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
(51537, 19067, 42718, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:16', '2022-02-14 09:50:16'),
(51538, 19067, 42718, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com   Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099_02142022-4542489   Good Morning,     Please see notes below.     Helena Halterman  1801473749  Welcome letter for BHO plans sent to SNBC@claimsmedinc.com on 2.10.22 – still processing for MBHP, Fallon, BMC and Unicare – event 9303674 – allow more time  Allie DiCostanzo  1669045738  Still being worked under event 9306743 – allow more time  Eliza Rodrigues  1821751405  Still being worked under event 9309562 – allow more time  Lauren Powell  1285304980  Welcome letters sent on 2.7.22 and 2.9.22 to SNBC@Claimsmedinc.com with effective date – please check email        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-14 10:50:43', '2022-02-14 10:50:43'),
(51539, 1019, 42718, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 02/01/2022,  See attached welcome letter  and location confirmation for ref', NULL, NULL, '2022-02-16 10:03:36', '2022-02-16 10:03:36'),
(51540, 1019, 42719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51541, 1019, 42719, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:15:10', '2021-10-22 09:15:10'),
(51542, 1019, 42719, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Faxed the enrollment application at 866-612-7790, attached is the copy of the application.', NULL, NULL, '2021-10-28 09:18:44', '2021-10-28 09:18:44'),
(51543, 1019, 42719, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:15:25', '2021-11-30 09:15:25'),
(51544, 11056, 42719, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:58', '2021-12-14 14:41:58'),
(51545, 19067, 42719, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:18:04', '2021-12-20 12:18:04'),
(51546, 19067, 42719, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:18', '2021-12-20 15:10:18'),
(51547, 19067, 42719, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:17', '2021-12-22 13:39:17'),
(51548, 19067, 42719, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:47', '2021-12-28 17:03:47'),
(51549, 19067, 42719, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:39:24', '2022-01-05 15:39:24'),
(51550, 19067, 42719, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:38:42', '2022-01-12 15:38:42'),
(51551, 19067, 42719, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Kindly see the attachment for the provider, Eliza Rodrigues.  Don\'t hesitate to reach out if you need anything else!  Thank you, Hammad Ahmed', NULL, NULL, '2022-01-13 17:26:14', '2022-01-13 17:26:14'),
(51552, 19067, 42719, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582_01192022-4265501    Good Afternoon,     I have received the CANS attestation and forwarded it to credentialing via email for processing. The credentialing specialist that was working your file is Jennifer Farino. I sent it to them for review and processing.        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:19:24', '2022-01-25 09:19:24'),
(51553, 19067, 42719, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Hello Jennifer Farino!  Hope you are doing well.  Any updates on the request below?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:22:30', '2022-02-04 09:22:30'),
(51554, 19067, 42719, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:04:47', '2022-02-07 10:04:47'),
(51555, 19067, 42719, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:56', '2022-02-14 09:50:56'),
(51556, 19067, 42719, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com   Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099_02142022-4542489   Good Morning,     Please see notes below.     Helena Halterman  1801473749  Welcome letter for BHO plans sent to SNBC@claimsmedinc.com on 2.10.22 – still processing for MBHP, Fallon, BMC and Unicare – event 9303674 – allow more time  Allie DiCostanzo  1669045738  Still being worked under event 9306743 – allow more time  Eliza Rodrigues  1821751405  Still being worked under event 9309562 – allow more time  Lauren Powell  1285304980  Welcome letters sent on 2.7.22 and 2.9.22 to SNBC@Claimsmedinc.com with effective date – please check email        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-14 10:50:48', '2022-02-14 10:50:48'),
(51557, 1019, 42719, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 02/01/2022,  See attached welcome letter  and location confirmation for ref', NULL, NULL, '2022-02-16 10:04:24', '2022-02-16 10:04:24'),
(51558, 1019, 42720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51559, 1019, 42720, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:15:33', '2021-10-22 09:15:33'),
(51560, 1019, 42720, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Sent the following email to Database and Credentialing Hello,  We need to enroll the following provider with BCBS MA, Eliza Rodrigues LCSW under our group Spectrum Neuro behavioral Care LLC. Let me know with the next steps.   Regards, Alex', NULL, NULL, '2021-10-28 09:39:08', '2021-10-28 09:39:08'),
(51561, 1019, 42720, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Received the following email from BCBS.  Please be advised that Blue Cross Blue Shield of Massachusetts does not currently credential LCSWs.  ', NULL, NULL, '2021-10-28 10:20:05', '2021-10-28 10:20:05'),
(51562, 1019, 42721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51563, 1019, 42721, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:15:52', '2021-10-22 09:15:52'),
(51564, 1019, 42721, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Cigna doesn\'t enroll LCSW.', NULL, NULL, '2021-10-28 10:17:05', '2021-10-28 10:17:05'),
(51565, 1019, 42722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51566, 1019, 42722, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:16:11', '2021-10-22 09:16:11'),
(51567, 1019, 42722, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Sent the enrollment application to PNM and Credentialing, see attached for reference.', NULL, NULL, '2021-10-28 10:32:02', '2021-10-28 10:32:02'),
(51568, 1019, 42722, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from PNM CCA.  Hello,     Provider Eliza Rodrigues, LCSW Is effective 10/28/2021 at Spectrum Neuro Behavioral Care LLC.     Thanks,           Venkateshlu Srinivasan  Provider Network Management', NULL, NULL, '2021-11-16 15:21:42', '2021-11-16 15:21:42'),
(51569, 1019, 42723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51570, 1019, 42723, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:16:28', '2021-10-22 09:16:28'),
(51571, 1019, 42724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51572, 1019, 42724, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:16:47', '2021-10-22 09:16:47'),
(51573, 1019, 42724, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Provider roster was sent out to Monica at humana to add the providers under our group, attached is the group roster for reference.', NULL, NULL, '2021-10-28 10:54:53', '2021-10-28 10:54:53'),
(51574, 11056, 42724, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:33:59', '2021-12-09 17:33:59'),
(51575, 19067, 42724, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:33:22', '2021-12-15 15:33:22'),
(51576, 19067, 42724, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:38', '2021-12-16 12:26:38'),
(51577, 19067, 42724, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:36:45', '2021-12-29 14:36:45'),
(51578, 19067, 42724, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:16:45', '2022-01-10 13:16:45'),
(51579, 19067, 42724, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:13:38', '2022-01-30 13:13:38'),
(51580, 19067, 42724, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:20', '2022-02-08 14:23:20'),
(51581, 19067, 42724, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:02', '2022-03-09 14:56:02'),
(51582, 19067, 42724, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:47:58', '2022-03-10 10:47:58'),
(51583, 22077, 42724, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:50:37', '2022-04-04 13:50:37'),
(51584, 1019, 42725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51585, 1019, 42725, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:17:11', '2021-10-22 09:17:11'),
(51586, 1019, 42725, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request Initiated thru Magellan Provider Portal.', NULL, NULL, '2021-10-28 11:15:13', '2021-10-28 11:15:13'),
(51587, 19067, 42725, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com Subject: Enrollment Status || Providers  || SNBCARE || || Magellan||  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:12:32', '2021-12-15 14:12:32'),
(51588, 19067, 42725, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:17:29', '2021-12-15 14:17:29'),
(51589, 19067, 42725, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:41:39', '2021-12-15 16:41:39'),
(51590, 19067, 42725, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 13:59:48', '2021-12-29 13:59:48'),
(51591, 19067, 42725, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:05', '2022-01-10 13:22:05'),
(51592, 19067, 42725, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:09:15', '2022-02-11 10:09:15'),
(51593, 19067, 42725, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello Judy!  Hope this email finds you well.  Any updates on the enrollment process of the providers, Barbara Arnold, Eliza Rodrigues & Lauren Powell.  Kindly make an update on it.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 11:43:01', '2022-03-17 11:43:01'),
(51594, 22077, 42725, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: FW: Enrollment Status || Providers || SNBCARE || || Magellan |  Hello,  Any updates on the credentialing process of the provider,  Barbara Arnold NPI: 1922432053  Eliza Rodrigues NPI: 1821751405  Fauzia Khan NPI: 1699761965  Thanks', NULL, NULL, '2022-04-04 14:28:16', '2022-04-04 14:28:16'),
(51595, 22077, 42725, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||  Good afternoon,  Barbara Arnold NPI: 1922432053: The provider is at the end of the credentialing process and should be active by next week. Please check next week, towards the end of the week.  Eliza Rodrigues NPI: 1821751405: Provider has been linked to your group effective date 1/18/2022  Fauzia Khan NPI: 1699761965: This provider has been linked to your group since 4/3/2020  Judy', NULL, NULL, '2022-04-05 14:23:25', '2022-04-05 14:23:25'),
(51596, 22077, 42725, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||  Hello,  Can you confirm the locations for the providers mentioned below  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Fauzia Khan	1699761965	63 EDDIE DOWLING HWY, SUITE 8 NORTH SMITHFIELD, RI 02896-7322   Thanks,', NULL, NULL, '2022-04-05 14:44:56', '2022-04-05 14:44:56'),
(51597, 19067, 42725, NULL, '2022-04-13 00:00:00.000', 'Approved', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||     Hello,     Eliza Rodrigues MIS 601542-706 and Fauzia Khan OS 710629-000     Locations in system are:  61 LINCOLN ST STE 203…  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     You can go on the Magellan website and add the providers for that location:  63 EDDIE DOWLING HWY, SUITE 8 NORTH SMITHFIELD, RI 02896-7322     Judy', NULL, NULL, '2022-04-06 10:17:43', '2022-04-06 10:17:43'),
(51598, 1019, 42726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51599, 1019, 42726, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:18:20', '2021-10-22 09:18:20'),
(51600, 1019, 42727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51601, 1019, 42727, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:18:46', '2021-10-22 09:18:46'),
(51602, 1019, 42728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51603, 1019, 42728, NULL, '2021-10-29 00:00:00.000', 'Initiated', 'Application Initiated thru PECOS, below is the email for Reference   To: SNBC@CLAIMSMEDINC.COM,ELIZARODRIGUES4@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102120210000781)   Sent: 10/22/2021 09:43 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T102120210000781        NPI: 1821751405        Medicare ID:         Name: ELIZA  RODRIGUES          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message.    ', NULL, NULL, '2021-10-22 09:13:22', '2021-10-22 09:13:22'),
(51604, 1019, 42728, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 10/04/2021, attached is the determination letter from Medicare.', NULL, NULL, '2021-11-16 15:31:47', '2021-11-16 15:31:47'),
(51605, 1019, 42729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51606, 1019, 42729, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:19:07', '2021-10-22 09:19:07'),
(51607, 1019, 42729, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated thru Website see attached for reference.', NULL, NULL, '2021-11-16 15:43:16', '2021-11-16 15:43:16'),
(51608, 1019, 42729, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Approved eff date 10/14/2021 see attachment for Reference.', NULL, NULL, '2021-11-30 14:50:57', '2021-11-30 14:50:57'),
(51609, 1019, 42730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51610, 1019, 42730, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:19:44', '2021-10-22 09:19:44'),
(51611, 1019, 42731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51612, 1019, 42731, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:20:09', '2021-10-22 09:20:09'),
(51613, 1019, 42732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51614, 1019, 42732, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:20:35', '2021-10-22 09:20:35'),
(51615, 1019, 42733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51616, 1019, 42733, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:20:59', '2021-10-22 09:20:59'),
(51617, 1019, 42733, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Submitted the application thru provider express, below is the email we received for refence.  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Eliza Rodrigues has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.    You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-11-04 08:23:01', '2021-11-04 08:23:01'),
(51618, 11056, 42733, NULL, '2021-12-16 00:00:00.000', 'Not Eligible', 'Email received from Optum Behavioral Health\' via Spectrum Neuro Behavioral Health  Sub: Fwd: Optum Credentialing Application Cancelled for Eliza Rodrigues RE:  Network Participation - Eliza Rodrigues  Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application and determined that your license level does not meet the Optum credentialing standards.       We encourage you to visit providerexpress.com to review credentialing criteria specific to your area.  If you have any questions, please call Behavioral Network Services at 1-877-614-0484 and select the following options for assistance: Credentialing > Network Services > Credentialing to reach Provider Relations.   Sincerely,    Optum Behavioral Health Credentialing Department    ', NULL, NULL, '2021-12-09 17:05:33', '2021-12-09 17:05:33'),
(51619, 1019, 42734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51620, 11056, 42734, NULL, '2021-11-03 00:00:00.000', 'In Process', 'Aetna  Rep: Lori D  Status:  LOI has been submitted for an additional location. faxed at 859-455-8650 with W-9 with the effective date. 30 business days needed.   Contact no.: 1800-353-1232 option 3 for follow-up  Ref code: 60529532712', NULL, NULL, '2021-10-27 08:31:59', '2021-10-27 08:31:59'),
(51621, 11056, 42734, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Rep:  Kim B  Status:  They have received the request. Specified to list under TIN and providers.  The request is in the Demographic updates Dept.  Case no. : 18084943  Refcode: 6055748643', NULL, NULL, '2021-11-03 14:53:43', '2021-11-03 14:53:43'),
(51622, 11056, 42734, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Faxed the LOI again with a correction in the address.  ', NULL, NULL, '2021-11-04 08:27:41', '2021-11-04 08:27:41'),
(51623, 11056, 42734, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: still in process. Demographic dept received the request working on it.  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:19:46', '2021-11-11 15:19:46'),
(51624, 11056, 42734, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Dori M  Status: Still in the process  Case no. : 18084943  Ref code: 6059846680 ', NULL, NULL, '2021-11-24 18:09:03', '2021-11-24 18:09:03'),
(51625, 11056, 42734, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: CJ S   Status: The application has been processed with the wrong address. The new LOI which was set again to them has been misplaced. Again send them the LOI through fax  Refcode: 6060463093', NULL, NULL, '2021-11-30 14:36:48', '2021-11-30 14:36:48'),
(51626, 11056, 42734, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Rep:  Amby J   Status: The request is in process.   Refcode: 6063556901 ', NULL, NULL, '2021-12-13 15:20:33', '2021-12-13 15:20:33'),
(51627, 11056, 42734, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Rep: Jessie   Status: Again updated LOI has been demanded and faxed at 859-455-8650.  Please see the attachment.  Refcode: 6066122957', NULL, NULL, '2021-12-23 17:13:49', '2021-12-23 17:13:49'),
(51628, 19067, 42734, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || Aetna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Aetna.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar Kingsville, TX, 78363 Elsa Pearce	1083784102	6646 S. Staples St, 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 10:26:08', '2022-01-10 10:26:08'),
(51629, 19067, 42734, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Enrollment Status || RHC || Elsa Pearce || Aetna ||    Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Aetna.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar Kingsville, TX, 78363 Elsa Pearce	1083784102	6646 S. Staples St, 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 11:37:04', '2022-01-25 11:37:04');
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
(51630, 19067, 42734, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: 	RE: [EXTERNAL] Enrollment Status || RHC || Elsa Pearce || Aetna ||   Hammad,  Please contact provider services as I do not manage Facility agreements, I have mentioned previously and I am still getting these requests from you, If we can be a little more proactive and familiarize yourself with the provider service center, thank you     Check on credentialing status at 1-800-353-1232 (option 3).  Provider Services: 1-888-632-3862     Sylvia Machado-Petry Sr. Analyst, Network Ops Network Management – South TX Markets', NULL, NULL, '2022-02-11 13:08:33', '2022-02-11 13:08:33'),
(51631, 19067, 42734, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Spoke with Avi A. They received the application of location addition on 12/13/2021 the application is still in process it will get done by the end of March.  Ref: 6076423137', NULL, NULL, '2022-02-23 15:04:47', '2022-02-23 15:04:47'),
(51632, 19067, 42734, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Anna. She said that the Rockport location is not loaded yet allow them more time and provider Elsa Pearce is not linked to the tax id, we have to bill under group as we have facility contract with Aetna.  Ref# 6079946138', NULL, NULL, '2022-03-15 14:19:22', '2022-03-15 14:19:22'),
(51633, 1019, 42735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51634, 11056, 42735, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-10-27 13:05:51', '2021-10-27 13:05:51'),
(51635, 1019, 42736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51636, 11056, 42736, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to : pdavidson@anci-care.com & jmaligaya@anci-care.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Anci Care  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 14:09:33', '2021-10-27 14:09:33'),
(51637, 11056, 42736, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Anci Care  Hi.   Thank you for the updates.    This has been sent to Data Management for corrections.   Please Note:  Jennifer Maligaya is no longer with Ancillary Care Services.   Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-11-03 16:01:10', '2021-11-03 16:01:10'),
(51638, 11056, 42736, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Enail sent to: pdavidson@anci-care.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Anci Care   Hope all is well with you. Any updates regarding the updation and addition of the additional address under the TIN and providers of the facility? Please get to me at your earliest opportunity.  If you require documents or information feel free to reach out to me without any hesitation.  Thank you! Have a great day!', NULL, NULL, '2021-11-15 17:38:51', '2021-11-15 17:38:51'),
(51639, 11056, 42736, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from:  Shane.Radford@healthsmart.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - Anci Care   Good morning,  I am following up to the below request in reference to the requested address update.     The below address has been updated in our database and I am attaching the link for our website.  You can use this link to see all of your location information we have on file.   https://www.anci-care.com/contact.html  Please forward any future updates or request for information to vipproviders@anci-care.com  Please feel free to reach out if you should need any additional information.  Another Email:  Good morning,  Yes you can start billing under the TIN 460575924.   When we load new location it uses the same effective date as the primary location so the effective date for this location is 7/23/2020.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121   Please see the attachment. ', NULL, NULL, '2021-11-16 10:22:20', '2021-11-16 10:22:20'),
(51640, 11056, 42736, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Good afternoon,  I wanted to follow up and make sure you have gotten an answer on the Credentialing process for the providers locations.  According to our records your contract effective date and credentialing was done on July 23, 2020 and the Recredentialing is not due again until July 1, 2023.   I have attached the Recredentialing documents for your reference.  Please feel free to reach out to me if you should need any additional information.     Thank you,        Shane Radford| Provider Relations  HealthSmart | Network Solutions  Office: 214 574 2664 | Office: 214 574 1121  222 W Las Colinas Blvd | Suite 550 N | Irving, Tx 75039  Email: shane.radford@healthsmart.com', NULL, NULL, '2021-11-17 10:14:21', '2021-11-17 10:14:21'),
(51641, 1019, 42737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51642, 11056, 42737, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Rep : Connie Taylor  Status:  The address is not showing up on the directory of USPS.  COntact no. : 8067986317', NULL, NULL, '2021-10-27 15:34:09', '2021-10-27 15:34:09'),
(51643, 11056, 42737, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-16 13:25:52', '2021-11-16 13:25:52'),
(51644, 11056, 42737, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:01:04', '2021-11-17 18:01:04'),
(51645, 1019, 42738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51646, 11056, 42738, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to: tyesha.sullivan@christushealth.org 	christus.hp.credentialing@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Good morning!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 12:57:10', '2021-10-27 12:57:10'),
(51647, 11056, 42738, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Email received from:   Sub :   Ahmed,     In order to add the highlighted location, please complete and return the ancillary application form.  The location must be credentialed before it can be added to our system.     Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.     Feel free to call me if you have other questions.     Thanks, Michal    Application ahs been submitted. Please see the attachment', NULL, NULL, '2021-11-03 14:01:34', '2021-11-03 14:01:34'),
(51648, 11056, 42738, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Email sent to : michal.simms@christushealth.org  Sub : RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning!  Hope all is well with you. Could the highlighted location be added or not with the Tax I.D of the facility and also under the providers?  Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI.     Group Name  Statcare Minor Emergency Clinic  Tax ID  46-0575924  Group NPI  1689924904  Primary Location  500 E CAESAR KINGSVILLE, TX 78363  Additional Location  2101 FM 2165, Rockport, TX 78382  Provider Name  NPI  Katherine Rabagos  1134415631  Patrick Ayarzagoitia  1649568239  Rose Trevino  1437174794  William Francis  1457994436  Mary Gonzalez  1952713083  Traci Mason  1497127831  Juan Capupus  1891168597  Mari Capupus  1740517945  Petina Rogers  1801443916  Maegan Svatek  1639670250  Hannah Felhofer  1801387220     If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thanking you in anticipation!   Have a wonderful day!', NULL, NULL, '2021-11-15 17:16:15', '2021-11-15 17:16:15'),
(51649, 11056, 42738, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org  Sub:   RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-11-29 15:43:33', '2021-11-29 15:43:33'),
(51650, 11056, 42738, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan   Ahmed, has the request to credential the Rockport location been sent in already?   Replied:   Yes, Any update on that?', NULL, NULL, '2021-12-06 10:52:24', '2021-12-06 10:52:24'),
(51651, 11056, 42738, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan   If in the Credentialing process, they will have to get you an update.     Please allow 90-120 days from the date of submission for the Credentialing process to be completed.', NULL, NULL, '2021-12-16 12:41:06', '2021-12-16 12:41:06'),
(51652, 11056, 42738, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan   Good morning Ahmed, I hope all is well.     The certificate has been forwarded to Credentialing.  They are working to expedite this request.', NULL, NULL, '2021-12-23 16:53:14', '2021-12-23 16:53:14'),
(51653, 19067, 42738, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan   Greetings Michal!  Hope this email finds you well.  Any updates on the previous request?   Eagerly waiting for your response.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 16:15:35', '2022-01-10 16:15:35'),
(51654, 19067, 42738, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan    Greetings!  This is my Second Reminder on the below mentioned request. Kindly update us with the recent status of the enrollment.  Regards, Hammad.', NULL, NULL, '2022-01-25 11:42:47', '2022-01-25 11:42:47'),
(51655, 19067, 42738, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email received from: CHRISTUS.HP.Credentialing@christushealth.org  Subject: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan    Good Afternoon    Facility has been processed contract effective date 12/13/21    Thank you    Credentialing Verification Unit  CHRISTUS Health Plan - US Family Health Plan  919 Hidden Ridge Irving, TX 75038  Phone: (469)-282-0368  Fax: 210-766-8857  CHRISTUS.HP.Credentialing@christushealth.org', NULL, NULL, '2022-01-25 17:51:35', '2022-01-25 17:51:35'),
(51656, 19067, 42738, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Subject: RE: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Hello Ahmed,     I tell you this often… we do not credential the individual practitioners who work at a clinic/facility.     Please discontinue asking me for status on providers who are not being credentialed.      Please contact Credentialing at CHRISTUS.HP.Credentialing@christushealth.org for additional information.     Best regards, Michal     Ms. Michal Simms  Network Contractor Senior  Nueces Region  CHRISTUS Health Plan  US Family Health Plan  (o) 469-282-3227', NULL, NULL, '2022-02-11 13:12:10', '2022-02-11 13:12:10'),
(51657, 19067, 42738, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||   Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Christus Health Plan.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413   Thanks & Regards,', NULL, NULL, '2022-02-21 17:19:26', '2022-02-21 17:19:26'),
(51658, 19067, 42738, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Sent a fax of W9 @ 210-766-8855.', NULL, NULL, '2022-03-15 14:34:24', '2022-03-15 14:34:24'),
(51659, 1019, 42739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51660, 11056, 42739, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to : CSHNproviderrelations@christushealth.org & hunter.barrett@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn  Good morning!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 13:03:35', '2021-10-27 13:03:35'),
(51661, 11056, 42739, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Email received from : vicki.guerra@christushealth.org  \'Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn  Hello   Happy Thursday!     Thank you for sending this information. Statcare is not on the roster anymore with Christus Spohn Health Network and is OON provider. We would love for this provider group to be back on the roster with CSHN and Christus Networks. I believe the supervising physician for Katherine Rabagos does not have privileges at a Christus facility which is a requirement for contracting.     Has this changed?        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745   Responded back to them. Waiting for further response.', NULL, NULL, '2021-11-03 14:16:55', '2021-11-03 14:16:55'),
(51662, 11056, 42739, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn   Good morning Tyesha!  Hope this email finds you well.  Please elaborate this to us as well.  Thanking you in anticipation!    Hello Vicki,  As per our records she has privileges with Christus facility, I have mentioned the hospital privileges again, please review it and let me know if any action is required, as this is an urgent matter.  Christus Spohn­ Shoreline 600 E. Elizabeth St. Corpus Christi, TX 78404 361­881­3000  Christus Spohn­South 5950 Saratoga Blvd. Corpus Christi, TX 78414 361­985­5000  Christus Spohn­Kleberg 1311 E. General Cavazos Kingsville, TX 78363 361-595-5000', NULL, NULL, '2021-11-15 17:27:09', '2021-11-15 17:27:09'),
