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
(55071, 19067, 52764, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'CAQH Application faxed at 866-612-7790. See attachment for reference.', NULL, NULL, '2022-01-24 15:04:14', '2022-01-24 15:04:14'),
(55072, 19067, 52764, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||     Greetings!  I would like to know the enrollment status of the following provider with Beacon Health Options & Beacon Health Strategies. I faxed the CAQH Application form for both locations.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Barbara Arnold	1922432053 Barbara Arnold	1922432053  Kindly respond promptly.  Regards,', NULL, NULL, '2022-01-30 12:53:07', '2022-01-30 12:53:07'),
(55073, 19067, 52764, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-04 07:20:21', '2022-02-04 07:20:21'),
(55074, 19067, 52764, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  You haven\'t responded yet. Looking forward to hearing from you soon.  Regards.', NULL, NULL, '2022-02-11 09:47:06', '2022-02-11 09:47:06'),
(55075, 19067, 52764, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||    Good Afternoon Amhed,     I have received your email and I’m looking into this. I’ll get back to you later today.     Thank you!  Elody Ramirez Jr.  Network Management Rep II, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630', NULL, NULL, '2022-02-14 10:02:18', '2022-02-14 10:02:18'),
(55076, 19067, 52764, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: praccredspec@beaconhealthoptions.com  Subject: Beacon Health Options Alert for ARNOLD, BARBARA L-CS19 - CRED INITIAL FINAL PEND - BH - TEST{C1876181} zx       IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1876181}  PLEASE NOTE:  To prevent the unauthorized or inadvertent disclosure of sensitive company or personal health (PHI) information encrypted emails are only permitted to be replied/forwarded to Beacon Health Options’ domains, Beaconhealthoptions.com, ValueOptions.com and Beaconhs.com', NULL, NULL, '2022-02-17 15:32:43', '2022-02-17 15:32:43'),
(55077, 19067, 52764, NULL, '2022-03-07 00:00:00.000', 'In Process', 'Email sent to: yolanda.ramos@beaconhealthoptions.com  Subject: Requested Document - SNBC - Barbara Arnold - BHO    Hi Yolanda!  Kindly see the attached as per your request.   Regards,', NULL, NULL, '2022-02-28 17:16:44', '2022-02-28 17:16:44'),
(55078, 19067, 52764, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Any updates on the enrollment process?  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-07 13:53:22', '2022-03-07 13:53:22'),
(55079, 22077, 52764, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||  Hello  Any updates on the request below?  Thanks', NULL, NULL, '2022-04-04 12:52:50', '2022-04-04 12:52:50'),
(55080, 19067, 52765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55081, 19067, 52765, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'CAQH Application faxed at 866-612-7790. See attachment for reference.', NULL, NULL, '2022-01-24 15:04:36', '2022-01-24 15:04:36'),
(55082, 19067, 52765, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||     Greetings!  I would like to know the enrollment status of the following provider with Beacon Health Options & Beacon Health Strategies. I faxed the CAQH Application form for both locations.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Barbara Arnold	1922432053 Barbara Arnold	1922432053  Kindly respond promptly.  Regards,', NULL, NULL, '2022-01-30 12:52:58', '2022-01-30 12:52:58'),
(55083, 19067, 52765, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-04 07:20:40', '2022-02-04 07:20:40'),
(55084, 19067, 52765, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  You haven\'t responded yet. Looking forward to hearing from you soon.  Regards.', NULL, NULL, '2022-02-11 09:47:01', '2022-02-11 09:47:01'),
(55085, 19067, 52765, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||    Good Afternoon Amhed,     I have received your email and I’m looking into this. I’ll get back to you later today.     Thank you!  Elody Ramirez Jr.  Network Management Rep II, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630', NULL, NULL, '2022-02-14 10:02:26', '2022-02-14 10:02:26'),
(55086, 19067, 52765, NULL, '2022-03-07 00:00:00.000', 'In Process', 'Email sent to: yolanda.ramos@beaconhealthoptions.com  Subject: Requested Document - SNBC - Barbara Arnold - BHO    Hi Yolanda!  Kindly see the attached as per your request.   Regards,', NULL, NULL, '2022-02-28 17:17:14', '2022-02-28 17:17:14'),
(55087, 19067, 52765, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Any updates on the enrollment process?  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-07 13:53:13', '2022-03-07 13:53:13'),
(55088, 22077, 52765, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||  Hello  Any updates on the request below?  Thanks', NULL, NULL, '2022-04-04 12:54:18', '2022-04-04 12:54:18'),
(55089, 19067, 52766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55090, 19067, 52766, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: Provider-Enrollment@bcbsma.com  Subject: Provider Enrollment Query || SNBCARE || Barbara Arnold || BCBS ||    Greetings!  We need to enroll the following provider with BCBS MA, Barbara Arnold NPI: 1922432053 under our group Spectrum Neuro Behavioral Care LLC. Let me know the next steps.  Regards. ', NULL, NULL, '2022-01-24 09:48:02', '2022-01-24 09:48:02'),
(55091, 19067, 52766, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider-Enrollment@bcbsma.com  Subject: Re: Provider Enrollment Query || SNBCARE || Barbara Arnold || BCBS ||    Hello!  Any update on this?  Kindly respond promptly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:31:00', '2022-02-04 09:31:00'),
(55092, 19067, 52766, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: ProviderApplicationStatus@bcbsma.com  Subject: 	RE: Provider Enrollment Query || SNBCARE || Barbara Arnold || BCBS ||  Hello:     You would need to send in an application for the provider.     Please see the link below for information in regard to participating with Blue Cross Blue Shield of Massachusetts and guidance through the application process.     https://provider.bluecrossma.com/ProviderHome/portal/home/office-resources/enrollment/become-a-blue-cross-provider     Please make sure you select the correct application based on the providers specialty.     Best,     Network Management Services  Blue Cross and Blue Shield of Massachusetts', NULL, NULL, '2022-02-10 16:17:15', '2022-02-10 16:17:15'),
(55093, 19067, 52766, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Sent a fax at 617-246-5053. ', NULL, NULL, '2022-03-09 13:24:25', '2022-03-09 13:24:25'),
(55094, 19067, 52766, NULL, '2022-04-08 00:00:00.000', 'In Process', 'Email received from: ellen.dyer@bcbsma.com  Subject: Signature requested on \"Spectrum Neuro Behav_BHG__Barbara Arnold_0422_Attachment A.pdf\"    Hello,  Please review and sign the attached documents.  C074167 Barbara Arnold', NULL, NULL, '2022-04-01 11:21:36', '2022-04-01 11:21:36'),
(55095, 19067, 52767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55096, 19067, 52767, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Application initiated through Portal. See Attachment.', NULL, NULL, '2022-01-14 11:18:48', '2022-01-14 11:18:48'),
(55097, 19067, 52767, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com, Behavioralcontracting@evernorth.com, behPWS@cigna.com  Subject: Enrollment Query || Barbara Arnold || SNBCARE || Cigna ||   Hello!  Hope this email finds you well.  I would like to know the enrollment status of the following provider with Cigna.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Barbara Arnold	1922432053 Barbara Arnold	1922432053   Kindly respond promptly.  Regards,', NULL, NULL, '2022-02-04 12:02:04', '2022-02-04 12:02:04'),
(55098, 19067, 52767, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Query || Barbara Arnold || SNBCARE || Cigna ||    Your application is being processed    Thank you for reaching out to Evernorth Behavioral Health about the status of your application. My records show the following regarding your status:     c  Packet received – provider is in que for credentialing at current time there is no action needed from the provider or your office.      Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date.     Your assigned Evernorth Recruiter is:     Amanda Williams amanda.williams2@evernorth.com    You will need to follow up with the above recruiter for further details about regarding your credentialing status. I have copied your recruiter on this email for your convenience.', NULL, NULL, '2022-02-08 14:11:28', '2022-02-08 14:11:28'),
(55099, 19067, 52767, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: amanda.williams2@evernorth.com  Subject: Re: [External] Enrollment Query || Barbara Arnold || SNBCARE || Cigna ||   Good Morning Amanda!  Hope you are doing well. Can I get the welcome letter for the provider, Barbara Arnold.  Thanks!', NULL, NULL, '2022-03-17 10:47:28', '2022-03-17 10:47:28'),
(55100, 22077, 52767, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Fwd: [External] Enrollment Query || Barbara Arnold || SNBCARE || Cigna |  Hello!  Hope you are doing well. Can I get the welcome letter for the provider, Barbara Arnold.  Thanks!', NULL, NULL, '2022-04-04 13:10:24', '2022-04-04 13:10:24'),
(55101, 19067, 52768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55102, 19067, 52768, NULL, '2022-01-21 00:00:00.000', 'On Hold', 'Waiting for Aetna enrollment.', NULL, NULL, '2022-01-14 14:04:59', '2022-01-14 14:04:59'),
(55103, 19067, 52769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55104, 19067, 52769, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Greetings!  I would like to enroll the following provider, Barbara Arnold NPI: 1922432053. Please see the attached roster.  Let me know if anything is required.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-24 14:06:40', '2022-01-24 14:06:40'),
(55105, 19067, 52769, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Greetings!  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:03:39', '2022-01-30 13:03:39'),
(55106, 19067, 52769, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Hello!  Hope you are doing well.  I haven\'t heard from you in a while. Kindly look into my request.  Regards, Hammad.', NULL, NULL, '2022-02-08 14:16:41', '2022-02-08 14:16:41'),
(55107, 19067, 52769, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: BehavioralHealthProviderServices@humana.com, mtasby2@humana.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||  Hello!  I would like to enroll a provider with Humana as in-network. Kindly see attached roster  Kindly look into my request as soon as possible as it is time sensitive.  Regards,', NULL, NULL, '2022-03-09 14:06:19', '2022-03-09 14:06:19'),
(55108, 19067, 52769, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: RE: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||    Ahmed,     Spectrum Neuro Behavioral Care LLC, market roster submitted. Please allow up to 30 business days for complete processing (unless otherwise specified by state law). If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID. You will receive confirmation once the provider(s) have been added to the group.        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 13:20:35', '2022-03-10 13:20:35'),
(55109, 19067, 52769, NULL, '2022-04-07 00:00:00.000', 'Approved', 'Email received from: behavioralhealthproviderservices@humana.com  Subject: MA - Spectrum Neuro Behavioral Care LLC/ Barbara Arnold - Provider Status    Good afternoon,     Provider Barbara Arnold NPI 1922432053 has been added/linked to the groups contract with Humana Behavioral Health Network  effective 1/1/2022.     To check provider status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory.     If you have additional questions or concerns feel free to email behavioralhealthproviderservices@humana.com.     Emails are worked in the order they are received; please be advised that response times can take 30 Days.     Thank you,     Wanda M.     Behavioral Health Provider Services  Humana Behavioral Health Network  2001 W. John Carpenter Freeway Irving, TX 75063  T 800-890-8288  F 833-931-0662  behavioralhealthproviderservices@humana.com', NULL, NULL, '2022-03-31 13:05:50', '2022-03-31 13:05:50'),
(55110, 19067, 52770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55111, 19067, 52770, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Application initiated through Portal.', NULL, NULL, '2022-01-14 15:12:24', '2022-01-14 15:12:24'),
(55112, 19067, 52770, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Hello Judith!  I would like to know the enrollment status of the following provider. I initiated the application through the portal.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Barbara Arnold	1922432053 Barbara Arnold	1922432053  Regards.', NULL, NULL, '2022-02-11 10:20:27', '2022-02-11 10:20:27'),
(55113, 19067, 52770, 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 morning,  The provider was added to the roster 1/14/2022 and the provider is in the credentialing process.   Judy', NULL, NULL, '2022-02-11 10:38:20', '2022-02-11 10:38:20'),
(55114, 19067, 52770, 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 11:42:56', '2022-03-17 11:42:56'),
(55115, 22077, 52770, 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 14:27:34', '2022-04-04 14:27:34'),
(55116, 22077, 52770, 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 14:22:54', '2022-04-05 14:22:54'),
(55117, 19067, 52771, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55118, 19067, 52771, NULL, NULL, 'Not Eligible', '', NULL, NULL, '2022-03-18 13:22:08', '2022-03-18 13:22:08'),
(55119, 19067, 52772, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55120, 19067, 52772, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Greeting!  We would like to enroll the following provider, Barbara Arnold NPI: 1922432053. Please see the attached application.  Let me know if anything is required.  Regards, Hammad Ahmed', NULL, NULL, '2022-01-24 13:20:00', '2022-01-24 13:20:00'),
(55121, 19067, 52772, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Hi, Hammad!     Barbara’s actually not yet Tricare-certified, so if she’s not done so, she’ll need to fill out this app     http://apps.humana.com/marketing/documents.asp?file=4199936     and fax it with her license to WPS at 608-221-7535. Oh, and FYI, Anne has moved to a different part of the company, so she no longer handles this kind of stuff.     Thanks!          Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com', NULL, NULL, '2022-01-24 15:23:15', '2022-01-24 15:23:15'),
(55122, 19067, 52772, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Sent a fax at 608-221-7535. See attachment for reference.', NULL, NULL, '2022-01-24 15:54:41', '2022-01-24 15:54:41'),
(55123, 19067, 52772, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Hello!  I faxed the application on 01/24/2022. Any updates on the request so far?  Regards, Hammad. ', NULL, NULL, '2022-02-11 11:26:27', '2022-02-11 11:26:27'),
(55124, 19067, 52772, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Oh, no; new certs are taking about four months to process. I can escalate at three if it’s not complete, but even that is more than two months away.  ', NULL, NULL, '2022-02-16 09:42:08', '2022-02-16 09:42:08'),
(55125, 19067, 52772, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare    Hi Chuck,  Thanks for the update. Has the process started yet?  Regards, Hammad.', NULL, NULL, '2022-02-16 09:43:03', '2022-02-16 09:43:03'),
(55126, 19067, 52772, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare    Morning, Hammad!     I can only presume so. Since those apps go to WPS, and I have no access to their systems, I’m blind as to an app’s progress. I can tell when it’s done, because then it appears on my screens, but nothing before that.', NULL, NULL, '2022-02-16 09:43:57', '2022-02-16 09:43:57'),
(55127, 19067, 52772, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Morning, Hammad!     I can only presume so. Since those apps go to WPS, and I have no access to their systems, I’m blind as to an app’s progress. I can tell when it’s done, because then it appears on my screens, but nothing before that.', NULL, NULL, '2022-03-17 09:40:50', '2022-03-17 09:40:50'),
(55128, 19067, 52772, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Good Morning Chuck!  Hope you are doing well. Any updates on the process as of yet?  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 09:42:33', '2022-03-17 09:42:33'),
(55129, 22077, 52772, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare  Hello,  What are the updates for the enrollment process of Barbara Arnold  Thanks', NULL, NULL, '2022-04-06 13:54:43', '2022-04-06 13:54:43'),
(55130, 22077, 52772, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare  Hi, Alex!   Nothing yet, which is what I’d expect. If we get to the 24th with no action, then I can escalate it.     Thanks!', NULL, NULL, '2022-04-07 10:36:31', '2022-04-07 10:36:31'),
(55131, 19067, 52773, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55132, 19067, 52773, NULL, '2022-01-21 00:00:00.000', 'Approved', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    Greetings!  Hope this email finds you well.  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-14 16:23:05', '2022-01-14 16:23:05'),
(55133, 19067, 52774, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55134, 19067, 52774, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    Greetings!  Hope this email finds you well.  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-14 16:23:12', '2022-01-14 16:23:12'),
(55135, 19067, 52774, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: Provider_Data_Request@tufts-health.com  Subject: PRO0161963 - Request Received   Hello ,  We are in receipt of your request regarding Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS that was submitted on 2022-01-14 16:32:46 EST.  Please reference ticket number PRO0161963 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG8218378 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). SMR1.Point32Health.org made the following annotations', NULL, NULL, '2022-01-24 16:21:45', '2022-01-24 16:21:45'),
(55136, 19067, 52774, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS   Hello!  Any updates on the previously mentioned request?   Reference Ticket Number: PRO0161963   Regards, Hammad.', NULL, NULL, '2022-02-11 12:01:55', '2022-02-11 12:01:55'),
(55137, 19067, 52774, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: servicenow@point32health.org  Subject: Number: PPO0142872 - Request Completed    Hello,  We are in receipt of your request regarding Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS originally sent to tufts_health_plan_credentialing_department@tufts-health.com,Provider_Data_Request@tufts-health.com regarding your Status Inquiry submitted on 2022-01-14 16:32:47 EST.  Please reference ticket number PPO0142872 for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG8551326 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907).', NULL, NULL, '2022-03-18 13:19:49', '2022-03-18 13:19:49'),
(55138, 19067, 52774, NULL, '2022-03-25 00:00:00.000', 'Not Eligible', 'Email received from: Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Subject: PPO0142872 - Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    incident number - PPO0142872   Hi Hammad:   Sorry for the delay in answering your email.   Our Allied Health Contracting Department reviewed her application and decided she was not eligible for a contract.  They sited \"Eligibility not met\".    For further information, please reach out to them at AHCBehavioralHealth@Tufts-Health.com.   Regards,   Provider Operations Team Tufts Health Plan   Ref:MSG8551323', NULL, NULL, '2022-03-18 13:23:28', '2022-03-18 13:23:28'),
(55139, 19067, 52775, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55140, 19067, 52775, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Application initiated through Portal. See attachment for reference.', NULL, NULL, '2022-01-24 11:06:38', '2022-01-24 11:06:38'),
(55141, 19067, 52775, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Application initiated through Portal. See attachment for reference.', NULL, NULL, '2022-01-24 11:06:53', '2022-01-24 11:06:53'),
(55142, 19067, 52775, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || UBH ||   Greetings!  Hope you\'re doing well.  I would like to know the enrollment status of the following provider. I initiated an application via portal.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Barbara Arnold	1922432053 Barbara Arnold	1922432053  Regards,', NULL, NULL, '2022-02-11 11:31:51', '2022-02-11 11:31:51'),
(55143, 1019, 52775, NULL, '2022-02-21 00:00:00.000', 'Not Eligible', 'Received the following email from Optum, as she is a LCSW.  2/10/2022   Attn:  Alex Garrett, Credentialing Contact  barbaralynnearnold@gmail.com  snbc@claimsmedinc.com    RE:  Network Participation - Barbara Arnold    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      a0b2T000008EaLO|AMTLetter|Letters    United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum  U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California    © 2021 Optum, Inc. All Rights Reserved  BH3315b_04/2021', NULL, NULL, '2022-02-14 12:54:13', '2022-02-14 12:54:13'),
(55144, 19067, 52776, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 13:36:27', '2022-01-14 13:36:27'),
(55145, 19067, 52776, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || Commonwealth Care Alliance ||    Greetings!   We want to enroll the following provider. Please see the attached application.  Let me know if anything is required.  Thanks, Hammad Ahmed', NULL, NULL, '2022-01-24 09:55:59', '2022-01-24 09:55:59'),
(55146, 19067, 52776, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: PNMDepartment@commonwealthcare.org  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Commonwealth Care Alliance ||    Hello,     Provider Barbara L Arnold, LCSW Is effective 01/24/2022 at Spectrum Neuro Behavioral Care LLC.     Thanks,', NULL, NULL, '2022-02-10 16:33:26', '2022-02-10 16:33:26'),
(55147, 19067, 52776, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: PNMDepartment@commonwealthcare.org  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Commonwealth Care Alliance ||    Hi,  Can you please confirm the affected location?  Regards. ', NULL, NULL, '2022-02-17 13:51:46', '2022-02-17 13:51:46'),
(55148, 19067, 52776, NULL, '2022-02-24 00:00:00.000', 'Approved', 'Received the following email from: PNMDepartment@commonwealthcare.org  Hello,     Provider Barbara L Arnold, LCSW is active at 2 primary locations below:  61 Lincoln St Suite 203  100 New State Hwy under tin - 834482753     Thank You,', NULL, NULL, '2022-02-17 13:52:33', '2022-02-17 13:52:33'),
