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
(50141, 19067, 32735, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Subject: Re Enrollment Query CBUC & GWMC Leticia & Monica UHC - [ref:_02670638:ref]       Subject: The contact information you requested     Hello,     Thank you for contacting the UnitedHealthcare Network Management Resource Team. In response to your request, I’m sending you the product roster showing the demographic information, lines of business and effective dates for the health care professionals requested.    Leticia Aleman-Lisztenbee\'s credentialing was initiated 1/10/22. Please allow 3 weeks for processing.    Thank you', NULL, NULL, '2022-01-13 10:31:15', '2022-01-13 10:31:15'),
(50142, 19067, 32735, NULL, '2022-02-02 00:00:00.000', 'Approved', 'See attachment for reference. ', NULL, NULL, '2022-01-26 13:59:54', '2022-01-26 13:59:54'),
(50143, 1006, 32736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 10:06:33', '2021-07-16 10:06:33'),
(50144, 1006, 32736, NULL, '2021-07-23 00:00:00.000', 'On Hold', 'Pending CAQH and other documents from Ryan. ', NULL, NULL, '2021-07-16 17:15:07', '2021-07-16 17:15:07'),
(50145, 1006, 32736, NULL, '2021-08-23 00:00:00.000', 'On Hold', 'The request is pending due to Medicaid enrollment.', NULL, NULL, '2021-08-16 15:42:32', '2021-08-16 15:42:32'),
(50146, 11056, 32736, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : TERESA.Argueta@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   Good afternoon!  Hope all is well with you. I want to get the latest update regarding the enrollment status of the below mentioned providers under the facility TIN with Wellcare.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  If you have any questions or concerns feel free to reach out to me soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 13:25:47', '2021-09-29 13:25:47'),
(50147, 11056, 32736, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   We are in process of loading the contract and provider.   We will let you know once complete.   Signed contract was sent to configuration to load to WellCare 9.10.2021.   Thanks  Network Development', NULL, NULL, '2021-10-07 14:52:58', '2021-10-07 14:52:58'),
(50148, 11056, 32736, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good afternoon!  Hope this email finds you well. Yes, this request is to add an additional provider highlighted below. And add a secondary location for an already approved provider with the main address.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188 : Please list the secondary location below this provider.  If you have any questions or require additional information or documents please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-10-14 16:49:38', '2021-10-14 16:49:38'),
(50149, 11056, 32736, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good Afternoon,   To add an additional provider please submit all requests via our website. Also, this inbox is for contract change requests only. If you need to update demographic or location information, please reach out to your Account Manager.    https://www.wellcare.com/en/Texas/Become-a-Provider  ', NULL, NULL, '2021-10-22 09:20:39', '2021-10-22 09:20:39'),
(50150, 11056, 32736, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Thank you for the information.  We have already submitted an online application for the provider, Monica Gonzalez.  Please see the attachment.  Thank you!  Application has been submitted and attached.', NULL, NULL, '2021-11-09 16:44:28', '2021-11-09 16:44:28'),
(50151, 11056, 32736, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC   Good morning!  Hope all is well with you. Please let us know the credentialing status of the below-mentioned providers with Wellcare.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188:  Please list the secondary location below this provider in your systems.  Please let us know the Account Manager of our area. And do provide his email & contact no. too.  Thank you! Have a great weekend!', NULL, NULL, '2021-11-24 14:07:47', '2021-11-24 14:07:47'),
(50152, 11056, 32736, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   This provider is still being processed. You will be notified once completed.     Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-12-06 17:43:25', '2021-12-06 17:43:25'),
(50153, 11056, 32736, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub:  Add Provider- Katherine Paterson - CBUC & GWMC  Good morning!  Hope all is well with you. Please do provide the welcome letter for the provider, Monica Gonzalez. And also confirm about the locations, Have both of the locations been mentioned and listed under the provider? Also, list the provider in the Wellcare provider directory as soon a possible.  Eagerly, waiting for your response.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-21 17:18:22', '2021-12-21 17:18:22'),
(50154, 19067, 32736, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider and Groups.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S Hillside DR STE 4, Beeville, TX 78102-5324 Provider Name	NPI	Location Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663  Eagerly waiting for your response.    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:23:21', '2022-01-04 10:23:21'),
(50155, 19067, 32736, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||   Greetings!  Any updates on the previously mentioned request?  Waiting to hear from you soon.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:32:50', '2022-01-09 22:32:50'),
(50156, 19067, 32736, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||  Good Morning,   Here are the providers that are active and par for HMO and PPO lines of business   ACCEPT NEW PATIENTS	LINE OF BUSINESS	EFFECTIVE DATE	TERM DATE	PCP FLAG	MEMB COUNT	PROVIDER ID	LAST NAME	FIRST NAME	PROVIDER TYPE	SPECIALTY TYPE	PRIMARY SPECIALTY	IPA ID	IPA AFFIL	NATIONAL PROVIDER ID	PRIMARY NPI	DEFAULT VENDOR ADDR	VENDOR ID	VENDOR NAME	IRS TAX ID Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-01-20 23:48:58', '2022-01-20 23:48:58'),
(50157, 19067, 32736, NULL, '2022-04-21 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||  Good Morning,   Here are the providers that are active and par for HMO and PPO lines of business   ACCEPT NEW PATIENTS	LINE OF BUSINESS	EFFECTIVE DATE	TERM DATE	PCP FLAG	MEMB COUNT	PROVIDER ID	LAST NAME	FIRST NAME	PROVIDER TYPE	SPECIALTY TYPE	PRIMARY SPECIALTY	IPA ID	IPA AFFIL	NATIONAL PROVIDER ID	PRIMARY NPI	DEFAULT VENDOR ADDR	VENDOR ID	VENDOR NAME	IRS TAX ID Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-04-14 10:04:04', '2022-04-14 10:04:04'),
(50158, 11056, 32737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-16 14:50:22', '2021-07-16 14:50:22'),
(50159, 11056, 32737, NULL, '2021-07-24 00:00:00.000', 'Initiated', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-07-16 14:55:39', '2021-07-16 14:55:39'),
(50160, 11056, 32737, NULL, '2021-08-10 00:00:00.000', 'In Process', '	 Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-03 08:52:24', '2021-08-03 08:52:24'),
(50161, 11056, 32737, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-18 09:41:41', '2021-08-18 09:41:41'),
(50162, 11056, 32737, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:35:03', '2021-08-27 09:35:03'),
(50163, 11056, 32737, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email received from : mpswebinquiries@amerigroup.com  Sub  : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good Afternoon,   Thank you for contacting us. I will be happy to assist you.  After review, the provider Segun Adeoye is non-participating in the network. The group practice Nasa Health Clinic is also non participating. To get the status of your application you will need to email your request to txcredentialing@amerigroup.com. Please note many providers apply, once we have a panel opening the credentialing team will contact you.    This mailbox is for general questions. We are encouraging all of our providers, to please log-on and/or register on our website (website per market)/Availity, and submit your questions and/or concerns via our secure portal. Using our secure portal helps maintain  the Provider’s and Member’s privacy and assists us in responding to you in a thorough and timely manner.  Please use this link to access our website.  https://availity.com/healthplans  If the provider is requiring assistance please contact Availity technical support at 800-973-3957.   Please advise if there is any other way we can assist.  Thank you,  Nordra D. MPS Inquiries ', NULL, NULL, '2021-09-23 16:41:57', '2021-09-23 16:41:57'),
(50164, 11056, 32737, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good morning!  Hope all is well with you. We are still waiting to get updates regarding our credentialing process of our below mentioned provider & facility. We have been waiting for this since May and we are losing our patience, please respond to our emails soon.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a blessed day!', NULL, NULL, '2021-10-08 10:05:46', '2021-10-08 10:05:46'),
(50165, 11056, 32737, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:35:28', '2021-10-18 15:35:28'),
(50166, 11056, 32737, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:52:12', '2021-10-25 16:52:12'),
(50167, 11056, 32737, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-10 17:16:10', '2021-11-10 17:16:10'),
(50168, 11056, 32737, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Pardon us. Please accept our apology for the delay. Please find the attached Letter of Intent for credentialing.  Furthermore, any documents or information is required don\'t hesitate to contact us.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 18:03:31', '2021-11-18 18:03:31'),
(50169, 11056, 32737, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 17:57:43', '2021-12-03 17:57:43'),
(50170, 11056, 32737, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:46:24', '2021-12-14 17:46:24'),
(50171, 11056, 32737, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:24:25', '2021-12-20 10:24:25'),
(50172, 11056, 32737, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:38:15', '2021-12-23 09:38:15'),
(50173, 19067, 32737, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:00:21', '2021-12-30 14:00:21'),
(50174, 19067, 32737, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||   Hello!  Any update on below mentioned Providers.  Eagerly waiting for your response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 17:50:43', '2022-01-06 17:50:43'),
(50175, 11056, 33626, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-23 15:02:44', '2021-07-23 15:02:44'),
(50176, 11056, 33626, NULL, '2021-07-31 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA HealthClinic - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-07-23 16:18:35', '2021-07-23 16:18:35'),
(50177, 11056, 33626, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Hi,     This request is completed,     Locations are listed,     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  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com', NULL, NULL, '2021-07-23 16:23:00', '2021-07-23 16:23:00'),
(50178, 11056, 33626, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Hi,     This request is completed,     Locations are listed,     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  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com', NULL, NULL, '2021-07-23 16:23:29', '2021-07-23 16:23:29'),
(50179, 11056, 33627, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-23 15:02:51', '2021-07-23 15:02:51'),
(50180, 11056, 33627, NULL, '2021-07-31 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA HealthClinic - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-07-23 16:18:28', '2021-07-23 16:18:28'),
(50181, 11056, 33627, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Hi,     This request is completed,     Locations are listed,     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  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com', NULL, NULL, '2021-07-23 16:23:51', '2021-07-23 16:23:51'),
(50182, 11056, 33628, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-23 16:26:02', '2021-07-23 16:26:02'),
(50183, 11056, 33628, NULL, '2021-07-31 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA UrgentCare - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-07-23 16:27:03', '2021-07-23 16:27:03'),
(50184, 11056, 33628, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub  : Enrollment Query - NASA UrgentCare - TRPN  Hi,     This request is completed,     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  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com  Please see attachment.', NULL, NULL, '2021-07-23 16:30:45', '2021-07-23 16:30:45'),
(50185, 11056, 33629, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-23 16:26:07', '2021-07-23 16:26:07'),
(50186, 11056, 33629, NULL, '2021-07-31 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA UrgentCare - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-07-23 16:26:56', '2021-07-23 16:26:56'),
(50187, 11056, 33629, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub  : Enrollment Query - NASA UrgentCare - TRPN  Hi,     This request is completed,     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  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com  Please see attachment.', NULL, NULL, '2021-07-23 16:30:34', '2021-07-23 16:30:34'),
(50188, 1019, 34626, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:23', '2021-08-02 10:00:23'),
(50189, 1019, 34626, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:37:19', '2021-08-02 10:37:19'),
(50190, 1019, 34626, NULL, '2021-08-25 00:00:00.000', 'Initiated', 'Application Submitted online thru see attachment for confirmation.', NULL, NULL, '2021-08-18 09:05:27', '2021-08-18 09:05:27'),
(50191, 1019, 34626, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:43:11', '2021-09-01 07:43:11'),
(50192, 11056, 34626, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from: Aetna Provider Communications\' via Spectrum Neuro Behavioral Health  Sub: Welcome to our network. Let’s get started  Hi Kassandra LaRoche,  Welcome to the provider network effective Oct 1 2021 12:00AM.  Your Provider Identification Number (PIN) is 6448926.', NULL, NULL, '2021-12-09 15:43:37', '2021-12-09 15:43:37'),
(50193, 1019, 34627, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:23', '2021-08-02 10:00:23'),
(50194, 1019, 34627, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:37:29', '2021-08-02 10:37:29'),
(50195, 1019, 34627, NULL, '2021-08-25 00:00:00.000', 'Initiated', 'CAQH Application Faxed to Beacon at (866) 612-7790, see attachment for reference.', NULL, NULL, '2021-08-18 10:23:39', '2021-08-18 10:23:39'),
(50196, 1019, 34627, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:43:21', '2021-09-01 07:43:21'),
(50197, 1019, 34628, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:23', '2021-08-02 10:00:23'),
(50198, 1019, 34628, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:37:37', '2021-08-02 10:37:37'),
(50199, 1019, 34628, NULL, '2021-08-25 00:00:00.000', 'Initiated', 'CAQH Application Faxed to Beacon at (866) 612-7790, see attachment for reference. ', NULL, NULL, '2021-08-18 10:24:05', '2021-08-18 10:24:05'),
(50200, 1019, 34628, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:43:32', '2021-09-01 07:43:32'),
(50201, 1019, 34629, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:23', '2021-08-02 10:00:23'),
(50202, 1019, 34629, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:37:46', '2021-08-02 10:37:46'),
(50203, 1019, 34629, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:43:45', '2021-09-01 07:43:45'),
(50204, 1019, 34630, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:23', '2021-08-02 10:00:23'),
(50205, 1019, 34630, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:37:54', '2021-08-02 10:37:54'),
(50206, 1019, 34630, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:43:53', '2021-09-01 07:43:53'),
(50207, 1019, 34631, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50208, 1019, 34631, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-08-02 10:38:05', '2021-08-02 10:38:05'),
(50209, 1019, 34631, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:44:02', '2021-09-01 07:44:02'),
(50210, 1019, 34632, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50211, 1019, 34632, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:38:15', '2021-08-02 10:38:15'),
(50212, 1019, 34632, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:44:09', '2021-09-01 07:44:09'),
(50213, 1019, 34633, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50214, 1019, 34633, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:38:26', '2021-08-02 10:38:26'),
(50215, 1019, 34633, NULL, '2021-08-25 00:00:00.000', 'Initiated', 'Request Initiated thru Online Portal.', NULL, NULL, '2021-08-18 14:14:31', '2021-08-18 14:14:31'),
(50216, 1019, 34633, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:44:15', '2021-09-01 07:44:15'),
(50217, 1019, 34634, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50218, 1019, 34634, NULL, '2021-08-09 00:00:00.000', 'Initiated', 'Initiated and Signed thru PECOS, see attached for reference.', NULL, NULL, '2021-08-02 10:36:31', '2021-08-02 10:36:31'),
(50219, 1019, 34634, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Effective date 05/04/2021 see attachment from Medicare Portal for Ref', NULL, NULL, '2021-08-18 08:25:17', '2021-08-18 08:25:17'),
(50220, 1019, 34635, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50221, 1019, 34635, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:38:35', '2021-08-02 10:38:35'),
(50222, 1019, 34635, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:44:49', '2021-09-01 07:44:49'),
(50223, 1019, 34636, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50224, 1019, 34636, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:38:47', '2021-08-02 10:38:47'),
(50225, 1019, 34636, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:45:02', '2021-09-01 07:45:02'),
(50226, 1019, 34637, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50227, 1019, 34637, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:38:56', '2021-08-02 10:38:56'),
(50228, 1019, 34637, NULL, '2021-08-27 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com Sub:  Enrollment Application || Kassandra LaRoche || SNBCARE || Tufts Health Public Plans  Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Kassandra LaRoche. Do let me know if anything else is required.  ', NULL, NULL, '2021-08-20 15:01:26', '2021-08-20 15:01:26'),
(50229, 1019, 34637, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:45:20', '2021-09-01 07:45:20'),
(50230, 11056, 34637, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Email received from:  provider_data_request@tufts-health.com  Sub:  Fwd: PRO0146854 - Enrollment Application || Kassandra LaRoche || SNBCARE || Tufts Health Public Plans 1   incident number - PRO0146854 Hi Alex   KASSANDRA LAROCHE LICSW NPI 1427721885; Tin 83-4482753; Provider ID 577245. This provider linked in network to the Spectrum Neuro Behavioral Care 63 Eddie Dowling Hwy Ste 9., North Smithfield RI 02896 eff 10/12/2021.   Thank You Tina   Ref:MSG7707146 thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-12-03 13:48:45', '2021-12-03 13:48:45'),
(50231, 1019, 34638, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50232, 1019, 34638, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:39:05', '2021-08-02 10:39:05'),
(50233, 1019, 34638, NULL, '2021-08-27 00:00:00.000', 'Initiated', 'Sent the following email to provider_data_request@tufts-health.com SUB:  Enrollment Application || Kassandra LaRoche || SNBCARE || Tufts Health Public Plans  Please find the attached request to initiate the credentialing/contracting for our provider Cemetrice Muhammed.  Do let me know if anything else is required. ', NULL, NULL, '2021-08-20 14:54:02', '2021-08-20 14:54:02'),
(50234, 1019, 34638, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:45:27', '2021-09-01 07:45:27'),
(50235, 11056, 34638, NULL, '2021-12-10 00:00:00.000', 'Approved', '	 Email received from:  provider_data_request@tufts-health.com  Sub:  Fwd: PRO0146854 - Enrollment Application || Kassandra LaRoche || SNBCARE || Tufts Health Public Plans 1   incident number - PRO0146854 Hi Alex   KASSANDRA LAROCHE LICSW NPI 1427721885; Tin 83-4482753; Provider ID 577245. This provider linked in network to the Spectrum Neuro Behavioral Care 63 Eddie Dowling Hwy Ste 9., North Smithfield RI 02896 eff 10/12/2021.   Thank You Tina   Ref:MSG7707146 thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-12-03 13:49:43', '2021-12-03 13:49:43'),
(50236, 1019, 34639, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-02 10:00:24', '2021-08-02 10:00:24'),
(50237, 1019, 34639, NULL, '2021-08-09 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-08-02 10:39:13', '2021-08-02 10:39:13'),
(50238, 1019, 34639, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:45:34', '2021-09-01 07:45:34'),
(50239, 1006, 34640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-06 09:14:23', '2021-08-06 09:14:23'),
(50240, 1006, 34640, NULL, '2021-08-13 00:00:00.000', 'Initiated', 'Sent enrollment request via TMHP: Ticket Number:  	17958442 ', NULL, NULL, '2021-08-06 09:17:30', '2021-08-06 09:17:30'),
(50241, 1006, 34640, NULL, '2021-08-23 00:00:00.000', 'In Process', 'The request still shows as in-process on the TMHP website. Need to allow more time for processing. ', NULL, NULL, '2021-08-16 12:24:00', '2021-08-16 12:24:00'),