(51663, 11056, 42739, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  vicki.guerra@christushealth.org>  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn  Hi ,     Thank you for this information. We appreciate that Katherine has privileges for a Christus facility. Unfortunately, the sponsoring physician must have privileges too.     Does the sponsoring physician have privileges?        Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604  Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745', NULL, NULL, '2021-11-29 15:39:14', '2021-11-29 15:39:14'),
(51664, 11056, 42739, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope all is well with you. Yes, he also has privileges at a Christus facility named:  Christus Santa Rosa Health Care Any latest updates on the addition of the location with the facility and Christus Spohn as well?  If you have further queries please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 10:59:41', '2021-12-06 10:59:41'),
(51665, 11056, 42739, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Any updates on the addition of the highlighted location to the TIN of the facility mentioned below?   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-12-21 16:41:26', '2021-12-21 16:41:26'),
(51666, 19067, 42739, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Subject: 	RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn    Hi Ahmed,     Happy Wednesday!     Sorry for the delay. The provider would need to have privileges at a facility in the servicing area. The next question would be if the supervising physician has a plan of action.     Does the physician have an agreement with another physician or hospitalist group to follow the member if admitted at the hospital?     Thank you,', NULL, NULL, '2022-01-10 16:17:16', '2022-01-10 16:17:16'),
(51667, 19067, 42739, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn  Good Morning!  Hope this email finds you well.  The provider have the admitting privileges at:  Christus Spohn Shoreline Christus SpohnSouth Christus SpohnKleberg Regards.', NULL, NULL, '2022-01-25 12:01:52', '2022-01-25 12:01:52'),
(51668, 19067, 42739, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Subject: vicki.guerra@christushealth.org  Hi Ahmed,     Happy Wednesday!     I will need to check the database for the facility privileges. Please send me the below information for the supervising physician.     What is the:     Full Name – Physician?  NPI?  Last 4 social?', NULL, NULL, '2022-02-11 13:20:40', '2022-02-11 13:20:40'),
(51669, 19067, 42739, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn   Hi Ahmed,     Happy Wednesday!     I will need to check the database for the facility privileges. Please send me the below information for the supervising physician.     What is the:     Full Name – Physician?  NPI?  Last 4 social?     Thank you,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745', NULL, NULL, '2022-02-11 13:36:49', '2022-02-11 13:36:49'),
(51670, 19067, 42739, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn   Hello,  Name: Katherine Rabagos  NPI: 1134415631  Last 4 of SSN: 9977   Don\'t hesitate to reach me if you need any information.   Regards, Hammad.', NULL, NULL, '2022-02-11 13:37:17', '2022-02-11 13:37:17'),
(51671, 19067, 42739, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Spohn   Hello!  Disregard the previous email.  Supervising Physician of Katherine Rabagos is: Luis Leyton Gonzalez NPI: 1013911601 Last 4 of SSN: 6256 ', NULL, NULL, '2022-02-11 15:05:59', '2022-02-11 15:05:59'),
(51672, 19067, 42739, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Subject: Supervising Physician Leyton Gonzalez - StatCare Minor Emergency Clinic - Christus Spohn     Hi Hammad,     Happy Monday!     Dr. Leyton Gonzalez is in-active with privileges at any Spohn facility. Is there any other provider who can follow the member as an action plan for StatCare?     Thanks,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745   ', NULL, NULL, '2022-02-24 10:56:48', '2022-02-24 10:56:48'),
(51673, 19067, 42739, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Supervising Physician Leyton Gonzalez - StatCare Minor Emergency Clinic - Christus Spohn    Hi,  Hope this email finds you well. Dr. Leyton Gonzalez can\'t be credentialed with Spohn due to the fact that he does not use a hospital.  Regards, Hammad Ahmed', NULL, NULL, '2022-03-15 14:53:52', '2022-03-15 14:53:52'),
(51674, 19067, 42739, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Subject: Supervising Physician Leyton Gonzalez - StatCare Minor Emergency Clinic - Christus Spohn    Thank you Ahmed!     Until StatCare has a plan of action where a provider or hospitalist group (has hospital privileges as Spohn Shoreline, South, etc.) is in agreement to follow members, CSHN cannot extend a contract. StatCare does not meet the criteria. If this criteria is met, please email me back and CSHN can review again.', NULL, NULL, '2022-03-21 10:43:15', '2022-03-21 10:43:15'),
(51675, 1019, 42740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51676, 11056, 42740, NULL, '2021-11-03 00:00:00.000', 'In Process', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273 ', NULL, NULL, '2021-10-27 08:35:05', '2021-10-27 08:35:05'),
(51677, 11056, 42740, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-11-04 10:12:14', '2021-11-04 10:12:14'),
(51678, 11056, 42740, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM   ', NULL, NULL, '2021-11-12 13:03:29', '2021-11-12 13:03:29'),
(51679, 11056, 42740, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-11-19 13:04:22', '2021-11-19 13:04:22'),
(51680, 11056, 42740, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-11-30 17:08:26', '2021-11-30 17:08:26'),
(51681, 11056, 42740, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021       ', NULL, NULL, '2021-12-16 10:45:33', '2021-12-16 10:45:33'),
(51682, 1019, 42741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51683, 11056, 42741, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Aetna\'s approval.', NULL, NULL, '2021-10-27 13:05:18', '2021-10-27 13:05:18'),
(51684, 1019, 42742, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51685, 11056, 42742, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 12:17:42', '2021-10-27 12:17:42'),
(51686, 11056, 42742, NULL, '2021-11-10 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-11-03 16:08:42', '2021-11-03 16:08:42'),
(51687, 11056, 42742, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-11-15 17:43:28', '2021-11-15 17:43:28'),
(51688, 11056, 42742, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-11-29 15:19:34', '2021-11-29 15:19:34'),
(51689, 11056, 42742, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-20 17:53:48', '2021-12-20 17:53:48'),
(51690, 11056, 42742, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:49:37', '2021-12-22 15:49:37'),
(51691, 1019, 42743, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51692, 11056, 42743, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com & patti.davidson@healthsmart.com & Leslie.Perez@healthsmart.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart  Good morning!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 12:26:07', '2021-10-27 12:26:07'),
(51693, 11056, 42743, NULL, '2021-11-10 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com & patti.davidson@healthsmart.com & Leslie.Perez@healthsmart.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-11-03 16:10:24', '2021-11-03 16:10:24'),
(51694, 11056, 42743, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email received from:  mdiprsupport@healthsmart.com  Sub:   ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart   Hi,  We cannot process your Demo request due to the following missing information listed below. Location Phone & Fax # All communication, including requested documents, should be sent to pr.@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-15 15:21:53', '2021-11-15 15:21:53'),
(51695, 11056, 42743, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  mdiprsupport@healthsmart.com  &  pr.south@healthsmart.com  Sub:  ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart  Good afternoon!  Hope all is well with you. Here is the information you requested.  Location no.: 361-556-5770       Fax no. : 361-556-5771  Wrong Address: 2101 FM 2165, Rockport, TX 78382 Correct Address: 2102 FM 2165, Rockport, TX 78382   Please accept our apology and kindly do the corrections.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-29 15:21:30', '2021-11-29 15:21:30'),
(51696, 11056, 42743, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  &  South pr.south@healthsmart.com  Sub: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart   Good afternoon!  Hope you are doing well. Has the location been updated with the correct address yet? And Is it linked to the TIN as well?  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-12-21 16:50:45', '2021-12-21 16:50:45'),
(51697, 19067, 42743, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com, pr.south@healthsmart.com  Subject: Re: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart   Greetings!  Any updates on the below mentioned request?  Kindly respond once you get time.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 16:26:37', '2022-01-10 16:26:37'),
(51698, 19067, 42743, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com, pr.south@healthsmart.com  Subject: Re: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart   Greetings!  This is my SECOND REMINDER on the request below. Kindly respond as per your convenience.  Regards, Hammad.', NULL, NULL, '2022-01-26 17:42:35', '2022-01-26 17:42:35'),
(51699, 19067, 42743, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Subject: RE: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart    Good Afternoon,                   This has been updated in our system. Locations can be verified below after 30-45 days of submission.     https://providerlookup.healthsmart.com/SearchProviders.aspx           Valesia Glenn |Provider Relations  HealthSmart | Network Solutions  222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039', NULL, NULL, '2022-02-11 13:55:04', '2022-02-11 13:55:04'),
(51700, 19067, 42743, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart   Hi,  Can I get a location confirmation letter or any approval letter for the location of: 2102 FM 2165, Rockport, TX 78382   Regards, Hammad Ahmed', NULL, NULL, '2022-02-23 14:41:57', '2022-02-23 14:41:57'),
(51701, 19067, 42743, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Subject: RE: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart    Good Morning,                   This has been completed for all providers listed below. Unfortunately we don’t have confirmation letters/approval letters for locations.        Valesia Glenn |Provider Relations  HealthSmart | Network Solutions  222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039', NULL, NULL, '2022-02-24 10:00:20', '2022-02-24 10:00:20'),
(51702, 19067, 42743, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart   Hi,  Thanks for the update. Kindly provide an effective date for the affected location.  Regards, Hammad', NULL, NULL, '2022-02-24 10:00:43', '2022-02-24 10:00:43'),
(51703, 19067, 42743, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Email received from: pr.south@healthsmart.com  Subject: Fwd: ADD ADDRESS Fw: Demographic Updates Needed - StatCare Minor Emergency Clinic - HealthSmart    Hello,                   Your welcome, date completed 11/9/2021  ', NULL, NULL, '2022-03-15 15:04:46', '2022-03-15 15:04:46'),
(51704, 1019, 42744, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51705, 11056, 42744, NULL, '2021-11-03 00:00:00.000', 'In Process', 'Email received from : RSaldivar@humana.com  Sub : {}Demographic Update_Interaction#2000207180578 {humcrypt}Demographic Update_Interaction#2000207180578   Hi Ahmed,    Thank you for reaching out today. As mentioned on the call, I am sending you the copy of the template you would need to fill out to proceed with your request to add a new service address for your practice Rabagos Health Care under TIN: 460575924.   Attached is the excel sheet you would need to fill out. Please refer to the PDF file for the FAQs which could help you understand this template better. In addition, if you have questions about completing the form, you may read the instructions on the Data Dictionary Definition sheet for guidance. Please go to the highlighted section of the sheet below upon opening the file. This is the section you would need to go to supply your Update Request.  Send the completed roster to the email address below.  stxnm@humana.com   Required fields are highlighted in blue on each tab, and guidance on how to fill those fields can be found on the Data Dictionary Definition tab. If there are information that you think are not necessary, please put NA. On the other hand, if there are information you think are required but is not highlighted in blue, feel free to supply the information.   Thank you,  Rochele Saldivar Network Specialist | Provider Relations   Humana  HGS Manila T 800-626-2741 F NA RSaldivar@humana.com', NULL, NULL, '2021-10-27 08:45:23', '2021-10-27 08:45:23'),
(51706, 11056, 42744, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub : Demographic Update_Interaction#2000207180578- Location Update  Good afternoon!  Hope all is well with you. Please find the roster below in the attachment and see the facility updates Tab in the roster filled for the addition of location.  If any corrections and documents are required please don\'t hesitate to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-11-03 13:51:02', '2021-11-03 13:51:02'),
(51707, 11056, 42744, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to:   Sub :   Good morning!  Hope this email finds you well. Pardon us. There is a mistake in the address please kindly do the corrections before loading and listing it in your directory and under the TIN and providers.  Wrong Address: 2101 FM 2165, Rockport, TX 78382 Correct Address: 2102 FM 2165, Rockport, TX 78382  Please accept our apology and kindly do the corrections. Also have confirmed with the USPS portal.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-11-15 14:46:52', '2021-11-15 14:46:52'),
(51708, 11056, 42744, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to:   stxnm@humana.com  Sub : Demographic Update_Interaction#2000207180578- Location Update   Good morning!  Hope this email finds you well. Pardon us. There is a mistake in the address please kindly do the corrections before loading and listing it in your directory and under the TIN and providers.  Wrong Address: 2101 FM 2165, Rockport, TX 78382 Correct Address: 2102 FM 2165, Rockport, TX 78382  Please accept our apology and kindly do the corrections. Also have confirmed with the USPS portal.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-15 14:48:03', '2021-11-15 14:48:03'),
(51709, 11056, 42744, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  stxnm@humana.com  Sub:  Demographic Update_Interaction#2000207180578- Location Update  Good afternoon!  Hope all is well with you. Has the correct address been listed in your system under the facility, StatCare Minor Emergency Clinic TIN: 46-0575924? Correct Address: 2102 FM 2165, Rockport, TX 78382  Has this address been updated as well correctly?  Please add the location as soon as possible.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-29 15:28:45', '2021-11-29 15:28:45'),
(51710, 11056, 42744, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to: rsaldivar@humana.com  Sub:  Re: {humcrypt}Demographic Update_Interaction#2000207180578  Good morning!  Hope this email finds you well. Any updates on the addition of the new location? Has it been loaded in your system?  Please get back to me at your earliest opportunity.  Thank you! Have a  wonderful day!', NULL, NULL, '2021-12-06 10:21:14', '2021-12-06 10:21:14'),
(51711, 11056, 42744, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Sub:Demographic Update_Interaction#2000207180578- Location Update  In order to add the Rockport location, we will need a credentialing application filled out for the location.     Thank you        Network Operations Coordinator – Provider Contracting     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2021-12-16 13:39:13', '2021-12-16 13:39:13'),
(51712, 11056, 42744, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub: Demographic Update_Interaction#2000207180578- Location Update   Good afternoon!  Hope this email finds you well. Please find the attached credentialing application for the addition of the new Location.  Please see the attached in attachments below. Kindly keep us updated with the process timely.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 11:28:39', '2021-12-23 11:28:39');
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
(51713, 19067, 42744, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Demographic Update_Interaction#2000207180578- Location Update   Greetings!  Hope this email finds you well.  Any updates on this?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-12 16:27:21', '2022-01-12 16:27:21'),
(51714, 19067, 42744, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Demographic Update_Interaction#2000207180578- Location Update   Greetings!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad.', NULL, NULL, '2022-01-26 17:08:50', '2022-01-26 17:08:50'),
(51715, 19067, 42744, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Statcare SPID || Providers || Humana ||  Since this group is not in the Houston Market, we will not be responding to this request.', NULL, NULL, '2022-02-11 14:29:59', '2022-02-11 14:29:59'),
(51716, 19067, 42744, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Fwd: Enrollment Query || Statcare SPID || Providers || Humana ||   Hello!  Hope this email finds you well.  Kindly look into my request mentioned below.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:23:32', '2022-02-21 17:23:32'),
(51717, 19067, 42744, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: MLUCAS13@humana.com  Subject: ADD SERVICE LOCATION_2000232337222    Hi Ahmed,   Thank you for reaching out today. As mentioned on the call, I am sending you the copy of the template you would need to fill out to proceed with your request. Attached is the excel sheet you would need to fill out. Please refer to the PDF file for the FAQs which could help you understand this template better. In addition, if you have questions about completing the form, you may read the instructions on the Data Dictionary Definition sheet for guidance. Please go to the highlighted section of the sheet below upon opening the file. This is the section you would need to go to supply your provider’s information.      Send the completed roster to the email address below.  stxnm@humana.com     Required fields are highlighted in blue on each tab, and guidance on how to fill those fields can be found on the Data Dictionary Definition tab. If there are information that you think are not necessary, please put NA. On the other hand, if there are information you think are required but is not highlighted in blue, feel free to supply the information.     Thank you,    She     Maria Sherelyn D. Lucas  Network Specialist | Provider Relations     Humana  HGS Manila     T 800-626-2741 Opt 2  F 15025190099  MLUCAS13@humana.com   Humana.com', NULL, NULL, '2022-03-09 10:12:20', '2022-03-09 10:12:20'),
(51718, 19067, 42744, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: MLUCAS13@humana.com  Subject: ADD SERVICE LOCATION_2000232337222    Good Morning Maria,  Kindly see the attached as requested. Kindly see under Facility Hospital Updates tab.  Thanks & Regards.', NULL, NULL, '2022-03-09 10:16:00', '2022-03-09 10:16:00'),
(51719, 22077, 42744, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: mlucas13@humana.com  Subject: ADD SERVICE LOCATION_2000232337222  Hi,  Hope this email finds you well.Any updates on the roster we sent you?  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 13:51:53', '2022-04-22 13:51:53'),
(51720, 1019, 42745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51721, 11056, 42745, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s enrollment.', NULL, NULL, '2021-10-27 15:42:32', '2021-10-27 15:42:32'),
(51722, 1019, 42746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51723, 1019, 42746, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Request Initiated thru Pecos for location Addition. Below is the email for reference.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102620210003367)   Sent: 10/26/2021 16:15 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T102620210003367        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  ', NULL, NULL, '2021-10-27 07:43:00', '2021-10-27 07:43:00'),
(51724, 11056, 42746, NULL, '2021-11-10 00:00:00.000', 'Initiated', 'Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.', NULL, NULL, '2021-11-03 16:29:00', '2021-11-03 16:29:00'),
(51725, 11056, 42746, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Rep: Kierra  Status: Time frame is 15 - 30 days. In processing also has requested for address updation.  Ref code :061213202153413  please see the attachment.', NULL, NULL, '2021-11-16 13:01:06', '2021-11-16 13:01:06'),
(51726, 11056, 42746, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Christine H  Status:  Site visit remaining. The request has been sent again to the analyst for correction of the address. They gonna contact us in 24 to 48 hours for the correction and confirmation.  Refcode: 3212990954', NULL, NULL, '2021-11-30 10:16:31', '2021-11-30 10:16:31'),
(51727, 11056, 42746, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:           O20141015000457 Enrollment Status:    APPROVED Submitted By:            Katherine Rabagos   Effective Date: 10/01/2021  Please see the attached.', NULL, NULL, '2021-12-03 12:18:16', '2021-12-03 12:18:16'),
(51728, 1019, 42747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51729, 11056, 42747, NULL, '2021-11-10 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s enrollment', NULL, NULL, '2021-11-03 13:54:14', '2021-11-03 13:54:14'),
(51730, 1019, 42748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51731, 11056, 42748, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-10-27 15:43:06', '2021-10-27 15:43:06'),
(51732, 1019, 42749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51733, 11056, 42749, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-10-27 15:43:13', '2021-10-27 15:43:13'),
(51734, 1019, 42750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:54', '2021-10-27 07:40:54'),
(51735, 11056, 42750, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Rep : Tyler M  Status : Email them @ registrat@multiplan.com. Trying to get a less time-consuming procedure.  Ref code : 102720211250tylerm', NULL, NULL, '2021-10-27 12:44:58', '2021-10-27 12:44:58'),
(51736, 11056, 42750, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to : registrar@multiplan.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Multiplan  Good morning!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 12:51:09', '2021-10-27 12:51:09'),
(51737, 11056, 42750, NULL, '2021-11-10 00:00:00.000', 'Initiated', 'MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7800027    Submitter Name: Brad Peterson Date of Submission: 11/03/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard   Submitted case online. ', NULL, NULL, '2021-11-03 16:52:03', '2021-11-03 16:52:03'),
(51738, 11056, 42750, NULL, '2021-11-10 00:00:00.000', 'Initiated', 'New Customer Service Case 7800027 ', NULL, NULL, '2021-11-03 16:54:56', '2021-11-03 16:54:56'),
(51739, 11056, 42750, NULL, '2021-11-10 00:00:00.000', 'Initiated', 'New Customer Service Case 7800027 ', NULL, NULL, '2021-11-03 16:54:57', '2021-11-03 16:54:57'),
(51740, 11056, 42750, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email received from: james.darmawan@multiplan.com  Sub : E-mailing: Statcare Minor Emergency Clinic 9671500.zipx  Dear Ahmed,  We received your request to email the participation status letter. Please find the attached documents for Statcare Minor Emergency Clinic.  Please check the second email for the password.  You may check the status of your current inquiry by calling 800-950-7040 with reference to your Case # 7800027   Also confirmed on the call. Rep: James D  eff date : 10/01/2021  Ref code: 11152021jamesD ', NULL, NULL, '2021-11-15 14:08:48', '2021-11-15 14:08:48'),
(51741, 1019, 42751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51742, 11056, 42751, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Scott & White  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 15:48:05', '2021-10-27 15:48:05'),
(51743, 11056, 42751, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White  Good afternoon Ahmed,  I checked with the Director of Contracting and since we currently have a facility contract with Statcare Minor Emergency Clinic we only need to add the new Rockport address to NPI: 1689924904 for our Provider Directories.  We do ask that if you open a new location in the future please submit these updates through our website (see link below).      https://swhp.org/forms/html/demographic-Update-Form.html   If you have the phone # and fax # we can ago ahead and add the Rockport location this time.   Thank you so much,  Brenda K. Powell Manager, Internal Provider Network Services 1206 West Campus Dr | MS-A4-126 | Temple, TX  76502 254-298-3338 Office | 254-298-3044 Fax Brenda.Powell@BSWHealth.org www.swhp.org', NULL, NULL, '2021-11-04 10:23:10', '2021-11-04 10:23:10'),
(51744, 11056, 42751, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 7e548520-fe4f-41db-a5b5-18340075b087   Please see the attachment. ', NULL, NULL, '2021-11-04 10:41:50', '2021-11-04 10:41:50'),
(51745, 11056, 42751, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White  Good Morning Ahmed,  We have added the Rockport location to NPI: 1689924904.  This location will show in our Provider Directories at the next website re-fresh.     Thank you and have a great day!  Brenda     Provider Services 1206 West Campus Drive Temple, TX  76502 www.swhp.org', NULL, NULL, '2021-11-15 12:58:44', '2021-11-15 12:58:44'),
(51746, 11056, 42751, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  SWHPRegion4@bswhealth.org  Sub:   Enrollment Query - Statcare Minor Emergency Clinic - Scott & White  Good evening!  Hope you are doing well. Please provide me with the welcome letter for the New location. Please list all of the providers under the facility TIN underneath it too. Also, try to list this location in the provider directories soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-03 10:15:11', '2021-12-03 10:15:11'),
(51747, 11056, 42751, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub: Demographic Update_Interaction#2000207180578- Location Update   Good afternoon!  Hope this email finds you well. Please find the attached credentialing application for the addition of the new Location.  Please see the attached in attachments below. Kindly keep us updated with the process timely.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 11:28:51', '2021-12-23 11:28:51'),
(51748, 11056, 42751, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White   Good Morning Ahmed,  We have added the Rockport location effective 11/8/21.  We do not have individual providers listed under this facility contract today.  This location will be listed in our online directories as soon as our website is refreshed.  It should be updated within the next few weeks.  If you or a member calls our Customer Service Center they would be able to verify the status of this UC Center.     If you have further questions please do not hesitate to contact your PR Representative at SWHPRegion4@bswhealth.org     Thank you and have a great week!     Brenda K. Powell  Manager, Internal Provider Network Services', NULL, NULL, '2021-12-23 13:47:32', '2021-12-23 13:47:32'),
(51749, 19067, 42751, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: SWHPRegion4@bswhealth.org  Subject: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White     Good evening!  Hope you are doing well. Please provide me with the welcome letter for the New location. Please list all of the providers under the facility TIN underneath it too. Also, try to list this location in the provider directories soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2022-01-12 17:37:44', '2022-01-12 17:37:44'),
(51750, 19067, 42751, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: SWHPREGION4@bswhealth.org  Subject: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White     Good Evening,     There are no providers listed as this is a facility contract.  There is no welcome letter as this address was added to a NPI/TIN that is already contracted. This information is already showing up on in our internal directories.  Please allow more time the information to transfer to our external directories and the website is refreshed.         Thank you  Provider Relations Representative', NULL, NULL, '2022-01-12 17:38:58', '2022-01-12 17:38:58'),
(51751, 19067, 42751, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION4@bswhealth.org  Subject: Re: Re: Re: Re: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White   Greetings!  Has the provider been added in the Directory.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 18:08:14', '2022-01-26 18:08:14'),
(51752, 19067, 42751, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: HPREGION4@bswhealth.org  Subject: RE: Re: Re: Re: Re: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White  Good Morning,     Please see the facility listed below:       Thank you  Irene S  Provider Relations Representative 1, Provider Network Mgmt  Baylor Scott & White Health Plan  1206 West Campus Dr | MS-A4-126 | Temple, TX  76502  254.298.3218 Fax  BSWHealthPlan.com   ', NULL, NULL, '2022-02-11 14:42:50', '2022-02-11 14:42:50'),