(55149, 19067, 52777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 15:19:30', '2022-01-14 15:19:30'),
(55150, 19067, 52777, NULL, '2022-01-21 00:00:00.000', 'Approved', 'Kindly see the Approval Letter.', NULL, NULL, '2022-01-14 15:21:46', '2022-01-14 15:21:46'),
(55151, 19067, 52778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 15:19:47', '2022-01-14 15:19:47'),
(55152, 19067, 52778, NULL, '2022-03-08 00:00:00.000', 'Approved', 'Kindly see the approval letter. ', NULL, NULL, '2022-03-01 16:09:02', '2022-03-01 16:09:02'),
(55153, 19067, 52779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 15:21:46', '2022-01-14 15:21:46'),
(55154, 1019, 53748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-18 16:40:10', '2022-01-18 16:40:10'),
(55155, 1019, 53748, NULL, '2022-01-25 00:00:00.000', 'Initiated', 'Sent the following email for superior.  Sub: Practice Address Change Request || Group || UHC || GCIA Hello,  We want to change the mailing and servicing address for the following group, please get back to me with the next steps.   Group: Gulf Coast Imaging & Associates, LLC NPI: 1750871414 Tax ID: 820701672   Regards, Alex', NULL, NULL, '2022-01-18 16:41:36', '2022-01-18 16:41:36'),
(55156, 19067, 53748, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Faxed W9 for address modification. See attachment for reference.', NULL, NULL, '2022-02-07 15:08:28', '2022-02-07 15:08:28'),
(55157, 20067, 53748, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@SuperiorHealthPlan.com, Daniel.Velez@superiorhealthplan.com  Sub: Practice Address Change Request || Group || Superior Health || GCIA  Good Afternoon!  We\'ve submitted the address change request through fax on 02/07/2022. I would like to know the status of the request. Group Information is listed below.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363   Thank you,', NULL, NULL, '2022-03-07 13:01:58', '2022-03-07 13:01:58'),
(55158, 19067, 53748, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email received from: AM.Hidalgo@superiorhealthplan.com  Subject: Practice Address Change Request || Group || Superior Health || GCIA    Good Afternoon Corpus Team,     Would you kindly assist provider with email below.     Provider is located in Kingsville.   Thank you,     Nancy Peña  Provider Account Manager,  Hidalgo SDA  Account Management Team', NULL, NULL, '2022-03-07 17:58:43', '2022-03-07 17:58:43'),
(55159, 19067, 53748, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Practice Address Change Request || Group || Superior Health || GCIA    Good afternoon,     Your inquiry below was received (case #83834) and I wanted to provide an update to your demographic update request.     On 01/18/22 we received your email (attached) and assigned to an Account Manager under case #75971. The Account Manager provided education on how to submit your request for the demographic update. I’ve attached the email for your review.     The forms needed to complete the demographic update were not received so the request has not been submitted. Please review the email attached and complete the 2 forms required to complete your request. Email the completed forms back to AM.Houston@superiorhealthplan.com so an Account Manager can submit the required documents to our Provider Data Management team for processing.     Thank you,     Melinda Mendoza Account Manager  Provider Relations Department    711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401  Tolll-Free:  1-800-656-4817 Option 1 then Option 3  Fax:  1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-07 17:59:28', '2022-03-07 17:59:28'),
(55160, 19067, 53748, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Practice Address Change Request || Group || Superior Health || GCIA    Good Morning!  Hope this email finds you well. Kindly see the attached as per requested.  Thanks, Hammad Ahmed ', NULL, NULL, '2022-03-08 10:40:37', '2022-03-08 10:40:37'),
(55161, 19067, 53748, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Practice Address Change Request || Group || Superior Health || GCIA    Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #84039     Thank you,     Deidra Hernandez  Provider Account Manager    Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.Houston@SuperiorHealthPlan.com | SuperiorHealthPlan.com', NULL, NULL, '2022-03-08 14:44:14', '2022-03-08 14:44:14'),
(55162, 1009, 53748, NULL, '2022-04-05 00:00:00.000', 'In Process', 'Email sent to AM.Hidalgo@superiorhealthplan.com, Daniel.Velez@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Good Afternoon!  We\'ve submitted the address change request through fax on 02/07/2022. I would like to know the status of the request. Group Information is listed below.  Group Name Gulf Coast Imaging & Associates, LLC Tax ID 82-0701672 Group NPI 1750871414 Primary & Billing Location 500 E Caesar Ave, Suite B, Kingsville, TX 78363  Thank you,', NULL, NULL, '2022-03-29 16:27:18', '2022-03-29 16:27:18'),
(55163, 19067, 53748, NULL, '2022-04-07 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: REF # 84039 RE: Practice Address Change Request || Group || Superior Health || GCIA   Hello,     I hope you are doing well today.     Please note the request demo/W9 update has been submitted as a high priority under PRT-55707.     Once it has been completed AM will reach out to you. Please let us know if you have any questions     Thank you.     Bricia N. Martinez Provider Account Manager II   711 N. Carancahua Street, Ste. 600 Corpus Christi, TX 78401 Toll- Free: 1-800-656-4817, Option 1, than Option 3 Fax: 1-866-683-5630 ', NULL, NULL, '2022-03-31 13:15:11', '2022-03-31 13:15:11'),
(55164, 1019, 53749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-18 17:33:15', '2022-01-18 17:33:15'),
(55165, 1019, 53749, NULL, '2022-01-25 00:00:00.000', 'Initiated', 'Sent the following email for superior.  Sub: Practice Address Change Request || Group || Driscoll || GCIA Hello,  We want to change the mailing and servicing address for the following group, please get back to me with the next steps.   Group: Gulf Coast Imaging & Associates, LLC NPI: 1750871414 Tax ID: 820701672   Regards, Alex', NULL, NULL, '2022-01-18 17:33:53', '2022-01-18 17:33:53'),
(55166, 19067, 53749, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Left a voicemail @ 361-694-6552 (Esmie Silva)', NULL, NULL, '2022-02-07 11:01:16', '2022-02-07 11:01:16'),
(55167, 19067, 53749, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Esmie.Silva@dchstx.org  Subject: Re: address change    Wally,     Will anything else change: phone, fax, billing, credentialing, mailing addresses. And I we need a current W9.     Thanks     Esmie Silva  Provider Relations Representative  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-6552  Cell: (361) 739-6476  Fax: (956) 992-0392  Email: esmie.silva@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2022-02-17 17:48:56', '2022-02-17 17:48:56'),
(55168, 19067, 53749, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: esmie.silva@dchstx.org  Subject: Re: address change    Good Afternoon Silva,  We have an updated address for billing, credentialing, pay to and mailing address which is updated in the W9 form. Please review the attached W9 form.  Do let me know if you have any questions.  Thank you for contacting us!', NULL, NULL, '2022-02-17 17:49:50', '2022-02-17 17:49:50'),
(55169, 1009, 53749, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Received a response from Silva  Good morning Wally,     DHP has 30 days to complete an address change. ', NULL, NULL, '2022-02-18 10:36:20', '2022-02-18 10:36:20'),
(55170, 20067, 53749, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: Esmie.Silva@dchstx.org  Sub: Address Change || Gulf Coast Imaging & Associates || Driscoll  Good Afternoon!  I am writing this email to confirm if the location is updated in our directory or not?  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363   Thank you,', NULL, NULL, '2022-03-07 14:04:38', '2022-03-07 14:04:38'),
(55171, 20067, 53749, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email received from: Esmie.Silva@dchstx.org  Sub:  Address Change || Gulf Coast Imaging & Associates || Driscoll   Syed,    Driscoll has 30 days from the day we receive all the correct information including W9 to process the address change.  Information was received on Feb. 18. I will follow up.  Hope this helps. ', NULL, NULL, '2022-03-07 15:36:49', '2022-03-07 15:36:49'),
(55172, 1009, 53749, NULL, '2022-04-05 00:00:00.000', 'In Process', 'Good Morning Wally,     I’m sorry you haven’t been able to get a hold of Esmie, but can you please provide me with the following information and I will do a record change request right now?     Information needed upon submitting a request to DHP:  Brief statement-explaining if you’re add/terming/changing a practice location, provider, Tax ID.    Provider Name:  Group Name:  Tax ID#:  New Address:  Term old address if it applies  Phone#  Fax #:  Business Hours:  Age Limitations:  Individual NPI#  Individual TPI#:  Group NPI:  Group TPI:  Mailing Address:  Billing Address:  Pay to Address:  Credentialing Address:  W-9:  ', NULL, NULL, '2022-03-29 15:18:11', '2022-03-29 15:18:11'),
(55173, 1009, 53749, NULL, '2022-04-05 00:00:00.000', 'In Process', 'Good Afternoon Miguel,  Sorry for the late response. Please review the attachment and let me know what\'s the time process to change the address so we can submit the claims. We have claims and we don\'t want that those claims get timely file. Please respond at your earliest convenience.  Thank you for your help and let me know if you have any questions.', NULL, NULL, '2022-03-29 15:19:10', '2022-03-29 15:19:10'),
(55174, 1009, 53749, NULL, '2022-04-08 00:00:00.000', 'In Process', 'Received an email from Miguel,  Good Afternoon Wally,     I got your email for the change request but it can take up to 30 days for a change to be made. If you have any questions, please feel free to contact me.', NULL, NULL, '2022-04-01 12:44:08', '2022-04-01 12:44:08'),
(55175, 20067, 54748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-21 17:10:50', '2022-01-21 17:10:50'),
(55176, 20067, 54748, NULL, '2022-01-28 00:00:00.000', 'Approved', 'received the following email  Good Afternoon,  Please see attached welcome packet.  Thanks,  Effective Date: 01/19/2022', NULL, NULL, '2022-01-21 17:13:51', '2022-01-21 17:13:51'),
(55177, 20067, 54749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-21 17:46:03', '2022-01-21 17:46:03'),
(55178, 20067, 54749, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Received the following email  Please see attached welcome packet thank you.     Thanks,  Effective date: 01/19/2022', NULL, NULL, '2022-01-21 17:48:55', '2022-01-21 17:48:55'),
(55179, 20067, 54750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-24 10:25:29', '2022-01-24 10:25:29'),
(55180, 1019, 54750, NULL, '2022-02-21 00:00:00.000', 'Initiated', 'Request sent to Jquonda via Email, see attached for the agreement signed by provider', NULL, NULL, '2022-02-14 13:46:32', '2022-02-14 13:46:32'),
(55181, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-03-17 09:29:11', '2022-03-17 09:29:11'),
(55182, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Attached are the W9 for the Urgent Care Centers. Let me know if you have any questions.   Regards, Alex ', NULL, NULL, '2022-03-17 09:30:11', '2022-03-17 09:30:11'),
(55183, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  Attached please find the contracts.  Please let me know if you have any questions.  Thanks', NULL, NULL, '2022-03-17 09:31:01', '2022-03-17 09:31:01'),
(55184, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  As per our previous discussions the Urgent care contract has to be for $150.00, but you have sent me the contracts for $125.00.    Regards, Alex', NULL, NULL, '2022-03-17 09:31:55', '2022-03-17 09:31:55'),
(55185, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from:  Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  My apologies.  Here you go.  I\'ll correct the other contracts and get them back to you.  Thanks', NULL, NULL, '2022-03-17 09:33:02', '2022-03-17 09:33:02'),
(55186, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub:Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Any update on the agreements also can you please expedite the one of Valley Med as we are losing 50 to 60 patients daily.    Regards, Alex', NULL, NULL, '2022-03-17 09:33:55', '2022-03-17 09:33:55'),
(55187, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  Any updates on the remaining agreements?  Thanks, Jquonda', NULL, NULL, '2022-03-17 09:35:04', '2022-03-17 09:35:04'),
(55188, 20067, 54750, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub:Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Hope you\'re doing as I was not well so I was out of the office attached are the remaining agreements, I\'ll share the others as well by today. ', NULL, NULL, '2022-03-17 09:35:35', '2022-03-17 09:35:35'),
(55189, 19067, 54751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-24 15:06:20', '2022-01-24 15:06:20'),
(55190, 19067, 54751, NULL, '2022-01-31 00:00:00.000', 'Not Eligible', 'Not Eligible due to LCSW', NULL, NULL, '2022-01-24 15:10:10', '2022-01-24 15:10:10'),
(55191, 19067, 54752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-24 17:31:53', '2022-01-24 17:31:53'),
(55192, 19067, 54752, NULL, '2022-01-31 00:00:00.000', 'New/Not Initiated', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Query || Group || GCIA || Cigna ||     Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following group with Cigna.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363  Have a beautiful day! Hammad Ahmed. ', NULL, NULL, '2022-01-24 17:39:57', '2022-01-24 17:39:57'),
(55193, 19067, 54752, NULL, '2022-02-03 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-01-27 09:41:29', '2022-01-27 09:41:29');
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
(55194, 19067, 54752, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Secure email received from: PDMCOGZ@cigna.com  Subject: New Email Notice: You have a secure email from Cigna  /  Completion Notification_W202201242139130     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 # (W202201242139130).     PID  HCP Name  2068501  GULF COAST IMAGING & ASSOCIATES LLC     As per the source document the request has been completed.        Sincerely,  PDM', NULL, NULL, '2022-01-27 09:42:40', '2022-01-27 09:42:40'),
(55195, 19067, 54752, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Spoke with Kamarine, she said the application is in process. It will take 20-25 business days. Cigna Internal Reference # (W202201242139130).  Ref# KAMARINE02072022', NULL, NULL, '2022-02-07 10:35:31', '2022-02-07 10:35:31'),
(55196, 19067, 54752, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: psscentral@cigna.com  Subject: Provider Services and Contracting - GCIA - Cigna   Hi,  I would like to enroll the below group as an in-network with Cigna  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363 Primary Specialty	261QR0208X - Clinic/Center Radiology, Mobile Secondary Specialty	335V00000X - Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier  Regards,', NULL, NULL, '2022-03-07 10:24:04', '2022-03-07 10:24:04'),
(55197, 1009, 54752, NULL, '2022-04-05 00:00:00.000', 'In Process', 'Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following group with Cigna.  Group Name Gulf Coast Imaging & Associates, LLC Tax ID 82-0701672 Group NPI 1750871414 Primary & Billing Location 500 E Caesar Ave, Suite B, Kingsville, TX 78363  Have a beautiful day!', NULL, NULL, '2022-03-29 16:22:33', '2022-03-29 16:22:33'),
(55198, 19067, 54753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-24 17:43:36', '2022-01-24 17:43:36'),
(55199, 19067, 54753, NULL, '2022-01-31 00:00:00.000', 'New/Not Initiated', 'Email sent to: stxnm@humana.com, LClark44@humana.com  Subject: Enrollment Query || Group || GCIA || Humana ||  Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following group with Humana.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363  Have a beautiful day!  Hammad Ahmed', NULL, NULL, '2022-01-24 17:44:18', '2022-01-24 17:44:18'),
(55200, 19067, 54753, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Called Humama @ 800-626-2741 spoke with Jayson. She gave me the effective date which is 06/01/2020. Requested an approval letter.  Plans: Humana HMO, Medicare HMO, Medicare PPO, Humana PPO.   Ref: 2000226491198 ', NULL, NULL, '2022-02-07 13:07:58', '2022-02-07 13:07:58'),
(55201, 19067, 54753, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email sent to: HGamboa@humana.com  Subject: Location Update || Gulf coast Imaging Associates LLC_2000228320923 || Group || Humana    Hello!  Kindly see the attached form for service location update as requested. Don\'t hesitate to contact me if you have any questions or concerns.  Regards,', NULL, NULL, '2022-02-15 16:23:22', '2022-02-15 16:23:22'),
(55202, 19067, 54753, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: rsolis@humana.com  Subject: (NRC) Credentialing application for Gulf Coast Imaging   Hello  I spoke with Leonel Riviera today and he informed me that Gulf Coast Imaging & Assoc has moved and had the phone number changed as well.  I have updated our records but we will need a new credentialing application with the new information.  I have attached a blank one in case you need it.  Please return to me for processing.     Thank you     Becky Solis     Network Operations Coordinator – Provider Contracting  (NRC 7 day)  South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229     F 855.461.6048  stxnm@humana.com', NULL, NULL, '2022-02-16 15:03:01', '2022-02-16 15:03:01'),
(55203, 19067, 54753, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: rsolis@humana.com  Subject: Re: (NRC) Credentialing application for Gulf Coast Imaging   Hi Becky!  Kindly see the attached form as per your request.  Don\'t hesitate to reach out to me if you need any document or information.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 11:08:33', '2022-02-21 11:08:33'),
(55204, 20067, 54753, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: rsolis@humana.com  Sub: Re: (NRC) Credentialing application for Gulf Coast Imaging   Good Morning!  Hope this email finds you in good health. Any updates on the application?  Thank you, Syed Ahad.', NULL, NULL, '2022-03-07 12:23:56', '2022-03-07 12:23:56'),
(55205, 1009, 54753, NULL, '2022-04-05 00:00:00.000', 'In Process', 'Email sent to rsolis@humana.com   Good Morning!  Hope this email finds you in good health. Any updates on the application?  Thank you,', NULL, NULL, '2022-03-29 16:25:37', '2022-03-29 16:25:37'),
(55206, 19067, 54753, NULL, '2022-04-08 00:00:00.000', 'In Process', 'Email sent to: rsolis@humana.com  Subject: Fwd: (NRC) Credentialing application for Gulf Coast Imaging    Hi Becky,  Kindly see the attached form.  Thanks,', NULL, NULL, '2022-04-01 18:03:37', '2022-04-01 18:03:37'),
(55207, 19067, 54753, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email received from: rsolis@humana.com  Subject: RE: (NRC) Credentialing application for Gulf Coast Imaging    Hello  I am no longer going to be in this department after April 8th.  I have forwarded your email to stxnm@humana.com which is the department I currently work in.  They will assign your task appropriately.     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  bs', NULL, NULL, '2022-04-04 08:06:47', '2022-04-04 08:06:47'),
(55208, 19067, 54753, NULL, '2022-04-19 00:00:00.000', 'In Process', 'Sent a fax @ 608-221-7535.', NULL, NULL, '2022-04-12 13:51:48', '2022-04-12 13:51:48'),
(55209, 19067, 54753, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: rsolis@humana.com  Subject: Fwd: (NRC) Credentialing application for Gulf Coast Imaging    Hello,     Hope you are doing well, kindly update us on the request that Becky forwarded you on April 2nd. Also please provide the new POC name and contact information for future communication.     Regards,  Sufyan  ', NULL, NULL, '2022-04-13 11:02:12', '2022-04-13 11:02:12'),
(55210, 19067, 54754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-24 17:47:27', '2022-01-24 17:47:27'),
(55211, 19067, 54754, NULL, '2022-01-31 00:00:00.000', 'New/Not Initiated', 'Email sent to: BharathB@aetna.com, SidleyJ1@firsthealth.com, pdsdallas@aetna.com, MadirajuP@aetna.com  Subject: Enrollment Query || Group || GCIA || First Health ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following group with First Health.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363  Have a beautiful day!  Hammad.', NULL, NULL, '2022-01-24 17:48:42', '2022-01-24 17:48:42'),
(55212, 19067, 54754, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, SidleyJ1@firsthealth.com, pdsdallas@aetna.com, MadirajuP@aetna.com  Subject: Enrollment Query || Group || GCIA || First Health ||    Hello!  Hope this email finds you well. Any updates on the below mentioned request?  Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-07 09:26:48', '2022-02-07 09:26:48'),
(55213, 19067, 54754, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Secure email received from: SidleyJ1@firsthealth.com  Subject: [SEND SECURE] RE: [EXTERNAL] Enrollment Query || Group || GCIA || First Health ||   Good afternoon,     I hope that this email finds you well!     I do not show this TIN as participating within the FH network. I also do not show a current negotiation in our system with another negotiator.     Please click or copy/paste the link https://tinyurl.com/FirstHealth-100TX to review an agreement. The system will walk you through the fields that need to be completed on the provider end. The system will automatically send you a copy of the fully signed agreement once we have counter-signed. I will then work with our Data Team for implementation into our systems.     Please do not hesitate to reach out if you have any questions or concerns when reviewing.     Take care,     Jeanette Sidley  Senior Analyst, Network Relations    Phone: 916-374-4876  SidleyJ1@firsthealth.com  TX, CO, KS, OK and MI', NULL, NULL, '2022-02-09 10:58:10', '2022-02-09 10:58:10'),
(55214, 19067, 54754, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Signed the agreement for AmeriHealth. See attachment for reference.', NULL, NULL, '2022-02-09 14:51:56', '2022-02-09 14:51:56'),
(55215, 19067, 54754, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Signed the agreement for First Health. See attachment for reference.', NULL, NULL, '2022-02-15 17:20:09', '2022-02-15 17:20:09'),
