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
(3786, 1006, 6906, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received the following reply from Kody Dunnet:  \"Hi Brad  Jennifer Lee Ullrich, CSW – in cred  Jonathan Schubert, CSW – in cred  I would check in with me later next week to get a status on them.   Thanks Kody\"', NULL, NULL, '2020-09-23 17:35:30', '2020-09-23 17:35:30'),
(3787, 1006, 6906, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to Kody Dunnett Kody_Dunnett@tufts-health.com regarding the status of enrollment. ', NULL, NULL, '2020-10-05 18:13:14', '2020-10-05 18:13:14'),
(3788, 1006, 6906, NULL, '2020-10-20 00:00:00.000', 'Rejected', 'Received following rejection from Kody: \"Hi Brad  Jennifer Lee Ullrich, LICSW and Jonathan Schubert, LCSW both had their apps discontinued.  The Cred Specialist wrote “Discontinued as provider only holds LCSW and not required LICSW”  Thanks\"', NULL, NULL, '2020-10-13 10:25:33', '2020-10-13 10:25:33'),
(3789, 1006, 6907, NULL, NULL, 'New/Not Initiated', 'Submitted form via fax to 866-612-7790', NULL, NULL, '2020-07-16 15:04:09', '2020-07-16 15:04:09'),
(3790, 1006, 6907, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-16 15:04:15', '2020-07-16 15:04:15'),
(3791, 1006, 6907, NULL, NULL, 'In Process', 'Sent followup email to provider.relations@beaconhealthoptions.com:  Sub: Status Update - SNBCare - Enrollment Query  \"Hello,   I wanted to get a status update on two Group Addition forms that I sent a few weeks ago, I wanted to check on their status and see how long they\'ll take to get processed and the providers to be credentialed & contracted? Provider/Group info is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Provider Name: Jennifer Lee Ullrich NPI# 1356906572  Provider Name: Jonathan Schubert NPI# 1235755505  Please get back to me as soon as you\'re able.   Thanks. \"', NULL, NULL, '2020-07-21 11:02:42', '2020-07-21 11:02:42'),
(3792, 1006, 6907, NULL, NULL, 'In Process', 'Received fax from Beacon requesting Ownership and Disclosure form for your Primary Practice. Filled out and sent to \"Knapp, Jessica\" Jessica.Knapp@beaconhealthoptions.com> ', NULL, NULL, '2020-07-23 10:50:38', '2020-07-23 10:50:38'),
(3793, 1006, 6907, NULL, NULL, 'In Process', 'Received following update from Jessica Knapp:   Sub: RE: Jonathan Schubert - Provider# 1067907 - SNBCare  \"Hello!  Thank-you for the timely response. I am out of the office tomorrow so I am working on Jonathan’s application today to get it reviewed for the NCC date on 7/28/2020. After that, it’s handled by another department where they link for billing and send out welcome letters via e-mail with the effective date. I am unsure of their time frames, but I’d say you could hear by next week after the 28th or the following week.  Thanks, Jessica  Jessica Knapp Credentialing Specialist ––––––––––––––––––––––– Beacon Health Options P.O. Box 989 Latham, NY 12110 www.beaconhealthoptions.com\"', NULL, NULL, '2020-07-23 12:32:44', '2020-07-23 12:32:44'),
(3794, 1006, 6907, NULL, NULL, 'In Process', 'Received following status update from provider.relations@beaconhealthoptions.com:  Sub: RE: Status Update - SNBCare - Enrollment Query  \"Good afternoon,  Jonathan Schubert is currently showing to be credentialed with Beacon Health Options for all lines of business, it looks like the data team is on the last step of loading the provider under the group.  Please allow a little more time for Jonathan.  Thank You!   Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-07-30 12:13:29', '2020-07-30 12:13:29'),
(3795, 1006, 6907, NULL, '2020-08-11 00:00:00.000', 'Approved', 'Welcome letter received, attached. ', NULL, NULL, '2020-08-04 17:01:11', '2020-08-04 17:01:11'),
(3796, 1006, 6908, NULL, NULL, 'New/Not Initiated', 'Submitted online application via Providerxpress ', NULL, NULL, '2020-07-16 15:47:06', '2020-07-16 15:47:06'),
(3797, 1006, 6908, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-16 15:47:12', '2020-07-16 15:47:12'),
(3798, 1006, 6908, NULL, NULL, 'In Process', 'Sent email to Hamel Sherzer, Wendy L asking if we can set up the new LCSW\'s the same way as Prisca/Peggy. ', NULL, NULL, '2020-07-16 15:49:13', '2020-07-16 15:49:13'),
(3799, 1006, 6908, NULL, NULL, 'In Process', 'Rep: Earl He is still under the review process for credentialing, which takes 2~3 weeks after which her credentialing/contracting can take upto 90~120 days. ', NULL, NULL, '2020-07-28 09:09:52', '2020-07-28 09:09:52'),
(3800, 1006, 6908, NULL, '2020-08-10 00:00:00.000', 'In Process', 'Sent another email to \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com> asking what the procedure will be to add supervisory protocols under the provider with Prisac Hefti. Waiting on response.', NULL, NULL, '2020-08-06 17:13:06', '2020-08-06 17:13:06'),
(3801, 1006, 6908, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Received email from Wendy asking for their licensure level & state they will work in, informed her for both. That they\'re LCSW and will work in MA. ', NULL, NULL, '2020-08-10 09:23:45', '2020-08-10 09:23:45'),
(3802, 1006, 6908, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Sent a followup email regarding status. ', NULL, NULL, '2020-08-13 10:58:37', '2020-08-13 10:58:37'),
(3803, 1006, 6908, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Received following reply from UBH:   \"8/20/2020 Jonathan Schubert  Email:  credentialing@happierliving.com  Email:  snbc@claimsmedinc.com Dear Jonathan Schubert,  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 determine if your credentialing process is complete by going to our clinician directory Web site at www.providerexpress.com, click on Our Network, then click on Optum Clinician Directory.  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  Thank you,  Optum Credentialing Department\"', NULL, NULL, '2020-08-20 11:03:26', '2020-08-20 11:03:26'),
(3804, 1006, 6908, NULL, '2020-09-09 00:00:00.000', 'In Process', 'As per Wendy the request was forwarded to MA representatives, sent a new followup request today regarding supervisory protocols. ', NULL, NULL, '2020-09-02 16:53:32', '2020-09-02 16:53:32'),
(3805, 1006, 6908, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Left VM to wendy for followup regarding this request. ', NULL, NULL, '2020-09-09 13:39:35', '2020-09-09 13:39:35'),
(3806, 1006, 6908, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent another followup email to both \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com>, ian.evans@optum.com regarding the status of the request.  ', NULL, NULL, '2020-09-15 16:52:39', '2020-09-15 16:52:39'),
(3807, 1006, 6908, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent another followup email to \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com> & ian.evans@optum.com regarding the status of enrollment. ', NULL, NULL, '2020-09-23 18:16:06', '2020-09-23 18:16:06'),
(3808, 1006, 6908, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Received the following reply from Wendy:  \"Good Afternoon Brad,  I have followed up with a colleague who handles the Massachusetts territory so that they can further assist you for the providers below given their location, they should be outreaching to you directly. Unfortunately as discussed prior Stacie and myself can only address these types of requests for you RI location. Should you have any additional questions please let me know.  Thank you,  We at Optum Behavioral Health would like to express our sincere appreciation for the services you are providing to our members during this difficult time.  Please frequently visit Provider Express at the link listed below for the most current COVID19 information and updates on telehealth policies, coding, reimbursement and member resources.   If you require any assistance and have any questions that are not available on the Provider Express Portal please email me.  Link to Optum Provider Express:  https://www.providerexpress.com/content/ope-provexpr/us/en/COVID-19_Provider_Updates.html  Providers make it possible. Thank you!  Wendy Hamel Sherzer  Network Manager - Rhode Island  Phone: 401-732-7120 Fax: 1-844-606-9423\"', NULL, NULL, '2020-09-24 16:56:14', '2020-09-24 16:56:14'),
(3809, 1006, 6908, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to Wendy regarding the status of the request.  ', NULL, NULL, '2020-10-05 18:09:59', '2020-10-05 18:09:59'),
(3810, 1006, 6908, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Received following reply from Wendy:   \"Hello Brad,   I had sent the MA provider information over to my colleague Janet for follow up for that state and should be outreached by a provider relations representative assigned to that area.\"  Sent her reply:  \"I\'m still waiting to be reached out to in-regards to the MA supervisory protocol request, it\'s been more than 3 months at this point and we\'re hoping we can move it along as those specific providers have not been able to see any UBH patients due to this. I would appreciate if you could just let me know which MA provider representative I need to get in touch with to get updates on this.   Thank you!\"', NULL, NULL, '2020-10-13 10:12:01', '2020-10-13 10:12:01'),
(3811, 1006, 6908, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Received an update from Janet Choup, sent her the following email @ janet.choup@optum.com:  \"Good Afternoon Janet,  I\'ve been reaching out to Wendy for the past few months in regards to setting up a supervisory protocol for our providers as they aren\'t able to be enrolled with UBH due to being LCSW\'s, we already have a supervisory protocol like this set up already for our RI providers. Group and provider information is as follows:  Group TIN# 2753 Group NPI# 1356906572 Provider Name: Jennifer Lee Ullrich Provider NPI# 1710489760 Provider Name: Jonathan Schubert Provider NPI# 1235755505  Please let me know what else is required to get this process finished ASAP as it\'s already been a few months that we\'ve been trying to get this protocol in place.  Thank you.\"', NULL, NULL, '2020-10-20 10:55:57', '2020-10-20 10:55:57'),
(3812, 1006, 6908, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Received following reply from Janet:  \"Are you planning to bill with the same TIN? If so, it’s the same contract that supervisory is already allowed.\"  Sent reply:  Hello Janet,   Appreciate the update and yes it will be under the same TIN# 83-4482753, but I have a query for the supervisory protocol that\'s currently in place under it as we\'ve submitted a few claims under the protocol with the rendering provider being the LCSW and the supervising provider being the LICSW but those claims were denied stating that the provider was not enrolled. Would you be able to look into this for me? As I haven\'t been able to get in touch with Wendy.   Thank you. \"', NULL, NULL, '2020-10-30 14:35:19', '2020-10-30 14:35:19'),
(3813, 1006, 6908, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Choup, Janet\" janet.choup@optum.com regarding query. ', NULL, NULL, '2020-11-06 18:07:12', '2020-11-06 18:07:12'),
(3814, 1006, 6908, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Sent a follow-up email to Wendy asking if it\'s feasible for us to submit claims under all of our LCSW\'s via the supervisory protocol. ', NULL, NULL, '2020-11-13 18:19:03', '2020-11-13 18:19:03'),
(3815, 1006, 6908, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com: \"Hello,  I hope you\'re doing well, I wanted to follow-up on my previous email:\"Hello Wendy,  Appreciate the update, so we should be using the supervising provider as the rendering on all the claims. Also, I just wanted to re-confirm that since the supervisory protocols are in place we should be able to bill all the claims under Prisca Hefti? I\'m asking this since we now have 4 different LCSW providers in RI & MA and as per the supervisory protocol, we should be able to bill in both states.  Thanks.\"  Please get back to me as soon as you\'re able to.\"', NULL, NULL, '2020-11-20 12:03:16', '2020-11-20 12:03:16'),
(3816, 1006, 6908, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Received following response in regards to MA providers: \"Good Afternoon,  As previously advised Stacie and I can address questions regarding RI only and as stated you are able to bill Prisca Hefti for Supervisory Protocol. Please be aware that all claims billed by non-licensed providers should be billed under the applicable supervisor (which may not necessarily all be under Prisca Hefti ). If you have additional providers to be credentialed in the roll of Supervisor that have yet to be for RI please let us know.  Thank you,  Wendy Hamel Sherzer  Network Manager - Rhode Island  Phone: 401-732-7120 Fax: 1-844-606-9423 Behavioral Network online resources:  www.providerexpress.com\"', NULL, NULL, '2020-11-20 14:08:36', '2020-11-20 14:08:36'),
(3817, 1006, 6909, NULL, NULL, 'New/Not Initiated', 'Request initiated via Magellan online portal. ', NULL, NULL, '2020-07-16 17:41:27', '2020-07-16 17:41:27'),
(3818, 1006, 6909, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-16 17:41:31', '2020-07-16 17:41:31'),
(3819, 1006, 6909, NULL, NULL, 'In Process', 'Received following email from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  \"Good Day, CAQH ID: 14878838 If all of the information is showing correctly in the CAQH application, such as the work history and malpractice insurance, then send nothing more.  Judy Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management O 410-953-3537 | F   1-888-656-1598 | E JJonesWright@magellanhealth.com\"', NULL, NULL, '2020-07-17 17:08:13', '2020-07-17 17:08:13'),
(3820, 1006, 6909, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Received following update from Judith:  \"Almost there, maybe the provider will show as active by next week.  Judy\"', NULL, NULL, '2020-08-06 15:59:59', '2020-08-06 15:59:59'),
(3821, 1006, 6909, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent followup email to \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> ', NULL, NULL, '2020-08-18 10:59:52', '2020-08-18 10:59:52'),
(3822, 1006, 6909, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Good Afternoon,  The provider has been credentialed and linked to your group effective date 8/3/2020', NULL, NULL, '2020-08-18 16:42:54', '2020-08-18 16:42:54'),
(3823, 1005, 6910, NULL, NULL, 'New/Not Initiated', 'TMHP Enrollment Revalidation Required for the following TPIs by 9/1/2020: • 347139302 • 347139301 ', NULL, NULL, '2020-07-20 12:15:28', '2020-07-20 12:15:28'),
(3824, 2027, 6910, NULL, NULL, 'In Process', 'Re validation process completed Ticket# 17081212   ', NULL, NULL, '2020-07-20 15:31:51', '2020-07-20 15:31:51'),
(3825, 2027, 6910, NULL, NULL, 'In Process', 'Revalidation process for Medicaid THS  initated Ticket# 17081611 ', NULL, NULL, '2020-07-20 15:55:39', '2020-07-20 15:55:39'),
(3826, 1006, 6910, NULL, NULL, 'In Process', 'Revalidation application approved for Traditional Medicaid.  Received following update from Medicaid regarding CUCC:   \"Dear COLUMBUS URGENT CARE PA:  TMHP records indicate that HHSC has approved your revalidation application as a Texas State health-care programs provider. You can find all of the details about your revalidation in the Revalidation Success Letter on your Message Dashboard.  If you have any questions about this email or feel that you received it in error, you can contact TMHP online or call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.  Online Provider Enrollment Resources:  Provider Information Management System (PIMS)—Update provider information, including license information. Provider Enrollment on the Portal—Submit and update your enrollment application online. Message Dashboard—Read TMHP correspondence and notifications online. Contact TMHP—Get help and information from TMHP.\"', NULL, NULL, '2020-07-27 10:14:04', '2020-07-27 10:14:04'),
(3827, 1006, 6910, NULL, NULL, 'In Process', 'Also received a deficiency for THSteps, corrected and resubmitted. ', NULL, NULL, '2020-07-27 10:47:08', '2020-07-27 10:47:08'),
(3828, 2027, 6910, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Re-validation has been completed with medicaid and effective date is 01/18/2015 next due re-validation is 7/25/2025.  ', NULL, NULL, '2020-09-10 17:37:17', '2020-09-10 17:37:17'),
(3829, 1005, 6911, NULL, NULL, 'New/Not Initiated', 'Spoke with Evelyn, She asked me to update the address First via PIMS - Provider Information section and said once this gets approved then we can add additional rendering providers. Request submitted | PEP Transaction ID 17081920', NULL, NULL, '2020-07-20 16:51:05', '2020-07-20 16:51:05'),
(3830, 1005, 6911, NULL, NULL, 'In Process', 'PEP Transaction ID	17081920 In process.', NULL, NULL, '2020-07-20 16:51:21', '2020-07-20 16:51:21'),
(3831, 2027, 6911, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Group is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 16:39:10', '2020-08-18 16:39:10'),
(3832, 2027, 6912, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 13:18:20', '2020-07-21 13:18:20'),
(3833, 2027, 6912, NULL, NULL, 'New/Not Initiated', 'I have called many times to the insurance network management department but they did not pick my call i leave a voice message so now i am initiating this task ', NULL, NULL, '2020-07-21 13:20:37', '2020-07-21 13:20:37'),
(3834, 2027, 6912, NULL, NULL, 'Approved', 'Providers have been updated in the BCBS database in this location, screenshot attached', NULL, NULL, '2020-07-21 15:44:51', '2020-07-21 15:44:51'),
(3835, 1006, 6913, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 13:21:14', '2020-07-21 13:21:14'),
(3836, 1006, 6913, NULL, NULL, 'In Process', 'Received following email from Medrano, Miguel Miguel.Medrano@beaconhealthoptions.com>:  Sub: MBHP Credentialing | Mahreen Rashid, PMHNP  \"Good morning,  For the submitted credentialing application of Mahreen Rashid, PMHNP to MBHP, please submit:  ·         Notice page (attached) ·         Member race/ethnicity population (attached) ·         Primary Care Clinician (PCC) linkage (attached) ·         In-network physician or facility to refer to for admitting purposes. Katie Tawakol is not a physician. (attached) ·         Corrected hours of operation without overlaps between locations. (attached) ·         Business demographic data (attached) ·         W-9 for the billing address 63 Eddie Dowling Hwy, North Smithfield, RI 02896 (attached) ·         Years of clinical and managed care experience (attached) ·         ANCC certification information (attached) ·         Collaborating physician (attached) ·         Malpractice claims information. If there are no claims, mark the ‘N/A’ box. (attached) ·         CANS certification (or confirm the provider will provide only medication-management and no psychotherapy) ·         Collaborative practice agreement ·         Updated resume listing the current practice with Spectrum Neuro Behavioral Care.  Email or fax to my attention within 7 days: Email: Miguel.Medrano@BeaconHealthOptions.com Fax: 877-390-2324   Thank you,  Miguel Medrano MBHP Network Operations ––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership a Beacon Health Options company 1000 Washington Street, Suite 310 Boston, MA 02118 Email: miguel.medrano@beaconhealthoptions.com Fax: 877.390.2324 www.masspartnership.com \"', NULL, NULL, '2020-07-21 13:22:25', '2020-07-21 13:22:25'),
(3837, 1006, 6913, NULL, NULL, 'In Process', 'Sent reply to \"Medrano, Miguel\" Miguel.Medrano@beaconhealthoptions.com>:  Sub: MBHP Credentialing | Mahreen Rashid, PMHNP  \"Hey Miguel,   Here\'s the form with all of the information filled out, also the provider will only be doing medicine management and doesn\'t need a CANS certificate.  I\'m not sure what the \"Collaborative practice agreement\" is that you\'re requesting. \"', NULL, NULL, '2020-07-21 16:00:11', '2020-07-21 16:00:11'),
(3838, 1006, 6913, NULL, NULL, 'In Process', 'Received another email from Medrano, Miguel Miguel.Medrano@beaconhealthoptions.com> requesting further clarification and updates.   They have been sent.  ', NULL, NULL, '2020-07-30 09:44:06', '2020-07-30 09:44:06'),
(3839, 1006, 6913, NULL, '2020-11-02 00:00:00.000', 'On Hold', 'Request has been put on hold until group enrollment has been completed. ', NULL, NULL, '2020-10-07 16:54:23', '2020-10-07 16:54:23'),
(3840, 1006, 6913, NULL, '2020-11-04 00:00:00.000', 'On Hold', 'Received the following email from Miguel: \"Good morning,     For the submitted credentialing application of Mahreen Rashid, PMHNP to MBHP, please submit:  ·         In-network physician or facility to refer to for admitting purposes. (attached)  ·         Demographic data (attached)  ·         MCSR Registration (attached)  ·         Years of clinical and managed care experience (attached)  ·         Malpractice claims information. If there are no claims, mark the ‘N/A’ box. (attached)  ·         The submitted attestation of cultural competency indicates the provider has not participated in a cultural competency training. Complete a cultural competency training and re-submit the attestation. (attached)  ·         CANS certification (or confirm the provider will only provide medication-management and no psychotherapy)  ·         Updated current resume listing practice with “Spectrum Neuro Behavioral Care”.  ·         Collaborative practice agreement with Fauzia Wali-Khan, Psychiatrist.     Email or fax to my attention: Email: Miguel.Medrano@BeaconHealthOptions.com Fax: 877-390-2324     Thank you,  Miguel Medrano MBHP Network Operations ––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership a Beacon Health Options company 1000 Washington Street, Suite 310 Boston, MA 02118 Email: miguel.medrano@beaconhealthoptions.com Fax: 877.390.2324 www.masspartnership.com\"', NULL, NULL, '2020-11-03 11:06:35', '2020-11-03 11:06:35'),
(3841, 1006, 6913, NULL, '2020-11-11 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-04 17:35:06', '2020-11-04 17:35:06'),
(3842, 1006, 6913, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Sent following email to Miguel: \"Hey Miguel,   Here are the filled applications for the LCSW\'s, I\'ll reply to your email regarding Mahreen, Pandeeswari & Fauzia as soon as I\'m able to.   Thanks. \"', NULL, NULL, '2020-11-12 18:45:10', '2020-11-12 18:45:10'),
(3843, 1006, 6913, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Received another follow-up email from Miguel Medrano regarding the requested info:  For the submitted credentialing application of Mahreen Rashid, PMHNP to MBHP, please submit:  ·         In-network physician or facility to refer to for admitting purposes. (attached)  ·         Demographic data (attached)  ·         MCSR Registration (attached)  ·         Years of clinical and managed care experience (attached)  ·         Malpractice claims information. If there are no claims, mark the ‘N/A’ box. (attached)  ·         The submitted attestation of cultural competency indicates the provider has not participated in a cultural competency training. Complete a cultural competency training and re-submit the attestation. (attached)  ·         CANS certification (or confirm the provider will only provide medication-management and no psychotherapy)  ·         Updated current resume listing practice with “Spectrum Neuro Behavioral Care”.  ·         Collaborative practice agreement with Fauzia Wali-Khan, Psychiatrist.  ', NULL, NULL, '2020-11-19 18:11:33', '2020-11-19 18:11:33'),
(3844, 1006, 6913, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Sent following email to Miguel: \"Hey Miguel,   I\'m sorry for the delay, would we be able to set up a meeting tomorrow so I can go over a few questions I had regarding all of the providers missing information? Please let me know what number I should reach out to you at and when you will be available.  Thanks.  \"', NULL, NULL, '2020-11-24 15:30:36', '2020-11-24 15:30:36'),
(3845, 1006, 6913, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request. ', NULL, NULL, '2020-12-11 17:40:13', '2020-12-11 17:40:13'),
(3846, 3040, 6913, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: MNHPnetworkoperations@beaconhealthoption.com  Subject: Enroll Providers || Spectrum Neuro Behavioral Care LLC || Rashid, Mahreen & Ullrich, Jennifer Lee || MBHP ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers for our group   Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-21 08:16:01', '2021-04-21 08:16:01'),
(3847, 1019, 6913, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:33:58', '2021-06-04 15:33:58'),
(3848, 1019, 6913, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:49:26', '2021-06-23 10:49:26'),
(3849, 19067, 6913, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:02:48', '2021-12-13 15:02:48'),
(3850, 19067, 6913, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:44:46', '2021-12-29 13:44:46'),
(3851, 19067, 6913, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:05:03', '2022-01-10 14:05:03'),
(3852, 19067, 6913, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:20', '2022-02-11 10:45:20'),
(3853, 19067, 6913, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: 	RE: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Ahmed,     The below providers that will need to complete the form, please indicate in the service section they want to add MBHP line of insurance.     Peggy Pionke – Complete the attached form  Katie Tawakolv – Already in network  Mahreen Rashid – Complete the attached form  Prisca Hefti – Already in network  Jennifer Ullrich – Complete the attached form     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-15 09:48:11', '2022-02-15 09:48:11'),
(3854, 19067, 6913, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Randy,  Please provide an effective date and approval letter for the providers who are now in-network with MBHP.   Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 17:12:06', '2022-03-16 17:12:06'),
(3855, 22077, 6913, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:13:14', '2022-04-05 08:13:14'),
(3856, 22077, 6913, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:20:10', '2022-04-05 10:20:10'),
(3857, 2027, 6914, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 13:24:50', '2020-07-21 13:24:50'),
(3858, 2027, 6914, NULL, NULL, 'Initiated', ' I have called many times to the insurance network management department but they did not pick my call i leave a voice message so now i am initiating this task ', NULL, NULL, '2020-07-21 13:25:06', '2020-07-21 13:25:06'),
(3859, 2027, 6914, NULL, NULL, 'Approved', 'Provider has been updated in the BCBS database in this location, screenshot attached ', NULL, NULL, '2020-07-21 17:03:40', '2020-07-21 17:03:40'),
(3860, 2027, 6921, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 16:37:33', '2020-07-21 16:37:33'),
(3861, 2027, 6921, NULL, NULL, 'Approved', 'Provider has been updated in the BCBS database in this location, screenshot attached', NULL, NULL, '2020-07-21 16:39:16', '2020-07-21 16:39:16'),
(3862, 2027, 6922, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 16:43:02', '2020-07-21 16:43:02'),
(3863, 2027, 6922, NULL, NULL, 'Approved', 'Provider has been updated in the BCBS database in this location, screenshot attached ', NULL, NULL, '2020-07-21 16:43:28', '2020-07-21 16:43:28'),
(3864, 2027, 6923, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 16:53:03', '2020-07-21 16:53:03'),
(3865, 2027, 6923, NULL, NULL, 'Approved', 'Provider has been updated in the BCBS database in this location, screenshot attached ', NULL, NULL, '2020-07-21 16:53:16', '2020-07-21 16:53:16'),
(3866, 2027, 6923, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-21 16:55:17', '2020-07-21 16:55:17'),
(3867, 2027, 6923, NULL, NULL, 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Group-Providers)-(Valley Med Urgent Care PLLC)-(BCBS)  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.    ', NULL, NULL, '2020-07-23 13:39:54', '2020-07-23 13:39:54'),
(3868, 2027, 6923, NULL, NULL, 'In Process', 'from: txintaketeampiermailbox@bcbstx.com   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 13:40:58', '2020-07-23 13:40:58'),
(3869, 2027, 6923, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Garcia, Homero)-(Valley Med Urgent Care )-(Blue Cross Blue Shield)  May I know the current enrollment status of the below mentioned provider in all three locations of  (Valley Med Urgent Care):   May i know the current application status of this provider. Details are mentioned below:  Provider Name: Garcia, Homero    Provider NPI# 1730564857   Group Name: Valley Med Urgent Care PLLC      Tax ID:  81-5123542    Thanks.', NULL, NULL, '2020-10-11 17:18:38', '2020-10-11 17:18:38'),
(3870, 2027, 6923, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-02 09:16:01', '2020-11-02 09:16:01'),
(3871, 2027, 6923, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com   This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 14:05:44', '2020-11-09 14:05:44'),
(3872, 2027, 6923, NULL, '2020-11-16 00:00:00.000', 'Approved', 'This provider is showing linked with insurance and effective date is 05/28/2019', NULL, NULL, '2020-11-09 15:07:42', '2020-11-09 15:07:42'),
(3873, 2027, 6924, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 17:06:29', '2020-07-21 17:06:29'),
(3874, 2027, 6924, NULL, NULL, 'Approved', 'Provider has been updated in the BCBS database in this location, screenshot attached ', NULL, NULL, '2020-07-21 17:06:42', '2020-07-21 17:06:42'),
(3875, 2027, 6925, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-21 17:21:38', '2020-07-21 17:21:38'),
(3876, 2027, 6925, NULL, NULL, 'Approved', 'Provider has been updated in the BCBS database in this location, screenshot attached ', NULL, NULL, '2020-07-21 17:22:07', '2020-07-21 17:22:07'),
(3877, 2027, 6926, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-22 16:51:02', '2020-07-22 16:51:02'),
(3878, 2027, 6926, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Group-Providers)-(Valley Med Urgent Care PLLC)-(BCBS)  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 13:45:49', '2020-07-23 13:45:49'),
(3879, 2027, 6926, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 13:47:32', '2020-07-23 13:47:32'),
(3880, 2027, 6926, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Garcia, Homero    Provider NPI# 1730564857   Group Name: Valley Med Urgent Care PLLC      Tax ID:  81-5123542    Thanks.', NULL, NULL, '2020-10-11 16:29:43', '2020-10-11 16:29:43'),
(3881, 2027, 6926, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-02 09:16:54', '2020-11-02 09:16:54'),
(3882, 2027, 6926, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com   This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 14:09:27', '2020-11-09 14:09:27'),
(3883, 2027, 6926, NULL, '2020-11-16 00:00:00.000', 'Approved', 'This provider is showing linked with insurance and effective date is 05/28/2019', NULL, NULL, '2020-11-09 15:10:41', '2020-11-09 15:10:41'),
(3884, 2028, 6927, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-22 17:38:25', '2020-07-22 17:38:25'),
(3885, 2028, 6927, NULL, NULL, 'In Process', 'Rep: Karina h As per rep, they will not be able to assist me for the initiation process provided a number which is Esmi Silwa 3616946552  (voicemail left for a call back) Ref:389002 ', NULL, NULL, '2020-07-23 15:17:21', '2020-07-23 15:17:21'),
(3886, 2028, 6927, NULL, NULL, 'In Process', 'TO: 	esmie.silva@dchstx.org Sub: Cyriaque, Stephane - Driscoll - BHUCC   Hello,  Hope you are doing great, I would like to enroll a provider into your group  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-24 10:35:34', '2020-07-24 10:35:34'),
(3887, 2028, 6927, NULL, NULL, 'In Process', 'To: Esmie.Silva@dchstx.org Sub: Cyriaque, Stephane - Driscoll - BHUCC  Hello, Attached is the Request for contract and W9 of Stephane Cyriaque. Please let me know if need any other information? Thank you', NULL, NULL, '2020-07-24 12:16:59', '2020-07-24 12:16:59'),
(3888, 2028, 6927, NULL, NULL, 'Rejected', 'From: Melinda.Lopez@dchstx.org Sub: Request for Contract Stephane Cyriaque FNP  Hello Samuel, I want to acknowledge receipt of the completed request for contract form submitted for Stephane Cyriaque FNP however cannot process due to Missouri City TX is not in our service area and we do not have any members that reside in this area.     The request for contract is being withdrawn due to not in our service area. Please refer to the map below of the 24 counties within our service area.', NULL, NULL, '2020-07-28 10:58:11', '2020-07-28 10:58:11'),
(3889, 2028, 6928, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-22 17:45:17', '2020-07-22 17:45:17'),
(3890, 2028, 6928, NULL, NULL, 'In Process', 'TO: mmedina@ghn-mci.com Sub:Re: Cyriaque, Stephane - Galaxy Health - BHUCC  Hello,  Hope you\'re doing great attached is the Contract Form which you sent  Regards, Samuel Sharon ', NULL, NULL, '2020-07-30 14:29:55', '2020-07-30 14:29:55'),
(3891, 1006, 6928, NULL, '2020-08-11 00:00:00.000', 'In Process', 'Received email from Michelle Monroe (mmonroe@ghn-mci.com) asking if we had any other providers in the group that she could add to the contract, replied the following:  \"Hey Michelle,   Appreciate you reaching out, currently Stephane Cyriaque is the only provider that\'s going to be working at Best Health Urgentcare & Clinic.   Please let me know if you have any other questions and how long the contracting time-frame is?  Thank you. \"', NULL, NULL, '2020-08-04 17:12:24', '2020-08-04 17:12:24'),
(3892, 1006, 6928, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Michelle asked for Masters degree, DEA & State License. Provided those to her. ', NULL, NULL, '2020-08-13 10:25:45', '2020-08-13 10:25:45'),
(3893, 2037, 6928, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Received email from Christine Guerue asking for the Malpractice of Dr. Stephane .I have sent the requested document via email. ------------ Good Morning,  The application for Stephane Cyriaque has been processed, the only additional item needed for completion will be a copy of his malpractice insurance.     Please feel free to contact me with any questions…  Thank you!     Christine Guerue  Credentialing Dept  Galaxy Health Network  2261 Brookhollow Plaza Dr, Ste 106  Arlington, TX 76006  PO Box 201425  Arlington, TX 76006-1425  cguerue@ghn-mci.com  800-975-3322 x1130  817-633-5729 fax  ', NULL, NULL, '2020-08-19 13:14:13', '2020-08-19 13:14:13'),
(3894, 2037, 6928, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Received confirmation email from Christine.The provider Stephane is on board with Galaxy from 08/19/2020. I have sent an email requesting executed contract to approve the task. Below is the confirmation email.  Good Morning,  Thank you, with this information the application/agreement for Stephane Cyriaque has now been marked complete and he will be added to the network effective 8/19/2020.  Please feel free to contact me with any questions.  Thanks again and have a great day!!   Chris Guerue Attachments Aug 25, 2020, 9:12 AM (1 day ago) to me ', NULL, NULL, '2020-08-26 13:43:39', '2020-08-26 13:43:39'),
(3895, 2037, 6928, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Got the confirmation over the phone as well as from the provider directory. Stephane is on board with Galaxy health networks for both Lines of Business MCS & PPO .Effective  08/19/2020 . Sending approval email to the Billing Department', NULL, NULL, '2020-09-10 18:00:13', '2020-09-10 18:00:13'),
(3896, 2028, 6929, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-22 17:49:59', '2020-07-22 17:49:59'),
(3897, 1006, 6929, NULL, NULL, 'Initiated', 'test', NULL, NULL, '2020-07-27 11:04:14', '2020-07-27 11:04:14'),
(3898, 1005, 6929, NULL, '2020-10-20 00:00:00.000', 'Rejected', 'Insurance is not enrolling any new Provider.', NULL, NULL, '2020-10-13 15:08:43', '2020-10-13 15:08:43'),
(3899, 11056, 6929, NULL, '2021-08-05 00:00:00.000', 'Revalidation', 'Approval email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,   Please see welcome letters and contract.   Let us know if you have any questions.   Thanks  Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com  Shametria eff date is : 06/18/2021  STEPHANE eff date is : 05/01/2021', NULL, NULL, '2021-07-29 14:14:49', '2021-07-29 14:14:49'),
(3900, 11056, 6929, NULL, '2021-08-05 00:00:00.000', 'Revalidated', 'Approval email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,   Please see welcome letters and contract.   Let us know if you have any questions.   Thanks  Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com  Shametria eff date is : 06/18/2021  STEPHANE eff date is : 05/01/2021  Please see the attachment', NULL, NULL, '2021-07-29 14:18:41', '2021-07-29 14:18:41'),
(3901, 2027, 6930, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 14:34:14', '2020-07-23 14:34:14');
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
(3902, 2027, 6930, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 14:34:50', '2020-07-23 14:34:50'),
(3903, 2027, 6930, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory', NULL, NULL, '2020-07-23 14:43:29', '2020-07-23 14:43:29'),
(3904, 2027, 6931, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 14:46:20', '2020-07-23 14:46:20'),
(3905, 2027, 6931, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 14:47:19', '2020-07-23 14:47:19'),
(3906, 2027, 6931, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 14:47:53', '2020-07-23 14:47:53'),
(3907, 2027, 6931, NULL, '2020-10-12 00:00:00.000', 'Approved', 'From: provider_relations_houston@bcbstx.com  MAYRA A LOPEZ, PA  8LY218 issued 11/13/2019 and linked to VALLEY MED URGENT CARE PLLC tax 815123542 (00Q9Z7). In network since 12/20/2019 BLUE ADVANTAGE HMO, BLUE ESSENTIALS HMO, BLUE CHOICE PPO, CHIP, HEALTHSELECT, and MEDICARE ADVANTAGE PPO.   Thank you. ', NULL, NULL, '2020-10-05 10:35:49', '2020-10-05 10:35:49'),