(50242, 11056, 34640, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	   17958442	Monica-CBUC	1871132811	8/23/2021	Enrollment - First Time Applicant	Closed Approved  Please see the attachment', NULL, NULL, '2021-08-25 09:20:33', '2021-08-25 09:20:33'),
(50243, 1006, 34641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-06 09:14:31', '2021-08-06 09:14:31'),
(50244, 1006, 34641, NULL, '2021-08-13 00:00:00.000', 'Initiated', 'Sent enrollment request via TMHP: Ticket Number:  	17958442 ', NULL, NULL, '2021-08-06 09:17:25', '2021-08-06 09:17:25'),
(50245, 1006, 34641, NULL, '2021-08-23 00:00:00.000', 'In Process', 'The request still shows as in-process on the TMHP website. Need to allow more time for processing. ', NULL, NULL, '2021-08-16 12:23:56', '2021-08-16 12:23:56'),
(50246, 11056, 34641, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	   17958442	Monica-CBUC	1871132811	8/23/2021	Enrollment - First Time Applicant	Closed Approved  Please see the attachment', NULL, NULL, '2021-08-25 09:19:39', '2021-08-25 09:19:39'),
(50247, 1006, 34642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-11 16:16:36', '2021-08-11 16:16:36'),
(50248, 1006, 34642, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent enrollment request @ contact@acpnusa.com:  Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Hello,   Please find the attached enrollment packets for our providers and group, please let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 16:26:48', '2021-08-11 16:26:48'),
(50249, 1006, 34642, NULL, '2021-08-24 00:00:00.000', 'Approved', 'We received the following approval confirmation contact@acpnusa.com:   Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Good evening.   Attached is the fully executed ACPN Participating Provider Agreement.  Thank you for your participation and if you have any questions, please let us know.\"  The executed contract is attached for reference. ', NULL, NULL, '2021-08-17 10:07:29', '2021-08-17 10:07:29'),
(50250, 1006, 34643, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-11 16:16:36', '2021-08-11 16:16:36'),
(50251, 1006, 34643, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent enrollment request @ contact@acpnusa.com:  Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Hello,   Please find the attached enrollment packets for our providers and group, please let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 16:27:52', '2021-08-11 16:27:52'),
(50252, 1006, 34643, NULL, '2021-08-24 00:00:00.000', 'Approved', 'We received the following approval confirmation contact@acpnusa.com:   Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Good evening.   Attached is the fully executed ACPN Participating Provider Agreement.  Thank you for your participation and if you have any questions, please let us know.\"  The executed contract is attached for reference. ', NULL, NULL, '2021-08-17 10:07:15', '2021-08-17 10:07:15'),
(50253, 1006, 34644, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-11 16:16:36', '2021-08-11 16:16:36'),
(50254, 1006, 34644, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent enrollment request @ contact@acpnusa.com:  Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Hello,   Please find the attached enrollment packets for our providers and group, please let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 16:27:29', '2021-08-11 16:27:29'),
(50255, 1006, 34644, NULL, '2021-08-24 00:00:00.000', 'Approved', 'We received the following approval confirmation contact@acpnusa.com:   Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Good evening.   Attached is the fully executed ACPN Participating Provider Agreement.  Thank you for your participation and if you have any questions, please let us know.\"  The executed contract is attached for reference. ', NULL, NULL, '2021-08-17 10:06:54', '2021-08-17 10:06:54'),
(50256, 1006, 34645, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-11 16:17:05', '2021-08-11 16:17:05'),
(50257, 1006, 34645, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent enrollment request @ contact@acpnusa.com:  Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Hello,   Please find the attached enrollment packets for our providers and group, please let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 16:26:33', '2021-08-11 16:26:33'),
(50258, 1006, 34645, NULL, '2021-08-24 00:00:00.000', 'Approved', 'We received the following approval confirmation contact@acpnusa.com:   Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Good evening.   Attached is the fully executed ACPN Participating Provider Agreement.  Thank you for your participation and if you have any questions, please let us know.\"  The executed contract is attached for reference. ', NULL, NULL, '2021-08-17 10:07:36', '2021-08-17 10:07:36'),
(50259, 1006, 34646, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-11 16:17:05', '2021-08-11 16:17:05'),
(50260, 1006, 34646, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent enrollment request @ contact@acpnusa.com:  Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Hello,   Please find the attached enrollment packets for our providers and group, please let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 16:27:43', '2021-08-11 16:27:43'),
(50261, 1006, 34646, NULL, '2021-08-24 00:00:00.000', 'Approved', 'We received the following approval confirmation contact@acpnusa.com:   Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Good evening.   Attached is the fully executed ACPN Participating Provider Agreement.  Thank you for your participation and if you have any questions, please let us know.\"  The executed contract is attached for reference. ', NULL, NULL, '2021-08-17 10:07:21', '2021-08-17 10:07:21'),
(50262, 1006, 34647, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-11 16:17:05', '2021-08-11 16:17:05'),
(50263, 1006, 34647, NULL, '2021-08-18 00:00:00.000', 'Initiated', 'Sent enrollment request @ contact@acpnusa.com:  Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Hello,   Please find the attached enrollment packets for our providers and group, please let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 16:27:22', '2021-08-11 16:27:22'),
(50264, 1006, 34647, NULL, '2021-08-24 00:00:00.000', 'Approved', 'We received the following approval confirmation contact@acpnusa.com:   Sub: Enrollment Request - CBUC/GWMC - ACPN  \"Good evening.   Attached is the fully executed ACPN Participating Provider Agreement.  Thank you for your participation and if you have any questions, please let us know.\"  The executed contract is attached for reference. ', NULL, NULL, '2021-08-17 10:07:06', '2021-08-17 10:07:06'),
(50265, 1019, 35640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-18 08:25:17', '2021-08-18 08:25:17'),
(50266, 1019, 35640, NULL, '2021-08-25 00:00:00.000', 'Initiated', 'Sent the following application by mail to Gainwell, see attached for reference.', NULL, NULL, '2021-08-18 14:28:32', '2021-08-18 14:28:32'),
(50267, 1019, 35640, NULL, '2021-09-08 00:00:00.000', 'Not Eligible', 'Provider will no longer work with SNBCARE.', NULL, NULL, '2021-09-01 07:44:30', '2021-09-01 07:44:30'),
(50268, 1019, 36640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50269, 1019, 36640, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:49:58', '2021-08-31 09:49:58'),
(50270, 1019, 36640, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Application submitted online thru website, below is the ref for submission   Request ID for this Submission: 18842329  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-09-13 11:51:03', '2021-09-13 11:51:03'),
(50271, 1019, 36640, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Resubmitted the application as Aetna didn\'t received it on our first attempt.', NULL, NULL, '2021-11-01 08:08:24', '2021-11-01 08:08:24'),
(50272, 1019, 36640, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:07:35', '2021-11-16 09:07:35');
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
(50273, 11056, 36640, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:23', '2021-12-01 17:07:23'),
(50274, 19067, 36640, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:08', '2021-12-15 17:13:08'),
(50275, 19067, 36640, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:24', '2021-12-16 10:56:24'),
(50276, 19067, 36640, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:45', '2021-12-20 10:30:45'),
(50277, 19067, 36640, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:00', '2021-12-28 13:21:00'),
(50278, 19067, 36640, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:39', '2022-01-10 11:33:39'),
(50279, 19067, 36640, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:13:06', '2022-01-30 12:13:06'),
(50280, 1019, 36640, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:49', '2022-02-01 12:19:49'),
(50281, 19067, 36640, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:22', '2022-02-10 15:12:22'),
(50282, 19067, 36640, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:00:53', '2022-02-10 16:00:53'),
(50283, 19067, 36640, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:02:39', '2022-02-14 14:02:39'),
(50284, 19067, 36640, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:07:05', '2022-02-14 14:07:05'),
(50285, 1019, 36641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50286, 1019, 36641, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:10', '2021-08-31 09:50:10'),
(50287, 1019, 36641, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the enrollment application at (866) 612-7790, see attachment for ref.', NULL, NULL, '2021-09-13 14:34:37', '2021-09-13 14:34:37'),
(50288, 1019, 36641, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:47:15', '2021-11-01 08:47:15'),
(50289, 1019, 36641, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Resubmitted the application as it was denied due to DEA see attachment for reference.', NULL, NULL, '2021-11-17 12:16:26', '2021-11-17 12:16:26'),
(50290, 11056, 36641, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-12-01 17:27:54', '2021-12-01 17:27:54'),
(50291, 11056, 36641, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-12-01 17:27:54', '2021-12-01 17:27:54'),
(50292, 11056, 36641, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:40:37', '2021-12-14 14:40:37'),
(50293, 19067, 36641, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:16:41', '2021-12-20 12:16:41'),
(50294, 19067, 36641, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:31', '2021-12-20 15:09:31'),
(50295, 19067, 36641, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:37:41', '2021-12-22 13:37:41'),
(50296, 19067, 36641, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:05:01', '2021-12-28 17:05:01'),
(50297, 19067, 36641, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:36:23', '2022-01-05 15:36:23'),
(50298, 19067, 36641, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: jennifer.rinaldi@beaconhealthoptions.com  Subject: Attn: Jennifer Rinaldi    Hello Jennifer,  Attached is the ANCC certificate for Helena Haltermann. Let me know if you have any questions.', NULL, NULL, '2022-01-12 11:09:28', '2022-01-12 11:09:28'),
(50299, 19067, 36641, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:32:29', '2022-01-25 09:32:29'),
(50300, 19067, 36641, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:49:50', '2022-02-04 08:49:50'),
(50301, 19067, 36641, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:02:54', '2022-02-07 10:02:54'),
(50302, 19067, 36641, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:27', '2022-02-14 09:50:27'),
(50303, 1019, 36641, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022,  See attached welcome letter for ref', NULL, NULL, '2022-02-14 13:16:33', '2022-02-14 13:16:33'),
(50304, 1019, 36642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50305, 1019, 36642, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:23', '2021-08-31 09:50:23'),
(50306, 1019, 36642, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the enrollment application at (866) 612-7790, see attachment for ref.', NULL, NULL, '2021-09-13 14:35:28', '2021-09-13 14:35:28'),
(50307, 1019, 36642, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:47:33', '2021-11-01 08:47:33'),
(50308, 1019, 36642, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Resubmitted the application as it was denied due to DEA see attachment for reference.', NULL, NULL, '2021-11-17 12:16:41', '2021-11-17 12:16:41'),
(50309, 11056, 36642, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-12-01 17:27:45', '2021-12-01 17:27:45'),
(50310, 11056, 36642, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:14', '2021-12-14 14:41:14'),
(50311, 19067, 36642, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:40', '2021-12-20 12:17:40'),
(50312, 19067, 36642, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:42', '2021-12-20 15:09:42'),
(50313, 19067, 36642, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:38:03', '2021-12-22 13:38:03'),
(50314, 19067, 36642, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:05:14', '2021-12-28 17:05:14'),
(50315, 19067, 36642, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:40:15', '2022-01-05 15:40:15'),
(50316, 19067, 36642, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: jennifer.rinaldi@beaconhealthoptions.com  Subject: Attn: Jennifer Rinaldi    Hello Jennifer,  Attached is the ANCC certificate for Helena Haltermann. Let me know if you have any questions.', NULL, NULL, '2022-01-12 11:09:56', '2022-01-12 11:09:56'),
(50317, 19067, 36642, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:32:39', '2022-01-25 09:32:39'),
(50318, 19067, 36642, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:50:02', '2022-02-04 08:50:02'),
(50319, 19067, 36642, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:03:04', '2022-02-07 10:03:04'),
(50320, 19067, 36642, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:51:08', '2022-02-14 09:51:08'),
(50321, 1019, 36642, NULL, '2022-02-21 00:00:00.000', 'Approved', ' Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022,  See attached welcome letter for ref', NULL, NULL, '2022-02-14 13:17:07', '2022-02-14 13:17:07'),
(50322, 1019, 36643, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50323, 1019, 36643, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:39', '2021-08-31 09:50:39'),
(50324, 1019, 36643, NULL, '2021-09-29 00:00:00.000', 'Initiated', 'Faxed the Contracting application to (617) 246-5053  Attached is the copy of the application', NULL, NULL, '2021-09-22 10:13:22', '2021-09-22 10:13:22'),
(50325, 1019, 36643, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Signed the attached contract thru DocuSign.', NULL, NULL, '2021-10-18 10:08:15', '2021-10-18 10:08:15'),
(50326, 1019, 36643, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Spoken with Chris Ref 11/01/2021 - Chris  As per her they received our signed contract on 10/18/2021 and it will take 50 to 60 days for Processing.', NULL, NULL, '2021-11-01 09:16:06', '2021-11-01 09:16:06'),
(50327, 1019, 36643, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the Welcome Letter eff date 11/02/2021', NULL, NULL, '2021-11-30 12:31:40', '2021-11-30 12:31:40'),
(50328, 1019, 36644, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50329, 1019, 36644, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:58', '2021-08-31 09:50:58'),
(50330, 1019, 36644, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Application Submitted online thru website, see attachment for ref.', NULL, NULL, '2021-09-13 15:13:50', '2021-09-13 15:13:50'),
(50331, 1019, 36644, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Contract signed online thru Docusign. ', NULL, NULL, '2021-10-18 10:45:55', '2021-10-18 10:45:55'),
(50332, 1019, 36644, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Received the following email from Cigna/Evernorth  Hello,     Please see below for the provider status update.     Allie DiCostanzo  Status- Unable to locate an application for this provider     Diana Filoteo- Nichols  Your clinic application has been received, a recruiter will be outreaching you to follow up.     Helena Halterman  Status- Packet Received  Recruiter contact- Kristen.McCanlies@evernorth.com     Jessica Hartman  Status- Contracted- Effective date: 06/09/2021     Erin Oliva  Status- Contracted- Effective date: 05/19/2021', NULL, NULL, '2021-11-02 07:19:25', '2021-11-02 07:19:25'),
(50333, 1019, 36644, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Cigna/ Evernorth.  Dear Helena Halterman,  Thank you for completing your credentialing packet through DocuSign. Our next step in the credentialing process is to verify your credentials. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose.  While we are verifying your credentials, you may be considered a non-participating provider. Please note that you may be considered a participating provider for customers who have coverage through a Health Maintenance Organization (HMO), which includes an employee assistance program (EAP) (as long as you are eligible to provide these services). To verify a customer’s benefits and eligibility, call the number on the back of their ID card.  No further action is needed from you at this time. Should we need additional information, we will contact you by means listed on your Evernorth Behavioral Provider Application.  Once we verify your credentials, we will send an email, which will include a copy of your final agreement. The subject line of this email will begin with “Status Update: Completed.” The agreement will include Evernorth\'s countersignature and your effective date as an Evernorth Behavioral Health contracted provider.  Thank you for applying to participate in the Evernorth Behavioral Health network. We look forward to working with you and helping you realize your professional goals.  Sincerely,  +  Kristen McCanlies  Provider Relations Associate Analyst, Behavioral Health  O: 903.337.2488  F: 860.687.7181  EVERNORTH.COM', NULL, NULL, '2021-11-16 15:08:57', '2021-11-16 15:08:57'),
(50334, 1019, 36644, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Cigna,  KERRY SMITH holds a Licensed Certified Social Worker which is Not accepted in the state of ma.     Helena Halterman– provider is in que for credentialing at current time there is no action needed from the provider or your office.     Dina Filoteo Nichols-Packet sent – your assigned Evernorth Recruiter has reviewed your Provider Information Form and has sent your onboarding packet via DocuSign. Please review, and sign.     Eliza Rodrigues- I do not show an application on file.     +  Julia Perkins', NULL, NULL, '2021-11-30 13:05:58', '2021-11-30 13:05:58');
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
(50335, 11056, 36644, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  Behavioralcontracting@evernorth.com , Kristen.McCanlies@evernorth.com & Julia.Perkins@evernorth.com  Sub:  Re: [External] Enrollment Status || Providers || SNBCARE || CIGNA  Good Morning,     I need an update on the credentialing process for the following providers.     Group Name  Spectrum Neuro Behavioral Care LLC  Tax ID  2753  Group NPI  1356906572  Smith, Kerry  1275083230  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Smith, Kerry  1275083230  100 New State Highway, Raynham, MA, 02767.  Halterman, Helena  1801473749  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Halterman, Helena  1801473749  100 New State Highway, Raynham, MA, 02767.  Filoteo-Nichols, Dina  1770021099  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Filoteo-Nichols, Dina  1770021099  100 New State Highway, Raynham, MA, 02767.  Rodrigues, Eliza  1821751405  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Rodrigues, Eliza  1821751405  100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-12-02 17:53:31', '2021-12-02 17:53:31'),
(50336, 19067, 36644, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: behPWS@cigna.com, Romelyn.Lucar@evernorth.com, Kristen.McCanlies@evernorth.com, Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 13:31:06', '2021-12-16 13:31:06'),
(50337, 19067, 36644, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Behavioralcontracting@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||   Hello Hammad,     Dina Filoteo-Nichols is currently in process.  Julie is the recruiter that is currently assisting with the onboarding process.  I have included her in this email so you may reach out to her directly.  Helena Halterman is currently in process.  Kristen is currently assisting with the onboarding process. I have included her in this email so you may reach out to her directly.  Jessica Hartman is currently affiliated with 63 Eddie Dowling Hwy, Ste. 9 North Smithfield, RI 02896.  If Ste. 8 is the correct suite we will either need you to add that location or update that location.  I have included the change form.  Erin Oliva is currently in process.  Romelyn is currently assisting with the onboarding process.  I have included their email so you may reach out to them directly.        Rochelle  Provider Relations Analyst, Behavioral Health  E: BehavioralContracting@Evernorth.com', NULL, NULL, '2021-12-16 17:30:09', '2021-12-16 17:30:09'),
(50338, 19067, 36644, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: Kristen.McCanlies@evernorth.com  Subject: Automatic reply: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Thank you for your email.  Please note, due to a high volume of provider requests to join the network, it may take your Cigna Recruiter 3-5 days to respond to your email.     We appreciate your patience during this time.     Thank you,     Kristen McCanlies  Behavioral NCU | Provider Relations Associate Analyst  T: 903.337.2488 | F: 860.687.7181  Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.©Copyright 2021 Cigna.', NULL, NULL, '2021-12-17 15:02:56', '2021-12-17 15:02:56'),
