:47:59'),
(53878, 11056, 46736, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope you are having a wonderful day. Please find the attached Texas Credentialing Application for certification and credentialing of the below-mentioned provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please get back to me soon with the latest updates on the credentialing process of the provider.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-20 17:25:12', '2021-12-20 17:25:12'),
(53879, 11056, 46736, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good evening –     A request to update this provider to network has been submitted. Please allow up to 60 days for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-12-23 15:41:27', '2021-12-23 15:41:27'),
(53880, 19067, 46736, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Greetings!   Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:32:37', '2022-01-10 17:32:37'),
(53881, 19067, 46736, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:29', '2022-01-26 17:34:29'),
(53882, 19067, 46736, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:57:45', '2022-02-11 16:57:45'),
(53883, 19067, 46736, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:44:46', '2022-02-21 17:44:46'),
(53884, 19067, 46736, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:52', '2022-03-15 17:58:52'),
(53885, 22077, 46736, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:07:06', '2022-04-08 11:07:06'),
(53886, 22077, 46736, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:01:21', '2022-04-25 08:01:21'),
(53887, 11056, 46737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:36:02', '2021-11-24 15:36:02'),
(53888, 11056, 46737, NULL, '2021-12-01 00:00:00.000', 'In Process', '	 Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 15:36:40', '2021-11-24 15:36:40'),
(53889, 11056, 46737, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:   Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-24 15:39:19', '2021-11-24 15:39:19'),
(53890, 11056, 46737, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-03 16:01:28', '2021-12-03 16:01:28'),
(53891, 11056, 46737, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a wonderful day. Please find the attached Texas Credentialing Application for certification and credentialing of the below-mentioned provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please get back to me soon with the latest updates on the credentialing process of the provider.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-13 17:46:43', '2021-12-13 17:46:43'),
(53892, 11056, 46737, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope you are having a wonderful day. Please find the attached Texas Credentialing Application for certification and credentialing of the below-mentioned provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please get back to me soon with the latest updates on the credentialing process of the provider.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-20 17:25:07', '2021-12-20 17:25:07'),
(53893, 11056, 46737, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good evening –     A request to update this provider to network has been submitted. Please allow up to 60 days for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-12-23 15:41:22', '2021-12-23 15:41:22'),
(53894, 19067, 46737, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Greetings!   Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:32:31', '2022-01-10 17:32:31'),
(53895, 19067, 46737, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:24', '2022-01-26 17:34:24'),
(53896, 19067, 46737, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:57:36', '2022-02-11 16:57:36'),
(53897, 19067, 46737, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:44:41', '2022-02-21 17:44:41'),
(53898, 19067, 46737, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:59', '2022-03-15 17:58:59'),
(53899, 22077, 46737, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:06:52', '2022-04-08 11:06:52'),
(53900, 22077, 46737, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:02:26', '2022-04-25 08:02:26'),
(53901, 11056, 46738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 15:36:12', '2021-11-24 15:36:12'),
(53902, 11056, 46738, NULL, '2021-12-01 00:00:00.000', 'In Process', '	 Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 15:36:45', '2021-11-24 15:36:45'),
(53903, 11056, 46738, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:   Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-24 15:39:27', '2021-11-24 15:39:27'),
(53904, 11056, 46738, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-03 16:01:21', '2021-12-03 16:01:21'),
(53905, 11056, 46738, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-13 17:48:30', '2021-12-13 17:48:30'),
(53906, 11056, 46738, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope you are having a wonderful day. Please find the attached Texas Credentialing Application for certification and credentialing of the below-mentioned provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please get back to me soon with the latest updates on the credentialing process of the provider.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-12-20 17:24:54', '2021-12-20 17:24:54'),
(53907, 11056, 46738, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good evening –     A request to update this provider to network has been submitted. Please allow up to 60 days for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-12-23 15:41:11', '2021-12-23 15:41:11'),
(53908, 19067, 46738, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Greetings!   Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:32:23', '2022-01-10 17:32:23'),
(53909, 19067, 46738, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:19', '2022-01-26 17:34:19'),
(53910, 19067, 46738, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:57:28', '2022-02-11 16:57:28'),
(53911, 19067, 46738, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:44:36', '2022-02-21 17:44:36'),
(53912, 19067, 46738, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:59:04', '2022-03-15 17:59:04'),
(53913, 22077, 46738, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:06:40', '2022-04-08 11:06:40');
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
(53914, 22077, 46738, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:03:02', '2022-04-25 08:03:02'),
(53915, 11056, 46739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 17:22:46', '2021-11-24 17:22:46'),
(53916, 11056, 46739, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - UHC  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 17:23:57', '2021-11-24 17:23:57'),
(53917, 11056, 46739, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email received from : networkhelp@uhc.com   Sub : Secure Message from estrellita_thomas@uhc.com  Good Morning,     Thank you for contacting the Network Management Resource Team (NMRT) about the UnitedHealthcare credentialing and contracting process for medical health care professionals.     Please follow these steps to request to join our medical networks:     Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested    Confirm you have access to the UnitedHealthcare Provider Portal: Our credentialing/contracting request tool is within our secure Provider Portal, and a One Healthcare ID is required to access the portal. If you don’t currently have access, you’ll need to set up an account.    Submit a request using OnboardPro: Once you have access to the portal, sign in and select the OnboardPro tile. The attached quick reference guide has instructions. For more information or additional assistance, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    One Healthcare ID assistance  If you need help registering for a One Healthcare ID or have questions about existing access, please contact the UnitedHealthcare Web Support team help desk at 866-842-3278, option 1, 7 a.m.–11 p.m. CT, Monday–Friday.      Questions? We’re here to help   If we can further assist you, respond to this email.      Sincerely,  Estrellita “Nikki” Thomas  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-24 17:24:23', '2021-11-24 17:24:23'),
(53918, 11056, 46739, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  networkhelp@uhc.com  Sub: Secure Message from japarker@uhc.com    Greetings,        Thank you for contacting the UnitedHealthcare Network Management Resource Team about the UnitedHealthcare credentialing and contracting process for medical health care professionals. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts.    ·         Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested     ·         Submit your request through the RFP portal at  ncc-optum.secure.force.com        Questions? We’re here to help   If we can further assist you, please respond to this email.     Please send all responses or questions for this email to networkhelp@uhc.com for further assistance.  Emails sent to me directly will be deleted with the understanding it was re-mailed to networkhelp@uhc.com.     Sincerely,     Associate Network Contractor   United Healthcare   Network Management Resource Team (NMRT) ', NULL, NULL, '2021-11-24 17:24:54', '2021-11-24 17:24:54'),
(53919, 11056, 46739, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Secure Message from estrellita_thomas@uhc.com   Good afternoon!  Hope all is well with you. The CAQH has been updated and attested of the provider, Elsa. Kindly escalate the request for credentialing of the provider soon.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-10 17:43:26', '2021-12-10 17:43:26'),
(53920, 19067, 46739, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email sent to: networkhealth@uhc.com  subject: Enrollment Query || Elsa Pearce || RHC || UHC ||  Hello,  Hope you\'re staying healthy and you\'re having a productive day.  I would like to know the enrollment status for the provider with below mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly.    Thanks & Regards Ahmed, Hammad', NULL, NULL, '2021-12-22 15:49:14', '2021-12-22 15:49:14'),
(53921, 19067, 46739, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Query || Elsa Pearce || RHC || UHC ||    Hello,  Please find the attachment. Form for Elsa Pearce. I would like to enroll this provider.   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-22 17:51:39', '2021-12-22 17:51:39'),
(53922, 19067, 46739, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com    Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:16:09', '2021-12-28 10:16:09'),
(53923, 19067, 46739, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Application submitted through portal.', NULL, NULL, '2021-12-28 10:39:13', '2021-12-28 10:39:13'),
(53924, 19067, 46739, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com  Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:58:15', '2021-12-28 10:58:15'),
(53925, 19067, 46739, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Provider Link to TIN || Elsa Pearce || RHC || UHC  Hello,  I received an email stating Urgent Care providers do not require credentialing.  I am writing this to link and contract a provider to the TIN.  Group Name Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904   Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 10:59:55', '2021-12-28 10:59:55'),
(53926, 19067, 46739, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: United_Healthcare_Provider_Operations@uhc.com   Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6389124  Received On: Dec 28, 2021 4:07:36 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2021-12-30 16:49:12', '2021-12-30 16:49:12'),
(53927, 19067, 46739, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from:  joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com  Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)   ', NULL, NULL, '2022-01-02 20:35:53', '2022-01-02 20:35:53'),
(53928, 19067, 46739, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com    Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2022-01-02 20:37:46', '2022-01-02 20:37:46'),
(53929, 19067, 46739, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the holidays and having a great new year!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2022-01-02 20:55:37', '2022-01-02 20:55:37'),
(53930, 19067, 46739, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: Secure message from United_Healthcare_Provider_Operations@uhc.com Subject: United_Healthcare_Provider_Operations@uhc.com    UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6395835  Received On: Jan 3, 2022 2:05:58 AM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-01-02 23:51:58', '2022-01-02 23:51:58'),
(53931, 19067, 46739, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, United_Healthcare_Provider_Operations@uhc.com  Subject: Re: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||  Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:23:57', '2022-01-10 17:23:57'),
(53932, 19067, 46739, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Secure email received from: zanetta_mccrimon@uhc.com    Subject: Re: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   Good Morning Hammad Ahmed,     Thank you for contacting the Submission Inquiry Team. We will be glad to assist regarding your inquiry.     Your request to add ELSA PEARCE to Tax ID *5924 is currently in process and you will receive a response when it is completed. You reference numbers are PR-6389124 and PR-6395835. The request was submitted twice. Thank you for your patience and have a great day!     Please do not reply directly to this email. Send all responses or questions pertaining to this email to submission_inquiry@uhc.com for further assistance. If sent to zanetta_mccrimon@uhc.com, it will be considered responded to already and will be deleted.        Thank you,     Zanetta', NULL, NULL, '2022-01-12 11:55:50', '2022-01-12 11:55:50'),
(53933, 19067, 46739, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: united_healthcare_provider_operations@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||    Oops! We received your email in error.     If you need to update your practitioner or group information within UnitedHealthcare’s systems, please take one of the following actions:  If you have an Optum ID with access to My Practice Profile (MPP), access MPP at provider.linkhealth.com  If you have a Delegated Credentialing Agreement, submit your request to delprov@uhc.com  All other requests, submit to hpdemo@uhc.com  Thank you.', NULL, NULL, '2022-01-26 17:48:11', '2022-01-26 17:48:11'),
(53934, 1019, 46739, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Faxed the requested document to Aperture as requested see attachment for reference. ', NULL, NULL, '2022-02-09 12:58:55', '2022-02-09 12:58:55'),
(53935, 19067, 46739, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Fwd: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the weekend and had a productive day!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards,', NULL, NULL, '2022-02-21 17:59:35', '2022-02-21 17:59:35'),
(53936, 19067, 46739, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Secure email received from: psivaku1@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   We’ve reviewed the provider/group updates you requested on Jan 3, 2022 2:04:23 AM. Your request was assigned reference number PR-6395835.    We determined that your request can’t be completed.   Action May Be Needed Please see the attached report and review the Comments column for details. If comments indicate resubmission or missing information is needed, resubmit your original request with all indicated information.    The original submission is attached for your reference.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you. ', NULL, NULL, '2022-03-03 10:30:30', '2022-03-03 10:30:30'),
(53937, 19067, 46739, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Secure email received from: skanna17@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com   Good news! We’ve completed the provider/group updates you requested on Feb 21, 2022 11:08:02 PM. Your request was assigned reference number PR-6496454 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-03-30 13:14:29', '2022-03-30 13:14:29'),
(53938, 22077, 46739, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Effective Date || Elsa Pearce || RHC || UHC  Hi,  I would like to get the effective date for the following provider,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-25 09:40:05', '2022-04-25 09:40:05'),
(53939, 11056, 46740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 17:23:01', '2021-11-24 17:23:01'),
(53940, 11056, 46740, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - UHC  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 17:23:53', '2021-11-24 17:23:53'),