(3908, 2027, 6932, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 15:00:01', '2020-07-23 15:00:01'),
(3909, 2027, 6932, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 15:00:50', '2020-07-23 15:00:50'),
(3910, 2027, 6932, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 15:01:28', '2020-07-23 15:01:28'),
(3911, 2027, 6932, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Naranjo, Diego)-(Valley Med Urgent Care PLLC (Brownsville)-(Blue Cross Blue Shield)  May I know the current status of the below mentioned provider:  Provider Name: Naranjo, Diego Provider NPI# 1568929800 Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 1265945125  Thanks.', NULL, NULL, '2020-09-21 09:55:58', '2020-09-21 09:55:58'),
(3912, 2027, 6932, NULL, '2020-10-07 00:00:00.000', 'In Process', 'To: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Sub: (Naranjo, Diego)-(Valley Med Urgent Care PLLC (Brownsville)-(Blue Cross Blue Shield)  May I know the current status of the below mentioned provider:  Provider Name: Naranjo, Diego Provider NPI# 1568929800 Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 1265945125  Thanks.', NULL, NULL, '2020-09-30 17:37:33', '2020-09-30 17:37:33'),
(3913, 2027, 6932, NULL, '2020-10-08 00:00:00.000', 'Approved', 'Provider is now showing linked in all three locations of vmuc and effective date is 11/18/2019. SS from provider directory is attached', NULL, NULL, '2020-10-01 15:04:55', '2020-10-01 15:04:55'),
(3914, 2027, 6933, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 15:03:58', '2020-07-23 15:03:58'),
(3915, 2027, 6933, NULL, NULL, 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 15:04:54', '2020-07-23 15:04:54'),
(3916, 2027, 6933, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 15:05:34', '2020-07-23 15:05:34'),
(3917, 2027, 6933, NULL, '2020-10-08 00:00:00.000', 'Approved', 'Provider is now showing linked in all three locations of vmuc and effective date is 11/18/2019. SS from provider directory is attached', NULL, NULL, '2020-10-01 15:27:10', '2020-10-01 15:27:10'),
(3918, 2027, 6934, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 15:06:42', '2020-07-23 15:06:42'),
(3919, 2027, 6934, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory ', NULL, NULL, '2020-07-23 15:09:14', '2020-07-23 15:09:14'),
(3920, 2027, 6935, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 15:21:56', '2020-07-23 15:21:56'),
(3921, 2027, 6935, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory ', NULL, NULL, '2020-07-23 15:22:22', '2020-07-23 15:22:22'),
(3922, 2027, 6936, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 15:40:02', '2020-07-23 15:40:02'),
(3923, 2027, 6936, NULL, NULL, 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 15:40:44', '2020-07-23 15:40:44'),
(3924, 2027, 6936, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 15:41:52', '2020-07-23 15:41:52'),
(3925, 2027, 6936, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care): Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542  Thanks.', NULL, NULL, '2020-10-11 16:59:08', '2020-10-11 16:59:08'),
(3926, 2027, 6936, NULL, '2020-10-30 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance and the effective date is 4/10/2020. Screenshot from provider directory is attached.', NULL, NULL, '2020-10-23 12:27:25', '2020-10-23 12:27:25'),
(3927, 2027, 6937, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 15:46:44', '2020-07-23 15:46:44'),
(3928, 2027, 6937, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory ', NULL, NULL, '2020-07-23 15:47:32', '2020-07-23 15:47:32'),
(3929, 2027, 6938, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 16:44:15', '2020-07-23 16:44:15'),
(3930, 2027, 6938, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 16:45:22', '2020-07-23 16:45:22'),
(3931, 2027, 6938, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 16:51:48', '2020-07-23 16:51:48'),
(3932, 2027, 6938, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care):   Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542   Thanks.', NULL, NULL, '2020-10-11 17:42:39', '2020-10-11 17:42:39'),
(3933, 2027, 6938, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-02 09:17:15', '2020-11-02 09:17:15'),
(3934, 2027, 6938, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-09 17:31:03', '2020-11-09 17:31:03'),
(3935, 2027, 6938, NULL, '2020-11-17 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance and effective date is 04/26/2019', NULL, NULL, '2020-11-10 12:16:31', '2020-11-10 12:16:31'),
(3936, 2027, 6939, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-23 16:53:29', '2020-07-23 16:53:29'),
(3937, 2027, 6939, NULL, NULL, 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 16:54:08', '2020-07-23 16:54:08'),
(3938, 2027, 6939, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 16:54:44', '2020-07-23 16:54:44'),
(3939, 2027, 6939, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care): Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542  Thanks.', NULL, NULL, '2020-10-11 16:58:57', '2020-10-11 16:58:57'),
(3940, 2027, 6939, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-02 09:17:39', '2020-11-02 09:17:39'),
(3941, 2027, 6939, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-09 17:31:25', '2020-11-09 17:31:25'),
(3942, 2027, 6939, NULL, '2020-11-17 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance and effective date is 04/26/2019', NULL, NULL, '2020-11-10 12:12:45', '2020-11-10 12:12:45'),
(3943, 2027, 6940, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-24 09:40:50', '2020-07-24 09:40:50'),
(3944, 2027, 6940, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory', NULL, NULL, '2020-07-24 09:42:15', '2020-07-24 09:42:15'),
(3945, 2027, 6941, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-24 09:48:29', '2020-07-24 09:48:29'),
(3946, 2027, 6941, NULL, NULL, 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Group-Providers)-(Valley Med Urgent Care PLLC)-(BCBS)  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.', NULL, NULL, '2020-07-24 09:50:19', '2020-07-24 09:50:19'),
(3947, 2027, 6941, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-24 09:51:01', '2020-07-24 09:51:01'),
(3948, 2027, 6941, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care):   Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542   Thanks.', NULL, NULL, '2020-10-11 17:43:00', '2020-10-11 17:43:00'),
(3949, 1005, 6941, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:28:16', '2020-10-12 14:28:16'),
(3950, 2027, 6942, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-24 09:54:05', '2020-07-24 09:54:05'),
(3951, 2027, 6942, NULL, NULL, 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Group-Providers)-(Valley Med Urgent Care PLLC)-(BCBS)  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-24 09:55:22', '2020-07-24 09:55:22'),
(3952, 2027, 6942, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-24 09:56:26', '2020-07-24 09:56:26'),
(3953, 2027, 6942, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care): Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542  Thanks.', NULL, NULL, '2020-10-11 16:58:22', '2020-10-11 16:58:22'),
(3954, 1005, 6942, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:27:07', '2020-10-12 14:27:07'),
(3955, 2027, 6943, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-24 10:05:38', '2020-07-24 10:05:38'),
(3956, 2027, 6943, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory', NULL, NULL, '2020-07-24 10:05:53', '2020-07-24 10:05:53'),
(3957, 2027, 6944, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-24 10:13:01', '2020-07-24 10:13:01'),
(3958, 2027, 6944, NULL, NULL, 'Approved', 'This provider is now showing in network with this address screenshot attached as a confirmation from BCBS provider directory', NULL, NULL, '2020-07-24 10:13:23', '2020-07-24 10:13:23'),
(3959, 2028, 6947, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-28 13:52:09', '2020-07-28 13:52:09'),
(3960, 2028, 6947, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-28 13:53:31', '2020-07-28 13:53:31'),
(3961, 1006, 6948, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-29 10:31:47', '2020-07-29 10:31:47'),
(3962, 1006, 6948, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-29 10:32:37', '2020-07-29 10:32:37'),
(3963, 1006, 6949, NULL, NULL, 'New/Not Initiated', 'Need to add provider to Staples location. ', NULL, NULL, '2020-07-29 16:58:43', '2020-07-29 16:58:43'),
(3964, 1006, 6949, NULL, NULL, 'In Process', 'Enrollment Tracking Information Applicant Name: PATRICK AYARZAGOITIA   Tracking ID: T072920200004799  Submitted Date: WED - JULY 29 2020 06:53:49 PM EST  Submitted By: Patrick Ayarzagoitia  Contact Email(s): KALONZO@WELLMED.NET ANNISSA.GOINS@EMCARE.COM PAYARZAGOITIA@GMAIL.COM RHC@CLAIMSMEDINC.COM TENNA.BEHM@EMCARE.COM ABOSMANS@WELLMED.NET Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare.', NULL, NULL, '2020-07-29 17:51:10', '2020-07-29 17:51:10'),
(3965, 2037, 6949, NULL, '2020-10-19 00:00:00.000', 'Approved', 'Application got approved  Tracking Number: T072920200004799. Pecos Approval Uploaded.', NULL, NULL, '2020-10-12 14:24:34', '2020-10-12 14:24:34'),
(3966, 2027, 6950, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-31 03:08:41', '2020-07-31 03:08:41'),
(3967, 2027, 6950, NULL, NULL, 'Approved', 'Location is updated in the aetna network screenshot attached', NULL, NULL, '2020-07-31 03:09:41', '2020-07-31 03:09:41'),
(3968, 2027, 6951, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-31 03:30:08', '2020-07-31 03:30:08'),
(3969, 2027, 6951, NULL, NULL, 'Initiated', 'To: 	Laura.Bevin@aetna.com,DavisE11@aetna.com  Sub: Address Update-((Valley Med Urgent Care PLLC )-(Aetna)  Please find the attached LOI and W9 to add a new location address  101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166   in this group. Details are mentioned below: Group Name: Valley Med Urgent Care PLLC  Tax ID: 81-5123542. Group NPI# 1518404631 Thanks.', NULL, NULL, '2020-07-31 05:13:21', '2020-07-31 05:13:21'),
(3970, 2027, 6951, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent Fax To: 859-455-8650 LOI and W9 attached', NULL, NULL, '2020-08-26 13:15:47', '2020-08-26 13:15:47'),
(3971, 1005, 6951, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Location has been added and showing in online provider directory. Need to reconfirm.', NULL, NULL, '2020-09-24 13:14:02', '2020-09-24 13:14:02'),
(3972, 2027, 6951, NULL, '2020-10-01 00:00:00.000', 'Approved', 'Group location is now showing linked with insurance and effective date is 7/1/2018', NULL, NULL, '2020-09-24 14:43:11', '2020-09-24 14:43:11'),
(3973, 2028, 6952, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-31 06:31:27', '2020-07-31 06:31:27'),
(3974, 2028, 6952, NULL, NULL, 'Initiated', 'To: jason_trieu@uhc.com Sub: Cyriaque, Stephane - UHC Plan (Texas Star Kids) - BHUCC  Hello,  We would like to enroll Stephane Cyriaque with UHC Plan (Texas Star Kids). Attached is the W9 and LOI for the provider  Please respond back to us as soon as you\'re able. Thank you', NULL, NULL, '2020-07-31 07:42:04', '2020-07-31 07:42:04'),
(3975, 1006, 6952, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Sent a followup email to Jason Trieu @ \"Trieu, Jason\" jason_trieu@uhc.com> for the status of the request.   ', NULL, NULL, '2020-08-13 13:03:10', '2020-08-13 13:03:10'),
(3976, 2037, 6952, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Sent a followup email to Jason Trieu @ \"Trieu, Jason\" jason_trieu@uhc.com> for the status of the request.  ', NULL, NULL, '2020-09-16 09:57:57', '2020-09-16 09:57:57'),
(3977, 2037, 6952, NULL, '2020-09-23 00:00:00.000', 'In Process', 'As per live call to Community Health Choice @ 7132952295 . Information is still not reflecting into their system . Catina.J has sent in a request for the update to the contracting department. We will be receiving a an update shortly. Ticket number : 319439. (Contact# 713-295-2295) ', NULL, NULL, '2020-09-16 10:40:58', '2020-09-16 10:40:58'),
(3978, 2037, 6952, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Received Roaster to fill out. Roaster filled and submitted back to Jason. Reference emails as follows:  ---------------- Hi Sherry,   Can you please fill out the attached roster report? Once filled out, I can submit to load and update our sytems.   Thank you ---------------------------- Hello Jason,  Thank you for the prompt response.Kindly find the attached roster. Also, if I may know by when will the addition be reflecting into your system and if you could possibly forward me the updated roaster for the confirmation of the plan\'s successful addition once done.   Please feel free to contact me for any additional information if needed. Regards: Sherry.', NULL, NULL, '2020-09-16 17:13:34', '2020-09-16 17:13:34'),
(3979, 2037, 6952, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Received and Email from Jason. Responded him back.Reference emails as follows: ------------------------ Hi Jason,  Thank you for your response. Yes you can send it over to the same email address.  Looking forward hearing back from you soon.  Thanks, Sherry.  ------------Original Message:  From:    \"Trieu, Jason\" jason_trieu@uhc.com To:      \"sd@claimsmedinc.com\" sd@claimsmedinc.com Date:    10/02/2020 05:24:00 PM GMT Subject: Secure Message from jason_trieu@uhc.com  Hi Sherry,  I apologize for the delay response. Is this the best mail to send the agreement to for provider to review?  Thank you  Jason Trieu', NULL, NULL, '2020-10-02 13:06:48', '2020-10-02 13:06:48'),
(3980, 2037, 6952, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Agreement received from Jason. Forwarded to Stephane for signature and submission.Reference email: ------------------- Hi Stephane,  Please review and sign the attached amendment to add Texas Medicaid Benefit and Texas CHIP Benefits to the contract.  Please print out two copies and mail to address provided on the UPS label.  Kindly let us know once it has been mailed out.  Thank you', NULL, NULL, '2020-10-02 16:58:34', '2020-10-02 16:58:34'),
(3981, 2037, 6952, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Agreement sent to Stephane for review and signatures.Needs to be mailed by UPS.Waiting for the submission confirmation of submission by Stephane.', NULL, NULL, '2020-10-06 14:40:53', '2020-10-06 14:40:53'),
(3982, 2037, 6952, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Stephane has signed and submitted back the agreement on 07/10/2020 with a days delivery time. I have requested a confirmation of receiving from Jason. ', NULL, NULL, '2020-10-13 17:37:52', '2020-10-13 17:37:52'),
(3983, 2037, 6952, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Follow up email sent to jason trieu', NULL, NULL, '2020-10-15 10:40:17', '2020-10-15 10:40:17'),
(3984, 2037, 6952, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Confirmation email receieved from Jason with the effective date of future 01/01/2021 Asked for the executed contract and follow up request submitted for the backdation of the effective date', NULL, NULL, '2020-10-27 14:13:32', '2020-10-27 14:13:32'),
(3985, 2037, 6952, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Following up on the request for backdation', NULL, NULL, '2020-11-03 11:15:33', '2020-11-03 11:15:33'),
(3986, 2037, 6952, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Following up on the request for backdation. Stephane is following up with Jason aswell', NULL, NULL, '2020-11-10 10:48:16', '2020-11-10 10:48:16'),
(3987, 2037, 6952, NULL, '2020-11-25 00:00:00.000', 'Approved', 'Request for backdation on the effective date could not be processed. Effective 01/01/2021. Approval sent and agreement uploaded in EMRBS', NULL, NULL, '2020-11-18 16:55:06', '2020-11-18 16:55:06'),
(3988, 2027, 6953, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-31 07:01:41', '2020-07-31 07:01:41'),
(3989, 2027, 6953, NULL, NULL, 'Approved', 'Group location is updated and showing in network  screenshot from provider directory is attached', NULL, NULL, '2020-07-31 07:04:05', '2020-07-31 07:04:05'),
(3990, 2027, 6954, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-31 08:39:17', '2020-07-31 08:39:17'),
(3991, 2027, 6954, NULL, NULL, 'In Process', 'provider is showing in network in the provider directory so iam attaching a screenshot but still waiting for the welcome letter or executed signed contract with effective date for the confirmation', NULL, NULL, '2020-07-31 10:23:41', '2020-07-31 10:23:41'),
(3992, 2027, 6954, NULL, NULL, 'In Process', 'To: corey_j_ford@uhc.com  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Brownsville)-(United HealthCare - UHC)  Please send us the welcome packet for this provider as I have confirmed through your provider directory that this provider is already showing in your network and this provider is under group contract with Valley Med Urgent Care PLLC (Brownsville). The details are mentioned below:  Provider Name:Escobar, Angiollet Solis Provider NPI# 1962917997  Tax ID: 81-5123542 Group Name: Valley Med Urgent Care PLLC  Thanks.', NULL, NULL, '2020-07-31 10:37:14', '2020-07-31 10:37:14'),
(3993, 2027, 6954, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Can I have the welcome letter for this provider as this provider is showing in the provider directory of UHC. Details are mentioned below:  Provider Name: Escobar, Angiollet Solis  Provider NPI# 1962917997 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-10-11 17:07:42', '2020-10-11 17:07:42'),
(3994, 2027, 6954, NULL, '2020-10-21 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance and effective date is 2/28/2018', NULL, NULL, '2020-10-14 10:48:39', '2020-10-14 10:48:39'),
(3995, 1006, 7950, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-04 17:29:15', '2020-08-04 17:29:15'),
(3996, 1006, 7950, NULL, '2020-08-11 00:00:00.000', 'Approved', 'Welcome letter received for the group. Attached. ', NULL, NULL, '2020-08-04 17:29:47', '2020-08-04 17:29:47'),
(3997, 1006, 7951, NULL, NULL, 'New/Not Initiated', 'Sent Provider Data Request form to 866-612-7795', NULL, NULL, '2020-08-05 15:32:47', '2020-08-05 15:32:47'),
(3998, 1006, 7951, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Sent request to add CBHI benefit for Fallon Health/Beacon Health Strategies. ', NULL, NULL, '2020-08-05 15:33:30', '2020-08-05 15:33:30'),
(3999, 1005, 7951, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 15:14:02', '2020-09-24 15:14:02'),
(4000, 1006, 7951, NULL, '2020-10-05 00:00:00.000', 'Approved', 'Request has been approved, the discussion has been attached in notes. Claims should no longer have any issues moving forward. ', NULL, NULL, '2020-09-28 16:45:00', '2020-09-28 16:45:00'),
(4001, 1006, 7952, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 15:53:11', '2020-08-05 15:53:11'),
(4002, 1006, 7952, NULL, '2020-08-12 00:00:00.000', 'Initiated', ' Application Tracking ID: T072720200003974        NPI: 1801986054        Medicare ID: 003226401        Name: JOANNA C WOOD          State: RI        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149', NULL, NULL, '2020-08-05 15:53:18', '2020-08-05 15:53:18'),
(4003, 1006, 7952, NULL, '2020-08-12 00:00:00.000', 'In Process', 'CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE PE0000043283	   CMS855R Web	           07/27/2020	   Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.', NULL, NULL, '2020-08-05 15:55:13', '2020-08-05 15:55:13'),
(4004, 1006, 7952, NULL, '2020-08-25 00:00:00.000', 'In Process', 'CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000043283	    CMS855R Web	            07/27/2020	   Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks. ', NULL, NULL, '2020-08-18 15:00:20', '2020-08-18 15:00:20'),
(4005, 1006, 7952, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Request still shows up as in process. Need to allow more time. ', NULL, NULL, '2020-08-26 09:42:40', '2020-08-26 09:42:40'),
(4006, 1006, 7952, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Welcome letter received with following PTAN & Effective date: PTAN: U400677029 EFF: 05/01/2020', NULL, NULL, '2020-09-02 10:01:17', '2020-09-02 10:01:17'),
(4007, 1006, 7953, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 15:56:53', '2020-08-05 15:56:53'),
(4008, 1006, 7953, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Submitted Clinician Add Form to Northeastprteam@uhc.com:  \"Hello,   Please find the attached Clinician add form, let me know if anything else is required for this request to be completed. Also, do let me know how long this process will take.  Thanks. \"', NULL, NULL, '2020-08-05 15:57:31', '2020-08-05 15:57:31'),
(4009, 1006, 7953, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Requested updated status on the request. ', NULL, NULL, '2020-08-05 16:37:57', '2020-08-05 16:37:57'),
(4010, 1006, 7953, NULL, '2020-08-10 00:00:00.000', 'In Process', 'Sent another clinician tax id/update form via the online portal on providerxpress, as the one submitted via email has still not been found in their system. ', NULL, NULL, '2020-08-06 11:28:51', '2020-08-06 11:28:51'),
(4011, 1006, 7953, NULL, '2020-08-19 00:00:00.000', 'In Process', 'Provider shows up as enrolled with our TIN#, need to ask UBH to send us a roster.  Ref# Jey O 08-18-2020', NULL, NULL, '2020-08-18 18:06:40', '2020-08-18 18:06:40'),
(4012, 1006, 7953, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Sent an email to rhodeisland_pr_team@uhc.com to send over a provider roster as UBH is no longer attending calls. ', NULL, NULL, '2020-08-20 15:03:51', '2020-08-20 15:03:51'),
(4013, 1006, 7953, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Sent another email requesting executed contract & roster @ \"Warner, Stacie M\" Stacie.Warner@optum.com> ', NULL, NULL, '2020-08-20 17:01:20', '2020-08-20 17:01:20'),
(4014, 1006, 7953, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent another followup email to \"Warner, Stacie M\" stacie.warner@optum.com> to send us plan roster for approval. ', NULL, NULL, '2020-08-26 18:16:14', '2020-08-26 18:16:14'),
(4015, 1006, 7953, NULL, '2020-09-04 00:00:00.000', 'Approved', 'Attached approval found on Providerxpress Optum website as proof of approval.   Eff: 07/01/2020', NULL, NULL, '2020-08-28 12:50:52', '2020-08-28 12:50:52'),
(4016, 1006, 7954, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 16:48:39', '2020-08-05 16:48:39'),
(4017, 1006, 7954, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Submitted practitioner change form to BCBSRI as per their request. ', NULL, NULL, '2020-08-05 16:52:23', '2020-08-05 16:52:23'),
(4018, 1006, 7954, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Affiliation letter received but was missing some plans, sent them email for clarification. ', NULL, NULL, '2020-08-05 16:56:21', '2020-08-05 16:56:21'),
(4019, 1006, 7954, NULL, '2020-08-12 00:00:00.000', 'Approved', 'Received following reply from Marisa Calicchia:  \"Hi Brad,  Yes Joanna Wood is listed in all networks below. Regional products depend on the out of network benefits of those members so that could differ out of state member to out of state member.  Thanks,  Marisa Calicchia | Provider Relations Representative | Blue Cross & Blue Shield of Rhode Island | EMAIL: Marisa.Calicchia@BCBSRI.org | OFFICE: 401-459-5600 | FAX: 401-459-5531 |  You can now verify and change your provider data online! Need help? Ask me how or email providerdirectory@bcbsri.org\"', NULL, NULL, '2020-08-05 17:04:06', '2020-08-05 17:04:06'),
(4020, 1006, 7955, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 17:16:25', '2020-08-05 17:16:25'),
(4021, 1006, 7955, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Initiated online application via Aetna\'s website. ', NULL, NULL, '2020-08-05 17:16:43', '2020-08-05 17:16:43'),
(4022, 1006, 7955, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent followup email to \"Bevin, Laura J\" Laura.Bevin@aetna.com>, regarding status for the request.  ', NULL, NULL, '2020-08-18 13:20:04', '2020-08-18 13:20:04'),
(4023, 1006, 7955, NULL, '2020-08-28 00:00:00.000', 'In Process', 'No response, sent another follow-up email to Laura Bevin. ', NULL, NULL, '2020-08-21 09:35:40', '2020-08-21 09:35:40'),
(4024, 1006, 7955, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Received following update from Laura:   \"Hello,  Joanna Wood, 7664369 – waiting to be linked to the group contract  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-08-25 09:31:34', '2020-08-25 09:31:34'),
(4025, 1006, 7955, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Received another update from Laura:   \"Hello,  Please allow 1-2 weeks for Joanna Wood, 7664369 to be linked to the group contract.\"', NULL, NULL, '2020-08-25 13:55:30', '2020-08-25 13:55:30'),
(4026, 1006, 7955, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura Bevin . ', NULL, NULL, '2020-09-02 17:34:54', '2020-09-02 17:34:54'),
(4027, 1006, 7955, NULL, '2020-09-10 00:00:00.000', 'Approved', 'Received following approval from Bevin Laura: \"Good morning,  Joanna Wood, 7664369 has a 09/01/2020 effective date.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-09-03 10:09:05', '2020-09-03 10:09:05'),
(4028, 1006, 7956, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 17:21:43', '2020-08-05 17:21:43'),
(4029, 1006, 7956, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Sent an email to John \"Chuck\" Mcgrew to verify if Joanna was already certified and what we needed to do to get her added to our group. ', NULL, NULL, '2020-08-05 17:22:43', '2020-08-05 17:22:43'),
(4030, 1006, 7956, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Received following email from Chuck:   \"Hi, Brad!  Yup, she’s certified and credentialed as network, in fact, so the attached form should be all we need.  Thanks!\"  Filled out the form & sent it to Chuck @ JMcGrew3@humana.com', NULL, NULL, '2020-08-18 14:18:58', '2020-08-18 14:18:58'),
(4031, 1006, 7956, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Sent followup email to Chuck Mcgrew:  \"Good morning Chuck,   I just wanted to follow-up with you to see if you received the form? I also wanted to know how long it might take to get the provided added as PAR under our group?  Thank you!\"', NULL, NULL, '2020-08-21 09:40:28', '2020-08-21 09:40:28'),
(4032, 1006, 7956, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Received following update from Chuck Mcgrew:   \" Hi, Brad!  Yup, received and submitted. Her affiliation is complete, insofar as I can make it, but there are still other departments that have to do their bit before she shows up Out There.  Thanks!\"  Told him that I\'ll check back in around next week, where we should have an approval. ', NULL, NULL, '2020-08-21 12:44:09', '2020-08-21 12:44:09');
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
(4033, 1006, 7956, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Sent another followup email to Chuck for the status. ', NULL, NULL, '2020-09-02 17:32:39', '2020-09-02 17:32:39'),
(4034, 1006, 7956, NULL, '2020-09-10 00:00:00.000', 'Approved', 'Received the following emails from Chuck:  \"Hi, Brad!  Well, she was completely added to the group the day I put her in. :-) This other stuff (which is still pending; it usually takes a good couple weeks for the Other Guys to get to it, and then there are yet Other–Other Guys beyond them) mostly makes her visible in the Portal/Directory and the Referral system. She should still be able to see patients and file claims.  Thanks!\"  \"I show her effective as of 8/1/20.  Chuck McGrew Tricare Community Liaison II Servicing provider relations matters in the following areas: RI / CT / Western MA Humana Military T 502-313-9524 F 806-517-2809 jmcgrew3@humana.com www.humanamilitary.com\"', NULL, NULL, '2020-09-03 10:27:29', '2020-09-03 10:27:29'),
(4035, 1006, 7957, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 17:25:29', '2020-08-05 17:25:29'),
(4036, 1006, 7957, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Initiated task via online portal', NULL, NULL, '2020-08-05 17:25:43', '2020-08-05 17:25:43'),
(4037, 1006, 7957, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Received following email from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  \"Good Day,  CAQH ID: 11652182 If all of the information is showing correctly in the CAQH application, such as the work history and malpractice insurance, then send nothing more.  Judy  Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management\"', NULL, NULL, '2020-08-05 17:26:50', '2020-08-05 17:26:50'),
(4038, 1006, 7957, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Received following update from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  \"This provider is about 2 weeks or so from completion.  Judy\"', NULL, NULL, '2020-08-18 17:00:50', '2020-08-18 17:00:50'),
(4039, 1006, 7957, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Received following approval from Judith:  \"Good Morning,  This provider has been linked to your group effective date 8/24/2020.\"', NULL, NULL, '2020-09-02 09:52:59', '2020-09-02 09:52:59'),
(4040, 1006, 7958, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 17:28:13', '2020-08-05 17:28:13'),
(4041, 1006, 7958, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Submitted online request for enrollment via Cignas behavioral health portal. ', NULL, NULL, '2020-08-05 17:28:34', '2020-08-05 17:28:34'),
(4042, 1006, 7958, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Received a contract to sign, signed and sent back to Williams, Amanda M. ', NULL, NULL, '2020-08-05 17:29:24', '2020-08-05 17:29:24'),
(4043, 1006, 7958, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent follow-up email to \"Ford, Emily R HHHH\" emily.ford3@cigna.com> regarding the status of enrollment. ', NULL, NULL, '2020-08-18 17:40:31', '2020-08-18 17:40:31'),
(4044, 1006, 7958, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Haven\'t received any response from Emily, sent a follow-up email to Behavioral Contracting BehavioralContracting@cigna.com>:  \"Good morning,  I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status of the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760 Provider Name: Joanna Wood NPI# 1801986054 Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Please get back to me as soon as you\'re able and please expedite the request.  Thank you!\"', NULL, NULL, '2020-08-21 09:44:19', '2020-08-21 09:44:19'),
(4045, 1006, 7958, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Received following update regarding contracting from Cigna @ Williams, Amanda M 244 Amanda.Williams2@cigna.com>:   \"Dear Joanna Wood,  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 will be considered a non-participating provider.  Please note that you may be considered a participating provider for customers who have coverage through a Cigna Health Maintenance Organization (HMO), which includes an employee assistance program (EAP) (as long as you are eligible to provide these services). To verify a Cigna 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 Cigna 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 Cigna\'s countersignature and your effective date as a Cigna Behavioral Health contracted provider.  Thank you for applying to the Cigna Behavioral Health network. We look forward to working with you and helping you realize your professional goals.  Sincerely, ConnectedCare Provider Operations  Amanda Williams                             Cigna Behavioral Health NCU | Provider Recruiter  T: 903.361.4632 | F: 860.697.6191 Amanda.Williams2@cigna.com\'', NULL, NULL, '2020-08-25 17:40:15', '2020-08-25 17:40:15'),
(4046, 1006, 7958, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Sent a followup email to Amanda.Williams2@cigna.com regarding status. ', NULL, NULL, '2020-09-02 17:41:00', '2020-09-02 17:41:00'),
(4047, 1006, 7958, NULL, '2020-09-20 00:00:00.000', 'In Process', 'Received the following response from Williams, Amanda M 244 Amanda.Williams2@cigna.com>:  \"Good afternoon Brad,  We have received Joanna Wood’s signed contract. She is just awaiting credentialing.  ConnectedCare Provider Operations  Amanda Williams                             Cigna Behavioral Health NCU | Provider Relations Associate Analyst  T: 903.361.4632 | F: 860.697.6191 Amanda.Williams2@cigna.com\"', NULL, NULL, '2020-09-03 12:58:34', '2020-09-03 12:58:34'),
(4048, 1006, 7958, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent a followup email to \"Williams, Amanda M 244\" Amanda.Williams2@cigna.com> regarding enrollment status. ', NULL, NULL, '2020-09-15 17:23:43', '2020-09-15 17:23:43'),
(4049, 1006, 7958, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Received following email from Williams, Amanda M 244 Amanda.Williams2@cigna.com>:  \"Good afternoon Joanna Wood,  I am voiding the current contract due to an error on my part. I sent you the incorrect contract to sign. I am correcting this right now and will be sending the correct contract for you to sign within the next half hour. I do apologize for this inconvenience that this may have caused.  Kind Regards,  ConnectedCare Provider Operations  Amanda Williams                             Cigna Behavioral Health NCU | Provider Relations Associate Analyst  T: 903.361.4632 | F: 860.697.6191 Amanda.Williams2@cigna.com\"', NULL, NULL, '2020-09-22 15:17:37', '2020-09-22 15:17:37'),
(4050, 1006, 7958, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Hello Amanda,  The contract that you re-sent has been signed, please expedite this request as it has been on-going for a few months now and we need to get this provider enrolled ASAP. Thank you. ', NULL, NULL, '2020-09-22 15:34:50', '2020-09-22 15:34:50'),
(4051, 1006, 7958, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Left a VM to Amanda to get back to me regarding the status of the enrollment. ', NULL, NULL, '2020-09-28 15:59:45', '2020-09-28 15:59:45'),
(4052, 1006, 7958, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Signed and executed contract has been received:  \"Congratulations! You are now a fully credentialed and contracted provider in the Cigna Behavioral Health network. You may access your signed agreement by clicking on the “Completed Documented” box below. No further action is required of you at this time.\" ', NULL, NULL, '2020-10-02 17:01:10', '2020-10-02 17:01:10'),
(4053, 1006, 7959, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 17:31:00', '2020-08-05 17:31:00'),
(4054, 1006, 7959, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Submitted application for enrollment online via Beacon online portal.   Followup @ https://join.beaconhealthoptions.com/validate/AC00665E2E31063AE053A17D866236DB ', NULL, NULL, '2020-08-05 17:32:34', '2020-08-05 17:32:34'),
(4055, 1006, 7959, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Checked via https://join.beaconhealthoptions.com/ received following update: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.  Your application was submitted on 08/03/2020 at 07:04:27 PM EST\" ', NULL, NULL, '2020-08-18 17:12:59', '2020-08-18 17:12:59'),
(4056, 1006, 7959, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Joanna Wood - Application is still in process, nothing else is currently required. Need to check back in a few weeks.  Ref# 09022020-8814267', NULL, NULL, '2020-09-02 17:17:12', '2020-09-02 17:17:12'),
(4057, 1006, 7959, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent a followup email to provider relations asking for updated status as well as to expedite the request. ', NULL, NULL, '2020-09-15 17:02:39', '2020-09-15 17:02:39'),
(4058, 1006, 7959, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Received following email from @ provider.relations@beaconhealthoptions.com:  \"Good morning,  Looking into the request below, I am seeing for the provider Joanna Wood that the application is currently being processed to have her linked to the group.  For the provider Jennifer Lee Ullrich I am unable to see the application yet on file since the provider is not already in our system. If the application as sent in the same way and around the same time this should be in process as well, and a shell should be in the process of being created for this provider.  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-09-16 15:59:41', '2020-09-16 15:59:41'),
(4059, 1006, 7959, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a follow-up email to Kayla @ provider.relations@beaconhealthoptions.com to expedite the request.  ', NULL, NULL, '2020-09-23 15:09:05', '2020-09-23 15:09:05'),
(4060, 1006, 7959, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Received the following update from Kayla:  \"Good Afternoon,  The application is still in process for both of the below providers. Applications typically take from 90-120 days business days and unfortunately there is no way for us to expedite it unless it is past the 120 days.  Thank You!   Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632 www.beaconhealthoptions.com\"', NULL, NULL, '2020-10-05 15:26:36', '2020-10-05 15:26:36'),
(4061, 1006, 7959, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Request still shows up as in process with status \"Under Review\" :  \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.  Your application was submitted on 08/03/2020 at 07:04:27 PM EST  If you have any questions on the enrollment process, please call our National Provider Service Line at 800-397-1630 (Monday through Friday, 8 a.m. to 8 p.m. EST).\"', NULL, NULL, '2020-10-13 10:32:06', '2020-10-13 10:32:06'),
(4062, 1006, 7959, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Sent a followup email to Kayla regarding status:  \"Hello Kayla,   I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status of our provider again, her details are as follows:  Provider Name: Joanna Wood NPI# 1801986054 TIN# 83-4482753  Please get back to me as soon as you\'re able.   Thanks. \"', NULL, NULL, '2020-10-20 16:45:52', '2020-10-20 16:45:52'),