(50339, 19067, 36644, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 18:02:58', '2021-12-28 18:02:58'),
(50340, 19067, 36644, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||    Both providers are in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  F:  860.697.6085  EVERNORTH.COM', NULL, NULL, '2021-12-29 09:12:43', '2021-12-29 09:12:43'),
(50341, 19067, 36644, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Re: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Greetings!  Any updates on the previously mentioned request?  Kindly respond as soon as you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:08:13', '2022-01-10 13:08:13'),
(50342, 19067, 36644, NULL, '2022-02-03 00:00:00.000', 'Approved', 'See attachment of provider directory as a reference.', NULL, NULL, '2022-01-27 09:23:34', '2022-01-27 09:23:34'),
(50343, 1019, 36645, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50344, 1019, 36645, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:13', '2021-08-31 09:51:13'),
(50345, 1019, 36645, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org,    PNMDepartment@commonwealthcare.org-----------Hello, We want to enroll the following provider with CCA under our group, please let me know the process for that as she is already In Network with CCA.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 ', NULL, NULL, '2021-09-13 16:40:34', '2021-09-13 16:40:34'),
(50346, 1019, 36645, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,   Providers Kameelah Abdul-Aziz, PMHNP, Helena Halterman, PMNHP is in process, please allow time for credentialing period.  Credentialing period can take 30-45 days and you will receive confirmation once completed.   Thank you, Aravindrajan Bangaru Provider Network Management  Commonwealth Care Alliance  2 Avenue De Lafayette 5th Floor  Boston MA 02111  PNMDepartment@commonwealthcare.org', NULL, NULL, '2021-09-22 08:30:58', '2021-09-22 08:30:58'),
(50347, 1019, 36645, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from CCA, as they don\'t sent welcome letter for each provider.  October 22, 2021     Helena Lynn Halterman, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 10/22/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111    61 Lincoln St Suite 203 & 100 New State Hwy  ', NULL, NULL, '2021-11-16 15:15:44', '2021-11-16 15:15:44'),
(50348, 1019, 36646, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50349, 1019, 36646, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:28', '2021-08-31 09:51:28'),
(50350, 1019, 36647, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50351, 1019, 36647, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:48', '2021-08-31 09:51:48'),
(50352, 1019, 36647, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:59', '2021-10-07 01:18:59'),
(50353, 1019, 36647, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Provider roster was sent out to Monica at humana to add the providers under our group, attached is the group roster for reference.', NULL, NULL, '2021-10-28 10:56:49', '2021-10-28 10:56:49'),
(50354, 11056, 36647, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:34:58', '2021-12-09 17:34:58'),
(50355, 19067, 36647, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:47', '2021-12-15 15:32:47'),
(50356, 19067, 36647, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:25:29', '2021-12-16 12:25:29'),
(50357, 19067, 36647, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:20', '2021-12-29 14:37:20'),
(50358, 19067, 36647, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:25', '2022-01-10 13:17:25'),
(50359, 19067, 36647, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:14:13', '2022-01-30 13:14:13'),
(50360, 19067, 36647, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:28', '2022-02-08 14:23:28'),
(50361, 19067, 36647, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:21', '2022-03-09 14:56:21'),
(50362, 19067, 36647, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:08', '2022-03-10 10:49:08'),
(50363, 22077, 36647, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:53:07', '2022-04-04 13:53:07'),
(50364, 1019, 36648, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50365, 1019, 36648, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:55', '2021-08-31 09:51:55'),
(50366, 1019, 36648, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Request Initiated thru Provider Portal, Attached is the SS for Ref ', NULL, NULL, '2021-09-14 07:47:53', '2021-09-14 07:47:53'),
(50367, 1019, 36648, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com  In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  601536-453         HELENA L HALTERMAN  601536-462         KAMEELAH ABDUL-AZIZ     Thank you,  Magellan Contracting Team', NULL, NULL, '2021-09-22 08:24:31', '2021-09-22 08:24:31'),
(50368, 1019, 36648, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent the following email to ARViviano@magellanhealth.com  Good Morning Angela,  You guys are already authorized to view her CAQH, and I\'m seeing the you have already started seeing their CAQH, so why are you sending me an email that you are not authorized to view their CAQH?  Regards, Alex', NULL, NULL, '2021-09-22 08:27:25', '2021-09-22 08:27:25'),
(50369, 19067, 36648, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:18:50', '2021-12-15 14:18:50'),
(50370, 19067, 36648, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||  Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:37:09', '2021-12-15 16:37:09'),
(50371, 19067, 36648, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 14:00:07', '2021-12-29 14:00:07'),
(50372, 19067, 36648, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:27', '2022-01-10 13:22:27'),
(50373, 19067, 36648, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:08:09', '2022-02-11 10:08:09'),
(50374, 19067, 36648, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.', NULL, NULL, '2022-03-17 11:00:38', '2022-03-17 11:00:38'),
(50375, 1019, 36649, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50376, 1019, 36649, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:13', '2021-08-31 09:52:13'),
(50377, 1019, 36649, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Application was emailed to MassHealth at pec@maximus.com', NULL, NULL, '2021-11-30 14:22:50', '2021-11-30 14:22:50'),
(50378, 11056, 36649, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from: PEC@maximus.com  Sub: Re: [EXTERNAL] Need Welcome Letter  Good Afternoon,  Effective date:11/17/2021.  PID: 110179037A  Thank you for contacting the MassHealth Provider Enrollment and Credentialing Department.     We have attached provider Helena Haterman’s Welcome Letter as per your request.     If you have any questions or concerns please feel free to contact us.     Best Regards,     PEC  Provider Enrollment and Credentialing Department  Business Support Services, US Services     MAXIMUS  Remote: Boston, MA  PEC@maximus.com   Please see the attached.', NULL, NULL, '2021-12-09 14:40:41', '2021-12-09 14:40:41'),
(50379, 1019, 36650, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50380, 1019, 36650, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:29', '2021-08-31 09:52:29'),
(50381, 1019, 36651, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50382, 1019, 36651, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:46', '2021-08-31 09:52:46'),
(50383, 1019, 36651, NULL, '2021-09-28 00:00:00.000', 'Approved', 'Received the following email from Medicare, along with the approval confirmation.  Date:  09/13/2021 12:20 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T090720210003740. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T090720210003740   NPI ID: 1801473749   Medicare ID: S400780798   Name: HELENA HALTERMAN  State: MA   Form Type: 855I  Date: 09/13/2021  Status: APPROVED  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ', NULL, NULL, '2021-09-21 08:31:46', '2021-09-21 08:31:46'),
(50384, 1019, 36652, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50385, 1019, 36652, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:04', '2021-08-31 09:53:04'),
(50386, 1019, 36652, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN request initiated thru website ref - 21280000005', NULL, NULL, '2021-10-07 01:43:18', '2021-10-07 01:43:18'),
(50387, 1019, 36652, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 09/01/2021, Approval letter for reference. ', NULL, NULL, '2021-11-16 15:54:53', '2021-11-16 15:54:53'),
(50388, 1019, 36653, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50389, 1019, 36653, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:19', '2021-08-31 09:53:19'),
(50390, 1019, 36653, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Enrollment Application faxed at (608) 221-7535, attached is the application for ref ', NULL, NULL, '2021-10-06 23:47:20', '2021-10-06 23:47:20'),
(50391, 19067, 36653, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:05', '2021-12-16 14:10:05'),
(50392, 19067, 36653, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:06:54', '2021-12-29 12:06:54'),
(50393, 19067, 36653, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:13:51', '2022-01-10 14:13:51'),
(50394, 19067, 36653, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:35', '2022-01-11 09:37:35'),
(50395, 19067, 36653, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:46:48', '2022-01-11 10:46:48'),
(50396, 19067, 36653, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:01', '2022-02-11 11:16:01'),
(50397, 19067, 36653, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:22:48', '2022-02-11 11:22:48'),
(50398, 19067, 36653, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:48:50', '2022-03-17 09:48:50'),
(50399, 19067, 36653, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:33:54', '2022-03-17 10:33:54'),
(50400, 19067, 36653, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:06', '2022-03-17 10:36:06'),
(50401, 19067, 36653, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:57:52', '2022-03-17 13:57:52'),
(50402, 19067, 36653, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject: Enrollment Query || Helena Halterman || SNBCARE || Tricare   Hi again,  Can you please provide me with the current enrollment status of the following provider with Tricare,  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Helena Halterman	1801473749 Helena Halterman	1801473749  Regards,', NULL, NULL, '2022-03-17 15:34:44', '2022-03-17 15:34:44'),
(50403, 22077, 36653, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject:  Enrollment Query || Helena Halterman || SNBCARE || Tricare  Hi,  I would to know the enrollment status of the following provider Helena Halterman  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Helena Halterman	1801473749 Helena Halterman	1801473749  Thanks', NULL, NULL, '2022-04-07 08:09:59', '2022-04-07 08:09:59'),
(50404, 1019, 36654, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50405, 1019, 36654, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:33', '2021-08-31 09:53:33'),
(50406, 1019, 36654, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Helena Haltermann. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:39:28', '2021-09-14 08:39:28'),
(50407, 1019, 36654, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:43:19 EDT.  Please reference ticket number PRO0149040 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7538552 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-09-22 08:59:42', '2021-09-22 08:59:42'),
(50408, 11056, 36654, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:51:56', '2021-12-03 14:51:56'),
(50409, 11056, 36654, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email received from: servicenow@tufts-health.com  Sub: PPO0129278 - Request Received  Hello ,  We are in receipt of your request regarding Re: Allied Health Provider Agreement for Helena Lynn Halterman, NP originally sent to tufts_health_plan_credentialing_department@tufts-health.com regarding your submitted on 2021-10-26 12:26:33 EDT.   Please reference ticket number PPO0129278  for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG7953390', NULL, NULL, '2021-12-10 18:01:25', '2021-12-10 18:01:25'),
(50410, 11056, 36654, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email received from: servicenow@tufts-health.com  Sub: PPO0129278 - Request Received  Hello ,  We are in receipt of your request regarding Re: Allied Health Provider Agreement for Helena Lynn Halterman, NP originally sent to tufts_health_plan_credentialing_department@tufts-health.com regarding your submitted on 2021-10-26 12:26:33 EDT.   Please reference ticket number PPO0129278  for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG7953390', NULL, NULL, '2021-12-10 18:01:37', '2021-12-10 18:01:37'),
(50411, 19067, 36654, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Providers & Groups || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well. I want to get the latest updates regarding the credentialing process of the following Providers.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572   Provider Name	NPI	Location Erin Oliva	1407349632	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896-7322 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 New State HWY Raynham, MA 02767-5423   Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 17:21:21', '2021-12-17 17:21:21'),
(50412, 19067, 36654, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:39', '2021-12-29 10:05:39'),
(50413, 19067, 36654, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:46', '2022-01-10 14:44:46'),
(50414, 19067, 36654, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:38:41', '2022-02-11 11:38:41'),
(50415, 22077, 36654, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:08:54', '2022-04-05 10:08:54'),
(50416, 1019, 36655, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50417, 1019, 36655, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:46', '2021-08-31 09:53:46'),
(50418, 1019, 36655, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Helena Haltermann. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:40:33', '2021-09-14 08:40:33'),
(50419, 1019, 36655, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:43:19 EDT.  Please reference ticket number PRO0149040 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7538552 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-09-22 08:59:56', '2021-09-22 08:59:56');
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
(50420, 11056, 36655, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:53:44', '2021-12-03 14:53:44'),
(50421, 11056, 36655, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email received from: servicenow@tufts-health.com  Sub: PPO0129278 - Request Received  Hello ,  We are in receipt of your request regarding Re: Allied Health Provider Agreement for Helena Lynn Halterman, NP originally sent to tufts_health_plan_credentialing_department@tufts-health.com regarding your submitted on 2021-10-26 12:26:33 EDT.   Please reference ticket number PPO0129278  for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG7953390', NULL, NULL, '2021-12-10 18:01:51', '2021-12-10 18:01:51'),
(50422, 19067, 36655, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Providers & Groups || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well. I want to get the latest updates regarding the credentialing process of the following Providers.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572   Provider Name	NPI	Location Erin Oliva	1407349632	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896-7322 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 New State HWY Raynham, MA 02767-5423   Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 17:21:12', '2021-12-17 17:21:12'),
(50423, 19067, 36655, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:51', '2021-12-29 10:05:51'),
(50424, 19067, 36655, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:46:06', '2022-01-10 14:46:06'),
(50425, 19067, 36655, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:38:51', '2022-02-11 11:38:51'),
(50426, 22077, 36655, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:40:59', '2022-04-05 10:40:59'),
(50427, 1019, 36656, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:08:39', '2021-08-30 13:08:39'),
(50428, 1019, 36656, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:54:02', '2021-08-31 09:54:02'),
(50429, 1019, 36656, NULL, '2021-09-28 00:00:00.000', 'Initiated', 'Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Helena Halterman has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services  This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2021-09-21 08:54:48', '2021-09-21 08:54:48'),
(50430, 1019, 36656, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from donotreplyemail@aperturecvo.com  Health Plan(s) Requesting Information: Optum Behavioral Health Massachusetts  Credentials Request for: Halterman, Helena Lynn  Attention: Credentialing information  Information Requested: Copy of current legible DEA certificate(s) for MA or the name of the practitioner who prescribes on your behalf. How to Respond:  Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested. NOTE:  This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information.', NULL, NULL, '2021-09-22 08:19:20', '2021-09-22 08:19:20'),
(50431, 1019, 36656, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from UBH for Approval. See Attachments for location confirmation  001100221    Helena Halterman  snbc@claimsmedinc.com  snbc@claimsmedinc.com    Dear Helena Halterman:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 10/15/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.    Provider Express: You and/or administrative staff should self-register to obtain your Login ID at providerexpress.com > \"First-time User\". Please allow 5 business days from the date of this notification before attempting to register. Please review your provider profile for accuracy in Provider Express and submit corrections within 10 business days. Provider Express allows access to information and services you need 24/7, including:    Authorization: for routine outpatient services, when required, is typically obtained by the Member prior to their first visit.  Please verify that the authorization is in place prior to providing services through Provider Express.   ', NULL, NULL, '2021-11-30 16:58:01', '2021-11-30 16:58:01'),
(50432, 1019, 36657, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50433, 1019, 36657, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:49:51', '2021-08-31 09:49:51'),
(50434, 1019, 36657, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Application submitted online thru website, below is the ref for submission   Request ID for this Submission: 18842329  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-09-13 11:51:15', '2021-09-13 11:51:15'),
(50435, 1019, 36657, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Resubmitted her application as Aetna Didn\'t receive it on our first attempt.', NULL, NULL, '2021-11-01 08:07:34', '2021-11-01 08:07:34'),
(50436, 1019, 36657, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:06:23', '2021-11-16 09:06:23'),
(50437, 11056, 36657, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:17', '2021-12-01 17:07:17'),
(50438, 19067, 36657, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:12:59', '2021-12-15 17:12:59'),
(50439, 19067, 36657, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:18', '2021-12-16 10:56:18'),
(50440, 19067, 36657, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:40', '2021-12-20 10:30:40'),
(50441, 19067, 36657, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:55', '2021-12-28 13:20:55'),
(50442, 19067, 36657, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:33', '2022-01-10 11:33:33'),
(50443, 19067, 36657, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:13:17', '2022-01-30 12:13:17'),
(50444, 1019, 36657, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:43', '2022-02-01 12:19:43'),
(50445, 19067, 36657, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:29', '2022-02-10 15:12:29'),
(50446, 19067, 36657, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:00:57', '2022-02-10 16:00:57'),
(50447, 19067, 36657, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:02:45', '2022-02-14 14:02:45'),
(50448, 19067, 36657, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:07:19', '2022-02-14 14:07:19'),
(50449, 1019, 36658, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50450, 1019, 36658, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:04', '2021-08-31 09:50:04'),
(50451, 1019, 36658, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the enrollment application at (866) 612-7790, see attachment for ref.', NULL, NULL, '2021-09-13 14:34:08', '2021-09-13 14:34:08'),
(50452, 1019, 36658, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:47:06', '2021-11-01 08:47:06'),
(50453, 1019, 36658, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Resubmitted the application as it was denied due to DEA see attachment for reference.', NULL, NULL, '2021-11-17 12:16:16', '2021-11-17 12:16:16'),
(50454, 11056, 36658, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-12-01 17:27:50', '2021-12-01 17:27:50'),
(50455, 11056, 36658, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:40:44', '2021-12-14 14:40:44'),
(50456, 19067, 36658, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:16:37', '2021-12-20 12:16:37'),