(53941, 11056, 46740, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email received from : networkhelp@uhc.com   Sub : Secure Message from estrellita_thomas@uhc.com  Good Morning,     Thank you for contacting the Network Management Resource Team (NMRT) about the UnitedHealthcare credentialing and contracting process for medical health care professionals.     Please follow these steps to request to join our medical networks:     Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested    Confirm you have access to the UnitedHealthcare Provider Portal: Our credentialing/contracting request tool is within our secure Provider Portal, and a One Healthcare ID is required to access the portal. If you don’t currently have access, you’ll need to set up an account.    Submit a request using OnboardPro: Once you have access to the portal, sign in and select the OnboardPro tile. The attached quick reference guide has instructions. For more information or additional assistance, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    One Healthcare ID assistance  If you need help registering for a One Healthcare ID or have questions about existing access, please contact the UnitedHealthcare Web Support team help desk at 866-842-3278, option 1, 7 a.m.–11 p.m. CT, Monday–Friday.      Questions? We’re here to help   If we can further assist you, respond to this email.      Sincerely,  Estrellita “Nikki” Thomas  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-24 17:24:18', '2021-11-24 17:24:18'),
(53942, 11056, 46740, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  networkhelp@uhc.com  Sub: Secure Message from japarker@uhc.com    Greetings,        Thank you for contacting the UnitedHealthcare Network Management Resource Team about the UnitedHealthcare credentialing and contracting process for medical health care professionals. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts.    ·         Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested     ·         Submit your request through the RFP portal at  ncc-optum.secure.force.com        Questions? We’re here to help   If we can further assist you, please respond to this email.     Please send all responses or questions for this email to networkhelp@uhc.com for further assistance.  Emails sent to me directly will be deleted with the understanding it was re-mailed to networkhelp@uhc.com.     Sincerely,     Associate Network Contractor   United Healthcare   Network Management Resource Team (NMRT) ', NULL, NULL, '2021-11-24 17:24:48', '2021-11-24 17:24:48'),
(53943, 11056, 46740, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Secure Message from estrellita_thomas@uhc.com   Good afternoon!  Hope all is well with you. The CAQH has been updated and attested of the provider, Elsa. Kindly escalate the request for credentialing of the provider soon.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-10 17:43:14', '2021-12-10 17:43:14'),
(53944, 19067, 46740, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email sent to: networkhealth@uhc.com  subject: Enrollment Query || Elsa Pearce || RHC || UHC ||  Hello,  Hope you\'re staying healthy and you\'re having a productive day.  I would like to know the enrollment status for the provider with below mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly.    Thanks & Regards Ahmed, Hammad', NULL, NULL, '2021-12-22 15:49:10', '2021-12-22 15:49:10'),
(53945, 19067, 46740, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Query || Elsa Pearce || RHC || UHC ||    Hello,  Please find the attachment. Form for Elsa Pearce. I would like to enroll this provider.   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-22 17:51:31', '2021-12-22 17:51:31'),
(53946, 19067, 46740, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com    Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:16:03', '2021-12-28 10:16:03'),
(53947, 19067, 46740, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Application submitted through Portal.', NULL, NULL, '2021-12-28 10:44:53', '2021-12-28 10:44:53'),
(53948, 19067, 46740, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com  Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:58:10', '2021-12-28 10:58:10'),
(53949, 19067, 46740, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Provider Link to TIN || Elsa Pearce || RHC || UHC  Hello,  I received an email stating Urgent Care providers do not require credentialing.  I am writing this to link and contract a provider to the TIN.  Group Name Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904   Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 10:59:49', '2021-12-28 10:59:49'),
(53950, 19067, 46740, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: United_Healthcare_Provider_Operations@uhc.com   Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6389124  Received On: Dec 28, 2021 4:07:36 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2021-12-30 16:49:05', '2021-12-30 16:49:05'),
(53951, 19067, 46740, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from:  joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com  Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)   ', NULL, NULL, '2022-01-02 20:35:47', '2022-01-02 20:35:47'),
(53952, 19067, 46740, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com    Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2022-01-02 20:37:41', '2022-01-02 20:37:41'),
(53953, 19067, 46740, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the holidays and having a great new year!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2022-01-02 20:55:27', '2022-01-02 20:55:27'),
(53954, 19067, 46740, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: Secure message from United_Healthcare_Provider_Operations@uhc.com Subject: United_Healthcare_Provider_Operations@uhc.com    UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6395835  Received On: Jan 3, 2022 2:05:58 AM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-01-02 23:51:50', '2022-01-02 23:51:50'),
(53955, 19067, 46740, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, United_Healthcare_Provider_Operations@uhc.com  Subject: Re: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||  Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:24:08', '2022-01-10 17:24:08'),
(53956, 19067, 46740, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Secure email received from: zanetta_mccrimon@uhc.com    Subject: Re: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   Good Morning Hammad Ahmed,     Thank you for contacting the Submission Inquiry Team. We will be glad to assist regarding your inquiry.     Your request to add ELSA PEARCE to Tax ID *5924 is currently in process and you will receive a response when it is completed. You reference numbers are PR-6389124 and PR-6395835. The request was submitted twice. Thank you for your patience and have a great day!     Please do not reply directly to this email. Send all responses or questions pertaining to this email to submission_inquiry@uhc.com for further assistance. If sent to zanetta_mccrimon@uhc.com, it will be considered responded to already and will be deleted.        Thank you,     Zanetta', NULL, NULL, '2022-01-12 11:55:42', '2022-01-12 11:55:42'),
(53957, 19067, 46740, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: united_healthcare_provider_operations@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||    Oops! We received your email in error.     If you need to update your practitioner or group information within UnitedHealthcare’s systems, please take one of the following actions:  If you have an Optum ID with access to My Practice Profile (MPP), access MPP at provider.linkhealth.com  If you have a Delegated Credentialing Agreement, submit your request to delprov@uhc.com  All other requests, submit to hpdemo@uhc.com  Thank you.', NULL, NULL, '2022-01-26 17:48:06', '2022-01-26 17:48:06'),
(53958, 1019, 46740, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Faxed the requested document to Aperture as requested see attachment for reference. ', NULL, NULL, '2022-02-09 12:58:32', '2022-02-09 12:58:32'),
(53959, 19067, 46740, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Fwd: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the weekend and had a productive day!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards,', NULL, NULL, '2022-02-21 17:59:28', '2022-02-21 17:59:28'),
(53960, 19067, 46740, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Secure email received from: psivaku1@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   We’ve reviewed the provider/group updates you requested on Jan 3, 2022 2:04:23 AM. Your request was assigned reference number PR-6395835.    We determined that your request can’t be completed.   Action May Be Needed Please see the attached report and review the Comments column for details. If comments indicate resubmission or missing information is needed, resubmit your original request with all indicated information.    The original submission is attached for your reference.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you. ', NULL, NULL, '2022-03-03 10:30:24', '2022-03-03 10:30:24'),
(53961, 19067, 46740, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Secure email received from: skanna17@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com   Good news! We’ve completed the provider/group updates you requested on Feb 21, 2022 11:08:02 PM. Your request was assigned reference number PR-6496454 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-03-30 13:14:21', '2022-03-30 13:14:21'),
(53962, 22077, 46740, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Effective Date || Elsa Pearce || RHC || UHC  Hi,  I would like to get the effective date for the following provider,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-25 09:39:54', '2022-04-25 09:39:54'),
(53963, 11056, 46741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-24 17:23:13', '2021-11-24 17:23:13'),
(53964, 11056, 46741, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - UHC  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-24 17:23:48', '2021-11-24 17:23:48'),
(53965, 11056, 46741, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email received from : networkhelp@uhc.com   Sub : Secure Message from estrellita_thomas@uhc.com  Good Morning,     Thank you for contacting the Network Management Resource Team (NMRT) about the UnitedHealthcare credentialing and contracting process for medical health care professionals.     Please follow these steps to request to join our medical networks:     Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested    Confirm you have access to the UnitedHealthcare Provider Portal: Our credentialing/contracting request tool is within our secure Provider Portal, and a One Healthcare ID is required to access the portal. If you don’t currently have access, you’ll need to set up an account.    Submit a request using OnboardPro: Once you have access to the portal, sign in and select the OnboardPro tile. The attached quick reference guide has instructions. For more information or additional assistance, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    One Healthcare ID assistance  If you need help registering for a One Healthcare ID or have questions about existing access, please contact the UnitedHealthcare Web Support team help desk at 866-842-3278, option 1, 7 a.m.–11 p.m. CT, Monday–Friday.      Questions? We’re here to help   If we can further assist you, respond to this email.      Sincerely,  Estrellita “Nikki” Thomas  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-24 17:24:11', '2021-11-24 17:24:11'),
(53966, 11056, 46741, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  networkhelp@uhc.com  Sub: Secure Message from japarker@uhc.com    Greetings,        Thank you for contacting the UnitedHealthcare Network Management Resource Team about the UnitedHealthcare credentialing and contracting process for medical health care professionals. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts.    ·         Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested     ·         Submit your request through the RFP portal at  ncc-optum.secure.force.com        Questions? We’re here to help   If we can further assist you, please respond to this email.     Please send all responses or questions for this email to networkhelp@uhc.com for further assistance.  Emails sent to me directly will be deleted with the understanding it was re-mailed to networkhelp@uhc.com.     Sincerely,     Associate Network Contractor   United Healthcare   Network Management Resource Team (NMRT) ', NULL, NULL, '2021-11-24 17:24:41', '2021-11-24 17:24:41'),
(53967, 11056, 46741, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Secure Message from estrellita_thomas@uhc.com   Good afternoon!  Hope all is well with you. The CAQH has been updated and attested of the provider, Elsa. Kindly escalate the request for credentialing of the provider soon.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-10 17:43:42', '2021-12-10 17:43:42'),
(53968, 19067, 46741, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email sent to: networkhealth@uhc.com  subject: Enrollment Query || Elsa Pearce || RHC || UHC ||  Hello,  Hope you\'re staying healthy and you\'re having a productive day.  I would like to know the enrollment status for the provider with below mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly.    Thanks & Regards Ahmed, Hammad', NULL, NULL, '2021-12-22 15:48:57', '2021-12-22 15:48:57'),
(53969, 19067, 46741, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Query || Elsa Pearce || RHC || UHC ||    Hello,  Please find the attachment. Form for Elsa Pearce. I would like to enroll this provider.   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-22 17:51:24', '2021-12-22 17:51:24'),
(53970, 19067, 46741, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com    Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:15:56', '2021-12-28 10:15:56'),
(53971, 19067, 46741, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Application submitted through portal.', NULL, NULL, '2021-12-28 10:50:23', '2021-12-28 10:50:23'),
(53972, 19067, 46741, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com  Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:58:06', '2021-12-28 10:58:06'),
(53973, 19067, 46741, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Provider Link to TIN || Elsa Pearce || RHC || UHC  Hello,  I received an email stating Urgent Care providers do not require credentialing.  I am writing this to link and contract a provider to the TIN.  Group Name Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904   Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 10:59:45', '2021-12-28 10:59:45'),
(53974, 19067, 46741, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: United_Healthcare_Provider_Operations@uhc.com   Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6389124  Received On: Dec 28, 2021 4:07:36 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2021-12-30 16:48:57', '2021-12-30 16:48:57'),
(53975, 19067, 46741, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from:  joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com  Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)   ', NULL, NULL, '2022-01-02 20:35:27', '2022-01-02 20:35:27'),
(53976, 19067, 46741, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com    Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2022-01-02 20:37:36', '2022-01-02 20:37:36'),
(53977, 19067, 46741, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the holidays and having a great new year!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2022-01-02 20:55:50', '2022-01-02 20:55:50'),
(53978, 19067, 46741, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: Secure message from United_Healthcare_Provider_Operations@uhc.com Subject: United_Healthcare_Provider_Operations@uhc.com    UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6395835  Received On: Jan 3, 2022 2:05:58 AM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-01-02 23:51:40', '2022-01-02 23:51:40'),
(53979, 19067, 46741, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, United_Healthcare_Provider_Operations@uhc.com  Subject: Re: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||  Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:24:13', '2022-01-10 17:24:13'),
(53980, 19067, 46741, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Secure email received from: zanetta_mccrimon@uhc.com    Subject: Re: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   Good Morning Hammad Ahmed,     Thank you for contacting the Submission Inquiry Team. We will be glad to assist regarding your inquiry.     Your request to add ELSA PEARCE to Tax ID *5924 is currently in process and you will receive a response when it is completed. You reference numbers are PR-6389124 and PR-6395835. The request was submitted twice. Thank you for your patience and have a great day!     Please do not reply directly to this email. Send all responses or questions pertaining to this email to submission_inquiry@uhc.com for further assistance. If sent to zanetta_mccrimon@uhc.com, it will be considered responded to already and will be deleted.        Thank you,     Zanetta', NULL, NULL, '2022-01-12 11:55:33', '2022-01-12 11:55:33'),