(4063, 1006, 7959, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received the following status update from Kayla:   \"Good morning,  The application for the below provider is still being processed, please allow more time.  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-10-23 09:40:38', '2020-10-23 09:40:38'),
(4064, 1006, 7959, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent followup email to provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the status of enrollment for the following provider:   Provider Name: Joanna Wood NPI# 1801986054 TIN# 83-4482753  Please get back to me ASAP as this provider has been showing up as Under Review for the past 3 months and we need to expedite her credentialing.   Thanks.\"', NULL, NULL, '2020-11-03 18:18:30', '2020-11-03 18:18:30'),
(4065, 1006, 7959, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Received following update from Beacon:   \"Good afternoon,  The application is still being processed. Please allow at least 90-120 days. Please let me know if you have any further questions.  Thank you, Provider Relations II, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 Office: 800.397.1630 www.beaconhealthoptions.com\"', NULL, NULL, '2020-11-10 18:07:48', '2020-11-10 18:07:48'),
(4066, 1006, 7959, NULL, '2020-11-25 00:00:00.000', 'In Process', 'The request is still processing, need to allow more time as per rep. ', NULL, NULL, '2020-11-18 17:18:59', '2020-11-18 17:18:59'),
(4067, 1006, 7959, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in-process, need to allow more time: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.\"', NULL, NULL, '2020-11-25 17:45:49', '2020-11-25 17:45:49'),
(4068, 1006, 7959, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Sent another followup @ provider.relations@beaconhealthoptions.com:  \"Hello,   I want to get an update regarding the enrollment status for the following providers:  Provider Name: Joanna Wood NPI# 1801986054 Provider Name: Jennifer Ullrich NPI# 1710489760 Group NPI# 1356906572  Please get back to me as soon as possible as both these requests have been processing for quite a while.  Thanks.\"', NULL, NULL, '2020-12-07 17:08:52', '2020-12-07 17:08:52'),
(4069, 1006, 7959, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Received reply from Kayla stating that they\'re still processing sent her this email: \"Good afternoon Kayla,   I see, the reason I\'m checking in on these providers is that they\'re both still showing up as \"Under Review\" and neither of their credentialing looks to have been started as of yet. Could you please get them expedited?  Thanks. \"', NULL, NULL, '2020-12-09 14:28:33', '2020-12-09 14:28:33'),
(4070, 1006, 7959, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com.  Sub: Provider Enrollment Status - SNBCare', NULL, NULL, '2020-12-18 15:52:03', '2020-12-18 15:52:03'),
(4071, 1006, 7959, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Request still shows as in-process but representative sent in a request to get it re-evaluated as it\'s been 90+ days. Event# 8773133 Ref# 12292020-0058739 Rep: John N ', NULL, NULL, '2020-12-29 18:03:24', '2020-12-29 18:03:24'),
(4072, 1006, 7959, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Called Beacon but wasn\'t able to reach anyone, requested a call back from them. ', NULL, NULL, '2021-01-15 17:05:01', '2021-01-15 17:05:01'),
(4073, 1006, 7959, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Credentialing is still in process, need to allow more time for the contracts to be sent out.  Ref# 01202021-0292859', NULL, NULL, '2021-01-20 13:05:58', '2021-01-20 13:05:58'),
(4074, 1006, 7959, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:19:55', '2021-02-11 15:19:55'),
(4075, 1006, 7959, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:08:35', '2021-03-03 18:08:35'),
(4076, 1019, 7959, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:43:42', '2021-03-23 10:43:42'),
(4077, 1019, 7959, NULL, '2021-07-01 00:00:00.000', 'Not Eligible', 'Provider is no Longer working with SNBCARE', NULL, NULL, '2021-05-20 08:38:56', '2021-05-20 08:38:56'),
(4078, 1006, 7960, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-05 17:34:16', '2020-08-05 17:34:16'),
(4079, 1006, 7960, NULL, '2020-08-12 00:00:00.000', 'Initiated', 'Submitted enrollment form to Tufts @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com', NULL, NULL, '2020-08-05 17:34:58', '2020-08-05 17:34:58'),
(4080, 1006, 7960, NULL, '2020-08-18 00:00:00.000', 'In Process', 'Sent another followup email to kody_dunnett@tufts-health.com:  Sub: Jennifer Ullrich/Jonathan Schubert/Joanna Wood - SNBCare - Provider Status Update   \"Hey Kody,   I hope you\'re doing well, I wanted to get an update regarding the status of my providers and see if there was any way we could get their request for enrollment expedited, their info is as follows:  Provider Name: Jennifer Ullrich NPI# 1710489760 Provider Name: Jonathan Schubert NPI# 1235755505 Provider Name: Joanna Wood NPI# 1801986054 Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Please get back to me as soon as you\'re able, as no one from the Tufts credentialing has been able to get back to me.   Thank you!\"', NULL, NULL, '2020-08-11 15:14:58', '2020-08-11 15:14:58'),
(4081, 1006, 7960, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Received following update from Kody Dunnett Kody_Dunnett@tufts-health.com>:  \"Hi Brad Joanna C Wood, LICSW – credentialed, in network, but not linked to TIN.  Can you resubmit that app to me?  BH Contracting has been backlogged and a bit understaffed, so their response times have been delayed.  I apologize for the inconvenience.  Thanks Kody\"', NULL, NULL, '2020-08-17 10:42:29', '2020-08-17 10:42:29'),
(4082, 1006, 7960, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Received following update from Kody:   \"Hi Brad  I am honestly not sure, I am hoping soon.  I just sent Joanna’s application over to them.  Thanks\"', NULL, NULL, '2020-08-19 14:34:43', '2020-08-19 14:34:43'),
(4083, 1006, 7960, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Received following confirmation from Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@Tufts-Health.com>:  \"HI Joanna Wood LICSW - ID 498539, in network, linked to TIN 834482753 effective 7.1.2020 Thanks send securely Ref:MSG5716423\"  Need to confirm what plans we are enrolled under for Joanna. ', NULL, NULL, '2020-08-21 09:58:46', '2020-08-21 09:58:46'),
(4084, 1006, 7960, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent a followup email to Kody & Tufts Credentialing regarding what plans we are enrolled under. ', NULL, NULL, '2020-08-26 18:13:09', '2020-08-26 18:13:09'),
(4085, 1006, 7960, NULL, '2020-09-07 00:00:00.000', 'Approved', 'Commercial - 888-884-2404 - Moe: Contracted with Tufts Commercial Eff: 04/01/2019 and linked to group 07/01/2020  Senior - 800-279-9022 - Mirza: contracted with Senior plans Eff: 09/01/2013 and linked to group 07/01/2020', NULL, NULL, '2020-08-31 15:31:49', '2020-08-31 15:31:49'),
(4086, 2027, 7961, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-11 10:26:10', '2020-08-11 10:26:10'),
(4087, 2027, 7961, NULL, '2020-08-18 00:00:00.000', 'Initiated', 'Certification documentation is being requested for this location of vmuc so i have sent those documents by fax as per their request and attached', NULL, NULL, '2020-08-11 10:28:24', '2020-08-11 10:28:24'),
(4088, 2027, 7961, NULL, '2020-10-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  (Rodriguez, Cynthia)-(Valley Med Urgent Care PLLC (McAllen)-(Tricare)  May I know the current enrollment status of the below mentioned provider:  Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Tax-ID: 81-5123542 Please confirm if this provider is showing linked in all three locations of Valley Med Urgent Care.    .Thanks.', NULL, NULL, '2020-10-16 14:43:54', '2020-10-16 14:43:54'),
(4089, 1006, 7961, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Sent a follow-up email to KMoten4@humana.com:  \"Hello,   I wanted to get an update regarding the status of enrollment for the following providers under our group:   Provider Names: Eder Francisco Hernandez NPI# 1386956852 Provider Name: Cynthia Rodriguez NPI# 1124282553  Both of these providers should be coming up under three locations under the given TIN# 81-5123542. Please let me know if you need any additional information.  Thank you. \"', NULL, NULL, '2020-10-23 18:11:50', '2020-10-23 18:11:50'),
(4090, 2027, 7961, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Tricare)  Hi Katherine,  I want to know if this below mentioned provider is enrolled in all three locations of (Valley Med Urgent Care). Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 12:42:16', '2020-10-29 12:42:16'),
(4091, 2027, 7961, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care)-(Tricare)  This is a followup email. Please reply to me as soon as possible  Thanks.', NULL, NULL, '2020-11-05 14:25:06', '2020-11-05 14:25:06'),
(4092, 2037, 7961, NULL, '2020-11-19 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care)-(Tricare)  This is a followup email. Please reply to me as soon as possible  Thanks.', NULL, NULL, '2020-11-12 17:16:09', '2020-11-12 17:16:09'),
(4093, 2027, 7961, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-19 10:46:00', '2020-11-19 10:46:00'),
(4094, 2027, 7961, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  May I know the current status of the below mentioned provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-11-30 15:21:45', '2020-11-30 15:21:45'),
(4095, 2037, 7961, NULL, '2020-12-17 00:00:00.000', 'In Process', 'May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1) Group Name: Columbus Urgent Care PA     Group Tax-ID: 471914151       Provider Name: Jose, Julie                Provider NPI# 1447883061     --------------------------------------- 2)  Group Name: Valley Med Urgent Care (All three locations)      Group Tax-ID: 81-5123542     Provider Name: Rodriguez, Cynthia     Provider NPI# 1124282553      Provider Name: Campos, Moses                Provider NPI# 1558680009      Provider Name: Wright, Larry Donald                Provider NPI# 1033769765', NULL, NULL, '2020-12-08 15:09:05', '2020-12-08 15:09:05'),
(4096, 3040, 7961, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 14:15:01', '2020-12-17 14:15:01'),
(4097, 3040, 7961, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email send to : HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached spreadsheet to add locations for the below providers.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Kindly send me the credentialing application form for Campos, Moses.  Please feel free to email me if you need anything else from my end. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-18 09:44:08', '2020-12-18 09:44:08'),
(4098, 3040, 7961, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia|| || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.  The use of Humana Military’s standard roster template is highly encouraged and will result in more efficient processing times.  The use of other formats requires significant manual processing and slower load times.', NULL, NULL, '2020-12-18 16:00:04', '2020-12-18 16:00:04'),
(4099, 3040, 7961, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email rcvd from:HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.', NULL, NULL, '2020-12-28 12:12:47', '2020-12-28 12:12:47'),
(4100, 3040, 7961, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Email sent to: 	HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the update on the enrollment status of below mentioned providers. We already sent the credential application form for Moses Campos.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-04 16:46:19', '2021-01-04 16:46:19'),
(4101, 3040, 7961, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Follow up Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-11 14:43:11', '2021-01-11 14:43:11'),
(4102, 3040, 7961, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com,   HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-18 13:56:16', '2021-01-18 13:56:16'),
(4103, 3040, 7961, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. The two providers are already certified and the dates are mentioned below.  Practice Detail: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Can you please advise that did you received the credentialing application for below provider.  Provider 3: Provider Name: Wright, Larry Donald Provider NPI# 1033769765   Please feel free to email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:35:34', '2021-01-25 13:35:34'),
(4104, 3040, 7961, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:35:15', '2021-02-01 15:35:15'),
(4105, 3040, 7961, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:52:32', '2021-02-08 13:52:32'),
(4106, 3040, 7961, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-02-15 13:36:34', '2021-02-15 13:36:34'),
(4107, 3040, 7961, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks  ', NULL, NULL, '2021-02-22 13:35:26', '2021-02-22 13:35:26'),
(4108, 3040, 7961, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please note the I checked the provider enrollment status on Tricare portal for below mentioned providers its shows the credentialing is completed but on Tricare provider directory its not showing up. Can you please check and advise.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Cynthia Rodriguez PA Provider NPI# 1124282553  Provider Name: Larry D Wright NP Provider NPI# 1033769765  Also I checked the provider enrollment status for the below mentioned provider its only showing in 02 locations in-process. In McAllen location provider is not showing up. Can you please check this and advise.   Provider Name: Deborah Potter NP Provider NPI# 1861914053  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 16:52:19', '2021-03-01 16:52:19'),
(4109, 3040, 7961, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Missing on Directory || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please find the attached screenshot from the provider directory where the provider is showing at one location only. While on the provider portal the provider is showing in all three locations. Can you please check and advise.   Find below are the details for the facility and provider:   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Cynthia Rodriguez  Provider NPI# 1124282553  I really appreciate all your help. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-11 15:16:16', '2021-03-11 15:16:16'),
(4110, 3040, 7961, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Missing on Directory || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update for me?  Thanks  ', NULL, NULL, '2021-03-18 16:02:51', '2021-03-18 16:02:51'),
(4111, 3040, 7961, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:34', '2021-04-15 08:07:34'),
(4112, 3040, 7961, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 2: Provider Name: Campos, Moses - eff: 3/16/2021 (showing under all 3 locations) Provider NPI# 1558680009', NULL, NULL, '2021-04-15 10:22:29', '2021-04-15 10:22:29'),
(4113, 1006, 7962, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 10:37:53', '2020-08-12 10:37:53'),
(4114, 1006, 7962, NULL, '2020-08-19 00:00:00.000', 'In Process', 'As per my conversation with Katherine Moten, group certification request was sent out:   \"For billing purposes, the Group and Provider need to be certified in the system so that WPS can process claims.  Thank you.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com\"', NULL, NULL, '2020-08-12 10:41:51', '2020-08-12 10:41:51'),
(4115, 2037, 7962, NULL, '2020-10-30 00:00:00.000', 'In Process', 'The certification application  of group is currently being processed.We need to allow more time 10479711. Rep:Jessica.', NULL, NULL, '2020-10-06 15:09:26', '2020-10-06 15:09:26'),
(4116, 2037, 7962, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email sent to K-Moten ---------------------- Hope this email finds you well.   If I may get an update on the certification process submitted on 08/11/2020. The details are as follows:  Group Name: Best Health Urgent Care & ClinicTIN# 84-4737737NPI# 1780192633', NULL, NULL, '2020-10-23 10:21:10', '2020-10-23 10:21:10'),
(4117, 1006, 7962, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent follow-up email to KMoten4@humana.com regarding cert status. ', NULL, NULL, '2020-11-04 15:59:13', '2020-11-04 15:59:13'),
(4118, 1006, 7962, NULL, '2020-11-14 00:00:00.000', 'In Process', 'Received the following update from Katherine:  \"Good Afternoon,  This provider is still showing not certified. Please allow more time.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2020-11-04 16:41:54', '2020-11-04 16:41:54'),
(4119, 2037, 7962, NULL, '2020-11-23 00:00:00.000', 'In Process', '	 Sent follow-up email to KMoten4@humana.com regarding cert status. ', NULL, NULL, '2020-11-16 12:52:43', '2020-11-16 12:52:43'),
(4120, 2037, 7962, NULL, '2020-12-07 00:00:00.000', 'In Process', 'As per the live call the credentialing application for review and a response . Ref#10939955. Need to call after two weeks. Rep: Joey 11/23/2020', NULL, NULL, '2020-11-23 17:03:40', '2020-11-23 17:03:40'),
(4121, 2037, 7962, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up mail sent to Katherine', NULL, NULL, '2020-12-08 15:22:11', '2020-12-08 15:22:11'),
(4122, 2037, 7962, NULL, '2020-12-15 00:00:00.000', 'Approved', 'Received confirmation email from K morten with the effective date 09/04/2020. Confirmation email uploaded.', NULL, NULL, '2020-12-08 16:49:51', '2020-12-08 16:49:51'),
(4123, 3040, 7962, NULL, NULL, 'Revalidation', 'Email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.  Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-06 14:31:25', '2021-04-06 14:31:25'),
(4124, 1005, 7962, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria & Cyriaque, Stephane || Superior Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Tann, Shametria Provider NPI# 1124615612  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-09 16:47:18', '2021-06-09 16:47:18'),
(4125, 1006, 7962, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Please disregard the previous post.   We received the following email from Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  \"Good Afternoon Adil,  It looks like this provider was credential in error.  We do not show we have a contract on file to network this Group tax id. We are only networking Providers based on the need for the area for certain specialties.  This special  As a non-network TRICARE certified provider you can see TRCARE Benes with the following TRICARE plans.\"  Replied with:   \"Hello Yvonne,  I hope you\'re doing well, how does Tricare credential a provider in error, and what is required to get them correctly credentialed in the system? Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-22 12:49:54', '2021-06-22 12:49:54'),
(4126, 1006, 7962, NULL, '2021-07-15 00:00:00.000', 'Revalidation', 'We received the following updates from Yvonne @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  \"Good Morning Brad,  The person who worked this application is new and she failed to check to see if the Group  tax id was network before approving a credentialing application.  When a provider is credential this does not make them network we must have a sign contract agreement on file to activate them as network.  Humana Military do not have a Contract agreement for Best Health Urgent Care and Clinic on file.  We do show the Group and Stephane Cyiraques as non-network and TRICARE certified who can see TRICARE Beneficiaries.  I will check with Contracting to see if they will agree to send a contract agreement for this group tax id to become network and will let you know once I receive a respond back.\"  \"Good Morning Brad,  I am sorry, contracting did not approve to network this provider’s group tax id.  As a non-network TRICARE certified provider the provider can see the following TRICARE Beneficiaries.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult  Thanks, Yvonne\"  Replied with:  \"Hello Yvonne,   I appreciate the update, can you please let me know when we can request for group and provider contracting? As we would appreciate it if we can our providers and group enrolled ASAP. Thank you.\" ', NULL, NULL, '2021-07-08 14:54:25', '2021-07-08 14:54:25'),
(4127, 11056, 7962, NULL, '2021-07-29 00:00:00.000', 'Revalidation', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Good Morning Brad,  I am sorry, contracting did not approve to network this provider’s group tax id.  As a non-network TRICARE certified provider the provider can see the following TRICARE Beneficiaries.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult  Thanks, Yvonne', NULL, NULL, '2021-07-22 11:02:12', '2021-07-22 11:02:12');
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
(4128, 11056, 7962, NULL, '2021-08-03 00:00:00.000', 'Revalidation', 'On Hold   Email received from : ywyatt@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Good Morning Brad,  You can check with us in 6 months to see if the Panel is open to new providers.       As a non-network TRICARE certified  provider you can see TRICARE Beneficiaries who has the following plans     •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult               Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-27 10:45:37', '2021-07-27 10:45:37'),
(4129, 22077, 7962, NULL, '2022-04-21 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: 	Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Hi,  I would like to enroll the following provider  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary & Billing Address	3003 TEXAS PKWY UNIT B MISSOURI CITY, TX 77489-5242 Provider Name	NPI Stephane Cyriaque	1780192633 Shametria Tann	1124615612  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:17:17', '2022-04-14 13:17:17'),
(4130, 1006, 7963, NULL, NULL, 'New/Not Initiated', 'Good afternoon Brad,     We are currently in the process of re-credentialing Nasa Urgent Care Inc. and are in need of an updated application.  The CVO made several attempts to acquire this information from your group, with no success.     Keep in mind that in order for us to complete the credentialing it is imperative we have this document.      Thank you in advance,   Rose Chandler  ', NULL, NULL, '2020-08-12 14:56:52', '2020-08-12 14:56:52'),
(4131, 1006, 7963, NULL, '2020-08-19 00:00:00.000', 'In Process', 'Sent email to \"Chandler, Rose\" Rose.Chandler@communityhealthchoice.org> with the requested application filled out. ', NULL, NULL, '2020-08-12 16:43:42', '2020-08-12 16:43:42'),
(4132, 2037, 7963, NULL, '2020-09-28 00:00:00.000', 'In Process', 'COI sent to rose @ Rose.Chandler@communityhealthchoice.org ------------------------------------- Hi Rose,  As per our conversation over the phone kindly find the attached professional liability insurance for the below : Nasa Urgent Care. Tax ID: 81-3237149.  Please feel free to contact me for any further information if required.  ', NULL, NULL, '2020-09-21 17:17:07', '2020-09-21 17:17:07'),
(4133, 2037, 7963, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Got the confirmation of Receiving. Reference Email as follows: ------------- Hello Sherry,  Information received.  Thank you,  Rose   ', NULL, NULL, '2020-09-23 14:31:10', '2020-09-23 14:31:10'),
(4134, 2037, 7963, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Follow up email sent to rose . Re-credentialing in process.', NULL, NULL, '2020-10-06 17:36:54', '2020-10-06 17:36:54'),
(4135, 2037, 7963, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Response received. --------------------- Hello Sherry,  The MCMC board is scheduled for review on 10/22/2020.  ', NULL, NULL, '2020-10-06 18:02:21', '2020-10-06 18:02:21'),
(4136, 2037, 7963, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Follow up email sent to Rose: ---------------- Hi Rose, If I may get an update on the review  of the MCMC board on the recredentialing process of the below: Nasa Urgent Care.Tax ID: 81-3237149.  Thank you!', NULL, NULL, '2020-10-23 09:32:35', '2020-10-23 09:32:35'),
(4137, 2037, 7963, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Follow up email sent to Jason Trieu:  Hello Jason,  Following up on the signed amended agreement mailed out on the 07th of October to the below address. If I may know by when it will be executed with an effective date.', NULL, NULL, '2020-10-23 09:44:34', '2020-10-23 09:44:34'),
(4138, 2037, 7963, NULL, '2020-11-05 00:00:00.000', 'Approved', 'Approval letter received.Effective 10/22/2020. Plans added in the notes and notification sent out to the billing.', NULL, NULL, '2020-10-29 11:03:12', '2020-10-29 11:03:12'),
(4139, 1006, 7964, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 17:50:57', '2020-08-12 17:50:57'),
(4140, 1006, 7964, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Received following update:  \"PATRICK AYARZAGOITIA, APN 8LH078 issued 07/12/2019 and linked to STATCARE MINOR EMERGENCY CLINIC tax 460575924  In networks as of 04/27/2020 with BLUE ADVANTAGE HMO, BLUE ESSENTIALS HMO, BLUE CHOICE PPO, CHIP, HEALTHSELECT, MEDICARE ADVANTAGE PPO, TEXAS STARKIDS and TEXAS STAR PROGRAM.   He will be due for recredentialing in three years.   Thank you. \"', NULL, NULL, '2020-08-12 17:51:11', '2020-08-12 17:51:11'),
(4141, 1006, 7965, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 17:52:42', '2020-08-12 17:52:42'),
(4142, 1006, 7965, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Received following update:  \"PATRICK AYARZAGOITIA, APN 8LH078 issued 07/12/2019 and linked to STATCARE MINOR EMERGENCY CLINIC tax 460575924  In networks as of 04/27/2020 with BLUE ADVANTAGE HMO, BLUE ESSENTIALS HMO, BLUE CHOICE PPO, CHIP, HEALTHSELECT, MEDICARE ADVANTAGE PPO, TEXAS STARKIDS and TEXAS STAR PROGRAM.   He will be due for recredentialing in three years.   Thank you. \" ', NULL, NULL, '2020-08-12 17:52:53', '2020-08-12 17:52:53'),
(4143, 1006, 7966, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 17:56:23', '2020-08-12 17:56:23'),
(4144, 1006, 7966, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Received following email from SoTexasAncillary SoTexasAncillary@aetna.com>:  Sub: Gonzalez, Mary C - Aetna - RHC  \"Good afternoon Sharon/Rabagos HealthCare, Statcare Minor Emergency Clinic (Aetna provider # 4697325) holds a facility contract under contract # 5240633.  It is a global urgent care facility contract.  As such, we do not perform roster loads for individual physicians/providers or link them to the contract.  The UC facility agreement covers for everything, as it is a global agreement & everything is submitted under the facility.  We do not require separate credentialing for the physicians related to the UC agreement.     Unless the physicians are contracted separately under separate TINs, we do not need to credential or contract the physician(s) separately.  If they are wanting to do separate contracting under a different TIN, then that would need to be directed to the local market.  But it is not required when connected to the UC agreement.     Please let me know if you have any other questions/concerns.     Once UC agreements have been re-assigned, the new person can address any further concerns you might have.  At this time, I’ll continue to address via the SoTexasAncillary@AETNA.com should you have any further questions/concerns.     Thank you,  Elizabeth\"', NULL, NULL, '2020-08-12 17:56:37', '2020-08-12 17:56:37'),
(4145, 1006, 7967, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 17:57:28', '2020-08-12 17:57:28'),
(4146, 1006, 7967, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Received following email from SoTexasAncillary SoTexasAncillary@aetna.com>:  Sub: Gonzalez, Mary C - Aetna - RHC  \"Good afternoon Sharon/Rabagos HealthCare, Statcare Minor Emergency Clinic (Aetna provider # 4697325) holds a facility contract under contract # 5240633.  It is a global urgent care facility contract.  As such, we do not perform roster loads for individual physicians/providers or link them to the contract.  The UC facility agreement covers for everything, as it is a global agreement & everything is submitted under the facility.  We do not require separate credentialing for the physicians related to the UC agreement.     Unless the physicians are contracted separately under separate TINs, we do not need to credential or contract the physician(s) separately.  If they are wanting to do separate contracting under a different TIN, then that would need to be directed to the local market.  But it is not required when connected to the UC agreement.     Please let me know if you have any other questions/concerns.     Once UC agreements have been re-assigned, the new person can address any further concerns you might have.  At this time, I’ll continue to address via the SoTexasAncillary@AETNA.com should you have any further questions/concerns.     Thank you,  Elizabeth\"', NULL, NULL, '2020-08-12 17:57:37', '2020-08-12 17:57:37'),
(4147, 1006, 7968, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 17:59:10', '2020-08-12 17:59:10'),
(4148, 1006, 7968, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Request has been approved:   PROVIDER NAME           PROVIDER PTAN  PROVIDER NPI    EFFECTIVE DATE   END DATE MARY C GONZALEZ NP      P02490924       1952713083         05/01/2020             N/A', NULL, NULL, '2020-08-12 17:59:19', '2020-08-12 17:59:19'),
(4149, 1006, 7969, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 18:00:49', '2020-08-12 18:00:49'),
(4150, 1006, 7969, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Request has been approved:   PROVIDER NAME           PROVIDER PTAN  PROVIDER NPI    EFFECTIVE DATE   END DATE MARY C GONZALEZ NP      P02490924       1952713083         05/01/2020             N/A', NULL, NULL, '2020-08-12 18:00:58', '2020-08-12 18:00:58'),
(4151, 1006, 7970, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 18:03:23', '2020-08-12 18:03:23'),
(4152, 1006, 7970, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Provider is effective on 7/21/2020, all locations are updated. Welcome letter and location update is attached.  ', NULL, NULL, '2020-08-12 18:03:31', '2020-08-12 18:03:31'),
(4153, 1006, 7971, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-12 18:04:33', '2020-08-12 18:04:33'),
(4154, 1006, 7971, NULL, '2020-08-19 00:00:00.000', 'In Process', 'Provider is effective on 7/21/2020, all locations are updated. Welcome letter and location update is attached.  ', NULL, NULL, '2020-08-12 18:04:41', '2020-08-12 18:04:41'),
(4155, 1006, 7971, NULL, '2020-08-19 00:00:00.000', 'Approved', NULL, NULL, NULL, '2020-08-12 18:05:28', '2020-08-12 18:05:28'),
(4156, 2027, 7972, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-13 13:08:16', '2020-08-13 13:08:16'),
(4157, 2027, 7972, NULL, '2020-08-20 00:00:00.000', 'Approved', 'Re credentialing of the provider has been done approval letter has attached effective date is 7/1/2020', NULL, NULL, '2020-08-13 13:09:51', '2020-08-13 13:09:51'),
(4158, 20067, 7972, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Attached is the welcome letter', NULL, NULL, '2022-03-10 09:45:38', '2022-03-10 09:45:38'),
(4159, 2027, 7973, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-13 13:57:31', '2020-08-13 13:57:31'),
(4160, 2027, 7973, NULL, '2020-08-20 00:00:00.000', 'Approved', 'Re credentialing of the provider has been done approval letter has attached effective date is 7/8/2020', NULL, NULL, '2020-08-13 14:06:07', '2020-08-13 14:06:07'),
(4161, 1006, 7974, NULL, NULL, 'New/Not Initiated', 'Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	20226001329 NPI :	1356321509', NULL, NULL, '2020-08-13 17:29:58', '2020-08-13 17:29:58'),
(4162, 1006, 7974, NULL, '2020-08-20 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2020-08-13 17:30:19', '2020-08-13 17:30:19'),
(4163, 1006, 7974, NULL, '2020-09-04 00:00:00.000', 'In Process', 'Request is still in-process. ', NULL, NULL, '2020-08-28 10:26:02', '2020-08-28 10:26:02'),
(4164, 2027, 7974, NULL, '2020-09-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 08/13/2018', NULL, NULL, '2020-09-17 12:33:16', '2020-09-17 12:33:16'),
(4165, 1006, 7975, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-14 17:00:17', '2020-08-14 17:00:17'),
(4166, 1006, 7975, NULL, '2020-08-21 00:00:00.000', 'Approved', 'Attached provider roster with plans and effective date mentioned.  ', NULL, NULL, '2020-08-14 17:03:55', '2020-08-14 17:03:55'),
(4167, 1006, 7976, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-14 17:06:23', '2020-08-14 17:06:23'),
(4168, 1006, 7976, NULL, '2020-08-21 00:00:00.000', 'Approved', 'Attached provider roster with plans and effective date mentioned.  ', NULL, NULL, '2020-08-14 17:06:33', '2020-08-14 17:06:33'),
(4169, 2027, 7977, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 10:53:51', '2020-08-18 10:53:51'),
(4170, 2027, 7977, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Call to insurance: Talk to the representative the provider is now showing in network with effective date 7/1/2020 Screenshot from provider directory is attached and plans are mentioned below. Teresa Saavedra-Star+plus-All 3 locations  Teresa Saavedra-Star Kids-All 3 locations  Teresa Saavedra-Star Health-All 3 locations  Teresa Saavedra-Star-All 3 locations  Teresa Saavedra-Chip RSA-All 3 locations  Teresa Saavedra-Chip Perinate-All 3 locations Teresa Saavedra-Chip-All 3 locations Teresa Saavedra- Allwell Medicare HMO-All 3 locations Teresa Saavedra-Allwell Dual Medicare HMO SNP-All 3 locations', NULL, NULL, '2020-08-18 10:55:09', '2020-08-18 10:55:09'),
(4171, 2027, 7978, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 12:30:42', '2020-08-18 12:30:42'),
(4172, 2027, 7978, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Online application has been submitted and screenshot attached', NULL, NULL, '2020-08-18 12:31:23', '2020-08-18 12:31:23'),
(4173, 2027, 7978, NULL, '2020-08-25 00:00:00.000', 'In Process', 'From: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Dear Provider,     Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our growing network. We continuously strive to maintain a strong network of providers to satisfy the needs of our valued members.      Furthermore, we have reviewed your online application to contract submitted on 7/29/2020 and determined based on your specialty and geographic location;  Longpoint Medical Center would be an ideal contender to join our network of providers. We have forwarded your application to the next step in the contracting process; where it has been assigned to one of our team of Contract Managers. A Contract Manager will be in contact with you shortly to gather additional information required, and to guide you through the contracting process.     Thank you again and we are truly excited to have you become a part of our network.     Best Regards', NULL, NULL, '2020-08-18 12:34:10', '2020-08-18 12:34:10'),
(4174, 2027, 7978, NULL, '2020-08-31 00:00:00.000', 'In Process', 'From: Jose.Herrera@bswhealth.org  Martin,   I have not received a response to my original request for documents on 8/20/2020.   current W9 Coverage of Insurance document. Type of providers and number of providers A list of CPT codes/services that you will be billing   Thank you,', NULL, NULL, '2020-08-24 14:25:17', '2020-08-24 14:25:17'),
(4175, 2027, 7978, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To; Jose.Herrera@bswhealth.org  Please give me 2 or 3 days. I am gathering the required information which you have asked for and I will send you all the necessary documents within 3 days.  Thanks.   ', NULL, NULL, '2020-08-24 14:25:50', '2020-08-24 14:25:50'),
(4176, 2027, 7978, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: Jose.Herrera@bswhealth.org  Sub: new contract request - Longpoint Medical Center  Sorry for the late response. Please find the requested documents and (CPT) codes attached in this email to start the process. We have 16 providers in this location and below are the types of providers mentioned. 1-MD 2-FNP 3-NP   	Top 25 CPT\'s List	  CPT Codes	Description	  99202	OFFICE/OUTPATIENT VISIT NEW	  99203	OFFICE/OUTPATIENT VISIT NEW	  99204	OFFICE/OUTPATIENT VISIT NEW	  99205	OFFICE/OUTPATIENT VISIT NEW	  99212	OFFICE/OUTPATIENT VISIT EST	  99213	OFFICE/OUTPATIENT VISIT EST	  99214	OFFICE/OUTPATIENT VISIT EST	  99215	OFFICE/OUTPATIENT VISIT EST	  96372	THER/PROPH/DIAG INJ SC/IM	  94640	AIRWAY INHALATION TREATMENT	  93000	ELECTROCARDIOGRAM COMPLETE	  93010	ELECTROCARDIOGRAM REPORT	  92551	PURE TONE HEARING TEST AIR	  94760	MEASURE BLOOD OXYGEN LEVEL	  97602	WOUND(S) CARE NON-SELECTIVE	  99000	SPECIMEN HANDLING OFFICE-LAB	  81003	URINALYSIS AUTO W/O SCOPE	  81025	URINE PREGNANCY TEST	  83036	GLYCOSYLATED HEMOGLOBIN TEST	  86677	HELICOBACTER PYLORI ANTIBODY	  87635	SARS-COV-2 COVID-19 AMP PRB	  86769	SARS-COV-2 COVID-19 ANTIBODY	  87804	INFLUENZA ASSAY W/OPTIC	  87807	RSV ASSAY W/OPTIC	  87880	STREP A ASSAY W/OPTIC	    Thanks.', NULL, NULL, '2020-09-01 16:00:10', '2020-09-01 16:00:10'),
(4177, 2027, 7978, NULL, '2020-09-08 00:00:00.000', 'In Process', 'From: Jose.Herrera@bswhealth.org  I am out of the office and returning on Wednesday September 2, 2020.  I will have no access to e-mail.  Please expect a delay in my response to your e-mail', NULL, NULL, '2020-09-01 17:58:34', '2020-09-01 17:58:34'),