(55216, 19067, 54754, NULL, '2022-02-22 00:00:00.000', 'Approved', 'Received the final agreement. See attachment for reference.  Effective date: 04/01/2022', NULL, NULL, '2022-02-15 17:29:06', '2022-02-15 17:29:06'),
(55217, 19067, 54755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-25 17:14:27', '2022-01-25 17:14:27'),
(55218, 19067, 54755, NULL, '2022-03-23 00:00:00.000', 'Approved', 'Plan of Aetna', NULL, NULL, '2022-03-16 11:25:59', '2022-03-16 11:25:59'),
(55219, 19067, 54756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-26 13:40:48', '2022-01-26 13:40:48'),
(55220, 19067, 54756, NULL, '2022-02-02 00:00:00.000', 'Initiated', 'Application initiated through Portal. See attachment for reference.', NULL, NULL, '2022-01-26 13:42:54', '2022-01-26 13:42:54'),
(55221, 19067, 54756, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: credentialing@brighthealthplan.com  Subject: Enrollment Query || RSM || Group || Bright Health Management ||    Hello!  Hope you\'re having a productive day.  I initiated an application for enrollment for the below group. I would like to get an update on the request.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford, TX 77477   Kindly respond as per your convenience.  Regards,', NULL, NULL, '2022-02-08 13:22:02', '2022-02-08 13:22:02'),
(55222, 19067, 54756, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: tsummers@brighthealthgroup.com  Subject: Enrollment Query || RSM || Group || Bright Health Management ||     Hello -     The review process for requests to join our network may take up to 90 days. If you have submitted your form and have not been contacted within this time frame, please feel free to email the provider engagement team for a status update.     providerengagement@brighthealthgroup.com        Thanks  Teresa Summers | Credentialing Manager   e:  tsummers@brighthealthgroup.com    w: brighthealthgroup.com ', NULL, NULL, '2022-02-08 15:28:44', '2022-02-08 15:28:44'),
(55223, 19067, 54756, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: providerengagement@brighthealthgroup.com  Subject: Enrollment Query || RSM || Group || Bright Health Management ||   Hello!  Hope you\'re having a productive day.  I initiated an application for enrollment for the below group. I would like to get an update on the application.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford, TX 77477   Kindly respond as per your convenience.  Regards,', NULL, NULL, '2022-03-11 09:58:50', '2022-03-11 09:58:50'),
(55224, 19067, 54756, NULL, '2022-03-18 00:00:00.000', 'Not Eligible', 'Email received from: providerengagement@brighthealthgroup.com  Subject: Enrollment Query || RSM || Group || Bright Health Management ||    Hello Hammad,     Thank you for your interest in joining the Bright Health provider network. We have carefully evaluated your request to join our network. Unfortunately, at this time we cannot offer a contract because our panel is closed in your region and/or for your specialty.     We’ve saved your information and will reach out to you if the needs of our members or network ever change. In the meantime, you can follow Bright Health on our website at www.brighthealthcare.com.     Sincerely,     Danielle Fontaine on behalf of  The Bright Health Network Development Team     Danielle Fontaine | Provider Engagement   e:  providerengagement@brighthealthgroup.com  w: brighthealthgroup.com ', NULL, NULL, '2022-03-11 15:41:06', '2022-03-11 15:41:06'),
(55225, 20067, 54757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-27 10:06:50', '2022-01-27 10:06:50'),
(55226, 20067, 54757, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Plan of Aetna', NULL, NULL, '2022-02-04 15:34:50', '2022-02-04 15:34:50'),
(55227, 19067, 54758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-27 10:23:14', '2022-01-27 10:23:14'),
(55228, 19067, 54758, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to: MHTXProviderServices@MolinaHealthCare.Com  Subject: Enrollment Query || GCIA || Group || Molina Health ||   Good Morning!  Hope this email finds you well.  I would like to enroll the mentioned group with Molina Health.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363  Regards,', NULL, NULL, '2022-01-27 10:24:11', '2022-01-27 10:24:11'),
(55229, 19067, 54758, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: MHTXProviderServices@molinahealthcare.com  Subject: Enrollment Query || GCIA || Group || Molina Health ||    Good afternoon Hammad,     Thank you for your email. I am more than happy to assist you with your inquiry. In order to participate with Molina I will need to ask you to complete the attached form and return it to the address on the form along with a current W-9.     Please let us know if you have any additional questions or concerns.     Best Regards,  Denise     Denise Arvia | Director, Provider Services                 Molina Healthcare of Texas  denise.arvia@MolinaHealthcare.com                    www.MolinaHealthcare.com', NULL, NULL, '2022-02-04 15:02:43', '2022-02-04 15:02:43'),
(55230, 19067, 54758, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Re: Enrollment Query || GCIA || Group || Molina Health ||   Greetings!  Hope this email finds you well.  Kindly see the attachment for the form along with W9 as per your request.  Don\'t hesitate to reach out if you need anything else.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 16:26:00', '2022-02-04 16:26:00'),
(55231, 1019, 54758, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Sent the following email to Denise.  Hello Denise, Any update on our request, can you please get back to us as its an urgent matter.  Regards ,Alex', NULL, NULL, '2022-02-15 13:37:43', '2022-02-15 13:37:43'),
(55232, 19067, 54758, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Subject: Molina Provider Contracting - Gulf Coast Imaging & Associates, LLC    Good Morning,     Happy Wednesday!  - Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Gulf Coast Imaging & Associates, LLC) to contract under TAX ID number (82-0701672).  `     I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.     Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.     Please see your designated Coordinators information below:  JEFFERSON, NORTHEAST, WEST & NUECES  Evelin Suazo  Evelin.Suazo@Molinahealthcare.com  281-675-5376        Best Regards,     Provider Contract Coordination Department | JG   Molina Healthcare of Texas, Inc.', NULL, NULL, '2022-02-23 13:41:46', '2022-02-23 13:41:46'),
(55233, 20067, 54758, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: Evelin.Suazo@Molinahealthcare.com  Sub: Application Status || Gulf Coast Imaging & Associates, LLC || Molina Health  Good Morning!  Hope you are doing great. I would like to know the application status of the listed group.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363 Primary Specialty	261QR0208X - Clinic/Center Radiology, Mobile  Thank you, Syed Ahad.', NULL, NULL, '2022-03-07 12:36:35', '2022-03-07 12:36:35'),
(55234, 19067, 54758, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email received from: Evelin.Suazo@molinahealthcare.com  Subject: [SEND SECURE] Molina Contracting PDL 187874    PDL# 187874  Group: Gulf Coast Imaging & Associates, LLC  Tax ID: 820701672     Good morning,  This is Evelin your Contract Coordinator at Molina. I received your contract request to become an in-network provider with Molina but, before I can send the contract please kindly provide me with the following information:  Authorized Representative: Name of the person that will sign the contract:  Title:  Email address:     Please complete the attached forms once completed please sent them back to me. Thank you     Complete the Sample Claim Form ( Number: 25, 31, 32, and 33)    Complete the Molina Data Collection Form    Complete the Molina TAHP             Send all required information within 30 calendar days to:     Email: evelin.suazo@MolinaHealthcare.com     Effective April 1, 2018 all providers must meet the HHS defined credentialing standards for all providers.  Additionally, for the PSA the provider must meet Molina’s credentialing criteria.  Credentialing is now handled through the Texas Association of Health Plans (TAHP) Credentialing Verification Office (CVO).  This is a new process so that providers can enter their credentialing information once into the CVO system and it will be sent to all 5 Medicaid MCOs.     If not yet registered for Availity, go to www.Availity.com, click register in the top right of the page, then follow the organization registration process.  Once your registration is approved, you can proceed to the next step.                We look forward to having you as a part of our network and encourage you to visit www.molinahealthcare.com to learn more about us.  My contact information is listed below should you have any questions or concerns.     Thank you,   Evelin Suazo  Associate Specialist,Provider Contracts  Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com  1660 Westridge Circle N  Irving, Texas, 75038  281-675-5376', NULL, NULL, '2022-03-07 17:33:39', '2022-03-07 17:33:39'),
(55235, 19067, 54758, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Kiesha.Stovall@molinahealthcare.com  Subject: FW: Enrollment Query || GCIA || Group || Molina Health ||    Good afternoon, looking in the system it seems your contract agent has not finished loading your contract yet, it seems she needs email information to contact someone in your office to load this and finish the process. Has Evelin Sauzo Evelin.Suazo@MolinaHealthCare.Com  been in contact with you? You may email her to get any updates you need further. Thank you     Kiesha Stovall | Provider Service Rep | Harris/Jefferson SDAs  Kiesha.Stovall@Molinahealthcare.com  Phone #832-963-4259  www.MolinaHealthcare.com     Attention Providers: We are looking for providers to participate in our Provider Advisory Committees. Click here for more information.     Learn how Molina is working with Availity at www.availity.com/molinahealthcare     We\'d love to hear your feedback about the Molina Healthcare of Texas Provider Services Team! Click here to complete a survey!     HHSC Notices: Healthy Texas Women Provider Certification Requirements and Texas Health Steps Additional Screening Tools', NULL, NULL, '2022-04-05 15:44:11', '2022-04-05 15:44:11'),
(55236, 19067, 54758, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Evelin.Suazo@MolinaHealthCare.Com  Subject: Enrollment Query || GCIA || Molina Health ||   Hello Evelin!  Hope this email finds you well. Kindly make an update on the credentialing process of the following facility,  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363  Thanks,', NULL, NULL, '2022-04-05 15:47:14', '2022-04-05 15:47:14'),
(55237, 19067, 54758, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Secure email received from: evelin.suazo@molinahealthcare.com  Subject: [SEND SECURE] FW: Molina Contracting PDL 187874    lease find a copy of the contract packet sent on 03/07/2022. Thank you      Evelin Suazo  Associate Specialist,Provider Contracts  Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com  1660 Westridge Circle N  Irving, Texas, 75038  281-675-5376  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-04-07 07:15:17', '2022-04-07 07:15:17'),
(55238, 19067, 54758, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: Evelin.Suazo@molinahealthcare.com  Subject: Molina Contracting 187874 Enrollment Query || GCIA || Molina Health ||    PDL# 187874     Good morning,     The contract packet with all the forms needed to complete the contracting process was sent via email on 03/07/2022 and I still have not received it back. Please advise. Thank you   Evelin Suazo  Associate Specialist,Provider Contracts  Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com  1660 Westridge Circle N  Irving, Texas, 75038  281-675-5376  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-04-07 07:16:01', '2022-04-07 07:16:01'),
(55239, 19067, 54758, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: Evelin.Suazo@molinahealthcare.com  Subject: Documents || GCIA || Molina   Hi Evelin,  Hope this email finds you well. Kindly see the attached applications you requested.   Authorized who will sign the contract:   Name: Robert Rabagos Title: Owner Email: gcia@claimsmedinc.com  Do not hesitate to reach out if you have any questions or concerns.  Thanks,', NULL, NULL, '2022-04-08 11:57:26', '2022-04-08 11:57:26'),
(55240, 20067, 54759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 14:47:31', '2022-01-31 14:47:31'),
(55241, 20067, 54759, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email Received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#.  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Let me know if you have any questions. Thanks $ Regards, Syed Ahad.', NULL, NULL, '2022-01-31 15:25:27', '2022-01-31 15:25:27'),
(55242, 20067, 54759, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Morning,     Please proceed completing application by clicking on the following link: Add a Provider to an Existing Group Contract     Please allow a minimum of two weeks to obtain a response, please review your spam folder.     Please contact me if you have not received an email to confirm that the information has been sent.   Respectfully', NULL, NULL, '2022-02-04 10:27:17', '2022-02-04 10:27:17'),
(55243, 20067, 54759, NULL, '2022-02-16 00:00:00.000', 'Approved', 'Received the welcome letter Via Secure Email.  Effective Date: 09/01/2021 TPI:  3874372', NULL, NULL, '2022-02-09 17:40:05', '2022-02-09 17:40:05'),
(55244, 20067, 54760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 14:47:32', '2022-01-31 14:47:32'),
(55245, 20067, 54760, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email Received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#.  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Let me know if you have any questions. Thanks $ Regards, Syed Ahad.', NULL, NULL, '2022-01-31 15:25:19', '2022-01-31 15:25:19'),
(55246, 20067, 54760, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Morning,     Please proceed completing application by clicking on the following link: Add a Provider to an Existing Group Contract     Please allow a minimum of two weeks to obtain a response, please review your spam folder.     Please contact me if you have not received an email to confirm that the information has been sent.   Respectfully', NULL, NULL, '2022-02-04 10:27:10', '2022-02-04 10:27:10'),
(55247, 20067, 54760, NULL, '2022-02-16 00:00:00.000', 'Approved', 'Received the welcome letter Via Secure Email.  Effective Date: 09/01/2021 TPI: 3956146', NULL, NULL, '2022-02-09 17:38:57', '2022-02-09 17:38:57'),
(55248, 20067, 54761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:39:26', '2022-01-31 15:39:26'),
(55249, 20067, 54761, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', '	 CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.', NULL, NULL, '2022-01-31 15:45:29', '2022-01-31 15:45:29'),
(55250, 20067, 54762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:39:26', '2022-01-31 15:39:26'),
(55251, 20067, 54762, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', '	 CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.', NULL, NULL, '2022-01-31 15:45:44', '2022-01-31 15:45:44'),
(55252, 20067, 54763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:41:53', '2022-01-31 15:41:53'),
(55253, 20067, 54763, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', '	 CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.', NULL, NULL, '2022-01-31 15:46:04', '2022-01-31 15:46:04'),
(55254, 20067, 54764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:41:53', '2022-01-31 15:41:53'),
(55255, 20067, 54764, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', '	 CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.', NULL, NULL, '2022-01-31 15:46:26', '2022-01-31 15:46:26'),
(55256, 20067, 54765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:43:23', '2022-01-31 15:43:23'),
(55257, 20067, 54765, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', '	 CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.', NULL, NULL, '2022-01-31 15:46:33', '2022-01-31 15:46:33'),
(55258, 20067, 54766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:43:23', '2022-01-31 15:43:23'),
(55259, 20067, 54766, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', '	 CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.', NULL, NULL, '2022-01-31 15:46:40', '2022-01-31 15:46:40'),
(55260, 20067, 54767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:51:28', '2022-01-31 15:51:28'),
(55261, 20067, 54767, NULL, '2022-02-07 00:00:00.000', 'Initiated', '	 Email Sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#.  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Let me know if you have any questions. Thanks $ Regards, Syed Ahad.', NULL, NULL, '2022-01-31 15:55:03', '2022-01-31 15:55:03'),
(55262, 20067, 54767, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Morning,     Please proceed completing application by clicking on the following link: Add a Provider to an Existing Group Contract     Please allow a minimum of two weeks to obtain a response, please review your spam folder.     Please contact me if you have not received an email to confirm that the information has been sent.   Respectfully', NULL, NULL, '2022-02-04 10:27:03', '2022-02-04 10:27:03'),
(55263, 20067, 54767, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Application to add a provider into an existing group submitted online. Kindly see the attachment', NULL, NULL, '2022-02-17 09:56:21', '2022-02-17 09:56:21'),
(55264, 20067, 54767, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Good Morning Daniel!  I have submitted the application using the link which you provided. Kindly let me know if you have any updates for these applications.  Thank you', NULL, NULL, '2022-03-02 15:04:56', '2022-03-02 15:04:56'),
(55265, 20067, 54767, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:24:59', '2022-03-17 17:24:59'),
(55266, 22077, 54767, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com\\  Subject:  Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Hi,  Any updates on the previously mentioned request?  Thanks', NULL, NULL, '2022-04-07 09:46:30', '2022-04-07 09:46:30'),
(55267, 19067, 54767, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Email received from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter    Hello Syed,  Below please find the status for following providers under TIN 815123542.  Nubia Olivama Benavides NPI: 1801371935 Completed Provider Record/ Provider Effective Date: 4/1/2022 Edna Michi NPI: 1992293906 Completed Provider Record/ Provider Effective Date: 4/1/2022     Respectfully,     Daniel Velez  Provider Account Manager,  Region 4 - Provider Relations  Hidalgo SDA   3900 North 10th Street, Ste 600  McAllen, TX 78501 Direct: 1-877-278-4268 Ext 82661  Toll-Free:1-877-278-4268 Option 3 Fax: 1-866-390-1892  Daniel.Velez@superiorhealthplan.com | SuperiorHealthPlan.comtive Date: 4/1/2022', NULL, NULL, '2022-04-12 09:54:17', '2022-04-12 09:54:17'),
(55268, 20067, 54768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:51:28', '2022-01-31 15:51:28'),
(55269, 20067, 54768, NULL, '2022-02-07 00:00:00.000', 'Initiated', '	 Email Sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#.  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Let me know if you have any questions. Thanks $ Regards, Syed Ahad.', NULL, NULL, '2022-01-31 15:55:12', '2022-01-31 15:55:12'),
(55270, 20067, 54768, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Morning,     Please proceed completing application by clicking on the following link: Add a Provider to an Existing Group Contract     Please allow a minimum of two weeks to obtain a response, please review your spam folder.     Please contact me if you have not received an email to confirm that the information has been sent.   Respectfully', NULL, NULL, '2022-02-04 10:26:56', '2022-02-04 10:26:56'),
(55271, 20067, 54768, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Application to add a provider into an existing group submitted online Kindly see the attachment', NULL, NULL, '2022-02-17 10:00:19', '2022-02-17 10:00:19'),
(55272, 20067, 54768, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Good Morning Daniel!  I have submitted the application using the link which you provided. Kindly let me know if you have any updates for these applications.  Thank you', NULL, NULL, '2022-03-02 15:04:50', '2022-03-02 15:04:50'),
(55273, 20067, 54768, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:24:50', '2022-03-17 17:24:50'),
(55274, 22077, 54768, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com\\  Subject:  Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Hi,  Any updates on the previously mentioned request?  Thanks', NULL, NULL, '2022-04-07 09:44:16', '2022-04-07 09:44:16'),
(55275, 19067, 54768, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Email received from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter    Hello Syed,  Below please find the status for following providers under TIN 815123542.  Nubia Olivama Benavides NPI: 1801371935 Completed Provider Record/ Provider Effective Date: 4/1/2022 Edna Michi NPI: 1992293906 Completed Provider Record/ Provider Effective Date: 4/1/2022     Respectfully,     Daniel Velez  Provider Account Manager,  Region 4 - Provider Relations  Hidalgo SDA   3900 North 10th Street, Ste 600  McAllen, TX 78501 Direct: 1-877-278-4268 Ext 82661  Toll-Free:1-877-278-4268 Option 3 Fax: 1-866-390-1892  Daniel.Velez@superiorhealthplan.com | SuperiorHealthPlan.comtive Date: 4/1/2022', NULL, NULL, '2022-04-12 09:55:41', '2022-04-12 09:55:41'),
(55276, 20067, 54769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:52:18', '2022-01-31 15:52:18'),
(55277, 20067, 54769, NULL, '2022-02-07 00:00:00.000', 'Initiated', '	 Email Sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#.  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Let me know if you have any questions. Thanks $ Regards, Syed Ahad.', NULL, NULL, '2022-01-31 15:55:19', '2022-01-31 15:55:19'),
(55278, 20067, 54769, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Morning,     Please proceed completing application by clicking on the following link: Add a Provider to an Existing Group Contract     Please allow a minimum of two weeks to obtain a response, please review your spam folder.     Please contact me if you have not received an email to confirm that the information has been sent.   Respectfully', NULL, NULL, '2022-02-04 10:26:49', '2022-02-04 10:26:49'),
(55279, 20067, 54769, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Application to add a provider into an existing group submitted online. Kindly see the attachment', NULL, NULL, '2022-02-17 09:56:43', '2022-02-17 09:56:43'),