(50457, 19067, 36658, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:24', '2021-12-20 15:09:24'),
(50458, 19067, 36658, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:37:10', '2021-12-22 13:37:10'),
(50459, 19067, 36658, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:04:54', '2021-12-28 17:04:54'),
(50460, 19067, 36658, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:36:17', '2022-01-05 15:36:17'),
(50461, 19067, 36658, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: jennifer.rinaldi@beaconhealthoptions.com  Subject: Attn: Jennifer Rinaldi    Hello Jennifer,  Attached is the ANCC certificate for Helena Haltermann. Let me know if you have any questions.', NULL, NULL, '2022-01-12 11:09:23', '2022-01-12 11:09:23'),
(50462, 19067, 36658, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:32:23', '2022-01-25 09:32:23'),
(50463, 19067, 36658, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:49:57', '2022-02-04 08:49:57'),
(50464, 19067, 36658, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:02:59', '2022-02-07 10:02:59'),
(50465, 19067, 36658, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:32', '2022-02-14 09:50:32'),
(50466, 1019, 36658, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022,  See attached welcome letter  and location confirmation for ref', NULL, NULL, '2022-02-16 09:55:05', '2022-02-16 09:55:05'),
(50467, 1019, 36659, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50468, 1019, 36659, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:16', '2021-08-31 09:50:16'),
(50469, 1019, 36659, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the enrollment application at (866) 612-7790, see attachment for ref.', NULL, NULL, '2021-09-13 14:35:04', '2021-09-13 14:35:04'),
(50470, 1019, 36659, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:47:22', '2021-11-01 08:47:22'),
(50471, 1019, 36659, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Resubmitted the application as it was denied due to DEA see attachment for reference.', NULL, NULL, '2021-11-17 12:16:34', '2021-11-17 12:16:34'),
(50472, 11056, 36659, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations ', NULL, NULL, '2021-12-01 17:27:39', '2021-12-01 17:27:39'),
(50473, 11056, 36659, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:21', '2021-12-14 14:41:21'),
(50474, 19067, 36659, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:33', '2021-12-20 12:17:33'),
(50475, 19067, 36659, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:37', '2021-12-20 15:09:37'),
(50476, 19067, 36659, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:37:50', '2021-12-22 13:37:50'),
(50477, 19067, 36659, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:05:06', '2021-12-28 17:05:06'),
(50478, 19067, 36659, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:40:06', '2022-01-05 15:40:06'),
(50479, 19067, 36659, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: jennifer.rinaldi@beaconhealthoptions.com  Subject: Attn: Jennifer Rinaldi    Hello Jennifer,  Attached is the ANCC certificate for Helena Haltermann. Let me know if you have any questions.', NULL, NULL, '2022-01-12 11:09:52', '2022-01-12 11:09:52');
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
(50480, 19067, 36659, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:32:34', '2022-01-25 09:32:34'),
(50481, 19067, 36659, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:50:16', '2022-02-04 08:50:16'),
(50482, 19067, 36659, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:03:10', '2022-02-07 10:03:10'),
(50483, 19067, 36659, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:51:13', '2022-02-14 09:51:13'),
(50484, 1019, 36659, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022,  See attached welcome letter  and location confirmation for ref', NULL, NULL, '2022-02-16 09:56:46', '2022-02-16 09:56:46'),
(50485, 1019, 36660, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50486, 1019, 36660, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:31', '2021-08-31 09:50:31'),
(50487, 1019, 36660, NULL, '2021-09-29 00:00:00.000', 'Initiated', 'Faxed the Contracting application to (617) 246-5053  Attached is the copy of the application', NULL, NULL, '2021-09-22 10:13:44', '2021-09-22 10:13:44'),
(50488, 1019, 36660, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Signed the attached contract thru DocuSign.', NULL, NULL, '2021-10-18 10:08:59', '2021-10-18 10:08:59'),
(50489, 1019, 36660, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Spoken with Chris Ref 11/01/2021 - Chris  As per her they received our signed contract on 10/18/2021 and it will take 50 to 60 days for Processing.', NULL, NULL, '2021-11-01 09:15:55', '2021-11-01 09:15:55'),
(50490, 1019, 36660, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the Welcome Letter eff date 11/02/2021', NULL, NULL, '2021-11-30 12:31:19', '2021-11-30 12:31:19'),
(50491, 1019, 36661, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50492, 1019, 36661, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:50:49', '2021-08-31 09:50:49'),
(50493, 1019, 36661, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Application Submitted online thru website, see attachment for ref.', NULL, NULL, '2021-09-13 15:14:21', '2021-09-13 15:14:21'),
(50494, 1019, 36661, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Contract signed online thru Docusign. ', NULL, NULL, '2021-10-18 10:46:02', '2021-10-18 10:46:02'),
(50495, 1019, 36661, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Received the following email from Cigna/Evernorth  Hello,     Please see below for the provider status update.     Allie DiCostanzo  Status- Unable to locate an application for this provider     Diana Filoteo- Nichols  Your clinic application has been received, a recruiter will be outreaching you to follow up.     Helena Halterman  Status- Packet Received  Recruiter contact- Kristen.McCanlies@evernorth.com     Jessica Hartman  Status- Contracted- Effective date: 06/09/2021     Erin Oliva  Status- Contracted- Effective date: 05/19/2021', NULL, NULL, '2021-11-02 07:19:17', '2021-11-02 07:19:17'),
(50496, 1019, 36661, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Cigna/ Evernorth.  Dear Helena Halterman,  Thank you for completing your credentialing packet through DocuSign. Our next step in the credentialing process is to verify your credentials. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose.  While we are verifying your credentials, you may be considered a non-participating provider. Please note that you may be considered a participating provider for customers who have coverage through a Health Maintenance Organization (HMO), which includes an employee assistance program (EAP) (as long as you are eligible to provide these services). To verify a customer’s benefits and eligibility, call the number on the back of their ID card.  No further action is needed from you at this time. Should we need additional information, we will contact you by means listed on your Evernorth Behavioral Provider Application.  Once we verify your credentials, we will send an email, which will include a copy of your final agreement. The subject line of this email will begin with “Status Update: Completed.” The agreement will include Evernorth\'s countersignature and your effective date as an Evernorth Behavioral Health contracted provider.  Thank you for applying to participate in the Evernorth Behavioral Health network. We look forward to working with you and helping you realize your professional goals.  Sincerely,  +  Kristen McCanlies  Provider Relations Associate Analyst, Behavioral Health  O: 903.337.2488  F: 860.687.7181  EVERNORTH.COM', NULL, NULL, '2021-11-16 15:08:47', '2021-11-16 15:08:47'),
(50497, 1019, 36661, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Cigna,  KERRY SMITH holds a Licensed Certified Social Worker which is Not accepted in the state of ma.     Helena Halterman– provider is in que for credentialing at current time there is no action needed from the provider or your office.     Dina Filoteo Nichols-Packet sent – your assigned Evernorth Recruiter has reviewed your Provider Information Form and has sent your onboarding packet via DocuSign. Please review, and sign.     Eliza Rodrigues- I do not show an application on file.     +  Julia Perkins', NULL, NULL, '2021-11-30 13:05:51', '2021-11-30 13:05:51'),
(50498, 11056, 36661, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  Behavioralcontracting@evernorth.com , Kristen.McCanlies@evernorth.com & Julia.Perkins@evernorth.com  Sub:  Re: [External] Enrollment Status || Providers || SNBCARE || CIGNA  Good Morning,     I need an update on the credentialing process for the following providers.     Group Name  Spectrum Neuro Behavioral Care LLC  Tax ID  2753  Group NPI  1356906572  Smith, Kerry  1275083230  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Smith, Kerry  1275083230  100 New State Highway, Raynham, MA, 02767.  Halterman, Helena  1801473749  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Halterman, Helena  1801473749  100 New State Highway, Raynham, MA, 02767.  Filoteo-Nichols, Dina  1770021099  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Filoteo-Nichols, Dina  1770021099  100 New State Highway, Raynham, MA, 02767.  Rodrigues, Eliza  1821751405  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Rodrigues, Eliza  1821751405  100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-12-02 17:53:25', '2021-12-02 17:53:25'),
(50499, 19067, 36661, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: behPWS@cigna.com, Romelyn.Lucar@evernorth.com, Kristen.McCanlies@evernorth.com, Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 13:30:56', '2021-12-16 13:30:56'),
(50500, 19067, 36661, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Behavioralcontracting@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||   Hello Hammad,     Dina Filoteo-Nichols is currently in process.  Julie is the recruiter that is currently assisting with the onboarding process.  I have included her in this email so you may reach out to her directly.  Helena Halterman is currently in process.  Kristen is currently assisting with the onboarding process. I have included her in this email so you may reach out to her directly.  Jessica Hartman is currently affiliated with 63 Eddie Dowling Hwy, Ste. 9 North Smithfield, RI 02896.  If Ste. 8 is the correct suite we will either need you to add that location or update that location.  I have included the change form.  Erin Oliva is currently in process.  Romelyn is currently assisting with the onboarding process.  I have included their email so you may reach out to them directly.        Rochelle  Provider Relations Analyst, Behavioral Health  E: BehavioralContracting@Evernorth.com', NULL, NULL, '2021-12-16 17:30:02', '2021-12-16 17:30:02'),
(50501, 19067, 36661, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: Kristen.McCanlies@evernorth.com  Subject: Automatic reply: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Thank you for your email.  Please note, due to a high volume of provider requests to join the network, it may take your Cigna Recruiter 3-5 days to respond to your email.     We appreciate your patience during this time.     Thank you,     Kristen McCanlies  Behavioral NCU | Provider Relations Associate Analyst  T: 903.337.2488 | F: 860.687.7181  Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.©Copyright 2021 Cigna.', NULL, NULL, '2021-12-17 15:05:35', '2021-12-17 15:05:35'),
(50502, 19067, 36661, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 18:02:54', '2021-12-28 18:02:54'),
(50503, 19067, 36661, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||    Both providers are in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  F:  860.697.6085  EVERNORTH.COM', NULL, NULL, '2021-12-29 09:12:38', '2021-12-29 09:12:38'),
(50504, 19067, 36661, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Re: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Greetings!  Any updates on the previously mentioned request?  Kindly respond as soon as you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:08:19', '2022-01-10 13:08:19'),
(50505, 19067, 36661, NULL, '2022-02-03 00:00:00.000', 'Approved', 'See attachment of providers directory as a reference.', NULL, NULL, '2022-01-27 09:38:15', '2022-01-27 09:38:15'),
(50506, 1019, 36662, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50507, 1019, 36662, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:06', '2021-08-31 09:51:06'),
(50508, 1019, 36662, NULL, '2021-09-20 00:00:00.000', 'Initiated', '', NULL, NULL, '2021-09-13 16:39:59', '2021-09-13 16:39:59'),
(50509, 1019, 36662, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org,    PNMDepartment@commonwealthcare.org-----------Hello, We want to enroll the following provider with CCA under our group, please let me know the process for that as she is already In Network with CCA.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 ', NULL, NULL, '2021-09-13 16:40:08', '2021-09-13 16:40:08'),
(50510, 1019, 36662, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,   Providers Kameelah Abdul-Aziz, PMHNP, Helena Halterman, PMNHP is in process, please allow time for credentialing period.  Credentialing period can take 30-45 days and you will receive confirmation once completed.   Thank you, Aravindrajan Bangaru Provider Network Management  Commonwealth Care Alliance  2 Avenue De Lafayette 5th Floor  Boston MA 02111  PNMDepartment@commonwealthcare.org', NULL, NULL, '2021-09-22 08:30:49', '2021-09-22 08:30:49'),
(50511, 1019, 36662, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from CCA, as they don\'t sent welcome letter for each provider.  October 22, 2021     Helena Lynn Halterman, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 10/22/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111    61 Lincoln St Suite 203 & 100 New State Hwy  ', NULL, NULL, '2021-11-16 15:15:36', '2021-11-16 15:15:36'),
(50512, 1019, 36663, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50513, 1019, 36663, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:22', '2021-08-31 09:51:22'),
(50514, 1019, 36664, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50515, 1019, 36664, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:34', '2021-08-31 09:51:34'),
(50516, 1019, 36664, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:52', '2021-10-07 01:18:52'),
(50517, 1019, 36664, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Provider roster was sent out to Monica at humana to add the providers under our group, attached is the group roster for reference.', NULL, NULL, '2021-10-28 10:56:33', '2021-10-28 10:56:33'),
(50518, 11056, 36664, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:34:51', '2021-12-09 17:34:51'),
(50519, 19067, 36664, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:39', '2021-12-15 15:32:39'),
(50520, 19067, 36664, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:25:15', '2021-12-16 12:25:15'),
(50521, 19067, 36664, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:15', '2021-12-29 14:37:15'),
(50522, 19067, 36664, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:21', '2022-01-10 13:17:21'),
(50523, 19067, 36664, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:14:25', '2022-01-30 13:14:25'),
(50524, 19067, 36664, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:37', '2022-02-08 14:23:37'),
(50525, 19067, 36664, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:28', '2022-03-09 14:56:28'),
(50526, 19067, 36664, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:01', '2022-03-10 10:49:01'),
(50527, 22077, 36664, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:52:46', '2022-04-04 13:52:46'),
(50528, 1019, 36665, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50529, 1019, 36665, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:51:41', '2021-08-31 09:51:41'),
(50530, 1019, 36665, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Request Initiated thru Provider Portal, Attached is the SS for Ref ', NULL, NULL, '2021-09-14 07:48:39', '2021-09-14 07:48:39'),
(50531, 1019, 36665, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com  In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  601536-453         HELENA L HALTERMAN  601536-462         KAMEELAH ABDUL-AZIZ     Thank you,  Magellan Contracting Team', NULL, NULL, '2021-09-22 08:24:19', '2021-09-22 08:24:19'),
(50532, 1019, 36665, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent the following email to ARViviano@magellanhealth.com  Good Morning Angela,  You guys are already authorized to view her CAQH, and I\'m seeing the you have already started seeing their CAQH, so why are you sending me an email that you are not authorized to view their CAQH?  Regards, Alex', NULL, NULL, '2021-09-22 08:27:17', '2021-09-22 08:27:17'),
(50533, 19067, 36665, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com Subject: Enrollment Status - Raynham - Helena Halterman - Magellan  Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider.  Practice Name: Spectrum Neuro Behavioral Care LLC. - Raynham Tax ID: 834482753  Provider Name: Helena Halterman Provider NPI: 1801473749  If the provider is enrolled then provide us the Effective date and Welcome letter.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 13:50:08', '2021-12-15 13:50:08'),
(50534, 19067, 36665, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||  Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:36:02', '2021-12-15 16:36:02'),
(50535, 19067, 36665, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 14:00:03', '2021-12-29 14:00:03'),
(50536, 19067, 36665, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:21', '2022-01-10 13:22:21'),
(50537, 19067, 36665, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:08:14', '2022-02-11 10:08:14'),
(50538, 19067, 36665, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.', NULL, NULL, '2022-03-17 11:00:33', '2022-03-17 11:00:33'),
(50539, 1019, 36666, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50540, 1019, 36666, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:02', '2021-08-31 09:52:02'),
(50541, 1019, 36666, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Application was emailed to MassHealth at pec@maximus.com', NULL, NULL, '2021-11-30 14:22:42', '2021-11-30 14:22:42'),
(50542, 11056, 36666, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to:  PEC@maximus.com  Sub: Need Welcome Letter  Hello,  We need the welcome letter for the following provider as she was enrolled back in November, but we haven\'t received a copy of her welcome letter. Provider details are listed below,  Provider NAme: Helena Haterman NPI: 1801473749 PID: 110179037A   Regards', NULL, NULL, '2021-12-09 14:46:38', '2021-12-09 14:46:38'),
(50543, 11056, 36666, NULL, '2021-12-16 00:00:00.000', 'In Process', '[RequestId-21709314] Re# [EXTERNAL] Need Welcome Letter ', NULL, NULL, '2021-12-09 15:03:05', '2021-12-09 15:03:05'),
(50544, 19067, 36666, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com Subject: Provider Enrollment Status - SNBC Raynham  Hello,  Hope you are having a productive day.  I want to know the enrollment status for the following provider.  Practice Name: Spectrum Neuro Behavioral Care LLC. - Raynham Tax ID: 83-4482753  Provider name: Helena Halterman Provider NPI: 1801473749  If the provider is enrolled then provide us the Effective date and Welcome letter.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 13:35:23', '2021-12-15 13:35:23'),
(50545, 19067, 36666, NULL, '2021-12-24 00:00:00.000', 'Approved', 'Effective date: 11/17/2021  Email received from: PEC@maximus.com  Subject: Provider Enrollment Status - SNBC Raynham   Good Afternoon,   Provider Helena Halterman, PID/SL 110179037A, has been linked to group SNBC Raynham, PID/SL 110159328A, effective 11/17/2021. We also have attached the Welcome letter as per your request.     If you have any questions or concerns please feel free to contact us.     Best Regards,     PEC  Provider Enrollment and Credentialing Department  Business Support Services, US Services     MAXIMUS  Remote: Boston, MA  PEC@maximus.com', NULL, NULL, '2021-12-17 15:14:06', '2021-12-17 15:14:06'),
(50546, 1019, 36667, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50547, 1019, 36667, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:22', '2021-08-31 09:52:22'),
(50548, 1019, 36668, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50549, 1019, 36668, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:39', '2021-08-31 09:52:39'),
(50550, 1019, 36668, NULL, '2021-09-29 00:00:00.000', 'Approved', 'Eff 09/01/2021, Attached is the location confirmation for ref', NULL, NULL, '2021-09-22 08:16:41', '2021-09-22 08:16:41'),
(50551, 1019, 36669, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:40', '2021-08-30 13:10:40'),
(50552, 1019, 36669, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:52:53', '2021-08-31 09:52:53'),
(50553, 1019, 36669, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN request initiated thru website ref - 21280000005', NULL, NULL, '2021-10-07 01:43:02', '2021-10-07 01:43:02'),
(50554, 1019, 36669, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 09/01/2021, Approval letter for reference. ', NULL, NULL, '2021-11-16 15:54:36', '2021-11-16 15:54:36'),
(50555, 1019, 36670, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:41', '2021-08-30 13:10:41'),
(50556, 1019, 36670, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:12', '2021-08-31 09:53:12'),