(53981, 19067, 46741, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: united_healthcare_provider_operations@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||    Oops! We received your email in error.     If you need to update your practitioner or group information within UnitedHealthcare’s systems, please take one of the following actions:  If you have an Optum ID with access to My Practice Profile (MPP), access MPP at provider.linkhealth.com  If you have a Delegated Credentialing Agreement, submit your request to delprov@uhc.com  All other requests, submit to hpdemo@uhc.com  Thank you.', NULL, NULL, '2022-01-26 17:48:00', '2022-01-26 17:48:00'),
(53982, 1019, 46741, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Faxed the requested document to Aperture as requested see attachment for reference.', NULL, NULL, '2022-02-09 12:57:41', '2022-02-09 12:57:41'),
(53983, 19067, 46741, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Fwd: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the weekend and had a productive day!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards,', NULL, NULL, '2022-02-21 17:59:22', '2022-02-21 17:59:22');
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
(53984, 19067, 46741, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Secure email received from: psivaku1@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   We’ve reviewed the provider/group updates you requested on Jan 3, 2022 2:04:23 AM. Your request was assigned reference number PR-6395835.    We determined that your request can’t be completed.   Action May Be Needed Please see the attached report and review the Comments column for details. If comments indicate resubmission or missing information is needed, resubmit your original request with all indicated information.    The original submission is attached for your reference.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you. ', NULL, NULL, '2022-03-03 10:30:15', '2022-03-03 10:30:15'),
(53985, 19067, 46741, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Secure email received from: skanna17@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com   Good news! We’ve completed the provider/group updates you requested on Feb 21, 2022 11:08:02 PM. Your request was assigned reference number PR-6496454 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-03-30 13:14:12', '2022-03-30 13:14:12'),
(53986, 22077, 46741, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Effective Date || Elsa Pearce || RHC || UHC  Hi,  I would like to get the effective date for the following provider,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-25 09:39:40', '2022-04-25 09:39:40'),
(53987, 1019, 47715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 09:42:18', '2021-11-29 09:42:18'),
(53988, 1019, 47715, NULL, '2021-12-31 00:00:00.000', 'Not Eligible', 'Received the following email from Aetna as there panel is closed.  Request ID:91264946 NPI:1831638386  Dear Healthcare Professional:  Thank you for your interest in becoming a participating provider with Aetna. We regret to inform you that the network in your area is currently at capacity, and we are not accepting new providers in your field of practice at this time.  However, Aetna is constantly evaluating the needs of its networks, and at some point, may decide to add providers in your specialty. In the future, if you would like to find out if we are considering accepting new providers in your specialty, please do not hesitate to contact Credentialing Customer Service at 1-800-353-1232.  Have you thought about joining our First Health network? If interested, please access the application online, and follow the path for First Health which is located in our Other network section.  Again, thank you for your interest in Aetna.  Sincerely, Network Services', NULL, NULL, '2021-11-29 09:43:59', '2021-11-29 09:43:59'),
(53989, 19067, 47715, NULL, '2022-03-08 00:00:00.000', 'Initiated', 'Application initiated through Portal. See attachment for reference. ', NULL, NULL, '2022-03-01 11:25:22', '2022-03-01 11:25:22'),
(53990, 19067, 47715, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Secure email received from: AetnaMemberServices@aetna.com  Subject: Re: Facility application request form/47430304    Dear Healthcare Professional:  Thank you for contacting our Provider Service Department.  Facility Legal Name --> MK Healthcare PLLC  Tax ID Number --> 873354383 NPI Number--> 1275290587  NPI you provided of 1275290587 is registered as 193400000X which does not qualify use of Facility application request form.  We received your request to become an in-network provider with Aetna. Your request was received on a form intended for facility type 2 providers. As per your National Provider Identifier (NPI) we determined that your practice is a type 2 organizational group and therefore we would need you to complete the application for individual physicians/providers or physician/provider groups for further consideration.\"  You can find the correct application to join the Aetna network at www.aetna.com.  1. Click on \"Join Network\" 2. Click on \"How to apply\" 3. Click on \"Request for Participation\" 4. Click on \"Medical, Dental, Behavioral Health, Facility or Other\" 5. Click \" Medical, Dental, Behavioral Health, Facility or Other ? Request for participation\" a. Fill in all fields marked with a red asterisk. b. Review your form prior to submitting. 6. Click \"Submit\".  Please do not respond to this email as this mailbox is not monitored. If you have any further questions regarding this information, or a new question, please submit your request through our Contact Us option on www.Availity.com or www.Aetna.com.  Availity Please use the \"Contact Us\" form located on www.Availity.com  Not registered for Availity? Registering for Availity is easy Follow the steps below to register for Availity: 1. Go to www.availity.com. 2. Click on \"Register.\"  If you need help, please call Availity Client Services at 1-800-282-4548 from 8:00 a.m. to 7:30 p.m. ET.  Advantages of using Availity a. Allows 24-hour access to information about our products and services. b. Is easy to use for administrative tasks. c. Can be used to check member eligibility, benefits and claim status; submit precertification requests and referrals; submit and track reconsiderations and appeals; and much more!  Aetna.com If you are unable to register for Availity, please visit www.aetna.com and go to \"Providers\" and then \"Contact.\" You\'ll see all your options for contacting us.  Sincerely, Aetna Provider Service Centers 47430304  NOTICE TO RECIPIENT(S) OF INFORMATION: To view Aetna\'s privacy practices, please edit, copy and paste this website into your browser: https://www.aetna.com/legal-notices/privacy.html  For all the latest information regarding telemedicine and COVID-19 on our website at (copy&paste): https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq.html   *PW - Service Center - NAF   ', NULL, NULL, '2022-03-03 13:55:22', '2022-03-03 13:55:22'),
(53991, 1004, 47715, NULL, '2022-04-05 00:00:00.000', 'On Hold', 'Applied as individual provider.  Network still closed.', NULL, NULL, '2022-03-29 17:37:49', '2022-03-29 17:37:49'),
(53992, 1019, 47716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 09:42:18', '2021-11-29 09:42:18'),
(53993, 1019, 47716, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'To: MARYEMKIAN@GMAIL.COM,MKH@CLAIMSMEDINC.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T112420210000832)   Sent: 11/29/2021 09:47 AM   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: T112420210000832        NPI: 1275290587        Medicare ID:         Name: MK Healthcare PLLC        State: CO        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-29 09:43:06', '2021-11-29 09:43:06'),
(53994, 11056, 47716, NULL, '2021-12-21 00:00:00.000', 'Approved', 'Email received from: customerservice-donotreply@cms.hhs.gov  Sub: Medicare Enrollment Application Status Change Notification (Tracking ID: T112420210000832)  To:  maryemkian@gmail.com,mkh@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T112420210000832)   Effective Date:    11/24/2021  Date:  12/08/2021 13:35 PM Application Tracking ID: T112420210000832   NPI ID: 1275290587   Medicare ID: 1X5915   Name: MK HEALTHCARE PLLC  State: CO   Form Type: 855B  Date: 12/08/2021  Status: APPROVED   Please see the attachments.', NULL, NULL, '2021-12-14 17:22:32', '2021-12-14 17:22:32'),
(53995, 11056, 47717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:02:40', '2021-11-29 14:02:40'),
(53996, 11056, 47717, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: hunter.barrett@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:04:06', '2021-11-29 14:04:06'),
(53997, 11056, 47717, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:michal.simms@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal', NULL, NULL, '2021-11-29 14:04:48', '2021-11-29 14:04:48'),
(53998, 11056, 47717, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:michal.simms@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal', NULL, NULL, '2021-11-29 14:04:48', '2021-11-29 14:04:48'),
(53999, 11056, 47717, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-29 14:05:36', '2021-11-29 14:05:36'),
(54000, 11056, 47717, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  michal.simms@christushealth.org  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,  Eff date is: 09/1/2021  Because we have Rabagos Healthcare PLLC dba Statcare Minor Emergency on an Ancillary Agreement, the clinic is the participating provider.  We do not credential those providers that work in the clinic as long as they bill for services with the Clinic’s TIN and NPI.  The Clinic has participated in our Health Exchange plans since 2016.  Medicare Advantage was added on 2/1/2019, and Commercial was added eff 9/2/2021.     Our web search produces results under Statcare Minor Emergency Clinic.  See: https://www.christushealthplan.org/find-a-provider?location=Kingsville%20TX&distance=75&plan=tx%20hix&keyword=Statcare     Let me know if you need other information.    Ancillary contract no need for provider\'s credentialing.', NULL, NULL, '2021-11-29 14:17:51', '2021-11-29 14:17:51'),
(54001, 11056, 47718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:02:55', '2021-11-29 14:02:55'),
(54002, 11056, 47718, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: hunter.barrett@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:04:01', '2021-11-29 14:04:01'),
(54003, 11056, 47718, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:michal.simms@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal', NULL, NULL, '2021-11-29 14:04:43', '2021-11-29 14:04:43'),
(54004, 11056, 47718, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-29 14:05:29', '2021-11-29 14:05:29'),
(54005, 11056, 47718, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  michal.simms@christushealth.org  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,  Eff date is: 09/1/2021  Because we have Rabagos Healthcare PLLC dba Statcare Minor Emergency on an Ancillary Agreement, the clinic is the participating provider.  We do not credential those providers that work in the clinic as long as they bill for services with the Clinic’s TIN and NPI.  The Clinic has participated in our Health Exchange plans since 2016.  Medicare Advantage was added on 2/1/2019, and Commercial was added eff 9/2/2021.     Our web search produces results under Statcare Minor Emergency Clinic.  See: https://www.christushealthplan.org/find-a-provider?location=Kingsville%20TX&distance=75&plan=tx%20hix&keyword=Statcare     Let me know if you need other information.    Ancillary contract no need for provider\'s credentialing.', NULL, NULL, '2021-11-29 14:17:41', '2021-11-29 14:17:41'),
(54006, 11056, 47719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:03:08', '2021-11-29 14:03:08'),
(54007, 11056, 47719, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: hunter.barrett@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:03:55', '2021-11-29 14:03:55'),
(54008, 11056, 47719, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:michal.simms@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal', NULL, NULL, '2021-11-29 14:04:38', '2021-11-29 14:04:38'),
(54009, 11056, 47719, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-29 14:05:22', '2021-11-29 14:05:22'),
(54010, 11056, 47719, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  michal.simms@christushealth.org  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,  Eff date is: 09/1/2021  Because we have Rabagos Healthcare PLLC dba Statcare Minor Emergency on an Ancillary Agreement, the clinic is the participating provider.  We do not credential those providers that work in the clinic as long as they bill for services with the Clinic’s TIN and NPI.  The Clinic has participated in our Health Exchange plans since 2016.  Medicare Advantage was added on 2/1/2019, and Commercial was added eff 9/2/2021.     Our web search produces results under Statcare Minor Emergency Clinic.  See: https://www.christushealthplan.org/find-a-provider?location=Kingsville%20TX&distance=75&plan=tx%20hix&keyword=Statcare     Let me know if you need other information.    Ancillary contract no need for provider\'s credentialing.', NULL, NULL, '2021-11-29 14:17:33', '2021-11-29 14:17:33'),
(54011, 11056, 47720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:03:19', '2021-11-29 14:03:19'),
(54012, 11056, 47720, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: hunter.barrett@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:03:50', '2021-11-29 14:03:50'),
(54013, 11056, 47720, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:michal.simms@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal', NULL, NULL, '2021-11-29 14:04:33', '2021-11-29 14:04:33'),
(54014, 11056, 47720, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-29 14:05:16', '2021-11-29 14:05:16'),
(54015, 11056, 47720, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  michal.simms@christushealth.org  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,  Eff date is: 09/1/2021  Because we have Rabagos Healthcare PLLC dba Statcare Minor Emergency on an Ancillary Agreement, the clinic is the participating provider.  We do not credential those providers that work in the clinic as long as they bill for services with the Clinic’s TIN and NPI.  The Clinic has participated in our Health Exchange plans since 2016.  Medicare Advantage was added on 2/1/2019, and Commercial was added eff 9/2/2021.     Our web search produces results under Statcare Minor Emergency Clinic.  See: https://www.christushealthplan.org/find-a-provider?location=Kingsville%20TX&distance=75&plan=tx%20hix&keyword=Statcare     Let me know if you need other information.    Ancillary contract no need for provider\'s credentialing.', NULL, NULL, '2021-11-29 14:17:27', '2021-11-29 14:17:27'),
(54016, 11056, 47721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:39:48', '2021-11-29 14:39:48'),
(54017, 11056, 47721, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:40:45', '2021-11-29 14:40:45'),
(54018, 11056, 47721, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Christus Healthplan. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:41:12', '2021-11-29 14:41:12'),
(54019, 11056, 47721, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.     Feel free to call me if you have other questions.     Thanks, Michal', NULL, NULL, '2021-11-29 14:41:33', '2021-11-29 14:41:33'),
(54020, 11056, 47721, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  michal.simms@christushealth.org   Sub:   Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Good afternoon,    This request has been submitted to Credentialing; reference number is FL01481849.  Please allow 90-120 days for the Credentialing process to be completed.   Best regards, Michal    Ms. Michal Simms Network Contractor Senior  Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org  Dignity. Integrity. Excellence. Compassion. Stewardship.', NULL, NULL, '2021-11-29 14:41:59', '2021-11-29 14:41:59'),
(54021, 19067, 47721, NULL, '2021-12-14 00:00:00.000', 'In Process', 'They do not provide credentialing status over the call, asked me to email them.', NULL, NULL, '2021-12-07 17:30:08', '2021-12-07 17:30:08'),
(54022, 11056, 47721, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good afternoon!  Hope you are having a productive day. Please let me know the Credentialing of; Reference number is FL01481849. Any latest updates on it?  Also, provide me updates regarding the submitted Ancillary application.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-12-16 13:06:08', '2021-12-16 13:06:08'),
(54023, 19067, 47721, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||  Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Christus Health Plan.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 15:23:24', '2021-12-28 15:23:24'),
(54024, 19067, 47721, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 16:12:32', '2022-01-10 16:12:32'),
(54025, 19067, 47721, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Greetings!  This is my Second Reminder on the below mentioned request. Kindly respond promptly.    Regards.', NULL, NULL, '2022-01-25 11:40:23', '2022-01-25 11:40:23'),