(4178, 2027, 7978, NULL, '2020-09-21 00:00:00.000', 'In Process', 'From: Jose.Herrera@bswhealth.org  Martin,     Attached are the credentialing documents for Longpoint Medical PA dba Longpoint Medical Center.     Please be sure to filling ALL information on ALL pages of the documents and return to me.     Thank you,', NULL, NULL, '2020-09-14 13:48:55', '2020-09-14 13:48:55'),
(4179, 2027, 7978, NULL, '2020-09-21 00:00:00.000', 'In Process', 'To: Jose.Herrera@bswhealth.org  Please find the requested credentialing documents attached in this email.  Thanks. ', NULL, NULL, '2020-09-14 13:49:27', '2020-09-14 13:49:27'),
(4180, 1006, 7978, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for status update. ', NULL, NULL, '2020-10-16 14:18:32', '2020-10-16 14:18:32'),
(4181, 2037, 7978, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for status update. ', NULL, NULL, '2020-10-28 17:13:09', '2020-10-28 17:13:09'),
(4182, 2027, 7978, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: Jose.Herrera@bswhealth.org  May I know the current status of this request  Thanks.', NULL, NULL, '2020-11-04 15:20:17', '2020-11-04 15:20:17'),
(4183, 2027, 7978, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: Jose.Herrera@bswhealth.org  Martin,     The credentialing is complete and I am awaiting to execute the contract.  I should have it completed sometime next week and be able to provide you an effective date at that time.      Thank you,     Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2020-11-04 15:54:08', '2020-11-04 15:54:08'),
(4184, 2027, 7978, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: Jose.Herrera@bswhealth.org  May I know the current status of the request.  Thanks.', NULL, NULL, '2020-11-11 14:53:16', '2020-11-11 14:53:16'),
(4185, 2027, 7978, NULL, '2020-11-18 00:00:00.000', 'Approved', 'From: Jose.Herrera@bswhealth.org  Martin,     Attached is an executed copy of the contract with an effective date of 12/01/2020.     The effective date is when you can start seeing our members.     Benefit networks have not been loaded in our system yet.  If you do submit claims after 12/01/2020, the claims may deny.  You will be able to appeal any clams after 12/01/2020.      Thank you,     Jose Herrera', NULL, NULL, '2020-11-11 17:49:25', '2020-11-11 17:49:25'),
(4186, 2027, 7979, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 12:46:58', '2020-08-18 12:46:58'),
(4187, 2027, 7979, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Group is contracted with ambetter effective date is 7/1/2017 screenshot from provider directory is attached for confirmation purpose ', NULL, NULL, '2020-08-18 12:49:01', '2020-08-18 12:49:01'),
(4188, 2027, 7980, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 12:59:53', '2020-08-18 12:59:53'),
(4189, 2027, 7980, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Call to insurance: Talk to the representative the provider is now showing in network with effective date 7/1/2020 Screenshot from provider directory is attached', NULL, NULL, '2020-08-18 13:02:31', '2020-08-18 13:02:31'),
(4190, 2027, 7981, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 13:27:55', '2020-08-18 13:27:55'),
(4191, 2027, 7981, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Call to insurance: Talk to the representative the provider is now showing in network with effective date 7/1/2020 Screenshot from provider directory is attached', NULL, NULL, '2020-08-18 13:28:31', '2020-08-18 13:28:31'),
(4192, 2027, 7982, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 14:03:15', '2020-08-18 14:03:15'),
(4193, 2027, 7982, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Provider is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 14:07:10', '2020-08-18 14:07:10'),
(4194, 2027, 7983, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 14:14:19', '2020-08-18 14:14:19'),
(4195, 2027, 7983, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Provider is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 14:14:55', '2020-08-18 14:14:55'),
(4196, 2027, 7984, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 14:19:34', '2020-08-18 14:19:34'),
(4197, 2027, 7984, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Provider is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 14:20:48', '2020-08-18 14:20:48'),
(4198, 2037, 7985, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 14:44:39', '2020-08-18 14:44:39'),
(4199, 2037, 7985, NULL, '2020-08-25 00:00:00.000', 'Initiated', 'Reassigned the benefits to the group \"Bay Area Quick Care PLLC \" through PECOS.Below are the details along with the tracking number. Enrollment Tracking Information Applicant Name: WILLIAM FRANCIS   Tracking ID: T081820200003479  Submitted Date: TUE - AUGUST 18 2020 03:41:26 PM EST  Submitted By: William Francis  Contact Email(s): SD@CLAIMSMEDINC.COM PANSON@MIAMIDADEBILLING.COM WTFGLOBAL@GMAIL.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare.', NULL, NULL, '2020-08-18 14:50:06', '2020-08-18 14:50:06'),
(4200, 2037, 7985, NULL, '2020-08-31 00:00:00.000', 'Approved', 'Recevied confirmation letter from Medicare. PTAN: 1G0803. Effective Date: 08/01/2020.', NULL, NULL, '2020-08-24 14:20:29', '2020-08-24 14:20:29'),
(4201, 2027, 7986, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 15:00:51', '2020-08-18 15:00:51'),
(4202, 2027, 7986, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Provider is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 15:04:22', '2020-08-18 15:04:22'),
(4203, 2027, 7987, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 15:08:22', '2020-08-18 15:08:22'),
(4204, 2027, 7987, NULL, '2020-08-25 00:00:00.000', 'New/Not Initiated', 'Provider is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 15:09:40', '2020-08-18 15:09:40'),
(4205, 2027, 7987, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-19 10:14:22', '2020-08-19 10:14:22'),
(4206, 2027, 7988, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-18 17:34:25', '2020-08-18 17:34:25'),
(4207, 2027, 7988, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Group is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 17:35:17', '2020-08-18 17:35:17'),
(4208, 2027, 7989, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 10:43:57', '2020-08-19 10:43:57'),
(4209, 2027, 7989, NULL, '2020-08-26 00:00:00.000', 'Approved', '	 Provider is contracted with medicaid and effective date is 5/8/2020', NULL, NULL, '2020-08-19 10:44:17', '2020-08-19 10:44:17'),
(4210, 2027, 7990, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 12:03:54', '2020-08-19 12:03:54'),
(4211, 2027, 7990, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Attestation has been done transaction screenshot is attached ', NULL, NULL, '2020-08-19 12:05:29', '2020-08-19 12:05:29'),
(4212, 2027, 7990, NULL, '2020-08-26 00:00:00.000', 'In Process', 'From: RosterStatus@uhc.com  UHC Logo  Thanks for using My Practice Profile to submit demographic updates to your care provider data. We\'re processing your request. Your request number is GL000001122467  How to Check the Status of Your Updates To access My Practice Profile, sign in to Link by clicking on the Link button in the top right corner of UHCprovider.com. Then, select the My Practice Profile tile on your Link dashboard. Click My Practice Profile in the top left corner and choose Transaction Status. Click on GL000001122467 from the list on the main page or type GL000001122467 in the search bar to see the details of your request.  Learn More Want to learn more about using My Practice Profile to view, update and attest to the care provider demographic information UnitedHealthcare members see for your organization? Go to UHCprovider.com/mpp for an interactive guide, videos and training.  We\'re Here to Help If you have questions about using My Practice Profile, please call the UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 1, from 7 a.m. to 9 p.m. Central Time, Monday through Friday. For all other questions, please call Provider Services at 877-842-3210. Thank you.', NULL, NULL, '2020-08-19 12:13:21', '2020-08-19 12:13:21'),
(4213, 2027, 7990, NULL, '2020-10-28 00:00:00.000', 'Approved', 'This is an ancillary contract and effective date is 11/05/2015', NULL, NULL, '2020-10-21 10:04:52', '2020-10-21 10:04:52'),
(4214, 2027, 7991, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 12:23:24', '2020-08-19 12:23:24'),
(4215, 2027, 7991, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and effective date is 6/1/2017', NULL, NULL, '2020-08-19 12:24:43', '2020-08-19 12:24:43'),
(4216, 2027, 7992, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 12:29:51', '2020-08-19 12:29:51'),
(4217, 2027, 7992, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and effective date is 6/1/2017', NULL, NULL, '2020-08-19 12:30:42', '2020-08-19 12:30:42'),
(4218, 2037, 7993, NULL, NULL, 'New/Not Initiated', 'Received a request for Dehnisch, Frank\'s Malpractice Face-sheet via fax.I have attached Frank\'s COI and faxed back to Mulitiplan @ 844-835-5544 for re-credentialing process.Document uploaded to CAQH aswell with the Expiry date of 07-20-2021.', NULL, NULL, '2020-08-19 12:34:36', '2020-08-19 12:34:36'),
(4219, 2037, 7993, NULL, '2020-10-21 00:00:00.000', 'In Process', 'As per live call the professional liability insurance for Fran was received and the  re credentialing is currently being processed. Case#7381635.The file will be updated Within 10 Business days. Sam.R', NULL, NULL, '2020-10-07 17:07:42', '2020-10-07 17:07:42'),
(4220, 2037, 7993, NULL, '2020-10-20 00:00:00.000', 'Approved', 'Received a confirmation fax from Multiplan notifying the successful re credentialing of Frank effective 09/17/2020. Multiplan & PHCS.Notification Sent to the billing', NULL, NULL, '2020-10-13 15:01:49', '2020-10-13 15:01:49'),
(4221, 2027, 7994, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 14:00:01', '2020-08-19 14:00:01'),
(4222, 2027, 7994, NULL, '2020-08-26 00:00:00.000', 'New/Not Initiated', 'Provider is now contracted with medicaid effective date is 7/25/2018', NULL, NULL, '2020-08-19 14:01:31', '2020-08-19 14:01:31'),
(4223, 1005, 7994, NULL, '2020-09-01 00:00:00.000', 'Approved', 'Just updating task status.', NULL, NULL, '2020-08-25 14:07:07', '2020-08-25 14:07:07'),
(4224, 2027, 7995, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 14:07:14', '2020-08-19 14:07:14'),
(4225, 2027, 7995, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is now contracted with medicaid effective date is 7/25/2018', NULL, NULL, '2020-08-19 14:08:27', '2020-08-19 14:08:27'),
(4226, 2027, 7996, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 14:11:13', '2020-08-19 14:11:13'),
(4227, 2027, 7996, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is now contracted with medicaid effective date is 7/25/2018', NULL, NULL, '2020-08-19 14:11:28', '2020-08-19 14:11:28'),
(4228, 2027, 7997, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 14:32:13', '2020-08-19 14:32:13'),
(4229, 2027, 7997, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and the effective date is 6/14/2018', NULL, NULL, '2020-08-19 14:33:13', '2020-08-19 14:33:13'),
(4230, 2027, 7998, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 14:37:06', '2020-08-19 14:37:06'),
(4231, 2027, 7998, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and the effective date is 6/14/2018 ', NULL, NULL, '2020-08-19 14:37:19', '2020-08-19 14:37:19'),
(4232, 2027, 7999, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 15:09:41', '2020-08-19 15:09:41'),
(4233, 2027, 7999, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and effective date is 12/29/2018', NULL, NULL, '2020-08-19 15:11:13', '2020-08-19 15:11:13'),
(4234, 2027, 8000, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 15:14:49', '2020-08-19 15:14:49'),
(4235, 2027, 8000, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and effective date is 12/29/2018', NULL, NULL, '2020-08-19 15:15:09', '2020-08-19 15:15:09'),
(4236, 2027, 8001, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 15:18:26', '2020-08-19 15:18:26'),
(4237, 2027, 8001, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and effective date is 12/29/2018', NULL, NULL, '2020-08-19 15:18:41', '2020-08-19 15:18:41'),
(4238, 1006, 8002, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:36:42', '2020-08-19 16:36:42'),
(4239, 1006, 8002, NULL, '2020-08-26 00:00:00.000', 'Initiated', 'Submitted online enrollment request for group/provider. ', NULL, NULL, '2020-08-19 16:37:28', '2020-08-19 16:37:28'),
(4240, 1006, 8002, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com   800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\"', NULL, NULL, '2020-09-29 09:16:35', '2020-09-29 09:16:35'),
(4241, 1006, 8002, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com.  ', NULL, NULL, '2020-10-15 17:31:12', '2020-10-15 17:31:12'),
(4242, 1006, 8002, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email to behavioralhealthproviderservices@humana.com regarding a status update. ', NULL, NULL, '2020-10-22 17:54:58', '2020-10-22 17:54:58'),
(4243, 1006, 8002, NULL, '2020-11-13 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169411049', NULL, NULL, '2020-10-30 10:37:10', '2020-10-30 10:37:10'),
(4244, 1006, 8002, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com ', NULL, NULL, '2020-11-06 18:04:53', '2020-11-06 18:04:53'),
(4245, 1006, 8002, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:01:27', '2020-11-16 18:01:27'),
(4246, 1006, 8002, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:21:25', '2020-11-30 15:21:25'),
(4247, 1006, 8002, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:12:24', '2020-12-10 18:12:24'),
(4248, 1006, 8002, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-22 14:05:07', '2020-12-22 14:05:07'),
(4249, 1006, 8002, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:36:29', '2020-12-29 16:36:29'),
(4250, 1006, 8002, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:23', '2021-01-15 17:43:23'),
(4251, 1006, 8002, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:00', '2021-01-28 10:53:00'),
(4252, 1006, 8002, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com', NULL, NULL, '2021-02-09 13:27:25', '2021-02-09 13:27:25'),
(4253, 1006, 8002, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com', NULL, NULL, '2021-02-09 13:27:32', '2021-02-09 13:27:32'),
(4254, 1006, 8002, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:56:29', '2021-02-10 09:56:29'),
(4255, 1006, 8002, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:49:55', '2021-03-02 11:49:55'),
(4256, 1019, 8002, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:36:05', '2021-04-19 10:36:05'),
(4257, 1019, 8002, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com SUB: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We haven\'t received any welcome letters for the following providers and our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632   Regards, Alex ', NULL, NULL, '2021-04-20 14:32:12', '2021-04-20 14:32:12'),
(4258, 1019, 8002, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to ask you guys for the welcome letters. Can you please send us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Regards, Alex', NULL, NULL, '2021-04-23 15:04:29', '2021-04-23 15:04:29'),
(4259, 1019, 8002, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:49', '2021-06-10 09:43:49'),
(4260, 1019, 8002, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:47:38', '2021-06-11 11:47:38'),
(4261, 1006, 8003, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:36:44', '2020-08-19 16:36:44'),
(4262, 1006, 8003, NULL, '2020-08-26 00:00:00.000', 'Initiated', 'Submitted online enrollment request for group/provider.  ', NULL, NULL, '2020-08-19 16:38:04', '2020-08-19 16:38:04'),
(4263, 1006, 8003, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com   800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\"', NULL, NULL, '2020-09-29 09:17:12', '2020-09-29 09:17:12'),
(4264, 1006, 8003, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com.  ', NULL, NULL, '2020-10-15 17:31:34', '2020-10-15 17:31:34'),
(4265, 1006, 8003, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email to behavioralhealthproviderservices@humana.com regarding a status update. ', NULL, NULL, '2020-10-22 17:55:13', '2020-10-22 17:55:13'),
(4266, 1006, 8003, NULL, '2020-11-13 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169412028', NULL, NULL, '2020-10-30 10:38:49', '2020-10-30 10:38:49'),
(4267, 1006, 8003, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com ', NULL, NULL, '2020-11-06 18:04:41', '2020-11-06 18:04:41'),
(4268, 1006, 8003, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:01:37', '2020-11-16 18:01:37'),
(4269, 1006, 8003, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:21:44', '2020-11-30 15:21:44'),
(4270, 1006, 8003, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:12:42', '2020-12-10 18:12:42'),
(4271, 1006, 8003, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-22 14:07:30', '2020-12-22 14:07:30'),
(4272, 1006, 8003, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:36:09', '2020-12-29 16:36:09'),
(4273, 1006, 8003, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:29', '2021-01-15 17:43:29'),
(4274, 1006, 8003, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:13', '2021-01-28 10:53:13'),
(4275, 1006, 8003, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com', NULL, NULL, '2021-02-09 13:27:59', '2021-02-09 13:27:59'),
(4276, 1006, 8003, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:56:48', '2021-02-10 09:56:48'),
(4277, 1006, 8003, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:51:54', '2021-03-02 11:51:54'),
(4278, 1019, 8003, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from : mtasby2@humana.com Good Morning Alex, Executed agreements are mailed upon approval and completion.  All providers listed on the attached roster is link to group \'Spectrum Neuro Behavioral Care LLC\' effective 4/1/2021.  When adding new locations, complete the attached roster (facility tab) (roster tab) Please Note: you only need to list new information pertaining to additional location.    Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations', NULL, NULL, '2021-04-05 08:31:52', '2021-04-05 08:31:52'),
(4279, 1019, 8003, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:38:03', '2021-04-19 10:38:03'),
(4280, 1019, 8003, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021', NULL, NULL, '2021-04-20 10:03:22', '2021-04-20 10:03:22'),
(4281, 1006, 8004, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:36:45', '2020-08-19 16:36:45'),
(4282, 1006, 8004, NULL, '2020-08-26 00:00:00.000', 'Initiated', 'Submitted online enrollment request for group/provider.  ', NULL, NULL, '2020-08-19 16:38:27', '2020-08-19 16:38:27'),
(4283, 1006, 8004, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Sent followup email to credentialinginquiries@humana.com regarding status. ', NULL, NULL, '2020-09-24 14:23:14', '2020-09-24 14:23:14'),
(4284, 1006, 8004, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com 800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\"', NULL, NULL, '2020-09-29 09:17:44', '2020-09-29 09:17:44'),
(4285, 1006, 8004, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com.  ', NULL, NULL, '2020-10-15 17:31:49', '2020-10-15 17:31:49'),
(4286, 1006, 8004, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email to behavioralhealthproviderservices@humana.com regarding a status update. ', NULL, NULL, '2020-10-22 17:55:25', '2020-10-22 17:55:25'),
(4287, 1006, 8004, NULL, '2020-11-13 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169412791', NULL, NULL, '2020-10-30 10:43:05', '2020-10-30 10:43:05');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(4288, 1006, 8004, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com ', NULL, NULL, '2020-11-06 18:04:34', '2020-11-06 18:04:34'),
(4289, 1006, 8004, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:01:48', '2020-11-16 18:01:48'),
(4290, 1006, 8004, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:22:13', '2020-11-30 15:22:13'),
(4291, 1006, 8004, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:12:54', '2020-12-10 18:12:54'),
(4292, 1006, 8004, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-24 10:44:17', '2020-12-24 10:44:17'),
(4293, 1006, 8004, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:35:59', '2020-12-29 16:35:59'),
(4294, 1006, 8004, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:35', '2021-01-15 17:43:35'),
(4295, 1006, 8004, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:26', '2021-01-28 10:53:26'),
(4296, 1006, 8004, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Sent another follow-up email as the previous email wasn\'t receiving messages. ', NULL, NULL, '2021-01-29 16:44:57', '2021-01-29 16:44:57'),
(4297, 1006, 8004, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com ', NULL, NULL, '2021-02-09 13:29:04', '2021-02-09 13:29:04'),
(4298, 1006, 8004, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:57:02', '2021-02-10 09:57:02'),
(4299, 1006, 8004, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:52:01', '2021-03-02 11:52:01'),
(4300, 1019, 8004, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from : mtasby2@humana.com  Good Morning Alex, Executed agreements are mailed upon approval and completion.  All providers listed on the attached roster is link to group \'Spectrum Neuro Behavioral Care LLC\' effective 4/1/2021.  When adding new locations, complete the attached roster (facility tab) (roster tab) Please Note: you only need to list new information pertaining to additional location.    Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations', NULL, NULL, '2021-04-05 08:48:40', '2021-04-05 08:48:40'),
(4301, 1019, 8004, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:38:44', '2021-04-19 10:38:44'),
(4302, 1019, 8004, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 10:15:57', '2021-04-20 10:15:57'),
(4303, 1006, 8005, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:36:46', '2020-08-19 16:36:46'),
(4304, 1006, 8005, NULL, '2020-08-26 00:00:00.000', 'Initiated', 'Submitted online enrollment request for group/provider.  ', NULL, NULL, '2020-08-19 16:38:52', '2020-08-19 16:38:52'),
(4305, 1006, 8005, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com   800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\"', NULL, NULL, '2020-09-29 09:16:14', '2020-09-29 09:16:14'),
(4306, 1006, 8005, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com.  ', NULL, NULL, '2020-10-15 17:31:01', '2020-10-15 17:31:01'),
(4307, 1006, 8005, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email to behavioralhealthproviderservices@humana.com regarding a status update. ', NULL, NULL, '2020-10-22 17:54:46', '2020-10-22 17:54:46'),
(4308, 1006, 8005, NULL, '2020-11-13 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169409511', NULL, NULL, '2020-10-30 10:35:51', '2020-10-30 10:35:51'),
(4309, 1006, 8005, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com ', NULL, NULL, '2020-11-06 18:05:05', '2020-11-06 18:05:05'),
(4310, 1006, 8005, NULL, '2020-11-27 00:00:00.000', 'New/Not Initiated', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:02:01', '2020-11-16 18:02:01'),
(4311, 1006, 8005, NULL, '2020-11-27 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-20 11:22:27', '2020-11-20 11:22:27'),
(4312, 1006, 8005, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:22:03', '2020-11-30 15:22:03'),
(4313, 1006, 8005, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:13:00', '2020-12-10 18:13:00'),
(4314, 1006, 8005, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-24 10:44:33', '2020-12-24 10:44:33'),
(4315, 1006, 8005, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:35:51', '2020-12-29 16:35:51'),
(4316, 1006, 8005, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:39', '2021-01-15 17:43:39'),
(4317, 1006, 8005, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:31', '2021-01-28 10:53:31'),
(4318, 1006, 8005, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com ', NULL, NULL, '2021-02-09 13:29:13', '2021-02-09 13:29:13'),
(4319, 1006, 8005, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:57:13', '2021-02-10 09:57:13'),
(4320, 1006, 8005, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:52:07', '2021-03-02 11:52:07'),
(4321, 1019, 8005, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from : mtasby2@humana.com  Good Morning Alex, Executed agreements are mailed upon approval and completion.  All providers listed on the attached roster is link to group \'Spectrum Neuro Behavioral Care LLC\' effective 4/1/2021.  When adding new locations, complete the attached roster (facility tab) (roster tab) Please Note: you only need to list new information pertaining to additional location.    Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations', NULL, NULL, '2021-04-05 08:49:16', '2021-04-05 08:49:16'),
(4322, 1019, 8005, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:39:08', '2021-04-19 10:39:08'),
(4323, 1019, 8005, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 11:27:02', '2021-04-20 11:27:02'),
(4324, 1006, 8006, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:48:33', '2020-08-19 16:48:33'),
(4325, 1006, 8006, NULL, '2020-08-26 00:00:00.000', 'Initiated', 'Submitted online enrollment request for group/provider.  ', NULL, NULL, '2020-08-19 16:49:43', '2020-08-19 16:49:43'),
(4326, 1006, 8006, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Sent followup email to credentialinginquiries@humana.com regarding status. ', NULL, NULL, '2020-09-24 14:23:05', '2020-09-24 14:23:05'),
(4327, 1006, 8006, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com   800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\" ', NULL, NULL, '2020-09-29 10:03:12', '2020-09-29 10:03:12'),
(4328, 1006, 8006, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to behavioralhealthproviderservices@humana.com regarding status. ', NULL, NULL, '2020-10-16 10:19:44', '2020-10-16 10:19:44'),
(4329, 1006, 8006, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email to behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to get an update regarding the credentialing/contracting status for the following providers:  Name: Prisca Hefti NPI# 1508133182 Name: Fauzia Wali-Khan NPI# 1699761965 Name: Mahreen Rashid NPI# 1396393146 Name: Katie Tawakol NPI# 1609222116 TIN# 83-4482753  Please get back to me as soon as you\'re able.   Thank you!\"', NULL, NULL, '2020-10-23 17:42:39', '2020-10-23 17:42:39'),
(4330, 1006, 8006, NULL, '2020-11-06 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169411049', NULL, NULL, '2020-10-30 10:38:27', '2020-10-30 10:38:27'),
(4331, 1006, 8006, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-11-06 18:01:51', '2020-11-06 18:01:51'),
(4332, 1006, 8006, NULL, '2020-11-27 00:00:00.000', 'New/Not Initiated', NULL, NULL, NULL, '2020-11-16 18:02:08', '2020-11-16 18:02:08'),
(4333, 1006, 8006, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:02:18', '2020-11-16 18:02:18'),
(4334, 1006, 8006, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:21:07', '2020-11-30 15:21:07'),
(4335, 1006, 8006, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:12:36', '2020-12-10 18:12:36'),
(4336, 1006, 8006, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-22 14:05:16', '2020-12-22 14:05:16'),
(4337, 1006, 8006, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:36:37', '2020-12-29 16:36:37'),
(4338, 1006, 8006, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:46', '2021-01-15 17:43:46'),
(4339, 1006, 8006, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:36', '2021-01-28 10:53:36'),
(4340, 1006, 8006, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com ', NULL, NULL, '2021-02-09 13:29:28', '2021-02-09 13:29:28'),
(4341, 1006, 8006, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:57:25', '2021-02-10 09:57:25'),
(4342, 1006, 8006, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:52:13', '2021-03-02 11:52:13'),
(4343, 1019, 8006, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from : mtasby2@humana.com  Good Morning Alex, Executed agreements are mailed upon approval and completion.  All providers listed on the attached roster is link to group \'Spectrum Neuro Behavioral Care LLC\' effective 4/1/2021.  When adding new locations, complete the attached roster (facility tab) (roster tab) Please Note: you only need to list new information pertaining to additional location.    Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations', NULL, NULL, '2021-04-05 08:49:43', '2021-04-05 08:49:43'),
(4344, 1019, 8006, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:37:21', '2021-04-19 10:37:21'),
(4345, 1019, 8006, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com SUB: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We haven\'t received any welcome letters for the following providers and our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632   Regards, Alex ', NULL, NULL, '2021-04-20 14:32:35', '2021-04-20 14:32:35'),
(4346, 1019, 8006, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to ask you guys for the welcome letters. Can you please send us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Regards, Alex', NULL, NULL, '2021-04-23 15:06:48', '2021-04-23 15:06:48'),
(4347, 1019, 8006, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:42', '2021-06-10 09:43:42'),
(4348, 1019, 8006, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:46:51', '2021-06-11 11:46:51'),
(4349, 1006, 8007, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:48:34', '2020-08-19 16:48:34'),
(4350, 1006, 8007, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Submitted online enrollment request for group/provider.  ', NULL, NULL, '2020-08-19 16:52:16', '2020-08-19 16:52:16'),
(4351, 1006, 8007, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Sent followup email to credentialinginquiries@humana.com regarding status. ', NULL, NULL, '2020-09-24 14:22:48', '2020-09-24 14:22:48'),
(4352, 1006, 8007, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com   800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\" ', NULL, NULL, '2020-09-29 10:03:16', '2020-09-29 10:03:16'),
(4353, 1006, 8007, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to behavioralhealthproviderservices@humana.com regarding status. ', NULL, NULL, '2020-10-16 10:20:14', '2020-10-16 10:20:14'),
(4354, 1006, 8007, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email to behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to get an update regarding the credentialing/contracting status for the following providers:  Name: Prisca Hefti NPI# 1508133182 Name: Fauzia Wali-Khan NPI# 1699761965 Name: Mahreen Rashid NPI# 1396393146 Name: Katie Tawakol NPI# 1609222116 TIN# 83-4482753  Please get back to me as soon as you\'re able.   Thank you!\"', NULL, NULL, '2020-10-23 17:42:50', '2020-10-23 17:42:50'),
(4355, 1006, 8007, NULL, '2020-11-13 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169412028', NULL, NULL, '2020-10-30 10:39:09', '2020-10-30 10:39:09'),
(4356, 1006, 8007, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com ', NULL, NULL, '2020-11-06 18:04:19', '2020-11-06 18:04:19'),
(4357, 1006, 8007, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:02:30', '2020-11-16 18:02:30'),
(4358, 1006, 8007, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:21:36', '2020-11-30 15:21:36'),
(4359, 1006, 8007, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:12:48', '2020-12-10 18:12:48'),
(4360, 1006, 8007, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-22 14:07:37', '2020-12-22 14:07:37'),
(4361, 1006, 8007, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:36:21', '2020-12-29 16:36:21'),
(4362, 1006, 8007, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:51', '2021-01-15 17:43:51'),
(4363, 1006, 8007, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:40', '2021-01-28 10:53:40'),
(4364, 1006, 8007, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com ', NULL, NULL, '2021-02-09 13:29:44', '2021-02-09 13:29:44'),
(4365, 1006, 8007, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:57:35', '2021-02-10 09:57:35'),
(4366, 1006, 8007, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:52:33', '2021-03-02 11:52:33'),
(4367, 1019, 8007, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from : mtasby2@humana.com  Good Morning Alex, Executed agreements are mailed upon approval and completion.  All providers listed on the attached roster is link to group \'Spectrum Neuro Behavioral Care LLC\' effective 4/1/2021.  When adding new locations, complete the attached roster (facility tab) (roster tab) Please Note: you only need to list new information pertaining to additional location.    Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations', NULL, NULL, '2021-04-05 08:49:54', '2021-04-05 08:49:54'),
(4368, 1019, 8007, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:38:17', '2021-04-19 10:38:17'),
(4369, 1019, 8007, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 10:06:42', '2021-04-20 10:06:42'),
(4370, 1006, 8008, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 16:48:35', '2020-08-19 16:48:35'),
(4371, 1006, 8008, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Submitted online enrollment request for group/provider.  ', NULL, NULL, '2020-08-19 16:53:01', '2020-08-19 16:53:01'),
(4372, 1006, 8008, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received an email from Furquan that he has sent over the request via mail to Medicaid RI. ', NULL, NULL, '2020-09-23 15:29:25', '2020-09-23 15:29:25'),
(4373, 1006, 8008, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Sent followup email to credentialinginquiries@humana.com regarding status. ', NULL, NULL, '2020-09-24 14:22:58', '2020-09-24 14:22:58'),
(4374, 1006, 8008, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply: \"Hi Brad,  I have forwarded your request to Humana Behavioral Health and copied them on this email. You can follow up with them at:  Humana Behavioral Health: behavioralhealthproviderservices@humana.com   800-444-5445 – HBH representatives number General HBH phone number 800-207-5101 PR is 800-890-8288 – Humana HBH  New providers and facilities that have not been contracted do not come to the Credentialing area initially. We will not be able to provide the status of applications.  Thank You, Humana Inc. Credentialing Department\" ', NULL, NULL, '2020-09-29 10:03:24', '2020-09-29 10:03:24'),
(4375, 1006, 8008, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Sent a followup email to behavioralhealthproviderservices@humana.com for status.   ', NULL, NULL, '2020-10-15 18:06:35', '2020-10-15 18:06:35'),
(4376, 1006, 8008, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent another follow-up email on 10/22/2020. Will follow-up again in a few days. ', NULL, NULL, '2020-10-28 17:50:07', '2020-10-28 17:50:07'),
(4377, 1006, 8008, NULL, '2020-11-13 00:00:00.000', 'In Process', 'As per my discussion with the Humana Behavioral representative, they said to please allow 90 days for the request to be processed appropriately.  Ref# 10000169413697', NULL, NULL, '2020-10-30 10:43:48', '2020-10-30 10:43:48'),
(4378, 1006, 8008, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to behavioralhealthproviderservices@humana.com ', NULL, NULL, '2020-11-06 18:04:06', '2020-11-06 18:04:06'),
(4379, 1006, 8008, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received reply from Humana Behavioral stating that we should enroll our group and sent us LOI\'s, LOI\'s were filled and sent on 11/10/2020.   Sent following follow-up email today @ behavioralhealthproviderservices@humana.com:   \"Hello,   I wanted to reach out again regarding the status of enrollment for our providers as well as our group. Please get back to me as soon as possible as this request has been ongoing for a few months without a response.   Thanks. \"', NULL, NULL, '2020-11-16 18:02:42', '2020-11-16 18:02:42'),
(4380, 1006, 8008, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com. Since my calls weren\'t going through. ', NULL, NULL, '2020-11-30 15:21:54', '2020-11-30 15:21:54'),
(4381, 1006, 8008, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent another follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com', NULL, NULL, '2020-12-10 18:13:07', '2020-12-10 18:13:07'),
(4382, 1006, 8008, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Called Humana provider representative, as per her the provider shows up for different groups but not for our group. We should try to reach out @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com Ref# 2000161025280 ', NULL, NULL, '2020-12-24 10:44:46', '2020-12-24 10:44:46'),
(4383, 1006, 8008, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Called in, rep said that she has submitted an internal request for a follow-up need to allow 7~10 business days for that to process. Rep: Cherry  Ref# 2000161857346', NULL, NULL, '2020-12-29 16:36:15', '2020-12-29 16:36:15'),
(4384, 1006, 8008, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ Behavioral Health Provider Services behavioralhealthproviderservices@humana.com.  Wasn\'t able to get a representative on call. ', NULL, NULL, '2021-01-15 17:43:58', '2021-01-15 17:43:58'),
(4385, 1006, 8008, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerservices@humanabehavioralhealth.com regarding updated status on request and currently on call. ', NULL, NULL, '2021-01-28 10:53:46', '2021-01-28 10:53:46'),
(4386, 1006, 8008, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent the group roster & signed MA contract @ Monica Tasby mtasby2@humana.com ', NULL, NULL, '2021-02-09 13:29:55', '2021-02-09 13:29:55'),