(50557, 1019, 36670, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Enrollment Application faxed at (608) 221-7535, attached is the application for ref ', NULL, NULL, '2021-10-06 23:46:57', '2021-10-06 23:46:57'),
(50558, 19067, 36670, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:00', '2021-12-16 14:10:00'),
(50559, 19067, 36670, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:06:48', '2021-12-29 12:06:48'),
(50560, 19067, 36670, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:13:45', '2022-01-10 14:13:45'),
(50561, 19067, 36670, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:40', '2022-01-11 09:37:40'),
(50562, 19067, 36670, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:46:44', '2022-01-11 10:46:44'),
(50563, 19067, 36670, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:08', '2022-02-11 11:16:08'),
(50564, 19067, 36670, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:22:43', '2022-02-11 11:22:43'),
(50565, 19067, 36670, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:48:45', '2022-03-17 09:48:45'),
(50566, 19067, 36670, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:33:47', '2022-03-17 10:33:47'),
(50567, 19067, 36670, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:02', '2022-03-17 10:36:02');
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
(50568, 19067, 36670, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:57:59', '2022-03-17 13:57:59'),
(50569, 19067, 36670, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject: Enrollment Query || Helena Halterman || SNBCARE || Tricare   Hi again,  Can you please provide me with the current enrollment status of the following provider with Tricare,  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Helena Halterman	1801473749 Helena Halterman	1801473749  Regards,', NULL, NULL, '2022-03-17 15:34:50', '2022-03-17 15:34:50'),
(50570, 22077, 36670, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject:  Enrollment Query || Helena Halterman || SNBCARE || Tricare  Hi,  I would to know the enrollment status of the following provider Helena Halterman  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Helena Halterman	1801473749 Helena Halterman	1801473749  Thanks', NULL, NULL, '2022-04-07 08:09:40', '2022-04-07 08:09:40'),
(50571, 1019, 36671, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:41', '2021-08-30 13:10:41'),
(50572, 1019, 36671, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:26', '2021-08-31 09:53:26'),
(50573, 1019, 36671, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Helena Haltermann. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:38:55', '2021-09-14 08:38:55'),
(50574, 1019, 36671, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:43:19 EDT.  Please reference ticket number PRO0149040 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7538552 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-09-22 08:59:34', '2021-09-22 08:59:34'),
(50575, 11056, 36671, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:51:48', '2021-12-03 14:51:48'),
(50576, 11056, 36671, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email received from: servicenow@tufts-health.com  Sub: PPO0129278 - Request Received  Hello ,  We are in receipt of your request regarding Re: Allied Health Provider Agreement for Helena Lynn Halterman, NP originally sent to tufts_health_plan_credentialing_department@tufts-health.com regarding your submitted on 2021-10-26 12:26:33 EDT.   Please reference ticket number PPO0129278  for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG7953390', NULL, NULL, '2021-12-10 18:01:13', '2021-12-10 18:01:13'),
(50577, 19067, 36671, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Providers & Groups || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well. I want to get the latest updates regarding the credentialing process of the following Providers.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572   Provider Name	NPI	Location Erin Oliva	1407349632	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896-7322 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 New State HWY Raynham, MA 02767-5423   Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 17:21:16', '2021-12-17 17:21:16'),
(50578, 19067, 36671, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:35', '2021-12-29 10:05:35'),
(50579, 19067, 36671, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:40', '2022-01-10 14:44:40'),
(50580, 19067, 36671, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:38:46', '2022-02-11 11:38:46'),
(50581, 22077, 36671, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:08:32', '2022-04-05 10:08:32'),
(50582, 1019, 36672, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:41', '2021-08-30 13:10:41'),
(50583, 1019, 36672, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:39', '2021-08-31 09:53:39'),
(50584, 1019, 36672, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Helena Haltermann. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:39:53', '2021-09-14 08:39:53'),
(50585, 1019, 36672, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:43:19 EDT.  Please reference ticket number PRO0149040 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7538552 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-09-22 08:59:49', '2021-09-22 08:59:49'),
(50586, 11056, 36672, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:53:32', '2021-12-03 14:53:32'),
(50587, 11056, 36672, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email received from: servicenow@tufts-health.com  Sub: PPO0129278 - Request Received  Hello ,  We are in receipt of your request regarding Re: Allied Health Provider Agreement for Helena Lynn Halterman, NP originally sent to tufts_health_plan_credentialing_department@tufts-health.com regarding your submitted on 2021-10-26 12:26:33 EDT.   Please reference ticket number PPO0129278  for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG7953390', NULL, NULL, '2021-12-10 18:01:45', '2021-12-10 18:01:45'),
(50588, 19067, 36672, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Providers & Groups || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well. I want to get the latest updates regarding the credentialing process of the following Providers.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572   Provider Name	NPI	Location Erin Oliva	1407349632	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896-7322 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 New State HWY Raynham, MA 02767-5423   Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 17:21:07', '2021-12-17 17:21:07'),
(50589, 19067, 36672, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:46', '2021-12-29 10:05:46'),
(50590, 19067, 36672, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:46:01', '2022-01-10 14:46:01'),
(50591, 19067, 36672, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:38:56', '2022-02-11 11:38:56'),
(50592, 22077, 36672, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:41:18', '2022-04-05 10:41:18'),
(50593, 1019, 36673, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-30 13:10:41', '2021-08-30 13:10:41'),
(50594, 1019, 36673, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her NPPES & CAQH Access.', NULL, NULL, '2021-08-31 09:53:54', '2021-08-31 09:53:54'),
(50595, 1019, 36673, NULL, '2021-09-28 00:00:00.000', 'Initiated', 'Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Helena Halterman has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services  This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2021-09-21 08:54:39', '2021-09-21 08:54:39'),
(50596, 1019, 36673, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from donotreplyemail@aperturecvo.com  Health Plan(s) Requesting Information: Optum Behavioral Health Massachusetts  Credentials Request for: Halterman, Helena Lynn  Attention: Credentialing information  Information Requested: Copy of current legible DEA certificate(s) for MA or the name of the practitioner who prescribes on your behalf. How to Respond:  Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested. NOTE:  This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information.', NULL, NULL, '2021-09-22 08:19:09', '2021-09-22 08:19:09'),
(50597, 1019, 36673, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from UBH for Approval. See Attachments for location confirmation  001100221    Helena Halterman  snbc@claimsmedinc.com  snbc@claimsmedinc.com    Dear Helena Halterman:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 10/15/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.    Provider Express: You and/or administrative staff should self-register to obtain your Login ID at providerexpress.com > \"First-time User\". Please allow 5 business days from the date of this notification before attempting to register. Please review your provider profile for accuracy in Provider Express and submit corrections within 10 business days. Provider Express allows access to information and services you need 24/7, including:    Authorization: for routine outpatient services, when required, is typically obtained by the Member prior to their first visit.  Please verify that the authorization is in place prior to providing services through Provider Express.   ', NULL, NULL, '2021-11-30 16:57:45', '2021-11-30 16:57:45'),
(50598, 1019, 36674, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:00', '2021-08-31 09:27:00'),
(50599, 1019, 36674, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:44:52', '2021-08-31 09:44:52'),
(50600, 1019, 36674, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Initiated request online thru website, attached is the ref email received for confirmation.  Request ID for this Submission: 25728923  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-09-13 10:49:08', '2021-09-13 10:49:08'),
(50601, 1019, 36674, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:33:15', '2021-10-25 10:33:15'),
(50602, 1019, 36675, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:00', '2021-08-31 09:27:00'),
(50603, 1019, 36675, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:04', '2021-08-31 09:45:04'),
(50604, 1019, 36675, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:10:16', '2021-09-13 11:10:16'),
(50605, 1019, 36675, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:33:38', '2021-10-25 10:33:38'),
(50606, 1019, 36676, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:00', '2021-08-31 09:27:00'),
(50607, 1019, 36676, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:17', '2021-08-31 09:45:17'),
(50608, 1019, 36676, NULL, '2021-09-20 00:00:00.000', 'New/Not Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:12:13', '2021-09-13 11:12:13'),
(50609, 1019, 36676, NULL, '2021-09-20 00:00:00.000', 'New/Not Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:12:13', '2021-09-13 11:12:13'),
(50610, 1019, 36676, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:13:09', '2021-09-13 11:13:09'),
(50611, 1019, 36676, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:13:09', '2021-09-13 11:13:09'),
(50612, 1019, 36676, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:34:01', '2021-10-25 10:34:01'),
(50613, 1019, 36677, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:00', '2021-08-31 09:27:00'),
(50614, 1019, 36677, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:43', '2021-08-31 09:45:43'),
(50615, 1019, 36677, NULL, '2021-09-29 00:00:00.000', 'Initiated', 'Faxed the Contracting application to (617) 246-5053  Attached is the copy of the application', NULL, NULL, '2021-09-22 10:14:42', '2021-09-22 10:14:42'),
(50616, 1019, 36677, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Signed the attached contract thru DocuSign.', NULL, NULL, '2021-10-18 10:11:59', '2021-10-18 10:11:59'),
(50617, 1019, 36677, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:34:20', '2021-10-25 10:34:20'),
(50618, 1019, 36678, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:00', '2021-08-31 09:27:00'),
(50619, 1019, 36678, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:57', '2021-08-31 09:45:57'),
(50620, 1019, 36678, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Application Submitted online thru website, see attachment for ref. ', NULL, NULL, '2021-09-13 16:20:28', '2021-09-13 16:20:28'),
(50621, 1019, 36678, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Contract signed online thru Docusign.', NULL, NULL, '2021-10-18 10:39:49', '2021-10-18 10:39:49'),
(50622, 1019, 36678, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:35:47', '2021-10-25 10:35:47'),
(50623, 1019, 36679, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:00', '2021-08-31 09:27:00'),
(50624, 1019, 36679, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:12', '2021-08-31 09:46:12'),
(50625, 1019, 36679, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org,    PNMDepartment@commonwealthcare.org-----------Hello, We want to enroll the following provider with CCA under our group, please let me know the process for that as she is already In Network with CCA.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 ', NULL, NULL, '2021-09-13 16:39:26', '2021-09-13 16:39:26'),
(50626, 1019, 36679, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,   Providers Kameelah Abdul-Aziz, PMHNP, Helena Halterman, PMNHP is in process, please allow time for credentialing period.  Credentialing period can take 30-45 days and you will receive confirmation once completed.   Thank you, Aravindrajan Bangaru Provider Network Management  Commonwealth Care Alliance  2 Avenue De Lafayette 5th Floor  Boston MA 02111  PNMDepartment@commonwealthcare.org', NULL, NULL, '2021-09-22 08:31:24', '2021-09-22 08:31:24'),
(50627, 1019, 36679, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:36:24', '2021-10-25 10:36:24'),
(50628, 1019, 36679, NULL, '2021-11-23 00:00:00.000', 'Approved', 'October 22, 2021     Kameelah Abdul-Aziz, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 10/22/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111  ', NULL, NULL, '2021-11-16 15:18:05', '2021-11-16 15:18:05'),
(50629, 1019, 36680, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50630, 1019, 36680, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:27', '2021-08-31 09:46:27'),
(50631, 1019, 36680, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:36:44', '2021-10-25 10:36:44'),
(50632, 1019, 36681, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50633, 1019, 36681, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:41', '2021-08-31 09:46:41'),
(50634, 1019, 36681, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:45', '2021-10-07 01:18:45'),
(50635, 1019, 36681, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:37:09', '2021-10-25 10:37:09'),
(50636, 1019, 36682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50637, 1019, 36682, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:58', '2021-08-31 09:46:58'),
(50638, 1019, 36682, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Request Initiated thru Provider Portal, Attached is the SS for Ref ', NULL, NULL, '2021-09-14 07:59:40', '2021-09-14 07:59:40'),
(50639, 1019, 36682, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com  In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  601536-453         HELENA L HALTERMAN  601536-462         KAMEELAH ABDUL-AZIZ     Thank you,  Magellan Contracting Team', NULL, NULL, '2021-09-22 08:25:14', '2021-09-22 08:25:14'),
(50640, 1019, 36682, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent the following email to ARViviano@magellanhealth.com  Good Morning Angela,  You guys are already authorized to view her CAQH, and I\'m seeing the you have already started seeing their CAQH, so why are you sending me an email that you are not authorized to view their CAQH?  Regards, Alex', NULL, NULL, '2021-09-22 08:26:50', '2021-09-22 08:26:50'),
(50641, 1019, 36682, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:37:27', '2021-10-25 10:37:27'),
(50642, 1019, 36683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50643, 1019, 36683, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:14', '2021-08-31 09:47:14'),
(50644, 1019, 36683, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:37:51', '2021-10-25 10:37:51'),
(50645, 1019, 36684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50646, 1019, 36684, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:29', '2021-08-31 09:47:29'),
(50647, 1019, 36684, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:09', '2021-10-25 10:38:09'),
(50648, 1019, 36685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50649, 1019, 36685, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:47', '2021-08-31 09:47:47'),
(50650, 1019, 36685, NULL, '2021-09-14 00:00:00.000', 'Initiated', 'Application Summited thru PECOS attached is the confirmation email of submission  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T090720210002418)   Sent: 09/07/2021 15:33 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: T090720210002418        NPI: 1518635291        Medicare ID:         Name: KAMEELAH  ABDUL-AZIZ          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- 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.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message.  ', NULL, NULL, '2021-09-07 14:40:54', '2021-09-07 14:40:54'),
(50651, 1019, 36685, NULL, '2021-09-29 00:00:00.000', 'Approved', 'Received the following Approval letter from NGSPECommunications@anthem.com  Eff 08/01/2021, attached is the approval letter for ref.', NULL, NULL, '2021-09-22 08:49:26', '2021-09-22 08:49:26'),
(50652, 1019, 36686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50653, 1019, 36686, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:04', '2021-08-31 09:48:04'),
(50654, 1019, 36686, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN requested thru railroad portal. ref - 21280000004', NULL, NULL, '2021-10-07 01:40:09', '2021-10-07 01:40:09'),
(50655, 1019, 36686, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:30', '2021-10-25 10:38:30'),
(50656, 1019, 36687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50657, 1019, 36687, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:18', '2021-08-31 09:48:18'),
(50658, 1019, 36687, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Enrollment Application faxed at (608) 221-7535, attached is the application for ref ', NULL, NULL, '2021-10-06 23:46:20', '2021-10-06 23:46:20'),
(50659, 1019, 36687, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:49', '2021-10-25 10:38:49'),
(50660, 1019, 36688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50661, 1019, 36688, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:32', '2021-08-31 09:48:32'),
(50662, 1019, 36688, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Kameelah Abdul-Aziz. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:44:45', '2021-09-14 08:44:45'),
(50663, 1019, 36688, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:50:19 EDT.  Please reference ticket number PRO0149043 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7538656', NULL, NULL, '2021-09-22 08:58:04', '2021-09-22 08:58:04'),
(50664, 1019, 36688, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:39:07', '2021-10-25 10:39:07'),
(50665, 1019, 36689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50666, 1019, 36689, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:49', '2021-08-31 09:48:49'),
(50667, 1019, 36689, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Kameelah Abdul-Aziz. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:45:35', '2021-09-14 08:45:35'),
(50668, 1019, 36689, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:50:19 EDT.  Please reference ticket number PRO0149043 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7538656', NULL, NULL, '2021-09-22 08:58:18', '2021-09-22 08:58:18'),
(50669, 1019, 36689, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:39:24', '2021-10-25 10:39:24'),
(50670, 1019, 36690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:27:01', '2021-08-31 09:27:01'),
(50671, 1019, 36690, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:49:03', '2021-08-31 09:49:03'),
(50672, 1019, 36690, NULL, '2021-09-29 00:00:00.000', 'Initiated', 'Received the following email from bhcredentialing@optum.com Dear Kameelah Abdul-Aziz,  Optum is in receipt of your request for network participation. Your application is now in process for credentialing.  Optum utilizes Aperture, LLC, (a credentialing verification organization) to retrieve your information and perform primary source verification of your credentials. You may receive requests from Aperture for additional information.  Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.  Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application             If you identify any incorrect information, please contact the              Provider Services Line at 1-877-614-0484 within 10 business               days.                Thank you,               Optum Behavioral Health Credentialing Department', NULL, NULL, '2021-09-22 08:35:01', '2021-09-22 08:35:01'),
(50673, 1019, 36690, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from bhcredentialing@optum.com Dear Kameelah Abdul-Aziz,  Optum is in receipt of your request for network participation. Your application is now in process for credentialing.  Optum utilizes Aperture, LLC, (a credentialing verification organization) to retrieve your information and perform primary source verification of your credentials. You may receive requests from Aperture for additional information.  Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.  Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application             If you identify any incorrect information, please contact the              Provider Services Line at 1-877-614-0484 within 10 business               days.                Thank you,               Optum Behavioral Health Credentialing Department', NULL, NULL, '2021-09-22 08:35:10', '2021-09-22 08:35:10'),