(54026, 19067, 47721, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Subject: RE: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Hello Ahmed,     I tell you this often… we do not credential the individual practitioners who work at a clinic/facility.     Please discontinue asking me for status on providers who are not being credentialed.      Please contact Credentialing at CHRISTUS.HP.Credentialing@christushealth.org for additional information.     Best regards, Michal     Ms. Michal Simms  Network Contractor Senior  Nueces Region  CHRISTUS Health Plan  US Family Health Plan  (o) 469-282-3227', NULL, NULL, '2022-02-11 13:11:59', '2022-02-11 13:11:59'),
(54027, 19067, 47721, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||   Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Christus Health Plan.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413   Thanks & Regards,', NULL, NULL, '2022-02-21 17:19:14', '2022-02-21 17:19:14'),
(54028, 19067, 47721, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Sent a fax of W9 @ 210-766-8855.', NULL, NULL, '2022-03-15 14:34:08', '2022-03-15 14:34:08'),
(54029, 19067, 47721, NULL, '2022-04-29 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Subject: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Hello Ahmed,     I tell you this often… we do not credential the individual practitioners who work at a clinic/facility.     Please discontinue asking me for status on providers who are not being credentialed.      Please contact Credentialing at CHRISTUS.HP.Credentialing@christushealth.org for additional information.     Best regards, Michal     Ms. Michal Simms  Network Contractor Senior  Nueces Region  CHRISTUS Health Plan  US Family Health Plan  (o) 469-282-3227     www.christushealthplan.org   ', NULL, NULL, '2022-04-22 10:10:14', '2022-04-22 10:10:14'),
(54030, 19067, 47721, NULL, '2022-04-29 00:00:00.000', 'Approved', 'Facility Contract, Eff 02/01/2019', NULL, NULL, '2022-04-22 10:10:48', '2022-04-22 10:10:48'),
(54031, 11056, 47722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:39:57', '2021-11-29 14:39:57'),
(54032, 11056, 47722, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:40:40', '2021-11-29 14:40:40'),
(54033, 11056, 47722, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Christus Healthplan. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:41:05', '2021-11-29 14:41:05'),
(54034, 11056, 47722, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.     Feel free to call me if you have other questions.     Thanks, Michal', NULL, NULL, '2021-11-29 14:41:28', '2021-11-29 14:41:28'),
(54035, 11056, 47722, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  michal.simms@christushealth.org   Sub:   Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Good afternoon,    This request has been submitted to Credentialing; reference number is FL01481849.  Please allow 90-120 days for the Credentialing process to be completed.   Best regards, Michal    Ms. Michal Simms Network Contractor Senior  Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org  Dignity. Integrity. Excellence. Compassion. Stewardship.', NULL, NULL, '2021-11-29 14:41:54', '2021-11-29 14:41:54'),
(54036, 19067, 47722, NULL, '2021-12-14 00:00:00.000', 'In Process', 'They do not provide credentialing status over the call, asked me to email them.', NULL, NULL, '2021-12-07 17:30:02', '2021-12-07 17:30:02'),
(54037, 11056, 47722, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good afternoon!  Hope you are having a productive day. Please let me know the Credentialing of; Reference number is FL01481849. Any latest updates on it?  Also, provide me updates regarding the submitted Ancillary application.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-12-16 13:06:03', '2021-12-16 13:06:03'),
(54038, 11056, 47722, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:16', '2021-12-23 14:12:16'),
(54039, 11056, 47723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 14:40:08', '2021-11-29 14:40:08'),
(54040, 11056, 47723, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:40:35', '2021-11-29 14:40:35'),
(54041, 11056, 47723, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Christus Healthplan. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 14:41:01', '2021-11-29 14:41:01'),
(54042, 11056, 47723, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.     Feel free to call me if you have other questions.     Thanks, Michal', NULL, NULL, '2021-11-29 14:41:23', '2021-11-29 14:41:23'),
(54043, 11056, 47723, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  michal.simms@christushealth.org   Sub:   Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Good afternoon,    This request has been submitted to Credentialing; reference number is FL01481849.  Please allow 90-120 days for the Credentialing process to be completed.   Best regards, Michal    Ms. Michal Simms Network Contractor Senior  Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org  Dignity. Integrity. Excellence. Compassion. Stewardship.', NULL, NULL, '2021-11-29 14:41:48', '2021-11-29 14:41:48'),
(54044, 19067, 47723, NULL, '2021-12-14 00:00:00.000', 'In Process', 'They do not provide credentialing status over the call, asked me to email them.', NULL, NULL, '2021-12-07 17:29:54', '2021-12-07 17:29:54'),
(54045, 11056, 47723, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good afternoon!  Hope you are having a productive day. Please let me know the Credentialing of; Reference number is FL01481849. Any latest updates on it?  Also, provide me updates regarding the submitted Ancillary application.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-12-16 13:05:49', '2021-12-16 13:05:49'),
(54046, 11056, 47723, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:41', '2021-12-23 14:18:41'),
(54047, 1019, 47724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 15:18:59', '2021-11-29 15:18:59'),
(54048, 1019, 47724, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Request Initiated thru Availity for Anthem BCBS. Application ID  PR-139233  ', NULL, NULL, '2021-11-29 15:21:12', '2021-11-29 15:21:12'),
(54049, 1019, 47724, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Application ID PR-139233 in process , see attached for reference', NULL, NULL, '2021-12-20 11:01:28', '2021-12-20 11:01:28'),
(54050, 19067, 47724, NULL, '2022-02-02 00:00:00.000', 'In Process', 'We have signed the Agreement see attachment for reference.', NULL, NULL, '2022-01-26 13:09:02', '2022-01-26 13:09:02'),
(54051, 19067, 47724, NULL, '2022-02-02 00:00:00.000', 'In Process', 'We have signed the Agreement see attachment for reference.', NULL, NULL, '2022-01-26 13:09:11', '2022-01-26 13:09:11'),
(54052, 19067, 47724, NULL, '2022-02-02 00:00:00.000', 'In Process', 'We have signed the Agreement see attachment for reference.', NULL, NULL, '2022-01-26 13:09:18', '2022-01-26 13:09:18'),
(54053, 20067, 47724, NULL, '2022-02-07 00:00:00.000', 'Approved', 'This is the group agreement with effective date: 03/01/2022 ', NULL, NULL, '2022-01-31 13:50:48', '2022-01-31 13:50:48'),
(54054, 1019, 47725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 15:44:18', '2021-11-29 15:44:18'),
(54055, 1019, 47725, NULL, '2021-12-31 00:00:00.000', 'Not Eligible', 'Received the following email from Cigna.  Hello,     We have received your request to become a Cigna participating health care professional.  At this time, we are not expanding our health care professional network in your specialty or geographic area. Your request will remain on file should a need arise for health care professionals in your specialty or location.     If you have questions, please call Cigna Customer Service at 1.800.88Cigna (882-4462). Thank you for your interest in Cigna.', NULL, NULL, '2021-11-29 15:45:19', '2021-11-29 15:45:19'),
(54056, 19067, 47725, NULL, '2022-03-08 00:00:00.000', 'Initiated', 'Application initiated via Call. Application tracking id: 12889145 Rep: Allison L', NULL, NULL, '2022-03-01 11:44:03', '2022-03-01 11:44:03'),
(54057, 11056, 47726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:23:20', '2021-11-29 17:23:20'),
(54058, 11056, 47726, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : 	SWHPRECRED@bswhealth.org & SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org  Sub  : Enrollment Query - CBUC & GWMC - Scott & White  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Scott & White. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 17:23:41', '2021-11-29 17:23:41'),
(54059, 11056, 47726, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 884361d0-5ac4-4942-9a3a-b7c64cc6f344   Application has been submitted.  Please see the attachment.', NULL, NULL, '2021-11-29 17:23:51', '2021-11-29 17:23:51'),
(54060, 11056, 47726, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query - CBUC & GWMC - Scott & White  Good afternoon Talha,  I do not see your Tax ID # is currently contracted with the Scott & White Health Plan nor FirstCare Health Plans.  You can request a contract by clicking the link below:     https://swhp.org/forms/html/provider-account-request.html     Someone from our Network Strategy Department will respond to you.     Thank you and have a great day.     Provider Services  1206 West Campus Drive Temple, TX  76502 www.swhp.org', NULL, NULL, '2021-11-29 17:24:01', '2021-11-29 17:24:01'),
(54061, 11056, 47726, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  SWHPPROVSERVICES@bswhealth.org  Sub:  Enrollment Query - CBUC & GWMC - Scott & White  Good afternoon!  Hope you are having a great day. I also have submitted the online application for the provider, Leticia Aleman-Listenbee. Her form submission identifier is: 884361d0-5ac4-4942-9a3a-b7c64cc6f344. Kindly provide me updates regarding this.  Also, assist me regarding contracting the Tax ID # with the Scott & White Health Plan and FirstCare Health Plans as well.  Thank you!', NULL, NULL, '2021-11-29 17:24:30', '2021-11-29 17:24:30'),
(54062, 11056, 47726, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org   &   SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub:  New Contract Request Enrollment Query - CBUC & GWMC - Scott & White  Dear Provider,     We received a new contract request for TIN 81-1890349, FNP Leticia Aleman-Listenbee.  To move forward in the review process, provide the supervising physician name and NPI.  Supervising physicians must be contracted with SWHP.  Respond by 11/25/2021 or the request will be closed.     Thank you     Network Development', NULL, NULL, '2021-12-17 14:58:12', '2021-12-17 14:58:12'),
(54063, 11056, 47726, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org  Sub: Enrollment Query - CBUC & GWMC - Scott & White   Good Evening,  A new contract request is processed through our Network Strategy/Contracting Department.  Please allow 30 days for someone to contact you regarding your inquiry.     Thank you and have a great day!  Brenda P', NULL, NULL, '2021-12-22 12:39:37', '2021-12-22 12:39:37');
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
(54064, 19067, 47726, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVSERVICES@bswhealth.org  Subject: Enrollment Query || CBUC & GWMC || Leticdia Aleman-Listenbee  || Scott & White ||  Good Morning!   Hope you are having a productive day.  I would like to know the enrollment status of the following Provider.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324   Waiting for your prompt response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 11:36:38', '2022-01-04 11:36:38'),
(54065, 19067, 47726, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HPPROVSERVICES@bswhealth.org  Subject: Enrollment Query || CBUC & GWMC || Leticdia Aleman-Listenbee || Scott & White ||     Good afternoon,  Unfortunately I do not have access to requests for new contracts being processed by our Network Strategy/Contracting Department.   You can reach them by emailing them directly at: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org     Thank you and have a great day!     Brenda K. Powell  Manager, Internal Provider Network Services  Baylor Scott & White Health Plan', NULL, NULL, '2022-01-06 17:20:17', '2022-01-06 17:20:17'),
(54066, 19067, 47726, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee  || Scott & White ||    Good Morning!   Hope you are having a productive day.  I would like to know the enrollment status of the following Provider.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324   Waiting for your prompt response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 17:23:58', '2022-01-06 17:23:58'),
(54067, 19067, 47726, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||    Dear provider,     This application was closed on 11/26/2021, due to no response.  We requested supervising physician information and explained it needed to be received by 11/25/2021 or the application would be closed. It was also explained that a supervising physician must be contracted with BSWHP.  On 11/15/2021, BSWHP was informed of a supervising physician, Frank Dehnisch NPI 1952376345.  BSWHP responded explaining that this provider is not contracted.  BSWHP inquired if there was an additional supervising physician who is contracted with BSWHP.  There was not a response to this inquiry.     If this provider has a supervising physician that is contracted with BSWHP, use the link below to reapply:     https://swhp.org/forms/html/provider-account-request.html     Thank you     Network Development  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-01-12 14:36:35', '2022-01-12 14:36:35'),
(54068, 19067, 47726, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: RE: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||    Dear provider,     This application was closed on 11/26/2021, due to no response.  We requested supervising physician information and explained it needed to be received by 11/25/2021 or the application would be closed. It was also explained that a supervising physician must be contracted with BSWHP.  On 11/15/2021, BSWHP was informed of a supervising physician, Frank Dehnisch NPI 1952376345.  BSWHP responded explaining that this provider is not contracted.  BSWHP inquired if there was an additional supervising physician who is contracted with BSWHP.  There was not a response to this inquiry.     If this provider has a supervising physician that is contracted with BSWHP, use the link below to reapply:     https://swhp.org/forms/html/provider-account-request.html     Thank you     Network Development  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-01-26 14:15:04', '2022-01-26 14:15:04'),
(54069, 22077, 47726, NULL, '2022-04-21 00:00:00.000', 'Not Eligible', 'Email received from: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: RE: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||    Dear provider,     This application was closed on 11/26/2021, due to no response.  We requested supervising physician information and explained it needed to be received by 11/25/2021 or the application would be closed. It was also explained that a supervising physician must be contracted with BSWHP.  On 11/15/2021, BSWHP was informed of a supervising physician, Frank Dehnisch NPI 1952376345.  BSWHP responded explaining that this provider is not contracted.  BSWHP inquired if there was an additional supervising physician who is contracted with BSWHP.  There was not a response to this inquiry.     If this provider has a supervising physician that is contracted with BSWHP, use the link below to reapply:     https://swhp.org/forms/html/provider-account-request.html     Thank you     Network Development  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-04-14 07:43:19', '2022-04-14 07:43:19'),
(54070, 1019, 47727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:25:53', '2021-11-29 17:25:53'),
(54071, 1019, 47727, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Sent the following email to Friday Health Plans.  Hello,  Below is listed the Group and Provider we want to enroll with Friday Health Plan.   Group Name	MK Healthcare PLLC Tax ID	873354383 Group NPI	1275290587 Provider Name	NPI	Location Kianinejad, Maryem	1831638386	3501 S Corona St Ste 1, Englewood, CO 80113-3907   Let me know if anything else is needed.   Regards, Alex', NULL, NULL, '2021-11-29 17:26:41', '2021-11-29 17:26:41'),
(54072, 1019, 47727, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Received the following email from jackie.young@fridayhealthplans.com Hello Alex,   I received your request for MK Healthcare to join our provider network.  If you would provide CPT codes/services, provider types and W-9,  I can build an agreement for your review.  Thank you, Jackie Young Senior Contract and Provider Relations Manager Colorado Phone/Cell: 303-880-5814', NULL, NULL, '2021-12-08 08:52:19', '2021-12-08 08:52:19'),
(54073, 1019, 47727, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Sent the following email to jackie.young@fridayhealthplans.com Hello Jackie,  Attached is the filled Roster for and Signed agreement for MK Healthcare as requested. Let me know if you have any questions.    Regards, Alex ', NULL, NULL, '2022-01-04 13:53:34', '2022-01-04 13:53:34'),
(54074, 1019, 47727, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Received the following email from Friday.  Hello Alex,     Hope you are doing well.     Just touching base to see if you are still interested in participating.      I need W-9 current and signed/dated as well as a sample claim to move forward with preparing and emailing agreement for signature.     If questions, please let me know.     Jackie Young  Senior Contract and Provider Relations Manager  Colorado     Phone/Cell: 303-880-5814     fridayhealthplans.com', NULL, NULL, '2022-02-04 12:44:50', '2022-02-04 12:44:50'),