(4387, 1006, 8008, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Monica @ mtasby2@humana.com:  \"Hello Brad,  Spectrum Neuro Behavioral Care LLC Agreement has been received and submitted. You have been assigned a tentative effective date of May 1, 2021 upon approval. Please allow up to 90 business days for complete processing (unless otherwise specified by state law). You will receive confirmation and a copy of your executed contract when complete. If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations  E-Mail: mtasby2@humana.com | | Web: www.humana.com Our Values\"', NULL, NULL, '2021-02-10 09:57:43', '2021-02-10 09:57:43'),
(4388, 1006, 8008, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:52:25', '2021-03-02 11:52:25'),
(4389, 1019, 8008, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:35', '2021-06-10 09:43:35'),
(4390, 1019, 8008, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE.', NULL, NULL, '2021-08-23 13:08:36', '2021-08-23 13:08:36'),
(4391, 2027, 8009, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-19 17:00:14', '2020-08-19 17:00:14'),
(4392, 2027, 8009, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Medicaid initiated ref#17155171 screenshot is attached ', NULL, NULL, '2020-08-19 17:01:23', '2020-08-19 17:01:23'),
(4393, 2027, 8009, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid effective date is 11/21/2019 and enrollment date is 09/04/2020. Welcome letter is attached  ', NULL, NULL, '2020-09-11 13:43:40', '2020-09-11 13:43:40'),
(4394, 1006, 8010, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-21 10:42:19', '2020-08-21 10:42:19'),
(4395, 1006, 8010, NULL, '2020-08-28 00:00:00.000', 'Approved', 'Requested BCBS to send over the executed group contract for our records.   \"Good morning,   Attached is the signed and executed group BLUE CHOICE PPO contract.  If you have any additional questions please reach out to your BCBSTX contracting rep Tanillya Gass.  Thank you. \"', NULL, NULL, '2020-08-21 10:44:21', '2020-08-21 10:44:21'),
(4396, 1006, 8011, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-21 17:22:18', '2020-08-21 17:22:18'),
(4397, 1006, 8011, NULL, '2020-08-28 00:00:00.000', 'Initiated', 'Initiated Railroad PTAN request:  \"Additional research is required to complete your request  Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active.\"', NULL, NULL, '2020-08-21 17:22:43', '2020-08-21 17:22:43'),
(4398, 1006, 8011, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JONATHAN SCHUBERT LCS PROVIDER PTAN	P02518084 PROVIDER NPI	1235755505 EFFECTIVE DATE	05/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	 ', NULL, NULL, '2020-09-18 10:12:42', '2020-09-18 10:12:42'),
(4399, 2037, 8012, NULL, NULL, 'New/Not Initiated', 'Initiated the credentialing request over the phone with Cigna @ (800) 244 6224 .Application id # 12295480.The process will be taking any where from  90 to 120 days. Rep: Andrea. Ref#Andrea08/24/2020.', NULL, NULL, '2020-08-24 13:00:16', '2020-08-24 13:00:16'),
(4400, 2037, 8012, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Initiated the credentialing request over the phone with Cigna @ (800) 244 6224 .Application id # 12295480.The process will be taking any where from  90 to 120 days. Rep: Andrea. Ref#Andrea08/24/2020.', NULL, NULL, '2020-08-24 13:01:17', '2020-08-24 13:01:17'),
(4401, 2037, 8012, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Cigna has picked up Dr. William\'s information from CAQH and the process is initiated.', NULL, NULL, '2020-08-26 10:58:32', '2020-08-26 10:58:32'),
(4402, 2037, 8012, NULL, '2020-09-15 00:00:00.000', 'New/Not Initiated', 'As per live call to Cigna the Application is still in process waiting contracting approval with the Tracking ID# 12295480.Ref#Essence09/08/2020', NULL, NULL, '2020-09-08 17:27:24', '2020-09-08 17:27:24'),
(4403, 2037, 8012, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Contract received. Signed and submitted back via DocuSign. Contract printed and placed on the server.Uploaded on EMRBS .', NULL, NULL, '2020-09-16 12:26:17', '2020-09-16 12:26:17'),
(4404, 2037, 8012, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Got the confirmation of receiving from Cigna of the agreement sent yesterday. ------------------------- Re:	Reference number 12295480 Application to participate in the Cigna medical network Dear WILLIAM FRANCIS,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2020-09-17 09:56:28', '2020-09-17 09:56:28'),
(4405, 2037, 8012, NULL, '2020-10-28 00:00:00.000', 'In Process', 'The request is received and is currently in process with no current requirement from Cigna. His Application is being processed simultaneously with the request to add him to the RHC (Tin) and will be taking approx 90 to  120 from 08/28/2020. Reference  : Lannette10/02/2020.', NULL, NULL, '2020-10-02 10:30:18', '2020-10-02 10:30:18'),
(4406, 2037, 8012, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent to cigna @ 	intake_pdm@cigna.com  ------------ Greetings, Following up on the enrollment application for the below mentioned provider. Group: Bay Area Quick Care TIN:      27-1702009.Provider: William Francis.NPI : 1457994436', NULL, NULL, '2020-10-28 10:29:05', '2020-10-28 10:29:05'),
(4407, 2037, 8012, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Received an email  from Dominique.Clermont@cigna.com confirming the specialty of  William Francis .Responded him back with the clarifimation. Both emails are as follows for reference: --------------------  Hi Dominique,  William Francis is a PCP with speciality as a (Nurse Practitioner). Practice provides: Speciality Care  with the speciality (General Practice).   Please feel free to contact me for any additional information. ---------------------------------------- Dominique.Clermont@cigna.com  Re: Credentialing for mid-level practitioner as primary care provider or specialist  Thank you for your credentialing request.  After careful review, we are unable to determine whether this mid-level practitioner is a primary care provider (PCP) or specialist. A provider type is required to ensure claims are reimbursed accordingly for either primary care or specialist care.  For claim purposes, the following provider types are always reimbursed as primary care:  •           Family medicine  •           Internal medicine  •           General practice  •           Pediatrics  What we need from you  If this mid-level practitioner is not aligned with any of the provider types listed above, please inform of us of the office specialty that best defines the services that you and this mid-level practitioner provide for our customers. The scope of a mid-level practitioner’s care can also be determined by the specialty of the supervising physician he or she primarily works with.  To ensure claims are reimbursed consistently and accurately for this mid-level practitioner, please send this information to me at Dominique.Clermont@cigna.com.  If you have any questions, you can contact me by email or at 800.882.4662.  We appreciate the care you provide our customers.     Thank you,', NULL, NULL, '2020-11-12 15:07:53', '2020-11-12 15:07:53'),
(4408, 2037, 8012, NULL, '2020-11-26 00:00:00.000', 'In Process', 'As per live call provider is still in credentialing process.', NULL, NULL, '2020-11-19 14:22:05', '2020-11-19 14:22:05'),
(4409, 2037, 8012, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Follow up email sent to Dominique.Clermont@cigna.com', NULL, NULL, '2020-11-30 14:48:07', '2020-11-30 14:48:07'),
(4410, 2037, 8012, NULL, '2020-12-16 00:00:00.000', 'Approved', 'Executed contract received with the effective date 12/07/2020.Uploaded on EMRBS and Par Plans updated in the notes.', NULL, NULL, '2020-12-09 12:08:11', '2020-12-09 12:08:11'),
(4411, 2037, 8013, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-24 13:35:31', '2020-08-24 13:35:31'),
(4412, 2037, 8013, NULL, '2020-08-31 00:00:00.000', 'In Process', 'Requested to add the below locations to the group: Statcare Minor Emergency Clinic. TIN# 46-0575924 NPI# 1689924904  Primary Location:   500 E CAESAR  KINGSVILLE , TX 78363.  Phone Number: 361-516-0800  Fax Number: 361-516-0855     Secondary Location:  4042 River Hill Drive Nueces County  Corpus Christi TX  78410-5606.  Phone Number:  361-933-5187 & 361-933-5188  Fax Number: 361-933-5189     Tertiary Location:   6646 S Staples St #122 Nueces County   Corpus Christi TX 78413-5426.  Phone Number: 361-334-2023  Fax Number:  361-334-2025  Got a confirmation email from Jennifer Maligaya: Jennifer MaligayaACS Aug 21, 2020, 12:31 PM (3 days ago) to me, Rabagos  Sherry,     The provided locations have been successfully added to our system. Have a great weekend. ------------------ WAITING FOR THE COPY OF THE EXECUTED CONTRACT TO APPROVE. ', NULL, NULL, '2020-08-24 13:50:33', '2020-08-24 13:50:33'),
(4413, 2037, 8013, NULL, '2020-09-02 00:00:00.000', 'Approved', 'received following update from Jennifer MaligayaACS jmaligaya@anci-care.com> regarding Address Update request:  \"Sherry, All the three provided locations have been successfully added to our system. Have a great weekend\"', NULL, NULL, '2020-08-26 10:30:37', '2020-08-26 10:30:37'),
(4414, 2037, 8014, NULL, NULL, 'New/Not Initiated', 'Adding Locations', NULL, NULL, '2020-08-24 13:52:22', '2020-08-24 13:52:22'),
(4415, 2037, 8014, NULL, '2020-08-31 00:00:00.000', 'In Process', 'Requested to add the below locations to the group: Statcare Minor Emergency Clinic. TIN# 46-0575924 NPI# 1689924904  Primary Location:   500 E CAESAR  KINGSVILLE , TX 78363.  Phone Number: 361-516-0800  Fax Number: 361-516-0855     Secondary Location:  4042 River Hill Drive Nueces County  Corpus Christi TX  78410-5606.  Phone Number:  361-933-5187 & 361-933-5188  Fax Number: 361-933-5189     Tertiary Location:   6646 S Staples St #122 Nueces County   Corpus Christi TX 78413-5426.  Phone Number: 361-334-2023  Fax Number:  361-334-2025  Got a confirmation email from Jennifer Maligaya: Jennifer MaligayaACS Aug 21, 2020, 12:31 PM (3 days ago) to me, Rabagos  Sherry,     The provided locations have been successfully added to our system. Have a great weekend. ------------------ WAITING FOR THE COPY OF THE EXECUTED CONTRACT TO APPROVE.', NULL, NULL, '2020-08-24 13:52:39', '2020-08-24 13:52:39');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(4416, 2037, 8014, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Location Added.Details recorded in Kingsville Location', NULL, NULL, '2020-09-18 17:35:12', '2020-09-18 17:35:12'),
(4417, 2037, 8015, NULL, NULL, 'New/Not Initiated', 'Adding Locations', NULL, NULL, '2020-08-24 13:53:39', '2020-08-24 13:53:39'),
(4418, 2037, 8015, NULL, '2020-08-31 00:00:00.000', 'In Process', 'Requested to add the below locations to the group: Statcare Minor Emergency Clinic. TIN# 46-0575924 NPI# 1689924904  Primary Location:   500 E CAESAR  KINGSVILLE , TX 78363.  Phone Number: 361-516-0800  Fax Number: 361-516-0855     Secondary Location:  4042 River Hill Drive Nueces County  Corpus Christi TX  78410-5606.  Phone Number:  361-933-5187 & 361-933-5188  Fax Number: 361-933-5189     Tertiary Location:   6646 S Staples St #122 Nueces County   Corpus Christi TX 78413-5426.  Phone Number: 361-334-2023  Fax Number:  361-334-2025  Got a confirmation email from Jennifer Maligaya: Jennifer MaligayaACS Aug 21, 2020, 12:31 PM (3 days ago) to me, Rabagos  Sherry,     The provided locations have been successfully added to our system. Have a great weekend. ------------------ WAITING FOR THE COPY OF THE EXECUTED CONTRACT TO APPROVE.', NULL, NULL, '2020-08-24 13:53:50', '2020-08-24 13:53:50'),
(4419, 2037, 8015, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Location Added.Details recorded in Kingsville Location', NULL, NULL, '2020-09-18 17:36:17', '2020-09-18 17:36:17'),
(4420, 2037, 8016, NULL, NULL, 'New/Not Initiated', 'Online Application Initiated.', NULL, NULL, '2020-08-24 13:57:33', '2020-08-24 13:57:33'),
(4421, 2037, 8016, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Online Application submitted on 08/19/2020 and was received on 08/20/2020. Application Tracking # PVB1137911.The process is going to take 60 business days to complete.Next follow up date  09/07/2020.Got the confirmation of receiving over the phone. Representative : Gelo. Call Reference # 5495839122.', NULL, NULL, '2020-08-24 14:01:25', '2020-08-24 14:01:25'),
(4422, 2037, 8016, NULL, '2020-09-17 00:00:00.000', 'Approved', '\"Linkage for an individual is not a requirement as we are holding a facility setup contract Effective 10/15/2015 and we can bill using the facility\'s NPI.  Approval Email sent to billing for William Francis\"', NULL, NULL, '2020-09-10 14:22:28', '2020-09-10 14:22:28'),
(4423, 2037, 8017, NULL, NULL, 'New/Not Initiated', 'Requested application from Multiplan online through muliplan.com', NULL, NULL, '2020-08-24 15:10:35', '2020-08-24 15:10:35'),
(4424, 2037, 8017, NULL, '2020-08-31 00:00:00.000', 'In Process', 'Waiting for Multiplan to approve and forward the application package for submission.', NULL, NULL, '2020-08-24 15:12:17', '2020-08-24 15:12:17'),
(4425, 2037, 8017, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Received Multiplan Individual Agreement for Signature for Francis William.Agreement Signed and sent back electronically.Below is the email for reference: -------------------- nominations@multiplan.com Attachments Sun, Aug 30, 5:40 PM (18 hours ago) to baqc  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks.  An agreement for signature is enclosed and available to sign electronically by clicking the following link:  Individual Agreement We have included a sample fee schedule for your review.  Please note, the applicability of the SLCP State Law Coordinating Provisions is determined by your service location(s). Please refer to your State Law Provisions.  Once we have received the signed agreement, we will begin the credentialing process. You will be notified of your effective date upon acceptance into the network(s) and a fully executed copy of the agreement will be sent to you via DocuSign email', NULL, NULL, '2020-08-31 12:12:39', '2020-08-31 12:12:39'),
(4426, 2037, 8017, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Got the confirmation of the receiving of the signed contract.Turn Around  30 to 60 Business days. Ref# Christy.C09/12/2020', NULL, NULL, '2020-09-11 14:15:27', '2020-09-11 14:15:27'),
(4427, 1006, 8017, NULL, '2020-09-22 00:00:00.000', 'In Process', 'The way the group is set-up any providers can bill under the TIN and come up as PAR, but provider is still going through credentialing/contracting with group.   Ref# 7356027', NULL, NULL, '2020-09-15 09:56:48', '2020-09-15 09:56:48'),
(4428, 1006, 8017, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Above comment is for RHC, not BAQC. Disregard. ', NULL, NULL, '2020-09-15 10:00:38', '2020-09-15 10:00:38'),
(4429, 1005, 8017, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Credentialing is in process for now.', NULL, NULL, '2020-10-02 15:42:34', '2020-10-02 15:42:34'),
(4430, 2037, 8017, NULL, '2020-10-19 00:00:00.000', 'In Process', 'as per the follow up call made to Multiplan the Contract has been forwarded for q&a review.Will get a call back on 10/15/2020 with the confirmation of the credentialing process initiation.Case#7356027', NULL, NULL, '2020-10-09 09:47:28', '2020-10-09 09:47:28'),
(4431, 2037, 8017, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Credentialing is in process.Follow up email sent.', NULL, NULL, '2020-10-19 10:23:16', '2020-10-19 10:23:16'),
(4432, 2037, 8017, NULL, '2020-11-25 00:00:00.000', 'In Process', 'as per the follow up call made to Multiplan the Contract has been forwarded for q&a review.Will get a call back on 10/15/2020 with the confirmation of the credentialing process initiation.Case#7356027', NULL, NULL, '2020-10-26 13:49:02', '2020-10-26 13:49:02'),
(4433, 2037, 8017, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Credentialing is in process.Need to allow more time', NULL, NULL, '2020-11-23 14:34:00', '2020-11-23 14:34:00'),
(4434, 2037, 8017, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Received Email from Multiplan ------------------------------------------------------------------ nominations@multiplan.com Dec 7, 2020, 4:42 PM (2 days ago) to baqc  Dear Provider Contact:  We have received your request to join MultiPlan\'s provider network. Your request has been processed by MultiPlan\'s Contracts and Development Team. We have released the necessary documents to our Registrar Department for review and processing. You will be contacted if additional information is needed. Once credentialing is approved; you will be notified of the provider\'s effective date.  Please note that implementation of a contract can take approximately 90 - 120 days unless otherwise mandated by state law.  As we process this provider\'s request, we ask that you assist us with the following:  Providers that participate in CAQH:   Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety Provide applicable supporting documents Providers NOT participating in CAQH:   you may initiate the process by clicking the following link: CAQH For future requests to add providers to your existing provider group contract, you can streamline the process by using our Online Portal. Please reference your Group Name and MultiPlan Contract ID.  If you need assistance with identifying your MultiPlan Contract ID or have questions regarding this email, please contact our Service Operations Department at 800-950-7040, 8:30 a.m. - 5:30 p.m. ET.  Among other things, Service Operations can answer questions about your credentialing application, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely,  Contracts and Development Team', NULL, NULL, '2020-12-09 13:43:14', '2020-12-09 13:43:14'),
(4435, 1006, 8017, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Sent a follow-up email @ registrar@multiplan.com', NULL, NULL, '2021-01-04 17:50:43', '2021-01-04 17:50:43'),
(4436, 1006, 8017, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Provider has been enrolled but waiting on written confirmation from Multiplan, sent follow up email @ registrar.   \"Francis William -  Effective Date: 12/04/2020 Provider ID# 13868721 Provider is enrolled in both PHCS & Multiplan  Ref# 7467802\"', NULL, NULL, '2021-01-18 17:24:15', '2021-01-18 17:24:15'),
(4437, 1006, 8017, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Sent another follow-up email @ registrar@multiplan.com. ', NULL, NULL, '2021-01-26 14:42:14', '2021-01-26 14:42:14'),
(4438, 1006, 8017, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Created a service case for written confirmation to be sent to us: \"Service Case Number:	7500229\"', NULL, NULL, '2021-02-02 16:58:13', '2021-02-02 16:58:13'),
(4439, 1006, 8017, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Welcome! Your application has been processed, effective 12/4/2020 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.)', NULL, NULL, '2021-02-03 09:22:20', '2021-02-03 09:22:20'),
(4440, 2037, 8018, NULL, NULL, 'New/Not Initiated', 'Application initiated over the phone.', NULL, NULL, '2020-08-24 17:04:10', '2020-08-24 17:04:10'),
(4441, 2037, 8018, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Spoke to Brittney from UHC @ (866) 574-6088. Application initiated over the phone with the Tracking ID# 01799568. Next Follow up after 20 business days.Ref: Brittney08/24/2020.', NULL, NULL, '2020-08-24 17:06:36', '2020-08-24 17:06:36'),
(4442, 2037, 8018, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Credentialing is completed.The provider\'s application is now in process for contracting. Estimated time for completion 30 to 45 business days. Got confirmation via call & email from UHC. Call reference # 1803384', NULL, NULL, '2020-08-26 13:18:43', '2020-08-26 13:18:43'),
(4443, 2037, 8018, NULL, '2020-09-07 00:00:00.000', 'In Process', 'As per live call to UHC @ 877-842-3210 they require a LOI with the W-9 form to add William Francis to the group TIN. Forwarded the requested documents to hpdemo@uhc.com. Reference Email : ---------------------- Greetings,  Kindly find the attached LOI with the W-9 Form to add Francis, William to the existing group \"Bay Area Quick Care PLLC\" as requested.  Feel free to contact me if you require additional information. Regards:', NULL, NULL, '2020-08-31 17:28:06', '2020-08-31 17:28:06'),
(4444, 2037, 8018, NULL, '2020-10-02 00:00:00.000', 'Approved', 'William Francis has been added to the contract effective 10/01/2020. Group roaster received as a confirmation of the successful addition of the provider.Roaster uploaded!', NULL, NULL, '2020-09-25 10:02:20', '2020-09-25 10:02:20'),
(4445, 2027, 8019, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 10:32:06', '2020-08-26 10:32:06'),
(4446, 2027, 8019, NULL, '2020-09-02 00:00:00.000', 'Approved', 'From: sotexasancillary@aetna.com  To: vmuc@claimsmedinc.com  Sub: Dr. Teresa Saavedra // Valley Med Urgent Care PLLC  Good morning,    Valley Med Urgent Care PLLC holds an urgent care facility contract under TIN 815123542.  With a facility agreement, it is a global agreement under the facility. You do not need to perform roster loads or add individual providers.  All claims should be submitted under the UC.   A request was received asking to link Dr. Teresa Saavedra to the UC TIN.  However, no maintenance needs to be performed since this is a facility agreement.   Thank you,     Elizabeth Davis', NULL, NULL, '2020-08-26 10:36:16', '2020-08-26 10:36:16'),
(4447, 2027, 8020, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:22:27', '2020-08-26 13:22:27'),
(4448, 2027, 8020, NULL, '2020-09-02 00:00:00.000', 'In Process', 'sent W9 and LOI by fax to add new service location as this is an ancillary contract waiting for the address to be updated', NULL, NULL, '2020-08-26 13:23:59', '2020-08-26 13:23:59'),
(4449, 1005, 8020, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Provider ID #: 5287961 Primary Care ID: 839333 Request is in process.', NULL, NULL, '2020-09-24 13:15:48', '2020-09-24 13:15:48'),
(4450, 2027, 8020, NULL, '2020-10-29 00:00:00.000', 'Approved', 'From: sotexasancillary@aetna.com  To: vmuc@claimsmedinc.com  Sub: Dr. Teresa Saavedra // Valley Med Urgent Care PLLC  Good morning,    Valley Med Urgent Care PLLC holds an urgent care facility contract under TIN 815123542.  With a facility agreement, it is a global agreement under the facility. You do not need to perform roster loads or add individual providers.  All claims should be submitted under the UC.   A request was received asking to link Dr. Teresa Saavedra to the UC TIN.  However, no maintenance needs to be performed since this is a facility agreement.   Thank you,     Elizabeth Davis', NULL, NULL, '2020-10-22 10:14:26', '2020-10-22 10:14:26'),
(4451, 1006, 8022, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:36', '2020-08-26 13:53:36'),
(4452, 1006, 8022, NULL, '2020-09-04 00:00:00.000', 'New/Not Initiated', 'Tried initiation with but: \"We are currently experiencing technical difficulties. Please try again later. Reference code: CMS0001\"', NULL, NULL, '2020-08-28 17:18:41', '2020-08-28 17:18:41'),
(4453, 2037, 8022, NULL, '2020-09-08 00:00:00.000', 'In Process', 'HHUC is an urgent care facility and can be added to the network by submitting LOI with W9 form. Individual provider will no longer be needed to get added.Submitted the requested information at humanahoustonpd@humana.com. Bellow is the reference email.: ----------------------- to humanahoustonpd@humana.com   Greetings,  Kindly find the attached letter of intent with the W9 form as requested.  Do feel free to contact me for additional information if required.  Regards:  Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 | sd@claimsmedinc.com', NULL, NULL, '2020-09-01 13:06:06', '2020-09-01 13:06:06'),
(4454, 2037, 8022, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Follow up email sent with the request to expedite the process @ nvidad@humana.com & humanahoustonpd@humana.com    ', NULL, NULL, '2020-10-01 14:17:36', '2020-10-01 14:17:36'),
(4455, 2037, 8022, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Another follow up email sent: Greetings,  As per the conversation we had over the phone today, kindly find the email for your reference of the initial request to add the below facility to the network.However no response was received.  Interaction Number# 2000148560579  Group: Healing Hands Urgent Care & Telehealth Billing Address :  6911 Twilight Elm Trace                                Katy , TX 77493-3392. TIN#                    :  85-1449677 Phone Number  :  954-649-7377 Fax Number       :  718-640-2713', NULL, NULL, '2020-10-30 13:50:59', '2020-10-30 13:50:59'),
(4456, 2037, 8022, NULL, '2020-11-23 00:00:00.000', 'On Hold', 'Rejection Recieved', NULL, NULL, '2020-11-16 12:26:40', '2020-11-16 12:26:40'),
(4457, 2037, 8022, NULL, '2021-03-31 00:00:00.000', 'On Hold', NULL, NULL, NULL, '2020-12-11 17:42:58', '2020-12-11 17:42:58'),
(4458, 1006, 8022, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The provider is no longer with the company. ', NULL, NULL, '2021-08-16 09:11:53', '2021-08-16 09:11:53'),
(4459, 1006, 8023, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:38', '2020-08-26 13:53:38'),
(4460, 2037, 8023, NULL, '2020-09-07 00:00:00.000', 'New/Not Initiated', 'Filled Individual\'s enrollment form and faxed @ 608-221-7535 . Copy of the sent fax placed in the folder on the server.', NULL, NULL, '2020-08-31 14:55:10', '2020-08-31 14:55:10'),
(4461, 2037, 8023, NULL, '2020-09-07 00:00:00.000', 'Initiated', 'Filled Individual\'s enrollment form and faxed @ 608-221-7535 . Copy of the sent fax placed in the folder on the server.', NULL, NULL, '2020-08-31 14:55:37', '2020-08-31 14:55:37'),
(4462, 2037, 8023, NULL, '2020-09-08 00:00:00.000', 'In Process', 'Filled Individual\'s enrollment form and faxed @ 608-221-7535 . Copy of the sent fax placed in the folder on the server. ', NULL, NULL, '2020-09-01 13:10:57', '2020-09-01 13:10:57'),
(4463, 2037, 8023, NULL, '2020-10-20 00:00:00.000', 'In Process', 'As per Sandra from TriCare East Erline Terrelonge is now a Certified provider with Effective Date 09/25/2020 and Expiration 09/28/2022.Group Affiliation# 85-1449677-77493-A002 . She is now in contracting process request submitted to ywyatt@humana.com:Reference Email as follows: ----------------- Hope this email finds you well. We have received a confirmation of certification approval for one of our providers and she is successfully linked to the below mentioned group TIN. This request is to initiate the process of bringing her in the Tricare\'s Network. Group                       : Healing Hands Urgent Care & Telehealth,  TIN                            : 85-1449677.   Provider                   : Erline Terrelonge.NPI                            : 1699166074. Effective Date           : 09/25/2020. Expiration Date        : 09/28/2022.                                 Group Affiliation#    : 851449677-77493-A002.  Thank you!', NULL, NULL, '2020-10-02 15:34:00', '2020-10-02 15:34:00'),
(4464, 2037, 8023, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Got a response from Yvonne : Request for contract application submitted.Reference email as follows: ---------------- Good Morning Sherry, As a non-network Tricare Certified  provider you can see Tricare Beneficiaries who has the following plans.  Tricare Select Tricare for Life Tricare Reserve Select Tricare Retired Reserve Tricare Retired Reserved Tricare Young Adult  To begin the contracting process as network you need to submit a request via the link below. https://infocenter.humana-military.com/hgbprovider/jointhenetwork                                                  ', NULL, NULL, '2020-10-05 10:47:07', '2020-10-05 10:47:07'),
(4465, 2037, 8023, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent to Yvonne', NULL, NULL, '2020-11-03 16:45:01', '2020-11-03 16:45:01'),
(4466, 2037, 8023, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Waiting for the credentialing application', NULL, NULL, '2020-11-19 17:31:36', '2020-11-19 17:31:36'),
(4467, 2037, 8023, NULL, '2020-11-23 00:00:00.000', 'In Process', 'in process', NULL, NULL, '2020-11-20 14:35:15', '2020-11-20 14:35:15'),
(4468, 2037, 8023, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Waiting for the credentialing app', NULL, NULL, '2020-11-23 17:27:44', '2020-11-23 17:27:44'),
(4469, 2037, 8023, NULL, '2020-12-10 00:00:00.000', 'In Process', 'As per live call need to allow more time.', NULL, NULL, '2020-11-30 14:28:20', '2020-11-30 14:28:20'),
(4470, 2037, 8023, NULL, '2020-12-18 00:00:00.000', 'In Process', 'need to allow more time.', NULL, NULL, '2020-12-11 17:36:34', '2020-12-11 17:36:34'),
(4471, 2037, 8023, NULL, '2021-01-08 00:00:00.000', 'In Process', 'need to allow more time.', NULL, NULL, '2020-12-21 18:01:57', '2020-12-21 18:01:57'),
(4472, 1006, 8023, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to ywyatt@humana.com', NULL, NULL, '2021-01-26 17:11:57', '2021-01-26 17:11:57'),
(4473, 1006, 8023, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Received the following reply from Yvonne: \"Hello Victor,   We show this tax id as non-network TRICARE certified.\"  Sent her following reply: \"Hello Yvonne,   I appreciate the update, what is required to get our group enrolled as in-network? The request should already be in-process.  Thank you.\"', NULL, NULL, '2021-02-03 11:56:24', '2021-02-03 11:56:24'),
(4474, 1006, 8023, NULL, '2021-02-15 00:00:00.000', 'Rejected', 'Received the following email from Yvonne: \"Good morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry.\"', NULL, NULL, '2021-02-08 11:36:02', '2021-02-08 11:36:02'),
(4475, 1006, 8023, NULL, NULL, 'Revalidation', 'The provider has been approved as an in-network provider, effective: 04/01/2021:  \"Good Afternoon Sherry,  Effective April 1, 2021.  Humana Military would like to welcome you as an East Region network provider and thank you for becoming a preferred provider for TRICARE beneficiaries.  Humana Military is committed to maintaining access to high quality care with an emphasis on premium customer service for both beneficiaries and providers. As a valued TRICARE network provider, we look forward to working with you to ensure that the health care needs of our military and their families are met.  We invite you to register for access to our provider self-service portal at HumanaMilitary.com.  Online access offers features that will save you time, ensure patient privacy, and help manage your office more efficiently.  It is simple, secure and available 24 hours a day, seven days a week for registered providers.  Within the portal, you can:  •            Verify patient eligibility •            Create and review referrals and authorizations •            Check claim status •            Manage your demographic data •            Access pharmacy data by patient •            Verify coverage and authorization requirements   It would be my pleasure to walk you through the registration process.   Additionally, we encourage you to explore the resources and self-service options we offer via the links below: •            Electronic claims                            •            Provider charts                •            Provider forms •            Provider handbook          If you need further assistance or require additional information, please do not hesitate to contact us by: •            Visiting HumanaMilitary.com •            Calling Humana Military at 1-800-444-5445 to access the self-service modules on the Interactive Voice Response (IVR) system. •            Using our Live agent chat feature through our provider self-service portal (requires registration)   Again, thank you for your support of the TRICARE program. You are critical to the success of TRICARE by partnering with Humana Military to serve our deserving military families.  Please feel free to contact me if you have additional questions.  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com\"', NULL, NULL, '2021-03-30 14:48:29', '2021-03-30 14:48:29'),
(4476, 1005, 8023, NULL, '2021-06-16 00:00:00.000', 'Revalidated', 'The provider has been approved as an in-network provider, effective: 04/01/2021: ', NULL, NULL, '2021-06-09 13:12:54', '2021-06-09 13:12:54'),
(4477, 1006, 8024, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:39', '2020-08-26 13:53:39'),
(4478, 2037, 8024, NULL, '2020-09-09 00:00:00.000', 'Initiated', 'Initiated on boarding request for facility online via multi-plans web. Received confirmation email. -------------------------------------------- Dear Healing Hands Urgent Care and Telehealth:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail. ------------------------------------------------------------- Nomination Tracking Number: 090220ZHO', NULL, NULL, '2020-09-02 10:56:28', '2020-09-02 10:56:28'),
(4479, 1005, 8024, NULL, '2020-09-25 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-18 12:12:40', '2020-09-18 12:12:40'),
(4480, 2037, 8024, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received PIF. Completed and resubmitted back via email @ PIF@MultiPlan.com. -------------- Greetings, Kindly find the attached provider interest form for the below mentioned group. Group: Healing Hands Urgent Care & Telehealth Billing Address :  6911 Twilight Elm Trace                               Katy , TX 77493-3392.TIN#                    :  85-1449677 Phone Number  :  954-649-7377Fax Number       :  718-640-2713Regards:', NULL, NULL, '2020-10-01 12:49:13', '2020-10-01 12:49:13'),
(4481, 2037, 8024, NULL, '2020-10-31 00:00:00.000', 'In Process', 'Confirmation of Receiving : -------------------------- Thank you for your interest to participate in MultiPlan\'s provider networks. This message serves as confirmation of receipt.  We are experiencing a high volume response and appreciate your patience while we process your request. Your completed Provider Information Form will be processed in order received.  In order to improve the contracting process, once we have evaluated your information and processed a contract, you will receive electronic documents for signature via DocuSign. To expedite the contracting process, please follow the instructions included in the DocuSign email.  Our contracting and credentialing process takes approximately 90 - 120 days unless otherwise mandated by state law. We will contact you if we require additional information.  This email box is intended for receipt of PIFs Provider Information Forms ONLY.  To inquire about the status of your submission, question on rates, CPT reimbursement values,  or any other inquiries, please contact MultiPlan via email http://provider.multiplan.com or by calling 800-950-7040.  Thank you. ', NULL, NULL, '2020-10-01 12:52:43', '2020-10-01 12:52:43'),
(4482, 2037, 8024, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received Request for information form completed and submitted back with all the supporting documents @ pif@multiplan.com ---------------- Greetings, Kindly find the attached completed RFI as requested along with the supporting documents. Please do feel free to contact me for any additional information if needed. Thank you!', NULL, NULL, '2020-10-19 13:21:56', '2020-10-19 13:21:56'),
(4483, 2037, 8024, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent.', NULL, NULL, '2020-11-03 16:46:54', '2020-11-03 16:46:54'),
(4484, 2037, 8024, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent regarding the process.', NULL, NULL, '2020-11-19 17:25:30', '2020-11-19 17:25:30'),
(4485, 2037, 8024, NULL, '2020-12-10 00:00:00.000', 'In Process', 'As per live call.Need to allow more time', NULL, NULL, '2020-11-30 17:45:53', '2020-11-30 17:45:53'),
(4486, 2037, 8024, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent: Subject: Multiplan Request for Information for Healing Hands Urgent Care and Telehealth - State: TX - SEID: 2093273209', NULL, NULL, '2020-12-11 13:41:27', '2020-12-11 13:41:27'),
(4487, 2037, 8024, NULL, '2021-01-09 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 16:53:29', '2020-12-29 16:53:29'),
(4488, 1006, 8024, NULL, '2021-02-02 00:00:00.000', 'In Process', 'follow up email sent to registrar@multiplan.com ', NULL, NULL, '2021-01-26 17:21:18', '2021-01-26 17:21:18'),
(4489, 1006, 8024, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Sent another follow-up @ registrar@multiplan.com', NULL, NULL, '2021-02-05 17:31:06', '2021-02-05 17:31:06'),
(4490, 1006, 8024, NULL, '2021-02-23 00:00:00.000', 'Rejected', 'Request was rejected on 10/26/2020 due to requirement of accreditations for Facility Contract.  Ref# 090220ZHO ', NULL, NULL, '2021-02-16 14:27:11', '2021-02-16 14:27:11'),
(4491, 1006, 8025, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:41', '2020-08-26 13:53:41'),
(4492, 2037, 8025, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Initiated Medicare enrollment application through PECOS. Medicare requested CP-575 obtained from the provider office and submitted to Medicare.Waiting for the approval to start the enrollment and reassignment of benefits.', NULL, NULL, '2020-09-11 14:55:02', '2020-09-11 14:55:02'),
(4493, 2037, 8025, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Received Letter from Medicare requesting CP-575,Bank Information and CMS-460. Filled out and attached the requested documentation and forwarded back via fax @ (877) 439-5479 Attn: Kaitlyn Hulett.', NULL, NULL, '2020-09-28 14:29:41', '2020-09-28 14:29:41'),
(4494, 2037, 8025, NULL, '2020-10-19 00:00:00.000', 'In Process', 'As per live call to Medicare the voided check that was submitted needs to have Legal business name mentioned on it thus the application is on development status.Sent an email to Erline for requested voided check. Below is the reference :  Hi Erline,  Hope this email finds you well.  Regarding the voided check that you sent to Brad, Medicare has sent us another development on it as the legal business name is not mentioned on that. Kindly provide us with a voided check with the entity\'s name on urgent basis.  Looking forward to hearing back from you soon.', NULL, NULL, '2020-10-12 16:57:41', '2020-10-12 16:57:41'),