(55280, 20067, 54769, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Good Morning Daniel!  I have submitted the application using the link which you provided. Kindly let me know if you have any updates for these applications.  Thank you', NULL, NULL, '2022-03-02 15:04:42', '2022-03-02 15:04:42'),
(55281, 20067, 54769, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:23:53', '2022-03-17 17:23:53'),
(55282, 22077, 54769, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com\\  Subject:  Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Hi,  Any updates on the previously mentioned request?  Thanks', NULL, NULL, '2022-04-07 09:46:17', '2022-04-07 09:46:17'),
(55283, 19067, 54769, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Email received from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter    Hello Syed,  Below please find the status for following providers under TIN 815123542.  Nubia Olivama Benavides NPI: 1801371935 Completed Provider Record/ Provider Effective Date: 4/1/2022 Edna Michi NPI: 1992293906 Completed Provider Record/ Provider Effective Date: 4/1/2022     Respectfully,     Daniel Velez  Provider Account Manager,  Region 4 - Provider Relations  Hidalgo SDA   3900 North 10th Street, Ste 600  McAllen, TX 78501 Direct: 1-877-278-4268 Ext 82661  Toll-Free:1-877-278-4268 Option 3 Fax: 1-866-390-1892  Daniel.Velez@superiorhealthplan.com | SuperiorHealthPlan.comtive Date: 4/1/2022', NULL, NULL, '2022-04-12 09:55:18', '2022-04-12 09:55:18'),
(55284, 20067, 54770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:52:18', '2022-01-31 15:52:18'),
(55285, 20067, 54770, NULL, '2022-02-07 00:00:00.000', 'Initiated', '	 Email Sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#.  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Let me know if you have any questions. Thanks $ Regards, Syed Ahad.', NULL, NULL, '2022-01-31 15:55:27', '2022-01-31 15:55:27'),
(55286, 20067, 54770, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Good Morning,     Please proceed completing application by clicking on the following link: Add a Provider to an Existing Group Contract     Please allow a minimum of two weeks to obtain a response, please review your spam folder.     Please contact me if you have not received an email to confirm that the information has been sent.   Respectfully', NULL, NULL, '2022-02-04 10:26:43', '2022-02-04 10:26:43'),
(55287, 20067, 54770, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Application to add a provider into an existing group submitted online Kindly see the attachment', NULL, NULL, '2022-02-17 10:00:35', '2022-02-17 10:00:35'),
(55288, 20067, 54770, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Good Morning Daniel!  I have submitted the application using the link which you provided. Kindly let me know if you have any updates for these applications.  Thank you', NULL, NULL, '2022-03-02 15:04:34', '2022-03-02 15:04:34'),
(55289, 20067, 54770, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:23:47', '2022-03-17 17:23:47'),
(55290, 22077, 54770, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com\\  Subject:  Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter  Hi,  Any updates on the previously mentioned request?  Thanks', NULL, NULL, '2022-04-07 09:44:01', '2022-04-07 09:44:01'),
(55291, 19067, 54770, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Email received from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter    Hello Syed,  Below please find the status for following providers under TIN 815123542.  Nubia Olivama Benavides NPI: 1801371935 Completed Provider Record/ Provider Effective Date: 4/1/2022 Edna Michi NPI: 1992293906 Completed Provider Record/ Provider Effective Date: 4/1/2022     Respectfully,     Daniel Velez  Provider Account Manager,  Region 4 - Provider Relations  Hidalgo SDA   3900 North 10th Street, Ste 600  McAllen, TX 78501 Direct: 1-877-278-4268 Ext 82661  Toll-Free:1-877-278-4268 Option 3 Fax: 1-866-390-1892  Daniel.Velez@superiorhealthplan.com | SuperiorHealthPlan.comtive Date: 4/1/2022', NULL, NULL, '2022-04-12 09:56:03', '2022-04-12 09:56:03'),
(55292, 20067, 54771, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:58:06', '2022-01-31 15:58:06'),
(55293, 20067, 54771, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#. 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,', NULL, NULL, '2022-01-31 16:05:42', '2022-01-31 16:05:42'),
(55294, 20067, 54771, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Good Morning!   Hope you are doing well. Kindly respond promptly.  Thank you', NULL, NULL, '2022-02-04 11:14:12', '2022-02-04 11:14:12'),
(55295, 20067, 54771, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Hello Syed,  My apologies for the delay in response, I’m running behind on emails.  Both of these providers will need to be credentialed.  I have attached the forms we will need to get them started and we will also need their current PAA or Collaborative agreement for each of them  Please do not send any other documents.  I will be glad to start them as soon as I receive the required documents.  Thank you  Karla Claunch    ', NULL, NULL, '2022-03-03 12:18:22', '2022-03-03 12:18:22'),
(55296, 20067, 54771, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Morning!  Hope all is well with you. Attached are the forms for both providers Edna Michi & Nubia Benavides.  Let me know if anything else is needed from my end.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-03 12:19:49', '2022-03-03 12:19:49'),
(55297, 20067, 54771, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hello,  Thank you for these requests and the additional DHP documents.  They are both now in credentialing process.  Please allow 90 days to complete.  A Welcome letter will be sent when the process is complete.  Please respond to any inquiries from Aperture/Verisys and our credentialing specialist for additional information.  I hope you have a great day   Karla Claunch    ', NULL, NULL, '2022-03-10 12:47:36', '2022-03-10 12:47:36'),
(55298, 22077, 54771, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hi,  Any update on the credentialing process of the provider Nubia Benavides & Edna Michi?  Don\'t hesitate to reach out if you have any questions  Thanks ', NULL, NULL, '2022-04-07 11:44:45', '2022-04-07 11:44:45');
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
(55299, 22077, 54771, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  These provider are in process.  Please allow 90 days to complete.     Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  4525 Ayers St  Corpus Christi TX 78415-1401  Phone: 361-694-6554  Fax: 361-808-2182  Email: karla.claunch@dchstx.org', NULL, NULL, '2022-04-15 15:20:15', '2022-04-15 15:20:15'),
(55300, 20067, 54772, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:58:06', '2022-01-31 15:58:06'),
(55301, 20067, 54772, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#. 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,', NULL, NULL, '2022-01-31 16:05:57', '2022-01-31 16:05:57'),
(55302, 20067, 54772, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Good Morning!   Hope you are doing well. Kindly respond promptly.  Thank you', NULL, NULL, '2022-02-04 11:14:06', '2022-02-04 11:14:06'),
(55303, 20067, 54772, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Hello Syed,  My apologies for the delay in response, I’m running behind on emails.  Both of these providers will need to be credentialed.  I have attached the forms we will need to get them started and we will also need their current PAA or Collaborative agreement for each of them  Please do not send any other documents.  I will be glad to start them as soon as I receive the required documents.  Thank you  Karla Claunch    ', NULL, NULL, '2022-03-03 12:18:16', '2022-03-03 12:18:16'),
(55304, 20067, 54772, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Morning!  Hope all is well with you. Attached are the forms for both providers Edna Michi & Nubia Benavides.  Let me know if anything else is needed from my end.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-03 12:19:56', '2022-03-03 12:19:56'),
(55305, 20067, 54772, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hello,  Thank you for these requests and the additional DHP documents.  They are both now in credentialing process.  Please allow 90 days to complete.  A Welcome letter will be sent when the process is complete.  Please respond to any inquiries from Aperture/Verisys and our credentialing specialist for additional information.  I hope you have a great day   Karla Claunch    ', NULL, NULL, '2022-03-10 12:47:31', '2022-03-10 12:47:31'),
(55306, 22077, 54772, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hi,  Any update on the credentialing process of the provider Nubia Benavides & Edna Michi?  Don\'t hesitate to reach out if you have any questions  Thanks ', NULL, NULL, '2022-04-07 11:43:40', '2022-04-07 11:43:40'),
(55307, 22077, 54772, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  These provider are in process.  Please allow 90 days to complete.     Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  4525 Ayers St  Corpus Christi TX 78415-1401  Phone: 361-694-6554  Fax: 361-808-2182  Email: karla.claunch@dchstx.org', NULL, NULL, '2022-04-15 15:20:03', '2022-04-15 15:20:03'),
(55308, 20067, 54773, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:58:47', '2022-01-31 15:58:47'),
(55309, 20067, 54773, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#. 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,', NULL, NULL, '2022-01-31 16:06:04', '2022-01-31 16:06:04'),
(55310, 20067, 54773, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Good Morning!   Hope you are doing well. Kindly respond promptly.  Thank you', NULL, NULL, '2022-02-04 11:13:58', '2022-02-04 11:13:58'),
(55311, 20067, 54773, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Hello Syed,  My apologies for the delay in response, I’m running behind on emails.  Both of these providers will need to be credentialed.  I have attached the forms we will need to get them started and we will also need their current PAA or Collaborative agreement for each of them  Please do not send any other documents.  I will be glad to start them as soon as I receive the required documents.  Thank you  Karla Claunch    ', NULL, NULL, '2022-03-03 12:18:10', '2022-03-03 12:18:10'),
(55312, 20067, 54773, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Morning!  Hope all is well with you. Attached are the forms for both providers Edna Michi & Nubia Benavides.  Let me know if anything else is needed from my end.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-03 12:20:04', '2022-03-03 12:20:04'),
(55313, 20067, 54773, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hello,  Thank you for these requests and the additional DHP documents.  They are both now in credentialing process.  Please allow 90 days to complete.  A Welcome letter will be sent when the process is complete.  Please respond to any inquiries from Aperture/Verisys and our credentialing specialist for additional information.  I hope you have a great day   Karla Claunch    ', NULL, NULL, '2022-03-10 12:47:25', '2022-03-10 12:47:25'),
(55314, 22077, 54773, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hi,  Any update on the credentialing process of the provider Nubia Benavides & Edna Michi?  Don\'t hesitate to reach out if you have any questions  Thanks ', NULL, NULL, '2022-04-07 11:45:11', '2022-04-07 11:45:11'),
(55315, 20067, 54774, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:58:47', '2022-01-31 15:58:47'),
(55316, 20067, 54774, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#. 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,', NULL, NULL, '2022-01-31 16:06:10', '2022-01-31 16:06:10'),
(55317, 20067, 54774, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Good Morning!   Hope you are doing well. Kindly respond promptly.  Thank you', NULL, NULL, '2022-02-04 11:13:51', '2022-02-04 11:13:51'),
(55318, 20067, 54774, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Hello Syed,  My apologies for the delay in response, I’m running behind on emails.  Both of these providers will need to be credentialed.  I have attached the forms we will need to get them started and we will also need their current PAA or Collaborative agreement for each of them  Please do not send any other documents.  I will be glad to start them as soon as I receive the required documents.  Thank you  Karla Claunch    ', NULL, NULL, '2022-03-03 12:18:04', '2022-03-03 12:18:04'),
(55319, 20067, 54774, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Morning!  Hope all is well with you. Attached are the forms for both providers Edna Michi & Nubia Benavides.  Let me know if anything else is needed from my end.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-03 12:20:10', '2022-03-03 12:20:10'),
(55320, 20067, 54774, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hello,  Thank you for these requests and the additional DHP documents.  They are both now in credentialing process.  Please allow 90 days to complete.  A Welcome letter will be sent when the process is complete.  Please respond to any inquiries from Aperture/Verisys and our credentialing specialist for additional information.  I hope you have a great day   Karla Claunch    ', NULL, NULL, '2022-03-10 12:47:20', '2022-03-10 12:47:20'),
(55321, 22077, 54774, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hi,  Any update on the credentialing process of the provider Nubia Benavides & Edna Michi?  Don\'t hesitate to reach out if you have any questions  Thanks ', NULL, NULL, '2022-04-07 11:44:13', '2022-04-07 11:44:13'),
(55322, 20067, 54775, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:59:22', '2022-01-31 15:59:22'),
(55323, 20067, 54775, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#. 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,', NULL, NULL, '2022-01-31 16:06:21', '2022-01-31 16:06:21'),
(55324, 20067, 54775, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Good Morning!   Hope you are doing well. Kindly respond promptly.  Thank you', NULL, NULL, '2022-02-04 11:13:44', '2022-02-04 11:13:44'),
(55325, 20067, 54775, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Hello Syed,  My apologies for the delay in response, I’m running behind on emails.  Both of these providers will need to be credentialed.  I have attached the forms we will need to get them started and we will also need their current PAA or Collaborative agreement for each of them  Please do not send any other documents.  I will be glad to start them as soon as I receive the required documents.  Thank you  Karla Claunch    ', NULL, NULL, '2022-03-03 12:17:15', '2022-03-03 12:17:15'),
(55326, 20067, 54775, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Morning!  Hope all is well with you. Attached are the forms for both providers Edna Michi & Nubia Benavides.  Let me know if anything else is needed from my end.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-03 12:20:16', '2022-03-03 12:20:16'),
(55327, 20067, 54775, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hello,  Thank you for these requests and the additional DHP documents.  They are both now in credentialing process.  Please allow 90 days to complete.  A Welcome letter will be sent when the process is complete.  Please respond to any inquiries from Aperture/Verisys and our credentialing specialist for additional information.  I hope you have a great day   Karla Claunch    ', NULL, NULL, '2022-03-10 12:47:12', '2022-03-10 12:47:12'),
(55328, 22077, 54775, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hi,  Any update on the credentialing process of the provider Nubia Benavides & Edna Michi?  Don\'t hesitate to reach out if you have any questions  Thanks ', NULL, NULL, '2022-04-07 11:44:59', '2022-04-07 11:44:59'),
(55329, 20067, 54776, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 15:59:22', '2022-01-31 15:59:22'),
(55330, 20067, 54776, NULL, '2022-02-07 00:00:00.000', 'Initiated', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Afternoon!  I would like to enroll these providers under the below-mentioned TIN#. 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,', NULL, NULL, '2022-01-31 16:06:28', '2022-01-31 16:06:28'),
(55331, 20067, 54776, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Good Morning!   Hope you are doing well. Kindly respond promptly.  Thank you', NULL, NULL, '2022-02-04 11:13:37', '2022-02-04 11:13:37'),
(55332, 20067, 54776, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Hello Syed,  My apologies for the delay in response, I’m running behind on emails.  Both of these providers will need to be credentialed.  I have attached the forms we will need to get them started and we will also need their current PAA or Collaborative agreement for each of them  Please do not send any other documents.  I will be glad to start them as soon as I receive the required documents.  Thank you  Karla Claunch    ', NULL, NULL, '2022-03-03 12:17:04', '2022-03-03 12:17:04'),
(55333, 20067, 54776, NULL, '2022-03-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll   Good Morning!  Hope all is well with you. Attached are the forms for both providers Edna Michi & Nubia Benavides.  Let me know if anything else is needed from my end.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-03 12:20:29', '2022-03-03 12:20:29'),
(55334, 20067, 54776, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hello,  Thank you for these requests and the additional DHP documents.  They are both now in credentialing process.  Please allow 90 days to complete.  A Welcome letter will be sent when the process is complete.  Please respond to any inquiries from Aperture/Verisys and our credentialing specialist for additional information.  I hope you have a great day   Karla Claunch    ', NULL, NULL, '2022-03-10 12:46:56', '2022-03-10 12:46:56'),
(55335, 22077, 54776, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Driscoll  Hi,  Any update on the credentialing process of the provider Nubia Benavides & Edna Michi?  Don\'t hesitate to reach out if you have any questions  Thanks ', NULL, NULL, '2022-04-07 11:43:51', '2022-04-07 11:43:51'),
(55336, 20067, 54777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:08:18', '2022-01-31 16:08:18'),
(55337, 20067, 54777, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.', NULL, NULL, '2022-02-02 17:37:58', '2022-02-02 17:37:58'),
(55338, 20067, 54778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:08:18', '2022-01-31 16:08:18'),
(55339, 20067, 54778, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.', NULL, NULL, '2022-02-02 17:37:41', '2022-02-02 17:37:41'),
(55340, 20067, 54779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:08:53', '2022-01-31 16:08:53'),
(55341, 20067, 54779, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.', NULL, NULL, '2022-02-02 17:37:24', '2022-02-02 17:37:24'),
(55342, 20067, 54780, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:08:53', '2022-01-31 16:08:53'),
(55343, 20067, 54780, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.', NULL, NULL, '2022-02-02 17:37:04', '2022-02-02 17:37:04'),
(55344, 20067, 54781, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:09:19', '2022-01-31 16:09:19'),
(55345, 20067, 54781, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.', NULL, NULL, '2022-02-02 17:36:36', '2022-02-02 17:36:36'),
(55346, 20067, 54782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:14:28', '2022-01-31 16:14:28'),
(55347, 20067, 54782, NULL, '2022-02-07 00:00:00.000', 'In Process', 'PROVIDER NAME	EDNA D MICHI PA PROVIDER PTAN	Q00204169 PROVIDER NPI	1992293906 EFFECTIVE DATE	09/01/2021 END DATE	 GROUP NAME	VALLEY MED URGENT CARE PLLC GROUP PTAN	DX8602 BUSINESS STATE	TX EFFECTIVE DATE	06/01/2017 END DATE	 ', NULL, NULL, '2022-01-31 17:28:31', '2022-01-31 17:28:31'),
(55348, 20067, 54782, NULL, '2022-02-23 00:00:00.000', 'Approved', '', NULL, NULL, '2022-02-16 17:51:39', '2022-02-16 17:51:39'),
(55349, 20067, 54783, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:14:28', '2022-01-31 16:14:28'),
(55350, 20067, 54783, NULL, '2022-02-07 00:00:00.000', 'In Process', 'PROVIDER NAME	NUBIA BENAVIDES NP PROVIDER PTAN	Q00204153 PROVIDER NPI	1801371935 EFFECTIVE DATE	09/01/2021 END DATE	 GROUP NAME	VALLEY MED URGENT CARE PLLC GROUP PTAN	DX8602 BUSINESS STATE	TX EFFECTIVE DATE	06/01/2017 END DATE', NULL, NULL, '2022-01-31 17:18:03', '2022-01-31 17:18:03'),
(55351, 20067, 54783, NULL, '2022-02-23 00:00:00.000', 'Approved', '', NULL, NULL, '2022-02-16 17:51:34', '2022-02-16 17:51:34'),
(55352, 20067, 54784, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:15:02', '2022-01-31 16:15:02'),
(55353, 20067, 54784, NULL, '2022-02-07 00:00:00.000', 'In Process', 'PROVIDER NAME	EDNA D MICHI PA PROVIDER PTAN	Q00204169 PROVIDER NPI	1992293906 EFFECTIVE DATE	09/01/2021 END DATE	 GROUP NAME	VALLEY MED URGENT CARE PLLC GROUP PTAN	DX8602 BUSINESS STATE	TX EFFECTIVE DATE	06/01/2017 END DATE	', NULL, NULL, '2022-01-31 17:26:58', '2022-01-31 17:26:58'),
(55354, 20067, 54784, NULL, '2022-02-23 00:00:00.000', 'Approved', '', NULL, NULL, '2022-02-16 17:51:29', '2022-02-16 17:51:29'),
(55355, 20067, 54785, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:15:02', '2022-01-31 16:15:02'),
(55356, 20067, 54785, NULL, '2022-02-07 00:00:00.000', 'In Process', 'PROVIDER NAME	NUBIA BENAVIDES NP PROVIDER PTAN	Q00204153 PROVIDER NPI	1801371935 EFFECTIVE DATE	09/01/2021 END DATE	 GROUP NAME	VALLEY MED URGENT CARE PLLC GROUP PTAN	DX8602 BUSINESS STATE	TX EFFECTIVE DATE	06/01/2017 END DATE', NULL, NULL, '2022-01-31 17:17:33', '2022-01-31 17:17:33'),
(55357, 20067, 54785, NULL, '2022-02-23 00:00:00.000', 'Approved', '', NULL, NULL, '2022-02-16 17:51:23', '2022-02-16 17:51:23'),
(55358, 20067, 54786, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:15:28', '2022-01-31 16:15:28'),
(55359, 20067, 54786, NULL, '2022-02-07 00:00:00.000', 'In Process', 'PROVIDER NAME	NUBIA BENAVIDES NP PROVIDER PTAN	Q00204153 PROVIDER NPI	1801371935 EFFECTIVE DATE	09/01/2021 END DATE	 GROUP NAME	VALLEY MED URGENT CARE PLLC GROUP PTAN	DX8602 BUSINESS STATE	TX EFFECTIVE DATE	06/01/2017 END DATE', NULL, NULL, '2022-01-31 17:16:22', '2022-01-31 17:16:22'),
(55360, 20067, 54786, NULL, '2022-02-23 00:00:00.000', 'Approved', '', NULL, NULL, '2022-02-16 17:51:19', '2022-02-16 17:51:19'),
(55361, 20067, 54787, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 16:17:02', '2022-01-31 16:17:02'),
(55362, 20067, 54787, NULL, '2022-02-07 00:00:00.000', 'In Process', 'PROVIDER NAME	EDNA D MICHI PA PROVIDER PTAN	Q00204169 PROVIDER NPI	1992293906 EFFECTIVE DATE	09/01/2021 END DATE	 GROUP NAME	VALLEY MED URGENT CARE PLLC GROUP PTAN	DX8602 BUSINESS STATE	TX EFFECTIVE DATE	06/01/2017 END DATE	', NULL, NULL, '2022-01-31 17:26:43', '2022-01-31 17:26:43'),