(50674, 1019, 36690, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:39:51', '2021-10-25 10:39:51'),
(50675, 1019, 36690, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from UBH.  10/15/2021    001100224    Kameelah Abdul Aziz  snbc@claimsmedinc.com  snbc@claimsmedinc.com    Dear Kameelah Abdul Aziz:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 10/15/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.    Provider Express: You and/or administrative staff should self-register to obtain your Login ID at providerexpress.com > \"First-time User\". Please allow 5 business days from the date of this notification before attempting to register. Please review your provider profile for accuracy in Provider Express and submit corrections within 10 business days. Provider Express allows access to information and services you need 24/7, including:', NULL, NULL, '2021-11-30 17:03:59', '2021-11-30 17:03:59'),
(50676, 1019, 36691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50677, 1019, 36691, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:44:43', '2021-08-31 09:44:43'),
(50678, 1019, 36691, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Initiated request online thru website, attached is the ref email received for confirmation.  Request ID for this Submission: 25728923  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-10-06 23:49:44', '2021-10-06 23:49:44'),
(50679, 1019, 36691, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:33:02', '2021-10-25 10:33:02'),
(50680, 1019, 36692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50681, 1019, 36692, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:44:58', '2021-08-31 09:44:58'),
(50682, 1019, 36692, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:11:02', '2021-09-13 11:11:02'),
(50683, 1019, 36692, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:33:27', '2021-10-25 10:33:27'),
(50684, 1019, 36693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50685, 1019, 36693, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:10', '2021-08-31 09:45:10'),
(50686, 1019, 36693, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Faxed the attached application to 866-612-7790.', NULL, NULL, '2021-09-13 11:11:34', '2021-09-13 11:11:34'),
(50687, 1019, 36693, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:33:49', '2021-10-25 10:33:49'),
(50688, 1019, 36694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50689, 1019, 36694, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:32', '2021-08-31 09:45:32'),
(50690, 1019, 36694, NULL, '2021-09-29 00:00:00.000', 'Initiated', 'Faxed the Contracting application to (617) 246-5053  Attached is the copy of the application', NULL, NULL, '2021-09-22 10:14:18', '2021-09-22 10:14:18'),
(50691, 1019, 36694, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Signed the attached contract thru DocuSign.', NULL, NULL, '2021-10-18 10:12:16', '2021-10-18 10:12:16'),
(50692, 1019, 36694, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:34:10', '2021-10-25 10:34:10'),
(50693, 1019, 36695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50694, 1019, 36695, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:45:51', '2021-08-31 09:45:51'),
(50695, 1019, 36695, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Application Submitted online thru website, see attachment for ref. ', NULL, NULL, '2021-09-13 16:19:55', '2021-09-13 16:19:55'),
(50696, 1019, 36695, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Contract signed online thru Docusign.', NULL, NULL, '2021-10-18 10:39:39', '2021-10-18 10:39:39'),
(50697, 1019, 36695, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:34:35', '2021-10-25 10:34:35'),
(50698, 1019, 36696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50699, 1019, 36696, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:03', '2021-08-31 09:46:03'),
(50700, 1019, 36696, NULL, '2021-09-20 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org,    PNMDepartment@commonwealthcare.org-----------Hello, We want to enroll the following provider with CCA under our group, please let me know the process for that as she is already In Network with CCA.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 ', NULL, NULL, '2021-09-13 16:39:01', '2021-09-13 16:39:01'),
(50701, 1019, 36696, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,   Providers Kameelah Abdul-Aziz, PMHNP, Helena Halterman, PMNHP is in process, please allow time for credentialing period.  Credentialing period can take 30-45 days and you will receive confirmation once completed.   Thank you, Aravindrajan Bangaru Provider Network Management  Commonwealth Care Alliance  2 Avenue De Lafayette 5th Floor  Boston MA 02111  PNMDepartment@commonwealthcare.org', NULL, NULL, '2021-09-22 08:31:17', '2021-09-22 08:31:17'),
(50702, 1019, 36696, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:36:06', '2021-10-25 10:36:06');
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
(50703, 1019, 36696, NULL, '2021-11-23 00:00:00.000', 'Approved', 'October 22, 2021     Kameelah Abdul-Aziz, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 10/22/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111  ', NULL, NULL, '2021-11-16 15:17:51', '2021-11-16 15:17:51'),
(50704, 1019, 36697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50705, 1019, 36697, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:18', '2021-08-31 09:46:18'),
(50706, 1019, 36697, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:36:33', '2021-10-25 10:36:33'),
(50707, 1019, 36698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50708, 1019, 36698, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:33', '2021-08-31 09:46:33'),
(50709, 1019, 36698, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:37', '2021-10-07 01:18:37'),
(50710, 1019, 36698, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:37:00', '2021-10-25 10:37:00'),
(50711, 1019, 36699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50712, 1019, 36699, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:46:51', '2021-08-31 09:46:51'),
(50713, 1019, 36699, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Request Initiated thru Provider Portal, Attached is the SS for Ref ', NULL, NULL, '2021-09-14 08:00:03', '2021-09-14 08:00:03'),
(50714, 1019, 36699, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com  In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  601536-453         HELENA L HALTERMAN  601536-462         KAMEELAH ABDUL-AZIZ     Thank you,  Magellan Contracting Team', NULL, NULL, '2021-09-22 08:25:06', '2021-09-22 08:25:06'),
(50715, 1019, 36699, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent the following email to ARViviano@magellanhealth.com  Good Morning Angela,  You guys are already authorized to view her CAQH, and I\'m seeing the you have already started seeing their CAQH, so why are you sending me an email that you are not authorized to view their CAQH?  Regards, Alex', NULL, NULL, '2021-09-22 08:25:51', '2021-09-22 08:25:51'),
(50716, 1019, 36699, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:37:17', '2021-10-25 10:37:17'),
(50717, 1019, 36700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50718, 1019, 36700, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:06', '2021-08-31 09:47:06'),
(50719, 1019, 36700, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:37:42', '2021-10-25 10:37:42'),
(50720, 1019, 36701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50721, 1019, 36701, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:21', '2021-08-31 09:47:21'),
(50722, 1019, 36701, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:00', '2021-10-25 10:38:00'),
(50723, 1019, 36702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50724, 1019, 36702, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:38', '2021-08-31 09:47:38'),
(50725, 1019, 36702, NULL, '2021-09-14 00:00:00.000', 'Initiated', 'Application Summited thru PECOS attached is the confirmation email of submission  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T090720210002418)   Sent: 09/07/2021 15:33 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: T090720210002418        NPI: 1518635291        Medicare ID:         Name: KAMEELAH  ABDUL-AZIZ          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- 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.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message. ', NULL, NULL, '2021-09-07 14:41:20', '2021-09-07 14:41:20'),
(50726, 1019, 36702, NULL, '2021-09-29 00:00:00.000', 'Approved', 'Received the following Approval letter from NGSPECommunications@anthem.com  Eff 08/01/2021, attached is the approval letter for ref. ', NULL, NULL, '2021-09-22 08:38:39', '2021-09-22 08:38:39'),
(50727, 1019, 36703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50728, 1019, 36703, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:47:56', '2021-08-31 09:47:56'),
(50729, 1019, 36703, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN requested thru railroad portal. ref - 21280000004', NULL, NULL, '2021-10-07 01:40:30', '2021-10-07 01:40:30'),
(50730, 1019, 36703, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:20', '2021-10-25 10:38:20'),
(50731, 1019, 36704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50732, 1019, 36704, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:10', '2021-08-31 09:48:10'),
(50733, 1019, 36704, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Enrollment Application faxed at (608) 221-7535, attached is the application for ref ', NULL, NULL, '2021-10-06 23:45:58', '2021-10-06 23:45:58'),
(50734, 1019, 36704, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:40', '2021-10-25 10:38:40'),
(50735, 1019, 36705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50736, 1019, 36705, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:25', '2021-08-31 09:48:25'),
(50737, 1019, 36705, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Kameelah Abdul-Aziz. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:44:28', '2021-09-14 08:44:28'),
(50738, 1019, 36705, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:50:19 EDT.  Please reference ticket number PRO0149043 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7538656', NULL, NULL, '2021-09-22 08:57:56', '2021-09-22 08:57:56'),
(50739, 1019, 36705, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:38:58', '2021-10-25 10:38:58'),
(50740, 1019, 36706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:57', '2021-08-31 09:28:57'),
(50741, 1019, 36706, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:42', '2021-08-31 09:48:42'),
(50742, 1019, 36706, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com; Provider_Data_Request@tufts-health.com  Hello, Please find the attached request to initiate the credentialing/contracting for our provider Kameelah Abdul-Aziz. Do let me know if anything else is required.', NULL, NULL, '2021-09-14 08:45:09', '2021-09-14 08:45:09'),
(50743, 1019, 36706, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application | Providers | SNBCARE | Tufts Health that was submitted on 2021-09-14 09:50:19 EDT.  Please reference ticket number PRO0149043 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7538656', NULL, NULL, '2021-09-22 08:58:12', '2021-09-22 08:58:12'),
(50744, 1019, 36706, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:39:16', '2021-10-25 10:39:16'),
(50745, 1019, 36707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-08-31 09:28:58', '2021-08-31 09:28:58'),
(50746, 1019, 36707, NULL, '2021-09-07 00:00:00.000', 'On Hold', 'Waiting for her APRN License.', NULL, NULL, '2021-08-31 09:48:57', '2021-08-31 09:48:57'),
(50747, 1019, 36707, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from bhcredentialing@optum.com Dear Kameelah Abdul-Aziz,  Optum is in receipt of your request for network participation. Your application is now in process for credentialing.  Optum utilizes Aperture, LLC, (a credentialing verification organization) to retrieve your information and perform primary source verification of your credentials. You may receive requests from Aperture for additional information.  Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.  Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application             If you identify any incorrect information, please contact the              Provider Services Line at 1-877-614-0484 within 10 business               days.                Thank you,               Optum Behavioral Health Credentialing Department', NULL, NULL, '2021-09-22 08:34:35', '2021-09-22 08:34:35'),
(50748, 1019, 36707, NULL, '2021-09-29 00:00:00.000', 'Initiated', 'Received the following email from bhcredentialing@optum.com Dear Kameelah Abdul-Aziz,  Optum is in receipt of your request for network participation. Your application is now in process for credentialing.  Optum utilizes Aperture, LLC, (a credentialing verification organization) to retrieve your information and perform primary source verification of your credentials. You may receive requests from Aperture for additional information.  Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.  Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application             If you identify any incorrect information, please contact the              Provider Services Line at 1-877-614-0484 within 10 business               days.                Thank you,               Optum Behavioral Health Credentialing Department', NULL, NULL, '2021-09-22 08:34:47', '2021-09-22 08:34:47'),
(50749, 1019, 36707, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received the following email from bhcredentialing@optum.com Dear Kameelah Abdul-Aziz,  Optum is in receipt of your request for network participation. Your application is now in process for credentialing.  Optum utilizes Aperture, LLC, (a credentialing verification organization) to retrieve your information and perform primary source verification of your credentials. You may receive requests from Aperture for additional information.  Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.  Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application             If you identify any incorrect information, please contact the              Provider Services Line at 1-877-614-0484 within 10 business               days.                Thank you,               Optum Behavioral Health Credentialing Department', NULL, NULL, '2021-09-22 08:34:54', '2021-09-22 08:34:54'),
(50750, 1019, 36707, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:39:32', '2021-10-25 10:39:32'),
(50751, 1019, 36707, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from UBH.  10/15/2021    001100224    Kameelah Abdul Aziz  snbc@claimsmedinc.com  snbc@claimsmedinc.com    Dear Kameelah Abdul Aziz:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 10/15/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.    Provider Express: You and/or administrative staff should self-register to obtain your Login ID at providerexpress.com > \"First-time User\". Please allow 5 business days from the date of this notification before attempting to register. Please review your provider profile for accuracy in Provider Express and submit corrections within 10 business days. Provider Express allows access to information and services you need 24/7, including:', NULL, NULL, '2021-11-30 17:03:50', '2021-11-30 17:03:50'),
(50752, 1006, 37640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-02 14:40:08', '2021-09-02 14:40:08'),
(50753, 1006, 37640, NULL, '2021-09-09 00:00:00.000', 'Initiated', 'Enrollment Tracking Information Applicant Name: MARIANA LUYANDO  Tracking ID: T090220210003198  Submitted Date: THU - SEPTEMBER02 2021 03:42:29 PM EST  Submitted By: MARIANA LUYANDO  Contact Email(s): MLUYANDO28@GMAIL.COM IVELA.BCHC@TACHC.ORG VMUC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in the Medicare program. The practitioner is adding, deleting, or changing general Medicare enrollment information. ', NULL, NULL, '2021-09-02 14:44:47', '2021-09-02 14:44:47'),
(50754, 3040, 37640, NULL, '2021-09-16 00:00:00.000', 'Approved', 'To:  IVELA.BCHC@TACHC.ORG,mluyando28@gmail.com,vmuc@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T090220210003198)  Date:  09/09/2021 11:47 AM  Application Tracking ID: T090220210003198   NPI ID: 1700960556   Medicare ID: 748265, 1T9145   Name: MARIANA LUYANDO  State: TX   Form Type: 855I  Date: 09/09/2021  Status: APPROVED', NULL, NULL, '2021-09-09 16:30:02', '2021-09-09 16:30:02'),
(50755, 1006, 37641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-02 14:40:33', '2021-09-02 14:40:33'),
(50756, 1006, 37641, NULL, '2021-09-09 00:00:00.000', 'Initiated', 'Enrollment Tracking Information Applicant Name: MARIANA LUYANDO  Tracking ID: T090220210003198  Submitted Date: THU - SEPTEMBER02 2021 03:42:29 PM EST  Submitted By: MARIANA LUYANDO  Contact Email(s): MLUYANDO28@GMAIL.COM IVELA.BCHC@TACHC.ORG VMUC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in the Medicare program. The practitioner is adding, deleting, or changing general Medicare enrollment information. ', NULL, NULL, '2021-09-02 14:44:32', '2021-09-02 14:44:32'),
(50757, 3040, 37641, NULL, '2021-09-16 00:00:00.000', 'Approved', 'To:  IVELA.BCHC@TACHC.ORG,mluyando28@gmail.com,vmuc@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T090220210003198)  Date:  09/09/2021 11:47 AM  Application Tracking ID: T090220210003198   NPI ID: 1700960556   Medicare ID: 748265, 1T9145   Name: MARIANA LUYANDO  State: TX   Form Type: 855I  Date: 09/09/2021  Status: APPROVED', NULL, NULL, '2021-09-09 16:30:18', '2021-09-09 16:30:18'),
(50758, 1006, 37642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-02 14:40:45', '2021-09-02 14:40:45'),
(50759, 1006, 37642, NULL, '2021-09-09 00:00:00.000', 'Initiated', 'Enrollment Tracking Information Applicant Name: MARIANA LUYANDO  Tracking ID: T090220210003198  Submitted Date: THU - SEPTEMBER02 2021 03:42:29 PM EST  Submitted By: MARIANA LUYANDO  Contact Email(s): MLUYANDO28@GMAIL.COM IVELA.BCHC@TACHC.ORG VMUC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in the Medicare program. The practitioner is adding, deleting, or changing general Medicare enrollment information. ', NULL, NULL, '2021-09-02 14:44:04', '2021-09-02 14:44:04'),
(50760, 3040, 37642, NULL, '2021-09-16 00:00:00.000', 'Approved', 'To:  IVELA.BCHC@TACHC.ORG,mluyando28@gmail.com,vmuc@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T090220210003198)  Date:  09/09/2021 11:47 AM  Application Tracking ID: T090220210003198   NPI ID: 1700960556   Medicare ID: 748265, 1T9145   Name: MARIANA LUYANDO  State: TX   Form Type: 855I  Date: 09/09/2021  Status: APPROVED', NULL, NULL, '2021-09-09 16:30:29', '2021-09-09 16:30:29'),
(50761, 12062, 38640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-03 09:02:00', '2021-09-03 09:02:00'),
(50762, 12062, 38640, NULL, '2021-09-10 00:00:00.000', 'Approved', '	 Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-09-03 09:17:23', '2021-09-03 09:17:23'),
(50763, 12062, 38641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-03 09:02:24', '2021-09-03 09:02:24'),
(50764, 12062, 38641, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-09-03 09:17:10', '2021-09-03 09:17:10'),
(50765, 12062, 38642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-03 09:02:48', '2021-09-03 09:02:48'),
(50766, 12062, 38642, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-09-03 09:16:40', '2021-09-03 09:16:40'),
(50767, 12062, 38643, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-03 09:23:11', '2021-09-03 09:23:11'),
(50768, 12062, 38643, NULL, '2021-09-11 00:00:00.000', 'Initiated', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 334796 ', NULL, NULL, '2021-09-03 17:12:56', '2021-09-03 17:12:56'),
(50769, 12062, 38643, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 334796', NULL, NULL, '2021-09-03 17:13:41', '2021-09-03 17:13:41'),
(50770, 10057, 38643, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:46:16', '2021-10-05 14:46:16'),
(50771, 10057, 38643, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  The following information is for Valley Med Urgent Care.  The onboarding case (02829164) for Luyando, Mariana is still in process.  The case was submitted on 9.3.21 and can take at least 2-3 months for processing.  A provider record ID number has been assigned to her which is #8QD630.  A welcome email will also be sent out once she is in network.  Jeniece K Wert is in network for the plans listed below with an effective date of 9.10.21.  The two locations are listed as satellite locations:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166;  800 E Alton Gloor Blvd Brownsville , TX 78526-4248', NULL, NULL, '2021-10-21 14:28:04', '2021-10-21 14:28:04'),
(50772, 10057, 38643, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachments:', NULL, NULL, '2021-11-15 15:09:39', '2021-11-15 15:09:39'),
(50773, 12062, 38644, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-03 09:23:40', '2021-09-03 09:23:40'),
(50774, 12062, 38644, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 334796', NULL, NULL, '2021-09-03 17:14:43', '2021-09-03 17:14:43'),
(50775, 10057, 38644, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:45:54', '2021-10-05 14:45:54'),