(4495, 2037, 8025, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Waiting on the voided check with the business name : ------------------------ Hi Erline,  Happy Monday!  Hope your day is off to a good start.   Following up on the copy of the voided check if you\'ve received it.', NULL, NULL, '2020-10-20 17:18:10', '2020-10-20 17:18:10'),
(4496, 2037, 8025, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Waiting on the voided check with the business name :', NULL, NULL, '2020-10-27 14:46:23', '2020-10-27 14:46:23'),
(4497, 2037, 8025, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Check Received -Group enrollment re initiated over PECOS. Waiting for the approval then we will be able to reassign benefits for Erline.', NULL, NULL, '2020-11-03 11:58:29', '2020-11-03 11:58:29'),
(4498, 2037, 8025, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Application rejected as the legal business name mentioned on the voided check was missing \"&\". Erline has put the contract on hold for the time being', NULL, NULL, '2020-12-07 12:41:51', '2020-12-07 12:41:51'),
(4499, 1006, 8025, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The provider is no longer with the company. ', NULL, NULL, '2021-08-16 09:11:57', '2021-08-16 09:11:57'),
(4500, 1006, 8026, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:42', '2020-08-26 13:53:42'),
(4501, 1006, 8026, NULL, '2020-09-04 00:00:00.000', 'In Process', 'Submitted online request for enrollment. ', NULL, NULL, '2020-08-28 15:10:27', '2020-08-28 15:10:27'),
(4502, 2037, 8026, NULL, '2020-09-08 00:00:00.000', 'In Process', 'Email received from Aetna. Replied with requested information: Below is the reference email. ------------------------------- I am in receipt of your request for the listed tin/provider, please provide your w9.      In addition, please advise what type of services you will be providing to our members.      Will this provider be hospital based?     Provider:  Erline Terrelonge, NP  TIN:  851449677', NULL, NULL, '2020-09-01 17:19:10', '2020-09-01 17:19:10'),
(4503, 2037, 8026, NULL, '2020-09-17 00:00:00.000', 'In Process', 'The individual application was placed on hold and the information for forwarded to the Ancillary (Urgent Care Dep.) for group contracting. However due to non-eligibility we may not be able to proceed.Following up for the individual enrollment for Erline Terrelonge. Reference Email below:  ---------------------------- Greetings Janette, Please note that there are certain listings in the participation criteria that we do not meet in order to proceed further with the contracting for urgent care facility. One of the reasons is the annual aggregate amount for professional liability which needs to be a minimum of 5,000,000. @Sylvia if you could advise on this as we want to proceed further with the individual enrollment for :Provider:  Erline Terrelonge, NP TIN:  851449677 Your prompt response will be highly appreciated. Regards:Sherry Deen ', NULL, NULL, '2020-09-10 13:14:25', '2020-09-10 13:14:25'),
(4504, 2037, 8026, NULL, '2020-09-28 00:00:00.000', 'In Process', 'Resumed Individual Enrollment Application. Agreement received via email from \"Sylvia Machado\" signed and resubmitted online. A Copy of the agreement has been placed on the server and uploaded.', NULL, NULL, '2020-09-21 17:46:14', '2020-09-21 17:46:14'),
(4505, 2037, 8026, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Follow up email sent to Sylvia :  Hi Sylvia,  Following up on the credentialing process of the individual provider mentioned below:  Provider : Erline Terrelonge NPI        : 1265045660 TIN#      :  85-1449677 Looking forward to hearing from you soon. ', NULL, NULL, '2020-10-15 15:07:35', '2020-10-15 15:07:35'),
(4506, 2037, 8026, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to Sylvia :  Hi Sylvia,  Following up on the credentialing process of the individual provider mentioned below:  Provider : Erline Terrelonge NPI        : 1265045660 TIN#      :  85-1449677 Looking forward to hearing from you soon.', NULL, NULL, '2020-10-27 14:47:07', '2020-10-27 14:47:07'),
(4507, 2037, 8026, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Follow up email sent to Sylvia.  Provider : Erline Terrelonge NPI        : 1265045660 TIN#      :  85-1449677', NULL, NULL, '2020-11-13 15:25:38', '2020-11-13 15:25:38'),
(4508, 2037, 8026, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Follow up email sent to Sylvia', NULL, NULL, '2020-11-24 15:07:57', '2020-11-24 15:07:57'),
(4509, 2037, 8026, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Another follow up email sent to Sylvia ------------------- Hi Sylvia, May I please have the current status of the below application. Provider:  Erline Terrelonge, NP TIN:  851449677', NULL, NULL, '2020-12-16 14:39:33', '2020-12-16 14:39:33'),
(4510, 2037, 8026, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Response received from Sylvia ---------------------------- Machado-Petry, Sylvia D Thu, Dec 17, 1:53 PM (22 hours ago) to me, Healing  Contract has been loaded, eff date is 1/1/21, once I obtain the final signature to execute the agreement, you will get the copy via adobesign, thank you.  ', NULL, NULL, '2020-12-18 13:59:10', '2020-12-18 13:59:10'),
(4511, 2037, 8026, NULL, '2020-12-25 00:00:00.000', 'Approved', 'Received approval confirmation from Aetna provider ID#4846847 . Effective 1/1/2021.  Snapshot uploaded .Notification sent to the billing.', NULL, NULL, '2020-12-18 14:02:47', '2020-12-18 14:02:47'),
(4512, 1006, 8027, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:43', '2020-08-26 13:53:43'),
(4513, 1006, 8027, NULL, '2020-09-04 00:00:00.000', 'In Process', 'Initiated request online via UHC online portal. Attached copy of initiation. ', NULL, NULL, '2020-08-28 16:53:25', '2020-08-28 16:53:25'),
(4514, 2037, 8027, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Received call from April (UHC) requesting W-9 form and billing address. Details sent to her @ april_charlot@uhc.com . Reference email : ---------------------------- Greetings April, As per the conversation over the phone kindly find the attached W-9 Form as requested along with the billing address and contact details as follows. Group: Healing Hands Urgent Care & Telehealth Billing Address : 6911 Twilight Elm Trace                               Katy , TX 77493-3392. Phone Number :  954-649-7377 Fax Number :       718-640-2713', NULL, NULL, '2020-09-09 12:14:48', '2020-09-09 12:14:48'),
(4515, 2037, 8027, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Called UHC and spoke to Jordan. As per her Erline is already in thier records and going through the process of Demographic updates of her Name from Erline Reid to Erline Terrelonge. PR-5470943. Once that process is completed we will then be able to request an individual contract for Erline with group TIN .  Also checked for the Pannel\'s for the facility but their business is closed for Urgent Care Facilities.  Waiting for the Demographics to be Updated. PR-5470943.', NULL, NULL, '2020-09-14 15:18:36', '2020-09-14 15:18:36'),
(4516, 2037, 8027, NULL, '2021-01-27 00:00:00.000', 'On Hold', 'As per live call to UHC Erline\'s credentialing has been completed and she is linked to the TIN but (Non-Par) as they are not accepting urgent care facilities due to non-network needs. and due to TIN not contracted so the contract will not be issued to the individual physician . Tracy suggested us to re-check after 3 to 6 month and if the panels are open by that time then we will be able to request a contract.', NULL, NULL, '2020-10-15 15:50:32', '2020-10-15 15:50:32'),
(4517, 1006, 8027, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The provider is no longer with the company. ', NULL, NULL, '2021-08-16 09:12:03', '2021-08-16 09:12:03'),
(4518, 1006, 8028, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 13:53:45', '2020-08-26 13:53:45'),
(4519, 1006, 8028, NULL, '2020-09-02 00:00:00.000', 'Initiated', 'Request has been initiated online via the participation form:  \"ERLINE R TERRELONGE,  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 01741616, for HEALING HANDS URGENT CARE & TELEH.  Your request may take up to 60-90 days to process. Once completed, a notification will be sent to the email address you provided during your submission.  To check the status of your case, please click on status checker or for any questions, please contact 1-877-229-0719.\"', NULL, NULL, '2020-08-26 18:17:03', '2020-08-26 18:17:03'),
(4520, 2037, 8028, NULL, '2020-09-08 00:00:00.000', 'In Process', 'Request has been initiated online via the participation form:  \"ERLINE R TERRELONGE,  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 01741616, for HEALING HANDS URGENT CARE & TELEH.  Your request may take up to 60-90 days to process. Once completed, a notification will be sent to the email address you provided during your submission.  To check the status of your case, please click on status checker or for any questions, please contact 1-877-229-0719.\"', NULL, NULL, '2020-09-01 13:11:43', '2020-09-01 13:11:43'),
(4521, 2037, 8028, NULL, '2020-09-15 00:00:00.000', 'In Process', 'PAR Contract Signed and submitted via email @ : TX_Standard_Contracting_Team@BCBSTX.com ------------------ Greetings,Kindly find the attached copy of the signed PAR contract for further processing.Do feel free to contact me for any additional information if required. Regards:Sherry Deen | Claims Med |  Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 |  sd@claimsmedinc.com', NULL, NULL, '2020-09-08 10:03:17', '2020-09-08 10:03:17'),
(4522, 2037, 8028, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Confirmation of Receiving form BCBS:  hank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01767792.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-09-08 10:05:53', '2020-09-08 10:05:53'),
(4523, 2037, 8028, NULL, '2020-09-25 00:00:00.000', 'In Process', 'Received UCC Acceptance Form. Signed and submitted back to Stephanie Deese @ Stephanie_P_Deese@bcbstx.com. Form attached.', NULL, NULL, '2020-09-18 17:00:25', '2020-09-18 17:00:25'),
(4524, 2037, 8028, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received Agreements for different network participation i.e PPO,Blue Essential,Blue Premier, & Blue Advantage. Signed and submitted back via secure Email.Documents placed on the server for records. --------------------- ----------------- Hi Sherry, Great, thanks for sending signed UCC acceptance form. I will create agreements and email it to you in a secured email.     Thanks,  Steph', NULL, NULL, '2020-09-23 10:06:27', '2020-09-23 10:06:27'),
(4525, 2037, 8028, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Response form Stephanie: -------------------------- Hi Sherry,     I will send agreements for execution. Once agreements are executed the servicing rep will contact you to start the credentialing process.    Regards,  Stephanie Deese | Network Management Consultant', NULL, NULL, '2020-09-25 10:38:10', '2020-09-25 10:38:10'),
(4526, 2037, 8028, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Follow up email sent to Stephanie', NULL, NULL, '2020-10-30 13:51:51', '2020-10-30 13:51:51'),
(4527, 2037, 8028, NULL, '2020-11-13 00:00:00.000', 'Approved', 'Contracted effective 10/28/2020. Details of the plans uploaded. Facility appearing on the provider directory.Snap Uploaded', NULL, NULL, '2020-11-06 13:13:39', '2020-11-06 13:13:39'),
(4528, 2027, 8029, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 14:16:40', '2020-08-26 14:16:40'),
(4529, 2027, 8029, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Provider is showing in network on this location and effective date is 4/24/2020', NULL, NULL, '2020-08-26 14:17:38', '2020-08-26 14:17:38'),
(4530, 2027, 8030, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 14:32:56', '2020-08-26 14:32:56'),
(4531, 2027, 8030, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Provider is showing in network on this location and effective date is 4/24/2020', NULL, NULL, '2020-08-26 14:35:39', '2020-08-26 14:35:39'),
(4532, 2037, 8031, NULL, NULL, 'New/Not Initiated', 'Initiation', NULL, NULL, '2020-08-26 16:29:25', '2020-08-26 16:29:25'),
(4533, 2037, 8031, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Received executed contract from ANCI Care.All three locations are added and the group is in-network with ANCI Care effective 08/01/2020.Below is the reference email:  Jennifer Maligaya Jennifer.Maligaya@healthsmart.com Attachments Hi Sherry, Per our discussion, please see the attachments and welcome to the Ancillary Care Services (ACS) network. Please see the attachments. My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!  Best Regards, Jennifer Maligaya Sr. Provider Relations, ACS and MyDecision', NULL, NULL, '2020-08-26 16:30:18', '2020-08-26 16:30:18'),
(4534, 2037, 8032, NULL, NULL, 'New/Not Initiated', 'Initiation', NULL, NULL, '2020-08-26 16:31:07', '2020-08-26 16:31:07'),
(4535, 2037, 8032, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Received executed contract from ANCI Care.All three locations are added and the group is in-network with ANCI Care effective 08/01/2020.Below is the reference email:  Jennifer Maligaya Jennifer.Maligaya@healthsmart.com Attachments Hi Sherry, Per our discussion, please see the attachments and welcome to the Ancillary Care Services (ACS) network. Please see the attachments. My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!  Best Regards, Jennifer Maligaya Sr. Provider Relations, ACS and MyDecision', NULL, NULL, '2020-08-26 16:31:21', '2020-08-26 16:31:21'),
(4536, 2037, 8033, NULL, NULL, 'New/Not Initiated', 'Initiation.', NULL, NULL, '2020-08-26 16:48:22', '2020-08-26 16:48:22'),
(4537, 2037, 8033, NULL, '2020-09-17 00:00:00.000', 'In Process', 'Initiated the request to add Dr. William Francis to the group BAQC. Roster & W-9 Form sent @ stxnm@humana.com. ----------- Sherry Deen  Attachments 3:48 PM (52 minutes ago) to stxnm, Bay  Greetings,  Kindly find the attached completed roster with the intention to add Dr. William Francis to the existing group \"Bay Area Quick Care\". Also find the attached W-9 form.  Feel free to contact me for any other requirements.', NULL, NULL, '2020-08-26 16:51:55', '2020-08-26 16:51:55'),
(4538, 2037, 8033, NULL, '2020-09-14 00:00:00.000', 'In Process', 'Confirmation of receiving from Humana :   S TX Network Mgmt Thu, Aug 27, 7:59 AM (4 days ago) to me  Thank you for your e-mail.  We have successfully received your message and will respond as soon as possible.    DEMOGRAPHIC REQUESTS  Please allow 45-60 days for completion of demographic requests.  You will receive an email notification once your request has been completed.   You may check your demographic information at any time through Humana’s online directory:  https://www.humana.com/finder/medical?pageId=e59a074a04e741fbb164fc08ce8222fe.  OTHER KEY RESOURCES  Humana\'s priority is the health and wellness of the patients and communities we serve.  We understand that supporting you in the care of your patients is critical in keeping patients safe.   Please visit https://www.humana.com/provider/coronavirus for up-to-date information related to COVID19 and how Humana is working to help you care for members.  For all other requests including contract copies and fee schedules, etc., please contact the South Texas market directly via email at STXNM@humana.com.   Thank you Network Operations Coordinator /Provider Contracting  South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741  F 855.461.6048  stxnm@humana.com', NULL, NULL, '2020-08-31 10:37:02', '2020-08-31 10:37:02'),
(4539, 2037, 8033, NULL, '2020-10-22 00:00:00.000', 'In Process', 'As per live call to Humana the application is in process. Representative Rod has sent a follow up email with the initial request that was sent from our end to the Texas team to get an update. Interaction# 2000148698033.', NULL, NULL, '2020-10-02 10:53:29', '2020-10-02 10:53:29'),
(4540, 2037, 8033, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Update received .As per live call to Humana the application is in process.  Interaction# 2000148698033.Point of Contact: clewis10@humana.com.Follow Up email sent.', NULL, NULL, '2020-10-09 13:42:59', '2020-10-09 13:42:59'),
(4541, 2037, 8033, NULL, '2020-11-12 00:00:00.000', 'In Process', ' Sherry Deen  Attachments 10:08 AM (32 minutes ago) to S  Greetings,  Kindly find the attached completed roster with the intention to add Dr. William Francis to the existing group \"Bay Area Quick Care\". Also find the attached W-9 form.    CAQH has been updated with Work/Education History Gap: 03/2015-03/2017 and Current hospital affiliation. Regards:', NULL, NULL, '2020-10-27 10:44:38', '2020-10-27 10:44:38'),
(4542, 2037, 8033, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up Email sent to stnxm@humana.com', NULL, NULL, '2020-11-09 14:09:53', '2020-11-09 14:09:53'),
(4543, 2037, 8033, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Response received : ------------------------------------- S TX Network Mgmt 8:39 AM (5 hours ago) to me  The request was received and is the queue for processing. You will receive an email notification once it is complete.     Thank you Network Operations Coordinator /Provider Contracting  South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741  F 855.461.6048 ', NULL, NULL, '2020-11-12 15:10:40', '2020-11-12 15:10:40'),
(4544, 2037, 8033, NULL, '2020-11-27 00:00:00.000', 'In Process', 'As per live call to Humana the application is in process.  Interaction# 2000148698033.Point of Contact: clewis10@humana.com.Follow Up email sent.', NULL, NULL, '2020-11-19 17:43:53', '2020-11-19 17:43:53'),
(4545, 2037, 8033, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Follow up email sent to clewis10@humana.com Subject: Linkage Request-William Francis-BAQC  Greetings, If I may follow up for the linkage request of the listed provider with the below mentioned group.  Provider: William Francis.NPI: 1457994436. Group: Bay Area Quick Care. TIN: 27-1702009.', NULL, NULL, '2020-11-30 15:12:47', '2020-11-30 15:12:47'),
(4546, 2037, 8033, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Another follow up email sent to Clewes', NULL, NULL, '2020-12-14 15:12:58', '2020-12-14 15:12:58'),
(4547, 2037, 8033, NULL, '2021-01-07 00:00:00.000', 'In Process', 'As per live call to Humana the provider\'s credentialing is still under process need to allow 45 to 60 days from the confirmation of receiving which is 11/04/2020.Interaction number 2000160733183.', NULL, NULL, '2020-12-21 11:00:17', '2020-12-21 11:00:17'),
(4548, 1006, 8033, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Sent follow-up @ S TX Network Mgmt stxnm@humana.com ', NULL, NULL, '2021-01-11 17:31:49', '2021-01-11 17:31:49'),
(4549, 1006, 8033, NULL, '2021-01-20 00:00:00.000', 'In Process', 'The request is still processing, received the following response from S TX Network Mgmt stxnm@humana.com: \"Hello  The request to add William Francis, FNP to the group contract is in process of being loaded. You will receive an email notification once the load is complete.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com\"', NULL, NULL, '2021-01-12 09:22:15', '2021-01-12 09:22:15'),
(4550, 1006, 8033, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Sent follow up email to stxnm@humana.com  Emaild:  Hello,  I wanted to get an update regarding the enrollment status for the following provider:   Provider Name: Francis William  NPI# 1437481421 TIN# 27-170200 Thanks and regards.', NULL, NULL, '2021-01-26 15:05:48', '2021-01-26 15:05:48');
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
(4551, 1006, 8033, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ stxnm@humana.com as the provider has been enrolled as per their last email:  \"The request to add William Francis, FNP to the group contract is complete in Humana’s systems effective 7/1/2020.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com\"', NULL, NULL, '2021-01-28 13:20:25', '2021-01-28 13:20:25'),
(4552, 1006, 8033, NULL, '2021-02-04 00:00:00.000', 'Approved', 'The email notification sent this morning is the only written letter you will receive regarding the new provider being added.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com', NULL, NULL, '2021-01-28 14:50:07', '2021-01-28 14:50:07'),
(4553, 1006, 8034, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 17:03:38', '2020-08-26 17:03:38'),
(4554, 2037, 8034, NULL, '2020-09-09 00:00:00.000', 'Initiated', 'Initiated the process by filling application. Sent completed application to with required documents @ Patti.Davidson@healthsmart.com ', NULL, NULL, '2020-09-02 14:03:49', '2020-09-02 14:03:49'),
(4555, 2037, 8034, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Agreement received. Signed and sent back to Patti. Bellow is the reference email and copy of the agreement uploaded in the system. ------------------------------------  Sherry Deen sd@claimsmedinc.com Attachments 3:18 PM (3 minutes ago) to Healing, Patti  Hello Patti,  Thank you for the prompt response. Attached is the signed provider agreement for you to proceed further with the enrollment request. Feel free to contact me for any additional information if needed.', NULL, NULL, '2020-09-02 15:25:50', '2020-09-02 15:25:50'),
(4556, 2037, 8034, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Received confirmation email from Patti. ----------------------------- Hi.  Thank you!   I have submitted the documents on for credentialing process and approval.  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2020-09-08 09:04:50', '2020-09-08 09:04:50'),
(4557, 2037, 8034, NULL, '2020-09-30 00:00:00.000', 'Approved', 'Received Welcome Letter from Anci-Care the group is effective with them as of 09/01/2020. Welcome Packet placed on the server and the copy of the executed contract is uploaded on EMRBS. Below is the Reference Email: ----------------- Good Afternoon,     Congratulations and welcome to the Ancillary Care Services (ACS) network. Please see the attachments. My name is Jennifer Maligaya and I am the Sr. Provider Relations Representative to the ACS Providers.     My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!     Best Regards,     Jennifer Maligaya | Sr. Provider Relations Representative', NULL, NULL, '2020-09-23 15:38:08', '2020-09-23 15:38:08'),
(4558, 1006, 8035, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 17:03:45', '2020-08-26 17:03:45'),
(4559, 2037, 8035, NULL, '2020-09-08 00:00:00.000', 'New/Not Initiated', 'Initiated.', NULL, NULL, '2020-09-01 17:21:55', '2020-09-01 17:21:55'),
(4560, 2037, 8035, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Received provider data record form via email from Susdey. Documents completed and sent by fax to 817-633-5729. Attachments uploaded and placed on the server.Below is the reference email. -------------- Susdey Sud Attachments Tue, Sep 1, 3:40 PM (17 hours ago) to hhuc@claimsmedinc.com  Hello,  We have received application for the following provider:  Erline R. Terrelonge   We need the contract to be signed as well and please see the attachment.    Thank you, Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 633-5729 ------------------------------ Greetings Susdey,  Kindly find the attached signed contract as requested.  Do feel free to contact me for any additional information if required. Regards:  Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 | sd@claimsmedinc.com ', NULL, NULL, '2020-09-02 09:22:25', '2020-09-02 09:22:25'),
(4561, 2037, 8035, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Received confirmation email that the enrollment application for Erline Terrelonge/Healing Hands Urgent Care and Telehealth effective 09/01/2020. Requested Welcome Packet. Below are the reference emails. ------------------------ Thank you for your quick response, I have marked all paperwork complete and Erline Terrelonge/Healing Hands Urgent Care and Telehealth will now be added as a network provider effective 9/1/2020.     Please feel free to contact me with any questions…  Thanks again and have a great day!!     Christine Guerue  Credentialing Dept ------------------- Hello Chris,  Thank you so very much for all your kind assistance throughout the process. Just wanted to confirm the estimated time for us to receive the welcome packet/copy of the executed contract. Also if I may have the provider id if there is one assigned to Erline Terrelonge/Healing Hands Urgent Care and Telehealth.  Thank you again!', NULL, NULL, '2020-09-15 09:11:43', '2020-09-15 09:11:43'),
(4562, 2037, 8035, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Following up with Malanie for the Welcome Packet: Reference Emails as follows: ------------  Chris Guerue Attachments 9:25 AM (22 minutes ago) to me  Hi Sherry,  We just utilize the TIN as provider ID.  Sorry, I’m not sure the time frame for a Welcome letter, Malanie would have to confirm that, I know that the Network Support department is behind because of the pandemic, we returned to the office about a month ago after working from home since the end of March, so I’m not sure where they are at but if you reach out to Malanie she should be able to expediate it for you.  I’m not seeing  her in the office today but feel free to email her at mmedina@ghn-mci.com or if you prefer you can leave her a voice message at 800-975-3322 ext. 1603.     Thank you and have a good day!     Christine Guerue Credentialing Dept ---------------------------------- Hi Malanie,  I got your contact details from Chris in reference to the welcome packet for below mentioned provider.If I may know the estimated time of  receiving the copy of the executed contract. Also if its possible to go ahead and expedite the request just a bit that would be greatly appreciated. ', NULL, NULL, '2020-09-15 09:52:40', '2020-09-15 09:52:40'),
(4563, 2037, 8035, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Welcome Letter received along with a copy of the fully executed contract. Placed on the server and uploaded on EMRBS.Approval email sent to the billing.Reference Email. -----------------------------  Good Afternoon Sherry,     Provider has been loaded and attached is the Welcome Letter along with a copy of the fully executed agreement.     Myranda F. Jaramillo-Texas Rep', NULL, NULL, '2020-09-15 15:30:29', '2020-09-15 15:30:29'),
(4564, 1006, 8036, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-26 17:03:53', '2020-08-26 17:03:53'),
(4565, 2037, 8036, NULL, '2020-09-09 00:00:00.000', 'Initiated', 'Initiated the process online. Below is the response. -------------- Your application has been submitted! Please allow 15 business days for a HealthSmart team member to contact you on next steps. Thank you for your interest in being a part of the HealthSmart Preferred Care Provider Network!', NULL, NULL, '2020-09-02 12:51:57', '2020-09-02 12:51:57'),
(4566, 2037, 8036, NULL, '2020-09-10 00:00:00.000', 'In Process', 'Contracted received for signature via email.Signed and re-submitted @ pr.south@healthsmart.com with CAQH access form.Inventory Log ID : 61160 Documents placed on the server as well as uploaded in EMRBS.', NULL, NULL, '2020-09-03 15:50:45', '2020-09-03 15:50:45'),
(4567, 2037, 8036, NULL, '2020-09-10 00:00:00.000', 'In Process', 'Reference Email:   Sherry Deen Attachments 4:19 PM (1 minute ago) to pr.south, Healing  Greetings,  Kindly find the attached signed contract and CAQH access form for further processing. Do feel free to contact me for any additional information if required.', NULL, NULL, '2020-09-03 16:24:57', '2020-09-03 16:24:57'),
(4568, 2037, 8036, NULL, '2020-09-17 00:00:00.000', 'In Process', 'Requested W9 Form sent. Reference email as follows: ----------------------- Greetings,   Kindly find the attached W-9 form as requested to proceed further with the process.Please note that the CAQH is updated. Inventory Log ID : 61160 Do feel free to contact me for any further information if required. Regards:  Sherry Deen', NULL, NULL, '2020-09-10 09:01:16', '2020-09-10 09:01:16'),
(4569, 2037, 8036, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Received confirmation email from HealthSmart. Credentials have been forward to the concerned department for processing.Turn Around 30 days.Below is the reference email. ---------------------------------- Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  *Terrelonge, Erline APN  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :61160)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2020-09-11 10:12:18', '2020-09-11 10:12:18'),
(4570, 2037, 8036, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Follow up email sent to pr.south@healthsmart.com -------- Following up on the credentialing process of the individual provider mentioned below: Provider : Erline TerrelongeNPI        : 1265045660TIN#      :  85-1449677Looking forward to hearing from you soon.', NULL, NULL, '2020-10-15 16:41:54', '2020-10-15 16:41:54'),
(4571, 2037, 8036, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Response received: -------------- Hi,  Provider \" Terrelonge, Erline APN \" is currently in the credentialing process. ', NULL, NULL, '2020-10-19 09:12:37', '2020-10-19 09:12:37'),
(4572, 2037, 8036, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Need to Allow more time as the application is in credentialing process with no deficiencies as of now.', NULL, NULL, '2020-10-26 13:51:31', '2020-10-26 13:51:31'),
(4573, 2037, 8036, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Response received: Copy of the executed contract requested. -------------------------------- Hi,  Provider \'\' Terrelonge, Erline APN \'\' is Effective \'\' 09/17/2020 \'\'.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 61160 )', NULL, NULL, '2020-11-25 12:45:45', '2020-11-25 12:45:45'),
(4574, 2037, 8036, NULL, '2020-12-07 00:00:00.000', 'Approved', 'Received confirmation email effective 09/17/2020. Par Plan Details updated in the notes. --------------------------- MDI PR Support mdiprsupport@healthsmart.com Nov 7, 2020, 10:47 AM to me  Hi,  Provider \'\' Terrelonge, Erline APN \'\' is Effective \'\' 09/17/2020 \'\'.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 61160 )  Thanks HealthSmart Provider Relations.', NULL, NULL, '2020-11-30 12:09:41', '2020-11-30 12:09:41'),
(4575, 2037, 8037, NULL, NULL, 'New/Not Initiated', 'Initiated.', NULL, NULL, '2020-08-26 17:51:04', '2020-08-26 17:51:04'),
(4576, 2037, 8037, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Filled provider on-boarding form and submitted online.Friendly copy of the application placed in the folder.', NULL, NULL, '2020-08-26 18:02:41', '2020-08-26 18:02:41'),
(4577, 2037, 8037, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Follow up email sent to :	provider_relations_south_texas@bcbstx.com ------  confirmation we have received your inquiry, case number is 01904496.', NULL, NULL, '2020-10-08 17:03:21', '2020-10-08 17:03:21'),
(4578, 2037, 8037, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Follow Up email Sent: ---------------- Sherry Deen 2:23 PM (0 minutes ago) to Marina_Machuca, Bay  Hello Mariana,  If I may have an updated status of the on boarding request for the below mentioned provider.  Group: Bay Area Quick Care TIN           : 27-1702009. Provider: William Francis. NPI: 1457994436', NULL, NULL, '2020-10-23 14:29:26', '2020-10-23 14:29:26'),
(4579, 2037, 8037, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Got a Network  Manager for the group: Gave a call to her as per Connie William Francis is currently going through the credentialing process with the provider ID# 8NE775. She advised me to call back by next Friday to double check. ------------------------ Contact Details:  Connie Traylor 806-798-6317 connie_traylor@bcbxtx.com', NULL, NULL, '2020-10-23 15:08:27', '2020-10-23 15:08:27'),
(4580, 2037, 8037, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Follow up call made to Connie and left voice mail with all the details.', NULL, NULL, '2020-10-30 13:14:23', '2020-10-30 13:14:23'),
(4581, 2037, 8037, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Called connie to follow up and left voice. Sent a follow up email @ connie_traylor@bcbxtx.com --------------------------- ', NULL, NULL, '2020-11-02 12:54:00', '2020-11-02 12:54:00'),
(4582, 2037, 8037, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Good morning Sherry,     William Francis, APN, has been issued provider ID, 8NE775.  He is currently pending for networks. I will notify you once he becomes active in networks. He has ID 8NN047, tied to Statcare Minor Emergency Clinic, but I see nothing showing that a request has been made to add networks.  I will check on this today. Does he have a TPI number for this group? Or commerical products only?     The addresses you have listed below for Statcare Minor Emergency Clinic are currently listed in our system under the group. -------------------------------------  Hello Connie, Thank you for the email.I will be looking forward to the networks being added. Is there an action required from my end to do so? and what is the estimated time of completion of the process?More over kindly find below William\'s TPI for both the groups to add the Medicare/Medicaid plans as well along with the commercial products. Provider: William Francis.NPI: 1457994436 Group:Bay Area Quick Care William\'s TPI: 4144909-01  Group: Statcare Minor Emergency Clinic  William\'s TPI: 4144909-02   Please do let me know if you need additional information.', NULL, NULL, '2020-11-18 14:04:49', '2020-11-18 14:04:49'),
(4583, 2037, 8037, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Connie Traylor Nov 18, 2020, 2:16 PM (1 day ago) to me  Hi Sherry,     I did some double checking and it looks like his CAQH application hasn\'t crossed over to BCBS yet. He is currently out of network and is in pending status for both groups listed below.     Please feel free to check back with me in 7-10 days for status. If I see anything I\'ll let you know.  When he becomes active in network with either of these groups I will notify you.', NULL, NULL, '2020-11-19 16:46:48', '2020-11-19 16:46:48'),
(4584, 2037, 8037, NULL, '2020-12-11 00:00:00.000', 'Approved', 'Received the welcome letter the provider is now in network effective 11/24/2020. Par plan details uploaded in the attachments. Confirmation email received from Connie and email sent to the billing.', NULL, NULL, '2020-12-04 13:07:25', '2020-12-04 13:07:25'),
(4585, 1006, 8038, NULL, NULL, 'New/Not Initiated', 'Kingsville has been approved, need to add address for location. ', NULL, NULL, '2020-08-26 18:00:47', '2020-08-26 18:00:47'),
(4586, 2037, 8038, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Follow up for location addition. Case number is 01878315.Also fax sent @ 3618520624 and email sent at provider_relations_south_texas@bcbstx.com', NULL, NULL, '2020-09-30 13:32:45', '2020-09-30 13:32:45'),
(4587, 2037, 8038, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Follow up email sent: @ provider_relations_south_texas@bcbstx.com  ----------------- Greetings, This email is a follow up on a request to add two additional locations for the below mentioned provider : StatCare Minor Emergency Clinic.TIN# : 46-0575924Provider: Mary C Gonzalez.NPI Type 1: 1952713083 Locations:Secondary Location:4042 River Hill Drive Nueces County Corpus Christi TX  78410-5606. Phone Number:  361-933-5187 & 361-933-5188Fax Number: 361-933-5189 Tertiary Location: 6646 S Staples St #122 Nueces County  Corpus Christi TX 78413-5426.Phone Number: 361-334-2023Fax Number:  361-334-2025 Your prompt response would be highly appreciated as it is a matter of urgency.', NULL, NULL, '2020-10-19 10:08:29', '2020-10-19 10:08:29'),
(4588, 2037, 8038, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Response received: Good afternoon,  Your previous request to change primary location and add satellite location has been submitted but not processed.  Please check back in ten days.   Thank you. ', NULL, NULL, '2020-10-21 17:43:12', '2020-10-21 17:43:12'),
(4589, 2037, 8038, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-02 16:00:12', '2020-11-02 16:00:12'),
(4590, 2037, 8038, NULL, '2020-11-25 00:00:00.000', 'Approved', 'Location has been added screenshot from the directory uploaded', NULL, NULL, '2020-11-18 13:54:25', '2020-11-18 13:54:25'),
(4591, 1006, 8039, NULL, NULL, 'New/Not Initiated', 'Kingsville has been approved, need to add address for location. ', NULL, NULL, '2020-08-26 18:00:55', '2020-08-26 18:00:55'),
(4592, 2037, 8039, NULL, '2020-10-07 00:00:00.000', 'In Process', 'Follow up for location addition. Case number is 01878315.Also fax sent @ 3618520624 and email sent at provider_relations_south_texas@bcbstx.com', NULL, NULL, '2020-09-30 13:33:23', '2020-09-30 13:33:23'),
(4593, 2037, 8039, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Follow up for location addition. Case number is 01878315.Also fax sent @ 3618520624 and email sent at provider_relations_south_texas@bcbstx.com', NULL, NULL, '2020-09-30 13:33:35', '2020-09-30 13:33:35'),
(4594, 2037, 8039, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Follow up email sent: @ provider_relations_south_texas@bcbstx.com  ----------------- Greetings, This email is a follow up on a request to add two additional locations for the below mentioned provider : StatCare Minor Emergency Clinic.TIN# : 46-0575924Provider: Mary C Gonzalez.NPI Type 1: 1952713083 Locations:Secondary Location:4042 River Hill Drive Nueces County Corpus Christi TX  78410-5606. Phone Number:  361-933-5187 & 361-933-5188Fax Number: 361-933-5189 Tertiary Location: 6646 S Staples St #122 Nueces County  Corpus Christi TX 78413-5426.Phone Number: 361-334-2023Fax Number:  361-334-2025 Your prompt response would be highly appreciated as it is a matter of urgency.', NULL, NULL, '2020-10-19 10:08:37', '2020-10-19 10:08:37'),