(54075, 1019, 47727, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Sent the following email to Friday Health.  Hello Jackie,  I\'m still waiting for the Sample claim, attached is the W9 form.   Regards, Alex', NULL, NULL, '2022-02-04 12:45:16', '2022-02-04 12:45:16'),
(54076, 19067, 47727, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Email received from: jackie.young@fridayhealthplans.com  Subject: MK Healthcare_Friday Health Plans_Contract Effective date 4.15.22    Hello Alex,     Please see the attached fully executed Agreement, effective 4.15.22.  We are excited to have you join our network!     I encourage you to visit the Provider Hub on our website. Under “Provider Tools” you’ll find our Provider Manual, which includes important information regarding auths, credentialing, and payment. A few important highlights:  For any additions or changes to existing staff, please send an updated roster to providers@fridayhealthplans.com. Keep in mind, the credentialing process for new providers can take 4-6 weeks. Be sure staff is familiar with authorization requirements located here. Front office staff will definitely want to register for our Provider Portal, where they can check member eligibility, as well as auth and claim status. I have attached a Portal Access Guide as well.   Here is a link to page with a video for navigating our portal, Provider Hub | Friday Health Plans     All payments go through our payment vendor, Zelis Payments. For contact information and highlights regarding electronic payment, visit this page. Explanations of Payment (EOP’s) are available through the Zelis Provider Portal, which is available here.    You will find that I have also attached an easy-reference 4X4 card for some of the quick Friday Health Plans contacts and a training that will be of use for additional provider resources. This is a great additional resource for any front office staff!     Jackie Young  Senior Contract and Provider Relations Manager  Colorado     Phone/Cell: 303-880-5814     fridayhealthplans.com      Find us on Linked InLike us on FacebookFollow us on Instagram  Friday Health Plans 700 Main Street Alamosa, CO 81101 (719) 589-3696', NULL, NULL, '2022-03-15 10:13:25', '2022-03-15 10:13:25'),
(54077, 11056, 47728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:42:02', '2021-11-29 17:42:02'),
(54078, 11056, 47728, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 17:42:22', '2021-11-29 17:42:22'),
(54079, 11056, 47728, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Healthplan  Hi Ahmed,     Happy Tuesday!     I wanted to check on the Christus hospital privileges. But, I will need the last four digits of the Social Security. I cannot pull up the name for provider.     Does the provider have facility privileges with Christus? Or, does the provider utilize one of the hospitalist groups at Christus to follow the member?     Thank you,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745   Have responded them with their query.', NULL, NULL, '2021-11-29 17:42:35', '2021-11-29 17:42:35'),
(54080, 11056, 47728, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  CHRISTUS.HP.Credentialing@christushealth.org  Sub : PLEASE DISREGARD LAST EMAIL: Enrollment Query - CBUC & GWMC - Christus Healthplan  Hi Ahmed,     Different question, I noticed the provider is a NP. Does the provider have a supervising physician who has privileges at a Christus facility?        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745 ', NULL, NULL, '2021-11-29 17:42:44', '2021-11-29 17:42:44'),
(54081, 11056, 47728, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  vicki.guerra@christushealth.org  Sub:  PLEASE DISREGARD LAST EMAIL: Enrollment Query - CBUC & GWMC - Christus Healthplan   Good afternoon!  Hope this email finds you well. Yes, Here it is. Supervising Physician Name:  Frank Dehnisch              NPI - 1952376345   Admitting Privileges:    Christus Spohn Hospital    Furthermore, any information or documents are required don\'t hesitate to contact me.   Thank you! Have a great day!', NULL, NULL, '2021-11-29 17:44:32', '2021-11-29 17:44:32'),
(54082, 11056, 47728, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Sub: PLEASE DISREGARD LAST EMAIL: Enrollment Query - CBUC & GWMC - Christus Healthplan  Good morning!  Hope this email finds you well. I wanted to get the latest updates on the credentialing of the provider, Leticia Aleman-Listenbee. We have an Ancillary contract for the group with Christus Healthplan. Kindly, confirm this as well. # FL01383347  Please elaborate on this soon and confirm the effective dates and locations as well.  Thank you! ', NULL, NULL, '2021-12-13 17:58:00', '2021-12-13 17:58:00'),
(54083, 11056, 47728, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from Michal michal.simms@christushealth.org  Sub:   \"Thank you for sending this notice.  Coastal Bend Urgent Care LLC is contracted with CHRISTUS Health as an Ancillary Provider.  We credential the clinics and not the individual practitioners.  The participating provider is COASTAL BEND URGENT CARE.  George West Medical Clinic has been credentialed effective 11/19/2020  under the Coastal Bend Urgent Care records – re # FL01383347.  Let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818   Ancillary Contract: Please see the group task as well.', NULL, NULL, '2021-12-20 17:01:30', '2021-12-20 17:01:30'),
(54084, 1019, 47729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:47:28', '2021-11-29 17:47:28'),
(54085, 1019, 47729, NULL, '2021-12-06 00:00:00.000', 'Not Eligible', 'UHC Required a Supervising Physician to get enroll with them.  ', NULL, NULL, '2021-11-29 17:49:21', '2021-11-29 17:49:21'),
(54086, 19067, 47729, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: national_credentialing@uhc.com  Subject: Request for Credentialing    4/5/2022  Maryem Kianinejad mkh@claimsmedinc.com MPIN#: 6474237  Re: Update on your UnitedHealthcare Credentialing Application  Dear Maryem Kianinejad:  Thank you for your interest in joining the UnitedHealthcare network. We received your request for participation. Our records show that you are currently affiliated with a delegated credentialing group in our network. Unless your status with the delegate has or will be changing, no further review is needed by UnitedHealthcare.  What happens next? We’ve forwarded your request for participation to the contracting team. They’ll coordinate with your delegated group and will follow up with you if they have any questions. You may also want to contact your group directly with questions about your delegation agreement.  What if you’re no longer a part of the delegated group? If you are no longer affiliated with the group, please email us at the address noted below. Be sure to include in your email that you are no longer contracted with a delegated group and provide the date that your affiliation with the group ended. We will then work with you to complete the credentialing process.  Questions? We\'re here to help. If you have any questions, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join.  Sincerely,   PLEASE DO NOT REPLY TO THIS EMAIL: This email box is not monitored. Please follow the instructions above to contact UnitedHealthcare and to provide any requested information.', NULL, NULL, '2022-04-05 10:18:05', '2022-04-05 10:18:05'),
(54087, 11056, 47730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:56:53', '2021-11-29 17:56:53'),
(54088, 11056, 47730, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com &  mmedina@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 17:59:20', '2021-11-29 17:59:20'),
(54089, 11056, 47730, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s   Thanks; Karen A', NULL, NULL, '2021-11-29 17:59:39', '2021-11-29 17:59:39'),
(54090, 11056, 47730, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s  Eff date: 06/24/2019  Please see the attachment.  Thanks; Karen A', NULL, NULL, '2021-11-29 18:03:54', '2021-11-29 18:03:54'),
(54091, 11056, 47731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:57:04', '2021-11-29 17:57:04'),
(54092, 11056, 47731, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com &  mmedina@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 17:59:16', '2021-11-29 17:59:16'),
(54093, 11056, 47731, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s   Thanks; Karen A', NULL, NULL, '2021-11-29 17:59:44', '2021-11-29 17:59:44'),
(54094, 11056, 47731, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s  Eff date: 06/24/2019  Please see the attachment.  Thanks; Karen A', NULL, NULL, '2021-11-29 18:04:11', '2021-11-29 18:04:11'),
(54095, 11056, 47732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-29 17:57:16', '2021-11-29 17:57:16'),
(54096, 11056, 47732, NULL, '2021-12-06 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com &  mmedina@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-29 17:59:11', '2021-11-29 17:59:11'),
(54097, 11056, 47732, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s   Thanks; Karen A', NULL, NULL, '2021-11-29 17:59:49', '2021-11-29 17:59:49'),
(54098, 11056, 47732, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s  Eff date: 03/302021  Please see the attachment.  Thanks; Karen A', NULL, NULL, '2021-11-29 18:06:37', '2021-11-29 18:06:37'),
(54099, 11056, 47733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 14:51:08', '2021-11-30 14:51:08'),
(54100, 11056, 47733, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 14:52:46', '2021-11-30 14:52:46'),
(54101, 11056, 47733, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 14:53:10', '2021-11-30 14:53:10'),
(54102, 11056, 47733, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Hello, Please use the link below and select from the dropdown for your request. This is for HealthSmart PPO Only.     https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network        Valesia Glenn |Provider Relations HealthSmart | Network Solutions 222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039    The application has been submitted online. Please see the attachment.', NULL, NULL, '2021-11-30 14:53:33', '2021-11-30 14:53:33'),
(54103, 11056, 47733, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Please find the attached application form for the provider, Elsa Pearce. I have already submitted this to Health Smart through Online on 9th, November 2021.  Also, provide me the updates regarding the application.  Thank you!', NULL, NULL, '2021-11-30 14:54:03', '2021-11-30 14:54:03'),
(54104, 11056, 47733, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Please clarify what you are requesting.  Are you asking for credentialling status? Please allow a minimum of 45 days.', NULL, NULL, '2021-12-13 17:34:56', '2021-12-13 17:34:56'),
(54105, 11056, 47733, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Good afternoon!  Hope all is well with you. I wanted to get the latest updates regarding the credentialing process of the below-mentioned provider under facility TIN with all mentioned locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-20 10:41:00', '2021-12-20 10:41:00'),
(54106, 19067, 47733, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello, Locations can be verified below after 30-45 days of submission.    https://providerlookup.healthsmart.com/SearchProviders.aspx     Thank you,  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-12-29 09:40:02', '2021-12-29 09:40:02'),
(54107, 19067, 47733, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Good morning!  Hope you are having a wonderful day. Any latest updates on the credentialing process?  If you need any documents or information don\'t hesitate in reaching out to me.  Thank you! Have a  blessed day!', NULL, NULL, '2022-01-10 16:29:06', '2022-01-10 16:29:06'),
(54108, 19067, 47733, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello!  Any updates on the request below?  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:45:26', '2022-01-26 17:45:26'),
(54109, 19067, 47733, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hi,  Provider \" Elsa Pearce, PA \" is effective date \" 03/01/2022 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Documents ID : 3508873)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-02-11 13:52:51', '2022-02-11 13:52:51'),
(54110, 19067, 47733, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hello!  Can I get an approval letter for provider, Elsa Pearce.  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:43:59', '2022-02-23 14:43:59'),
(54111, 19067, 47733, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Query - Statcare Minor Emergency Clinic - Elsa Pearce - Health Smart   Hi Valesia,    Hope you are having a wonderful day.    I would like to know the enrollment status of the provider with other locations as well and if the provider is enrolled with any location provide the welcome letter for that location.    Group Name  Statcare Minor Emergency Clinic  Tax ID  46-0575924  Group NPI  1689924904  Primary Location  500 E CAESAR KINGSVILLE, TX 78363  Secondary Location  6646 S. Staples St. # 122 Corpus Christi, TX 78413  Tertiary Location  4042 River Hill Corpus Christi, TX 78410  Quaternary Location  3817 South Padre Island Drive Corpus Christi, TX 78415  Quinary Location  2102 FM 2165, Rockport, TX 78382  Provider Name  NPI  Elsa Pearce  1083784102     Please respond to my query at your earliest convenience.     Thank You!  Have a wonderful day!', NULL, NULL, '2022-03-08 13:29:47', '2022-03-08 13:29:47'),
(54112, 11056, 47734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 14:51:19', '2021-11-30 14:51:19'),
(54113, 11056, 47734, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 14:52:40', '2021-11-30 14:52:40'),
(54114, 11056, 47734, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 14:53:05', '2021-11-30 14:53:05'),
(54115, 11056, 47734, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Hello, Please use the link below and select from the dropdown for your request. This is for HealthSmart PPO Only.     https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network        Valesia Glenn |Provider Relations HealthSmart | Network Solutions 222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039    The application has been submitted online. Please see the attachment.', NULL, NULL, '2021-11-30 14:53:28', '2021-11-30 14:53:28'),
(54116, 11056, 47734, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Please find the attached application form for the provider, Elsa Pearce. I have already submitted this to Health Smart through Online on 9th, November 2021.  Also, provide me the updates regarding the application.  Thank you!', NULL, NULL, '2021-11-30 14:53:58', '2021-11-30 14:53:58'),
(54117, 11056, 47734, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Please clarify what you are requesting.  Are you asking for credentialling status? Please allow a minimum of 45 days.', NULL, NULL, '2021-12-13 17:34:51', '2021-12-13 17:34:51'),
(54118, 11056, 47734, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Good afternoon!  Hope all is well with you. I wanted to get the latest updates regarding the credentialing process of the below-mentioned provider under facility TIN with all mentioned locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-20 10:40:54', '2021-12-20 10:40:54'),
(54119, 19067, 47734, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello, Locations can be verified below after 30-45 days of submission.    https://providerlookup.healthsmart.com/SearchProviders.aspx     Thank you,  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-12-29 09:39:56', '2021-12-29 09:39:56'),
(54120, 19067, 47734, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Good morning!  Hope you are having a wonderful day. Any latest updates on the credentialing process?  If you need any documents or information don\'t hesitate in reaching out to me.  Thank you! Have a  blessed day!', NULL, NULL, '2022-01-10 16:29:11', '2022-01-10 16:29:11'),
(54121, 19067, 47734, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello!  Any updates on the request below?  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:45:21', '2022-01-26 17:45:21'),
(54122, 19067, 47734, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hi,  Provider \" Elsa Pearce, PA \" is effective date \" 03/01/2022 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Documents ID : 3508873)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-02-11 13:52:57', '2022-02-11 13:52:57'),
(54123, 19067, 47734, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hello!  Can I get an approval letter for provider, Elsa Pearce.  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:44:04', '2022-02-23 14:44:04'),