(50776, 10057, 38644, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  The following information is for Valley Med Urgent Care.  The onboarding case (02829164) for Luyando, Mariana is still in process.  The case was submitted on 9.3.21 and can take at least 2-3 months for processing.  A provider record ID number has been assigned to her which is #8QD630.  A welcome email will also be sent out once she is in network.  Jeniece K Wert is in network for the plans listed below with an effective date of 9.10.21.  The two locations are listed as satellite locations:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166;  800 E Alton Gloor Blvd Brownsville , TX 78526-4248', NULL, NULL, '2021-10-21 14:28:24', '2021-10-21 14:28:24'),
(50777, 10057, 38644, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachments:', NULL, NULL, '2021-11-15 15:09:29', '2021-11-15 15:09:29'),
(50778, 12062, 38645, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-03 09:23:59', '2021-09-03 09:23:59'),
(50779, 12062, 38645, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 334796', NULL, NULL, '2021-09-03 17:14:44', '2021-09-03 17:14:44'),
(50780, 10057, 38645, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  The following information is for Valley Med Urgent Care.  The onboarding case (02829164) for Luyando, Mariana is still in process.  The case was submitted on 9.3.21 and can take at least 2-3 months for processing.  A provider record ID number has been assigned to her which is #8QD630.  A welcome email will also be sent out once she is in network.  Jeniece K Wert is in network for the plans listed below with an effective date of 9.10.21.  The two locations are listed as satellite locations:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166;  800 E Alton Gloor Blvd Brownsville , TX 78526-4248', NULL, NULL, '2021-10-21 14:28:31', '2021-10-21 14:28:31'),
(50781, 10057, 38645, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachments:', NULL, NULL, '2021-11-15 15:09:19', '2021-11-15 15:09:19'),
(50782, 12062, 39640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 13:25:02', '2021-09-07 13:25:02'),
(50783, 12062, 39640, NULL, '2021-09-14 00:00:00.000', 'In Process', 'I have initiated the application process for providers credentialing with CIGNA and received the Application ID (12742026) AND A PROVIDER\'S ID ( 0437490 ) with a tele representative DANNY .the reference to this call is Danny as representative\'s name and todays date Sep 7,2021', NULL, NULL, '2021-09-07 13:32:46', '2021-09-07 13:32:46'),
(50784, 12062, 39640, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I called a rep at cigna she said the appplication is still in process and will take about 90 business days to complete. Reference: Essence as rep name & 09/14/2021', NULL, NULL, '2021-09-13 14:31:46', '2021-09-13 14:31:46'),
(50785, 12062, 39640, NULL, '2021-09-21 00:00:00.000', 'In Process', 'received email acknowledgment that the application has been received and under review. See attached screenshot for reference  Subject of email : Cigna Credentialing Status Update: Application Received', NULL, NULL, '2021-09-14 12:47:37', '2021-09-14 12:47:37'),
(50786, 10057, 39640, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Email Received From :   Please find attachments', NULL, NULL, '2021-10-28 14:56:18', '2021-10-28 14:56:18'),
(50787, 12062, 39641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 13:25:39', '2021-09-07 13:25:39'),
(50788, 12062, 39641, NULL, '2021-09-14 00:00:00.000', 'In Process', 'I have initiated the application process for providers credentialing with CIGNA and received the Application ID (12742026) AND A PROVIDER\'S ID ( 0437490 ) with a tele representative DANNY .the reference to this call is Danny as representative\'s name and todays date Sep 7,2021', NULL, NULL, '2021-09-07 13:32:26', '2021-09-07 13:32:26'),
(50789, 12062, 39641, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I called a rep at cigna she said the appplication is still in process and will take about 90 business days to complete. Reference: Essence as rep name & 09/14/2021  ', NULL, NULL, '2021-09-13 14:30:49', '2021-09-13 14:30:49'),
(50790, 12062, 39641, NULL, '2021-09-21 00:00:00.000', 'In Process', 'received email acknowledgment that the application has been received and under review. See attached screenshot for reference  Subject of email : Cigna Credentialing Status Update: Application Received', NULL, NULL, '2021-09-14 12:46:52', '2021-09-14 12:46:52'),
(50791, 10057, 39641, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Email Received From :   Please find attachments', NULL, NULL, '2021-10-28 14:56:06', '2021-10-28 14:56:06'),
(50792, 12062, 39642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 13:26:09', '2021-09-07 13:26:09'),
(50793, 12062, 39642, NULL, '2021-09-14 00:00:00.000', 'In Process', 'I have initiated the application process for providers credentialing with CIGNA and received the Application ID (12742026) AND A PROVIDER\'S ID ( 0437490 ) with a tele representative DANNY .the reference to this call is Danny as representative\'s name and todays date Sep 7,2021', NULL, NULL, '2021-09-07 13:32:03', '2021-09-07 13:32:03'),
(50794, 12062, 39642, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I called a rep at cigna she said the appplication is still in process and will take about 90 business days to complete. Reference: Essence as rep name & 09/14/2021', NULL, NULL, '2021-09-13 14:32:25', '2021-09-13 14:32:25'),
(50795, 12062, 39642, NULL, '2021-09-21 00:00:00.000', 'In Process', 'received email acknowledgment that the application has been received and under review. See attached screenshot for reference  Subject of email : Cigna Credentialing Status Update: Application Received', NULL, NULL, '2021-09-14 12:45:19', '2021-09-14 12:45:19'),
(50796, 10057, 39642, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Email Received From :   Please find attachments', NULL, NULL, '2021-10-28 14:55:28', '2021-10-28 14:55:28'),
(50797, 12062, 39643, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 16:24:49', '2021-09-07 16:24:49'),
(50798, 12062, 39643, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the TRICARE certification process . The certification form has been filled up and sent to Tricare via fax at (608) 221-7535', NULL, NULL, '2021-09-07 16:31:06', '2021-09-07 16:31:06'),
(50799, 12062, 39643, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I called a rep at tricare she said the appplication is still in process and will take about 90 business days to complete. Reference: korin as rep name & 09/14/2021', NULL, NULL, '2021-09-13 15:31:10', '2021-09-13 15:31:10'),
(50800, 10057, 39643, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:26:35', '2021-10-21 15:26:35'),
(50801, 10057, 39643, NULL, '2021-11-03 00:00:00.000', 'Not Eligible', '10/27/2021  Received email from Alex, Mariana is not working with us either. Please find attachment.', NULL, NULL, '2021-10-27 09:20:20', '2021-10-27 09:20:20'),
(50802, 12062, 39644, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 16:25:18', '2021-09-07 16:25:18'),
(50803, 12062, 39644, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the TRICARE certification process . The certification form has been filled up and sent to Tricare via fax at (608) 221-7535', NULL, NULL, '2021-09-07 16:30:31', '2021-09-07 16:30:31'),
(50804, 12062, 39644, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I called a rep at tricare she said the appplication is still in process and will take about 90 business days to complete. Reference: korin as rep name & 09/14/2021', NULL, NULL, '2021-09-13 15:30:52', '2021-09-13 15:30:52'),
(50805, 10057, 39644, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:26:27', '2021-10-21 15:26:27'),
(50806, 10057, 39644, NULL, '2021-11-03 00:00:00.000', 'Not Eligible', '10/27/2021  Received email from Alex, Mariana is not working with us either. Please find attachment.', NULL, NULL, '2021-10-27 09:20:08', '2021-10-27 09:20:08'),
(50807, 12062, 39645, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 16:25:34', '2021-09-07 16:25:34'),
(50808, 12062, 39645, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the TRICARE certification process . The certification form has been filled up and sent to Tricare via fax at (608) 221-7535', NULL, NULL, '2021-09-07 16:29:42', '2021-09-07 16:29:42'),
(50809, 12062, 39645, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I called a rep at tricare she said the appplication is still in process and will take about 90 business days to complete. Reference: korin as rep name & 09/14/2021', NULL, NULL, '2021-09-13 15:30:27', '2021-09-13 15:30:27'),
(50810, 10057, 39645, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:26:20', '2021-10-21 15:26:20'),
(50811, 10057, 39645, NULL, '2021-11-03 00:00:00.000', 'Not Eligible', '10/27/2021  Received email from Alex, Mariana is not working with us either.', NULL, NULL, '2021-10-27 09:19:27', '2021-10-27 09:19:27'),
(50812, 12062, 39646, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 16:59:32', '2021-09-07 16:59:32'),
(50813, 12062, 39646, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the provider credentialing process via EMAIL at networkhelp@uhc.com to UHC.  The reference of the subject email is provided below;  Subject : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC    Greetings,   Hope you are doing well. It is to request you that we have to enroll the below mentioned provider in UHC under the below locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# :   151840463 Practice TIN# : 81-5123542 Primary Address: 2534 Boca Chica Blvd , Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd ,Brownsville , TX 78526-4248 Tertiary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Details: Provider Name: Luyando, Mariana Provider NPI# : 1700960556  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-07 17:05:35', '2021-09-07 17:05:35'),
(50814, 10057, 39646, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the provider in UHC in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Luyando, Mariana 1700960556  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:55:44', '2021-10-19 13:55:44'),
(50815, 10057, 39646, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:27:40', '2021-11-10 15:27:40'),
(50816, 12062, 39647, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 16:59:56', '2021-09-07 16:59:56'),
(50817, 12062, 39647, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the provider credentialing process via EMAIL at networkhelp@uhc.com to UHC.  The reference of the subject email is provided below;  Subject : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC    Greetings,   Hope you are doing well. It is to request you that we have to enroll the below mentioned provider in UHC under the below locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# :   151840463 Practice TIN# : 81-5123542 Primary Address: 2534 Boca Chica Blvd , Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd ,Brownsville , TX 78526-4248 Tertiary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Details: Provider Name: Luyando, Mariana Provider NPI# : 1700960556  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-07 17:04:50', '2021-09-07 17:04:50'),
(50818, 10057, 39647, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the provider in UHC in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Luyando, Mariana 1700960556  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:55:38', '2021-10-19 13:55:38'),
(50819, 10057, 39647, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:27:29', '2021-11-10 15:27:29'),
(50820, 12062, 39648, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-07 17:00:18', '2021-09-07 17:00:18'),
(50821, 12062, 39648, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the provider credentialing process via EMAIL to UHC. The reference of the subject email is provided below; Subject : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC    Greetings,   Hope you are doing well. It is to request you that we have to enroll the below mentioned provider in UHC under the below locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# :   151840463 Practice TIN# : 81-5123542 Primary Address: 2534 Boca Chica Blvd , Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd ,Brownsville , TX 78526-4248 Tertiary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Details: Provider Name: Luyando, Mariana Provider NPI# : 1700960556  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-07 17:03:16', '2021-09-07 17:03:16'),
(50822, 12062, 39648, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have initiated the provider credentialing process via EMAIL at networkhelp@uhc.com to UHC.  The reference of the subject email is provided below;  Subject : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC    Greetings,   Hope you are doing well. It is to request you that we have to enroll the below mentioned provider in UHC under the below locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# :   151840463 Practice TIN# : 81-5123542 Primary Address: 2534 Boca Chica Blvd , Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd ,Brownsville , TX 78526-4248 Tertiary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Details: Provider Name: Luyando, Mariana Provider NPI# : 1700960556  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-07 17:06:05', '2021-09-07 17:06:05'),
(50823, 10057, 39648, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : NETWORK ENROLLMENT || Valley Med Urgent Care PLLC || Luyando, Mariana || UHC  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the provider in UHC in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Luyando, Mariana 1700960556  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:55:32', '2021-10-19 13:55:32'),
(50824, 10057, 39648, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:27:11', '2021-11-10 15:27:11'),
(50825, 3040, 39649, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-09 16:30:02', '2021-09-09 16:30:02'),
(50826, 12062, 39649, NULL, '2021-09-18 00:00:00.000', 'In Process', 'I have initiated the application for providers medicaid enrollment but unfortunately due to the technical issue on a medicaid website I was unable to submit providers e -signatures so that the application remained in completed therefore will resume the working by next working day', NULL, NULL, '2021-09-10 14:32:45', '2021-09-10 14:32:45'),
(50827, 12062, 39649, NULL, '2021-09-18 00:00:00.000', 'In Process', 'I have initiated the application for providers medicaid enrollment but unfortunately due to the technical issue on a medicaid website I was unable to submit providers e -signatures so that the application remained in completed therefore will resume the working by next working day', NULL, NULL, '2021-09-10 14:32:46', '2021-09-10 14:32:46'),
(50828, 12062, 39649, NULL, '2021-09-18 00:00:00.000', 'In Process', 'I have initiated the application for providers medicaid enrollment but unfortunately due to the technical issue on a medicaid website I was unable to submit providers e -signatures so that the application remained in completed therefore will resume the working by next working day', NULL, NULL, '2021-09-10 14:32:46', '2021-09-10 14:32:46'),
(50829, 12062, 39649, NULL, '2021-09-20 00:00:00.000', 'In Process', 'As per the tele conversation with the representative at medicaid, the application can also be signed and uploaded manually so I have done the same. the reference number for this call was 42242505000 .  The application number received :  18077392  see attached file for references  ', NULL, NULL, '2021-09-13 10:16:31', '2021-09-13 10:16:31');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(50830, 10057, 39649, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Checked Status on TMHP Portal still in process. Dated : 10/22/2021', NULL, NULL, '2021-10-22 11:04:20', '2021-10-22 11:04:20'),
(50831, 10057, 39649, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:29:28', '2021-11-10 15:29:28'),
(50832, 3040, 39650, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-09 16:30:18', '2021-09-09 16:30:18'),
(50833, 12062, 39650, NULL, '2021-09-20 00:00:00.000', 'In Process', 'I have initiated the application for providers medicaid enrollment but unfortunately due to the technical issue on a medicaid website I was unable to submit providers e -signatures so that the application remained in completed therefore will resume the working by next working day', NULL, NULL, '2021-09-13 09:01:19', '2021-09-13 09:01:19'),
(50834, 12062, 39650, NULL, '2021-09-20 00:00:00.000', 'In Process', 'As per the tele conversation with the representative at medicaid, the application can also be signed and uploaded manually so I have done the same. the reference number for this call was 42242505000 .  The application number received :  18077392  see attached file for references ', NULL, NULL, '2021-09-13 10:19:23', '2021-09-13 10:19:23'),
(50835, 10057, 39650, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Checked Status on TMHP Portal still in process. Dated : 10/22/2021', NULL, NULL, '2021-10-22 11:04:30', '2021-10-22 11:04:30'),
(50836, 10057, 39650, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:29:19', '2021-11-10 15:29:19'),
(50837, 3040, 39651, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-09 16:30:29', '2021-09-09 16:30:29'),
(50838, 12062, 39651, NULL, '2021-09-20 00:00:00.000', 'In Process', 'I have initiated the application for providers medicaid enrollment but unfortunately due to the technical issue on a medicaid website I was unable to submit providers e -signatures so that the application remained in completed therefore will resume the working by next working day', NULL, NULL, '2021-09-13 08:59:48', '2021-09-13 08:59:48'),
(50839, 12062, 39651, NULL, '2021-09-20 00:00:00.000', 'In Process', 'I have initiated the application for providers medicaid enrollment but unfortunately due to the technical issue on a medicaid website I was unable to submit providers e -signatures so that the application remained in completed therefore will resume the working by next working day', NULL, NULL, '2021-09-13 09:00:41', '2021-09-13 09:00:41'),
(50840, 12062, 39651, NULL, '2021-09-20 00:00:00.000', 'In Process', 'As per the tele conversation with the representative at medicaid, the application can also be signed and uploaded manually so I have done the same. the reference number for this call was 42242505000 .  The application number received :  18077392  see attached file for references ', NULL, NULL, '2021-09-13 10:20:55', '2021-09-13 10:20:55'),
(50841, 12062, 39651, NULL, '2021-09-20 00:00:00.000', 'In Process', 'As per the tele conversation with the representative at medicaid, the application can also be signed and uploaded manually so I have done the same. the reference number for this call was 42242505000 .  The application number received :  18077392  see attached file for references ', NULL, NULL, '2021-09-13 10:20:58', '2021-09-13 10:20:58'),
(50842, 10057, 39651, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Checked Status on TMHP Portal still in process. Dated : 10/22/2021', NULL, NULL, '2021-10-22 11:04:39', '2021-10-22 11:04:39'),
(50843, 10057, 39651, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:29:09', '2021-11-10 15:29:09'),
(50844, 12062, 39652, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-14 10:29:10', '2021-09-14 10:29:10'),
(50845, 12062, 39652, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I have initiated the enrollment procedure by sending mail as below; Tue, Sep 14, 2021 at 10:15 PM To: pr.south@healthsmart.com, mdiprsupport@healthsmart.com Cc: Valley Med Urgent Care vmuc@claimsmedinc.com  Subject :Provider Enrollment || Valley Med Urgent Care PLLC || Luyando, Mariana || Health Smart ||  Greetings !  Hope you are doing well. I wanted to enroll the below mentioned providers in Healthsmart for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Details: Provider Name: Luyando, Mariana Provider NPI# 1700960556 CAQH#  13661280  Name of Supervising Physicians:  Saavedra, Teresa  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-09-14 12:33:33', '2021-09-14 12:33:33'),
(50846, 12062, 39652, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received below mail;  From : mdiprsupport@healthsmart.com subject : Fw: Provider Enrollment || Valley Med Urgent Care PLLC || Luyando, Mariana || Health Smart || Hi,  We are returning your application due to missing information listed below.  * Current certificate of Insurance. * The application form does not have the tin \" 81-5123542 \" on it.  Please update the CAQH to include the missing tax id.  Please review the attached Application Review Form and forward the missing information within the next 5 days.  Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com Thanks HealthSmart Provider Relations ', NULL, NULL, '2021-09-21 14:43:22', '2021-09-21 14:43:22'),
(50847, 10057, 39652, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Providers Application – Health Smart  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Potter, Deborah	1861914053  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 16:08:32', '2021-10-14 16:08:32'),
(50848, 10057, 39652, NULL, '2021-11-12 00:00:00.000', 'Not Eligible', 'Quit from Practices', NULL, NULL, '2021-11-05 14:10:20', '2021-11-05 14:10:20'),
(50849, 12062, 39653, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-14 10:29:48', '2021-09-14 10:29:48'),