(4595, 2037, 8039, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Response received: Good afternoon,  Your previous request to change primary location and add satellite location has been submitted but not processed.  Please check back in ten days.   Thank you. ', NULL, NULL, '2020-10-21 17:43:45', '2020-10-21 17:43:45'),
(4596, 2037, 8039, NULL, '2020-11-06 00:00:00.000', 'Approved', 'Location has been added screenshot from the directory uploaded', NULL, NULL, '2020-10-30 15:56:40', '2020-10-30 15:56:40'),
(4597, 1006, 8040, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-08-28 10:28:18', '2020-08-28 10:28:18'),
(4598, 1006, 8040, NULL, '2020-09-04 00:00:00.000', 'In Process', 'Initiated enrollment via online tool. ', NULL, NULL, '2020-08-28 10:33:47', '2020-08-28 10:33:47'),
(4599, 1006, 8040, NULL, '2020-09-22 00:00:00.000', 'In Process', 'The request still shows as in-process on the website with the same reference number. ', NULL, NULL, '2020-09-15 17:12:03', '2020-09-15 17:12:03'),
(4600, 1006, 8040, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Request still shows up as in-process:  \"Additional research is required to complete your request  Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	20241000411 NPI :	1710489760\"', NULL, NULL, '2020-09-23 10:40:23', '2020-09-23 10:40:23'),
(4601, 1006, 8040, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Request still shows up as in process. ', NULL, NULL, '2020-09-29 13:29:33', '2020-09-29 13:29:33'),
(4602, 1006, 8040, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Talked to Raven @ 888-355-9165. As per her, every time we checked in on the request on RR provider portal it was re-initiating the request. Need to allow 30 days to elapse or call in directly for a follow-up ', NULL, NULL, '2020-10-02 15:34:39', '2020-10-02 15:34:39'),
(4603, 1005, 8040, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Request is in process.', NULL, NULL, '2020-10-12 14:54:18', '2020-10-12 14:54:18'),
(4604, 1006, 8040, NULL, '2020-11-06 00:00:00.000', 'Approved', 'PROVIDER NAME	JENNIFER L ULLRICH PROVIDER PTAN	P02531593 PROVIDER NPI	1710489760 EFFECTIVE DATE	05/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	 ', NULL, NULL, '2020-10-30 15:04:52', '2020-10-30 15:04:52'),
(4605, 2037, 9040, NULL, NULL, 'New/Not Initiated', 'As per live call to Cigna @ (800) 244 6224. The pannels are closed up until December. (Area Specific) They are not talking mid level Practitioners in  the area. Credentialing on hold. Ref# Red08/31/2020.', NULL, NULL, '2020-08-31 14:22:10', '2020-08-31 14:22:10'),
(4606, 2037, 9040, NULL, '2020-09-09 00:00:00.000', 'On Hold', '	 As per live call to Cigna @ (800) 244 6224. The pannels are closed up until December. (Area Specific) They are not talking mid level Practitioners in  the area. Credentialing on hold. Ref# Red08/31/2020.', NULL, NULL, '2020-09-02 09:33:52', '2020-09-02 09:33:52'),
(4607, 2037, 9040, NULL, '2020-12-31 00:00:00.000', 'On Hold', 'As per live call to Cigna @ (800) 244 6224. The pannels are closed up until December. (Area Specific) They are not talking mid level Practitioners in  the area. Credentialing on hold. Ref# Red08/31/2020.', NULL, NULL, '2020-10-09 09:23:47', '2020-10-09 09:23:47'),
(4608, 1006, 9040, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The provider is no longer with the company. ', NULL, NULL, '2021-08-16 09:12:06', '2021-08-16 09:12:06'),
(4609, 2037, 9041, NULL, NULL, 'New/Not Initiated', 'As per live call to Cigna @ (800) 244 6224 The group can online be credentialed if a minimum of two individual providers are linked to the TIN. We only have one provider with the practice at the moment so we won\'t be able to proceed further for the group credentialing.For individual enrollment for Eline Terrelonge the panels are closed up until December. (Area Specific) They are not talking mid level Practitioners in  the area. Credentialing on hold. Ref# Red08/31/2020.', NULL, NULL, '2020-08-31 14:25:40', '2020-08-31 14:25:40'),
(4610, 2037, 9041, NULL, '2020-09-08 00:00:00.000', 'On Hold', 'As per live call to Cigna @ (800) 244 6224 The group can only be credentialed if a minimum of two individual providers are linked to the TIN. We only have one provider with the practice at the moment so we won\'t be able to proceed further for the group credentialing.For individual enrollment for Eline Terrelonge the panels are closed up until December. (Area Specific) They are not talking mid level Practitioners in  the area. Credentialing on hold. Ref# Red08/31/2020.', NULL, NULL, '2020-09-01 13:09:23', '2020-09-01 13:09:23'),
(4611, 2037, 9041, NULL, '2020-12-16 00:00:00.000', 'On Hold', 'As per live call to Cigna @ (800) 244 6224 The group can only be credentialed if a minimum of two individual providers are linked to the TIN. We only have one provider with the practice at the moment so we won\'t be able to proceed further for the group credentialing.For individual enrollment for Eline Terrelonge the panels are closed up until December. (Area Specific) They are not talking mid level Practitioners in  the area. Credentialing on hold. Ref# Red08/31/2020.', NULL, NULL, '2020-10-09 09:22:31', '2020-10-09 09:22:31'),
(4612, 1006, 9041, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'The provider is no longer with the company. ', NULL, NULL, '2021-08-16 09:12:10', '2021-08-16 09:12:10'),
(4613, 2037, 9042, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-08-31 14:57:40', '2020-08-31 14:57:40'),
(4614, 2037, 9042, NULL, '2020-09-07 00:00:00.000', 'Initiated', 'Filled Group\'s enrollment form and faxed @ 608-221-7535 . Copy of the sent fax placed in the folder on the server.', NULL, NULL, '2020-08-31 15:00:44', '2020-08-31 15:00:44'),
(4615, 2037, 9042, NULL, '2020-09-08 00:00:00.000', 'In Process', 'Filled Group\'s enrollment form and faxed to 608-221-7535 . Copy of the sent fax placed in the folder on the server.', NULL, NULL, '2020-09-01 13:10:14', '2020-09-01 13:10:14'),
(4616, 2037, 9042, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Urgent Care Agreement received for signatures over the secure email.Signed and submitted back.Copy of the signed agreement placed on the server and uploaded on EMRBS.', NULL, NULL, '2020-10-06 14:47:34', '2020-10-06 14:47:34'),
(4617, 2037, 9042, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Copy of GROUP Location and Rendering spreadsheet received, Completed and submitted back to CGude1@humana.com. ---------------- Reference email as follows: Hi Cornelius,  Kindly find the attached completed spreadsheet as requested to proceed further with the loading of the contract.  Please feel free to contact me for any additional information if needed.  Thank you!', NULL, NULL, '2020-10-07 10:49:28', '2020-10-07 10:49:28'),
(4618, 2037, 9042, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent to Cornelius', NULL, NULL, '2020-10-30 13:39:24', '2020-10-30 13:39:24'),
(4619, 2037, 9042, NULL, '2020-11-30 00:00:00.000', 'In Process', '	 Follow up email sent to Cornelius', NULL, NULL, '2020-11-19 17:33:16', '2020-11-19 17:33:16'),
(4620, 2037, 9042, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Follow up email sent to Cornelius', NULL, NULL, '2020-11-30 14:29:24', '2020-11-30 14:29:24'),
(4621, 2037, 9042, NULL, '2020-12-18 00:00:00.000', 'In Process', 'need to allow more time.', NULL, NULL, '2020-12-11 17:36:42', '2020-12-11 17:36:42'),
(4622, 2037, 9042, NULL, '2021-01-08 00:00:00.000', 'In Process', 'need to allow more time.', NULL, NULL, '2020-12-21 18:01:44', '2020-12-21 18:01:44'),
(4623, 1006, 9042, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to CGude1@humana.com', NULL, NULL, '2021-01-26 17:30:36', '2021-01-26 17:30:36'),
(4624, 1006, 9042, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ Cornelius Gude CGude1@humana.com ', NULL, NULL, '2021-02-03 10:47:23', '2021-02-03 10:47:23'),
(4625, 1006, 9042, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ Yvonne Wyatt ywyatt@humana.com', NULL, NULL, '2021-02-16 14:49:05', '2021-02-16 14:49:05'),
(4626, 1006, 9042, NULL, '2021-03-15 00:00:00.000', 'Rejected', 'Good morning Brad,     We show this tax id as non-network TRICARE certified.     As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary.        •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult                             Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com  ', NULL, NULL, '2021-03-08 11:58:20', '2021-03-08 11:58:20'),
(4627, 2037, 9043, NULL, NULL, 'New/Not Initiated', 'Received the group contract the group is effective from 06-08-2020 with the provider Id# 1298741. Contract uploaded in EMRBS and placed in the folder on the server.', NULL, NULL, '2020-08-31 16:26:37', '2020-08-31 16:26:37'),
(4628, 2037, 9043, NULL, '2020-09-07 00:00:00.000', 'Approved', 'Received the copy of the Executed group contract. Approval Email sent to the billing. ----------------------- LaNetrice Myart  Attachments Aug 19, 2020, 4:28 PM (12 days ago) to me, ProviderInfo, PLLC  Hello Sherry,   Attached is a copy of the requested contract agreement. If you  have any questions please feel free to give me a call.     Thank you,', NULL, NULL, '2020-08-31 16:31:48', '2020-08-31 16:31:48'),
(4629, 1006, 9044, NULL, NULL, 'New/Not Initiated', 'Need to enroll supervising physician to be able to bill for Stephane/BHUCC. ', NULL, NULL, '2020-08-31 17:26:48', '2020-08-31 17:26:48'),
(4630, 1006, 9044, NULL, '2020-09-07 00:00:00.000', 'Approved', 'Received following email from Cigna, notifying us that Segun has been added to BHUCC:  \"Dear Health Care Professional,  \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future request should be sent to Intake_PDM@cigna.com  Name: Segun Adeoye PID: 5883559 Effective date: 05/01/2020  Sincerely, Data Management\"', NULL, NULL, '2020-08-31 17:27:47', '2020-08-31 17:27:47'),
(4631, 2037, 9045, NULL, NULL, 'New/Not Initiated', 'Initiation.', NULL, NULL, '2020-09-01 15:53:17', '2020-09-01 15:53:17'),
(4632, 2037, 9045, NULL, '2020-09-10 00:00:00.000', 'In Process', 'Individual Enrollment application has been submitted via TMHP provider portal. Tracking number with confirmation uploaded in attachments. http://www.tmhp.com/Pages/default.aspx User: cmalowitz Password: Claims@1000', NULL, NULL, '2020-09-01 15:56:25', '2020-09-01 15:56:25'),
(4633, 1005, 9045, NULL, '2020-10-03 00:00:00.000', 'New/Not Initiated', 'Portal Ticket #	17184007	 Status. In Progress', NULL, NULL, '2020-09-24 14:28:01', '2020-09-24 14:28:01'),
(4634, 1005, 9045, NULL, '2020-10-03 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-24 14:28:18', '2020-09-24 14:28:18'),
(4635, 2037, 9045, NULL, '2020-10-06 00:00:00.000', 'Approved', 'William Francis got approved by Medicaid effective 08/01/2020 TPI: 4144909-01. Welcome letter Attached  and Approval email sent.', NULL, NULL, '2020-09-29 15:44:52', '2020-09-29 15:44:52'),
(4636, 1006, 9045, NULL, '2021-09-09 00:00:00.000', 'Revalidation', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:19', '2021-09-02 10:26:19'),
(4637, 11056, 9045, NULL, '2021-10-05 00:00:00.000', 'Revalidation', '	 Disenrolled  Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	  18058681	PIMS Enrollment Informati		9/15/2021	Provider Information Change (PIC) Form	Closed', NULL, NULL, '2021-09-28 10:29:55', '2021-09-28 10:29:55'),
(4638, 11056, 9045, NULL, '2021-12-08 00:00:00.000', 'Revalidated', 'Disenrolled  Portal Ticket #Ascending	Application Name	NPI	Status Update Date	Transction Type	Status   15122518	Cynthia Malowitz	1336173244	6/22/2018	Enrollment - First Time Applicant	Closed', NULL, NULL, '2021-12-01 12:23:31', '2021-12-01 12:23:31'),
(4639, 1006, 9046, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-01 15:54:10', '2020-09-01 15:54:10'),
(4640, 1006, 9046, NULL, '2020-09-08 00:00:00.000', 'Approved', 'Ancillary contract attached for approval. ', NULL, NULL, '2020-09-01 15:59:48', '2020-09-01 15:59:48'),
(4641, 1006, 9047, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-01 15:54:11', '2020-09-01 15:54:11'),
(4642, 1006, 9047, NULL, '2020-09-08 00:00:00.000', 'Approved', 'Ancillary contract, address has been updated. Attached the address update.', NULL, NULL, '2020-09-01 16:06:34', '2020-09-01 16:06:34'),
(4643, 1006, 9048, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-01 15:54:13', '2020-09-01 15:54:13'),
(4644, 1006, 9048, NULL, '2020-09-08 00:00:00.000', 'Approved', 'Ancillary contract, address has been updated. Attached the address update.', NULL, NULL, '2020-09-01 16:06:25', '2020-09-01 16:06:25'),
(4645, 2037, 9049, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-01 17:25:52', '2020-09-01 17:25:52'),
(4646, 2037, 9049, NULL, '2020-09-08 00:00:00.000', 'In Process', 'Filled out provider enrollment form and faxed over to Fax#   608-221-7535. forms attached and placed on the server. ', NULL, NULL, '2020-09-01 17:27:55', '2020-09-01 17:27:55'),
(4647, 2037, 9049, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Attachments uploaded and placed on the server.', NULL, NULL, '2020-09-02 09:45:24', '2020-09-02 09:45:24'),
(4648, 2037, 9049, NULL, '2020-10-20 00:00:00.000', 'In Process', 'As per Sandra from TriCare East William Francis is now a Certified provider with Effective Date 09/28/2020 and Expiration 09/30/2022.Group Affiliation# 271702009-78418-A001. He is now in contracting process request submitted to Katherine Moten @  Reference Email as follows: --------------------- Hello Katherine,  Hope this email finds you well. We have received a confirmation of certification approval for one of our providers and he is successfully linked to the below mentioned group TIN. This is to request the credentialing process initiation or to get a confirmation if the process has already begun. Group                       : Bay Area Quick Care  TIN                            : 27-1702009   Provider                   : William Francis.NPI                            : 1457994436. Effective Date          : 09/28/2020. Expiration Date        : 09/30/2022.                                 Group Affiliation#    :271702009-78418-A001 Regards: ', NULL, NULL, '2020-10-02 13:48:13', '2020-10-02 13:48:13'),
(4649, 2037, 9049, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Request for contract application submitted.', NULL, NULL, '2020-10-05 12:28:46', '2020-10-05 12:28:46'),
(4650, 2037, 9049, NULL, '2020-10-30 00:00:00.000', 'In Process', 'As per live call to Tricare William Francis is Contracted an is showing In-Network with the effective date 09/29/2020. Per Angela the Welcome letter has been mailed out to the practice location. Waiting for the letter in order to approve the task.', NULL, NULL, '2020-10-23 13:08:03', '2020-10-23 13:08:03'),
(4651, 2037, 9049, NULL, '2020-10-30 00:00:00.000', 'In Process', 'And the provider is successfully likned to the Tax ID aswell. Call Confirmation#10643314', NULL, NULL, '2020-10-23 13:11:05', '2020-10-23 13:11:05'),
(4652, 2037, 9049, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Waiting for the letter in order to approve the task.', NULL, NULL, '2020-10-30 13:17:04', '2020-10-30 13:17:04'),
(4653, 2037, 9049, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Follow up email sent for effective date and Welcome letter to jtrenz@humana.com. ------------- Jacqoline Trenz 502-318-5398 jtrenz@humana.com', NULL, NULL, '2020-11-02 13:53:28', '2020-11-02 13:53:28'),
(4654, 2037, 9049, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Credentialing application filled out and submitted to Katherine Moten for William Francis along with the supporting documents.', NULL, NULL, '2020-11-11 14:02:52', '2020-11-11 14:02:52'),
(4655, 2037, 9049, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Confirmation of receiving from Katherine Moten: ----------------- Katherine Moten KMoten4@humana.com  I have submitted this request. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com ', NULL, NULL, '2020-11-13 09:41:24', '2020-11-13 09:41:24'),
(4656, 2037, 9049, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-11-30 17:53:48', '2020-11-30 17:53:48'),
(4657, 2037, 9049, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Currently being processed', NULL, NULL, '2020-12-11 17:37:04', '2020-12-11 17:37:04'),
(4658, 2037, 9049, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-21 18:00:57', '2020-12-21 18:00:57'),
(4659, 2037, 9049, NULL, '2021-01-06 00:00:00.000', 'Approved', 'As per live call to Tricare East provider is showing certified and completely loaded into the system effective 09/29/2020 and we can start to bill out claims.Directory Confirmation uploaded in EMRBS welcome letter will be received shortly.', NULL, NULL, '2020-12-30 10:43:04', '2020-12-30 10:43:04'),
(4660, 2037, 9050, NULL, NULL, 'New/Not Initiated', 'Received provider data record form via email from Susdey. Documents completed and sent by fax to 817-633-5729. Attachments uploaded and placed on the server.Below is the reference email. -------------- Susdey Sud  Attachments Mon, Aug 31, 3:17 PM (2 days ago) to me  Hello,  As requested, please see the attachment.  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 633-5729 ', NULL, NULL, '2020-09-02 09:43:18', '2020-09-02 09:43:18'),
(4661, 2037, 9050, NULL, '2020-09-09 00:00:00.000', 'In Process', '	 Received provider data record form via email from Susdey. Documents completed and sent by fax to 817-633-5729. Attachments uploaded and placed on the server.Below is the reference email. -------------- Susdey Sud  Attachments Mon, Aug 31, 3:17 PM (2 days ago) to me  Hello,  As requested, please see the attachment.  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 633-5729', NULL, NULL, '2020-09-02 09:43:27', '2020-09-02 09:43:27'),
(4662, 2037, 9050, NULL, '2020-09-09 00:00:00.000', 'In Process', '	 Received provider data record form via email from Susdey. Documents completed and sent by fax to 817-633-5729. Attachments uploaded and placed on the server.Below is the reference email. -------------- Susdey Sud  Attachments Mon, Aug 31, 3:17 PM (2 days ago) to me  Hello,  As requested, please see the attachment.  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 633-5729', NULL, NULL, '2020-09-02 09:43:27', '2020-09-02 09:43:27'),
(4663, 2037, 9050, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Email sent to Galaxy request Confirmation/Welcome letter ------------------------ Greetings, As per live call we got the confirmation that the below mentioned provider has become par with Galaxy Health Network effective 08-31-2020. Provider Name: William R Francis.Type 1 NPI: 1457994436.TIN Number : 27-1702009.Primary Location: 9929 South Padre Island Drive                                Suite 109                                 Corpus Christi , TX 78418-5148 Kindly send us the confirmation via email along with the welcome letter/copy of the executed contract.', NULL, NULL, '2020-09-08 17:47:09', '2020-09-08 17:47:09'),
(4664, 2037, 9050, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Got the confirmation via email . Reference as follows: Approval Email Sent to the Billing. ----------------- Good Afternoon Sherry,     I show the provider linked to Bay Area Quick Care .  Thank you,       Myranda F. Jaramillo-Texas Rep  Network Support  Galaxy Health Network  (P) 800-975-3322 ext 1116  (F) 817-633-5729', NULL, NULL, '2020-09-09 16:01:03', '2020-09-09 16:01:03'),
(4665, 2027, 9051, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 10:20:46', '2020-09-02 10:20:46'),
(4666, 2027, 9051, NULL, '2020-09-09 00:00:00.000', 'Approved', 'This provider is under ancillary contract and effective date is 10/10/2018. Screenshot from provider directory and executed signed contract is attached', NULL, NULL, '2020-09-02 10:35:57', '2020-09-02 10:35:57'),
(4667, 2027, 9052, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 13:11:21', '2020-09-02 13:11:21'),
(4668, 2027, 9052, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is linked with medicare and effective date is 3/19/2020', NULL, NULL, '2020-09-02 13:12:22', '2020-09-02 13:12:22'),
(4669, 2027, 9053, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 13:39:23', '2020-09-02 13:39:23'),
(4670, 2027, 9053, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is linked with medicare and effective date is 3/1/2020', NULL, NULL, '2020-09-02 13:43:08', '2020-09-02 13:43:08'),
(4671, 2027, 9054, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 13:49:30', '2020-09-02 13:49:30'),
(4672, 2027, 9054, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is now linked with medicare and effective date is 3/6/2020 screen shot attached for confirmation', NULL, NULL, '2020-09-02 13:51:58', '2020-09-02 13:51:58'),
(4673, 2027, 9055, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 14:03:27', '2020-09-02 14:03:27'),
(4674, 2027, 9055, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is now linked with medicare and effective date is 1/29/2020 screenshot is attached for confirmation', NULL, NULL, '2020-09-02 14:04:34', '2020-09-02 14:04:34'),
(4675, 2027, 9056, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 14:18:54', '2020-09-02 14:18:54'),
(4676, 2027, 9056, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is now linked with medicare and effective date is 3/1/2020. Screenshot is attached for confirmation', NULL, NULL, '2020-09-02 14:20:24', '2020-09-02 14:20:24'),
(4677, 2027, 9057, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 14:26:00', '2020-09-02 14:26:00'),
(4678, 2027, 9057, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is linked with medicare and effective date is 2/11/2020. Screenshot is attached for confirmation', NULL, NULL, '2020-09-02 14:27:09', '2020-09-02 14:27:09'),
(4679, 2037, 9058, NULL, NULL, 'New/Not Initiated', 'New', NULL, NULL, '2020-09-02 16:52:45', '2020-09-02 16:52:45'),
(4680, 2037, 9058, NULL, '2020-09-30 00:00:00.000', 'Approved', 'Approval Email Sent to the billing ------------------ Hello!    This is to inform the billing department that you can start sending test claims for the below mentioned Provider/group to Aetna using the Type 2 NPI.We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement and we can consider William Francis as in-network with the payer.  ', NULL, NULL, '2020-09-23 15:56:09', '2020-09-23 15:56:09'),
(4681, 2037, 9059, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:54:44', '2020-09-02 16:54:44'),
(4682, 2037, 9059, NULL, '2020-10-25 00:00:00.000', 'In Process', 'Waiting for provider to get enrolled first.Application submitted through BAQC.Then we will be sending the linkage request.', NULL, NULL, '2020-09-25 17:15:08', '2020-09-25 17:15:08'),
(4683, 2037, 9059, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Linkage request sent with W9 Form ------------------ Greetings,  Kindly find the attached Letter with the intention with the W9 to link an individual provider to the existing group TIN. Please add all three service location addresses mentioned on the letter.  Do feel free to contact me for additional information if required.', NULL, NULL, '2020-10-07 14:55:43', '2020-10-07 14:55:43'),
(4684, 2037, 9059, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01899370.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.', NULL, NULL, '2020-10-08 14:20:43', '2020-10-08 14:20:43'),
(4685, 2037, 9059, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Submitted on-boarding application (Linkage to an existing group) uploaded roaster and W9 and submitted . Notification Received. ------------------------ 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: 257626 --------------------', NULL, NULL, '2020-10-23 16:50:52', '2020-10-23 16:50:52'),
(4686, 2037, 9059, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Case number 01942543, for William Francis Linkage to STATCARE MINOR EMERGENCY CLINIC.', NULL, NULL, '2020-10-23 16:54:25', '2020-10-23 16:54:25'),
(4687, 2037, 9059, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Good morning Sherry,     William Francis, APN, has been issued provider ID, 8NE775.  He is currently pending for networks. I will notify you once he becomes active in networks. He has ID 8NN047, tied to Statcare Minor Emergency Clinic, but I see nothing showing that a request has been made to add networks.  I will check on this today. Does he have a TPI number for this group? Or commerical products only?     The addresses you have listed below for Statcare Minor Emergency Clinic are currently listed in our system under the group. -------------------------------------  Hello Connie, Thank you for the email.I will be looking forward to the networks being added. Is there an action required from my end to do so? and what is the estimated time of completion of the process?More over kindly find below William\'s TPI for both the groups to add the Medicare/Medicaid plans as well along with the commercial products. Provider: William Francis.NPI: 1457994436 Group:Bay Area Quick Care William\'s TPI: 4144909-01  Group: Statcare Minor Emergency Clinic  William\'s TPI: 4144909-02   Please do let me know if you need additional information.', NULL, NULL, '2020-11-18 14:03:28', '2020-11-18 14:03:28'),
(4688, 2037, 9059, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Connie Traylor Nov 18, 2020, 2:16 PM (1 day ago) to me  Hi Sherry,     I did some double checking and it looks like his CAQH application hasn\'t crossed over to BCBS yet. He is currently out of network and is in pending status for both groups listed below.     Please feel free to check back with me in 7-10 days for status. If I see anything I\'ll let you know.  When he becomes active in network with either of these groups I will notify you.', NULL, NULL, '2020-11-19 16:46:50', '2020-11-19 16:46:50'),
(4689, 2037, 9059, NULL, '2020-12-11 00:00:00.000', 'Approved', 'The provider is now in network effective 12/04/2020. Par plan details uploaded in the attachments. Confirmation email received from Connie and email sent to the billing.', NULL, NULL, '2020-12-04 13:24:52', '2020-12-04 13:24:52'),
(4690, 2037, 9060, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:55:25', '2020-09-02 16:55:25'),
(4691, 2037, 9060, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Linkage Request Sent to Galaxy Health @ intake_pdm@cigna.com.LOI+W9. ----------------------- Greetings, Kindly find the attached requested documents with letter of intent to add the following provider to an existing group in your network.', NULL, NULL, '2020-09-08 17:36:26', '2020-09-08 17:36:26'),
(4692, 2037, 9060, NULL, '2020-10-28 00:00:00.000', 'In Process', 'The request is received and is currently in process with no current requirement from Cigna. His Application is being processed simultaneously with the request to add him to the BAQC (Tin) and will be taking approx 90 to  120 from 08/28/2020. Reference  : Lannette10/02/2020.', NULL, NULL, '2020-10-02 10:37:41', '2020-10-02 10:37:41'),
(4693, 2037, 9060, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01899370.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.', NULL, NULL, '2020-10-07 15:10:06', '2020-10-07 15:10:06'),
(4694, 2037, 9060, NULL, '2020-10-28 00:00:00.000', 'In Process', 'As per live call to Cigna the linkage request has been added to the initial credentialing application of William Francis through BAQC. Provider will be added to both the tax ID numbers upon approval. I have verified that all the three locations would be added to William for RHC. Application Tracking#12295480.Rep: Nathalia.S.', NULL, NULL, '2020-10-08 14:25:42', '2020-10-08 14:25:42'),
(4695, 2037, 9060, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent to cigna @ 	intake_pdm@cigna.com  ------------ Greetings, Following up on the enrollment application for the below mentioned provider. Group: Stat Care Minor Emergency Clinic.  TIN:      46-0575924. Provider: William Francis. NPI : 1457994436', NULL, NULL, '2020-10-28 10:31:14', '2020-10-28 10:31:14');
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
(4696, 2037, 9060, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Received an email  from Dominique.Clermont@cigna.com confirming the specialty of  William Francis .Responded him back with the clarifimation. Both emails are as follows for reference: --------------------  Hi Dominique,  William Francis is a PCP with speciality as a (Nurse Practitioner). Practice provides: Speciality Care  with the speciality (General Practice).   Please feel free to contact me for any additional information. ---------------------------------------- Dominique.Clermont@cigna.com  Re: Credentialing for mid-level practitioner as primary care provider or specialist  Thank you for your credentialing request.  After careful review, we are unable to determine whether this mid-level practitioner is a primary care provider (PCP) or specialist. A provider type is required to ensure claims are reimbursed accordingly for either primary care or specialist care.  For claim purposes, the following provider types are always reimbursed as primary care:  •           Family medicine  •           Internal medicine  •           General practice  •           Pediatrics  What we need from you  If this mid-level practitioner is not aligned with any of the provider types listed above, please inform of us of the office specialty that best defines the services that you and this mid-level practitioner provide for our customers. The scope of a mid-level practitioner’s care can also be determined by the specialty of the supervising physician he or she primarily works with.  To ensure claims are reimbursed consistently and accurately for this mid-level practitioner, please send this information to me at Dominique.Clermont@cigna.com.  If you have any questions, you can contact me by email or at 800.882.4662.  We appreciate the care you provide our customers.     Thank you,', NULL, NULL, '2020-11-12 15:08:17', '2020-11-12 15:08:17'),
(4697, 2037, 9060, NULL, '2020-11-26 00:00:00.000', 'In Process', 'As per the live call to Cigna the application is Still being processed need to allow more time', NULL, NULL, '2020-11-19 17:37:32', '2020-11-19 17:37:32'),
(4698, 2037, 9060, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Follow up email sent to Dominique.Clermont@cigna.com', NULL, NULL, '2020-11-30 14:48:22', '2020-11-30 14:48:22'),
(4699, 2037, 9060, NULL, '2020-12-16 00:00:00.000', 'In Process', 'As per the live call to Cigna William Francis got on board with cigna (BAQC) effective 12/07/2020 and also RHC Tax ID is also included in the BAQC contract with the same effective date. For RHC he is in the process of being fully loaded . Need to allow one more week to get the confirmation for RHC before we can start to bill.', NULL, NULL, '2020-12-09 13:27:36', '2020-12-09 13:27:36'),
(4700, 2037, 9060, NULL, '2020-12-23 00:00:00.000', 'In Process', '	 As per the live call to Cigna William Francis got on board with cigna (BAQC) effective 12/07/2020 and also RHC Tax ID is also included in the BAQC contract with the same effective date. For RHC he is in the process of being fully loaded . Need to allow one more week to get the confirmation for RHC before we can start to bill.', NULL, NULL, '2020-12-16 14:41:10', '2020-12-16 14:41:10'),
(4701, 2037, 9060, NULL, '2021-01-06 00:00:00.000', 'In Process', 'In the process of being loaded.Need to allow two more weeks', NULL, NULL, '2020-12-23 17:13:13', '2020-12-23 17:13:13'),
(4702, 2037, 9060, NULL, '2021-01-06 00:00:00.000', 'Approved', 'William\'s Profile has been fully loaded with CIGNA-RHC effective date 12/07/2020. Provider is appearing in the directory with all three locations added. Snapshots uploaded in EMRBS.and par plans detail updated in the notes.', NULL, NULL, '2020-12-30 12:20:42', '2020-12-30 12:20:42'),
(4703, 2037, 9061, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:56:07', '2020-09-02 16:56:07'),
(4704, 2037, 9061, NULL, '2020-09-09 00:00:00.000', 'Initiated', 'Reassigning of Benefits request Initiated Via PECOS.', NULL, NULL, '2020-09-02 17:32:40', '2020-09-02 17:32:40'),
(4705, 2037, 9061, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T090220200004521)   Sent: 09/02/2020 18:27 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T090220200004521        NPI: 1457994436        Medicare ID: 1B6508, 1G0803        Name: WILLIAM R FRANCIS          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-09-02 17:33:29', '2020-09-02 17:33:29'),
(4706, 2037, 9061, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Medicare Approved the enrollment application. William Francis is effective 08/01/2020 with the provider ID , P-Tan (1G6537). For RHC all three Locations. Sending approval to the billing department.', NULL, NULL, '2020-09-09 09:07:37', '2020-09-09 09:07:37'),
(4707, 2037, 9062, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:56:43', '2020-09-02 16:56:43'),
(4708, 2037, 9062, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Linkage Request: William Francis- (RHC) sent to registrar@multiplan.com. LOI,W9,Multiplan cover sheet with State Credentialing Application from CAQH. Confirmation of Receiving from Multiplan:  registrar 4:02 PM  to me  Thank you for contacting Registrar at MultiPlan.  On behalf of MultiPlan, please accept our gratitude for your efforts in the fight against Coronavirus.  Please do not respond to this email as this mailbox is set up for replies only. To ensure a timely resolution to your inquiry, please see the options below.  New Requests: This message serves as confirmation of receipt. Your submission will be handled in the order in which it was received, unless mandated by state regulation.  We will contact you if additional information is necessary. Inquiries: Please use MultiPlan\'s customer service portal to inquire about submission status, request a contract copy, or inquire about your fee schedule. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions.  If you need assistance navigating the portal please contact customer service at 800-950-7040. Submitting Missing Information: When submitting missing information, please email the information to registrarmissinginfo@multiplan.com   Thank you,  Registrar Department MultiPlan ', NULL, NULL, '2020-09-08 16:27:48', '2020-09-08 16:27:48'),
(4709, 1006, 9062, NULL, '2020-09-22 00:00:00.000', 'In Process', 'RHC:  The way the group is set-up any providers can bill under the TIN and come up as PAR, but provider is still going through credentialing/contracting with group.   Ref# 7356027 ', NULL, NULL, '2020-09-15 09:59:50', '2020-09-15 09:59:50'),
(4710, 2037, 9062, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Received COI Confirmation and Hospital Affiliation letter from Multi. Filled/Signed and submitted back to Multi @ appmissinginfo@multiplan.com.', NULL, NULL, '2020-09-17 11:07:50', '2020-09-17 11:07:50'),
(4711, 2037, 9062, NULL, '2020-10-07 00:00:00.000', 'Approved', 'Welcome Packet received. William Francis effective from 09/08/2020. Approval email sent and attachment Uploaded.', NULL, NULL, '2020-09-30 15:51:19', '2020-09-30 15:51:19'),
(4712, 2037, 9063, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:57:17', '2020-09-02 16:57:17'),
(4713, 2037, 9063, NULL, '2020-09-10 00:00:00.000', 'Initiated', 'Linkage Request with W-9 Sent to hpdemo@uhc.com. Reference email attached: ------------------------- Greetings, Kindly find the attached Letter with the intention to link an individual provider to the existing group TIN.Details are mentioned in the letter along with the W-9 Form. Do feel free to contact me for additional information if required.', NULL, NULL, '2020-09-03 14:27:29', '2020-09-03 14:27:29'),
(4714, 2037, 9063, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Follow up email sent to networkhelp@uhc.com ----------------- Greetings, If I may have the current status of the request to link William Francis to Stat Care Minor Emergency Clinic.Attached is the initial request with letter of intent submitted on 09/03/2020. Looking forward to hearing back from you soon. Thank you.', NULL, NULL, '2020-10-07 14:14:45', '2020-10-07 14:14:45'),
(4715, 2037, 9063, NULL, '2020-10-19 00:00:00.000', 'Approved', 'As per Live call William Francis Linked to RHC-All Three Locations- Proof Uploaded on EMRBS and placed on the Server.Effective Date: 08/24/2020Reference: 01879197.', NULL, NULL, '2020-10-12 17:10:06', '2020-10-12 17:10:06'),
(4716, 2037, 9064, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:57:40', '2020-09-02 16:57:40'),
(4717, 2037, 9064, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Linkage for an individual is not a requirement as we are holding a facility setup contract Effective 02/13/2017 and we can bill using the facility\'s NPI. Ref#2000144811146. Rep: Christine. Approval Email sent to billing for William Francis.  ', NULL, NULL, '2020-09-10 13:34:24', '2020-09-10 13:34:24'),
(4718, 2037, 9065, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:58:06', '2020-09-02 16:58:06'),
(4719, 2037, 9065, NULL, '2020-09-16 00:00:00.000', 'In Process', 'LOI for Linkage with W-9 Sent via fax @608-221-7535. Note: Process will be initiated once the provider will be certified first for BAQC. Application in process.Ref#10210905 Turn Around Time 30 to 60 business days after certification.', NULL, NULL, '2020-09-09 10:48:43', '2020-09-09 10:48:43'),
(4720, 2037, 9065, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Note: Process will be initiated once the provider will be certified first for BAQC.BAQC Application in process.Ref#10210905.Rep: Sandra.', NULL, NULL, '2020-10-08 14:53:08', '2020-10-08 14:53:08'),