(55363, 20067, 54787, NULL, '2022-02-23 00:00:00.000', 'Approved', '', NULL, NULL, '2022-02-16 17:51:13', '2022-02-16 17:51:13'),
(55364, 20067, 54788, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:31:22', '2022-01-31 17:31:22'),
(55365, 20067, 54788, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2022-01-31 17:38:29', '2022-01-31 17:38:29'),
(55366, 20067, 54789, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:31:22', '2022-01-31 17:31:22'),
(55367, 20067, 54789, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2022-01-31 17:38:19', '2022-01-31 17:38:19'),
(55368, 20067, 54790, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:32:16', '2022-01-31 17:32:16'),
(55369, 20067, 54790, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2022-01-31 17:37:55', '2022-01-31 17:37:55'),
(55370, 20067, 54791, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:32:16', '2022-01-31 17:32:16'),
(55371, 20067, 54791, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2022-01-31 17:37:46', '2022-01-31 17:37:46'),
(55372, 20067, 54792, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:33:06', '2022-01-31 17:33:06'),
(55373, 20067, 54792, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2022-01-31 17:37:29', '2022-01-31 17:37:29'),
(55374, 20067, 54793, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:33:06', '2022-01-31 17:33:06'),
(55375, 20067, 54793, NULL, '2022-02-07 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2022-01-31 17:37:20', '2022-01-31 17:37:20'),
(55376, 20067, 54794, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:39:37', '2022-01-31 17:39:37'),
(55377, 20067, 54794, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2022-01-31 17:46:54', '2022-01-31 17:46:54'),
(55378, 20067, 54795, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:39:37', '2022-01-31 17:39:37'),
(55379, 20067, 54795, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2022-01-31 17:46:37', '2022-01-31 17:46:37'),
(55380, 20067, 54796, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:40:33', '2022-01-31 17:40:33'),
(55381, 20067, 54796, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2022-01-31 17:46:14', '2022-01-31 17:46:14'),
(55382, 20067, 54797, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:40:33', '2022-01-31 17:40:33'),
(55383, 20067, 54797, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2022-01-31 17:46:01', '2022-01-31 17:46:01'),
(55384, 20067, 54798, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:41:26', '2022-01-31 17:41:26'),
(55385, 20067, 54798, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2022-01-31 17:45:11', '2022-01-31 17:45:11'),
(55386, 20067, 54799, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 17:41:26', '2022-01-31 17:41:26'),
(55387, 20067, 54799, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2022-01-31 17:44:14', '2022-01-31 17:44:14'),
(55388, 20067, 54800, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 18:00:03', '2022-01-31 18:00:03'),
(55389, 20067, 54800, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached.  Effective Date: 10/01/2017', NULL, NULL, '2022-02-02 17:55:19', '2022-02-02 17:55:19'),
(55390, 20067, 54801, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 18:00:04', '2022-01-31 18:00:04'),
(55391, 20067, 54801, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached.  Effective Date: 10/01/2017', NULL, NULL, '2022-02-02 17:55:01', '2022-02-02 17:55:01'),
(55392, 20067, 54802, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 18:01:33', '2022-01-31 18:01:33'),
(55393, 20067, 54802, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached.  Effective Date: 10/01/2017', NULL, NULL, '2022-02-02 17:54:46', '2022-02-02 17:54:46'),
(55394, 20067, 54803, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 18:01:33', '2022-01-31 18:01:33'),
(55395, 20067, 54803, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached.  Effective Date: 10/01/2017', NULL, NULL, '2022-02-02 17:54:30', '2022-02-02 17:54:30'),
(55396, 20067, 54804, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 18:03:35', '2022-01-31 18:03:35'),
(55397, 20067, 54804, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached.  Effective Date: 10/01/2017', NULL, NULL, '2022-02-02 17:54:11', '2022-02-02 17:54:11'),
(55398, 20067, 54805, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-31 18:03:35', '2022-01-31 18:03:35'),
(55399, 20067, 54805, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached.  Effective Date: 10/01/2017', NULL, NULL, '2022-02-02 17:53:46', '2022-02-02 17:53:46'),
(55400, 20067, 54806, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:36:03', '2022-02-01 08:36:03'),
(55401, 20067, 54806, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906   Thanks & Regards,  ', NULL, NULL, '2022-02-01 08:45:01', '2022-02-01 08:45:01'),
(55402, 20067, 54806, NULL, '2022-02-24 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@SuperiorHealthPlan.com, AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,  Syed Ahad.', NULL, NULL, '2022-02-17 12:54:02', '2022-02-17 12:54:02'),
(55403, 20067, 54806, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:10:06', '2022-02-21 10:10:06'),
(55404, 20067, 54806, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- EDNA MICHI   Dear Provider,  We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.   To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:  http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/  For Re-Credentialing, please email your information to credentialing@centene.com.', NULL, NULL, '2022-02-25 15:48:38', '2022-02-25 15:48:38'),
(55405, 20067, 54806, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Call Superior Health Plan for credentialing status  Provider Edna Michi Effective Date: 04/01/2022  Secondary and Tertiary Locations added over the call. Location will be update within 15-20 business days.  Submitted the request for welcome letters over the call. An Account manager will contact on phone# 713-893-6214 or email address: vmuc@claimsmedinc.com  Ref# I73428875  ', NULL, NULL, '2022-03-15 17:11:16', '2022-03-15 17:11:16'),
(55406, 20067, 54807, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:36:03', '2022-02-01 08:36:03'),
(55407, 20067, 54807, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906   Thanks & Regards,  ', NULL, NULL, '2022-02-01 08:44:53', '2022-02-01 08:44:53'),
(55408, 20067, 54807, NULL, '2022-02-24 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@SuperiorHealthPlan.com, AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,  Syed Ahad.', NULL, NULL, '2022-02-17 12:53:54', '2022-02-17 12:53:54'),
(55409, 20067, 54807, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:09:58', '2022-02-21 10:09:58'),
(55410, 20067, 54807, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:09:58', '2022-02-21 10:09:58'),
(55411, 20067, 54807, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- NUBIA BENAVIDES   Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.', NULL, NULL, '2022-02-25 15:50:36', '2022-02-25 15:50:36'),
(55412, 20067, 54807, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Call Superior Health Plan for credentialing status  Provider Nubia Benavides Effective Date: 04/01/2022 Secondary and Tertiary Locations added over the call. Location will be update within 15-20 days  Submitted the request for welcome letters over the call. An Account manager will contact on phone# 713-893-6214 or email address: vmuc@claimsmedinc.com  Ref# I73426455', NULL, NULL, '2022-03-15 17:05:07', '2022-03-15 17:05:07'),
(55413, 20067, 54808, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:36:42', '2022-02-01 08:36:42'),
(55414, 20067, 54808, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906   Thanks & Regards,  ', NULL, NULL, '2022-02-01 08:44:41', '2022-02-01 08:44:41'),
(55415, 20067, 54808, NULL, '2022-02-24 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@SuperiorHealthPlan.com, AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,  Syed Ahad.', NULL, NULL, '2022-02-17 12:53:46', '2022-02-17 12:53:46'),
(55416, 20067, 54808, NULL, '2022-02-28 00:00:00.000', 'Initiated', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:09:51', '2022-02-21 10:09:51'),
(55417, 20067, 54808, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- EDNA MICHI   Dear Provider,  We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.   To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:  http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/  For Re-Credentialing, please email your information to credentialing@centene.com.', NULL, NULL, '2022-02-25 15:48:29', '2022-02-25 15:48:29'),
(55418, 20067, 54808, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Call Superior Health Plan for credentialing status  Provider Edna Michi Effective Date: 04/01/2022  Secondary and Tertiary Locations added over the call. Location will be update within 15-20 business days.  Ref# I73428875 ', NULL, NULL, '2022-03-15 17:10:05', '2022-03-15 17:10:05'),
(55419, 22077, 54808, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Re: [SECURE] Add a provider- EDNA MICHI  Hi,  We submitted the application on 02/21/2022. Any updates on it?  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-08 09:56:04', '2022-04-08 09:56:04'),
(55420, 19067, 54808, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Spoke with Vanessa @ 877-391-5921. Got the eff date as of 04/01/2022. Ref# I752633305', NULL, NULL, '2022-04-12 11:12:37', '2022-04-12 11:12:37'),
(55421, 20067, 54809, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:36:42', '2022-02-01 08:36:42'),
(55422, 20067, 54809, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906   Thanks & Regards,  ', NULL, NULL, '2022-02-01 08:44:33', '2022-02-01 08:44:33'),
(55423, 20067, 54809, NULL, '2022-02-24 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@SuperiorHealthPlan.com, AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,  Syed Ahad.', NULL, NULL, '2022-02-17 12:53:40', '2022-02-17 12:53:40');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(55424, 20067, 54809, NULL, '2022-02-28 00:00:00.000', 'Initiated', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:09:44', '2022-02-21 10:09:44'),
(55425, 20067, 54809, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- NUBIA BENAVIDES   Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.', NULL, NULL, '2022-02-25 15:50:31', '2022-02-25 15:50:31'),
(55426, 20067, 54809, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Call Superior Health Plan for credentialing status  Provider Nubia Benavides Effective Date: 04/01/2022 Secondary and Tertiary Locations added over the call. Location will be update within 15-20 days  Ref# I73426455', NULL, NULL, '2022-03-15 17:02:01', '2022-03-15 17:02:01'),
(55427, 22077, 54809, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: 	Re: [SECURE] Add a provider- NUBIA BENAVIDES  Hi,  I would like to know the enrollment status of the provider we have submitted the application on 24-02-2022  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 Nubia Olivama Benavides	1801371935  Kindly make an update on it,  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-08 08:29:36', '2022-04-08 08:29:36'),
(55428, 19067, 54809, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Spoke with Vanessa @ 877-391-5921. Got the eff date as of 04/01/2022. Ref# I752633305', NULL, NULL, '2022-04-12 11:12:51', '2022-04-12 11:12:51'),
(55429, 20067, 54810, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:37:18', '2022-02-01 08:37:18'),
(55430, 20067, 54810, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906   Thanks & Regards,  ', NULL, NULL, '2022-02-01 08:44:19', '2022-02-01 08:44:19'),
(55431, 20067, 54810, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@SuperiorHealthPlan.com, AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,  Syed Ahad.', NULL, NULL, '2022-02-17 12:53:33', '2022-02-17 12:53:33'),
(55432, 20067, 54810, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:09:37', '2022-02-21 10:09:37'),
(55433, 20067, 54810, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- EDNA MICHI   Dear Provider,  We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.   To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:  http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/  For Re-Credentialing, please email your information to credentialing@centene.com.', NULL, NULL, '2022-02-25 15:48:52', '2022-02-25 15:48:52'),
(55434, 20067, 54810, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Call Superior Health Plan for credentialing status  Provider Edna Michi Effective Date: 04/01/2022  Secondary and Tertiary Locations added over the call. Location will be update within 15-20 business days.  Ref# I73428875 ', NULL, NULL, '2022-03-15 17:09:53', '2022-03-15 17:09:53'),
(55435, 22077, 54810, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Re: [SECURE] Add a provider- EDNA MICHI  Hi,  We submitted the application on 02/21/2022. Any updates on it?  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-08 09:55:45', '2022-04-08 09:55:45'),
(55436, 19067, 54810, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Spoke with Vanessa @ 877-391-5921. Got the eff date as of 04/01/2022. Ref# I752633305', NULL, NULL, '2022-04-12 11:12:43', '2022-04-12 11:12:43'),
(55437, 20067, 54811, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:37:18', '2022-02-01 08:37:18'),
(55438, 20067, 54811, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health 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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906   Thanks & Regards,  ', NULL, NULL, '2022-02-01 08:44:10', '2022-02-01 08:44:10'),
(55439, 20067, 54811, NULL, '2022-02-24 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@SuperiorHealthPlan.com, AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers under Superior Health  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 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & Regards,  Syed Ahad.', NULL, NULL, '2022-02-17 12:53:23', '2022-02-17 12:53:23'),
(55440, 20067, 54811, NULL, '2022-02-28 00:00:00.000', 'Initiated', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || Nubia Benavides & Edna Michi || Superior Health  Good Morning Syed,     There are no records for the following providers under TIN: 81-5123542.     Nubia Olivama Benavides NPI: 1801371935  Edna Michi NPI: 1992293906.     Please submit your credentialing request through Add a Provider to an Existing Group Contract to initiate to process.     Respectfully,     Daniel Velez', NULL, NULL, '2022-02-21 10:09:20', '2022-02-21 10:09:20'),
(55441, 20067, 54811, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- NUBIA BENAVIDES   Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.', NULL, NULL, '2022-02-25 15:50:25', '2022-02-25 15:50:25'),
(55442, 20067, 54811, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Call Superior Health Plan for credentialing status  Provider Nubia Benavides Effective Date: 04/01/2022 Secondary and Tertiary Locations added over the call. Location will be update within 15-20 days  Ref# I73426455', NULL, NULL, '2022-03-15 17:01:35', '2022-03-15 17:01:35'),
(55443, 22077, 54811, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: 	Re: [SECURE] Add a provider- NUBIA BENAVIDES  Hi,  I would like to know the enrollment status of the provider we have submitted the application on 24-02-2022  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 Nubia Olivama Benavides	1801371935  Kindly make an update on it,  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-08 08:29:15', '2022-04-08 08:29:15'),
(55444, 19067, 54811, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Spoke with Vanessa @ 877-391-5921. Got the eff date as of 04/01/2022. Ref# I752633305', NULL, NULL, '2022-04-12 11:12:56', '2022-04-12 11:12:56'),
(55445, 20067, 54812, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:51:56', '2022-02-01 08:51:56'),
(55446, 20067, 54812, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2022-02-04 14:37:38', '2022-02-04 14:37:38'),
(55447, 20067, 54813, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:51:56', '2022-02-01 08:51:56'),
(55448, 20067, 54813, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2022-02-04 14:37:24', '2022-02-04 14:37:24'),
(55449, 20067, 54814, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:53:00', '2022-02-01 08:53:00'),
(55450, 20067, 54814, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2022-02-04 14:35:13', '2022-02-04 14:35:13'),
(55451, 20067, 54815, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:53:00', '2022-02-01 08:53:00'),
(55452, 20067, 54815, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2022-02-04 14:34:55', '2022-02-04 14:34:55'),
(55453, 20067, 54816, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:53:24', '2022-02-01 08:53:24'),
(55454, 20067, 54816, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2022-02-04 14:34:32', '2022-02-04 14:34:32'),
(55455, 20067, 54817, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 08:54:00', '2022-02-01 08:54:00'),
(55456, 20067, 54817, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2022-02-04 14:32:35', '2022-02-04 14:32:35'),
(55457, 20067, 54818, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:27:19', '2022-02-01 15:27:19'),
(55458, 20067, 54818, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || NUCC || Ancy Kurian || Ambetter ||   Good afternoon!  I would like to enroll Ancy kurian into an Existing group. Information is mentioned below. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Let me know if you have any questions. Thank you,', NULL, NULL, '2022-02-01 15:52:03', '2022-02-01 15:52:03'),
(55459, 20067, 54818, NULL, '2022-03-08 00:00:00.000', 'Initiated', 'Application to add provider into an existing group is submitted through portal See the Attachment', NULL, NULL, '2022-03-01 12:31:22', '2022-03-01 12:31:22'),
(55460, 20067, 54818, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || NUCC || Ancy Kurian || Ambetter ||  Good Afternoon!  I would like to know the credentialing status of the listed provider under Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  Thank you, Syed.', NULL, NULL, '2022-03-21 13:59:49', '2022-03-21 13:59:49'),
(55461, 19067, 54818, NULL, '2022-04-07 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: ${SECURE}RE: Enrollment Status || NUCC || Ancy Kurian || Ambetter ||    Good afternoon,     For this provider, their current status shows as credentialing and provider validation. This means that credentialing has received documents and they are being reviewed for completeness before an effective date is established. They should reach out with further information on the agreement as they are still working on it. Please allow time for them to review information submitted.     Adriano Garcia; CPhT  Provider Account Manager  Region 7 (Harris & Jefferson)         ', NULL, NULL, '2022-03-31 09:35:16', '2022-03-31 09:35:16'),
(55462, 22077, 54818, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: 	Re: ${SECURE}RE: Enrollment Status || NUCC || Ancy Kurian || Ambetter ||  Hi,  Any updates on the mentioned request for provider, Ancy Kurian?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:34:46', '2022-04-14 13:34:46'),
(55463, 20067, 54819, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:28:22', '2022-02-01 15:28:22'),
(55464, 20067, 54819, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: jmaligaya@anci-care.com, pr.south@healthsmart.com  Sub: Enroll Providers ||Normandy Urgent Care Center || Ancy Kurian || Anci Care||  I would like to know the enrollment status of the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-01 16:03:56', '2022-02-01 16:03:56'),
(55465, 20067, 54819, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Enroll Providers ||Normandy Urgent Care Center || Ancy Kurian || Anci Care||  Hi,  We currently show the following providers credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Kurian, Ancy V NP  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-02-16 15:09:02', '2022-02-16 15:09:02'),
(55466, 20067, 54819, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Demographic Update || Ancy Kurian || Anci Care  Good afternoon!  Hope this email finds you well. Kindly see the attached demographic update form for Ancy Kurian.  Thank you,', NULL, NULL, '2022-02-16 15:10:41', '2022-02-16 15:10:41'),
(55467, 20067, 54819, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Demographic Update || Ancy Kurian || Anci Care  Hi,  We are returning your application due to missing information listed below.  *    Name of Supervising Physicians  Please review the attached Application Review Form and forward the missing information within the next 5 days.  Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks HealthSmart Provider Relations', NULL, NULL, '2022-02-24 09:48:31', '2022-02-24 09:48:31'),
(55468, 20067, 54819, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Demographic Update || Ancy Kurian || Anci Care  Good Morning!  The corrections have been completed and CAQH is updated. Kindly see the attachments', NULL, NULL, '2022-02-24 09:49:11', '2022-02-24 09:49:11'),
(55469, 20067, 54819, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Demographic Update || Ancy Kurian || Anci Care  Good Afternoon!  Hope you are doing well. Any updates for provider Ancy Kurian?  Thank you', NULL, NULL, '2022-03-09 16:35:45', '2022-03-09 16:35:45'),
(55470, 20067, 54819, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Demographic Update || Ancy Kurian || Anci Care  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-15 12:50:04', '2022-03-15 12:50:04'),
(55471, 22077, 54819, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Demographic Update || Ancy Kurian || Anci Care  Hi,  Hope you are doing well. Any updates for provider Ancy Kurian?  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 14:14:09', '2022-04-14 14:14:09'),
(55472, 22077, 54819, NULL, '2022-04-28 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Subject: 	Re: Demographic Update || Ancy Kurian || Anci Care  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Documents ID : 3555171)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-04-21 07:21:31', '2022-04-21 07:21:31'),
(55473, 20067, 54820, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:31:10', '2022-02-01 15:31:10'),
(55474, 20067, 54820, NULL, '2022-02-08 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-02-01 16:07:50', '2022-02-01 16:07:50'),
(55475, 20067, 54821, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:32:01', '2022-02-01 15:32:01'),