(51753, 19067, 42751, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: hpregion4@bswhealth.org  Subject: Re: Re: Re: Re: Re: Enrollment Query - Statcare Minor Emergency Clinic - Scott & White    Hello!  Thanks for the update.  Can I get an approval letter for the new location?  Regards.', NULL, NULL, '2022-03-15 16:22:27', '2022-03-15 16:22:27'),
(51754, 19067, 42751, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Email received from:   Subject:    Good afternoon,     There is no approval letter as this was only an add address to an existing contracted NPI/TIN. Please see addresses that are contracted under this NPI and TIN.       Thank you  Irene S  Provider Relations Representative 1, Provider Network Mgmt  Baylor Scott & White Health Plan  1206 West Campus Dr | MS-A4-126 | Temple, TX  76502  254.298.3218 Fax  BSWHealthPlan.com', NULL, NULL, '2022-03-15 16:23:37', '2022-03-15 16:23:37'),
(51755, 1019, 42752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51756, 11056, 42752, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-10-27 13:08:45', '2021-10-27 13:08:45'),
(51757, 1019, 42753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51758, 11056, 42753, NULL, '2021-11-03 00:00:00.000', 'Initiated', 'Email sent to:efry@trpnppo.com , trpndataentry@trpnppo.com & mflores@trpnppo.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good morning!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day! ', NULL, NULL, '2021-10-27 12:37:49', '2021-10-27 12:37:49'),
(51759, 11056, 42753, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email received from : ccampos@trpnppo.com  Sub : RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN   Good morning,     This request is completed.   Carlos Campos  Data Entry Department Supervisor  Three Rivers Provider Network  6970 O’Bannon Drive  Las Vegas, NV 89117  P: 619.869.8940  F: 619.271.2563  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com', NULL, NULL, '2021-11-15 12:50:52', '2021-11-15 12:50:52'),
(51760, 11056, 42753, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:   ccampos@trpnppo.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope this email finds you well. Please provide me with the welcome letter or linking letter or demographic updates letter for the addition of the location.  Kindly correct the address: 2102 FM 2165, Rockport, TX 78382. Not 2101.  Eagerly waiting for the welcome letter for the new location update.  Thank you! Have a great day!', NULL, NULL, '2021-11-29 15:02:04', '2021-11-29 15:02:04'),
(51761, 11056, 42753, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: efry@trpnppo.com  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN   Good afternoon!  Hope all is well with you. Kindly confirm the effective date for the additional location: 2102 FM 2165, Rockport, TX 78382.    Please get back to me soon.  Thank you! ', NULL, NULL, '2021-12-23 15:08:26', '2021-12-23 15:08:26'),
(51762, 19067, 42753, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Re: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN   Greetings!  Hope you are doing well.  Any updates on below mentioned request?  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 17:42:47', '2022-01-12 17:42:47'),
(51763, 19067, 42753, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: trpndataentry@trpnppo.com  Subject: Fwd: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN   Hi,     Good morning,     I added this location on 07/12/2021,     Carlos Campos   Data Entry Department Supervisor  Three Rivers Provider Network  6970 O’Bannon Drive  Las Vegas, NV 89117  P: 619.869.8940  F: 619.271.2563  ccampos@trpnppo.com  trpndataentry@trpnppo.com  www.trpnppo.com  ', NULL, NULL, '2022-01-26 18:01:31', '2022-01-26 18:01:31'),
(51764, 19067, 42753, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Secure email received from: ncuevas@trpnppo.com  Subject: FW: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN   Hello,  Please be informed that location 2102 FM 2165 has been  added as requested with effective date of 12/14/2021.  Regards,     Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com', NULL, NULL, '2022-02-09 15:22:22', '2022-02-09 15:22:22'),
(51765, 19067, 42753, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Secure email sent to: ncuevas@trpnppo.com  Subject: RE: FW: Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN    Hello!  Can I get an approval letter for the affected location?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 18:02:30', '2022-02-21 18:02:30'),
(51766, 19067, 42753, NULL, '2022-03-07 00:00:00.000', 'Approved', 'Received the following email:   Hello,  Please be informed that location 2102 FM 2165 has been  added as requested with an effective date of 12/14/2021.  Regards,     Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com', NULL, NULL, '2022-02-28 17:23:36', '2022-02-28 17:23:36'),
(51767, 1019, 42754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51768, 11056, 42754, NULL, '2021-11-03 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com & JTRENZ@humana.com  Sub : Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope all is well with you. I want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN. Kindly assist me with the procedure soon for adding the location.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the additional & billing locations.   Thank you! Have a great day!', NULL, NULL, '2021-10-27 10:09:26', '2021-10-27 10:09:26'),
(51769, 11056, 42754, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Good morning –     Please use the attached Provider Roster spreadsheet (FIRST TAB on bottom left to add location, SECOND TAB on bottom left to add all the provider you want to have at that location).  When complete, please email to HGBproviderrosters@humana.com for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-03 13:53:43', '2021-11-03 13:53:43'),
(51770, 11056, 42754, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Sub : Demographic Updates - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. Please find the attached Provider Roster spreadsheet below in attachments. If any corrections are needed please let me know.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful day!  send again with a correction in address.', NULL, NULL, '2021-11-15 12:47:02', '2021-11-15 12:47:02'),
(51771, 11056, 42754, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  HGBProviderRosters@humana.com  Sub:  Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Pardon us. There is a mistake in the address please kindly do the corrections before loading and listing it in your directory and under the TIN and providers.  Wrong Address: 2101 FM 2165, Rockport, TX 78382 Correct Address: 2102 FM 2165, Rockport, TX 78382  Please accept our apology and kindly do the corrections. Also have confirmed with the USPS portal.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-29 16:44:23', '2021-11-29 16:44:23'),
(51772, 11056, 42754, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub:  Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well.  Has the correct address been listed in your system under the facility, StatCare Minor Emergency Clinic TIN: 46-0575924? Correct Address: 2102 FM 2165, Rockport, TX 78382    Please provide the updates regarding the demographic updates soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-06 09:38:54', '2021-12-06 09:38:54'),
(51773, 11056, 42754, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:   Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Good afternoon –     The Rockport location is not yet in our system.  When did you email the Provider Roster to add the location? The roster should have been emailed to hgbProviderRosters@humana.com.    Replied:  Yes, I have submitted the roster at HGBProviderRosters@humana.com on November 3rd, 2021.   Thank you!', NULL, NULL, '2021-12-06 10:08:53', '2021-12-06 10:08:53'),
(51774, 11056, 42754, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub:  Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well.  Has the correct address been listed in your system under the facility, StatCare Minor Emergency Clinic TIN: 46-0575924? Correct Address: 2102 FM 2165, Rockport, TX 78382    Please provide the updates regarding the demographic updates soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-06 10:09:24', '2021-12-06 10:09:24'),
(51775, 11056, 42754, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Sub: Demographic Updates - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. Any updates on the addition of the location: 2102 FM 2165, Rockport, TX 78382 under facility Statcare Minor Emergency Clinic TIN: 46-0575924?  Please provide the updates regarding the demographic updates soon.  Thank you! Have a blessed day! ', NULL, NULL, '2021-12-16 13:57:28', '2021-12-16 13:57:28'),
(51776, 11056, 42754, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Demographic Updates - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope you are staying healthy. I am still waiting for the updates related to the addition of the location. Kindly get back to me with the updates.  Eagerly, waiting to hear from you soon.   Thank you! Have a blessed weekend!', NULL, NULL, '2021-12-23 16:35:54', '2021-12-23 16:35:54'),
(51777, 19067, 42754, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Demographic Updates - Statcare Minor Emergency Clinic - Tricare   Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request.  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:35:29', '2022-01-10 17:35:29'),
(51778, 19067, 42754, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Demographic Updates - Statcare Minor Emergency Clinic - Tricare  Greetings!  This is my SECOND REMINDER on the request below.  Kindly respond as per your convenience.  Regards, Hammad. ', NULL, NULL, '2022-01-26 17:38:09', '2022-01-26 17:38:09'),
(51779, 19067, 42754, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: Re: Demographic Updates - Statcare Minor Emergency Clinic - Tricare    Address shows as updated in the system to 2102 FM 2165, Rockport TX 78382', NULL, NULL, '2022-01-27 10:06:28', '2022-01-27 10:06:28'),
(51780, 19067, 42754, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:02', '2022-02-21 17:45:02'),
(51781, 19067, 42754, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:32', '2022-03-15 17:58:32'),
(51782, 22077, 42754, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:07:44', '2022-04-08 11:07:44'),
(51783, 22077, 42754, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Locations added through the portal', NULL, NULL, '2022-04-25 08:22:44', '2022-04-25 08:22:44'),
(51784, 1019, 42755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51785, 11056, 42755, NULL, '2021-11-03 00:00:00.000', 'In Process', 'Email sent to:  credentialing@triwest.com ,jmonson@triwest.com & ccarroll@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  Good morning!  Hope all is well with you. Please let us know with procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-27 10:43:50', '2021-10-27 10:43:50'),
(51786, 11056, 42755, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   TriWest Classification: Confidential     Hello,     According to our systems, TriWest has this location loaded and effective.     Thank you,  Jess   ', NULL, NULL, '2021-11-04 10:30:01', '2021-11-04 10:30:01'),
(51787, 11056, 42755, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Confirmation email sent : jmonson@triwest.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest   I am asking about the highlighted one. Mentioned below.  Additional Location : 2101 FM 2165, Rockport, TX 78382 ', NULL, NULL, '2021-11-15 12:38:08', '2021-11-15 12:38:08'),
(51788, 11056, 42755, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com   ', NULL, NULL, '2021-11-22 09:19:42', '2021-11-22 09:19:42'),
(51789, 11056, 42755, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email received from:  jmonson@triwest.com, Svaldez.@TriWest.com & ccarroll@triwest.com  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential: Hello,   All locations are showing active in our systems.   Another Email : Talha,  Statcare Mino Emergency Clinic located at 2102 FM 2165 Rockport, TX 78382 was approved as of November 4, 2021.  See attached pulled directly from the Triwest Provider Directory for StatCare TIN 46_0575924. As stated, all 5 locations are contracted, loaded, and active for CCN.     Thank you,     Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Thank you,   Jess Monson  Direct Contract Manager/ TriWest Healthcare Alliance Phoenix Corporate Office, Phoenix AZ 85016 O: (602) 865-0260 jmonson@TriWest.com www.triwest.com  Best Regards, Sara Valdez, Provider Credentialing Specialist|TriWest Healthcare Alliance E: Svaldez.@TriWest.com   ', NULL, NULL, '2021-11-22 09:19:42', '2021-11-22 09:19:42'),
(51790, 1019, 42756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51791, 11056, 42756, NULL, '2021-11-03 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Demographic Updates - Adding a Location - UHC - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN. Please assist with the query at your earliest convenience  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-10-27 08:47:45', '2021-10-27 08:47:45'),
(51792, 11056, 42756, NULL, '2021-11-05 00:00:00.000', 'Initiated', ' Thank you for your submission, your updates have been submitted for processing. Please note that your submission may take up to 10 business days to complete.  You may check the status of your request beginning on the next business day by selecting “transaction status” on the dashboard. Your request number is GL000001979956.', NULL, NULL, '2021-10-29 15:53:47', '2021-10-29 15:53:47'),
(51793, 11056, 42756, NULL, '2021-11-10 00:00:00.000', 'In Process', 'Email received from : unitedhealthcare_request_addlinfo@uhc.com  Sub : Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106  UnitedHealthcare Insurance Company     We’ve reviewed the provider/group updates you requested on Nov 1, 2021 12:16:58 PM, Your request was assigned reference number PR-6279106 . The subject of your original submission was: Demographic Updates - Adding a Location - UHC - StatCare Minor Emergency Clinic . Action Required Reply to this email to supply the following information:  GroupName : Statcare Minor Emergency Clinic; Last 4-Digits of TIN: 5924 Request: Add an address to the above provider  1.Please provide the billing/remittance address and phone number.  2.The effective date wasn\'t provided or is invalid. Please respond with a valid effective date (mm/dd/yyyy).  3.The address (2101 FM 2165, Rockport, TX 7838286) could not be validated against USPS.com, and request to confirm the correct address With Phone & fax number.    If we don’t receive a response by Nov 8, 2021 12:16:58 PM. we may not be able to make all of the updates you requested.  ', NULL, NULL, '2021-11-03 15:47:46', '2021-11-03 15:47:46'),
(51794, 11056, 42756, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: networkhelp@uhc.com  Sub : Secure Message from kayla_hoffman13@uhc.com  Good Afternoon,     Thank you for contacting UnitedHealthcare network. Based on the nature of your inquiry, your request will need to be handled by the demographic team. Please submit the request to the demographic department (hpdemo@uhc.com) for assistance.     You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.     For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to also check your status online. Additionally, the following hyperlink  (under no access to my practice profile) has the recommended forms for these types of requests if unable to use the Link App.     If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).        Thank you,     Kayla Hoffman  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-11 13:35:45', '2021-11-11 13:35:45'),
(51795, 11056, 42756, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:   unitedhealthcare_request_addlinfo@uhc.com   &   networkhelp@uhc.com  Sub:  Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106  Good afternoon!  Hope all is well with you. Here is the information you requested. We will also check out with USPS directory and try to resolve it soon.  The location is effective from 10/01/2021 Billing Contact no. : 361-516-0800                          Billing Fax no. : 361-516-0855 Additional Location Contact no. : 361-556-5770     Additional Location Fax no. : 361-556-5771   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Remittance/ Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  For more queries and concerns please reach out to me, also for the documents and information too.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-29 09:23:44', '2021-11-29 09:23:44'),
(51796, 11056, 42756, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: unitedhealthcare_request_addlinfo@uhc.com  &  networkhelp@uhc.com  Sub: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106   Good morning!  Hope this email finds you well. Pardon us. There is a mistake in the address please kindly do the corrections before loading and listing it in your directory and under the TIN and providers.  Wrong Address: 2101 FM 2165, Rockport, TX 78382 Correct Address: 2102 FM 2165, Rockport, TX 78382  Please accept our apology and kindly do the corrections. Also have confirmed with the USPS portal.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 11:52:49', '2021-12-23 11:52:49'),
(51797, 19067, 42756, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com, unitedhealthcare_request_addlinfo@uhc.com  Subject: Re: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106   Good Evening!   Any updates on the previously mentioned request?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:27:34', '2022-01-10 17:27:34'),
(51798, 19067, 42756, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Secure email received from: tremacie_a_stone@uhc.com  Subject: Secure Message from   Good Afternoon Hammad Ahmed,   Your request for address update for group Statcare Minor Emergency Clinic TAX ID 5924* has been completed.  The address is now 2102 FM 2165, Rockport, TX 78382.    Have a great day!   Tremacie  UnitedHealthcare Operations  *--SecureDelivery--*', NULL, NULL, '2022-01-12 11:49:42', '2022-01-12 11:49:42'),
(51799, 19067, 42756, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: unitedhealthcare_request_addlinfo@uhc.com, networkhelp@uhc.com  Subject: Re: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106  Hello!  Has the address been updated?  Regards, Hammad.', NULL, NULL, '2022-01-26 17:50:56', '2022-01-26 17:50:56'),
(51800, 19067, 42756, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: unitedhealthcare_request_addlinfo@uhc.com, networkhelp@uhc.com  Subject: Re: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106   Hello!  Any updates on previously mentioned request?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 17:02:59', '2022-02-11 17:02:59'),
(51801, 19067, 42756, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Secure email received from: united_healthcare_provider_operations@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com     Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6478237  Received On: Feb 11, 2022 10:11:02 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-02-15 17:07:11', '2022-02-15 17:07:11'),
(51802, 19067, 42756, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Received a call from UHC 952-202-4505 regarding address confirmation. The request in in process and it will take up to 90 business days. Rep: Steve Ref: PR-6478237 ', NULL, NULL, '2022-02-16 11:12:32', '2022-02-16 11:12:32'),
(51803, 19067, 42756, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: unitedhealthcare_request_addlinfo@uhc.com  Subject: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6478237    UnitedHealthcare Insurance Company     We’ve reviewed the provider/group updates you requested on Feb 15, 2022 9:23:31 AM, Your request was assigned reference number PR-6478237 . The subject of your original submission was: Re: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6279106 . Action Required Reply to this email to supply the following information:  Group:STATCARE MINOR EMERGENCY CLINIC NPI:1689924904  Please provide the following information to complete address add.  What is the effective date for address add? Whats is the phone and fax for new address/ Whats is the correct billing for new location?    If we don’t receive a response by Feb 22, 2022 9:23:31 AM. we may not be able to make all of the updates you requested.    Questions? We’re here to help. For questions pertaining to this communication, contact us at submission_inquiry@uhc.com. Please include the reference number in the subject line of your email.     Thank you.  UnitedHealthcare Provider Operations', NULL, NULL, '2022-02-21 13:13:54', '2022-02-21 13:13:54'),
(51804, 19067, 42756, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: unitedhealthcare_request_addlinfo@uhc.com  Subject: Re: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-6478237   Hi,  Hope this email finds you well. Following is the information as per you requested.  The effective date of this location is 10/01/2021  Phone: 361-556-5770  Fax: 361-556-5771  Billing Location: 500 E Caesar Kingsville, TX 78363.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 13:23:21', '2022-02-21 13:23:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(51805, 19067, 42756, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: united_healthcare_provider_operations@uhc.com  Subject: Submission Received: PR-6495583     UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6495583  Received On: Feb 21, 2022 6:32:08 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-02-21 13:30:25', '2022-02-21 13:30:25'),
(51806, 19067, 42756, NULL, '2022-03-02 00:00:00.000', 'Approved', 'Effective Date: 10/01/2021  ', NULL, NULL, '2022-02-23 14:10:43', '2022-02-23 14:10:43'),
(51807, 19067, 42756, NULL, '2022-03-02 00:00:00.000', 'Approved', 'See attachment of provider\'s directory.', NULL, NULL, '2022-02-23 14:11:17', '2022-02-23 14:11:17'),
(51808, 1019, 42757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 07:40:55', '2021-10-27 07:40:55'),
(51809, 11056, 42757, NULL, '2021-11-03 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-10-27 13:09:00', '2021-10-27 13:09:00'),
(51810, 11056, 42758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:35:21', '2021-10-27 15:35:21'),
(51811, 11056, 42758, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email received from : customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102820210003226)   Sent: 10/28/2021 16:03 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: T102820210003226        NPI: 1154999654        Medicare ID: 1V5988, 1V5995        Name: LETICIA A ALEMAN-LISTENBEE          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-01 16:41:33', '2021-11-01 16:41:33'),
(51812, 11056, 42758, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Email received from : medenroll@novitas-solutions.com  Sub ; Medicare Provider Enrollment Notification LETICIA ALEMAN-LISTENBEE NP  Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.  eff date : 11/01/2021  Please see the attached.', NULL, NULL, '2021-11-04 13:37:52', '2021-11-04 13:37:52'),
(51813, 11056, 42758, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Eff date : 09/01/2021', NULL, NULL, '2021-11-04 13:51:03', '2021-11-04 13:51:03'),
(51814, 11056, 42759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:35:56', '2021-10-27 15:35:56'),
(51815, 11056, 42759, NULL, '2021-11-05 00:00:00.000', 'Initiated', '	 View Summary Thank you for completing the BCBSIL 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: 349737', NULL, NULL, '2021-10-29 12:50:52', '2021-10-29 12:50:52'),
(51816, 11056, 42759, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Corrected 1  View Summary 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: 349775', NULL, NULL, '2021-10-29 13:21:20', '2021-10-29 13:21:20'),
(51817, 11056, 42759, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Sub : BCBS of Texas Provider On-boarding Request Form Received : Case Number - 03063270  AHMED TALHA,  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 03063270, for COASTAL BEND URGENT CARE LLC.  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.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-11-08 16:26:55', '2021-11-08 16:26:55'),
(51818, 11056, 42759, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Case no. :  03063270 Please see the attachment.', NULL, NULL, '2021-11-16 14:05:34', '2021-11-16 14:05:34'),
(51819, 11056, 42759, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  provider_relations_south_texas@bcbstx.com  Sub:   BCBS of Texas Provider Onboarding Request Form Received: Case Number - 03063270  Good afternoon!  Hope all is well with you. Please provide me the latest updates on Case no.:03063270 &  Application ID: 349775 of the provider, Letica Aleman-Listenbee regarding credentialing and enrollment processing with BCBS.  Eagerly, waiting for the updates.  Thank you!', NULL, NULL, '2021-11-24 13:41:31', '2021-11-24 13:41:31'),
(51820, 11056, 42759, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Case no. : 03063270  In progress. Please see the attachment.', NULL, NULL, '2021-12-03 15:55:14', '2021-12-03 15:55:14'),
(51821, 11056, 42759, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Please see the attachment. ', NULL, NULL, '2021-12-14 14:45:56', '2021-12-14 14:45:56'),
(51822, 11056, 42759, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Please see the attachment.', NULL, NULL, '2021-12-14 14:46:24', '2021-12-14 14:46:24'),
(51823, 11056, 42759, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Please see the attachment.', NULL, NULL, '2021-12-14 14:46:45', '2021-12-14 14:46:45'),
(51824, 11056, 42759, NULL, '2021-12-27 00:00:00.000', 'In Process', '	 REp: Geraldi   Provider ID: 8QN604   Status: Credentialing is still is in process. Welcome letter may be expected in first week of jan  REFCODE: Geraldi12202021', NULL, NULL, '2021-12-20 13:17:34', '2021-12-20 13:17:34'),
(51825, 11056, 42759, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Case no. : 03063270  In progress. Please see the attachment.', NULL, NULL, '2021-12-22 10:44:52', '2021-12-22 10:44:52'),
(51826, 19067, 42759, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Case no. : 03063270  In progress. Please see the attachment.', NULL, NULL, '2021-12-28 17:12:17', '2021-12-28 17:12:17'),
(51827, 19067, 42759, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: provider_relations_south_texas@bcbstx.com  Subject: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || BCBS TX ||  Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider and Group.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside, DR STE 4, Beeville, TX 78102-5324   Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:56:55', '2022-01-04 12:56:55'),
(51828, 19067, 42759, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || BCBS TX || : Case Number - 03307181   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03307181.  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, '2022-01-05 16:26:55', '2022-01-05 16:26:55'),
(51829, 19067, 42759, NULL, '2022-01-19 00:00:00.000', 'In Process', 'In Progress, check the attachment.', NULL, NULL, '2022-01-12 13:31:29', '2022-01-12 13:31:29'),
(51830, 19067, 42759, NULL, '2022-02-02 00:00:00.000', 'Approved', 'See attachment for provider directory as a reference.', NULL, NULL, '2022-01-26 09:49:55', '2022-01-26 09:49:55'),
(51831, 11056, 42760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:36:05', '2021-10-27 15:36:05'),
(51832, 11056, 42760, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : mmedina@ghn-mci.com & Kavalos@ghn-mci.com  Sub : Enrollment Query - CBUC & GWMC - Galaxy Health  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 13:51:05', '2021-11-01 13:51:05'),
(51833, 11056, 42760, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from:kavalos@ghn-mci.com  Sub : Enrollment Query - CBUC & GWMC - Galaxy Health   please provide Dr. title, specialty. Effective date and phone/fax number for the practice location.  Thanks;  Karen A  Have provided with the details.', NULL, NULL, '2021-11-08 13:36:55', '2021-11-08 13:36:55'),
(51834, 11056, 42760, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health   Good evening Karen!  Hope you had a great weekend. Here it is. If anything else is needed please feel free to reach out to me.  Provider Name: Leticia Aleman-Listenbee           Effective date: 09/01/2021 Degree :  MSN                                                          Title: FNP Practice contact no. # : 361-226-1126                      fax no. : 361 542-4076   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-11-17 12:46:57', '2021-11-17 12:46:57'),
(51835, 11056, 42760, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Hello Ahmed;     This is all we need to for the update allow 60-90 days for the update to be completed.     Thanks;     Karen A', NULL, NULL, '2021-11-24 13:58:54', '2021-11-24 13:58:54'),
(51836, 11056, 42760, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Hello Ahmed;     This is all we need to for the update allow 60-90 days for the update to be completed.     Thanks;     Karen A', NULL, NULL, '2021-11-24 13:58:55', '2021-11-24 13:58:55'),
(51837, 11056, 42760, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Kavalos@ghn-mci.com  Sub: Enrollment Query - CBUC & GWMC - Galaxy Health  Good morning Karen!  Hope you are doing great. Any update on the credentialing process of the provider, Leticia Aleman-Listenbee?  Are you in need of any information or document? Please let me know.  Take Care of yourself!  Thank you! Have a wonderfully blessed day!', NULL, NULL, '2021-12-03 15:39:21', '2021-12-03 15:39:21'),
(51838, 11056, 42760, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Enrollment Status Query - Galaxy Health - CBUC/GWMC   Is this eff date is for all of the providers or not? Provide me with welcome letters too.', NULL, NULL, '2021-12-17 14:26:05', '2021-12-17 14:26:05'),