(54124, 19067, 47734, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Query - Statcare Minor Emergency Clinic - Elsa Pearce - Health Smart   Hi Valesia,    Hope you are having a wonderful day.    I would like to know the enrollment status of the provider with other locations as well and if the provider is enrolled with any location provide the welcome letter for that location.    Group Name  Statcare Minor Emergency Clinic  Tax ID  46-0575924  Group NPI  1689924904  Primary Location  500 E CAESAR KINGSVILLE, TX 78363  Secondary Location  6646 S. Staples St. # 122 Corpus Christi, TX 78413  Tertiary Location  4042 River Hill Corpus Christi, TX 78410  Quaternary Location  3817 South Padre Island Drive Corpus Christi, TX 78415  Quinary Location  2102 FM 2165, Rockport, TX 78382  Provider Name  NPI  Elsa Pearce  1083784102     Please respond to my query at your earliest convenience.     Thank You!  Have a wonderful day!', NULL, NULL, '2022-03-08 13:29:52', '2022-03-08 13:29:52'),
(54125, 11056, 47735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 14:51:32', '2021-11-30 14:51:32'),
(54126, 11056, 47735, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 14:52:35', '2021-11-30 14:52:35'),
(54127, 11056, 47735, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 14:52:59', '2021-11-30 14:52:59'),
(54128, 11056, 47735, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Hello, Please use the link below and select from the dropdown for your request. This is for HealthSmart PPO Only.     https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network        Valesia Glenn |Provider Relations HealthSmart | Network Solutions 222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039    The application has been submitted online. Please see the attachment.', NULL, NULL, '2021-11-30 14:53:24', '2021-11-30 14:53:24'),
(54129, 11056, 47735, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Please find the attached application form for the provider, Elsa Pearce. I have already submitted this to Health Smart through Online on 9th, November 2021.  Also, provide me the updates regarding the application.  Thank you!', NULL, NULL, '2021-11-30 14:53:53', '2021-11-30 14:53:53'),
(54130, 11056, 47735, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Please clarify what you are requesting.  Are you asking for credentialling status? Please allow a minimum of 45 days.', NULL, NULL, '2021-12-13 17:34:20', '2021-12-13 17:34:20'),
(54131, 11056, 47735, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Good afternoon!  Hope all is well with you. I wanted to get the latest updates regarding the credentialing process of the below-mentioned provider under facility TIN with all mentioned locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-20 10:40:40', '2021-12-20 10:40:40'),
(54132, 19067, 47735, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello, Locations can be verified below after 30-45 days of submission.    https://providerlookup.healthsmart.com/SearchProviders.aspx     Thank you,  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-12-29 09:39:51', '2021-12-29 09:39:51'),
(54133, 19067, 47735, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Good morning!  Hope you are having a wonderful day. Any latest updates on the credentialing process?  If you need any documents or information don\'t hesitate in reaching out to me.  Thank you! Have a  blessed day!', NULL, NULL, '2022-01-10 16:29:17', '2022-01-10 16:29:17'),
(54134, 19067, 47735, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello!  Any updates on the request below?  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:45:14', '2022-01-26 17:45:14'),
(54135, 19067, 47735, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hi,  Provider \" Elsa Pearce, PA \" is effective date \" 03/01/2022 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Documents ID : 3508873)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-02-11 13:53:02', '2022-02-11 13:53:02'),
(54136, 19067, 47735, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hello!  Can I get an approval letter for provider, Elsa Pearce.  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:44:09', '2022-02-23 14:44:09'),
(54137, 19067, 47735, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Query - Statcare Minor Emergency Clinic - Elsa Pearce - Health Smart   Hi Valesia,    Hope you are having a wonderful day.    I would like to know the enrollment status of the provider with other locations as well and if the provider is enrolled with any location provide the welcome letter for that location.    Group Name  Statcare Minor Emergency Clinic  Tax ID  46-0575924  Group NPI  1689924904  Primary Location  500 E CAESAR KINGSVILLE, TX 78363  Secondary Location  6646 S. Staples St. # 122 Corpus Christi, TX 78413  Tertiary Location  4042 River Hill Corpus Christi, TX 78410  Quaternary Location  3817 South Padre Island Drive Corpus Christi, TX 78415  Quinary Location  2102 FM 2165, Rockport, TX 78382  Provider Name  NPI  Elsa Pearce  1083784102     Please respond to my query at your earliest convenience.     Thank You!  Have a wonderful day!', NULL, NULL, '2022-03-08 13:29:58', '2022-03-08 13:29:58'),
(54138, 19067, 47735, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Approval Letter received. Eff date: 03/01/2022', NULL, NULL, '2022-03-21 15:16:10', '2022-03-21 15:16:10'),
(54139, 11056, 47736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:03:42', '2021-11-30 15:03:42'),
(54140, 11056, 47736, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : stxnm@humana.com &  LClark44@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:05:57', '2021-11-30 15:05:57'),
(54141, 11056, 47736, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Humana has 4 Network Development Regions in Texas. Updates can only be made by the region where the provider’s office resides. Based on your service address, your request for a contract/ existing contract/updates are handled by another Network Development Market. Please remove the HumanaHoustonPD mailbox from your distribution and use the STXNM@humana.com email in its place.     Thank you.     HumanaHoustonPD     Dallas/Fort Worth/North TX/East TX   NTXNM@humana.com    San Antonio/Corpus Christi/South Texas    STXNM@humana.com     Austin/El Paso/Central Texas/BCS/West TX/Panhandle    networkrelationsaustintx@humana.com    Another request has been sent to STXNM@humana.com', NULL, NULL, '2021-11-30 15:06:36', '2021-11-30 15:06:36'),
(54142, 11056, 47736, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good morning!  Hope this email finds you well. Please find the attached roster for the provider, Elsa Pearce for enrolling and credentialing under the facility.  Furthermore, if any documents and corrections are required please don\'t hesitate in reaching out to me.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-30 15:07:05', '2021-11-30 15:07:05');
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
(54143, 11056, 47736, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from:  stxnm@humana.com   Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Humana  At this time Statcare Minor Emergency clinic is contracted on Ancillary Contract paper.  It is loaded as a facility so we do not add providers to this contract.  This is an urgent care facility.  The Group has Urgent Care Contract with Humana effective 02/8/2017. Emptoris Contract Number: 38183.  Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com bs   Please see the attached.', NULL, NULL, '2021-12-09 12:35:48', '2021-12-09 12:35:48'),
(54144, 11056, 47737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:03:53', '2021-11-30 15:03:53'),
(54145, 11056, 47737, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : stxnm@humana.com &  LClark44@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:06:05', '2021-11-30 15:06:05'),
(54146, 11056, 47737, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Humana has 4 Network Development Regions in Texas. Updates can only be made by the region where the provider’s office resides. Based on your service address, your request for a contract/ existing contract/updates are handled by another Network Development Market. Please remove the HumanaHoustonPD mailbox from your distribution and use the STXNM@humana.com email in its place.     Thank you.     HumanaHoustonPD     Dallas/Fort Worth/North TX/East TX   NTXNM@humana.com    San Antonio/Corpus Christi/South Texas    STXNM@humana.com     Austin/El Paso/Central Texas/BCS/West TX/Panhandle    networkrelationsaustintx@humana.com    Another request has been sent to STXNM@humana.com', NULL, NULL, '2021-11-30 15:06:42', '2021-11-30 15:06:42'),
(54147, 11056, 47737, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good morning!  Hope this email finds you well. Please find the attached roster for the provider, Elsa Pearce for enrolling and credentialing under the facility.  Furthermore, if any documents and corrections are required please don\'t hesitate in reaching out to me.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-30 15:07:11', '2021-11-30 15:07:11'),
(54148, 11056, 47737, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from:  stxnm@humana.com   Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Humana  At this time Statcare Minor Emergency clinic is contracted on Ancillary Contract paper.  It is loaded as a facility so we do not add providers to this contract.  This is an urgent care facility.  The Group has Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.  Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com bs   Please see the attached.', NULL, NULL, '2021-12-09 12:31:11', '2021-12-09 12:31:11'),
(54149, 11056, 47737, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from:  stxnm@humana.com   Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Humana  At this time Statcare Minor Emergency clinic is contracted on Ancillary Contract paper.  It is loaded as a facility so we do not add providers to this contract.  This is an urgent care facility.  The Group has Urgent Care Contract with Humana effective 02/8/2017. Emptoris Contract Number: 38183.  Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com bs   Please see the attached.', NULL, NULL, '2021-12-09 12:34:40', '2021-12-09 12:34:40'),
(54150, 11056, 47738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:04:05', '2021-11-30 15:04:05'),
(54151, 11056, 47738, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to : stxnm@humana.com &  LClark44@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:06:10', '2021-11-30 15:06:10'),
(54152, 11056, 47738, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Humana has 4 Network Development Regions in Texas. Updates can only be made by the region where the provider’s office resides. Based on your service address, your request for a contract/ existing contract/updates are handled by another Network Development Market. Please remove the HumanaHoustonPD mailbox from your distribution and use the STXNM@humana.com email in its place.     Thank you.     HumanaHoustonPD     Dallas/Fort Worth/North TX/East TX   NTXNM@humana.com    San Antonio/Corpus Christi/South Texas    STXNM@humana.com     Austin/El Paso/Central Texas/BCS/West TX/Panhandle    networkrelationsaustintx@humana.com    Another request has been sent to STXNM@humana.com', NULL, NULL, '2021-11-30 15:06:49', '2021-11-30 15:06:49'),
(54153, 11056, 47738, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good morning!  Hope this email finds you well. Please find the attached roster for the provider, Elsa Pearce for enrolling and credentialing under the facility.  Furthermore, if any documents and corrections are required please don\'t hesitate in reaching out to me.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-30 15:07:15', '2021-11-30 15:07:15'),
(54154, 11056, 47738, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub: Re: Demographic Change Status - RHC - Humana  Demographic Update_Interaction#2000207180578  Enrollment Query - Statcare Minor Emergency Clinic - Humana   Good afternoon Marfa!  Hope this email finds you well. Any updates on the application yet? Have all the locations been listed under the Facility TIN & the providers?  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Take Care!  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 13:46:23', '2021-12-16 13:46:23'),
(54155, 11056, 47738, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub: Re: Demographic Change Status - RHC - Humana  Enrollment Query - Statcare Minor Emergency Clinic - Humana   Good afternoon!  Hope this email finds you well. Please let us know about the application submitted for listing the location under the Tax I.D and providers. Have all the locations been listed under the TIN yet or not?  Please respond to our query at your earliest opportunity.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-23 15:21:18', '2021-12-23 15:21:18'),
(54156, 19067, 47738, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Enrollment Query || Statcare SPID || Providers || Humana ||     Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with the mentioned location.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Location	3817 South Padre Island Drive, Corpus Christi, TX 78415 Provider Name	NPI Elsa Pearce	1083784102 Petina Rogers	1801443916 Traci Mason	1497127831 Maegan Svatek	1639670250 Patrick Ayarzagoitia	1649568239 Mari Capupus	1740517945 William Francis	1457994436 Mary Gonzalez	1952713083 Katherine Rabagos	1134415631 Juan Capupus	1891168597 Rose Trevino	1437174794   Thanks! Have a wonderful day. Hammad Ahmed.', NULL, NULL, '2022-01-12 16:23:25', '2022-01-12 16:23:25'),
(54157, 19067, 47738, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Statcare SPID || Providers || Humana ||   Greetings!  Any updates on the following request?  Kindly respond in a timely manner.  Regards, Hammad.', NULL, NULL, '2022-01-26 16:30:41', '2022-01-26 16:30:41'),
(54158, 19067, 47738, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Statcare SPID || Providers || Humana ||  Since this group is not in the Houston Market, we will not be responding to this request.', NULL, NULL, '2022-02-11 14:29:53', '2022-02-11 14:29:53'),
(54159, 19067, 47738, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Fwd: Enrollment Query || Statcare SPID || Providers || Humana ||   Hello!  Hope this email finds you well.  Kindly look into my request mentioned below.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:23:26', '2022-02-21 17:23:26'),
(54160, 19067, 47738, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Subject: Enrollment Query || Statcare SPID || Providers || Humana ||    This contract is an Ancillary contract for an Urgent Care Clinic.  We do not add individual providers to this type of contract.     Thank you        Network Operations Coordinator – Provider Contracting     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2022-03-15 16:04:08', '2022-03-15 16:04:08'),
(54161, 11056, 47739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:34:51', '2021-11-30 15:34:51'),
(54162, 11056, 47739, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to: efry@trpnppo.com & trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:35:38', '2021-11-30 15:35:38'),
(54163, 11056, 47739, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope this email finds you well.  Please find the attached form of the provider to be credentialed under the Tax I.D of the facility. The provider is providing services on all of the following 5 locations. Therefore, kindly list them under the provider during enrollment.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-30 15:35:59', '2021-11-30 15:35:59'),
(54164, 11056, 47739, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Emai sent to:  trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope all is well with you. Any update on the credentialing process of the below-mentioned provider? Have u received the Provider Update form for the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-30 15:36:23', '2021-11-30 15:36:23'),
(54165, 11056, 47739, NULL, '2021-12-13 00:00:00.000', 'Approved', 'Email received from:  ncuevas@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Hello,  This email is to let you know that provider Elsa C Pearce PAC., is active in our network, her effective date is 10/29/2021.  I Hope you\'re doing well too, yes all the five locations are included on the TAX ID indicated as requested in your 11/01/2021 email.  Regards,      Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com   Welcome Letter and location proofs have been attached. Please see the attachments as well.', NULL, NULL, '2021-12-06 13:10:39', '2021-12-06 13:10:39'),
(54166, 11056, 47740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:35:01', '2021-11-30 15:35:01'),
(54167, 11056, 47740, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to: efry@trpnppo.com & trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:35:43', '2021-11-30 15:35:43'),
(54168, 11056, 47740, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope this email finds you well.  Please find the attached form of the provider to be credentialed under the Tax I.D of the facility. The provider is providing services on all of the following 5 locations. Therefore, kindly list them under the provider during enrollment.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-30 15:36:04', '2021-11-30 15:36:04'),
