Email received from: mdiprsupport@healthsmart.com  Subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian    Hi,  We are returning your application due to missing information listed below.  * SSN # * Current state license * W9 Form * Current certificate of Insurance * Explain in Work History * Explain in Employment * Current Release and Attestation date * ALL Disclosure Questions Answered * CAQH not Updated please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks. HealthSmart Provider Relations.