(51839, 11056, 42760, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - CBUC & GWMC - Galaxy Health    Hello Ahmed;     Update completed effective date is 11/1/2021 Malanie from Galaxy already send you an email confirming this.     Sincerely:  Karen Avalos  Provider Relations  Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497', NULL, NULL, '2021-12-23 10:12:10', '2021-12-23 10:12:10'),
(51840, 11056, 42760, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - CBUC & GWMC - Galaxy Health    Hello Ahmed;     Update completed effective date is 11/1/2021 Malanie from Galaxy already send you an email confirming this.     Sincerely:  Karen Avalos  Provider Relations  Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497', NULL, NULL, '2021-12-23 10:12:10', '2021-12-23 10:12:10'),
(51841, 19067, 42760, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Hello!  Hope you\'re doing well,  I would like to know the enrollment status of the following Providers & Groups with Galaxy Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:24:13', '2021-12-30 13:24:13'),
(51842, 19067, 42760, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, kavalos@ghn-mci.com, dmarley@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Greetings!  You haven\'t responded yet.  Still waiting to get the updates about the previously mentioned request.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:28:12', '2022-01-09 22:28:12'),
(51843, 19067, 42760, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Good Morning!  Hope this email finds you well.  This is my SECOND REMINDER on the below mentioned request. Kindly look into this.  Kindly respond as per your convenience.   Regards, Hammad.', NULL, NULL, '2022-01-26 11:09:30', '2022-01-26 11:09:30'),
(51844, 1019, 42760, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Hello,  Can you please send me a copy of their welcome letters.     Regards, Alex', NULL, NULL, '2022-02-02 13:33:00', '2022-02-02 13:33:00'),
(51845, 19067, 42760, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||    Hello Ahmed;     There is no welcome letters this is not a personal agreement.', NULL, NULL, '2022-02-21 16:26:11', '2022-02-21 16:26:11'),
(51846, 20067, 42760, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Good Afternoon!  Hope you had a great weekend. I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663  Eagerly waiting to hear from you.  Thank you, ', NULL, NULL, '2022-03-07 16:55:16', '2022-03-07 16:55:16'),
(51847, 22077, 42760, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Hi,  I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Waiting to hear from you soon.  Thanks. Alex', NULL, NULL, '2022-04-13 14:24:51', '2022-04-13 14:24:51'),
(51848, 11056, 42761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:36:21', '2021-10-27 15:36:21'),
(51849, 11056, 42761, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921K0S   Email received from : donotreply@multiplan.com  Sub : Provider Nomination  Dear Leticia Aleman-Listenbee:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-10-29 09:33:58', '2021-10-29 09:33:58'),
(51850, 11056, 42761, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Rep :Lania R  Status: Still in process. Application has been received yesterday. 90- 120 days. nomination is processing.   Ref code: 102921K0S', NULL, NULL, '2021-11-08 12:44:58', '2021-11-08 12:44:58'),
(51851, 11056, 42761, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-15 13:56:17', '2021-11-15 13:56:17'),
(51852, 11056, 42761, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November,2021. in process.  Ref code: 102921K0S', NULL, NULL, '2021-11-24 14:50:29', '2021-11-24 14:50:29'),
(51853, 11056, 42761, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November,2021. in process.  Ref code: 102921K0S', NULL, NULL, '2021-11-24 14:50:30', '2021-11-24 14:50:30'),
(51854, 11056, 42761, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:09:59', '2021-11-29 13:09:59'),
(51855, 11056, 42761, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021  Refcode: 102921K0S', NULL, NULL, '2021-12-14 14:01:11', '2021-12-14 14:01:11'),
(51856, 11056, 42761, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:22:31', '2021-12-20 17:22:31'),
(51857, 11056, 42761, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Rep:  Maegan K   Leticia: Contracting is in process. Need more time to be credentialed.   Ref code: 12232021maegank', NULL, NULL, '2021-12-23 10:39:39', '2021-12-23 10:39:39'),
(51858, 19067, 42761, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Called @ 800-950-7040 Spoke with Marie. Leticia got effective on 12/17/2021. I asked her for the Welcome kit. Ref# 7864837', NULL, NULL, '2022-01-04 11:52:18', '2022-01-04 11:52:18'),
(51859, 19067, 42761, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Secure email received from: welcomepackets@multiplan.com  Subject: SECURE: MultiPlan Network Participation (13982165-9933249)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Aleman Listenbee, Leticia A., MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  NOTICE OF CONFIDENTIALITY: Information included in and/or attached to this transmission may be confidential. This transmission is intended for the addressee(s) only. Any unauthorized disclosure, reproduction, or distribution of and /or any unauthorized action taken in reliance on the information in this transmission is prohibited. If you believe that you received this transmission in error, please notify the sender by reply transmission and destroy the transmission without copying or disclosing it. We may also need to contact you for additional information as required by HIPAA or state law.  This message was secured by Zix(R).', NULL, NULL, '2022-01-06 16:18:43', '2022-01-06 16:18:43'),
(51860, 19067, 42761, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Approved. See Attachment.', NULL, NULL, '2022-01-13 11:33:17', '2022-01-13 11:33:17'),
(51861, 19067, 42761, NULL, '2022-02-02 00:00:00.000', 'Approved', 'See attachment of Provider\'s Directory for reference. ', NULL, NULL, '2022-01-26 14:33:08', '2022-01-26 14:33:08'),
(51862, 19067, 42761, NULL, '2022-02-16 00:00:00.000', 'Approved', 'Approval Letter.', NULL, NULL, '2022-02-09 15:53:55', '2022-02-09 15:53:55'),
(51863, 11056, 42762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:36:28', '2021-10-27 15:36:28'),
(51864, 11056, 42762, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to: HumanaHoustonPD@humana.com , pcalupaz@humana.com & JTRENZ@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 13:57:07', '2021-11-01 13:57:07'),
(51865, 11056, 42762, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to: HumanaHoustonPD@humana.com , JTRENZ@humana.com & pcalupaz@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 14:11:29', '2021-11-01 14:11:29'),
(51866, 11056, 42762, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Query - CBUC & GWMC - Humana  Humana has 4 Network Development Regions in Texas. Updates can only be made by the region where the provider’s office resides. Based on your service address, your request for a contract/ existing contract/updates are handled by another Network Development Market. Please remove the HumanaHoustonPD mailbox from your distribution and use the STXNM@humana.com email in its place.     Thank you.     HumanaHoustonPD     Dallas/Fort Worth/North TX/East TX   NTXNM@humana.com    San Antonio/Corpus Christi/South Texas    STXNM@humana.com     Austin/El Paso/Central Texas/BCS/West TX/Panhandle    networkrelationsaustintx@humana.com    Another request has been sent to STXNM@humana.com', NULL, NULL, '2021-11-08 12:52:10', '2021-11-08 12:52:10'),
(51867, 11056, 42762, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email sent to:  stxnm@humana.com  Sub:  Enrollment Query - CBUC & GWMC - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 13:40:18', '2021-11-17 13:40:18'),
(51868, 11056, 42762, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Good morning!  Hope this email finds you well. Please find the attached roster for the provider, Leticia Aleman-Listenbee for enrolling and credentialing under the facility.  Furthermore, if any documents and corrections are required please don\'t hesitate in reaching out to me.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-24 09:18:18', '2021-11-24 09:18:18'),
(51869, 11056, 42762, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com   Sub:  Enrollment Query - CBUC & GWMC - Humana  Good afternoon1  Hope this email finds you well. Please provide me with the latest updates regarding the credentialing process of the provider,  Leticia Aleman-Listenbee, and also about the roster which I have submitted to you on 5th of November,2021.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Eagerly, waiting for your response.  Thank you!', NULL, NULL, '2021-12-03 15:48:54', '2021-12-03 15:48:54'),
(51870, 11056, 42762, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub:  Enrollment Query - CBUC & GWMC - Humana  Good morning!  Hope this email finds you well. Please provide the latest updates regarding the enrollment process of the below-mentioned provider under facility TIN  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-17 17:22:39', '2021-12-17 17:22:39'),
(51871, 11056, 42762, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Sub: Enrollment Query - CBUC & GWMC - Humana   Hello,  The request was received and is in the queue.   We are experiencing a large volume of requests. Please allow a minimum of 45 days or longer for processing.   Thank you,   South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741 F 855.461.6048 stxnm@humana.com', NULL, NULL, '2021-12-22 12:49:59', '2021-12-22 12:49:59'),
(51872, 19067, 42762, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||  Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S Hillside, DR STE 4, Beeville, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside, DR STE 4, Beeville, TX 78102-5324    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:47:58', '2022-01-04 12:47:58'),
(51873, 19067, 42762, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: stxnm@humana.com  Subject: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Monica Gonzalez was added to the group on 11/22/2021     Leticia Aleman-Listenbee was added to the group on 12/17/2021.   Thank you   Network Operations Coordinator – Provider Contracting     South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2022-01-11 13:06:45', '2022-01-11 13:06:45'),
(51874, 19067, 42762, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Monica & Leticia & Group || Humana ||    Greetings!  I am unable to find these providers on Humana\'s provider directory.  Kindly assist me in this matter.  Regards, Hammad.', NULL, NULL, '2022-01-26 13:33:22', '2022-01-26 13:33:22'),
(51875, 19067, 42762, NULL, '2022-03-07 00:00:00.000', 'Approved', 'Email received from: stxnm@humana.com  Monica Gonzalez is loaded with a 1/1/2021 effective date  Leticia Aleman-Listenbee loaded on 11/1/2021', NULL, NULL, '2022-02-28 15:54:39', '2022-02-28 15:54:39'),
(51876, 11056, 42763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:36:53', '2021-10-27 15:36:53'),
(51877, 11056, 42763, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Thank You! Request ID for this Submission: 40515837  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-10-29 08:43:02', '2021-10-29 08:43:02'),
(51878, 11056, 42763, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Rep: Gelo C   Status: Application has get rejected. Aetna has no need for new providers. 859-455-8650 fax LOI   Ref code: 6056836804', NULL, NULL, '2021-11-08 17:01:40', '2021-11-08 17:01:40'),
(51879, 11056, 42763, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Rep: Kim P  Status:  canceled and discontinued. the network is not accepting the provider specialty full capacity. out of network New opening is from 12/1/2021  ref code: 6058198794', NULL, NULL, '2021-11-17 09:56:57', '2021-11-17 09:56:57'),
(51880, 11056, 42763, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: CJ S   Status:Closed not accepting Mid-level and new practitioner. Panel is closed Not have schedule of re-opening.   Refcode: 6060463093', NULL, NULL, '2021-11-30 14:21:27', '2021-11-30 14:21:27'),
(51881, 11056, 42763, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Rep:  Amby J   Status: LOI sent out again for linking and adding the provider under the TIN    Refcode: 6063556901  Please see the attachment.', NULL, NULL, '2021-12-13 14:38:50', '2021-12-13 14:38:50'),
(51882, 11056, 42763, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status: Application has been set again and in processing  Tracking no.: pvb1376698   Ref code: 6065804152', NULL, NULL, '2021-12-22 13:54:01', '2021-12-22 13:54:01'),
(51883, 19067, 42763, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || CBUC & GWMC || Leticia Aleman-Listenbee || Aetna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following provider with Aetna.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S Hillside DR STE 04, Beeville, TX 78102 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County George West, TX 78022    Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 14:28:38', '2021-12-28 14:28:38'),
(51884, 19067, 42763, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: RE: [EXTERNAL] Enrollment Status || CBUC & GWMC || Leticia Aleman-Listenbee || Aetna ||   This tin is also on a facility/ancillary agreement, this is not a provider/physician’s contract therefore providers are not added to facility contracts, thank you.', NULL, NULL, '2022-01-03 09:31:59', '2022-01-03 09:31:59'),
(51885, 19067, 42763, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: 	Re: [EXTERNAL] Enrollment Status || CBUC & GWMC || Leticia Aleman-Listenbee || Aetna ||   Hello!  How do I link this provider to the TIN?  Thanks!', NULL, NULL, '2022-01-09 22:15:50', '2022-01-09 22:15:50'),
(51886, 19067, 42763, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || CBUC & GWMC || Leticia Aleman-Listenbee || Aetna ||   Hi,  Please provide the effective date for the group.   Regards.', NULL, NULL, '2022-01-26 16:08:42', '2022-01-26 16:08:42'),
(51887, 1019, 42763, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group is enrolled as an urgentcare. The contract is attached in the group task.   Eff: 01/15/2018', NULL, NULL, '2022-02-02 12:38:38', '2022-02-02 12:38:38'),
(51888, 11056, 42764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:37:08', '2021-10-27 15:37:08'),
(51889, 11056, 42764, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no. 12785882  REF CODE : tom10282021', NULL, NULL, '2021-10-29 08:29:24', '2021-10-29 08:29:24'),
(51890, 11056, 42764, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Rep : Santana A  Status: Still in process. 10/28/21 case started. Turn around time 90-120 days.  Ref code: Santanaa11092021', NULL, NULL, '2021-11-09 10:34:59', '2021-11-09 10:34:59'),
(51891, 11056, 42764, NULL, '2021-11-26 00:00:00.000', 'In Process', '	 Rep: Cherrelle C  Status: The application is still in process. The time frame for credentialing is 90 - 120 days  Refcode: 11192021Cherrellec', NULL, NULL, '2021-11-19 13:07:38', '2021-11-19 13:07:38'),
(51892, 11056, 42764, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from:   9psscent@cigna.com  Sub:  Cigna Credentialing Status Update: Credentialing Verification  Re:	Reference number 12785882 Application complete: Credentialing process to begin Dear LETICIA ALEMAN-LISTENBEE,  We have confirmed that your application is complete, and have forwarded it for credentialing review', NULL, NULL, '2021-11-30 12:31:01', '2021-11-30 12:31:01'),
(51893, 11056, 42764, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from:   9psscent@cigna.com  Sub:  Cigna Credentialing Status Update: Credentialing Verification  Re:	Reference number 12785882 Application complete: Credentialing process to begin Dear LETICIA ALEMAN-LISTENBEE,  We have confirmed that your application is complete, and have forwarded it for credentialing review', NULL, NULL, '2021-11-30 12:31:05', '2021-11-30 12:31:05'),
(51894, 11056, 42764, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Rep: Marco C  Status: The Application still is in process  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-15 17:59:12', '2021-12-15 17:59:12'),
(51895, 11056, 42764, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Joiya B  Status: Application is in process.  Refcode: 12202021joiya', NULL, NULL, '2021-12-20 13:38:01', '2021-12-20 13:38:01'),
(51896, 11056, 42764, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: Jillian.MacDonald@cigna.com  Sub: Provider: Leticia Aleman-Listenbee   Good afternoon,     While credentialing this provider, I noticed the name appearing on the license is, “Leticia Aleman.” I do not see this listed as an alias on the application, so I wanted to confirm this is the same person as our provider. Could you please confirm?     Thanks,  Jillian Provider SOLUTIONS & OPERATIONS  Jillian MacDonald Network Solutions & Operations | Network Operations | Credentialing Representative T: 804.546.2275 | E: jillian.macdonald@cigna.com | F: 860.771.4223   Replied:  Good Afternoon,  Yes, \"Leticia Aleman-Listenbee\"  and “Leticia Aleman” are the same person as the provider. Let me know if you have any questions.    Regards, Alex', NULL, NULL, '2021-12-23 17:23:03', '2021-12-23 17:23:03'),
(51897, 19067, 42764, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: jillian.macdonald@cigna.com  Subject: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Cigna ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West , TX 78022-3663    Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:12:56', '2021-12-30 14:12:56'),
(51898, 19067, 42764, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: Jillian.MacDonald@cigna.com  Subject: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Cigna ||    Good morning,   This provider was sent to committee for approval on 12/30/2021. If you have further questions, I would encourage you to call 1-800-88-CIGNA and they can assist you further.   Thanks,  Jillian', NULL, NULL, '2022-01-03 09:27:43', '2022-01-03 09:27:43'),
(51899, 19067, 42764, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jillian.macdonald@cigna.com  Subject: Re: [External] Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Cigna ||  Greetings!  Any updates on the previously mentioned request?  And when are we expecting the welcome letter?  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:18:43', '2022-01-09 22:18:43'),
(51900, 19067, 42764, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: Jillian.MacDonald@cigna.com  Subject: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Cigna ||    Good morning,     Unfortunately, I do not know any of that information as my job is to gather information and be sure the provider has everything they need for the credentialing process. I would urge you to call provider services at 1-800-882-4462 and they can answer your questions.', NULL, NULL, '2022-01-26 16:10:50', '2022-01-26 16:10:50'),
(51901, 1019, 42764, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Received the following email from WelcomeHealthCareProvider@cigna.com  Sub: Welcome to the Cigna network   Dear LETICIA ALEMAN-LISTENBEE MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Attached are the Plans & Approval Confirmations', NULL, NULL, '2022-02-02 12:53:48', '2022-02-02 12:53:48'),
(51902, 11056, 42765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:37:23', '2021-10-27 15:37:23'),
(51903, 11056, 42765, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : patti.davidson@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query - CBUC & GWMC - Anci-Care  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Anci-Care. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day! ', NULL, NULL, '2021-11-01 13:40:14', '2021-11-01 13:40:14'),
(51904, 11056, 42765, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from : Shane.Radford@healthsmart.com  Sub : Enrollment Query - CBUC & GWMC - Anci-Care  Ahmed,     I am responding to your below request.  Both sites have been completed and the credentialing information has been loaded.  Please feel free to contact me if you should need any additional information.     Thank you,     Shane Radford| Provider Relations  HealthSmart | Network Solutions  Office: 214 574 2664 ext. 202644  222 W Las Colinas Blvd | Suite 550 N | Irving, Tx 75039  Email: shane.radford@healthsmart.com', NULL, NULL, '2021-11-08 16:39:53', '2021-11-08 16:39:53'),
(51905, 11056, 42765, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email received from: shane.radford@healthsmart.com  Sub : Enrollment Query - CBUC & GWMC - Anci-Care  Good afternoon,  I will have to get the contract pulled and sent over so that we can forward you a copy of the contract.  I see that both of these locations were just recredentialed 9/16/2021. I will get the recredentialing letters as well and have those forwarded to you.  Please feel free to reach out to me if you should need any additional information.    Ahmed  Good morning,  I wanted to follow up on your request for the effective date and the welcome letter.  The effective date of the contract is 7/20/2017 and I have attached the recredentialing letter for your records.  I have requested a copy of the contract and I will forward to your attention as soon as it is returned to me.    Ahmed,  Good afternoon I have attached the requested contract for your records  Thank you,        Shane Radford| Provider Relations  HealthSmart | Network Solutions  Office: 214 574 2664 | Office: 214 574 1121  222 W Las Colinas Blvd | Suite 550 N | Irving, Tx 75039  Email: shane.radford@healthsmart.com', NULL, NULL, '2021-11-11 17:39:14', '2021-11-11 17:39:14'),
(51906, 11056, 42766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:37:37', '2021-10-27 15:37:37'),
(51907, 11056, 42766, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to:  christus.hp.credentialing@christushealth.org & hunter.barrett@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Spohn  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 14:23:25', '2021-11-01 14:23:25'),
(51908, 11056, 42766, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from : michal.simms@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal', NULL, NULL, '2021-11-08 14:19:49', '2021-11-08 14:19:49'),
(51909, 11056, 42766, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from:  michal.simms@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Spohn  Hello Ahmed,     Because we have Beeville Medical Clinic on an Ancillary Agreement, the clinic is the participating provider.  We do not credential those providers that work in the clinic as long as they bill for services with the Clinic’s TIN and NPI.   Eff date : 04/01/2018  Please let me know if you have questions.     Thanks, Michal   Another Email:   Hello Ahmed,     Thank you for sending the prospective provider form and W9.     Since Coastal Bend Urgent Care is contracted with CHRISTUS Health under an Ancillary Agreement, the participating provider is Coastal Bend Urgent Care, not the individual practitioners.  We do not credential individual providers under an ancillary agreement.  Claims should be submitted group to group and not with an individual’s NPI.     Let me know if you need other information.     Thanks, Michal  Please see the attachment', NULL, NULL, '2021-11-17 12:20:16', '2021-11-17 12:20:16'),
(51910, 11056, 42767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:37:41', '2021-10-27 15:37:41'),
(51911, 11056, 42767, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 14:18:58', '2021-11-01 14:18:58'),
(51912, 11056, 42767, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from: vicki.guerra@christushealth.org  Sub : Enrollment Query - CBUC & GWMC - Christus Healthplan  Hi Ahmed,     Happy Tuesday!     I wanted to check on the Christus hospital privileges. But, I will need the last four digits of the Social Security. I cannot pull up the name for provider.     Does the provider have facility privileges with Christus? Or, does the provider utilize one of the hospitalist groups at Christus to follow the member?     Thank you,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745   Have responded them with their query.', NULL, NULL, '2021-11-08 15:48:43', '2021-11-08 15:48:43'),
(51913, 11056, 42767, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email sent to:  CHRISTUS.HP.Credentialing@christushealth.org  Sub : PLEASE DISREGARD LAST EMAIL: Enrollment Query - CBUC & GWMC - Christus Healthplan  Hi Ahmed,     Different question, I noticed the provider is a NP. Does the provider have a supervising physician who has privileges at a Christus facility?        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745   ', NULL, NULL, '2021-11-17 12:34:21', '2021-11-17 12:34:21'),
(51914, 11056, 42767, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  vicki.guerra@christushealth.org  Sub:  PLEASE DISREGARD LAST EMAIL: Enrollment Query - CBUC & GWMC - Christus Healthplan   Good afternoon!  Hope this email finds you well. Yes, Here it is. Supervising Physician Name:  Frank Dehnisch              NPI - 1952376345   Admitting Privileges:    Christus Spohn Hospital    Furthermore, any information or documents are required don\'t hesitate to contact me.   Thank you! Have a great day!', NULL, NULL, '2021-11-29 17:44:43', '2021-11-29 17:44:43');
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
(51915, 11056, 42767, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Sub: PLEASE DISREGARD LAST EMAIL: Enrollment Query - CBUC & GWMC - Christus Healthplan  Good morning!  Hope this email finds you well. I wanted to get the latest updates on the credentialing of the provider, Leticia Aleman-Listenbee. We have an Ancillary contract for the group with Christus Healthplan. Kindly, confirm this as well. # FL01383347  Please elaborate on this soon and confirm the effective dates and locations as well.  Thank you!', NULL, NULL, '2021-12-13 17:58:26', '2021-12-13 17:58:26'),
(51916, 11056, 42767, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from Michal michal.simms@christushealth.org  Sub:   \"Thank you for sending this notice.  Coastal Bend Urgent Care LLC is contracted with CHRISTUS Health as an Ancillary Provider.  We credential the clinics and not the individual practitioners.  The participating provider is COASTAL BEND URGENT CARE.  George West Medical Clinic has been credentialed effective 11/19/2020  under the Coastal Bend Urgent Care records – re # FL01383347.  Let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818   Ancillary Contract: Please see the group task as well.', NULL, NULL, '2021-12-20 17:02:05', '2021-12-20 17:02:05'),
(51917, 11056, 42768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:39:16', '2021-10-27 15:39:16'),
(51918, 11056, 42768, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub : Enrollment Query - CBUC & GWMC - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Tricare. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 13:23:17', '2021-11-01 13:23:17'),
(51919, 11056, 42768, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Query - CBUC & GWMC - Tricare  Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-08 10:28:07', '2021-11-08 10:28:07'),
(51920, 11056, 42768, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub : Enrollment Query - CBUC & GWMC - Tricare  Good morning!  Hope this email finds you well. Please also assist regarding a provider having a Nurse Practitioner speciality. I don\'t find a certification form at humanamilitary.com for a Nurse Practitioner specialty.  Kindly, do provide me with the form If you could.  Thank you! Have a great day!', NULL, NULL, '2021-11-16 17:59:15', '2021-11-16 17:59:15'),
(51921, 11056, 42768, NULL, '2021-12-01 00:00:00.000', 'In Process', 'https://docushare-web.apps.external.pioneer.humana.com/Marketing/docushare-app?file=3301818     Please use the Allied Health professional provider certification application found on humanamilitary.com     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East    The form has been filled and attached.', NULL, NULL, '2021-11-24 12:52:29', '2021-11-24 12:52:29'),
(51922, 11056, 42768, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub:  Enrollment Query - CBUC & GWMC - Tricare  https://docushare-web.apps.external.pioneer.humana.com/Marketing/docushare-app?file=3301818     Please use the Allied Health professional provider certification application found on humanamilitary.com     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East    The form has been filled and attached.', NULL, NULL, '2021-11-24 12:53:46', '2021-11-24 12:53:46'),
(51923, 11056, 42768, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - CBUC & GWMC - Tricare  Good afternoon!  Hope this email finds you well. Please find the attached form, I had faxed them a week ago. Any updates on it and credentialing process of the provider, Leticia Aleman-Listenbee?  Thank you! Have a great day! ', NULL, NULL, '2021-12-03 15:31:08', '2021-12-03 15:31:08'),
(51924, 11056, 42768, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - CBUC & GWMC - Tricare   Good afternoon, Mr. Talha –     A provider cannot be credentialed until their NPI is first CERTIFIED.  The attached application should have been faxed to TRICARE East Certification at 608.221.7535.     The certification process will take at least 90 days.   If you fax a CREDENTIALING packet before the provider is certified, it will not be processed because the provider NPI cannot be found in our system until certification is complete.     Can you advise if her CERTIFICATION application was faxed to the Certification Team? If so, please allow 90 days from faxing for processing.  The NPI can then be checked on the provider portal at humanamilitary.com (see example below from email dated Nov 1, 2021).     Please let me know if I can provide further assistance.  The application has already been provided.', NULL, NULL, '2021-12-17 18:01:47', '2021-12-17 18:01:47'),