(55476, 20067, 54821, NULL, '2022-02-08 00:00:00.000', 'Not Eligible', 'Email rcvd from: vicki.guerra@christushealth.org  Subject: Christus Spohn Health Network - Counties  Hi Adil,  Happy Thursday!  Thank you for speaking with me. The email address CSHNproviderrelations@christushealth.org is not a working email. I apologize for the delay and we are updating our website.  Please click on the website below. It will give you the map of our services areas based on county.  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area  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, '2022-02-01 16:10:14', '2022-02-01 16:10:14'),
(55477, 20067, 54822, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:35:04', '2022-02-01 15:35:04'),
(55478, 20067, 54822, NULL, '2022-02-08 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllie', NULL, NULL, '2022-02-01 16:13:45', '2022-02-01 16:13:45'),
(55479, 20067, 54823, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:35:22', '2022-02-01 15:35:22'),
(55480, 20067, 54823, NULL, '2022-02-08 00:00:00.000', 'Approved', 'Group Has an Ancillary contract no need to add individual provider ', NULL, NULL, '2022-02-01 16:17:28', '2022-02-01 16:17:28'),
(55481, 20067, 54824, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:35:36', '2022-02-01 15:35:36'),
(55482, 20067, 54824, NULL, '2022-02-08 00:00:00.000', 'Not Eligible', '	 Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch ', NULL, NULL, '2022-02-01 16:26:08', '2022-02-01 16:26:08'),
(55483, 20067, 54825, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:35:48', '2022-02-01 15:35:48'),
(55484, 20067, 54825, NULL, '2022-02-08 00:00:00.000', 'Approved', '	 I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   Effective date: 03/01/2020', NULL, NULL, '2022-02-01 16:28:25', '2022-02-01 16:28:25'),
(55485, 20067, 54826, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:36:01', '2022-02-01 15:36:01'),
(55486, 20067, 54826, NULL, '2022-02-08 00:00:00.000', 'Initiated', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Enrollment Request || NUCC || Ancy Kurian || Galaxy Health  Good Afternoon!  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider under the below location Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-01 17:14:15', '2022-02-01 17:14:15'),
(55487, 20067, 54826, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: contracting@ghn-mci.com, providers@ghn-mci.com  Sub: Re: Enrollment Request || NUCC || Ancy Kurian || Galaxy Health  Good Afternoon!  I would like to add the below-mentioned provider to an existing group. Can you please help me out with this?  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thank you,', NULL, NULL, '2022-03-01 15:17:17', '2022-03-01 15:17:17'),
(55488, 22077, 54826, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:01:54', '2022-04-15 08:01:54'),
(55489, 22077, 54826, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:14:56', '2022-04-19 13:14:56'),
(55490, 22077, 54826, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:26:13', '2022-04-19 13:26:13'),
(55491, 20067, 54827, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:36:40', '2022-02-01 15:36:40'),
(55492, 20067, 54827, NULL, '2022-02-08 00:00:00.000', 'New/Not Initiated', 'Email sent to: CredentialingInquiries@humana.com  Sub: Enrollment Query || NUCC|| Ancy Kurian || Humana  Good Afternoon! Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned provider under the below location.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-01 17:34:01', '2022-02-01 17:34:01'),
(55493, 20067, 54827, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2022-02-04 16:10:13', '2022-02-04 16:10:13'),
(55494, 20067, 54828, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:36:56', '2022-02-01 15:36:56'),
(55495, 20067, 54828, NULL, '2022-02-08 00:00:00.000', 'New/Not Initiated', 'Email sent to: MyartL@usamco.com  Sub: Enrollment Query || NUCC || Ancy Kurian || MCO  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned provider.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-01 17:41:00', '2022-02-01 17:41:00'),
(55496, 20067, 54828, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2022-02-04 16:16:46', '2022-02-04 16:16:46'),
(55497, 20067, 54828, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Email received from: MyartL@usamco.com  Sub:  Enrollment Query || NUCC || Ancy Kurian || MCO   Hello Syed,     Normandy Urgent Care Center is contracted with USA under a facility agreement.  If the providers are billing under the facility’s name and tax id number the provider’s do not have to be contracted.     Please let me know if you have any additional questions.     Thank you,', NULL, NULL, '2022-03-17 15:13:15', '2022-03-17 15:13:15'),
(55498, 20067, 54829, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:37:18', '2022-02-01 15:37:18'),
(55499, 20067, 54830, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:37:41', '2022-02-01 15:37:41'),
(55500, 20067, 54830, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2022-02-04 16:29:00', '2022-02-04 16:29:00'),
(55501, 20067, 54831, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:37:59', '2022-02-01 15:37:59'),
(55502, 20067, 54831, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Normandy Urgent Care Center || Ancy Kurian || Molina Health ||  Good Afternoon!  Hope this email finds you in good health. I would like to add the below mentioned provider under the existing group. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935 Thanks & Regards, ', NULL, NULL, '2022-02-04 17:11:59', '2022-02-04 17:11:59'),
(55503, 20067, 54831, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Enrollment Status || Normandy Urgent Care Center || Ancy Kurian || Molina Health ||  Good Afternoon!  I would like to add the below-mentioned provider to an existing group. Can you please help me out with this?  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935	  Thank you,', NULL, NULL, '2022-03-01 14:27:48', '2022-03-01 14:27:48'),
(55504, 20067, 54831, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Ancy Kurian || Molina Health ||   Good Afternoon!  I would like to add the below-mentioned provider to an existing group. Can you please help me out with this?  Group Name Normandy Urgent Care Center Tax ID 270796429 Group NPI 1407171077 Ancy Kurian NPI 1316558935  Thank you,', NULL, NULL, '2022-03-09 14:23:01', '2022-03-09 14:23:01'),
(55505, 20067, 54831, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Ancy Kurian || Molina Health ||  Good Afternoon,     Please submit a contract request form along with valid W9 to the contracting mailbox MHTContractrequest@Molinahealthcare.com.     Thank You,', NULL, NULL, '2022-03-10 14:07:11', '2022-03-10 14:07:11'),
(55506, 20067, 54831, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Good Afternoon!  Please see the attached contract request for Ancy Kurian along with W9 for both locations.  Thank you,', NULL, NULL, '2022-03-10 14:08:53', '2022-03-10 14:08:53'),
(55507, 20067, 54831, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Good Afternoon!  Hope you had a great weekend. Kindly update me about the current credentialing status for Ancy Kurian: 1316558935  Thank you,', NULL, NULL, '2022-03-21 14:40:13', '2022-03-21 14:40:13'),
(55508, 20067, 54831, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Good Morning,     Thank You, Please allow time for the intake coordinator to process the request.   If you would like to follow up on the request to see if it was received, please send email to the contracting mailbox.', NULL, NULL, '2022-03-22 12:53:14', '2022-03-22 12:53:14'),
(55509, 19067, 54831, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@MolinaHealthCare.Com  Subject: Enrollment Query || Ancy Kurian || NUCC || Molina ||    Hello,  Hope this email finds you well. Kindly see the attached contract request form along with W9 for the provider, Ancy Kurian. Do let me know if you need any documents or information.  Thanks,', NULL, NULL, '2022-03-30 18:01:49', '2022-03-30 18:01:49'),
(55510, 22077, 54831, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Hi,  I would like to know the enrollment process for the provider Ancy Kurian.  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 10:55:27', '2022-04-15 10:55:27'),
(55511, 19067, 54831, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email received from: Sharon.Washington@molinahealthcare.com  Subject: Missing provider contract-#179917    Hi,     Just following up with how Molina should proceed with the response provided that provider (Kurian) does not show to have been requested for contracting with Molina under Normandy. I’ve attached a copy of your group roster. If interested in contracting this provider, please complete and return the attached CRF form and return with a current W-9.     Thank you,        Sharon Washington | Manager, Provider Services | Harris/Jefferson/Bexar/Northeast  Sharon.Washington@Molinahealthcare.com  Mobile: 281-768-0662', NULL, NULL, '2022-04-18 10:58:50', '2022-04-18 10:58:50'),
(55512, 19067, 54831, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: mhtcontractrequest@molinahealthcare.com  Subject: Contract Request Form || NUCC || Ancy Kurian || Molina   Hello,  Attached is the CRF for our provider, Ancy Kurian.  Kindly start her credentialing process as we are already late on this process and don\'t hesitate to reach out if you have any questions or concerns.  Thanks,', NULL, NULL, '2022-04-18 11:16:19', '2022-04-18 11:16:19'),
(55513, 19067, 54831, NULL, '2022-04-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com  Subject: Contract Form || Ancy Kurian || NUCC || Molina   Hello,  Kindly see the attached Contract request form for the provider, Ancy Kurian.  Thanks,', NULL, NULL, '2022-04-21 15:30:55', '2022-04-21 15:30:55'),
(55514, 22077, 54831, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email received from:Michele.Thomas-Martin@molinahealthcare.com  Subject: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Good Morning,     Please submit a contract request form along with valid W9 to the contracting mailbox MHTContractrequest@Molinahealthcare.com.    There is no request on file for the provider.  If you have already submitted  the contract request form, please follow up with the contracting mailbox MHTContractrequest@Molinahealthcare.com.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  Molina Healthcare Of Texas, Inc  Michele.Thomas-Martin@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  (972)200-2688', NULL, NULL, '2022-04-22 09:48:41', '2022-04-22 09:48:41'),
(55515, 22077, 54831, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Subject: Contract Form || Ancy Kurian || NUCC || Molina  Hello,  Kindly see the attached Contract request form for the provider, Ancy Kurian.  Thanks,', NULL, NULL, '2022-04-22 09:50:05', '2022-04-22 09:50:05'),
(55516, 20067, 54832, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:38:03', '2022-02-01 15:38:03'),
(55517, 20067, 54832, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Addition of Provider || NUCC || Ancy Kurian || Molina marketplace  Good Afternoon!  Hope this email finds you in good health. I would like to add the below mentioned provider under the existing group. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935 Thanks & Regards,  ', NULL, NULL, '2022-02-04 17:19:07', '2022-02-04 17:19:07'),
(55518, 20067, 54832, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:30:47', '2022-02-21 09:30:47'),
(55519, 20067, 54832, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Addition of Provider || NUCC || Ancy Kurian || Molina marketplace  Good Morning –  Happy Monday! Hope you are doing well. if you are a group of providers please complete attached contract request form and submit with a current W9 to mhtcontractrequest@Molinahealthcare.com and advise you are a group of providers. if you are an urgent care we do not affiliate individual providers to Urgent care facility. Thank you in advance have a wonderful day.  Best Regards,', NULL, NULL, '2022-03-01 14:01:35', '2022-03-01 14:01:35'),
(55520, 20067, 54832, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Addition of Provider || NUCC || Ancy Kurian || Molina marketplace  Good Afternoon!  Attached is the contract request form of the provider and W9 of both locations.  Thank you, ', NULL, NULL, '2022-03-18 10:33:00', '2022-03-18 10:33:00'),
(55521, 19067, 54832, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@MolinaHealthCare.Com  Subject: Enrollment Query || Ancy Kurian || NUCC || Molina ||    Hello,  Hope this email finds you well. Kindly see the attached contract request form along with W9 for the provider, Ancy Kurian. Do let me know if you need any documents or information.  Thanks,', NULL, NULL, '2022-03-30 18:01:58', '2022-03-30 18:01:58'),
(55522, 22077, 54832, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Subject: Re: Addition of Provider || NUCC || Ancy Kurian || Molina marketplace  Hi,  I would like to know the enrollment process for the following provider  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  I am looking forward to your kind response!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 14:29:44', '2022-04-15 14:29:44'),
(55523, 20067, 54833, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:38:25', '2022-02-01 15:38:25'),
(55524, 20067, 54833, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: registrar@multiplan.com  Sub: Addition of provider || NUCC || Ancy Kurian || Molina Marketplace   Good afternoon!  Hope this email finds you well, I would like to add the below-mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thank you,', NULL, NULL, '2022-02-04 17:26:26', '2022-02-04 17:26:26'),
(55525, 20067, 54833, NULL, '2022-03-09 00:00:00.000', 'Initiated', 'Email sent to: registrar@multiplan.com  Sub: Addition of provider || NUCC || Ancy Kurian || Multiplan  Good afternoon!  Hope this email finds you well, I would like to add the below mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thank you, ', NULL, NULL, '2022-03-02 10:04:59', '2022-03-02 10:04:59'),
(55526, 20067, 54833, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: fax7814878257@multiplan.com  Sub:Ancy Kurian APP0008381833  Ref APP0008381833     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.        Danny H.  Provider Data Management  Appmissinginfo@multiplan.com     MultiPlan, Inc  16 Crosby Drive  Bedford, MA 01730  (fx) 781-487-8257', NULL, NULL, '2022-03-10 15:51:17', '2022-03-10 15:51:17'),
(55527, 22077, 54833, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:51:39', '2022-04-15 14:51:39'),
(55528, 20067, 54834, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:38:43', '2022-02-01 15:38:43'),
(55529, 20067, 54834, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Doesnt cover this area', NULL, NULL, '2022-02-04 15:46:00', '2022-02-04 15:46:00'),
(55530, 20067, 54835, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:38:56', '2022-02-01 15:38:56'),
(55531, 20067, 54835, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com  Sub: Addition of Provider || NUCC || Ancy Kurian || Prime health Services  Good Evening!  Hope this email finds you in good health. I would like to add the below-mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-04 17:45:31', '2022-02-04 17:45:31'),
(55532, 20067, 54835, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Re: Addition of Provider || NUCC || Ancy Kurian || Prime health Services   Dear Syed Ahad, We\'ve got your ticket! This is a generic response from the Prime Health Services Credentialing ticket system.  We have received your ticket and it has been placed into our queue. Your request has been created with id 178078. The title of the request is : Addition of Provider || NUCC || Ancy Kurian || Prime health Services. Thank you for your patience as we look into your issue. -Prime Health Services Credentialing Team', NULL, NULL, '2022-02-04 18:02:00', '2022-02-04 18:02:00'),
(55533, 20067, 54835, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub: Re: Addition of Provider || NUCC || Ancy Kurian || Prime health Services  Good Morning!  Hope you are doing well. I would like to know the credentialing status of provider Ancy Kurian.  NPI# 1316558935 Request ID# 178078  Thank you, ', NULL, NULL, '2022-03-02 10:11:08', '2022-03-02 10:11:08'),
(55534, 20067, 54835, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com   Sub: Addition of Provider || NUCC || Ancy Kurian || Prime health Services  Good Afternoon,  Please email a current CAQH Credentialing application or State Credentialing application for provider Kurian.  The Updates Department will respond regarding the effective date, Tax ID link and locations.  Thank you, Nancy', NULL, NULL, '2022-03-09 12:43:50', '2022-03-09 12:43:50'),
(55535, 20067, 54835, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub: Re: Addition of Provider || NUCC || Ancy Kurian || Prime health Services   Good Afternoon!  Hope this email finds you in good health. Attached is the State Credentialing application for provider Kurian.  Thank you,', NULL, NULL, '2022-03-09 12:54:26', '2022-03-09 12:54:26'),
(55536, 20067, 54835, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Re: Addition of Provider || NUCC || Ancy Kurian || Prime health Services  Thank you!  I\'ve started the credentialing process for provider Ancy Kurian.  Nancy', NULL, NULL, '2022-03-21 13:54:30', '2022-03-21 13:54:30'),
(55537, 22077, 54835, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  subject: Re: Addition of Provider || NUCC || Ancy Kurian || Prime health Services  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-18 10:47:47', '2022-04-18 10:47:47'),
(55538, 22077, 54835, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Subject: Re: Re: Addition of Provider || NUCC || Ancy Kurian || Prime health Services  Good Morning,  Provider Kurian is in the last stages of the credentialing process.  Please refer inquiries regarding the effective date, Tax ID link and locations to: updates@primehealthservices.com   Thank you, Nancy', NULL, NULL, '2022-04-19 07:18:52', '2022-04-19 07:18:52'),
(55539, 20067, 54836, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:40:27', '2022-02-01 15:40:27');
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
(55540, 20067, 54836, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2022-02-04 17:46:50', '2022-02-04 17:46:50'),
(55541, 20067, 54837, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:40:27', '2022-02-01 15:40:27'),
(55542, 20067, 54837, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Sub: Addition of Provider || NUCC || Ancy Kurian || Scott & White  Good Evening!  Hope this email finds you in good health. I would like to add the below-mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-04 17:52:24', '2022-02-04 17:52:24'),
(55543, 20067, 54837, NULL, '2022-03-09 00:00:00.000', 'Initiated', 'Application Initiated Online  Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: c3a368b7-bf34-40e5-863c-8a3c7287b8a4  See the attachment.', NULL, NULL, '2022-03-02 10:58:40', '2022-03-02 10:58:40'),
(55544, 20067, 54837, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: HPEXPEDITES@bswhealth.org  Sub: SWHP - Add Provider Ancy V Kurian to Normandy Urgent Care Center   Good Morning/Afternoon,  Here at Scott & White/FirstCare Health Plan we take pride in working expediently to provide you with quality service in a timely and accurate manner.  We have recently received a request to add a provider(s) to your existing Scott & White/FirstCare Health Plan group agreement.  In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept.     Please return the documents (to us via email hpexpedites@bswhealth.org) listed below to us within 5 business days:     Provider Information Form (attached) Group and Provider Tab  Copy of the CME Form(attached/if applicable)  Copy of the Hospital Privilege Form (attached/if applicable)  Copy of the W- 9 (attached)     This will be the only request sent.  Any documents received after 30 calendar days, will not be processed and will require you re-apply through www.bswhealthplan.com     Thank you and have a great day,  Provider Service Specialist  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-03-10 10:31:41', '2022-03-10 10:31:41'),
(55545, 20067, 54837, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: hpexpedites@bswhealth.org   Sub: SWHP - Add Provider Ancy V Kurian to Normandy Urgent Care Center   Good Afternoon!  Hope this email finds you in good health. Attached are the requested documents.  Let me know if anything else is needed from my end  Thank you,', NULL, NULL, '2022-03-10 12:44:06', '2022-03-10 12:44:06'),
(55546, 20067, 54837, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: hpexpedites@bswhealth.org  Sub: Re: SWHP - Add Provider Ancy V Kurian to Normandy Urgent Care Center  Good Afternoon!  Hope this email finds you in good health. Can you please confirm the current credentialing status of the provider Ancy Kurian.  Thank you, Syed', NULL, NULL, '2022-03-21 13:40:36', '2022-03-21 13:40:36'),
(55547, 22077, 54837, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: HPEXPEDITES@bswhealth.org  Subject:  RE: {EXTERNAL} Re: SWHP - Add Provider Ancy V Kurian to Normandy Urgent Care Center  Good morning,     The enrollment is currently pending due to the provider not having an attested TPI. Please reach out to TMHP to check the status of the TPI so we may process the enrollment.     Thank you and have a great day,  Provider Service Specialist  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-04-07 15:18:19', '2022-04-07 15:18:19'),
(55548, 22077, 54837, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: HPEXPEDITES@bswhealth.org  Subject:  RE: Re: SWHP - Add Provider Ancy V Kurian to Normandy Urgent Care Center  Good afternoon,     The enrollment request has closed due to the provider not having an attested TPI to the GNPI/TIN. Please visit the link provided below to resubmit once the provider has received their attested TPI confirmation.     Provider Account Management (swhp.org)     Thank you and have a great day,  Provider Service Specialist  Baylor Scott & White Health Plan  1206 West Campus Drive | Temple, TX 76502  BSWHealthPlan.com', NULL, NULL, '2022-04-07 15:20:08', '2022-04-07 15:20:08'),
(55549, 20067, 54838, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:40:39', '2022-02-01 15:40:39'),
(55550, 20067, 54838, NULL, '2022-02-11 00:00:00.000', 'New/Not Initiated', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Good Afternoon!  I would like to add the below-mentioned provider under an existing group under Superior Health.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Provider Name	NPI Ancy Kurian	1316558935  Thank you,', NULL, NULL, '2022-02-04 16:07:57', '2022-02-04 16:07:57'),