(54169, 11056, 47740, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Emai sent to:  trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope all is well with you. Any update on the credentialing process of the below-mentioned provider? Have u received the Provider Update form for the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-30 15:36:28', '2021-11-30 15:36:28'),
(54170, 11056, 47740, NULL, '2021-12-13 00:00:00.000', 'Approved', 'Email received from:  ncuevas@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Hello,  This email is to let you know that provider Elsa C Pearce PAC., is active in our network, her effective date is 10/29/2021.  I Hope you\'re doing well too, yes all the five locations are included on the TAX ID indicated as requested in your 11/01/2021 email.  Regards,      Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com   Welcome Letter and location proofs have been attached. Please see the attachments as well.', NULL, NULL, '2021-12-06 13:10:51', '2021-12-06 13:10:51'),
(54171, 11056, 47741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:35:15', '2021-11-30 15:35:15'),
(54172, 11056, 47741, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to: efry@trpnppo.com & trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:35:49', '2021-11-30 15:35:49'),
(54173, 11056, 47741, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope this email finds you well.  Please find the attached form of the provider to be credentialed under the Tax I.D of the facility. The provider is providing services on all of the following 5 locations. Therefore, kindly list them under the provider during enrollment.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-30 15:36:09', '2021-11-30 15:36:09'),
(54174, 11056, 47741, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Emai sent to:  trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope all is well with you. Any update on the credentialing process of the below-mentioned provider? Have u received the Provider Update form for the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-30 15:36:33', '2021-11-30 15:36:33'),
(54175, 11056, 47741, NULL, '2021-12-13 00:00:00.000', 'Approved', 'Email received from:  ncuevas@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Hello,  This email is to let you know that provider Elsa C Pearce PAC., is active in our network, her effective date is 10/29/2021.  I Hope you\'re doing well too, yes all the five locations are included on the TAX ID indicated as requested in your 11/01/2021 email.  Regards,      Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com   Welcome Letter and location proofs have been attached. Please see the attachments as well.', NULL, NULL, '2021-12-06 13:11:03', '2021-12-06 13:11:03'),
(54176, 11056, 47742, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:42:03', '2021-11-30 15:42:03'),
(54177, 11056, 47742, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to :  credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:42:51', '2021-11-30 15:42:51'),
(54178, 11056, 47742, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email received from : providerservices@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential     Hello,     Please e-mail your request to credentialing@triwest.com and reference contract number 121TW62766C01.     Thank you,     Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance  providerservices@triwest.com  www.triwest.com  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)     Remember to now send your claims to PGBA! TriWest has a new claims processor and Payer ID. For more information, visit www.triwest.com/claimsconversion.', NULL, NULL, '2021-11-30 15:43:15', '2021-11-30 15:43:15'),
(54179, 11056, 47742, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from: Credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good Morning Ahmed  After the provider is loaded in our system for credentialing the providers information is sent to aperture (3rd party credentialing company) to process. This can take 30-120 days to complete. As long as the providers CAQH is up to date it will take less time. If Aperture sends a request for additional information please respond as soon as you can so that the process does not take longer. They will only make 3 attempts for the information before they end the process.   Kind regards,   Nicole Goergen  Provider Credentialing Specialist TriWest Healthcare Alliance Fax: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749) Choice Contact Center: (866) 606-8198 Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838 www.triwest.com     Follow TriWest:  www.facebook.com/triwest www.twitter.com/triwest linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-30 15:45:18', '2021-11-30 15:45:18'),
(54180, 11056, 47742, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope all is well with you. Any updates on the credentialing process of the provider, Elsa Pearce?  Please provide me with the enrollment status at your earliest convenience.  Thank you!', NULL, NULL, '2021-12-13 17:55:02', '2021-12-13 17:55:02'),
(54181, 11056, 47742, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Provider Elsa C Pearce PAC NPI 1083784102 ', NULL, NULL, '2021-12-14 12:35:49', '2021-12-14 12:35:49'),
(54182, 11056, 47742, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: rgiambrone@triwest.com  Sub: Provider Elsa C Pearce PAC NPI 1083784102   TriWest Classification: Confidential     Good Afternoon,     I am currently working on Credentialing Provider Elsa C Pearce PAC NPI 1083784102 however I need some more information. Can you please advise who the supervising Physician is for this Provider? Also please advise if this supervising position is Credentialed with Triwest or will need to be Credentialed with Triwest? It is a requirement of Triwest for PA that are contracted with Triwest for the Supervising Physician to be contracted as well. Thank you for time and help! Please let me know if you have any questions.     Regards,     Rebecca Giambrone, Provider Credentialing Specialist |TriWest Healthcare Alliance  E: rgiambrone@triwest.com  www.triwest.com ', NULL, NULL, '2021-12-20 17:32:17', '2021-12-20 17:32:17'),
(54183, 11056, 47742, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: smiguel@triwest.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good morning Ahmed,  Effective date: 12/14/2021   Please see the attached welcome letters for the additional locations.  Dear Elsa C Pearce, PAc: I am pleased to inform you that on 12/14/2021, the TriWest Healthcare Alliance Credentialing Committee reviewed and approved your credentialing application for participation as a TriWest network provider.    Shannael Miguel Provider Credentialing Spec  TRiWest Healthcare Alliance smiguel@triwest.com  www.triwest.com', NULL, NULL, '2021-12-21 10:45:57', '2021-12-21 10:45:57'),
(54184, 11056, 47743, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:42:14', '2021-11-30 15:42:14'),
(54185, 11056, 47743, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to :  credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:42:58', '2021-11-30 15:42:58'),
(54186, 11056, 47743, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email received from : providerservices@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential     Hello,     Please e-mail your request to credentialing@triwest.com and reference contract number 121TW62766C01.     Thank you,     Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance  providerservices@triwest.com  www.triwest.com  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)     Remember to now send your claims to PGBA! TriWest has a new claims processor and Payer ID. For more information, visit www.triwest.com/claimsconversion.', NULL, NULL, '2021-11-30 15:43:20', '2021-11-30 15:43:20'),
(54187, 11056, 47743, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from: Credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good Morning Ahmed  After the provider is loaded in our system for credentialing the providers information is sent to aperture (3rd party credentialing company) to process. This can take 30-120 days to complete. As long as the providers CAQH is up to date it will take less time. If Aperture sends a request for additional information please respond as soon as you can so that the process does not take longer. They will only make 3 attempts for the information before they end the process.   Kind regards,   Nicole Goergen  Provider Credentialing Specialist TriWest Healthcare Alliance Fax: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749) Choice Contact Center: (866) 606-8198 Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838 www.triwest.com     Follow TriWest:  www.facebook.com/triwest www.twitter.com/triwest linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-30 15:45:26', '2021-11-30 15:45:26'),
(54188, 11056, 47743, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope all is well with you. Any updates on the credentialing process of the provider, Elsa Pearce?  Please provide me with the enrollment status at your earliest convenience.  Thank you!', NULL, NULL, '2021-12-13 17:54:57', '2021-12-13 17:54:57'),
(54189, 11056, 47743, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Provider Elsa C Pearce PAC NPI 1083784102 ', NULL, NULL, '2021-12-14 12:35:56', '2021-12-14 12:35:56'),
(54190, 11056, 47743, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: rgiambrone@triwest.com  Sub: Provider Elsa C Pearce PAC NPI 1083784102   TriWest Classification: Confidential     Good Afternoon,     I am currently working on Credentialing Provider Elsa C Pearce PAC NPI 1083784102 however I need some more information. Can you please advise who the supervising Physician is for this Provider? Also please advise if this supervising position is Credentialed with Triwest or will need to be Credentialed with Triwest? It is a requirement of Triwest for PA that are contracted with Triwest for the Supervising Physician to be contracted as well. Thank you for time and help! Please let me know if you have any questions.     Regards,     Rebecca Giambrone, Provider Credentialing Specialist |TriWest Healthcare Alliance  E: rgiambrone@triwest.com  www.triwest.com   ', NULL, NULL, '2021-12-20 17:31:58', '2021-12-20 17:31:58'),
(54191, 11056, 47743, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: smiguel@triwest.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good morning Ahmed,  Effective date: 12/14/2021   Please see the attached welcome letters for the additional locations.  Dear Elsa C Pearce, PAc: I am pleased to inform you that on 12/14/2021, the TriWest Healthcare Alliance Credentialing Committee reviewed and approved your credentialing application for participation as a TriWest network provider.    Shannael Miguel Provider Credentialing Spec  TRiWest Healthcare Alliance smiguel@triwest.com  www.triwest.com', NULL, NULL, '2021-12-21 10:45:46', '2021-12-21 10:45:46'),
(54192, 11056, 47744, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-30 15:42:23', '2021-11-30 15:42:23'),
(54193, 11056, 47744, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email sent to :  credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:43:03', '2021-11-30 15:43:03'),
(54194, 11056, 47744, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Email received from : providerservices@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential     Hello,     Please e-mail your request to credentialing@triwest.com and reference contract number 121TW62766C01.     Thank you,     Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance  providerservices@triwest.com  www.triwest.com  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)     Remember to now send your claims to PGBA! TriWest has a new claims processor and Payer ID. For more information, visit www.triwest.com/claimsconversion.', NULL, NULL, '2021-11-30 15:43:25', '2021-11-30 15:43:25'),
(54195, 11056, 47744, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from: Credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good Morning Ahmed  After the provider is loaded in our system for credentialing the providers information is sent to aperture (3rd party credentialing company) to process. This can take 30-120 days to complete. As long as the providers CAQH is up to date it will take less time. If Aperture sends a request for additional information please respond as soon as you can so that the process does not take longer. They will only make 3 attempts for the information before they end the process.   Kind regards,   Nicole Goergen  Provider Credentialing Specialist TriWest Healthcare Alliance Fax: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749) Choice Contact Center: (866) 606-8198 Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838 www.triwest.com     Follow TriWest:  www.facebook.com/triwest www.twitter.com/triwest linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-30 15:45:33', '2021-11-30 15:45:33'),
(54196, 11056, 47744, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope all is well with you. Any updates on the credentialing process of the provider, Elsa Pearce?  Please provide me with the enrollment status at your earliest convenience.  Thank you!', NULL, NULL, '2021-12-13 17:54:43', '2021-12-13 17:54:43'),
(54197, 11056, 47744, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: rgiambrone@triwest.com  Sub: Provider Elsa C Pearce PAC NPI 1083784102   TriWest Classification: Confidential     Good Afternoon,     I am currently working on Credentialing Provider Elsa C Pearce PAC NPI 1083784102 however I need some more information. Can you please advise who the supervising Physician is for this Provider? Also please advise if this supervising position is Credentialed with Triwest or will need to be Credentialed with Triwest? It is a requirement of Triwest for PA that are contracted with Triwest for the Supervising Physician to be contracted as well. Thank you for time and help! Please let me know if you have any questions.     Regards,     Rebecca Giambrone, Provider Credentialing Specialist |TriWest Healthcare Alliance  E: rgiambrone@triwest.com  www.triwest.com ', NULL, NULL, '2021-12-20 17:32:12', '2021-12-20 17:32:12'),
(54198, 11056, 47744, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: smiguel@triwest.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good morning Ahmed,  Effective date: 12/14/2021   Please see the attached welcome letters for the additional locations.  Dear Elsa C Pearce, PAc: I am pleased to inform you that on 12/14/2021, the TriWest Healthcare Alliance Credentialing Committee reviewed and approved your credentialing application for participation as a TriWest network provider.    Shannael Miguel Provider Credentialing Spec  TRiWest Healthcare Alliance smiguel@triwest.com  www.triwest.com', NULL, NULL, '2021-12-21 10:45:29', '2021-12-21 10:45:29'),
(54199, 1019, 47745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-02 15:22:46', '2021-12-02 15:22:46'),
(54200, 1019, 47745, NULL, '2021-12-09 00:00:00.000', 'Initiated', 'Request Initiated thru PECOS for Change of Information, Please see below for reference.  Sent: 12/02/2021 14:24 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: T120220210002418        NPI: 1831638386        Medicare ID: 558240YMWG, 729620, 764500        Name: MARYEM  KIANINEJAD          State: CO        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-12-02 15:25:09', '2021-12-02 15:25:09'),
(54201, 11056, 47745, NULL, '2021-12-21 00:00:00.000', 'Approved', 'Email received from: customerservice-donotreply@cms.hhs.gov  Sub: Medicare Enrollment Application Status Change Notification (Tracking ID: T112420210000832)  To:  maryemkian@gmail.com,mkh@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T112420210000832)   Effective Date:    11/24/2021  Date:  12/08/2021 13:35 PM Application Tracking ID: T112420210000832   NPI ID: 1275290587   Medicare ID: 1X5915   Name: MK HEALTHCARE PLLC  State: CO   Form Type: 855B  Date: 12/08/2021  Status: APPROVED   Please see the attachments.', NULL, NULL, '2021-12-14 17:22:09', '2021-12-14 17:22:09'),
(54202, 11056, 47746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54203, 11056, 47746, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:23', '2021-12-03 10:41:23'),
(54204, 11056, 47746, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:42:35', '2021-12-03 10:42:35'),
(54205, 11056, 47746, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:43:34', '2021-12-03 10:43:34'),
(54206, 11056, 47746, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:22:04', '2021-12-03 12:22:04'),
(54207, 11056, 47747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54208, 11056, 47747, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:28', '2021-12-03 10:41:28'),
(54209, 11056, 47747, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:42:39', '2021-12-03 10:42:39'),
(54210, 11056, 47747, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:43:40', '2021-12-03 10:43:40'),
(54211, 11056, 47747, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:22:32', '2021-12-03 12:22:32'),
(54212, 11056, 47748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54213, 11056, 47748, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:34', '2021-12-03 10:41:34');