(51925, 11056, 42768, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - CBUC & GWMC - Tricare   Good afternoon!  Hope you are having a productive day. Yes, the CERTIFICATION application was faxed to the Certification Team. I am unable to get to the provider portal. Could you please let me know the certification status of the provider, Leticia Aleman-Listenbee?  Looking forward to hearing from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 11:19:26', '2021-12-22 11:19:26'),
(51926, 19067, 42768, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||     Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mocia Gonzalez	1871132811	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663   Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:59:01', '2022-01-04 10:59:01'),
(51927, 19067, 42768, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||   Good Morning Hammad,     This group tax id is not in my area. Celeste Santiago is the Rep for that area. I have include her on this email.  Please reach out to her to assist.  You can also check status by creating a log in on the Provider portal.', NULL, NULL, '2022-01-10 10:12:30', '2022-01-10 10:12:30'),
(51928, 19067, 42768, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com, ywyatt@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Greetings Celeste!  Hope this email finds you well.  Can you look into the request mentioned below?   Have a beautiful day! Hammad Ahmed. ', NULL, NULL, '2022-01-20 20:25:52', '2022-01-20 20:25:52'),
(51929, 19067, 42768, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Hammad,  Thank you for reaching out to me.  I am the new Provider Rep for the Corpus Christi Area, as well as Austin, and Del Rio area.  I have researched your providers you listed and have annotated in RED below  Group Name  Beeville Medical Clinic        Tax ID  81-1890349        Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified Authorized TRICARE Provider-assigned this location     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified Authorized TRICARE Provider-assigned to this location     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location        I have identified an issue for Mercedita Flynn, but that does not impact her as a provider and certification and or credentialing.  That alert has been submitted and is set to be corrected.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 11:35:15', '2022-02-16 11:35:15'),
(51930, 19067, 42768, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: Credentialing for Leticia Aleman    Hammad,  Attached is the credentialing application.  Please ensure the following documents are attached with the application  ·         TSCA- Required  ·         DEA Certificate  ·         DPS Certificate  ·         Other Controlled Dangerous Substance Certificate  ·         Provider’s License  ·         Liability Insurance- needs to list the practitioners name, and effective and term dates of policy.  ·         W9  ·         CLIA Certificate (if applicable)  ·         Radiology Certificate (if applicable)  ·         DD214 (if applicable)        In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  O (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 13:24:51', '2022-02-16 13:24:51'),
(51931, 19067, 42768, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: Credentialing for Leticia Aleman    Hammad,  Attached is the credentialing application.  Please ensure the following documents are attached with the application  ·         TSCA- Required  ·         DEA Certificate  ·         DPS Certificate  ·         Other Controlled Dangerous Substance Certificate  ·         Provider’s License  ·         Liability Insurance- needs to list the practitioners name, and effective and term dates of policy.  ·         W9  ·         CLIA Certificate (if applicable)  ·         Radiology Certificate (if applicable)  ·         DD214 (if applicable)        In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  O (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 14:52:37', '2022-02-16 14:52:37'),
(51932, 19067, 42768, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: Re: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare   Hi Celeste,  Kindly see attachment for the form as per your request, and do not hesitate to contact me if you have any questions or if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-16 14:53:49', '2022-02-16 14:53:49'),
(51933, 19067, 42768, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: RE: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare    Hammad,  The Credentialing application has been uploaded to this providers profile.  I have alerted credentialing for processing.  Note the timeline for this to be processed is 90-120 days.         Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-17 16:20:47', '2022-02-17 16:20:47'),
(51934, 19067, 42768, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email received from: CSantiago20@humana.com  Subject: Re: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare    Hammad,  I am missing the providers State License  for the credentialing application.  It was not included.     Respectfully,  Celeste Santiago  TRICARE Community Liaison II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com   ', NULL, NULL, '2022-03-16 10:36:13', '2022-03-16 10:36:13'),
(51935, 19067, 42768, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: Re: Credentialing for Leticia Aleman || CBUC & GWMC || Tricare   Hello,  Kindly see the attachment of State License as per you requested.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 10:44:11', '2022-03-16 10:44:11'),
(51936, 22077, 42768, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject; 	Re: Re: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||  Hi,  Hope this email finds you well,  I would like to know the effective date of the providers mentioned previously,   Looking forward to your kind response. Have a great day!  Thanks & Regards Alex', NULL, NULL, '2022-04-14 08:12:50', '2022-04-14 08:12:50'),
(51937, 22077, 42768, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||  Hi,  Hope this email finds you well,  I would like to know the effective date of the providers mentioned previously,   Looking forward to your kind response. Have a great day!  Thanks & Regards Alex', NULL, NULL, '2022-04-14 08:20:18', '2022-04-14 08:20:18'),
(51938, 19067, 42768, NULL, '2022-04-26 00:00:00.000', 'Approved', 'Email received from: CSantiago20@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Hi,     Group Name  Beeville Medical Clinic        Tax ID  81-1890349        Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified-1/10/2022 Authorized TRICARE Provider-assigned this location-Credentialed as of 04/15/2022     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified-1/10/22 Authorized TRICARE Provider-assigned to this location-Credentialed as of 4/15/2022     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location-01/19/2022     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location 01/19/2022     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location-12/15/2019     ', NULL, NULL, '2022-04-19 16:00:34', '2022-04-19 16:00:34'),
(51939, 11056, 42769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:39:21', '2021-10-27 15:39:21'),
(51940, 11056, 42769, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : providerservices@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Tricare. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 13:26:24', '2021-11-01 13:26:24'),
(51941, 11056, 42769, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : providerservices@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Tricare. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 13:26:24', '2021-11-01 13:26:24'),
(51942, 11056, 42769, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email received from : providerservices@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Hello,     Please e-mail your request to credentialing@triwest.com and reference contract number 121TW62766C01.     Thank you,     Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance  providerservices@triwest.com  www.triwest.com  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)     Remember to now send your claims to PGBA! TriWest has a new claims processor and Payer ID. For more information, visit www.triwest.com/claimsconversion.', NULL, NULL, '2021-11-08 10:01:46', '2021-11-08 10:01:46'),
(51943, 11056, 42769, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email received from:  Credentialing@triwest.com  Sub : Enrollment Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential     Good Afternoon     The provider cannot be loaded for credentialing as the providers CAQH is not completed.     Please have the provider complete the CAQH process.     If the provider is unable to complete the CAQH please have the provider fill out the attached provider application pages 2-9 and return it along with the required documents that are listed on page 1 of the credentialing packet.     Kind regards,     Nicole Goergen  Provider Credentialing Specialist  TriWest Healthcare Alliance  F: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Choice Contact Center: (866) 606-8198  Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838  www.triwest.com     Follow TriWest:  www.facebook.com/triwest  www.twitter.com/triwest  linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-16 17:57:14', '2021-11-16 17:57:14'),
(51944, 11056, 42769, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: credentialing@triwest.com  Sub:   Enrollment Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Good Afternoon     The provider cannot be loaded for credentialing as the provider\'s CAQH is not completed.     Please have the provider complete the CAQH process.     If the provider is unable to complete the CAQH please have the provider fill out the attached provider application pages 2-9 and return it along with the required documents that are listed on page 1 of the credentialing packet.     Kind regards,     Nicole Goergen  Provider Credentialing Specialist  TriWest Healthcare Alliance  F: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)  Choice Contact Center: (866) 606-8198  Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838  www.triwest.com     Follow TriWest:  www.facebook.com/triwest  www.twitter.com/triwest  linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-24 13:10:24', '2021-11-24 13:10:24'),
(51945, 11056, 42769, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  credentialing@triwest.com  Sub: Enrollment Query - CBUC & GWMC - Triwest  Good afternoon!  Hope you are doing well. The CAQH of the provider has been updated and attested. Is there any need for the form to be filled out or not?  Please get back to me at your earliest convenience.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 15:36:19', '2021-12-03 15:36:19'),
(51946, 11056, 42769, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub: Enrollment Query - CBUC & GWMC - Triwest  Good morning!  Hope you are doing great. Still waiting for your response. The CAQH of the provider is updated and attested. Is there any need for the form to be filled out or not?  Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-14 16:29:53', '2021-12-14 16:29:53'),
(51947, 11056, 42769, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: smiguel@triwest.com  Sub: Credentialing Application Approval re: Leticia Aleman-Listenbee FNP  TriWest Classification: Confidential   Hello, Dear Leticia Aleman-Listenbee, FNP:  I am pleased to inform you that on 12/6/2021, the TriWest Healthcare Alliance Credentialing Committee reviewed and approved your credentialing application for participation as a TriWest network provider.  Please find the attached approval letter for the above provider.   We value your participation and commitment to providing quality health care services!   Shannael Miguel Provider Credentialing Spec  TriWest Healthcare Alliance smiguel@triwest.com  www.triwest.com', NULL, NULL, '2021-12-20 12:35:20', '2021-12-20 12:35:20'),
(51948, 11056, 42770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:39:33', '2021-10-27 15:39:33'),
(51949, 11056, 42770, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Query - CBUC & GWMC - UHC  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with two locations.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-10-29 14:46:55', '2021-10-29 14:46:55'),
(51950, 11056, 42770, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com   Sub : Secure Message from estrellita_thomas@uhc.com  Good Morning,     Thank you for contacting the Network Management Resource Team (NMRT) about the UnitedHealthcare credentialing and contracting process for medical health care professionals.     Please follow these steps to request to join our medical networks:     Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested    Confirm you have access to the UnitedHealthcare Provider Portal: Our credentialing/contracting request tool is within our secure Provider Portal, and a One Healthcare ID is required to access the portal. If you don’t currently have access, you’ll need to set up an account.    Submit a request using OnboardPro: Once you have access to the portal, sign in and select the OnboardPro tile. The attached quick reference guide has instructions. For more information or additional assistance, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    One Healthcare ID assistance  If you need help registering for a One Healthcare ID or have questions about existing access, please contact the UnitedHealthcare Web Support team help desk at 866-842-3278, option 1, 7 a.m.–11 p.m. CT, Monday–Friday.      Questions? We’re here to help   If we can further assist you, respond to this email.      Sincerely,  Estrellita “Nikki” Thomas  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-09 12:18:57', '2021-11-09 12:18:57'),
(51951, 11056, 42770, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Secure Message from estrellita_thomas@uhc.com', NULL, NULL, '2021-11-09 12:23:15', '2021-11-09 12:23:15'),
(51952, 11056, 42770, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub : Secure Message from estrellita_thomas@uhc.com  Good afternoon!  Hope all is well with you. The CAQH has been updated and attested of the provider, Leticia. Kindly escalate the request for credentialing of the provider soon.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-16 17:52:40', '2021-11-16 17:52:40'),
(51953, 11056, 42770, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: networkhelp@uhc.com  Sub:  Secure Message from estrellita_thomas@uhc.com  Good Morning,  There is no escalation process for credentialing. Credentialing is a background check and the delay is not caused by UHC. If the information has been updated and attested our credentialing department will receive the information and move forward with the credentialing.  Please let us know if we can assist further via email.  Thank you, Estrellita “Nikki” Thomas UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-24 12:01:38', '2021-11-24 12:01:38'),
(51954, 11056, 42770, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Secure Message from j_mize@uhc.com', NULL, NULL, '2021-11-24 17:22:08', '2021-11-24 17:22:08'),
(51955, 11056, 42770, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub : Secure Message from estrellita_thomas@uhc.com Secure Message from j_mize@uhc.com   Good morning!  Hope all is well with you. Please provide me with the latest updates of the provider, Leticia Aleman-Listenbee.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-10 17:00:39', '2021-12-10 17:00:39'),
(51956, 19067, 42770, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || Leticia Aleman-Listenbee || CBUC & GWMC || UHC ||    Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status of the following provider.  Group Name	Coastal Bend Urgent Care Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County George West, TX 78022-3663  Kindly respond promptly.   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-22 16:42:50', '2021-12-22 16:42:50'),
(51957, 19067, 42770, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || Leticia Aleman-Listenbee || CBUC & GWMC || UHC ||   Hello, Please find the attachment. Form for Leticia Ann Aleman-Listenbee. I would like to enroll this provider. Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-22 17:35:31', '2021-12-22 17:35:31'),
(51958, 19067, 42770, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Secure email received from: networkhelp@uhc.com  Subject: The contact information you requested on credentialing and contracting with UnitedHealthcare    Thank you for contacting the Network Management Resource Team. We will be glad to assist you with your inquiry. Leticia Aleman-Listenbee is not credentialed with United Healthcare. I have attached below the information needed to begin this process.  Hello,  Thank you for contacting the UnitedHealthcare Network Management Resource Team about the UnitedHealthcare credentialing and contracting process for medical health care professionals. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts.   ·       Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested  ·       Submit your request through the RFP portal at  https://ncc-optum.secure.force.com/rfp  Questions? We’re here to help   If we can further assist you, please respond to this email.    Sincerely,  UnitedHealthcare Network Management Resource Team  *--SecureDelivery--*', NULL, NULL, '2021-12-23 13:33:05', '2021-12-23 13:33:05'),
(51959, 19067, 42770, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Application Submitted through Portal. See Attachment.', NULL, NULL, '2021-12-28 10:10:16', '2021-12-28 10:10:16'),
(51960, 19067, 42770, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || CBUC & GWMC || Leticia & Monica || UHC ||    Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers with United HealthCare.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Waiting for your response.  Thanks & Regards, Hammad Ahmed. ', NULL, NULL, '2022-01-04 10:41:03', '2022-01-04 10:41:03'),
(51961, 19067, 42770, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Subject: Enrollment Query CBUC & GWMC Leticia & Monica UHC - [ref:_02646667:ref]   Hello,   Thank you for contacting the UnitedHealthcare Network Management Resource Team. In response to your request, I’m sending you the product roster showing the demographic information, lines of business and effective dates for MONICA GONZALEZ. Leticia Aleman-Listenbee is not in our system. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts. · Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   · Submit your request through the RFP portal at https://ncc-optum.secure.force.com/rfp     Questions? We’re here to help   If we can further assist you, please respond to this email.     Sincerely,  UnitedHealthcare Network Management Resource Team', NULL, NULL, '2022-01-05 13:27:12', '2022-01-05 13:27:12'),
(51962, 19067, 42770, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Application submitted through Portal. See Attachment.', NULL, NULL, '2022-01-05 14:04:44', '2022-01-05 14:04:44'),
(51963, 19067, 42770, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Query || CBUC & GWMC || Leticia & Monica || UHC ||   Greetings!  Any updates on the following request?   Regards, Hammad Ahmed', NULL, NULL, '2022-01-12 14:49:48', '2022-01-12 14:49:48'),
(51964, 19067, 42770, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Subject: Re Enrollment Query CBUC & GWMC Leticia & Monica UHC - [ref:_02670638:ref]       Subject: The contact information you requested     Hello,     Thank you for contacting the UnitedHealthcare Network Management Resource Team. In response to your request, I’m sending you the product roster showing the demographic information, lines of business and effective dates for the health care professionals requested.    Leticia Aleman-Lisztenbee\'s credentialing was initiated 1/10/22. Please allow 3 weeks for processing.    Thank you', NULL, NULL, '2022-01-13 10:31:22', '2022-01-13 10:31:22'),
(51965, 19067, 42770, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Subject: Re: Re Enrollment Query  CBUC & GWMC  Leticia & Monica  UHC - [ref:_02670638:ref]   Greetings!  Any updates on Leticia Aleman-Listenbee\'s credentialing process?  Don\'t hesitate to reach out if you need any document or information.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 13:55:05', '2022-01-26 13:55:05'),
(51966, 19067, 42770, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: natlcred_outreach@uhc.com  Subject: Request for Credentialing Information    Date: 3/15/2022  ATTN: LETICIA ALEMAN-LISTENBEE Email: cbuc@claimsmedinc.com  Provider: LETICIA ALEMAN-LISTENBEE MPIN: 7912501 OPID: sande  Re: URGENT ACTION NEEDED: Additional Information Needed to Complete Your Credentialing Review  Dear LETICIA ALEMAN-LISTENBEE:  Please send us the following required information within 3 days from the date on letter so that we can continue processing your application for credentialing as a UnitedHealthcare provider.  What information is needed?  Copy of your current professional liability insurance binder sheet Other _____________________________________________ Where should the information be sent? Please reply to this email with the required information. If you can’t reply to the email, please send a new email with the required information to natlcred_outreach@uhc.com. Please include this email with your reply to avoid delays in processing.  What if the deadline is missed? If we don’t receive the information by the deadline, your credentialing application will be closed. This means your request to join the UnitedHealthcare network, or to continue as a network provider, will be denied. If you’re already a participating provider, your participation in our network will end.  What happens next? We’ll contact you when we’ve completed our review of your credentialing application. If you haven’t heard from us within 45 days, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number.  Questions? We’re here to help. If you have any questions, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join.  Sincerely,  Stephanie Anderson UnitedHealthcare National Credentialing Team _______________________________  Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company, Oxford Health Insurance, Inc. or their affiliates. Health Plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, LLC, UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Administrative services provided by United HealthCare Services, Inc., OptumRx, OptumHealth Care Solutions, Inc., Oxford Health Plans LLC or their affiliates. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH) or its affiliates.  Doc#: PCA-3-013200-12042018_12182018 © 2018 United HealthCare Services, Inc.', NULL, NULL, '2022-03-15 09:55:24', '2022-03-15 09:55:24'),
(51967, 19067, 42770, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: natlcred_outreach@uhc.com  Subject: Request for Credentialing Information    Good Morning!  Hope this email finds you well. Attached is the COI for provider, Leticia Ann Aleman-Listenbee as per you requested.  Thanks,', NULL, NULL, '2022-03-15 09:56:16', '2022-03-15 09:56:16'),
(51968, 22077, 42770, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: natlcred_outreach@uhc.com  Subject: Re: Request for Credentialing Information  Hi,  Any update on the below-mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 09:44:50', '2022-04-14 09:44:50'),
(51969, 11056, 42771, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:39:41', '2021-10-27 15:39:41'),
(51970, 11056, 42771, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Email sent to : efry@trpnppo.com & trpndataentry@trpnppo.com  Sub : Enrollment Query - CBUC & GWMC - TRPN  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with two locations.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-10-29 14:49:45', '2021-10-29 14:49:45'),
(51971, 11056, 42771, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Emai sent to: trpndataentry@trpnppo.com  Sub : Enrollment Query - CBUC & GWMC - TRPN  Good morning!  Hope all is well with you. Please find the attached form of the provider to be credentialed under the Tax I.D of the facility.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654   Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-08 10:36:03', '2021-11-08 10:36:03'),
(51972, 11056, 42771, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Query - CBUC & GWMC - TRPN  Good morning!  Hope all is well with you. Any update on the credentialing process of the below-mentioned provider? Have u received the Provider Update form for the provider?  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654   Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day! ', NULL, NULL, '2021-11-16 18:01:44', '2021-11-16 18:01:44'),
(51973, 11056, 42771, NULL, '2021-11-24 00:00:00.000', 'In Process', 'RE: Enrollment Query - CBUC & GWMC - TRPN ', NULL, NULL, '2021-11-17 16:34:12', '2021-11-17 16:34:12'),
(51974, 11056, 42771, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  trpndataentry@trpnppo.com  Sub:  Re: Enrollment Query - CBUC & GWMC - TRPN  Good afternoon!     Hope this email finds you well. I am still waiting to get the latest updates for the provider. Please respond to me at your earliest convenience.     Thank you!', NULL, NULL, '2021-11-24 15:25:15', '2021-11-24 15:25:15'),
(51975, 11056, 42771, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to:  jhorta@trpnppo.com  Sub: RE: Enrollment Query - CBUC & GWMC - TRPN  Good afternoon!     Hope this email finds you well. Please do provide me with the welcome letter for the provider and also list the provider in your directory.     Please get back to me with a welcome letter soon.     Thank you!  Have a wonderful day!', NULL, NULL, '2021-11-30 15:33:16', '2021-11-30 15:33:16'),
(51976, 11056, 42771, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to:  jhorta@trpnppo.com  Sub: RE: Enrollment Query - CBUC & GWMC - TRPN  Good afternoon!     Hope this email finds you well. Please do provide me with the welcome letter for the provider and also list the provider in your directory.     Please get back to me with a welcome letter soon.     Thank you!  Have a wonderful day!', NULL, NULL, '2021-11-30 15:33:16', '2021-11-30 15:33:16'),
(51977, 11056, 42771, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email received from:  jhorta@trpnppo.com  Sub:  RE: Enrollment Query - CBUC & GWMC - TRPN  Hello,   LETICIA ALEMAN-LISTENBEE is now active in-network, effective 10/29/2021  Per request, the Welcome letter attached  Yes, both locations ……Primary & billing location: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324  Secondary location: 504A Houston Street, George West, TX 78022-3663 have been added as requested  Jorge  Horta TRPN Data Entry Three Rivers Provider Network  Phone: 619-934-9535 Fax: 619-934-9617 6970 O’Bannon Drive Las Vegas, NV 89117  trpndataentry@trpnppo.com www.trpnppo.com TRPNSecure', NULL, NULL, '2021-11-30 17:59:28', '2021-11-30 17:59:28'),
(51978, 11056, 42772, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:06', '2021-10-27 15:40:06'),
(51979, 11056, 42772, NULL, '2021-11-08 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s enrollment.', NULL, NULL, '2021-11-01 08:12:56', '2021-11-01 08:12:56'),
(51980, 11056, 42773, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:06', '2021-10-27 15:40:06'),
(51981, 11056, 42773, NULL, '2021-11-08 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s enrollment.', NULL, NULL, '2021-11-01 14:13:01', '2021-11-01 14:13:01'),
(51982, 11056, 42774, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:16', '2021-10-27 15:40:16'),
(51983, 11056, 42774, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : 	SWHPRECRED@bswhealth.org & SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org  Sub  : Enrollment Query - CBUC & GWMC - Scott & White  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Scott & White. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 13:46:57', '2021-11-01 13:46:57'),
(51984, 11056, 42774, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 884361d0-5ac4-4942-9a3a-b7c64cc6f344   Application has been submitted.  Please see the attachment.', NULL, NULL, '2021-11-08 12:14:14', '2021-11-08 12:14:14'),
(51985, 11056, 42774, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email received from:  SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query - CBUC & GWMC - Scott & White  Good afternoon Talha,  I do not see your Tax ID # is currently contracted with the Scott & White Health Plan nor FirstCare Health Plans.  You can request a contract by clicking the link below:     https://swhp.org/forms/html/provider-account-request.html     Someone from our Network Strategy Department will respond to you.     Thank you and have a great day.     Provider Services  1206 West Campus Drive Temple, TX  76502 www.swhp.org', NULL, NULL, '2021-11-17 13:47:37', '2021-11-17 13:47:37'),
(51986, 11056, 42774, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email sent to:  SWHPPROVSERVICES@bswhealth.org  Sub:  Enrollment Query - CBUC & GWMC - Scott & White  Good afternoon!  Hope you are having a great day. I also have submitted the online application for the provider, Leticia Aleman-Listenbee. Her form submission identifier is: 884361d0-5ac4-4942-9a3a-b7c64cc6f344. Kindly provide me updates regarding this.  Also, assist me regarding contracting the Tax ID # with the Scott & White Health Plan and FirstCare Health Plans as well.  Thank you!', NULL, NULL, '2021-11-29 17:23:06', '2021-11-29 17:23:06'),
(51987, 11056, 42774, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org   &   SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub:  New Contract Request Enrollment Query - CBUC & GWMC - Scott & White  Dear Provider,     We received a new contract request for TIN 81-1890349, FNP Leticia Aleman-Listenbee.  To move forward in the review process, provide the supervising physician name and NPI.  Supervising physicians must be contracted with SWHP.  Respond by 11/25/2021 or the request will be closed.     Thank you     Network Development', NULL, NULL, '2021-12-17 14:58:38', '2021-12-17 14:58:38'),