(55551, 20067, 54838, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Good Afternoon!  I would like to add the below-mentioned provider under an existing group under Superior Health.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Provider Name	NPI Ancy Kurian	1316558935  Thank you,', NULL, NULL, '2022-02-04 17:56:04', '2022-02-04 17:56:04'),
(55552, 20067, 54838, NULL, '2022-03-09 00:00:00.000', 'Initiated', 'Application initiated online  See the attached application', NULL, NULL, '2022-03-02 12:16:09', '2022-03-02 12:16:09'),
(55553, 20067, 54838, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com    Sub: Re: Case 77800 RE: Enrollment Query || Ancy Kurian || NUCC|| Superior Health   Good Afternoon!  Hope this email finds you well. I have submitted the application Using the link which you provided.  I want to know the status of the application for Ancy Kurian NPI: 1316558935 TIN# 27-0796429.  Thank you,', NULL, NULL, '2022-03-18 14:52:03', '2022-03-18 14:52:03'),
(55554, 20067, 54838, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: TXPS-COORD@superiorhealthplan.com  Sub: [Secure] FW: Case 77800 RE: Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Hello,  Thank you for contacting Superior Health Plan. Your reference# is  R-16143975.  Below is the requested credentialing status under Tax ID 270796429  Provider Name: Ancy Kurian  Provider NPI: 1316558935  Superior Health Plan has submitted an application via email and is currently waiting a return of completed application from provider. Please check your inbox/junk/spam mail and send accordingly. Should you have additional questions or concerns, please contact your regional account manager at AM.Houston@superiorhealthplan.com.  Please do not reply to this message. Replies to this message are routed to an unmonitored mailbox.  Thank you, Superior Health Plan', NULL, NULL, '2022-03-18 17:18:27', '2022-03-18 17:18:27'),
(55555, 20067, 54838, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com, txps-coord@superiorhealthplan.com  Sub: Case 77800 Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Hello!  We haven\'t received any email from SHP. Kindly resend me the application so I can start work on it..  Thank you,', NULL, NULL, '2022-03-18 17:20:07', '2022-03-18 17:20:07'),
(55556, 20067, 54838, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub: ${SECURE}RE: Case 77800 RE: Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Hi Syed,     Thank you for your email. After doing some research, I found  that Network Development sent you an email on 03.17.22 to follow up on the application for tax 270796429 and NPI 1316558935. I am attaching the email that Network Development sent you on 03.17.22. Please follow their instructions and send them back the information that they are requesting, in order to continue with the process on your application.     Case 86104     Thank you,', NULL, NULL, '2022-03-22 12:42:36', '2022-03-22 12:42:36'),
(55557, 20067, 54838, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Sub: Contracting Packet || Ancy Kurian || Normandy Urgent Care Center || SHP  Hello,  Attached is the provider contracting packet for Ancy Kurian.  Thank you,', NULL, NULL, '2022-03-22 12:43:43', '2022-03-22 12:43:43'),
(55558, 22077, 54838, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: ${SECURE}RE: Case 77800 RE: Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 11:05:55', '2022-04-18 11:05:55'),
(55559, 22077, 54838, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: RE: ${SECURE}RE: Case 77800 RE: Enrollment Query || Ancy Kurian || NUCC|| Superior Health  Hello,     This provider is currently in the credentialing stage and the credentialing team is reviewing the necessary information to create the contract. if they need additional information they will reach out to you directly.', NULL, NULL, '2022-04-19 13:02:42', '2022-04-19 13:02:42'),
(55560, 20067, 54839, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:41:08', '2022-02-01 15:41:08'),
(55561, 20067, 54839, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: ccampos@trpnppo.com  Sub: Addition of Provider || NUCC || Ancy Kurian || TRPN  Good Evening!  Hope this email finds you in good health. I would like to add the below-mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards, ', NULL, NULL, '2022-02-04 17:59:32', '2022-02-04 17:59:32'),
(55562, 20067, 54839, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Secure email sent to: trpn.notification@zixmessagecenter.com   Sub: Addition of Provider || NUCC || Ancy Kurian || TRPN  Good Afternoon!  Hope this email finds you in good health. I would like to add the below mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935 Than you,', NULL, NULL, '2022-03-01 15:40:11', '2022-03-01 15:40:11'),
(55563, 20067, 54839, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Sub: Addition of Provider || NUCC || Ancy Kurian || TRPN  Good Afternoon!  Attached is the provider update form along with the W9 of both   Thank you, ', NULL, NULL, '2022-03-18 14:32:52', '2022-03-18 14:32:52'),
(55564, 22077, 54839, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: trpn.notification@zixmessagecenter.com  Subject: Re: Addition of Provider || NUCC || Ancy Kurian || TRPN  Hi,  I would like to enroll the following provider  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	779 NORMANDY ST STE 114 HOUSTON, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, HOUSTON, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards. ', NULL, NULL, '2022-04-18 13:43:00', '2022-04-18 13:43:00'),
(55565, 20067, 54840, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:41:23', '2022-02-01 15:41:23'),
(55566, 20067, 54840, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: ywyatt@humana.com  Sub: Addition of Provider || NUCC || Ancy Kurian || Tricare  Good Evening!  Hope this email finds you in good health. I would like to add the below-mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards,', NULL, NULL, '2022-02-04 18:06:44', '2022-02-04 18:06:44'),
(55567, 20067, 54840, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: Secured: RE: Addition of Provider || NUCC || Ancy Kurian || Tricare  Hello Syed,  Ancy Kurian do not appear in our system as TRICARE certified. You need to complete a certification application and fax it to WPS. WPS fax # 608-221-7535. The certification application can be found using the link below.    Provider claims, certification and other forms', NULL, NULL, '2022-03-18 13:48:50', '2022-03-18 13:48:50'),
(55568, 20067, 54840, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Fax the Form at 608-221-7535  See the attachment', NULL, NULL, '2022-03-18 13:57:05', '2022-03-18 13:57:05'),
(55569, 22077, 54840, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: 	Re: Enrollment Status Query - NUCC - IVUC - Tricare  Hi,  I would like to know the enrollment status for the following group and provider,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	799 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Address	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks & Regards.', NULL, NULL, '2022-04-19 15:25:21', '2022-04-19 15:25:21'),
(55570, 20067, 54841, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:41:32', '2022-02-01 15:41:32'),
(55571, 20067, 54841, NULL, '2022-02-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2022-02-04 18:08:15', '2022-02-04 18:08:15'),
(55572, 20067, 54842, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-01 15:42:07', '2022-02-01 15:42:07'),
(55573, 20067, 54842, NULL, '2022-02-11 00:00:00.000', 'Initiated', 'Email sent to: ashley.stevens@wellcare.com  Sub: Addition of provider || NUCC || Ancy Kurian || Wellcare   Good afternoon!  Hope this email finds you well, I would like to add the below-mentioned providers under the existing group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI Ancy Kurian	1316558935  Thank you,', NULL, NULL, '2022-02-04 17:33:25', '2022-02-04 17:33:25'),
(55574, 20067, 54842, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Addition of provider || NUCC || Ancy Kurian || Wellcare  Good Afternoon!  Hope you are doing well. The CAQH of Ancy Kurian has been updated. Kindly see the attached file and let me know if anything else is needed from my end.  Thank you,', NULL, NULL, '2022-03-02 14:29:23', '2022-03-02 14:29:23'),
(55575, 20067, 54842, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Addition of provider || NUCC || Ancy Kurian || Wellcare  CASE 00909635 has been created to add the requested provider.   We will reach out once provider is active and par.  Sincerely,', NULL, NULL, '2022-03-10 15:41:28', '2022-03-10 15:41:28'),
(55576, 20067, 54842, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Addition of provider || NUCC || Ancy Kurian || Wellcare  CASE 00909635 has been created to add the requested provider.   We will reach out once provider is active and par.  Sincerely,', NULL, NULL, '2022-03-21 13:01:28', '2022-03-21 13:01:28'),
(55577, 19067, 54842, NULL, '2022-04-12 00:00:00.000', 'Approved', 'Eff date: 02/01/2022. Attached is the welcome letter.', NULL, NULL, '2022-04-05 07:56:50', '2022-04-05 07:56:50'),
(55578, 20067, 54843, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-02 17:43:34', '2022-02-02 17:43:34'),
(55579, 20067, 54843, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Group has an ancillary contract.   Please see attachment. ', NULL, NULL, '2022-02-02 17:44:14', '2022-02-02 17:44:14'),
(55580, 1019, 54844, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-08 12:27:16', '2022-02-08 12:27:16'),
(55581, 19067, 54844, NULL, '2022-02-15 00:00:00.000', 'Initiated', 'Application initiated through portal. Tracking number: 0208221S5. See attachment for reference.', NULL, NULL, '2022-02-08 13:11:43', '2022-02-08 13:11:43'),
(55582, 20067, 54844, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email received from: ProviderServices@multiplan.com  Sub: PIF  Good Morning,  Thank you for nominating  Gulf Coast Imaging and Associates, LLC for the Multiplan network.  Attached is the Group Interest Form. Please fill out the form and send it back via fax (630) 245-2435 or email PIF@multiplan.com.  **Please do not reply back to this email.  This is an outbound email only.**  Sincerely,  Customer Service  MultiPlan', NULL, NULL, '2022-03-07 10:37:40', '2022-03-07 10:37:40'),
(55583, 20067, 54844, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: PIF@multiplan.com  Sub: PIF || Gulf Coast Imaging and Associates || Multiplan  Good Morning!  Kindly see the attached provider interest form. Let me know if anything else is required from my end.  Thank you', NULL, NULL, '2022-03-07 10:39:06', '2022-03-07 10:39:06'),
(55584, 1009, 54844, NULL, '2022-04-05 00:00:00.000', 'In Process', 'Email sent to pif@multiplan.com  Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following group with Multiplan.  Group Name Gulf Coast Imaging & Associates, LLC Tax ID 82-0701672 Group NPI 1750871414 Primary & Billing Location 500 E Caesar Ave, Suite B, Kingsville, TX 78363  Have a beautiful day!  -- Regards, Wally Williams', NULL, NULL, '2022-03-29 16:26:25', '2022-03-29 16:26:25'),
(55585, 19067, 54844, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email received from: pif@multiplan.com   Subject: Multiplan Request for Information for Gulf Coast Imaging and Associates, LLC - State: TX - SEID: 220211030715    Dear Provider:  We would like to invite you to participate in MultiPlan\'s provider networks.  When you choose to join MultiPlan, the nation\'s oldest and largest independent provider network, you select an organization that delivers patient volume from a diverse base of healthcare payers, offers administrative ease, and helps you evolve with the market through a wide range of network-based solutions.  You can access our Provider Handbook located under Helpful Resources in the Providers section at: www.multiplan.com  If you are interested in signing a MultiPlan Agreement and Provider Application, please complete the attached Request for Information form for each one of your locations and return to us by replying to this email.  Please ONLY use this email for the provider you nominated. If you need to nominate additional providers then please submit your provider nomination request by clicking the following link: Nominate Provider  MultiPlan has implemented an electronic signature process; you will receive electronic documents for signature via DocuSign. To expedite the contracting process, please follow the instructions included in the DocuSign email. If you would like additional information about MultiPlan or the services we offer, please visit our website at:www.multiplan.com  Sincerely,  Gloria Esplana  Director, Network Contract Support', NULL, NULL, '2022-04-06 13:35:19', '2022-04-06 13:35:19'),
(55586, 19067, 55759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-10 15:24:00', '2022-02-10 15:24:00'),
(55587, 19067, 55759, NULL, '2022-02-17 00:00:00.000', 'Initiated', 'Application initiated via Portal. See attachment.  Request id: 160662', NULL, NULL, '2022-02-10 15:25:13', '2022-02-10 15:25:13'),
(55588, 20067, 55759, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Call TriWest and spoke to Audrianna Call Ref#  Ph1795321w5v5m1  Application still under review, please allow more  time.', NULL, NULL, '2022-03-07 13:17:40', '2022-03-07 13:17:40'),
(55589, 1019, 55760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-11 17:50:34', '2022-02-11 17:50:34'),
(55590, 19067, 55760, NULL, '2022-02-18 00:00:00.000', 'Initiated', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject:  Medicare Enrollment Application Receipt Notification (Tracking ID: T021120220003747 )    To: JALBERT@APPARTNERS.COM,RHC@CLAIMSMEDINC.COM,SHANEMASS@GMAIL.COM,MCPRVENRL@CVSCAREMARK.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021120220003747)   Sent: 02/11/2022 17:58 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: T021120220003747        NPI: 1356959241        Medicare ID: 1H4266, 1L0763, 1L0766        Name: SHANE  MASS          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.  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, '2022-02-11 17:55:56', '2022-02-11 17:55:56'),
(55591, 19067, 55760, NULL, '2022-02-18 00:00:00.000', 'In Process', ' Application Tracking ID: T021120220003747', NULL, NULL, '2022-02-11 17:56:19', '2022-02-11 17:56:19'),
(55592, 19067, 55760, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Novitas Solutions has received this CMS-855, CMS-20134, CMS-460 or EFT application.  If we require additional information during the processing of the application, we will contact you.  See attachment for reference.', NULL, NULL, '2022-02-18 11:33:43', '2022-02-18 11:33:43'),
(55593, 19067, 55760, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: customerservice-donotreply@cms.hhs.gov   Subject: Medicare Enrollment Application Status Change Notification (Tracking ID: T021120220003747)    To:  JAlbert@APPartners.com,MCPrvenrl@cvscaremark.com,rhc@claimsmedinc.com,shanemass@gmail.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T021120220003747)  Date:  02/22/2022 14:26 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 T021120220003747. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T021120220003747   NPI ID: 1356959241   Medicare ID: 1H4266, 1L0766, 1L0763, 2A3981   Name: SHANE MASS  State: TX   Form Type: 855I  Date: 02/22/2022  Status: APPROVED  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  You will receive a notification letter from the Fee-For-Service Contractor listed above.  This letter will provide you with valuable information regarding your enrollment information.  Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.     PROVIDER ENROLLMENT SERVICES, P.O. BOX 3095, MECHANICSBURG, PA 17055-1813   If you have any questions about this identifier, you may:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or  2.) Contact your fee-for-service contractor listed above.  Please retain this e-mail for your records.  Please note:  The information provided in the Enrollment application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of application. In addition, you agreed to keep the PECOS updated with any changes to data listed on the enrollment application 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 any and all copies.  ', NULL, NULL, '2022-02-22 17:01:44', '2022-02-22 17:01:44'),
(55594, 19067, 55760, NULL, '2022-03-02 00:00:00.000', 'Approved', 'Email received from: medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification SHANE MASS     Please see the attached Notification letter. ', NULL, NULL, '2022-02-23 11:26:29', '2022-02-23 11:26:29'),
(55595, 1019, 55761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-14 13:47:15', '2022-02-14 13:47:15'),
(55596, 1019, 55761, NULL, '2022-02-21 00:00:00.000', 'Initiated', 'Request sent to Jquonda via Email, see attached for the agreement signed by provider', NULL, NULL, '2022-02-14 13:48:16', '2022-02-14 13:48:16'),
(55597, 1019, 55762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-14 13:47:25', '2022-02-14 13:47:25'),
(55598, 1019, 55762, NULL, '2022-02-21 00:00:00.000', 'Initiated', 'Request sent to Jquonda via Email, see attached for the agreement signed by provider', NULL, NULL, '2022-02-14 13:48:01', '2022-02-14 13:48:01'),
(55599, 20067, 55762, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Call Friday Health Plans.  We didn\'t receive the Agreement from your contract representative', NULL, NULL, '2022-03-09 15:29:25', '2022-03-09 15:29:25'),
(55600, 20067, 55762, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Attached are the W9 for the Urgent Care Centers. Let me know if you have any questions.   Regards, Alex', NULL, NULL, '2022-03-17 09:39:55', '2022-03-17 09:39:55'),
(55601, 20067, 55762, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  Attached please find the contracts.  Please let me know if you have any questions.  Thanks', NULL, NULL, '2022-03-17 09:40:07', '2022-03-17 09:40:07'),
(55602, 20067, 55762, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  As per our previous discussions the Urgent care contract has to be for $150.00, but you have sent me the contracts for $125.00.    Regards, Alex', NULL, NULL, '2022-03-17 09:40:19', '2022-03-17 09:40:19'),
(55603, 20067, 55762, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from:  Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  My apologies.  Here you go.  I\'ll correct the other contracts and get them back to you.  Thanks', NULL, NULL, '2022-03-17 09:40:29', '2022-03-17 09:40:29'),
(55604, 20067, 55762, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  Any updates on the remaining agreements?  Thanks, Jquonda', NULL, NULL, '2022-03-17 09:40:40', '2022-03-17 09:40:40'),
(55605, 20067, 55762, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub:Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Hope you\'re doing as I was not well so I was out of the office attached are the remaining agreements, I\'ll share the others as well by today', NULL, NULL, '2022-03-17 09:40:51', '2022-03-17 09:40:51'),
(55606, 20067, 56761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-17 12:09:02', '2022-02-17 12:09:02'),
(55607, 22077, 56761, NULL, '2022-04-15 00:00:00.000', 'Not Eligible', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2022-04-08 11:56:49', '2022-04-08 11:56:49'),
(55608, 20067, 56762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-17 12:09:03', '2022-02-17 12:09:03'),
(55609, 22077, 56762, NULL, '2022-04-14 00:00:00.000', 'Initiated', 'Email sent to: txcredentialing@amerigroup.com  Subject: Enrollment Request || VMUC || Nubia & Edna || Amerigroup  Hi,  We would like to enroll the following providers  Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542 Group NPI: 1518404631 Primary & Billing Address: 2534 Boca Chica Blvd Brownsville, TX 78521-3496 Provider Name	NPI Nubia Olivama Benavides: 1801371935 Edna Michi: 1992293906  Thanks', NULL, NULL, '2022-04-07 10:14:21', '2022-04-07 10:14:21'),
(55610, 22077, 56762, NULL, '2022-04-19 00:00:00.000', 'Not Eligible', 'Email received from: txcredentialing@amerigroup.com  Subject: RE: {EXTERNAL} Enrollment Request || VMUC || Nubia & Edna || Amerigroup  Good Day,     Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.      Those areas are managed by other Medicaid Managed Care Organizations.     Thank you again for your interest.     Sincerely,             Jason T. Hughes I Provider Network Manager  Amerigroup I 5959 Corporate Dr. Suite 1300, Houston, TX 77036  e: Jason.Hughes@amerigroup.com  Fax:  1-855-225-9928     For inquiries concerning:  Rejected claims – please contact EDI at 1-800-590-5745  Claims inquiries – please contact the Provider Services Unit at 1-800-454-3730  Multiplan credentialing- please contact Multiplan at 1-866-971-7427  Amerivantage Provider Services 1-866-805-4589  MMP Provider Services 1-855-878-1785   ', NULL, NULL, '2022-04-12 08:25:32', '2022-04-12 08:25:32'),
(55611, 20067, 56763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-17 12:13:23', '2022-02-17 12:13:23'),
(55612, 22077, 56763, NULL, '2022-04-15 00:00:00.000', 'Not Eligible', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2022-04-08 11:57:06', '2022-04-08 11:57:06'),
(55613, 20067, 56764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-17 12:13:23', '2022-02-17 12:13:23'),
(55614, 22077, 56764, NULL, '2022-04-14 00:00:00.000', 'Initiated', 'Email sent to: txcredentialing@amerigroup.com  Subject: Enrollment Request || VMUC || Nubia & Edna || Amerigroup  Hi,  We would like to enroll the following providers  Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542 Group NPI: 1518404631 Primary & Billing Address: 2534 Boca Chica Blvd Brownsville, TX 78521-3496 Provider Name	NPI Nubia Olivama Benavides: 1801371935 Edna Michi: 1992293906  Thanks', NULL, NULL, '2022-04-07 10:13:53', '2022-04-07 10:13:53'),
(55615, 22077, 56764, NULL, '2022-04-19 00:00:00.000', 'Not Eligible', 'Email received from: txcredentialing@amerigroup.com  Subject: RE: {EXTERNAL} Enrollment Request || VMUC || Nubia & Edna || Amerigroup  Good Day,     Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.      Those areas are managed by other Medicaid Managed Care Organizations.     Thank you again for your interest.     Sincerely,             Jason T. Hughes I Provider Network Manager  Amerigroup I 5959 Corporate Dr. Suite 1300, Houston, TX 77036  e: Jason.Hughes@amerigroup.com  Fax:  1-855-225-9928     For inquiries concerning:  Rejected claims – please contact EDI at 1-800-590-5745  Claims inquiries – please contact the Provider Services Unit at 1-800-454-3730  Multiplan credentialing- please contact Multiplan at 1-866-971-7427  Amerivantage Provider Services 1-866-805-4589  MMP Provider Services 1-855-878-1785   ', NULL, NULL, '2022-04-12 08:24:55', '2022-04-12 08:24:55'),