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
(54214, 11056, 47748, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:42:43', '2021-12-03 10:42:43'),
(54215, 11056, 47748, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:43:45', '2021-12-03 10:43:45'),
(54216, 11056, 47748, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:23:47', '2021-12-03 12:23:47'),
(54217, 11056, 47749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54218, 11056, 47749, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:39', '2021-12-03 10:41:39'),
(54219, 11056, 47749, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:42:48', '2021-12-03 10:42:48'),
(54220, 11056, 47749, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:43:49', '2021-12-03 10:43:49'),
(54221, 11056, 47749, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:24:07', '2021-12-03 12:24:07'),
(54222, 11056, 47750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54223, 11056, 47750, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:44', '2021-12-03 10:41:44'),
(54224, 11056, 47750, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:42:53', '2021-12-03 10:42:53'),
(54225, 11056, 47750, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:43:54', '2021-12-03 10:43:54'),
(54226, 11056, 47750, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:24:24', '2021-12-03 12:24:24'),
(54227, 11056, 47751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54228, 11056, 47751, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:50', '2021-12-03 10:41:50'),
(54229, 11056, 47751, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:42:58', '2021-12-03 10:42:58'),
(54230, 11056, 47751, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:43:58', '2021-12-03 10:43:58'),
(54231, 11056, 47751, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:24:41', '2021-12-03 12:24:41'),
(54232, 11056, 47752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54233, 11056, 47752, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:41:56', '2021-12-03 10:41:56'),
(54234, 11056, 47752, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:43:03', '2021-12-03 10:43:03'),
(54235, 11056, 47752, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:44:02', '2021-12-03 10:44:02'),
(54236, 11056, 47752, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:25:08', '2021-12-03 12:25:08'),
(54237, 11056, 47753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54238, 11056, 47753, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:42:00', '2021-12-03 10:42:00'),
(54239, 11056, 47753, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:43:07', '2021-12-03 10:43:07'),
(54240, 11056, 47753, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:44:07', '2021-12-03 10:44:07'),
(54241, 11056, 47753, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:25:27', '2021-12-03 12:25:27'),
(54242, 11056, 47754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54243, 11056, 47754, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:42:07', '2021-12-03 10:42:07'),
(54244, 11056, 47754, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:43:12', '2021-12-03 10:43:12'),
(54245, 11056, 47754, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:44:12', '2021-12-03 10:44:12'),
(54246, 11056, 47754, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:25:43', '2021-12-03 12:25:43'),
(54247, 11056, 47755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54248, 11056, 47755, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:42:12', '2021-12-03 10:42:12'),
(54249, 11056, 47755, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:43:19', '2021-12-03 10:43:19'),
(54250, 11056, 47755, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:44:17', '2021-12-03 10:44:17'),
(54251, 11056, 47755, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:26:02', '2021-12-03 12:26:02'),
(54252, 11056, 47756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 10:39:52', '2021-12-03 10:39:52'),
(54253, 11056, 47756, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 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: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.', NULL, NULL, '2021-12-03 10:42:17', '2021-12-03 10:42:17'),
(54254, 11056, 47756, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-12-03 10:43:26', '2021-12-03 10:43:26'),
(54255, 11056, 47756, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-12-03 10:44:21', '2021-12-03 10:44:21'),
(54256, 11056, 47756, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:26:21', '2021-12-03 12:26:21'),
(54257, 11056, 47757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:18:15', '2021-12-03 12:18:15'),
(54258, 11056, 47757, NULL, '2021-12-16 00:00:00.000', 'In Process', 'The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:40:19', '2021-12-09 12:40:19'),
(54259, 11056, 47757, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 16:59:58', '2021-12-21 16:59:58'),
(54260, 1019, 47757, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:33', '2022-02-02 10:26:33'),
(54261, 11056, 47758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:22:04', '2021-12-03 12:22:04'),
(54262, 11056, 47758, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Ticket no. : 42741689000 Rep: Patricia S  The issue has been resolved.  Enrollment Application Status  Application Status: In Progress PEP Ticket Number: 18226147', NULL, NULL, '2021-12-09 10:40:49', '2021-12-09 10:40:49'),
(54263, 11056, 47758, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda  Status: Locations have been listed we will be able to see the other locations   Revalidation date: 11/22/2026  Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:46:29', '2021-12-14 13:46:29'),
(54264, 11056, 47758, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Ref code: 42900508000  Status: Have to wait for the conversion.', NULL, NULL, '2021-12-20 16:00:45', '2021-12-20 16:00:45'),
(54265, 11056, 47758, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:02:14', '2021-12-21 17:02:14'),
(54266, 1019, 47758, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:28', '2022-02-02 10:26:28'),
(54267, 11056, 47759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:22:32', '2021-12-03 12:22:32'),
(54268, 11056, 47759, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:40:53', '2021-12-09 12:40:53'),
(54269, 11056, 47759, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:01:42', '2021-12-21 17:01:42'),
(54270, 1019, 47759, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:22', '2022-02-02 10:26:22'),
(54271, 11056, 47760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:23:47', '2021-12-03 12:23:47'),
(54272, 11056, 47760, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:00', '2021-12-09 12:41:00'),
(54273, 11056, 47760, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:01:34', '2021-12-21 17:01:34'),
(54274, 1019, 47760, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:17', '2022-02-02 10:26:17'),
(54275, 11056, 47761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:24:07', '2021-12-03 12:24:07'),
(54276, 11056, 47761, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:06', '2021-12-09 12:41:06'),
(54277, 11056, 47761, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:01:27', '2021-12-21 17:01:27'),
(54278, 1019, 47761, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:11', '2022-02-02 10:26:11'),
(54279, 11056, 47762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:24:24', '2021-12-03 12:24:24'),
(54280, 11056, 47762, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:12', '2021-12-09 12:41:12'),
(54281, 11056, 47762, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:01:19', '2021-12-21 17:01:19'),
(54282, 1019, 47762, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:05', '2022-02-02 10:26:05'),
(54283, 11056, 47763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:24:41', '2021-12-03 12:24:41'),
(54284, 11056, 47763, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:18', '2021-12-09 12:41:18'),
(54285, 11056, 47763, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:01:12', '2021-12-21 17:01:12'),
(54286, 1019, 47763, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:24:40', '2022-02-02 10:24:40'),
(54287, 11056, 47764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:25:08', '2021-12-03 12:25:08'),
(54288, 11056, 47764, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:24', '2021-12-09 12:41:24'),
(54289, 11056, 47764, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:01:03', '2021-12-21 17:01:03'),
(54290, 1019, 47764, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:24:34', '2022-02-02 10:24:34'),
(54291, 11056, 47765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:25:27', '2021-12-03 12:25:27'),
(54292, 11056, 47765, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:30', '2021-12-09 12:41:30'),
(54293, 11056, 47765, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:00:56', '2021-12-21 17:00:56'),
(54294, 1019, 47765, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:24:29', '2022-02-02 10:24:29'),
(54295, 11056, 47766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:25:43', '2021-12-03 12:25:43'),
(54296, 11056, 47766, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:35', '2021-12-09 12:41:35'),
(54297, 11056, 47766, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:00:50', '2021-12-21 17:00:50'),
(54298, 1019, 47766, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:24:22', '2022-02-02 10:24:22'),
(54299, 11056, 47767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:26:02', '2021-12-03 12:26:02'),
(54300, 11056, 47767, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:41', '2021-12-09 12:41:41'),
(54301, 11056, 47767, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:00:42', '2021-12-21 17:00:42'),
(54302, 1019, 47767, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:24:16', '2022-02-02 10:24:16'),
(54303, 11056, 47768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-03 12:26:21', '2021-12-03 12:26:21'),
(54304, 11056, 47768, NULL, '2021-12-16 00:00:00.000', 'Initiated', '	 The portal is on updation.  Portal will be available after 13 dec 2021', NULL, NULL, '2021-12-09 12:41:45', '2021-12-09 12:41:45'),
(54305, 11056, 47768, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Welcome to your provider record! At this time, your record is read-only. It can’t be edited because it originated in a different enrollment system. After TMHP or HHS completes changes to your record in the other system, your record will be editable in PEMS', NULL, NULL, '2021-12-21 17:00:34', '2021-12-21 17:00:34'),
(54306, 1019, 47768, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:23:49', '2022-02-02 10:23:49'),
(54307, 11056, 48745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-06 13:03:19', '2021-12-06 13:03:19'),
(54308, 11056, 48745, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to: efry@trpnppo.com & trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-06 13:03:46', '2021-12-06 13:03:46'),
(54309, 11056, 48745, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope this email finds you well.  Please find the attached form of the provider to be credentialed under the Tax I.D of the facility. The provider is providing services on all of the following 5 locations. Therefore, kindly list them under the provider during enrollment.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 13:03:58', '2021-12-06 13:03:58'),
(54310, 11056, 48745, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Emai sent to:  trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope all is well with you. Any update on the credentialing process of the below-mentioned provider? Have u received the Provider Update form for the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 13:04:24', '2021-12-06 13:04:24'),
(54311, 11056, 48745, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  trpndataentry@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning,  I have attach you the Provider Update Form,     Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network  6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563   Already have submitted the form.  ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-12-06 13:04:33', '2021-12-06 13:04:33'),
(54312, 11056, 48745, NULL, '2021-12-13 00:00:00.000', 'Approved', 'Email received from:  ncuevas@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Hello,  This email is to let you know that provider Elsa C Pearce PAC., is active in our network, her effective date is 10/29/2021.  I Hope you\'re doing well too, yes all the five locations are included on the TAX ID indicated as requested in your 11/01/2021 email.  Regards,      Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com   Welcome Letter and location proofs have been attached. Please see the attachments as well.', NULL, NULL, '2021-12-06 13:10:24', '2021-12-06 13:10:24'),
(54313, 11056, 48746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-09 09:24:46', '2021-12-09 09:24:46'),
(54314, 11056, 48746, NULL, '2021-12-16 00:00:00.000', 'In Process', ' To: ANCYVINOY@GMAIL.COM,RSM@CLAIMSMEDINC.COM,FO.STRHS@TACHC.ORG   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T120820210004338)   Sent: 12/08/2021 18:11 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: T120820210004338        NPI: 1316558935        Medicare ID:         Name: ANCY V KURIAN          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-12-09 09:27:40', '2021-12-09 09:27:40'),
(54315, 11056, 48746, NULL, '2021-12-22 00:00:00.000', 'Approved', 'Email received from: 	customerservice-donotreply@cms.hhs.gov  Sub: Medicare Enrollment Application Status Change Notification (Tracking ID: T120820210004338)  To:  FO.STRHS@TACHC.ORG,ancyvinoy@gmail.com,rsm@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T120820210004338)  Date:  12/14/2021 11:00 AM  Application Tracking ID: T120820210004338   NPI ID: 1316558935   Medicare ID: 1X8153   Name: ANCY KURIAN  State: TX   Form Type: 855I  Date: 12/14/2021  Status: APPROVED', NULL, NULL, '2021-12-15 14:14:41', '2021-12-15 14:14:41'),
(54316, 19067, 49745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 13:52:56', '2021-12-14 13:52:56'),
(54317, 19067, 49745, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Initiated via BCBS TX Portal. Application ID# 360826', NULL, NULL, '2021-12-14 13:56:13', '2021-12-14 13:56:13'),
(54318, 19067, 49745, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183    RE: ANCY V KURIAN, APN   Dear Provider,  Thank you for submitting the Provider Onboarding Form.  Please make sure the provider\'s CAQH is updated to ensure the next steps go smoothly.   Credentialing will be initiated through the Council for Affordable Quality Healthcare (CAQH) for the Universal Provider Datasource (UPD) once the agreement and all required documentation is received by BlueCross and BlueShield of Texas. If you are not registered with CAQH, please visit their site to complete the process: https://proview.caqh.org/Login/Index?ReturnUrl=%2fpr. If you are already registered with CAQH, please verify: Your CAQH profile and supporting documents are current  Authorization has either been assigned globally or add HCSC (BCBSTX).   TX is either the primary or a practicing state. Provider Status = Provider Data Submitted is not a complete CAQH record.  This status indicates CAQH is awaiting supporting documentation.  It does not identify what is missing or failed the review process Image_2021-12-17_13-15-29.png   NEEDS UPDATE.   An incomplete profile application with CAQH will delay credentialing and network participation.  For more information regarding CAQH, please visit our website or call the CAQH help desk at (888) 599-1771.   Sincerely,  Standard Contracting Team TX_Standard_Contracting_Team@bcbstx.com ', NULL, NULL, '2021-12-17 14:34:59', '2021-12-17 14:34:59'),
(54319, 19067, 49745, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183   Hello,  Hope you are having a productive day and you are staying healthy.  I have just updated Ancy Kurian\'s CAQH.  Let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 14:38:20', '2021-12-17 14:38:20'),
(54320, 19067, 49745, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || NUCC, IVUC || Ancy Kurian || BCBS TX ||   Hello,  I would like to know the enrollment status of the provider with mentioned locations with BCBS TX.   Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:42:58', '2021-12-23 17:42:58'),
(54321, 19067, 49745, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Status || NUCC, IVUC || Ancy Kurian || BCBS TX || : Case Number - 03279654  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03279654.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-12-28 12:32:54', '2021-12-28 12:32:54'),
(54322, 20067, 49745, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: connie_traylor@bcbstx.com,  Noemi_Diaz@bcbstx.com, carol_delao@bcbstx.com & txproviderupdatesubmission@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  Hope all is well with you. Any updates on the previously mentioned request?  I would also like to know the updates on case Number# 03279654  Looking Forward to hearing from you.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-10 14:10:28', '2022-01-10 14:10:28');