(51988, 11056, 42774, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: SWHPPROVSERVICES@bswhealth.org  Sub: Enrollment Query - CBUC & GWMC - Scott & White   Good Evening,  A new contract request is processed through our Network Strategy/Contracting Department.  Please allow 30 days for someone to contact you regarding your inquiry.     Thank you and have a great day!  Brenda P', NULL, NULL, '2021-12-22 12:40:12', '2021-12-22 12:40:12');
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
(51989, 19067, 42774, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVSERVICES@bswhealth.org  Subject: Enrollment Query || CBUC & GWMC || Leticdia Aleman-Listenbee  || Scott & White ||  Good Morning!   Hope you are having a productive day.  I would like to know the enrollment status of the following Provider.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324   Waiting for your prompt response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 11:36:40', '2022-01-04 11:36:40'),
(51990, 19067, 42774, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HPPROVSERVICES@bswhealth.org  Subject: Enrollment Query || CBUC & GWMC || Leticdia Aleman-Listenbee || Scott & White ||     Good afternoon,  Unfortunately I do not have access to requests for new contracts being processed by our Network Strategy/Contracting Department.   You can reach them by emailing them directly at: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org     Thank you and have a great day!     Brenda K. Powell  Manager, Internal Provider Network Services  Baylor Scott & White Health Plan', NULL, NULL, '2022-01-06 17:20:21', '2022-01-06 17:20:21'),
(51991, 19067, 42774, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee  || Scott & White ||    Good Morning!   Hope you are having a productive day.  I would like to know the enrollment status of the following Provider.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324   Waiting for your prompt response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 17:24:03', '2022-01-06 17:24:03'),
(51992, 19067, 42774, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||    Dear provider,     This application was closed on 11/26/2021, due to no response.  We requested supervising physician information and explained it needed to be received by 11/25/2021 or the application would be closed. It was also explained that a supervising physician must be contracted with BSWHP.  On 11/15/2021, BSWHP was informed of a supervising physician, Frank Dehnisch NPI 1952376345.  BSWHP responded explaining that this provider is not contracted.  BSWHP inquired if there was an additional supervising physician who is contracted with BSWHP.  There was not a response to this inquiry.     If this provider has a supervising physician that is contracted with BSWHP, use the link below to reapply:     https://swhp.org/forms/html/provider-account-request.html     Thank you     Network Development  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-01-12 14:36:28', '2022-01-12 14:36:28'),
(51993, 19067, 42774, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: RE: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||    Dear provider,     This application was closed on 11/26/2021, due to no response.  We requested supervising physician information and explained it needed to be received by 11/25/2021 or the application would be closed. It was also explained that a supervising physician must be contracted with BSWHP.  On 11/15/2021, BSWHP was informed of a supervising physician, Frank Dehnisch NPI 1952376345.  BSWHP responded explaining that this provider is not contracted.  BSWHP inquired if there was an additional supervising physician who is contracted with BSWHP.  There was not a response to this inquiry.     If this provider has a supervising physician that is contracted with BSWHP, use the link below to reapply:     https://swhp.org/forms/html/provider-account-request.html     Thank you     Network Development  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-01-26 14:15:09', '2022-01-26 14:15:09'),
(51994, 22077, 42774, NULL, '2022-04-21 00:00:00.000', 'Not Eligible', 'Email received from: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: RE: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||    Dear provider,     This application was closed on 11/26/2021, due to no response.  We requested supervising physician information and explained it needed to be received by 11/25/2021 or the application would be closed. It was also explained that a supervising physician must be contracted with BSWHP.  On 11/15/2021, BSWHP was informed of a supervising physician, Frank Dehnisch NPI 1952376345.  BSWHP responded explaining that this provider is not contracted.  BSWHP inquired if there was an additional supervising physician who is contracted with BSWHP.  There was not a response to this inquiry.     If this provider has a supervising physician that is contracted with BSWHP, use the link below to reapply:     https://swhp.org/forms/html/provider-account-request.html     Thank you     Network Development  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-04-14 07:43:11', '2022-04-14 07:43:11'),
(51995, 11056, 42775, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:35', '2021-10-27 15:40:35'),
(51996, 11056, 42775, NULL, '2021-11-08 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s enrollment.', NULL, NULL, '2021-11-01 13:17:14', '2021-11-01 13:17:14'),
(51997, 11056, 42776, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:39', '2021-10-27 15:40:39'),
(51998, 11056, 42776, NULL, '2021-11-08 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-11-01 13:16:53', '2021-11-01 13:16:53'),
(51999, 11056, 42777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:47', '2021-10-27 15:40:47'),
(52000, 11056, 42777, NULL, '2021-11-08 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollement.', NULL, NULL, '2021-11-01 13:28:37', '2021-11-01 13:28:37'),
(52001, 11056, 42778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 15:40:54', '2021-10-27 15:40:54'),
(52002, 11056, 42778, NULL, '2021-11-08 00:00:00.000', 'On Hold', 'Awaiting for Medicaid\'s enrollment.', NULL, NULL, '2021-11-01 13:03:16', '2021-11-01 13:03:16'),
(52003, 10057, 42779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 16:51:13', '2021-10-27 16:51:13'),
(52004, 10057, 42779, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request:   Request ID for this Submission: 31032361  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  Please see attachments', NULL, NULL, '2021-10-28 09:05:15', '2021-10-28 09:05:15'),
(52005, 10057, 42779, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : Laura.Bevin@aetna.com & DavisE11@aetna.com  Sub : Enrollment Status || VMUC || Edna Michi & Nubia Benavides || Aetna  Hello,  Hope this email finds you in good health. Could you provide me with the latest updates on below mentioned providers under TIN with all locations:  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Submission Request Reference:  1) Edna Michi - 31032361 2) Nubia Benavides - 61497247  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-17 11:47:25', '2021-11-17 11:47:25'),
(52006, 10057, 42779, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : gouldk@aetna.com  FW: [EXTERNAL] Enrollment Status || Valley Med Urgent Care PLLC || Edna Michi & Nubia Benavides || Aetna  Hi Steve – We contract urgent care on a facility agreement.  We do not credential and add the individual providers since we pay at the facility level.  I hope this helps.  Thanks, Kelly Gould', NULL, NULL, '2021-11-17 13:59:05', '2021-11-17 13:59:05'),
(52007, 10057, 42779, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : gouldk@aetna.com  Sub : Hello Kelly,  Thank you for reaching out. Can you please check the facility agreement for Valley Med Urgent Care PLLC. TIN 81-5123542 and let me know the next procedure ?  Looking forward to hearing from you.  Regards, Steve Albert ', NULL, NULL, '2021-11-17 14:00:41', '2021-11-17 14:00:41'),
(52008, 10057, 42779, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers   See Group Task', NULL, NULL, '2021-11-17 15:02:45', '2021-11-17 15:02:45'),
(52009, 10057, 42780, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 16:51:31', '2021-10-27 16:51:31'),
(52010, 10057, 42780, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request: Initiated   Request ID for this Submission: 31032361  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  Please see attachments', NULL, NULL, '2021-10-28 09:06:31', '2021-10-28 09:06:31'),
(52011, 10057, 42780, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : Laura.Bevin@aetna.com & DavisE11@aetna.com  Sub : Enrollment Status || VMUC || Edna Michi & Nubia Benavides || Aetna  Hello,  Hope this email finds you in good health. Could you provide me with the latest updates on below mentioned providers under TIN with all locations:  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Submission Request Reference:  1) Edna Michi - 31032361 2) Nubia Benavides - 61497247  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-17 11:47:20', '2021-11-17 11:47:20'),
(52012, 10057, 42780, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : gouldk@aetna.com  FW: [EXTERNAL] Enrollment Status || Valley Med Urgent Care PLLC || Edna Michi & Nubia Benavides || Aetna  Hi Steve – We contract urgent care on a facility agreement.  We do not credential and add the individual providers since we pay at the facility level.  I hope this helps.  Thanks, Kelly Gould', NULL, NULL, '2021-11-17 13:58:59', '2021-11-17 13:58:59'),
(52013, 10057, 42780, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : gouldk@aetna.com  Sub : Hello Kelly,  Thank you for reaching out. Can you please check the facility agreement for Valley Med Urgent Care PLLC. TIN 81-5123542 and let me know the next procedure ?  Looking forward to hearing from you.  Regards, Steve Albert ', NULL, NULL, '2021-11-17 14:00:36', '2021-11-17 14:00:36'),
(52014, 10057, 42780, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers   See Group Task', NULL, NULL, '2021-11-17 15:02:32', '2021-11-17 15:02:32'),
(52015, 10057, 42781, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-27 16:51:47', '2021-10-27 16:51:47'),
(52016, 10057, 42781, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request: Initiated   Request ID for this Submission: 31032361  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  Please see attachments', NULL, NULL, '2021-10-28 09:06:59', '2021-10-28 09:06:59'),
(52017, 10057, 42781, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : Laura.Bevin@aetna.com & DavisE11@aetna.com  Sub : Enrollment Status || VMUC || Edna Michi & Nubia Benavides || Aetna  Hello,  Hope this email finds you in good health. Could you provide me with the latest updates on below mentioned providers under TIN with all locations:  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Submission Request Reference:  1) Edna Michi - 31032361 2) Nubia Benavides - 61497247  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-17 11:47:15', '2021-11-17 11:47:15'),
(52018, 10057, 42781, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : gouldk@aetna.com  FW: [EXTERNAL] Enrollment Status || Valley Med Urgent Care PLLC || Edna Michi & Nubia Benavides || Aetna  Hi Steve – We contract urgent care on a facility agreement.  We do not credential and add the individual providers since we pay at the facility level.  I hope this helps.  Thanks, Kelly Gould', NULL, NULL, '2021-11-17 13:58:53', '2021-11-17 13:58:53'),
(52019, 10057, 42781, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : gouldk@aetna.com  Sub : Hello Kelly,  Thank you for reaching out. Can you please check the facility agreement for Valley Med Urgent Care PLLC. TIN 81-5123542 and let me know the next procedure ?  Looking forward to hearing from you.  Regards, Steve Albert ', NULL, NULL, '2021-11-17 14:00:30', '2021-11-17 14:00:30'),
(52020, 10057, 42781, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers   See Group Task', NULL, NULL, '2021-11-17 15:02:19', '2021-11-17 15:02:19'),
(52021, 11056, 42782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:32:37', '2021-10-28 08:32:37'),
(52022, 11056, 42782, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Thank You! Request ID for this Submission: 34249714  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-10-29 08:51:21', '2021-10-29 08:51:21'),
(52023, 11056, 42782, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Rep: Gelo C   Status: Application has get rejected. Aetna has no need for new providers. 859-455-8650 fax LOI   Ref code: 6056836804', NULL, NULL, '2021-11-08 17:01:02', '2021-11-08 17:01:02'),
(52024, 11056, 42782, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Rep: Kim P  Status:  canceled and discontinued. the network is not accepting the provider specialty full capacity. out of network New opening is from 12/1/2021  ref code: 6058198794', NULL, NULL, '2021-11-17 09:58:24', '2021-11-17 09:58:24'),
(52025, 11056, 42782, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Rep: Kim P  Status:  canceled and discontinued. the network is not accepting the provider specialty full capacity. out of network New opening is from 12/1/2021  ref code: 6058198794', NULL, NULL, '2021-11-17 09:58:24', '2021-11-17 09:58:24'),
(52026, 11056, 42782, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: CJ S   Status:Closed not accepting Mid-level and new practitioner. Panel is closed Not have schedule of re-opening.   Refcode: 6060463093', NULL, NULL, '2021-11-30 14:21:41', '2021-11-30 14:21:41'),
(52027, 11056, 42782, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Rep:  Amby J   Status: LOI sent out again for linking and adding the provider under the TIN    Refcode: 6063556901  Please see the attachment.', NULL, NULL, '2021-12-13 15:05:02', '2021-12-13 15:05:02'),
(52028, 11056, 42782, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status: Application has been set again and in processing  Tracking no.: Pvb1377229   Ref code: 6065804152', NULL, NULL, '2021-12-22 13:53:23', '2021-12-22 13:53:23'),
(52029, 19067, 42782, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || RHC || Elsa Pearce || Aetna ||   Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Aetna.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar Kingsville, TX, 78363 Elsa Pearce	1083784102	6646 S. Staples St, 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 14:18:13', '2021-12-28 14:18:13'),
(52030, 19067, 42782, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || Aetna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Aetna.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar Kingsville, TX, 78363 Elsa Pearce	1083784102	6646 S. Staples St, 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 10:26:02', '2022-01-10 10:26:02'),
(52031, 19067, 42782, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Enrollment Status || RHC || Elsa Pearce || Aetna ||    Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Aetna.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar Kingsville, TX, 78363 Elsa Pearce	1083784102	6646 S. Staples St, 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 11:36:37', '2022-01-25 11:36:37'),
(52032, 19067, 42782, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: 	RE: [EXTERNAL] Enrollment Status || RHC || Elsa Pearce || Aetna ||   Hammad,  Please contact provider services as I do not manage Facility agreements, I have mentioned previously and I am still getting these requests from you, If we can be a little more proactive and familiarize yourself with the provider service center, thank you     Check on credentialing status at 1-800-353-1232 (option 3).  Provider Services: 1-888-632-3862     Sylvia Machado-Petry Sr. Analyst, Network Ops Network Management – South TX Markets', NULL, NULL, '2022-02-11 13:08:38', '2022-02-11 13:08:38'),
(52033, 19067, 42782, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Spoke with Ava A. She said that we are on facility contract and we don\'t have to enroll individual providers.  Ref: 6076423137', NULL, NULL, '2022-02-23 15:07:32', '2022-02-23 15:07:32'),
(52034, 19067, 42782, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Anna. She said that the Rockport location is not loaded yet allow them more time and provider Elsa Pearce is not linked to the tax id, we have to bill under group as we have facility contract with Aetna.  Ref# 6079946138', NULL, NULL, '2022-03-15 14:19:47', '2022-03-15 14:19:47'),
(52035, 11056, 42783, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:32:48', '2021-10-28 08:32:48'),
(52036, 11056, 42783, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email receive from:	customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102720210000801)   Sent: 10/27/2021 10:42 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:  Application Tracking ID: T102720210000801        NPI: 1083784102        Medicare ID: 1B5118, 1V5150, 404573YLUJ, 632692AS8U, 638533AT3H                                    5 earliest of 6 total Medicare IDs are above        Name: ELSA C PEARCE          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-01 16:48:32', '2021-11-01 16:48:32'),
(52037, 11056, 42783, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Email received from : customerservice-donotreply@cms.hhs.gov  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T102720210000801)  Date:  11/02/2021 15:30 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T102720210000801. The application listed below has reached a final status.  Application Tracking ID: T102720210000801   NPI ID: 1083784102   Medicare ID: TXB162756, 404573YLUJ, 638533AT3H, 632692AS8U, 1B5118      5 earliest of 7 total Medicare IDs are above.  Name: ELSA PEARCE  State: TX   Form Type: 855I  Date: 11/02/2021  Status: APPROVED   Please also see the attachment.', NULL, NULL, '2021-11-03 08:31:42', '2021-11-03 08:31:42'),
(52038, 11056, 42784, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:32:56', '2021-10-28 08:32:56'),
(52039, 11056, 42784, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785885  REF CODE : tom10282021', NULL, NULL, '2021-10-29 08:30:21', '2021-10-29 08:30:21'),
(52040, 11056, 42784, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Rep : Santana A  Status: Still in process. 10/28/21 case started. Turn around time 90-120 days.  Ref code: Santanaa11092021', NULL, NULL, '2021-11-09 10:35:50', '2021-11-09 10:35:50'),
(52041, 11056, 42784, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Rep: Cherrelle C  Status: Application is still in process.Time frame for credentialing is 90 - 120 days  Refcode: 11192021Cherrellec ', NULL, NULL, '2021-11-19 13:05:27', '2021-11-19 13:05:27'),
(52042, 11056, 42784, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Cureently in process in the credentialing department Application no 12785885  Refcode: Danny11302021', NULL, NULL, '2021-11-30 17:02:18', '2021-11-30 17:02:18'),
(52043, 11056, 42784, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Rep: Marco C  Status: The Application still is in process  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-15 17:59:52', '2021-12-15 17:59:52'),
(52044, 11056, 42784, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Joiya B  Status: Application is in process.  Refcode: 12202021joiya', NULL, NULL, '2021-12-20 13:38:58', '2021-12-20 13:38:58'),
(52045, 19067, 42784, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Query || Elsa Pearce || RHC || Cigna ||  Hello,  I would like to know the enrollment status of the following provider.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar Kingsville TX 78363 Elsa Pearce	1083784102	6646 S. Staples St 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:40:06', '2021-12-28 17:40:06'),
(52046, 19067, 42784, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Secure email received from: PDMCOGZ@cigna.com  Subject: Enrollment Query || Elsa Pearce || RHC || Cigna ||     Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.                                                                                                                                                                                                                                               If you have any questions, please send an email to Intake PDM@cigna.com and include:                                                                                                                                                                                                                                         Cigna Internal Reference # (W202112282077482).                                                                                                                                                                                                                                                                                                                             PID  HCP Name     Effective\\ Term  date  9462619  ELSA, PEARCE  9/1/2021                                                                                                                                                                                                                                                                                                                                                           As per the source document the list of the above provider request has been completed.                                                                                                                                                                                                                                                 Sincerely,  PDM .                                                                                                                                                                                             \"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 requests should be sent to Intake_PDM@cigna.com\"', NULL, NULL, '2022-01-10 16:21:15', '2022-01-10 16:21:15'),
(52047, 19067, 42784, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: pdmcogz@cigna.com  Subject: Re: FW: [External] Enrollment Query || Elsa Pearce || RHC || Cigna ||   Hello!  Could you please confirm the locations which got affected.    Regards, Hammad.', NULL, NULL, '2022-01-26 16:24:59', '2022-01-26 16:24:59'),
(52048, 1019, 42784, NULL, '2022-02-16 00:00:00.000', 'Approved', 'Received the following email from Cigna.  Dear ELSA PEARCE PA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Effective Date: 01/04/2022. See attachments for Plans, Approval Confirmation and Locations Confirmation. ', NULL, NULL, '2022-02-09 13:57:24', '2022-02-09 13:57:24'),
(52049, 11056, 42785, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:34:52', '2021-10-28 08:34:52'),
(52050, 11056, 42785, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'View Summary  Thank you for completing the BCBSTX enrollment. We will notify you once your application has beenprocessed. If you requested to be contracted, please note that your claims may pay out of network forservices rendered until your contracts have been accepted, the credentialing process has been completed,and you receive an effective date. Application ID: 349759', NULL, NULL, '2021-10-29 14:01:23', '2021-10-29 14:01:23'),
(52051, 11056, 42785, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from : txintaketeampiermailbox@bcbstx.com  Sub : BCBS of Texas Provider On-boarding Request Form Received : Case Number - 03063690  AHMED TALHA,  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 03063690, for STATCARE MINOR EMERGENCY CLINIC.  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.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-11-08 16:29:28', '2021-11-08 16:29:28'),
(52052, 11056, 42785, NULL, '2021-11-23 00:00:00.000', 'In Process', '	 Case no. : 03063690  In progress. Please see the attachment', NULL, NULL, '2021-11-16 13:59:51', '2021-11-16 13:59:51'),
(52053, 11056, 42785, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Case no. : 03063690  In progress. Please see the attachment.', NULL, NULL, '2021-11-29 17:19:58', '2021-11-29 17:19:58'),
(52054, 11056, 42785, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Case no. : 03063690  In progress. Please see the attachment.', NULL, NULL, '2021-11-29 17:19:58', '2021-11-29 17:19:58'),
(52055, 19067, 42785, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Called BCBS TX as there was no one to talk to so I\'ve left a voicemail. The automated said they will respond within 3 business days. ', NULL, NULL, '2021-12-07 17:27:33', '2021-12-07 17:27:33'),
(52056, 11056, 42785, NULL, '2021-12-20 00:00:00.000', 'Approved', '	 Email received from: txintaketeampiermailbox@bcbstx.com & Connie_Traylor@bcbstx.com  Sub: BCBSTX New Provider Information   Group Name : STATCARE MINOR EMERGENCY CLINIC Group Record Id : H00084YJ01  Provider Name : ELSA C PEARCE Provider Record Number : H08QN60101 Specialty : Physician Assistant  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	11/24/2021 BCA - BlueChoice PPO	11/24/2021 HMO - Blue Essentials	11/24/2021 HME - Health Select	11/24/2021 PMC - Medicare Advantage PPO	11/24/2021  Please see the attachments.', NULL, NULL, '2021-12-13 11:40:19', '2021-12-13 11:40:19'),
(52057, 11056, 42786, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:35:12', '2021-10-28 08:35:12'),
(52058, 11056, 42786, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 14:52:28', '2021-11-01 14:52:28'),
(52059, 11056, 42786, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Healthplan  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Christus Healthplan. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-08 15:53:59', '2021-11-08 15:53:59'),
(52060, 11056, 42786, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.     Feel free to call me if you have other questions.     Thanks, Michal', NULL, NULL, '2021-11-15 17:33:29', '2021-11-15 17:33:29'),
(52061, 11056, 42786, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  michal.simms@christushealth.org   Sub:   Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  Good afternoon,    This request has been submitted to Credentialing; reference number is FL01481849.  Please allow 90-120 days for the Credentialing process to be completed.   Best regards, Michal    Ms. Michal Simms Network Contractor Senior  Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org  Dignity. Integrity. Excellence. Compassion. Stewardship.', NULL, NULL, '2021-11-29 14:39:10', '2021-11-29 14:39:10'),
(52062, 11056, 42786, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Healthplan  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good afternoon!  Hope you are having a productive day. Please let me know the Credentialing of; Reference number is FL01481849. Any latest updates on it?  Also, provide me updates regarding the submitted Ancillary application.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-12-16 13:06:13', '2021-12-16 13:06:13'),
(52063, 19067, 42786, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||  Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Christus Health Plan.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 15:23:34', '2021-12-28 15:23:34'),
(52064, 19067, 42786, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 16:12:28', '2022-01-10 16:12:28'),
(52065, 19067, 42786, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Greetings!  This is my Second Reminder on the below mentioned request. Kindly respond promptly.    Regards.', NULL, NULL, '2022-01-25 11:40:28', '2022-01-25 11:40:28'),
(52066, 19067, 42786, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: michal.simms@christushealth.org  Subject: RE: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Hello Ahmed,     I tell you this often… we do not credential the individual practitioners who work at a clinic/facility.     Please discontinue asking me for status on providers who are not being credentialed.      Please contact Credentialing at CHRISTUS.HP.Credentialing@christushealth.org for additional information.     Best regards, Michal     Ms. Michal Simms  Network Contractor Senior  Nueces Region  CHRISTUS Health Plan  US Family Health Plan  (o) 469-282-3227', NULL, NULL, '2022-02-11 13:12:05', '2022-02-11 13:12:05'),
(52067, 19067, 42786, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||   Hello,  Hope you are doing well.  I would like to know the enrollment status for the following provider with Christus Health Plan.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413   Thanks & Regards,', NULL, NULL, '2022-02-21 17:19:21', '2022-02-21 17:19:21'),
(52068, 19067, 42786, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Sent a fax of W9 @ 210-766-8855.', NULL, NULL, '2022-03-15 14:34:15', '2022-03-15 14:34:15'),
(52069, 19067, 42786, NULL, '2022-04-29 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Subject: Enrollment Status || RHC || Elsa Pearce || Christus Health Plan ||    Hello Ahmed,     I tell you this often… we do not credential the individual practitioners who work at a clinic/facility.     Please discontinue asking me for status on providers who are not being credentialed.      Please contact Credentialing at CHRISTUS.HP.Credentialing@christushealth.org for additional information.     Best regards, Michal     Ms. Michal Simms  Network Contractor Senior  Nueces Region  CHRISTUS Health Plan  US Family Health Plan  (o) 469-282-3227     www.christushealthplan.org   ', NULL, NULL, '2022-04-22 10:10:19', '2022-04-22 10:10:19'),
(52070, 19067, 42786, NULL, '2022-04-29 00:00:00.000', 'Approved', 'Facility Contract, Eff 02/01/2019', NULL, NULL, '2022-04-22 10:10:54', '2022-04-22 10:10:54'),
(52071, 11056, 42787, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:35:12', '2021-10-28 08:35:12'),
(52072, 11056, 42787, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to: hunter.barrett@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 15:32:36', '2021-11-01 15:32:36'),