(4721, 2037, 9065, NULL, '2020-10-30 00:00:00.000', 'In Process', 'As per live call to Tricare William Francis is Contracted an is showing In-Network with the effective date 10/06/2020. Per Angela the Welcome letter has been mailed out to the practice location. Waiting for the letter in order to approve the task.', NULL, NULL, '2020-10-23 13:08:22', '2020-10-23 13:08:22'),
(4722, 2037, 9065, NULL, '2020-10-30 00:00:00.000', 'In Process', 'And the provider is successfully likned to the Tax ID aswell. Call Confirmation#10643314', NULL, NULL, '2020-10-23 13:11:11', '2020-10-23 13:11:11'),
(4723, 2037, 9065, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Waiting for the welcome letter', NULL, NULL, '2020-10-29 16:49:30', '2020-10-29 16:49:30'),
(4724, 2037, 9065, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Waiting for the welcome letter', NULL, NULL, '2020-10-30 13:16:17', '2020-10-30 13:16:17'),
(4725, 2037, 9065, NULL, '2020-11-18 00:00:00.000', 'New/Not Initiated', 'Follow up email sent for effective date and Welcome letter to jtrenz@humana.com. ------------- Jacqoline Trenz 502-318-5398 jtrenz@humana.com', NULL, NULL, '2020-11-02 13:53:37', '2020-11-02 13:53:37'),
(4726, 1005, 9065, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Awaiting Welcome letter. Request is in process', NULL, NULL, '2020-11-02 14:32:35', '2020-11-02 14:32:35'),
(4727, 2037, 9065, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Credentialing application filled out and submitted to Katherine Moten for William Francis along with the supporting documents.', NULL, NULL, '2020-11-11 14:03:04', '2020-11-11 14:03:04'),
(4728, 2037, 9065, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Confirmation of receiving from Katherine Moten: ----------------- Katherine Moten KMoten4@humana.com  I have submitted this request. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2020-11-13 09:41:54', '2020-11-13 09:41:54'),
(4729, 2037, 9065, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-11-30 17:54:10', '2020-11-30 17:54:10'),
(4730, 2037, 9065, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Currently being processed', NULL, NULL, '2020-12-11 17:37:17', '2020-12-11 17:37:17'),
(4731, 2037, 9065, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-18 17:19:50', '2020-12-18 17:19:50'),
(4732, 2037, 9065, NULL, '2021-01-06 00:00:00.000', 'Approved', 'As per live call to Tricare East provider is showing certified and completely loaded into the system effective 10/07/2020 and we can start to bill out claims for All three locations.Directory Confirmation & Location addition confirmation uploaded in EMRBS welcome letter will be received shortly.', NULL, NULL, '2020-12-30 10:43:06', '2020-12-30 10:43:06'),
(4733, 2037, 9066, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 16:58:43', '2020-09-02 16:58:43'),
(4734, 2037, 9066, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Linkage Request Sent to Galaxy Health @ mmedina@ghn-mci.com.LOI+W9. ------------------- Greetings, Kindly find the attached requested documents with letter of intent to add the provider \"William Francis\" to an existing group in your network. Do feel free to contact me for any additional information if required.Regards:Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-', NULL, NULL, '2020-09-08 17:07:20', '2020-09-08 17:07:20'),
(4735, 2037, 9066, NULL, '2020-10-02 00:00:00.000', 'Approved', 'We are holding an Urgent Care contract with them so linkage of any individual provider is not a requirement.  ALL THREE LOCATIONS ADDED.', NULL, NULL, '2020-09-25 13:51:04', '2020-09-25 13:51:04'),
(4736, 1006, 9067, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-02 17:42:29', '2020-09-02 17:42:29'),
(4737, 1006, 9067, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Sent emails and filled out an information form to Nilda Amarante Nilda_Amarante@tufts-health.com>: \"Hey Nilda,   Here\'s the form and the W9, please let me know how long this process is going to take. Do let me know if anything else is required from my end.  Thank you!\"', NULL, NULL, '2020-09-02 18:36:31', '2020-09-02 18:36:31'),
(4738, 1006, 9067, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Received the following update from Nilda: \"Hi Brad,  I just had a conversation with Christina Vittoria regarding your group. Spectrum was issued a contract therefore we would not need to issue a separate provider contracts or amendments to add Public Plans to your individual providers.  Kody, please direct any new provider applications for Spectrum to Provider Data and/or Bennett Tansey.\"  Asked her if we\'re good to start sending claims with Tuft Public Plans if that is the case.', NULL, NULL, '2020-09-08 16:54:11', '2020-09-08 16:54:11'),
(4739, 1006, 9067, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Received the following email from Bennett Tansey Bennett_Tansey@tufts-health.com> :  \"Hi Brad,  Apologies for the delay. I am not seeing a profile for Joanna Wood linked to this TIN. Do you know if a PIF was submitted to our provider data team requesting the link?\"  Informed him that we had already submitted the PIF form to Nilda but were told that it wasn\'t required for this request as we already had a group contract in place. ', NULL, NULL, '2020-09-14 10:49:34', '2020-09-14 10:49:34'),
(4740, 1006, 9067, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to Bennett Tansey Bennett_Tansey@tufts-health.com> regarding the status of Public Plans. ', NULL, NULL, '2020-09-23 15:23:43', '2020-09-23 15:23:43'),
(4741, 1006, 9067, NULL, '2020-10-13 00:00:00.000', 'In Process', 'Sent a follow-up email to Bennett regarding the status. ', NULL, NULL, '2020-10-06 09:33:19', '2020-10-06 09:33:19'),
(4742, 1006, 9067, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent another follow-up email to Bennett Tansey Bennett_Tansey@tufts-health.com> & Nilda Amarante Nilda_Amarante@tufts-health.com> regarding enrollment status.  ', NULL, NULL, '2020-10-16 10:01:45', '2020-10-16 10:01:45'),
(4743, 1006, 9067, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Received following reply from Bennett:  \"Hi Brad,  I apologize for the delay.  I have reached out on several occasions to our provider data team, which is the team that handles provider enrollment inquiries, to request their assistance. I am going to speak with the team supervisor and will follow up as soon as possible. Thanks.\"', NULL, NULL, '2020-10-16 10:45:48', '2020-10-16 10:45:48'),
(4744, 1006, 9067, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received the following update from Bennett Tansey Bennett_Tansey@tufts-health.com>:  \"Hi Brad,  So as I mentioned I spoke with the supervisor of our data team. I have confirmed they are in possession of the PIF. They are working on linking the provider in-network and I have communicated that this is time sensitive because you have been waiting. I will follow up to confirm when it has been completed. I apologize again for the delay.\"', NULL, NULL, '2020-10-23 17:44:17', '2020-10-23 17:44:17'),
(4745, 1006, 9067, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent followup email to Bennett Tansey Bennett_Tansey@tufts-health.com> :  \"Hello Bennett,   I hope you\'re doing well, I wanted to check back in regarding the linkage status of our provider. Has there been any updates or is it still in-process?  Appreciate the help. \"', NULL, NULL, '2020-10-30 14:48:30', '2020-10-30 14:48:30'),
(4746, 1006, 9067, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email to Bennett Bennett_Tansey@tufts-health.com>.', NULL, NULL, '2020-11-09 18:11:24', '2020-11-09 18:11:24'),
(4747, 1006, 9067, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Sent new follow-up email to Bennett_Tansey@tufts-health.com & Nilda_Amarante@tufts-health.com:  \"Hello,   I wanted to touch base regarding this request again as it\'s been close to a month since we\'ve heard any updates. As I\'ve noted before this is quite an urgent issue and I would appreciate it if I could at least get an update on the status.   Thanks.\"', NULL, NULL, '2020-11-16 17:01:20', '2020-11-16 17:01:20'),
(4748, 1006, 9067, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received following reply from @ Bennett Tansey Bennett_Tansey@tufts-health.com:  \"Hi Brad,  I have been working with a contact in our configuration department this week. I am confident we should have this turned around for you soon. I apologize, I had hoped to have a firm ETA for you today. While I do not have that as of yet, I will follow up with you ASAP next week. This will be a top priority going forward.\"', NULL, NULL, '2020-11-20 17:35:47', '2020-11-20 17:35:47'),
(4749, 1006, 9067, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent a follow-up email to Bennett Tansey Bennett_Tansey@tufts-health.com regarding updated status. ', NULL, NULL, '2020-11-30 17:28:52', '2020-11-30 17:28:52'),
(4750, 1006, 9067, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Received following update from Bennett:  \"HI Brad,  Just following up on this. I have been, as I mentioned previously, in regular contact with our configuration team on the status of this.  What has caused the hold up is that we recently transitioned to a new core claims system for Rhode Island, and new fee schedules are being constructed in that system. I touched base with our config team again this afternoon. This has not been completed yet however I was given assurances it should be done by next week. I will continue to follow up and will get back in touch with you again next week to let you know the status. I apologize again for the delay.\"', NULL, NULL, '2020-12-04 17:59:07', '2020-12-04 17:59:07'),
(4751, 1006, 9067, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent followup email @ Bennett Tansey Bennett_Tansey@tufts-health.com, regarding updated status. ', NULL, NULL, '2020-12-11 17:37:02', '2020-12-11 17:37:02'),
(4752, 1006, 9067, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Sent a follow-up email to Bennett Tansey Bennett_Tansey@tufts-health.com', NULL, NULL, '2020-12-21 18:05:26', '2020-12-21 18:05:26'),
(4753, 1006, 9067, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Received following reply from Bennett:  \"Hi Brad,  I apologize, I have not received this back from our configuration team as of yet. I reached out for an update most recently earlier today. I will follow up as soon as I hear back that this has been completed.\"', NULL, NULL, '2020-12-24 13:49:11', '2020-12-24 13:49:11'),
(4754, 1006, 9067, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Sent a follow-up email to Bennett', NULL, NULL, '2021-01-04 18:41:22', '2021-01-04 18:41:22'),
(4755, 1006, 9067, NULL, '2021-01-19 00:00:00.000', 'Approved', 'Received the following response from Bennett: \"Hi Brad,  I am happy to inform you that the SR for spectrum neuro has been completed and providers are linked in network eff 6.1.20. I apologize again for the long wait you experienced on this.\"', NULL, NULL, '2021-01-12 09:25:30', '2021-01-12 09:25:30'),
(4756, 2037, 9068, NULL, NULL, 'New/Not Initiated', 'Notification letter received for amendments in contract with Humana Medicare Choice Care Network (Advantage Plans) to meet CMS requirements. Letter Placed on the server and attachment uploaded in EMRBS.', NULL, NULL, '2020-09-03 12:59:53', '2020-09-03 12:59:53'),
(4757, 2037, 9068, NULL, '2020-10-08 00:00:00.000', 'Approved', 'The Group having Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183', NULL, NULL, '2020-10-01 16:51:02', '2020-10-01 16:51:02'),
(4758, 1006, 9069, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-03 13:39:19', '2020-09-03 13:39:19'),
(4759, 1006, 9069, NULL, '2020-09-10 00:00:00.000', 'Initiated', 'Initiated request via Palmetto GBA website, attached form of initiation. ', NULL, NULL, '2020-09-03 17:32:50', '2020-09-03 17:32:50'),
(4760, 1006, 9069, NULL, '2020-09-30 00:00:00.000', 'In Process', 'The request still shows up as in-process:  \"Additional research is required to complete your request  Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	20247001278 NPI :	1801986054\"', NULL, NULL, '2020-09-23 10:46:36', '2020-09-23 10:46:36'),
(4761, 1006, 9069, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Request still shows up as in-process. ', NULL, NULL, '2020-09-28 17:00:08', '2020-09-28 17:00:08'),
(4762, 1006, 9069, NULL, '2020-10-09 00:00:00.000', 'Approved', 'PROVIDER NAME:	JOANNA C WOOD LIC PROVIDER PTAN:	P02525451 PROVIDER NPI:	1801986054 EFFECTIVE DATE:	05/01/2020 END DATE:	 GROUP NAME:	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN:	EA0360 BUSINESS STATE:	RI EFFECTIVE DATE:  07/29/2019 END DATE: 	', NULL, NULL, '2020-10-02 13:54:03', '2020-10-02 13:54:03'),
(4763, 1006, 9070, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-03 13:39:20', '2020-09-03 13:39:20'),
(4764, 1006, 9070, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Joanna Wood - Medicaid - She is active in the group.  Eff: 09/01/2020 Ref# 458469', NULL, NULL, '2020-10-02 11:18:59', '2020-10-02 11:18:59'),
(4765, 2027, 9071, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-08 14:33:37', '2020-09-08 14:33:37'),
(4766, 2027, 9071, NULL, '2020-09-15 00:00:00.000', 'Approved', 'Provider is linked with insurance under ancillary contract and effective date is 11/01/2015', NULL, NULL, '2020-09-08 14:34:53', '2020-09-08 14:34:53'),
(4767, 2027, 9072, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-08 15:04:06', '2020-09-08 15:04:06'),
(4768, 2027, 9072, NULL, '2020-09-15 00:00:00.000', 'Approved', 'Provider is linked with the insurance and effective date is 10/01/2019 Screenshot from provider directory is attached ', NULL, NULL, '2020-09-08 15:05:41', '2020-09-08 15:05:41'),
(4769, 2027, 9073, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-08 15:18:07', '2020-09-08 15:18:07'),
(4770, 2027, 9073, NULL, '2020-09-15 00:00:00.000', 'Approved', 'Provider is linked with medicare and effective date is 03/19/2020 Screenshot from pecos is attached for confirmation', NULL, NULL, '2020-09-08 15:20:04', '2020-09-08 15:20:04'),
(4771, 2037, 9074, NULL, NULL, 'New/Not Initiated', 'Initiated.', NULL, NULL, '2020-09-08 17:55:24', '2020-09-08 17:55:24'),
(4772, 2037, 9074, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Initiated enrollment request online. Reference Number: 20246001197', NULL, NULL, '2020-09-08 17:56:36', '2020-09-08 17:56:36'),
(4773, 2037, 9074, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Currently in process. Need to allow more time.', NULL, NULL, '2020-10-02 14:12:11', '2020-10-02 14:12:11'),
(4774, 2037, 9074, NULL, '2020-10-13 00:00:00.000', 'Approved', 'Provider got approved with P-Tan P02527094 & Effective 08/01/2020. Approval etter placed on the server and attached in EMRBS. ', NULL, NULL, '2020-10-06 16:18:04', '2020-10-06 16:18:04'),
(4775, 2027, 9075, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 13:26:07', '2020-09-09 13:26:07'),
(4776, 2027, 9075, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Medicare application submitted and tracking id is: T090920200002858	', NULL, NULL, '2020-09-09 13:26:48', '2020-09-09 13:26:48'),
(4777, 2027, 9075, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and the effective date is 08/01/2020. Welcome letter is attached ', NULL, NULL, '2020-09-15 12:54:34', '2020-09-15 12:54:34'),
(4778, 2027, 9076, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 13:29:32', '2020-09-09 13:29:32'),
(4779, 2027, 9076, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Medicare application submitted and tracking id is: T090920200002858	', NULL, NULL, '2020-09-09 13:30:27', '2020-09-09 13:30:27'),
(4780, 2027, 9076, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and the effective date is 08/01/2020. Welcome letter is attached ', NULL, NULL, '2020-10-02 17:40:48', '2020-10-02 17:40:48'),
(4781, 2027, 9077, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 13:32:09', '2020-09-09 13:32:09'),
(4782, 2027, 9077, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Medicare application submitted and tracking id is: T090920200002858', NULL, NULL, '2020-09-09 13:32:21', '2020-09-09 13:32:21'),
(4783, 2027, 9077, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and the effective date is 08/01/2020. Welcome letter is attached ', NULL, NULL, '2020-09-15 13:58:48', '2020-09-15 13:58:48'),
(4784, 2037, 9078, NULL, NULL, 'New/Not Initiated', 'Initiated Group On-Boarding', NULL, NULL, '2020-09-09 14:22:02', '2020-09-09 14:22:02'),
(4785, 2037, 9078, NULL, '2020-09-16 00:00:00.000', 'In Process', 'spoke to Erin from MCO .As per her the current status of the group BAQC  is out of network as of now. Sent Letter of intent with W-9 form @ turnere@usamco.com as requested by the representative.Waiting for response. Below is the email for reference.', NULL, NULL, '2020-09-09 14:24:04', '2020-09-09 14:24:04'),
(4786, 2037, 9078, NULL, '2020-09-17 00:00:00.000', 'In Process', 'New Agreement received.Signed and sent back for processing.Reference email is as follows: ----------------- Hello Erin, Thank you for the prompt response.Kindly find the attached signed agreement for you to proceed further.Feel free to contact me for any additional information if needed.  Regards:', NULL, NULL, '2020-09-10 14:58:12', '2020-09-10 14:58:12'),
(4787, 2037, 9078, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Received checklist for additional documents . Forwarded via email. Reference as follows: -------------- Sherry Deen Attachments 12:44 PM (0 minutes ago)  to Bay, Erin  Hello Erin,  I have the attached documents as per the checklist.Hope this information is sufficient for you to proceed further. Please verify and let me know if you need any additional documents. Regards:  Sherry Deen', NULL, NULL, '2020-09-14 12:49:38', '2020-09-14 12:49:38'),
(4788, 2037, 9078, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Application completion notification received from Erin waiting for the welcome letter and the effective date : ------------------ Good Afternoon Sherry,     The application for Bay Area Quick Care, PLLC  is complete and will be forwarded to provider relations for credentialing. You will receive a welcome email with effective date once processed.  It’s been a pleasure working with you, take care!', NULL, NULL, '2020-09-15 10:24:05', '2020-09-15 10:24:05'),
(4789, 2037, 9078, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Hello Erin, Thank you so very much for all your kind assistance throughout the process.I Will be looking forward to receiving the welcome packet with the effective date so that we may start billing.It\'s been a pleasure working with you too. I hope you have a wonderful rest of the week. Take care! Regards:Sherry Deen | ', NULL, NULL, '2020-09-15 10:43:33', '2020-09-15 10:43:33'),
(4790, 2037, 9078, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Follow up Email sent. ----------------- Hello Erin, If I may have the estimated time of completion and the receiving of the effective date with a welcome packet. Thank you!', NULL, NULL, '2020-09-23 12:10:25', '2020-09-23 12:10:25'),
(4791, 2037, 9078, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Response received: Hello Sherry,     You will receive an email from out provider relations team with the effective date for the group as soon as the credentialing process is complete. Typically we like to give 30-90 business days to complete this process. Please let me know if I have can of further assistance.', NULL, NULL, '2020-09-23 12:43:59', '2020-09-23 12:43:59'),
(4792, 2037, 9078, NULL, '2020-10-14 00:00:00.000', 'Approved', 'contracted with MCO and listed as an Urgent Care Facility.Effective 09/16/2020. Provider ID#1304027. Executed contract placed on the server and uploaded on EMRBS', NULL, NULL, '2020-10-07 13:00:39', '2020-10-07 13:00:39'),
(4793, 2037, 9079, NULL, NULL, 'New/Not Initiated', 'New', NULL, NULL, '2020-09-09 14:36:15', '2020-09-09 14:36:15'),
(4794, 2037, 9079, NULL, '2020-09-16 00:00:00.000', 'In Process', 'The Facility is in network with Anci-Care.Ref#2021753.Representative: Diane. Effective 02/15/2018. Requested copy of the executed contract from Jennifer maligaya.', NULL, NULL, '2020-09-09 14:38:44', '2020-09-09 14:38:44'),
(4795, 2037, 9079, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Contract received and uploaded. Sending approval email to the billing.-Reference email as follows: ------------------------- Hi Sherry,     Thank you for the quick turnaround on the consent. Please see the attached provider agreement between BAY AREA QUICK CARE and ACS. Thank you! ', NULL, NULL, '2020-09-09 14:39:01', '2020-09-09 14:39:01'),
(4796, 2027, 9080, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 14:50:04', '2020-09-09 14:50:04'),
(4797, 2027, 9080, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Application Tracking ID: T090920200003524        NPI: 1558680009        Medicare ID:         Name: MOSES  CAMPOS          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2020-09-09 14:52:36', '2020-09-09 14:52:36'),
(4798, 2027, 9080, NULL, '2020-09-22 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 08/01/2020. Welcome letter is attached.', NULL, NULL, '2020-09-15 10:06:37', '2020-09-15 10:06:37'),
(4799, 1006, 9081, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 14:58:56', '2020-09-09 14:58:56'),
(4800, 1006, 9081, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Enrollment Application Information:      Provider/Supplier Name: PANDEESWARI RAVEENDRAN       Provider/Supplier Specialty Type: PSYCHIATRY       State: MA      Form Type: AUTHORIZATION STATEMENT FOR ORGANIZATIONS (855R)      NPI: 1124247267      Web Tracking ID: T090920200003663      Signatory Name: FURQUAN SYED      Signatory Role: AUTHORIZED OFFICIAL      Topic/s Changed: Reassignment, Contact Person', NULL, NULL, '2020-09-09 15:01:38', '2020-09-09 15:01:38'),
(4801, 1006, 9081, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Received following status update via NGSMedicare:   \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE    PE0000078848	   CMS855R Web	           09/09/2020	   Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-09-14 12:55:56', '2020-09-14 12:55:56'),
(4802, 1006, 9081, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Status still shows up as in process, allow 3~6 weeks from the date of submission. ', NULL, NULL, '2020-09-23 16:45:23', '2020-09-23 16:45:23'),
(4803, 1006, 9081, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Request is still in process, need to allow more time for it to finish processing. ', NULL, NULL, '2020-09-28 13:41:57', '2020-09-28 13:41:57'),
(4804, 1006, 9081, NULL, '2020-10-08 00:00:00.000', 'In Process', 'Received the same update: \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000078848	 CMS855R Web	 09/09/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"  Need to check back with Medicare on call in next follow-up as it\'s been 3+ weeks. ', NULL, NULL, '2020-10-01 09:36:49', '2020-10-01 09:36:49'),
(4805, 1005, 9081, NULL, '2020-10-21 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-10-12 15:10:59', '2020-10-12 15:10:59'),
(4806, 1006, 9081, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Request is close to finalizing:  \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000078848	 CMS855R Web	 09/09/2020	 10/13/2020 Status:  NGS has approved your enrollment record updates but is still in the process of finalizing your case. You will receive a determination once the case is finalized.\"', NULL, NULL, '2020-10-22 18:00:10', '2020-10-22 18:00:10'),
(4807, 1006, 9081, NULL, '2020-11-06 00:00:00.000', 'Approved', 'The request has been approved with 09/01/2020 effective date, PTAN# S400689327. Proof of approval attached. ', NULL, NULL, '2020-10-30 13:33:27', '2020-10-30 13:33:27'),
(4808, 1006, 9082, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 16:06:58', '2020-09-09 16:06:58'),
(4809, 1006, 9082, NULL, '2020-09-16 00:00:00.000', 'Initiated', 'Sent initiation application to 617-246-5053. ', NULL, NULL, '2020-09-09 16:07:15', '2020-09-09 16:07:15'),
(4810, 1006, 9082, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Received following update from BCBSMA: \"Dear Provider: Blue Cross Blue Shield of Massachusetts (BCBSMA*) has received your request for Pandeeswari Reveendran. Unfortunately, we are unable to process your request due to the following;  Update Form required - the applicant is currently a Blue Cross Blue Shield of Massachusetts provider and a Contract Update Form for Behavioral Health providers is required. To download the correct form, please log on to bluecrossma.com/provider and click on Resource Center>Forms  ***Please Do Not Reply to this message***  Please note; the complete update form and all required documentation must be resubmitted for processing.  If you have any questions, please call Network Management Services at 1-800-316-BLUE (2583).    Sincerely, Contract Operations Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-09-11 10:16:30', '2020-09-11 10:16:30'),
(4811, 1006, 9082, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Submitted the requested contract update form to fax# (617) 246-5053. Attached. ', NULL, NULL, '2020-09-14 14:26:26', '2020-09-14 14:26:26'),
(4812, 1006, 9082, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Received Attachment A contract to sign. Signed and sent back to them. Attached for reference. ', NULL, NULL, '2020-09-14 16:50:45', '2020-09-14 16:50:45'),
(4813, 1006, 9082, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to providerapplicationstatus@bcbsma.com regarding the status of contracting/credentialing. ', NULL, NULL, '2020-09-23 18:07:04', '2020-09-23 18:07:04'),
(4814, 1006, 9082, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Received following update from providerapplicationstatus@bcbsma.com:  Sub: Infosecure RE: Pandeeswari Raveendran - Provider Status Request  \"Hello,  We did receive Pandeeswari Raveendran’s contract on 09-14-2020 and the process has started. Standard processing time is approximately 30-45 days from receipt date. Once complete a welcome letter will be sent stating the effective date claims can be submitted to Blue Cross Blue Shield of Massachusetts.  Regards, Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-09-24 14:16:25', '2020-09-24 14:16:25'),
(4815, 1006, 9082, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a follow-up email to provider status update. ', NULL, NULL, '2020-10-05 16:49:44', '2020-10-05 16:49:44'),
(4816, 1006, 9082, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Received the following update from BCBS:  \"Hello,  We did receive Pandeeswari Raveendran’s contract on 09-14-2020 and the process has started. Standard processing time is approximately 30-45 days from receipt date. Once complete a welcome letter will be sent stating the effective date claims can be submitted to Blue Cross Blue Shield of Massachusetts.  Regards, Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-10-06 16:48:25', '2020-10-06 16:48:25'),
(4817, 1006, 9082, NULL, '2020-10-21 00:00:00.000', 'In Process', 'Sent a followup email to providerapplicationstatus@bcbsma.com. ', NULL, NULL, '2020-10-14 18:03:59', '2020-10-14 18:03:59'),
(4818, 1006, 9082, NULL, '2020-10-22 00:00:00.000', 'Approved', 'Welcome letter received for provider.   EFF: 09/14/2020', NULL, NULL, '2020-10-15 10:09:30', '2020-10-15 10:09:30'),
(4819, 2037, 9083, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-09-09 17:11:34', '2020-09-09 17:11:34'),
(4820, 2037, 9083, NULL, '2020-09-16 00:00:00.000', 'In Process', 'As per live call to Health Smart the group BAQC is out of network with them. Initiated enrollment application process online. Waiting for the Agreement and CAQH access form  for Signatures.', NULL, NULL, '2020-09-09 17:17:17', '2020-09-09 17:17:17'),
(4821, 2037, 9083, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Follow up email sent to pr.south@healthsmart.com. Email for reference is as follows: ---------------------- Greetings, Following up on the enrollment application for the below mentioned group. Group: Bay Area Quick Care  Billing Address : 9929 South Padre Island Drive                              Suite 109  Corpus Christi , TX 78418-5148Speciality           :  Urgent Care. Phone Number  : 361-937-2121.Fax Number       : 361-937-2123.TIN                      : 27-1702009.NPI Type 2          : 1437481421    ', NULL, NULL, '2020-10-01 11:05:08', '2020-10-01 11:05:08'),
(4822, 2037, 9083, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Response received from Health Smart requesting the list of providers part of the group. Responded back with the requested information.Reference email as follows: --------------------------- Kindly find the attached list of providers as requested. Providers NPI  WILLIAM R FRANCIS 1457994436  Cynthia Kay Malowitz 1336173244  Kynda Kayleigh Orsak 1528553724   (Inventory Log ID : 62837)    Please feel free to contact me for any additional information.', NULL, NULL, '2020-10-05 09:38:32', '2020-10-05 09:38:32'),
(4823, 2037, 9083, NULL, '2020-11-06 00:00:00.000', 'Approved', 'The Facility is in network with Anci-Care.Ref#2021753.Representative: Diane.Email sent to pr.south@healthsmart.com with W9 requesting the copy of the executed contract. Effective 02/15/2018. ', NULL, NULL, '2020-10-30 13:21:18', '2020-10-30 13:21:18'),
(4824, 2037, 9084, NULL, NULL, 'New/Not Initiated', 'Initiation', NULL, NULL, '2020-09-09 17:18:55', '2020-09-09 17:18:55'),
(4825, 2037, 9084, NULL, '2020-09-16 00:00:00.000', 'In Process', 'As per live call to Health Smart the provider William Francis is out of network with them. Initiated enrollment application process online. Waiting for the Agreement and CAQH access form  for Signatures.', NULL, NULL, '2020-09-09 17:19:39', '2020-09-09 17:19:39'),
(4826, 2037, 9084, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Agreement and CAQH Access form received. --------------- Hi,  Thank you for your interest in HealthSmart.  Attached is a group agreement for signature by the group signatory.  Once signed, please return the following documents.  •    Signed and dated agreement.  Please do not enter the effective date or strike outs •    Complete a CAQH Access Form for each provider in the group. Additionally please send us W9  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log : 61593)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2020-09-11 10:51:20', '2020-09-11 10:51:20'),
(4827, 2037, 9084, NULL, '2020-09-18 00:00:00.000', 'In Process', 'Responded back with the required documents. Reference email as follows: --------------- Greetings,  Kindly find the attached signed contract,CAQH access form and the W-9 for further processing. Do feel free to contact me for any additional information if required. Regards: Sherry', NULL, NULL, '2020-09-11 10:56:41', '2020-09-11 10:56:41'),
(4828, 2037, 9084, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Notification received from CAQH: Health Smart has accessed William\'s Information from CAQH for further processing.', NULL, NULL, '2020-09-14 17:20:33', '2020-09-14 17:20:33'),
(4829, 2037, 9084, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Follow up email sent to pr.south@healthsmart.com. Email for reference is as follows: -------------- Greetings,  Following up on the enrollment application for the below mentioned provider.  Provider Name: William R Francis. Type 1 NPI: 1457994436. Group: Bay Area Quick Care  TIN                      : 27-1702009.  ', NULL, NULL, '2020-10-01 11:29:25', '2020-10-01 11:29:25'),
(4830, 2037, 9084, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Response received from Health Smart. Reference email as follows: --------------------- Hi,  Provider \" Francis, William R APN \" is currently in the credentialing process. (Inventory Log ID :61593)', NULL, NULL, '2020-10-05 09:24:43', '2020-10-05 09:24:43'),
(4831, 2037, 9084, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-30 13:18:18', '2020-10-30 13:18:18'),
(4832, 2037, 9084, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-02 13:59:42', '2020-11-02 13:59:42'),
(4833, 2037, 9084, NULL, '2020-11-17 00:00:00.000', 'Approved', 'Confirmation email received with the copy of the executed contract .Effective date: 11/01/2020. Contract uploaded. Below is the reference email: ------------ Hi,  Provider \'\' Francis, William R APN \'\' is Effective \'\' 11/01/2020 \'\'.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 61593 )  Thanks HealthSmart Provider Relations', NULL, NULL, '2020-11-10 15:05:43', '2020-11-10 15:05:43'),
(4834, 1006, 9085, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-09 18:02:18', '2020-09-09 18:02:18'),
(4835, 1006, 9085, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Sent provider group addition form to jessica.knapp@beaconhealthoptions.com. ', NULL, NULL, '2020-09-09 18:02:40', '2020-09-09 18:02:40'),
(4836, 1006, 9085, NULL, '2020-09-17 00:00:00.000', 'In Process', 'As per the representative, she doesn\'t know who to forward it to, called into beacon directly and they told me to fax it to 866-612-7790.   Fax sent. ', NULL, NULL, '2020-09-10 10:18:43', '2020-09-10 10:18:43'),
(4837, 1006, 9085, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Provider: Pandeeswari Raveendran The form has been received and the request is in process, it could take around 4~6 weeks, probably more.  Ref# 09142020-8924816', NULL, NULL, '2020-09-14 14:58:56', '2020-09-14 14:58:56'),
(4838, 1006, 9085, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to provider.relations@beaconhealthoptions.com regarding the status of enrollment. ', NULL, NULL, '2020-09-23 18:13:18', '2020-09-23 18:13:18'),
(4839, 1006, 9085, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Sent following email for followup to Beacon via valueoption email:  \"Hello,   I wanted to follow-up on the email I sent over last week, regarding the linkage status of the following provider:  Provider Name: Pandeeswari Raveendran NPI# 1124247267 TIN# 83-4482753  Please get back to me ASAP.  Thanks. \"', NULL, NULL, '2020-09-28 13:45:01', '2020-09-28 13:45:01'),
(4840, 1006, 9085, NULL, '2020-10-08 00:00:00.000', 'Approved', 'Provider is added to the group.  Provider ID# 732042 Eff: 09/22/2020 Welcome letter will be submitted in a few weeks.  Ref# 10012020-9120106', NULL, NULL, '2020-10-01 10:32:29', '2020-10-01 10:32:29'),
(4841, 2027, 9086, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 13:32:34', '2020-09-10 13:32:34'),
(4842, 2027, 9086, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Provider is linked with the insurance and effective date is 06/11/2020.Screenshot from provider directory is attached', NULL, NULL, '2020-09-10 13:33:46', '2020-09-10 13:33:46'),
(4843, 1006, 9087, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 15:10:45', '2020-09-10 15:10:45'),
(4844, 1006, 9087, NULL, '2020-09-17 00:00:00.000', 'In Process', 'Filled out Clinician Tax ID - Add / Update Form to add the provider to our group.  ', NULL, NULL, '2020-09-10 15:13:44', '2020-09-10 15:13:44'),
(4845, 1006, 9087, NULL, '2020-10-01 00:00:00.000', 'In Process', 'As per the reps, provider is linked to the group as of 09/01/2020. Waiting on welcome letter/provider roster, sent an email to ma_contracting@uhc.com for follow-up as well. ', NULL, NULL, '2020-09-24 13:37:39', '2020-09-24 13:37:39'),
(4846, 1006, 9087, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Sent another follow-up email to UBH for welcome letter/plan roster. ', NULL, NULL, '2020-09-28 13:46:53', '2020-09-28 13:46:53'),
(4847, 1006, 9087, NULL, '2020-10-06 00:00:00.000', 'Approved', 'Attached provider directory update as confirmation. ', NULL, NULL, '2020-09-29 18:00:06', '2020-09-29 18:00:06'),
(4848, 2027, 9088, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 15:11:00', '2020-09-10 15:11:00'),
(4849, 2027, 9088, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Provider is linked with insurance and effective date is 06/01/2019. Screenshot from provider directory is attached ', NULL, NULL, '2020-09-10 15:15:40', '2020-09-10 15:15:40'),
(4850, 1006, 9089, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-09-10 15:46:48', '2020-09-10 15:46:48'),
(4851, 1006, 9089, NULL, '2020-09-17 00:00:00.000', 'Initiated', 'Submitted online enrollment requests to add a provider to the group. ', NULL, NULL, '2020-09-10 15:47:24', '2020-09-10 15:47:24'),
(4852, 1006, 9089, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a followup email to \"Bevin, Laura J\" Laura.Bevin@aetna.com> regarding the status of enrollment. ', NULL, NULL, '2020-09-23 17:43:59', '2020-09-23 17:43:59'),
(4853, 1006, 9089, NULL, '2020-10-07 00:00:00.000', 'In Process', 'Received the following emails from Laura Bevin:  \"Good morning,  Pandeeswari Raveendran, 9326707 was already credentialed with Aetna so she is waiting to be linked to the group contract.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"  \"Hello, I would allow 2 weeks to have her linked.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-09-24 09:51:27', '2020-09-24 09:51:27'),
(4854, 1006, 9089, NULL, '2020-10-06 00:00:00.000', 'In Process', 'Received following reply regarding how long it should take to get her linked with the group:  \"Hello, I would allow 2 weeks to have her linked.  Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-09-28 13:52:08', '2020-09-28 13:52:08'),
(4855, 1006, 9089, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura regarding the status.  ', NULL, NULL, '2020-10-05 16:51:12', '2020-10-05 16:51:12'),
(4856, 1006, 9089, NULL, '2020-10-13 00:00:00.000', 'Approved', 'Received following update from Bevin, Laura J Laura.Bevin@aetna.com:  Sub: Pandeeswari Raveendran - Group Addition Status  \"Hello,  Pandeeswari Raveendran, 9326707 will have an 11/01/2020 effective date.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-10-06 17:36:27', '2020-10-06 17:36:27');