(50850, 12062, 39653, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I have initiated the enrollment procedure by sending mail as below; Tue, Sep 14, 2021 at 10:15 PM To: pr.south@healthsmart.com, mdiprsupport@healthsmart.com Cc: Valley Med Urgent Care vmuc@claimsmedinc.com  Subject :Provider Enrollment || Valley Med Urgent Care PLLC || Luyando, Mariana || Health Smart ||  Greetings !  Hope you are doing well. I wanted to enroll the below mentioned providers in Healthsmart for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Details: Provider Name: Luyando, Mariana Provider NPI# 1700960556 CAQH#  13661280  Name of Supervising Physicians:  Saavedra, Teresa  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-09-14 12:33:05', '2021-09-14 12:33:05'),
(50851, 12062, 39653, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received below mail;  From : mdiprsupport@healthsmart.com subject : Fw: Provider Enrollment || Valley Med Urgent Care PLLC || Luyando, Mariana || Health Smart || Hi,  We are returning your application due to missing information listed below.  * Current certificate of Insurance. * The application form does not have the tin \" 81-5123542 \" on it.  Please update the CAQH to include the missing tax id.  Please review the attached Application Review Form and forward the missing information within the next 5 days.  Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com Thanks HealthSmart Provider Relations ', NULL, NULL, '2021-09-21 14:42:53', '2021-09-21 14:42:53'),
(50852, 10057, 39653, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Providers Application – Health Smart  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Potter, Deborah	1861914053  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 16:08:25', '2021-10-14 16:08:25'),
(50853, 10057, 39653, NULL, '2021-11-12 00:00:00.000', 'Not Eligible', 'Quit from Practices', NULL, NULL, '2021-11-05 14:10:10', '2021-11-05 14:10:10'),
(50854, 12062, 39654, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-14 10:30:13', '2021-09-14 10:30:13'),
(50855, 12062, 39654, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I have initiated the enrollment procedure by sending mail as below; Tue, Sep 14, 2021 at 10:15 PM To: pr.south@healthsmart.com, mdiprsupport@healthsmart.com Cc: Valley Med Urgent Care vmuc@claimsmedinc.com  Subject :Provider Enrollment || Valley Med Urgent Care PLLC || Luyando, Mariana || Health Smart ||  Greetings !  Hope you are doing well. I wanted to enroll the below mentioned providers in Healthsmart for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Details: Provider Name: Luyando, Mariana Provider NPI# 1700960556 CAQH#  13661280  Name of Supervising Physicians:  Saavedra, Teresa  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you   ', NULL, NULL, '2021-09-14 12:18:00', '2021-09-14 12:18:00'),
(50856, 12062, 39654, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received below mail;  From : mdiprsupport@healthsmart.com subject : Fw: Provider Enrollment || Valley Med Urgent Care PLLC || Luyando, Mariana || Health Smart || Hi,  We are returning your application due to missing information listed below.  * Current certificate of Insurance. * The application form does not have the tin \" 81-5123542 \" on it.  Please update the CAQH to include the missing tax id.  Please review the attached Application Review Form and forward the missing information within the next 5 days.  Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com Thanks HealthSmart Provider Relations ', NULL, NULL, '2021-09-21 14:42:00', '2021-09-21 14:42:00'),
(50857, 10057, 39654, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Providers Application – Health Smart  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Potter, Deborah	1861914053  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 16:08:15', '2021-10-14 16:08:15'),
(50858, 10057, 39654, NULL, '2021-11-12 00:00:00.000', 'Not Eligible', 'Quit from Practices', NULL, NULL, '2021-11-05 14:09:55', '2021-11-05 14:09:55'),
(50859, 12062, 39655, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-14 15:57:40', '2021-09-14 15:57:40'),
(50860, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:51:05', '2021-09-14 16:51:05'),
(50861, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:51:19', '2021-09-14 16:51:19'),
(50862, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:51:58', '2021-09-14 16:51:58'),
(50863, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:52:00', '2021-09-14 16:52:00'),
(50864, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:52:02', '2021-09-14 16:52:02'),
(50865, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:52:04', '2021-09-14 16:52:04'),
(50866, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:52:06', '2021-09-14 16:52:06'),
(50867, 12062, 39655, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:52:08', '2021-09-14 16:52:08'),
(50868, 10057, 39655, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Luyando, Mariana || First Health ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in First Health for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards, ', NULL, NULL, '2021-10-22 14:33:38', '2021-10-22 14:33:38'),
(50869, 10057, 39655, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:26:42', '2021-11-10 15:26:42'),
(50870, 12062, 39656, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-14 15:58:27', '2021-09-14 15:58:27'),
(50871, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:00', '2021-09-14 16:39:00'),
(50872, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:10', '2021-09-14 16:39:10'),
(50873, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:24', '2021-09-14 16:39:24'),
(50874, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:39', '2021-09-14 16:39:39'),
(50875, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:41', '2021-09-14 16:39:41'),
(50876, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:51', '2021-09-14 16:39:51'),
(50877, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:39:54', '2021-09-14 16:39:54'),
(50878, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:40:00', '2021-09-14 16:40:00'),
(50879, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:40:43', '2021-09-14 16:40:43'),
(50880, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:40:46', '2021-09-14 16:40:46'),
(50881, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:40:47', '2021-09-14 16:40:47'),
(50882, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:40:50', '2021-09-14 16:40:50'),
(50883, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:44:17', '2021-09-14 16:44:17'),
(50884, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:44:26', '2021-09-14 16:44:26'),
(50885, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:44:43', '2021-09-14 16:44:43'),
(50886, 12062, 39656, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:44:58', '2021-09-14 16:44:58'),
(50887, 10057, 39656, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Luyando, Mariana || First Health ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in First Health for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards, ', NULL, NULL, '2021-10-22 14:33:31', '2021-10-22 14:33:31'),
(50888, 10057, 39656, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:26:30', '2021-11-10 15:26:30'),
(50889, 12062, 39657, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-14 15:58:44', '2021-09-14 15:58:44'),
(50890, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:36:00', '2021-09-14 16:36:00'),
(50891, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:36:20', '2021-09-14 16:36:20'),
(50892, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:36:30', '2021-09-14 16:36:30'),
(50893, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:11', '2021-09-14 16:37:11'),
(50894, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:19', '2021-09-14 16:37:19'),
(50895, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:20', '2021-09-14 16:37:20'),
(50896, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:21', '2021-09-14 16:37:21'),
(50897, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:23', '2021-09-14 16:37:23'),
(50898, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:25', '2021-09-14 16:37:25'),
(50899, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:28', '2021-09-14 16:37:28'),
(50900, 12062, 39657, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Submitted an online application successfully.  See attached doc for reference.', NULL, NULL, '2021-09-14 16:37:39', '2021-09-14 16:37:39'),
(50901, 10057, 39657, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Luyando, Mariana || First Health ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in First Health for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards, ', NULL, NULL, '2021-10-22 14:33:23', '2021-10-22 14:33:23'),
(50902, 10057, 39657, NULL, '2021-11-17 00:00:00.000', 'Not Eligible', 'Left Practice  Please see attachment: ', NULL, NULL, '2021-11-10 15:26:18', '2021-11-10 15:26:18'),
(50903, 11056, 39658, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-16 09:51:04', '2021-09-16 09:51:04'),
(50904, 11056, 39658, NULL, '2021-09-23 00:00:00.000', 'Initiated', '	 Online Application has been submitted. Because get an update through a rep. Jesse R that the group and provider are not participating.   Please see the attachment.', NULL, NULL, '2021-09-16 09:53:55', '2021-09-16 09:53:55'),
(50905, 11056, 39658, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com  Sub : Signature requested on \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.   Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Agreement has been filled and signed.', NULL, NULL, '2021-09-28 16:42:24', '2021-09-28 16:42:24'),
(50906, 11056, 39658, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : adobesign@adobesign.com & sidleyj1@firsthealth.com  Sub : Completed: \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Attached is the final agreement between:  Aetna Segun Adeoye Megan Weatherford   Signed by both sides.', NULL, NULL, '2021-10-08 14:40:04', '2021-10-08 14:40:04'),
(50907, 11056, 39658, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-15 16:27:48', '2021-10-15 16:27:48'),
(50908, 11056, 39658, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from  : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Hello Ahmed,   I hope that this email finds you well!   The effective date for the new group agreement we just established is 11/1/2021. I will be sending over a welcome letter once implementation has reached a certain point.   Please do not hesitate to reach out if you have any questions or concerns.   Take care! Jeanette', NULL, NULL, '2021-10-22 16:43:26', '2021-10-22 16:43:26'),
(50909, 11056, 39658, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope this email finds you and your son well. Any updates regarding the implementation? I am still waiting for the welcome letter for the provider, Segun Adeoye with both locations listed on it.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Take Care of yourself and your son!  Thank you! Have a blessed weekend!', NULL, NULL, '2021-11-11 10:40:36', '2021-11-11 10:40:36'),
(50910, 11056, 39658, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Enrollment & Location Status Query - NASA HealthClinic - First Health   Good morning,   I hope that this email finds you well!  This contract is still in implementation. I will absolutely send over a welcome letter for the group as soon as it has reached the point to where I have the group ID number.  Have a wonderful day!   Jeanette Sidley 750 Riverpoint Drive  West Sacramento, CA 95605 Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-19 10:45:29', '2021-11-19 10:45:29'),
(50911, 11056, 39658, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  SidleyJ1@firsthealth.com  Sub:  Enrollment & Location Status Query - NASA HealthClinic - First Health  Good morning Jeanette!  Hope you are having a blessed day. Has the implementation been completed? Have you got the group ID no.? Please respond to my queries and do provide me with the welcome letter.  Take Care!  Thanking you in anticipation.  Have a wonderful day!', NULL, NULL, '2021-12-03 17:54:08', '2021-12-03 17:54:08'),
(50912, 11056, 39658, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1074093 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,', NULL, NULL, '2021-12-14 18:05:28', '2021-12-14 18:05:28'),
(50913, 11056, 39658, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  You may reference your CPD ID # 1074093 (which becomes effective 11/01/2021)  Yes, I received confirmation yesterday morning that the contract loading is complete. You are good to go.   Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605  Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-12-22 17:48:08', '2021-12-22 17:48:08'),
(50914, 11056, 39659, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-16 09:51:10', '2021-09-16 09:51:10'),
(50915, 11056, 39659, NULL, '2021-09-23 00:00:00.000', 'Initiated', 'Online Application has been submitted. Because get an update through a rep. Jesse R that the group and provider are not participating.   Please see the attachment.', NULL, NULL, '2021-09-16 09:53:40', '2021-09-16 09:53:40'),
(50916, 11056, 39659, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com  Sub : Signature requested on \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.   Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Agreement has been filled and signed.', NULL, NULL, '2021-09-28 16:40:58', '2021-09-28 16:40:58'),
(50917, 11056, 39659, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com  Sub : Signature requested on \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.   Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Agreement has been filled and signed.', NULL, NULL, '2021-09-28 16:41:02', '2021-09-28 16:41:02'),
(50918, 11056, 39659, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : adobesign@adobesign.com & sidleyj1@firsthealth.com  Sub : Completed: \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Attached is the final agreement between:  Aetna Segun Adeoye Megan Weatherford   Signed by both sides.', NULL, NULL, '2021-10-08 14:39:49', '2021-10-08 14:39:49'),
(50919, 11056, 39659, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-15 16:27:42', '2021-10-15 16:27:42'),
(50920, 11056, 39659, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from  : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Hello Ahmed,   I hope that this email finds you well!   The effective date for the new group agreement we just established is 11/1/2021. I will be sending over a welcome letter once implementation has reached a certain point.   Please do not hesitate to reach out if you have any questions or concerns.   Take care! Jeanette', NULL, NULL, '2021-10-22 16:43:11', '2021-10-22 16:43:11'),
(50921, 11056, 39659, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope this email finds you and your son well. Any updates regarding the implementation? I am still waiting for the welcome letter for the provider, Segun Adeoye with both locations listed on it.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Take Care of yourself and your son!  Thank you! Have a blessed weekend!', NULL, NULL, '2021-11-11 10:40:42', '2021-11-11 10:40:42'),
(50922, 11056, 39659, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Enrollment & Location Status Query - NASA HealthClinic - First Health   Good morning,   I hope that this email finds you well!  This contract is still in implementation. I will absolutely send over a welcome letter for the group as soon as it has reached the point to where I have the group ID number.  Have a wonderful day!   Jeanette Sidley 750 Riverpoint Drive  West Sacramento, CA 95605 Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-19 10:45:17', '2021-11-19 10:45:17'),
(50923, 11056, 39659, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  SidleyJ1@firsthealth.com  Sub:  Enrollment & Location Status Query - NASA HealthClinic - First Health  Good morning Jeanette!  Hope you are having a blessed day. Has the implementation been completed? Have you got the group ID no.? Please respond to my queries and do provide me with the welcome letter.  Take Care!  Thanking you in anticipation.  Have a wonderful day!', NULL, NULL, '2021-12-03 17:53:56', '2021-12-03 17:53:56'),
(50924, 11056, 39659, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1074093 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,', NULL, NULL, '2021-12-14 18:05:15', '2021-12-14 18:05:15'),
(50925, 11056, 39659, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  You may reference your CPD ID # 1074093 (which becomes effective 11/01/2021)  Yes, I received confirmation yesterday morning that the contract loading is complete. You are good to go.   Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605  Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-12-22 17:47:41', '2021-12-22 17:47:41'),
(50926, 12062, 39660, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-16 10:07:58', '2021-09-16 10:07:58'),
(50927, 12062, 39660, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Submitted an online form for credentialing See attached for a reference.', NULL, NULL, '2021-09-16 11:06:19', '2021-09-16 11:06:19'),
(50928, 12062, 39660, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Submitted an online form ;  Please see attached form for reference.', NULL, NULL, '2021-09-16 11:07:36', '2021-09-16 11:07:36'),
(50929, 12062, 39660, NULL, '2021-09-28 00:00:00.000', 'In Process', ' Email received from :Valerie J. Gomez Valerie.J.Gomez@centene.com  Subject : [SECURE]      -       VALLEY MED URGENT CARE PLLC  Dear LUYANDO, MARIANA,        We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to shp.networkdevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.        To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:   http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/       For Re-Credentialing, please email your information to credentialing@superiorhealthplan.com.    ', NULL, NULL, '2021-09-21 12:48:25', '2021-09-21 12:48:25'),
(50930, 12062, 39660, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Responded to email:  TO : shp.networkdevelopment@superiorhealthplan.com subject :Add Provider- LUYANDO, MARIANA  Greetings,  Hope you are doing well. Please find the attached provider contracting form as per previous email requested.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon. Thank you  ', NULL, NULL, '2021-09-21 13:59:57', '2021-09-21 13:59:57'),
(50931, 10057, 39660, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:24:58', '2021-10-21 16:24:58'),
(50932, 10057, 39660, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good afternoon,  Here is the status for the requested providers-  MARIANA LUYANDO- We received your completed application on 09/24/2021.  Your effective date is 11/01/2021 and you will be receiving a welcome packet shortly.  JUAN HERNANDEZ-  We received your completed application on 09/13/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2021-10-22 08:54:04', '2021-10-22 08:54:04'),
(50933, 10057, 39660, NULL, '2021-11-10 00:00:00.000', 'Approved', 'MARIANA LUYANDO  VALLEY MED URGENT CARE PLLC  vmuc@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   11/01/2021 ', NULL, NULL, '2021-11-03 10:45:44', '2021-11-03 10:45:44'),
(50934, 12062, 39661, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-16 10:08:18', '2021-09-16 10:08:18'),
(50935, 12062, 39661, NULL, '2021-09-23 00:00:00.000', 'In Process', 'submitted a form online.  see attached for your reference', NULL, NULL, '2021-09-16 11:08:27', '2021-09-16 11:08:27'),
(50936, 12062, 39661, NULL, '2021-09-28 00:00:00.000', 'In Process', ' Dear LUYANDO, MARIANA,                We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to shp.networkdevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.        To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:   http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/       For Re-Credentialing, please email your information to credentialing@superiorhealthplan.com.    ', NULL, NULL, '2021-09-21 12:47:26', '2021-09-21 12:47:26'),
(50937, 12062, 39661, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Responded to email:  TO : shp.networkdevelopment@superiorhealthplan.com subject :Add Provider- LUYANDO, MARIANA  Greetings,  Hope you are doing well. Please find the attached provider contracting form as per previous email requested.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon. Thank you  ', NULL, NULL, '2021-09-21 13:59:14', '2021-09-21 13:59:14'),
(50938, 10057, 39661, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:25:09', '2021-10-21 16:25:09'),
(50939, 10057, 39661, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good afternoon,  Here is the status for the requested providers-  MARIANA LUYANDO- We received your completed application on 09/24/2021.  Your effective date is 11/01/2021 and you will be receiving a welcome packet shortly.  JUAN HERNANDEZ-  We received your completed application on 09/13/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2021-10-22 08:53:56', '2021-10-22 08:53:56'),
(50940, 10057, 39661, NULL, '2021-11-10 00:00:00.000', 'Approved', 'MARIANA LUYANDO  VALLEY MED URGENT CARE PLLC  vmuc@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   11/01/2021 ', NULL, NULL, '2021-11-03 10:45:14', '2021-11-03 10:45:14'),
(50941, 12062, 39662, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-16 10:08:46', '2021-09-16 10:08:46'),
(50942, 12062, 39662, NULL, '2021-09-23 00:00:00.000', 'In Process', 'submitted online form  see attached for your reference.  ', NULL, NULL, '2021-09-16 11:09:16', '2021-09-16 11:09:16');