(52073, 11056, 42787, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from:michal.simms@christushealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,     The process to enroll a provider to our network always begins with sending a completed prospective provider form and W9 to our department mailbox - CHP.networkdevelopment@christushealth.org.     Once your request is received, the request will be assigned to the representative that handles that region.     Your cooperation is greatly appreciated.     Michal   ', NULL, NULL, '2021-11-08 15:26:58', '2021-11-08 15:26:58'),
(52074, 11056, 42787, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-15 17:25:01', '2021-11-15 17:25:01'),
(52075, 11056, 42787, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-15 17:25:04', '2021-11-15 17:25:04'),
(52076, 11056, 42787, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email sent to:  michal.simms@christushealth.org   Sub : Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Good afternoon!  Hope this email finds you well. Please Find the attached prospective provider form with W-9 for the credentialing of the new provider, Elsa Pearce.  If any corrections or documents are required please let me know.  Thank you! Have a nice day!', NULL, NULL, '2021-11-15 17:25:07', '2021-11-15 17:25:07'),
(52077, 11056, 42787, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  michal.simms@christushealth.org  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Christus Spohn  Hello Ahmed,  Eff date is: 09/1/2021  Because we have Rabagos Healthcare PLLC dba Statcare Minor Emergency on an Ancillary Agreement, the clinic is the participating provider.  We do not credential those providers that work in the clinic as long as they bill for services with the Clinic’s TIN and NPI.  The Clinic has participated in our Health Exchange plans since 2016.  Medicare Advantage was added on 2/1/2019, and Commercial was added eff 9/2/2021.     Our web search produces results under Statcare Minor Emergency Clinic.  See: https://www.christushealthplan.org/find-a-provider?location=Kingsville%20TX&distance=75&plan=tx%20hix&keyword=Statcare     Let me know if you need other information.    Ancillary contract no need for provider\'s credentialing.', NULL, NULL, '2021-11-29 14:17:11', '2021-11-29 14:17:11'),
(52078, 11056, 42788, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:35:48', '2021-10-28 08:35:48'),
(52079, 11056, 42788, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : stxnm@humana.com &  LClark44@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 15:48:15', '2021-11-01 15:48:15'),
(52080, 11056, 42788, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Humana has 4 Network Development Regions in Texas. Updates can only be made by the region where the provider’s office resides. Based on your service address, your request for a contract/ existing contract/updates are handled by another Network Development Market. Please remove the HumanaHoustonPD mailbox from your distribution and use the STXNM@humana.com email in its place.     Thank you.     HumanaHoustonPD     Dallas/Fort Worth/North TX/East TX   NTXNM@humana.com    San Antonio/Corpus Christi/South Texas    STXNM@humana.com     Austin/El Paso/Central Texas/BCS/West TX/Panhandle    networkrelationsaustintx@humana.com    Another request has been sent to STXNM@humana.com', NULL, NULL, '2021-11-08 13:10:09', '2021-11-08 13:10:09'),
(52081, 11056, 42788, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good morning!  Hope this email finds you well. Please find the attached roster for the provider, Elsa Pearce for enrolling and credentialing under the facility.  Furthermore, if any documents and corrections are required please don\'t hesitate in reaching out to me.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-17 15:02:18', '2021-11-17 15:02:18'),
(52082, 11056, 42788, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com &  LClark44@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Humana  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates of below-mentioned provider  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-30 15:05:35', '2021-11-30 15:05:35'),
(52083, 11056, 42788, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from:  stxnm@humana.com   Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Humana  At this time Statcare Minor Emergency clinic is contracted on Ancillary Contract paper.  It is loaded as a facility so we do not add providers to this contract.  This is an urgent care facility.  The Group has Urgent Care Contract with Humana effective 02/8/2017. Emptoris Contract Number: 38183.  Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com bs   Please see the attached.', NULL, NULL, '2021-12-09 12:37:18', '2021-12-09 12:37:18'),
(52084, 11056, 42789, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:35:54', '2021-10-28 08:35:54'),
(52085, 11056, 42789, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921KOM', NULL, NULL, '2021-10-29 09:17:21', '2021-10-29 09:17:21'),
(52086, 11056, 42789, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Dear Elsa Pearce:  Thank you for your request to join our provider networks. We may contact you for further information and, if you meet our preliminary credentialing requirements, we will send you an application package in the mail.', NULL, NULL, '2021-10-29 09:20:49', '2021-10-29 09:20:49'),
(52087, 11056, 42789, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Rep :Lania R  Status: Still in process. The application has been received yesterday. 90- 120 days. Nomination is processing.  Ref code: 102921KOM', NULL, NULL, '2021-11-08 12:46:32', '2021-11-08 12:46:32');
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
(52088, 11056, 42789, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Rep: James D  Status:  Still in process.  Application is in progress  Ref code: 11152021', NULL, NULL, '2021-11-15 13:56:10', '2021-11-15 13:56:10'),
(52089, 11056, 42789, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: the provider interest form is received on 7 November 2021. in process.  Ref code: 102921KOM', NULL, NULL, '2021-11-24 14:52:01', '2021-11-24 14:52:01'),
(52090, 11056, 42789, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: It is still in process in the credentialing departmment.   Ref code: 7825718 ', NULL, NULL, '2021-11-29 13:10:37', '2021-11-29 13:10:37'),
(52091, 11056, 42789, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Rep: Paige L   Status: Nomination has been sent out to the registrar for adding and credentialing. 12/6/2021   Refcode: 102921KOM', NULL, NULL, '2021-12-14 14:03:03', '2021-12-14 14:03:03'),
(52092, 11056, 42789, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep:  James D   Status: Still in progress with registrar. 30 - 60 dyas from 11/9/2021   Refcode: 7825718', NULL, NULL, '2021-12-20 17:23:15', '2021-12-20 17:23:15'),
(52093, 11056, 42789, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from:  appmissinginfo@multiplan.com  Sub: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838   Dear Provider,  We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Supriya U  Provider Data Management  appmissinginfo@multiplan.com     MultiPlan, Inc  16 Crosby Drive  Bedford, MA 01730  Fax: 781-487-8257     Reference: APP0008351838  Please see the atatched', NULL, NULL, '2021-12-23 09:59:18', '2021-12-23 09:59:18'),
(52094, 19067, 42789, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: fax7814878257@multiplan.com  Subject: Regarding Pearce, Elsa C., MS’s MultiPlan Application – Reference: APP0008351838    Good morning!  Hope you are doing great. Here is the information you requested and I have faxed as well at 781-487-8257. Please see the attachment.  Furthermore, If any documents or information is needed feel free to contact me.  Thank you! Have a wonderful day!', NULL, NULL, '2022-01-12 16:33:16', '2022-01-12 16:33:16'),
(52095, 19067, 42789, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:25:20', '2022-01-12 17:25:20'),
(52096, 19067, 42789, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:30', '2022-01-26 17:28:30'),
(52097, 19067, 42789, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:35:58', '2022-02-11 14:35:58'),
(52098, 19067, 42789, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:20', '2022-02-23 14:28:20'),
(52099, 19067, 42789, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:41', '2022-03-15 16:19:41'),
(52100, 11056, 42790, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:36:00', '2021-10-28 08:36:00'),
(52101, 11056, 42790, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com &  mmedina@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 15:44:04', '2021-11-01 15:44:04'),
(52102, 11056, 42790, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s   Thanks; Karen A', NULL, NULL, '2021-11-17 13:57:59', '2021-11-17 13:57:59'),
(52103, 11056, 42790, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Galaxy Health  This is a facility agreement we don’t need to add providers, all providers are covered when billing under facility TIN’s  Eff date: 06/24/2019  Please see the attachment.  Thanks; Karen A', NULL, NULL, '2021-11-29 18:02:51', '2021-11-29 18:02:51'),
(52104, 11056, 42791, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:36:14', '2021-10-28 08:36:14'),
(52105, 11056, 42791, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-10-29 15:52:31', '2021-10-29 15:52:31'),
(52106, 11056, 42791, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email sent to : pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-08 13:28:33', '2021-11-08 13:28:33'),
(52107, 11056, 42791, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Hello, Please use the link below and select from the dropdown for your request. This is for HealthSmart PPO Only.     https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network        Valesia Glenn |Provider Relations HealthSmart | Network Solutions 222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039    The application has been submitted online. Please see the attachment.', NULL, NULL, '2021-11-17 14:15:41', '2021-11-17 14:15:41'),
(52108, 11056, 42791, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Hello, Please use the link below and select from the dropdown for your request. This is for HealthSmart PPO Only.     https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network        Valesia Glenn |Provider Relations HealthSmart | Network Solutions 222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039    The application has been submitted online. Please see the attachment.', NULL, NULL, '2021-11-17 14:15:42', '2021-11-17 14:15:42'),
(52109, 11056, 42791, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Good afternoon!  Hope this email finds you well. Please find the attached application form for the provider, Elsa Pearce. I have already submitted this to Health Smart through Online on 9th, November 2021.  Also, provide me the updates regarding the application.  Thank you!', NULL, NULL, '2021-11-30 14:50:06', '2021-11-30 14:50:06'),
(52110, 11056, 42791, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart  Please clarify what you are requesting.  Are you asking for credentialling status? Please allow a minimum of 45 days.', NULL, NULL, '2021-12-13 17:35:02', '2021-12-13 17:35:02'),
(52111, 11056, 42791, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Good afternoon!  Hope all is well with you. I wanted to get the latest updates regarding the credentialing process of the below-mentioned provider under facility TIN with all mentioned locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-20 10:41:05', '2021-12-20 10:41:05'),
(52112, 19067, 42791, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello, Locations can be verified below after 30-45 days of submission.    https://providerlookup.healthsmart.com/SearchProviders.aspx     Thank you,  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-12-29 09:40:07', '2021-12-29 09:40:07'),
(52113, 19067, 42791, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Good morning!  Hope you are having a wonderful day. Any latest updates on the credentialing process?  If you need any documents or information don\'t hesitate in reaching out to me.  Thank you! Have a  blessed day!', NULL, NULL, '2022-01-10 16:29:01', '2022-01-10 16:29:01'),
(52114, 19067, 42791, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart   Hello!  Any updates on the request below?  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:45:33', '2022-01-26 17:45:33'),
(52115, 19067, 42791, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Query - Statcare Minor Emergency Clinic - Health Smart    Hi,  Provider \" Elsa Pearce, PA \" is effective date \" 03/01/2022 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Documents ID : 3508873)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-02-11 13:52:46', '2022-02-11 13:52:46'),
(52116, 19067, 42791, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Effective date: 03/01/2022. See attachment of directory as a reference.', NULL, NULL, '2022-02-16 13:06:46', '2022-02-16 13:06:46'),
(52117, 19067, 42791, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Welcome Letter is attached.', NULL, NULL, '2022-03-08 13:27:55', '2022-03-08 13:27:55'),
(52118, 11056, 42792, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:37:05', '2021-10-28 08:37:05'),
(52119, 11056, 42792, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : SWHPPROVSERVICES@bswhealth.org   &  SWHPRECRED@bswhealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Scott & White  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 15:57:40', '2021-11-01 15:57:40'),
(52120, 11056, 42792, NULL, '2021-11-15 00:00:00.000', 'Approved', 'Email received from : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Scott & White  Good afternoon Ahmed,  I checked with the Director of Contracting and since we currently have a facility contract with Statcare Minor Emergency Clinic we only need to add the new Rockport address to NPI: 1689924904 for our Provider Directories.  We do ask that if you open a new location in the future please submit these updates through our website (see link below).      https://swhp.org/forms/html/demographic-Update-Form.html     If you have the phone # and fax # we can ago ahead and add the Rockport location this time.    Thank you so much,  Brenda K. Powell Manager, Internal Provider Network Services  1206 West Campus Dr | MS-A4-126 | Temple, TX  76502 254-298-3338 Office | 254-298-3044 Fax Brenda.Powell@BSWHealth.org www.swhp.org  ', NULL, NULL, '2021-11-08 12:34:00', '2021-11-08 12:34:00'),
(52121, 11056, 42793, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:37:11', '2021-10-28 08:37:11'),
(52122, 11056, 42793, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Email sent to: efry@trpnppo.com & trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-10-29 15:49:47', '2021-10-29 15:49:47'),
(52123, 11056, 42793, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope this email finds you well.  Please find the attached form of the provider to be credentialed under the Tax I.D of the facility. The provider is providing services on all of the following 5 locations. Therefore, kindly list them under the provider during enrollment.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-08 10:40:53', '2021-11-08 10:40:53'),
(52124, 11056, 42793, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Emai sent to:  trpndataentry@trpnppo.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning!  Hope all is well with you. Any update on the credentialing process of the below-mentioned provider? Have u received the Provider Update form for the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Kindly, also inform me whenever any documents or information is needed regarding the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-11-17 15:04:48', '2021-11-17 15:04:48'),
(52125, 11056, 42793, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email received from:  trpndataentry@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Good morning,  I have attach you the Provider Update Form,     Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network  6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563   Already have submitted the form.  ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-11-30 15:23:13', '2021-11-30 15:23:13'),
(52126, 11056, 42793, NULL, '2021-12-13 00:00:00.000', 'Approved', 'Email received from:  ncuevas@trpnppo.com  Sub:  RE: Enrollment Query - Statcare Minor Emergency Clinic - TRPN  Hello,  This email is to let you know that provider Elsa C Pearce PAC., is active in our network, her effective date is 10/29/2021.  I Hope you\'re doing well too, yes all the five locations are included on the TAX ID indicated as requested in your 11/01/2021 email.  Regards,      Norma Cuevas Data Entry Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 271-2510  Fax: (619) 271-2456 ncuevas@trpnppo.com www.trpnppo.com   Welcome Letter and location proofs have been attached. Please see the attachments as well.', NULL, NULL, '2021-12-06 13:10:01', '2021-12-06 13:10:01'),
(52127, 11056, 42794, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:37:19', '2021-10-28 08:37:19'),
(52128, 11056, 42794, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 16:04:36', '2021-11-01 16:04:36'),
(52129, 11056, 42794, NULL, '2021-12-01 00:00:00.000', 'Initiated', 'Email received from:  jtrenz@humana.com  Sub:   Good afternoon,     This provider NPI is NOT certified or TRICARE-authorized, so credentialing cannot be done until certification is complete.  Please visit humanamilitary.com, Provider link, then Forms to locate the appropriate certification application for the provider type (MD, PA, etc.) Complete the certification application and fax to the number located on the form.  Please allow 90 days for the certification process.  You can use the following Provider Search tool (as shown below highlighted in yellow) in the provider portal to check certification status in the future.     Once certification is complete, the credentialing paperwork can be submitted to Humana Military for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-11-24 15:38:55', '2021-11-24 15:38:55'),
(52130, 11056, 42794, NULL, '2021-12-10 00:00:00.000', 'Initiated', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-03 16:01:45', '2021-12-03 16:01:45'),
(52131, 11056, 42794, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-12-13 17:48:21', '2021-12-13 17:48:21'),
(52132, 11056, 42794, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope you are having a wonderful day. Please find the attached Texas Credentialing Application for certification and credentialing of the below-mentioned provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please get back to me soon with the latest updates on the credentialing process of the provider.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-20 17:25:24', '2021-12-20 17:25:24'),
(52133, 11056, 42794, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Good evening –     A request to update this provider to network has been submitted. Please allow up to 60 days for processing.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2021-12-23 15:42:59', '2021-12-23 15:42:59'),
(52134, 19067, 42794, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Query - Statcare Minor Emergency Clinic - Tricare   Greetings!   Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:32:47', '2022-01-10 17:32:47'),
(52135, 19067, 42794, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:41', '2022-01-26 17:34:41'),
(52136, 19067, 42794, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:58:04', '2022-02-11 16:58:04'),
(52137, 19067, 42794, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:44:57', '2022-02-21 17:44:57'),
(52138, 19067, 42794, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:40', '2022-03-15 17:58:40'),
(52139, 22077, 42794, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:05:17', '2022-04-08 11:05:17'),
(52140, 22077, 42794, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 07:59:58', '2022-04-25 07:59:58'),
(52141, 11056, 42795, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:37:19', '2021-10-28 08:37:19'),
(52142, 11056, 42795, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to :  credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 16:01:12', '2021-11-01 16:01:12'),
(52143, 11056, 42795, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email received from : providerservices@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential     Hello,     Please e-mail your request to credentialing@triwest.com and reference contract number 121TW62766C01.     Thank you,     Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance  providerservices@triwest.com  www.triwest.com  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749)     Remember to now send your claims to PGBA! TriWest has a new claims processor and Payer ID. For more information, visit www.triwest.com/claimsconversion.', NULL, NULL, '2021-11-08 09:58:26', '2021-11-08 09:58:26'),
(52144, 11056, 42795, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email received from: Credentialing@triwest.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good Morning Ahmed  After the provider is loaded in our system for credentialing the providers information is sent to aperture (3rd party credentialing company) to process. This can take 30-120 days to complete. As long as the providers CAQH is up to date it will take less time. If Aperture sends a request for additional information please respond as soon as you can so that the process does not take longer. They will only make 3 attempts for the information before they end the process.   Kind regards,   Nicole Goergen  Provider Credentialing Specialist TriWest Healthcare Alliance Fax: (866)549-4610  Community Care Network Region 4 Contact Center: 877-CCN-TRIW (226-8749) Choice Contact Center: (866) 606-8198 Veteran Affairs Patient-Centered Community Care (PC3) Contact Center: (855) 722-2838 www.triwest.com     Follow TriWest:  www.facebook.com/triwest www.twitter.com/triwest linkedin.com/company/TriWest-Healthcare-Alliance', NULL, NULL, '2021-11-17 15:16:10', '2021-11-17 15:16:10'),
(52145, 11056, 42795, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Triwest   Good afternoon!  Hope all is well with you. Any updates on the credentialing process of the provider, Elsa Pearce?  Please provide me with the enrollment status at your earliest convenience.  Thank you!', NULL, NULL, '2021-11-30 15:41:36', '2021-11-30 15:41:36'),
(52146, 11056, 42795, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email sent to: credentialing@triwest.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Triwest  Good afternoon!  Hope all is well with you. Any updates on the credentialing process of the provider, Elsa Pearce?  Please provide me with the enrollment status at your earliest convenience.  Thank you!', NULL, NULL, '2021-12-13 17:55:07', '2021-12-13 17:55:07'),
(52147, 11056, 42795, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Provider Elsa C Pearce PAC NPI 1083784102 ', NULL, NULL, '2021-12-14 12:35:27', '2021-12-14 12:35:27'),
(52148, 11056, 42795, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: rgiambrone@triwest.com  Sub: Provider Elsa C Pearce PAC NPI 1083784102   TriWest Classification: Confidential     Good Afternoon,     I am currently working on Credentialing Provider Elsa C Pearce PAC NPI 1083784102 however I need some more information. Can you please advise who the supervising Physician is for this Provider? Also please advise if this supervising position is Credentialed with Triwest or will need to be Credentialed with Triwest? It is a requirement of Triwest for PA that are contracted with Triwest for the Supervising Physician to be contracted as well. Thank you for time and help! Please let me know if you have any questions.     Regards,     Rebecca Giambrone, Provider Credentialing Specialist |TriWest Healthcare Alliance  E: rgiambrone@triwest.com  www.triwest.com ', NULL, NULL, '2021-12-20 17:32:25', '2021-12-20 17:32:25'),
(52149, 11056, 42795, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: smiguel@triwest.com  Sub:  Enrollment Query - Statcare Minor Emergency Clinic - Triwest  TriWest Classification: Confidential   Good morning Ahmed,  Effective date: 12/14/2021   Please see the attached welcome letters for the additional locations.  Dear Elsa C Pearce, PAc: I am pleased to inform you that on 12/14/2021, the TriWest Healthcare Alliance Credentialing Committee reviewed and approved your credentialing application for participation as a TriWest network provider.    Shannael Miguel Provider Credentialing Spec  TRiWest Healthcare Alliance smiguel@triwest.com  www.triwest.com', NULL, NULL, '2021-12-21 10:46:07', '2021-12-21 10:46:07'),
(52150, 11056, 42796, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 08:37:35', '2021-10-28 08:37:35'),
(52151, 11056, 42796, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - UHC  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-10-29 15:48:42', '2021-10-29 15:48:42'),
(52152, 11056, 42796, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com   Sub : Secure Message from estrellita_thomas@uhc.com  Good Morning,     Thank you for contacting the Network Management Resource Team (NMRT) about the UnitedHealthcare credentialing and contracting process for medical health care professionals.     Please follow these steps to request to join our medical networks:     Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested    Confirm you have access to the UnitedHealthcare Provider Portal: Our credentialing/contracting request tool is within our secure Provider Portal, and a One Healthcare ID is required to access the portal. If you don’t currently have access, you’ll need to set up an account.    Submit a request using OnboardPro: Once you have access to the portal, sign in and select the OnboardPro tile. The attached quick reference guide has instructions. For more information or additional assistance, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    One Healthcare ID assistance  If you need help registering for a One Healthcare ID or have questions about existing access, please contact the UnitedHealthcare Web Support team help desk at 866-842-3278, option 1, 7 a.m.–11 p.m. CT, Monday–Friday.      Questions? We’re here to help   If we can further assist you, respond to this email.      Sincerely,  Estrellita “Nikki” Thomas  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-11-08 09:48:52', '2021-11-08 09:48:52'),
(52153, 11056, 42796, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - UHC  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with UHC. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 15:21:45', '2021-11-17 15:21:45'),
(52154, 11056, 42796, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  networkhelp@uhc.com  Sub: Secure Message from japarker@uhc.com    Greetings,        Thank you for contacting the UnitedHealthcare Network Management Resource Team about the UnitedHealthcare credentialing and contracting process for medical health care professionals. You can find complete information on our process and requirements on our Credentialing page. For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts.    ·         Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested     ·         Submit your request through the RFP portal at  ncc-optum.secure.force.com        Questions? We’re here to help   If we can further assist you, please respond to this email.     Please send all responses or questions for this email to networkhelp@uhc.com for further assistance.  Emails sent to me directly will be deleted with the understanding it was re-mailed to networkhelp@uhc.com.     Sincerely,     Associate Network Contractor   United Healthcare   Network Management Resource Team (NMRT) ', NULL, NULL, '2021-11-24 17:16:35', '2021-11-24 17:16:35'),
(52155, 11056, 42796, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Secure Message from estrellita_thomas@uhc.com   Good afternoon!  Hope all is well with you. The CAQH has been updated and attested of the provider, Elsa. Kindly escalate the request for credentialing of the provider soon.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-10 17:43:31', '2021-12-10 17:43:31'),
(52156, 19067, 42796, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email sent to: networkhealth@uhc.com  subject: Enrollment Query || Elsa Pearce || RHC || UHC ||  Hello,  Hope you\'re staying healthy and you\'re having a productive day.  I would like to know the enrollment status for the provider with below mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly.    Thanks & Regards Ahmed, Hammad', NULL, NULL, '2021-12-22 15:49:05', '2021-12-22 15:49:05'),
(52157, 19067, 42796, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Query || Elsa Pearce || RHC || UHC ||    Hello,  Please find the attachment. Form for Elsa Pearce. I would like to enroll this provider.   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-22 17:51:44', '2021-12-22 17:51:44'),
(52158, 19067, 42796, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com    Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:16:14', '2021-12-28 10:16:14'),
(52159, 19067, 42796, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Application submitted through Portal.', NULL, NULL, '2021-12-28 10:31:26', '2021-12-28 10:31:26'),
(52160, 19067, 42796, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com  Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 10:58:20', '2021-12-28 10:58:20'),
(52161, 19067, 42796, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Provider Link to TIN || Elsa Pearce || RHC || UHC  Hello,  I received an email stating Urgent Care providers do not require credentialing.  I am writing this to link and contract a provider to the TIN.  Group Name Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904   Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 11:00:06', '2021-12-28 11:00:06'),
(52162, 19067, 42796, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: United_Healthcare_Provider_Operations@uhc.com   Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6389124  Received On: Dec 28, 2021 4:07:36 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2021-12-30 16:49:17', '2021-12-30 16:49:17'),
(52163, 19067, 42796, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from:  joi_crawford@uhc.com  Subject: Secure Message from joi_crawford@uhc.com  Good Afternoon,     Thank you for contacting the Network Management Resource Team. This provider does not show linked to the Tax ID mentioned below and therefore is not contracted or linked to the locations listed below. There was not request found in progress for this provider to be added to this Tax ID . If you wish to have the provider added you will need to submit a demographic request to start the process.     Please let us know if we can assist further.     Joi Crawford  United Healthcare  Network Management Resource Team (NMRT)   ', NULL, NULL, '2022-01-02 20:35:59', '2022-01-02 20:35:59'),
(52164, 19067, 42796, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: katherine_k_floyd@uhc.com  Subject: Secure Message from katherine_k_floyd@uhc.com    Good afternoon Ahmed,    PEARCE, ELSA C   Urgent Care providers do not require credentialing.  Please submit the request to the demographic department (hpdemo@uhc.com) to link and contract    the provider to the tin.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2022-01-02 20:37:53', '2022-01-02 20:37:53'),
(52165, 19067, 42796, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the holidays and having a great new year!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2022-01-02 20:55:46', '2022-01-02 20:55:46'),
(52166, 19067, 42796, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: Secure message from United_Healthcare_Provider_Operations@uhc.com Subject: United_Healthcare_Provider_Operations@uhc.com    UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6395835  Received On: Jan 3, 2022 2:05:58 AM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-01-02 23:52:04', '2022-01-02 23:52:04');
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
(52167, 19067, 42796, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, United_Healthcare_Provider_Operations@uhc.com  Subject: Re: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||  Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:24:03', '2022-01-10 17:24:03'),
(52168, 19067, 42796, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Secure email received from: zanetta_mccrimon@uhc.com    Subject: Re: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   Good Morning Hammad Ahmed,     Thank you for contacting the Submission Inquiry Team. We will be glad to assist regarding your inquiry.     Your request to add ELSA PEARCE to Tax ID *5924 is currently in process and you will receive a response when it is completed. You reference numbers are PR-6389124 and PR-6395835. The request was submitted twice. Thank you for your patience and have a great day!     Please do not reply directly to this email. Send all responses or questions pertaining to this email to submission_inquiry@uhc.com for further assistance. If sent to zanetta_mccrimon@uhc.com, it will be considered responded to already and will be deleted.        Thank you,     Zanetta', NULL, NULL, '2022-01-12 11:55:57', '2022-01-12 11:55:57'),
(52169, 19067, 42796, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email received from: united_healthcare_provider_operations@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||    Oops! We received your email in error.     If you need to update your practitioner or group information within UnitedHealthcare’s systems, please take one of the following actions:  If you have an Optum ID with access to My Practice Profile (MPP), access MPP at provider.linkhealth.com  If you have a Delegated Credentialing Agreement, submit your request to delprov@uhc.com  All other requests, submit to hpdemo@uhc.com  Thank you.', NULL, NULL, '2022-01-26 17:48:19', '2022-01-26 17:48:19'),
(52170, 1019, 42796, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Faxed the requested document to Aperture as requested see attachment for reference. ', NULL, NULL, '2022-02-09 12:59:18', '2022-02-09 12:59:18'),
(52171, 19067, 42796, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Fwd: Link and Contract Provider to the TIN ||  RHC || Elsa Pearce || UHC ||    Good Morning!   I hope you enjoyed the weekend and had a productive day!  I would like to link and contract the Provider to the TIN with the following Locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards,', NULL, NULL, '2022-02-21 17:59:43', '2022-02-21 17:59:43'),
(52172, 19067, 42796, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Secure email received from: psivaku1@uhc.com  Subject: Link and Contract Provider to the TIN || RHC || Elsa Pearce || UHC ||   We’ve reviewed the provider/group updates you requested on Jan 3, 2022 2:04:23 AM. Your request was assigned reference number PR-6395835.    We determined that your request can’t be completed.   Action May Be Needed Please see the attached report and review the Comments column for details. If comments indicate resubmission or missing information is needed, resubmit your original request with all indicated information.    The original submission is attached for your reference.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you. ', NULL, NULL, '2022-03-03 10:30:38', '2022-03-03 10:30:38'),
(52173, 19067, 42796, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Secure email received from: skanna17@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com   Good news! We’ve completed the provider/group updates you requested on Feb 21, 2022 11:08:02 PM. Your request was assigned reference number PR-6496454 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-03-30 13:14:36', '2022-03-30 13:14:36'),
(52174, 19067, 42796, NULL, '2022-04-29 00:00:00.000', 'Approved', 'Spoke with Anna @ 877-842-3210 and got the effective date for Elsa Pearce as of 03/26/2009. Ref# D7049', NULL, NULL, '2022-04-22 15:27:06', '2022-04-22 15:27:06'),
(52175, 10057, 42797, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 09:00:45', '2021-10-28 09:00:45'),
(52176, 10057, 42797, NULL, '2021-11-04 00:00:00.000', 'Initiated', '	 Request ID for this Submission: 61497247  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  Please see attachments:', NULL, NULL, '2021-10-28 09:09:34', '2021-10-28 09:09:34'),
(52177, 10057, 42797, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : Laura.Bevin@aetna.com & DavisE11@aetna.com  Sub : Enrollment Status || VMUC || Edna Michi & Nubia Benavides || Aetna  Hello,  Hope this email finds you in good health. Could you provide me with the latest updates on below mentioned providers under TIN with all locations:  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Submission Request Reference:  1) Edna Michi - 31032361 2) Nubia Benavides - 61497247  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-17 11:47:09', '2021-11-17 11:47:09'),
(52178, 10057, 42797, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : gouldk@aetna.com  FW: [EXTERNAL] Enrollment Status || Valley Med Urgent Care PLLC || Edna Michi & Nubia Benavides || Aetna  Hi Steve – We contract urgent care on a facility agreement.  We do not credential and add the individual providers since we pay at the facility level.  I hope this helps.  Thanks, Kelly Gould', NULL, NULL, '2021-11-17 13:58:48', '2021-11-17 13:58:48'),
(52179, 10057, 42797, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : gouldk@aetna.com  Sub : Hello Kelly,  Thank you for reaching out. Can you please check the facility agreement for Valley Med Urgent Care PLLC. TIN 81-5123542 and let me know the next procedure ?  Looking forward to hearing from you.  Regards, Steve Albert ', NULL, NULL, '2021-11-17 14:00:15', '2021-11-17 14:00:15'),
(52180, 10057, 42797, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers   See Group Task', NULL, NULL, '2021-11-17 15:01:59', '2021-11-17 15:01:59'),
(52181, 10057, 42798, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 09:00:59', '2021-10-28 09:00:59'),
(52182, 10057, 42798, NULL, '2021-11-04 00:00:00.000', 'Initiated', '	 Request ID for this Submission: 61497247  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  Please see attachments:', NULL, NULL, '2021-10-28 09:09:08', '2021-10-28 09:09:08'),
(52183, 10057, 42798, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : Laura.Bevin@aetna.com & DavisE11@aetna.com  Sub : Enrollment Status || VMUC || Edna Michi & Nubia Benavides || Aetna  Hello,  Hope this email finds you in good health. Could you provide me with the latest updates on below mentioned providers under TIN with all locations:  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Submission Request Reference:  1) Edna Michi - 31032361 2) Nubia Benavides - 61497247  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-17 11:47:03', '2021-11-17 11:47:03'),
(52184, 10057, 42798, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : gouldk@aetna.com  FW: [EXTERNAL] Enrollment Status || Valley Med Urgent Care PLLC || Edna Michi & Nubia Benavides || Aetna  Hi Steve – We contract urgent care on a facility agreement.  We do not credential and add the individual providers since we pay at the facility level.  I hope this helps.  Thanks, Kelly Gould', NULL, NULL, '2021-11-17 13:58:42', '2021-11-17 13:58:42'),
(52185, 10057, 42798, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : gouldk@aetna.com  Sub : Hello Kelly,  Thank you for reaching out. Can you please check the facility agreement for Valley Med Urgent Care PLLC. TIN 81-5123542 and let me know the next procedure ?  Looking forward to hearing from you.  Regards, Steve Albert ', NULL, NULL, '2021-11-17 14:00:00', '2021-11-17 14:00:00'),
(52186, 10057, 42798, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers   See Group Task', NULL, NULL, '2021-11-17 15:01:41', '2021-11-17 15:01:41'),
(52187, 10057, 42799, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 09:01:10', '2021-10-28 09:01:10'),
(52188, 10057, 42799, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request ID for this Submission: 61497247  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  Please see attachments:', NULL, NULL, '2021-10-28 09:08:42', '2021-10-28 09:08:42'),
(52189, 10057, 42799, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : Laura.Bevin@aetna.com & DavisE11@aetna.com  Sub : Enrollment Status || VMUC || Edna Michi & Nubia Benavides || Aetna  Hello,  Hope this email finds you in good health. Could you provide me with the latest updates on below mentioned providers under TIN with all locations:  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Submission Request Reference:  1) Edna Michi - 31032361 2) Nubia Benavides - 61497247  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-17 11:46:57', '2021-11-17 11:46:57'),
(52190, 10057, 42799, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : gouldk@aetna.com  FW: [EXTERNAL] Enrollment Status || Valley Med Urgent Care PLLC || Edna Michi & Nubia Benavides || Aetna  Hi Steve – We contract urgent care on a facility agreement.  We do not credential and add the individual providers since we pay at the facility level.  I hope this helps.  Thanks, Kelly Gould', NULL, NULL, '2021-11-17 13:58:35', '2021-11-17 13:58:35'),
(52191, 10057, 42799, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : gouldk@aetna.com  Sub : Hello Kelly,  Thank you for reaching out. Can you please check the facility agreement for Valley Med Urgent Care PLLC. TIN 81-5123542 and let me know the next procedure ?  Looking forward to hearing from you.  Regards, Steve Albert ', NULL, NULL, '2021-11-17 13:59:54', '2021-11-17 13:59:54'),
(52192, 10057, 42799, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers   See Group Task', NULL, NULL, '2021-11-17 15:01:12', '2021-11-17 15:01:12'),
(52193, 10057, 42800, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 14:31:38', '2021-10-28 14:31:38'),
(52194, 10057, 42800, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785891  REF CODE : Tom 10282021', NULL, NULL, '2021-10-29 08:32:24', '2021-10-29 08:32:24'),
(52195, 10057, 42800, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Hello,  Hope your day is going well.  Thank you for submitting a request to participate in the Cigna network of health care professionals.  We are unable to continue processing your request at this time because one or more of the following items is missing from your file:  _X_ Other:  1. Please provide office and billing address and phone# for the Tax ID ending in 3542.  Please submit the missing information to this email within five business days from today so further processing of the credentialing application can continue.  Have a great day.  Thank you,', NULL, NULL, '2021-11-15 11:10:35', '2021-11-15 11:10:35'),
(52196, 10057, 42800, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Good afternoon!  Hope this email finds you well. Here is the information you requested.  Practice Name: Valley Med Urgent Care PLLC  Billing & Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address : 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248 Phone no. : (956) 546-2000            Fax no. : (956) 546-2001  If anything else is required please let me know.  Thanks & Regards,', NULL, NULL, '2021-11-15 11:10:56', '2021-11-15 11:10:56'),
(52197, 10057, 42800, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Good morning Steve!  I am well.  Thanks so much for asking.  Hope you are doing well.  Thanks so much for the information.  I have now sent the provider to be reviewed by our credentialing department.   For status updates, please contact 9PSSCENT@Cigna.com or call Provider Support & Solutions Unit at 800.882.4462.  Have a great day.  Thank you,  Provider SOLUTIONS & OPERATIONS Karla C. Payton Network Solutions & Ope', NULL, NULL, '2021-11-15 11:12:21', '2021-11-15 11:12:21'),
(52198, 10057, 42800, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & Karla.Payton@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:32:31', '2021-11-15 17:32:31'),
(52199, 10057, 42800, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : 9psscent@cigna.com  Sub : Cigna Credentialing Status Update: Credentialing Verification  Re:	Reference number 12785891 Application complete: Credentialing process to begin Dear EDNA MICHI,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely,  Cigna', NULL, NULL, '2021-11-17 10:27:07', '2021-11-17 10:27:07'),
(52200, 10057, 42800, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:45:44', '2021-11-30 11:45:44'),
(52201, 10057, 42800, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Nubia: Application no 12785887 Edna: Application no 12785891  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:26:12', '2021-12-06 17:26:12'),
(52202, 10057, 42800, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. The request is under credentialing process. Once it completed you will receive completion notification with effective date.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  •         Cigna Internal Reference # (W202112062038617)  PID	HCP name 4070881	EDNA MICHI 3233147	NUBIA BENAVIDES  Sincerely, PDM', NULL, NULL, '2021-12-13 12:30:44', '2021-12-13 12:30:44'),
(52203, 10057, 42800, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear EDNA MICHI,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/13/2021. Your provider identification number is‍ ‌4070881. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-20 11:08:13', '2021-12-20 11:08:13'),
(52204, 10057, 42800, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Provider is already approved email also received.  Just waiting to get provider directory update.', NULL, NULL, '2021-12-28 13:05:11', '2021-12-28 13:05:11'),
(52205, 10057, 42800, NULL, '2022-01-06 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear EDNA MICHI,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/13/2021. Your provider identification number is‍ ‌4070881. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-30 15:51:46', '2021-12-30 15:51:46'),
(52206, 10057, 42801, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 14:31:53', '2021-10-28 14:31:53'),
(52207, 10057, 42801, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785891  REF CODE : Tom 10282021', NULL, NULL, '2021-10-29 08:32:18', '2021-10-29 08:32:18'),
(52208, 10057, 42801, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Hello,  Hope your day is going well.  Thank you for submitting a request to participate in the Cigna network of health care professionals.  We are unable to continue processing your request at this time because one or more of the following items is missing from your file:  _X_ Other:  1. Please provide office and billing address and phone# for the Tax ID ending in 3542.  Please submit the missing information to this email within five business days from today so further processing of the credentialing application can continue.  Have a great day.  Thank you,', NULL, NULL, '2021-11-15 11:10:27', '2021-11-15 11:10:27'),
(52209, 10057, 42801, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Good afternoon!  Hope this email finds you well. Here is the information you requested.  Practice Name: Valley Med Urgent Care PLLC  Billing & Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address : 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248 Phone no. : (956) 546-2000            Fax no. : (956) 546-2001  If anything else is required please let me know.  Thanks & Regards,', NULL, NULL, '2021-11-15 11:10:46', '2021-11-15 11:10:46'),
(52210, 10057, 42801, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Good morning Steve!  I am well.  Thanks so much for asking.  Hope you are doing well.  Thanks so much for the information.  I have now sent the provider to be reviewed by our credentialing department.   For status updates, please contact 9PSSCENT@Cigna.com or call Provider Support & Solutions Unit at 800.882.4462.  Have a great day.  Thank you,  Provider SOLUTIONS & OPERATIONS Karla C. Payton Network Solutions & Ope', NULL, NULL, '2021-11-15 11:12:15', '2021-11-15 11:12:15'),
(52211, 10057, 42801, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & Karla.Payton@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:32:24', '2021-11-15 17:32:24'),
(52212, 10057, 42801, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : 9psscent@cigna.com  Sub : Cigna Credentialing Status Update: Credentialing Verification  Re:	Reference number 12785891 Application complete: Credentialing process to begin Dear EDNA MICHI,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely,  Cigna', NULL, NULL, '2021-11-17 10:27:02', '2021-11-17 10:27:02'),
(52213, 10057, 42801, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:45:39', '2021-11-30 11:45:39'),
(52214, 10057, 42801, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Nubia: Application no 12785887 Edna: Application no 12785891  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:26:05', '2021-12-06 17:26:05'),
(52215, 10057, 42801, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. The request is under credentialing process. Once it completed you will receive completion notification with effective date.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  •         Cigna Internal Reference # (W202112062038617)  PID	HCP name 4070881	EDNA MICHI 3233147	NUBIA BENAVIDES  Sincerely, PDM', NULL, NULL, '2021-12-13 12:30:39', '2021-12-13 12:30:39'),
(52216, 10057, 42801, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear EDNA MICHI,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/13/2021. Your provider identification number is‍ ‌4070881. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-20 11:08:05', '2021-12-20 11:08:05'),
(52217, 10057, 42801, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Provider is already approved email also received.  Just waiting to get provider directory update.', NULL, NULL, '2021-12-28 13:05:05', '2021-12-28 13:05:05'),
(52218, 10057, 42801, NULL, '2022-01-06 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear EDNA MICHI,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/13/2021. Your provider identification number is‍ ‌4070881. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-30 15:50:58', '2021-12-30 15:50:58'),
(52219, 10057, 42802, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 14:32:07', '2021-10-28 14:32:07'),
(52220, 10057, 42802, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785891  REF CODE : Tom 10282021', NULL, NULL, '2021-10-29 08:32:10', '2021-10-29 08:32:10'),
(52221, 10057, 42802, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Hello,  Hope your day is going well.  Thank you for submitting a request to participate in the Cigna network of health care professionals.  We are unable to continue processing your request at this time because one or more of the following items is missing from your file:  _X_ Other:  1. Please provide office and billing address and phone# for the Tax ID ending in 3542.  Please submit the missing information to this email within five business days from today so further processing of the credentialing application can continue.  Have a great day.  Thank you,', NULL, NULL, '2021-11-15 11:09:22', '2021-11-15 11:09:22'),
(52222, 10057, 42802, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Good afternoon!  Hope this email finds you well. Here is the information you requested.  Practice Name: Valley Med Urgent Care PLLC  Billing & Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address : 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248 Phone no. : (956) 546-2000            Fax no. : (956) 546-2001  If anything else is required please let me know.  Thanks & Regards,', NULL, NULL, '2021-11-15 11:10:13', '2021-11-15 11:10:13'),
(52223, 10057, 42802, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : Karla.Payton@cigna.com  Sub : Edna Michi PA - Cigna Missing Information Email 11122021  Good morning Steve!  I am well.  Thanks so much for asking.  Hope you are doing well.  Thanks so much for the information.  I have now sent the provider to be reviewed by our credentialing department.   For status updates, please contact 9PSSCENT@Cigna.com or call Provider Support & Solutions Unit at 800.882.4462.  Have a great day.  Thank you,  Provider SOLUTIONS & OPERATIONS Karla C. Payton Network Solutions & Ope', NULL, NULL, '2021-11-15 11:12:05', '2021-11-15 11:12:05'),
(52224, 10057, 42802, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & Karla.Payton@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:32:18', '2021-11-15 17:32:18'),
(52225, 10057, 42802, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : 9psscent@cigna.com  Sub : Cigna Credentialing Status Update: Credentialing Verification  Re:	Reference number 12785891 Application complete: Credentialing process to begin Dear EDNA MICHI,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely,  Cigna', NULL, NULL, '2021-11-17 10:26:47', '2021-11-17 10:26:47'),
(52226, 10057, 42802, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:45:33', '2021-11-30 11:45:33'),
(52227, 10057, 42802, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Nubia: Application no 12785887 Edna: Application no 12785891  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:25:59', '2021-12-06 17:25:59'),
(52228, 10057, 42802, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. The request is under credentialing process. Once it completed you will receive completion notification with effective date.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  •         Cigna Internal Reference # (W202112062038617)  PID	HCP name 4070881	EDNA MICHI 3233147	NUBIA BENAVIDES  Sincerely, PDM', NULL, NULL, '2021-12-13 12:30:34', '2021-12-13 12:30:34'),
(52229, 10057, 42802, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear EDNA MICHI,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/13/2021. Your provider identification number is‍ ‌4070881. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-20 11:07:52', '2021-12-20 11:07:52'),
(52230, 10057, 42802, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Provider is already approved email also received.  Just waiting to get provider directory update.', NULL, NULL, '2021-12-28 13:05:00', '2021-12-28 13:05:00'),
(52231, 10057, 42802, NULL, '2022-01-06 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear EDNA MICHI,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/13/2021. Your provider identification number is‍ ‌4070881. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-30 15:47:25', '2021-12-30 15:47:25'),
(52232, 10057, 42803, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 14:33:14', '2021-10-28 14:33:14'),
(52233, 10057, 42803, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785887  REF CODE : Tom 10282021', NULL, NULL, '2021-10-29 08:33:48', '2021-10-29 08:33:48'),
(52234, 10057, 42803, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & Karla.Payton@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:32:08', '2021-11-15 17:32:08'),
(52235, 10057, 42803, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:45:28', '2021-11-30 11:45:28'),
(52236, 10057, 42803, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Nubia: Application no 12785887 Edna: Application no 12785891  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:25:36', '2021-12-06 17:25:36'),
(52237, 10057, 42803, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. The request is under credentialing process. Once it completed you will receive completion notification with effective date.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  •         Cigna Internal Reference # (W202112062038617)  PID	HCP name 4070881	EDNA MICHI 3233147	NUBIA BENAVIDES  Sincerely, PDM', NULL, NULL, '2021-12-13 12:30:29', '2021-12-13 12:30:29'),
(52238, 10057, 42803, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear NUBIA BENAVIDES MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/14/2021. Your provider identification number is‍ ‌3233147. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-20 10:53:49', '2021-12-20 10:53:49'),
(52239, 10057, 42804, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 14:33:30', '2021-10-28 14:33:30'),
(52240, 10057, 42804, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785887  REF CODE : Tom 10282021', NULL, NULL, '2021-10-29 08:33:41', '2021-10-29 08:33:41'),
(52241, 10057, 42804, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & Karla.Payton@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:32:01', '2021-11-15 17:32:01'),
(52242, 10057, 42804, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:45:23', '2021-11-30 11:45:23'),
(52243, 10057, 42804, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Nubia: Application no 12785887 Edna: Application no 12785891  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:25:29', '2021-12-06 17:25:29'),
(52244, 10057, 42804, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. The request is under credentialing process. Once it completed you will receive completion notification with effective date.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  •         Cigna Internal Reference # (W202112062038617)  PID	HCP name 4070881	EDNA MICHI 3233147	NUBIA BENAVIDES  Sincerely, PDM', NULL, NULL, '2021-12-13 12:30:24', '2021-12-13 12:30:24'),
(52245, 10057, 42804, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear NUBIA BENAVIDES MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/14/2021. Your provider identification number is‍ ‌3233147. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-20 10:53:39', '2021-12-20 10:53:39'),
(52246, 10057, 42805, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 14:33:43', '2021-10-28 14:33:43'),
(52247, 10057, 42805, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Application submitted through the call.  Rep : Tom M  Status :   8002446224. Call credentialing for follow-up after 15 days. Time frame for credentialing is 90 - 120 days  Application no 12785887  REF CODE : Tom 10282021', NULL, NULL, '2021-10-29 08:33:31', '2021-10-29 08:33:31'),
(52248, 10057, 42805, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & Karla.Payton@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:31:55', '2021-11-15 17:31:55'),
(52249, 10057, 42805, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:45:17', '2021-11-30 11:45:17'),
(52250, 10057, 42805, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Nubia: Application no 12785887 Edna: Application no 12785891  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935  Please get back to me as soon as possible. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:25:05', '2021-12-06 17:25:05'),
(52251, 10057, 42805, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : Enrollment Query || VMUC || Nubia Benavides & Edna Michi || Cigna  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. The request is under credentialing process. Once it completed you will receive completion notification with effective date.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  •         Cigna Internal Reference # (W202112062038617)  PID	HCP name 4070881	EDNA MICHI 3233147	NUBIA BENAVIDES  Sincerely, PDM', NULL, NULL, '2021-12-13 12:30:12', '2021-12-13 12:30:12'),
(52252, 10057, 42805, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear NUBIA BENAVIDES MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Let’s get started Your effective date is 12/14/2021. Your provider identification number is‍ ‌3233147. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-12-20 10:53:27', '2021-12-20 10:53:27'),
(52253, 10057, 42806, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-28 16:18:29', '2021-10-28 16:18:29'),
(52254, 10057, 42806, NULL, '2021-11-05 00:00:00.000', 'Initiated', 'Request Initiated :   Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 102921HG1', NULL, NULL, '2021-10-29 09:22:09', '2021-10-29 09:22:09');