(55616, 19067, 56765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-18 17:50:31', '2022-02-18 17:50:31'),
(55617, 19067, 56765, NULL, '2022-02-25 00:00:00.000', 'Initiated', 'Application initiated through Pecos.', NULL, NULL, '2022-02-18 17:51:22', '2022-02-18 17:51:22'),
(55618, 19067, 56765, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021820220002899 )     To: FANFAN0503@HOTMAIL.COM,BHMC@CLAIMSMEDINC.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021820220002899)   Sent: 02/18/2022 16:26 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: T021820220002899        NPI: 1780192633        Medicare ID:        Name: STEPHANE  CYRIAQUE        State: IN        Fee-for-Service Contractor: WISCONSIN PHYSICIANS SERVICE          MADISON,WI,53708-8248', NULL, NULL, '2022-02-18 17:52:21', '2022-02-18 17:52:21'),
(55619, 19067, 56765, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: 	OnBaseProdGHA@wpsic.com  Subject: Medicare Provider Enrollment has received your enrollment application    GHA Provider Enrollment has received your enrollment application(s).  You will be contacted if additional information is required.   For Web applications: For detailed status please log into your PECOS account and go to \"My Associates\" and then \"View Enrollments.\"   For Paper applications: To access your application status information, please go to the GHA Provider Portal, and enter your Application ID.  Provider: Stephane Cyriaque  Web Tracking Number: T021820220003368  Date Application Received: 02/18/2022  Application Type: 855R  Application ID: 584166002  Please keep this email as documentation of your control number.  This email cannot be regenerated.  You are receiving this email per your communication agreement with WPS.  If you no longer wish to receive these communications via email or would like to change the email address to which they are sent, please contact WPS Medicare Provider Enrollment at:  (866) 518-3285  MAC J5 States (Iowa, Kansas, Missouri and Nebraska) & MAC J5 National (866) 234-7331  MAC J8 States (Michigan and Indiana)  Please do not reply to this email, it is for informational purposes only.  Replies will not be received by a GHA Provider Enrollment representative.  Sincerely,  Automated Emailing Provider Enrollment Department WPS Government Health Administrators', NULL, NULL, '2022-02-23 13:06:17', '2022-02-23 13:06:17'),
(55620, 19067, 56765, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: OnbaseProd@wpsic.com  Subject: Medicare Provider Enrollment has received your enrollment application    GHA Provider Enrollment has received your enrollment application(s).  You will be contacted if additional information is required.   For Web applications: For detailed status please log into your PECOS account and go to \"My Associates\" and then \"View Enrollments.\"   For Paper applications: To access your application status information, please go to the GHA Provider Portal, and enter your Application ID.  Provider: Best Health Medical Center  Web Tracking Number: T021820220002899  Date Application Received: 02/18/2022  Application Type: 855B  Application ID: 584166004  Please keep this email as documentation of your control number.  This email cannot be regenerated.  You are receiving this email per your communication agreement with WPS.  If you no longer wish to receive these communications via email or would like to change the email address to which they are sent, please contact WPS Medicare Provider Enrollment at:  (866) 518-3285  MAC J5 States (Iowa, Kansas, Missouri and Nebraska) & MAC J5 National (866) 234-7331  MAC J8 States (Michigan and Indiana)  Please do not reply to this email, it is for informational purposes only.  Replies will not be received by a GHA Provider Enrollment representative.  Sincerely,  Automated Emailing Provider Enrollment Department WPS Government Health Administrators', NULL, NULL, '2022-02-24 09:16:26', '2022-02-24 09:16:26'),
(55621, 19067, 56765, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: 	customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T022320220000056 )    To: FANFAN0503@HOTMAIL.COM,BHMC@CLAIMSMEDINC.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T022320220000056)   Sent: 03/18/2022 19:13 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: T022320220000056        NPI: 1922752500        Medicare ID:         Name: Best Health Medical Center        State: IN        Fee-for-Service Contractor: WISCONSIN PHYSICIANS SERVICE                 MADISON,WI,53708-8248   ---------------------------------------------------------------------------------------------------------------------- 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, '2022-03-18 18:12:26', '2022-03-18 18:12:26'),
(55622, 19067, 56765, NULL, '2022-04-08 00:00:00.000', 'In Process', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021820220002899 )    Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021820220002899)   Sent: 04/01/2022 20:11 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T021820220002899        NPI: 1780192633        Medicare ID:         Name: STEPHANE  CYRIAQUE          State: IN        Fee-for-Service Contractor: WISCONSIN PHYSICIANS SERVICE                 MADISON,WI,53708-8248   ---------------------------------------------------------------------------------------------------------------------- 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, '2022-04-01 19:06:04', '2022-04-01 19:06:04');
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
(55623, 19067, 56765, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021820220003368 )     To: BHMC@CLAIMSMEDINC.COM,FANFAN0503@HOTMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T021820220003368)   Sent: 04/06/2022 16:56 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: T021820220003368        NPI: 1780192633        Medicare ID:         Name: STEPHANE  CYRIAQUE          State: IN        Fee-for-Service Contractor: WISCONSIN PHYSICIANS SERVICE                 MADISON,WI,53708-8248   ---------------------------------------------------------------------------------------------------------------------- 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, '2022-04-06 15:53:28', '2022-04-06 15:53:28'),
(55624, 19067, 56766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 10:59:06', '2022-02-23 10:59:06'),
(55625, 19067, 56766, NULL, '2022-03-02 00:00:00.000', 'Initiated', 'Email sent to: RuizS@vesservices.com  Subject: Re: VES - Gulf Coast Imaging    Good Morning Sharon,  Attached is the filled out agreement for Gulf Coast Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2022-02-23 11:01:48', '2022-02-23 11:01:48'),
(55626, 19067, 56766, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: ruizs@vesservices.com   Subject: Re: VES - Gulf Coast Imaging    Thanks Alex.  Attached is the countersigned agreement. We have everything we need and will get this location added to our directory.     Thanks again.     Sharon Ruiz  Diagnostic Facility Recruiter  Veterans Evaluation Services (VES) – A Maximus Company  Cell: 281-940-5336    Confidential Fax: 832-320-3841  Toll Free: 1-877-637-8387 ext. 5866  Email: RuizS@vesservices.com  WWW.VESSERVICES.COM', NULL, NULL, '2022-02-23 11:03:43', '2022-02-23 11:03:43'),
(55627, 19067, 56767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:21:38', '2022-02-23 11:21:38'),
(55628, 19067, 56767, NULL, '2022-03-02 00:00:00.000', 'Approved', 'Email received from: medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification SHANE MASS     Please see the attached Notification letter. ', NULL, NULL, '2022-02-23 11:25:42', '2022-02-23 11:25:42'),
(55629, 19067, 56768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:21:51', '2022-02-23 11:21:51'),
(55630, 19067, 56768, NULL, '2022-03-02 00:00:00.000', 'Approved', 'Email received from: medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification SHANE MASS     Please see the attached Notification letter. ', NULL, NULL, '2022-02-23 11:25:58', '2022-02-23 11:25:58'),
(55631, 19067, 56769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:22:08', '2022-02-23 11:22:08'),
(55632, 19067, 56769, NULL, '2022-03-02 00:00:00.000', 'Approved', 'Email received from: medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification SHANE MASS     Please see the attached Notification letter. ', NULL, NULL, '2022-02-23 11:26:06', '2022-02-23 11:26:06'),
(55633, 19067, 56770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:22:21', '2022-02-23 11:22:21'),
(55634, 19067, 56770, NULL, '2022-03-02 00:00:00.000', 'Approved', 'Email received from: medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification SHANE MASS     Please see the attached Notification letter. ', NULL, NULL, '2022-02-23 11:26:18', '2022-02-23 11:26:18'),
(55635, 19067, 56771, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:25:42', '2022-02-23 11:25:42'),
(55636, 19067, 56772, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:25:58', '2022-02-23 11:25:58'),
(55637, 19067, 56773, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:26:06', '2022-02-23 11:26:06'),
(55638, 19067, 56774, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:26:18', '2022-02-23 11:26:18'),
(55639, 19067, 56775, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-02-23 11:26:28', '2022-02-23 11:26:28'),
(55640, 19067, 56776, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-01 16:09:02', '2022-03-01 16:09:02'),
(55641, 20067, 56777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-03 16:36:39', '2022-03-03 16:36:39'),
(55642, 20067, 56777, NULL, '2022-03-10 00:00:00.000', 'Approved', 'Received welcome letter from Friday Health Plans.  See the attachment  ', NULL, NULL, '2022-03-03 16:41:47', '2022-03-03 16:41:47'),
(55643, 20067, 56778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-03 16:37:19', '2022-03-03 16:37:19'),
(55644, 20067, 56778, NULL, '2022-03-10 00:00:00.000', 'Approved', 'Received welcome letter from Friday Health Plans.  See the attachment  ', NULL, NULL, '2022-03-03 16:41:11', '2022-03-03 16:41:11'),
(55645, 20067, 56779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-04 13:26:53', '2022-03-04 13:26:53'),
(55646, 20067, 56779, NULL, '2022-03-11 00:00:00.000', 'Approved', 'Received the welcome letter from Friday Health Plan.  See the attachments.', NULL, NULL, '2022-03-04 13:37:09', '2022-03-04 13:37:09'),
(55647, 20067, 56780, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-04 13:27:30', '2022-03-04 13:27:30'),
(55648, 20067, 56780, NULL, '2022-03-11 00:00:00.000', 'Approved', 'Received the welcome letter from Friday Health Plan.  See the attachment', NULL, NULL, '2022-03-04 13:42:26', '2022-03-04 13:42:26'),
(55649, 20067, 56781, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-04 13:28:07', '2022-03-04 13:28:07'),
(55650, 20067, 56781, NULL, '2022-03-11 00:00:00.000', 'Approved', 'Received the welcome letter from Friday Healthplan.  See the attachment', NULL, NULL, '2022-03-04 13:44:15', '2022-03-04 13:44:15'),
(55651, 20067, 56782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-04 13:29:14', '2022-03-04 13:29:14'),
(55652, 20067, 56782, NULL, '2022-03-11 00:00:00.000', 'Approved', 'Received welcome letter from Friday Health Plan.  See the attachment.', NULL, NULL, '2022-03-04 13:46:56', '2022-03-04 13:46:56'),
(55653, 20067, 57777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-08 14:54:50', '2022-03-08 14:54:50'),
(55654, 20067, 57777, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Received the welcome letter  See the attached', NULL, NULL, '2022-03-08 14:55:43', '2022-03-08 14:55:43'),
(55655, 20067, 57778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-10 09:51:09', '2022-03-10 09:51:09'),
(55656, 22077, 57778, NULL, '2022-04-21 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2022-04-14 15:26:43', '2022-04-14 15:26:43'),
(55657, 20067, 57779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-10 09:55:54', '2022-03-10 09:55:54'),
(55658, 22077, 57779, NULL, '2022-04-21 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2022-04-14 15:26:33', '2022-04-14 15:26:33'),
(55659, 20067, 57780, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-10 09:56:41', '2022-03-10 09:56:41'),
(55660, 22077, 57780, NULL, '2022-04-21 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2022-04-14 15:26:23', '2022-04-14 15:26:23'),
(55661, 20067, 57781, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 15:14:47', '2022-03-11 15:14:47'),
(55662, 20067, 57781, NULL, '2022-03-18 00:00:00.000', 'Initiated', 'Application initiated through https://brighthealthcare.com/provider/join  See the attachment', NULL, NULL, '2022-03-11 15:20:18', '2022-03-11 15:20:18'),
(55663, 20067, 57781, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: dfontaine@brighthealthgroup.com  Sub: Application Status || Columbus Urgent Care || Group || Bright Health   Good Afternoon!  Hope you had a great weekend. I would like to know the application status for the listed group.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215  Thank you', NULL, NULL, '2022-03-21 12:54:06', '2022-03-21 12:54:06'),
(55664, 20067, 57781, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: dfontaine@brighthealthgroup.com  Sub: Application Status || Normandy Urgent Care Center || Group || Bright Health   Good Afternoon!  Hope you had a great weekend. I would like to know the application status for the listed group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935   Thank you,', NULL, NULL, '2022-03-21 14:03:52', '2022-03-21 14:03:52'),
(55665, 20067, 57782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 15:21:09', '2022-03-11 15:21:09'),
(55666, 20067, 57782, NULL, '2022-03-18 00:00:00.000', 'Initiated', 'Application initiated online  See the attachment', NULL, NULL, '2022-03-11 15:25:22', '2022-03-11 15:25:22'),
(55667, 20067, 57782, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: dfontaine@brighthealthgroup.com  Sub: Application Status || Normandy Urgent Care Center || Group || Bright Health   Good Afternoon!  Hope you had a great weekend. I would like to know the application status for the listed group.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935   Thank you,', NULL, NULL, '2022-03-21 14:04:17', '2022-03-21 14:04:17'),
(55668, 22077, 57782, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: dfontaine@brighthealthgroup.com  Subject: Re: [EXTERNAL] Application Status || Normandy Urgent Care Center || Group || Bright Health  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 15:24:16', '2022-04-14 15:24:16'),
(55669, 20067, 57783, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 15:25:58', '2022-03-11 15:25:58'),
(55670, 20067, 57783, NULL, '2022-03-18 00:00:00.000', 'Initiated', 'Application initiated online  See the attachment', NULL, NULL, '2022-03-11 15:30:38', '2022-03-11 15:30:38'),
(55671, 20067, 57784, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 15:31:09', '2022-03-11 15:31:09'),
(55672, 20067, 57784, NULL, '2022-03-18 00:00:00.000', 'Initiated', 'Application initiated online  See the attachment', NULL, NULL, '2022-03-11 15:35:00', '2022-03-11 15:35:00'),
(55673, 22077, 57784, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: dfontaine@brighthealthgroup.com  Subject: Enrollment Query || VMUC (Brownsville) || Group || Bright Health Management  Hi,  We would like to know the enrollment of the following Group  Group Name	Valley Med Urgent Care PLLC (Brownsville) Tax ID	81-5123542 Group NPI	1518404631 Primary & Billing Address	2534 Boca Chica Blvd Brownsville, TX 78521-3496   Thanks', NULL, NULL, '2022-04-07 10:58:56', '2022-04-07 10:58:56'),
(55674, 19067, 57785, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 15:35:23', '2022-03-11 15:35:23'),
(55675, 19067, 57786, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 15:35:23', '2022-03-11 15:35:23'),
(55676, 22077, 57786, NULL, '2022-04-20 00:00:00.000', 'Initiated', 'Email sent to: 	latina.small@anthem.com, txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com  Subject: Enrollment Request || MK Health || Amerigroup  Hi,  I would like to enroll the following provider please kindly assist me in the enrollment process  Group Name	MK Healthcare PLLC Tax ID	873354383 Group NPI	1275290587 Primary & Billing Address	3501 S Corona St Ste 1 Englewood, CO 80113-3907 Provider Name	NPI Maryem Kianinejad	1831638386  Thanks. ', NULL, NULL, '2022-04-13 08:25:19', '2022-04-13 08:25:19'),
(55677, 22077, 57786, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Secured email received from: latina.small@anthem.com, txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com  Subject:  {EXTERNAL} Enrollment Request || MK Health || Amerigroup  Good Morning,     Is this provider located in Texas or another state? Please confirm.     Thank You in Advance,     Latina Small, MBA, BSBM  Provider Experience Consultant  Amerigroup, Inc.     Houston Health Plan, Amerigroup Texas  5959 Corporate Dr. Suite 1300, Houston, TX 77036 l office/cell: 346-237-0834  fax: 1-866-495-7540  latina.small@Amerigroup.com  www.Amerigroup.com', NULL, NULL, '2022-04-13 10:03:54', '2022-04-13 10:03:54'),
(55678, 22077, 57786, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Secured email sent to: latina.small@anthem.com, txcredentialing@amerigroup.com, jason.hughes@amerigroup.com  Subject:  {EXTERNAL} Enrollment Request || MK Health || Amerigroup  Hi,     No, the provider is located in Colorado     Thanks.', NULL, NULL, '2022-04-13 10:07:44', '2022-04-13 10:07:44'),
(55679, 22077, 57786, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Secured email received from: latina.small@anthem.com  Subject: {EXTERNAL} Enrollment Request || MK Health || Amerigroup  Good Morning,     Ok, we only handle the Texas market. Unfortunately, we would not be able to assist. Please reach out to customer service at 800-282-4548 for further assistance to see if they can provide a contact in that market to assist you.     Thank You in Advance,     Latina Small, MBA, BSBM  Provider Experience Consultant  Amerigroup, Inc.     Houston Health Plan, Amerigroup Texas  5959 Corporate Dr. Suite 1300, Houston, TX 77036 l office/cell: 346-237-0834  fax: 1-866-495-7540  latina.small@Amerigroup.com  www.Amerigroup.com', NULL, NULL, '2022-04-13 10:12:19', '2022-04-13 10:12:19'),
(55680, 20067, 57787, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-11 16:59:43', '2022-03-11 16:59:43'),
(55681, 20067, 57787, NULL, '2022-03-23 00:00:00.000', 'Initiated', 'Application initiated through PECOS', NULL, NULL, '2022-03-16 14:55:35', '2022-03-16 14:55:35'),
(55682, 20067, 57787, NULL, '2022-03-23 00:00:00.000', 'In Process', 'From: customerservice-donotreply via Abdur Rauf Practices  To: NUCC@CLAIMSMEDINC.COM,CUCC@CLAIMSMEDINC.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T031520220004473)   Sent: 03/15/2022 19:10 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: T031520220004473        NPI: 1821413857        Medicare ID: 827661        Name: JOHNY  ABRAHAM          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2022-03-16 14:56:51', '2022-03-16 14:56:51'),
(55683, 19067, 57788, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-14 10:53:06', '2022-03-14 10:53:06'),
(55684, 19067, 57788, NULL, '2022-03-21 00:00:00.000', 'Approved', 'Plan of Aetna.', NULL, NULL, '2022-03-14 10:53:37', '2022-03-14 10:53:37'),
(55685, 20067, 57789, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-21 14:25:43', '2022-03-21 14:25:43'),
(55686, 20067, 57790, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-21 14:25:59', '2022-03-21 14:25:59'),
(55687, 20067, 57791, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-03-22 15:32:53', '2022-03-22 15:32:53'),
(55688, 19067, 57792, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-01 11:50:08', '2022-04-01 11:50:08'),
(55689, 19067, 58792, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-06 10:45:54', '2022-04-06 10:45:54'),
(55690, 19067, 58792, NULL, '2022-04-13 00:00:00.000', 'Initiated', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Enrollment Request || GCIA || Christus Healthplan ||   Good Morning!  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 group with the mentioned location.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Primary & Billing Location	500 E Caesar Ave, Suite B, Kingsville, TX 78363  Please respond to my query at your earliest convenience.   Thanks,', NULL, NULL, '2022-04-06 10:46:38', '2022-04-06 10:46:38'),
(55691, 19067, 58792, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Re: Enrollment Request || GCIA || Christus Healthplan ||   Hello,  Kindly see the attached Prospective Provider Form.  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-13 11:44:43', '2022-04-13 11:44:43'),
(55692, 19067, 58792, NULL, '2022-04-20 00:00:00.000', 'In Process', '', NULL, NULL, '2022-04-13 11:44:52', '2022-04-13 11:44:52'),
(55693, 19067, 58792, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enrollment Request || GCIA || Christus Healthplan ||    Hello!  Kindly disregard the previous email and see the updated attached prospective provider form.  Thanks, Hammad', NULL, NULL, '2022-04-13 14:05:00', '2022-04-13 14:05:00'),
(55694, 19067, 58793, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-13 10:11:43', '2022-04-13 10:11:43'),
(55695, 19067, 58793, NULL, '2022-04-20 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-04-13 10:12:03', '2022-04-13 10:12:03'),
(55696, 19067, 58794, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-13 10:12:30', '2022-04-13 10:12:30'),
(55697, 19067, 58794, NULL, '2022-04-20 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-04-13 10:12:56', '2022-04-13 10:12:56'),
(55698, 19067, 58795, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-13 10:13:11', '2022-04-13 10:13:11'),
(55699, 19067, 58795, NULL, '2022-04-20 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-04-13 10:13:23', '2022-04-13 10:13:23'),
(55700, 19067, 58796, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-13 10:13:42', '2022-04-13 10:13:42'),
(55701, 19067, 58796, NULL, '2022-04-20 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-04-13 10:13:52', '2022-04-13 10:13:52'),
(55702, 19067, 58797, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-14 10:46:29', '2022-04-14 10:46:29'),
(55703, 19067, 58797, NULL, '2022-04-21 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-04-14 10:48:11', '2022-04-14 10:48:11'),
(55704, 19067, 58797, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Application initiated through portal.', NULL, NULL, '2022-04-14 10:48:29', '2022-04-14 10:48:29'),
(55705, 22077, 58797, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Enrollment Query || Group || BHMC || Aetna  Hi,  We initiated the application through the portal on 04/14/2022 and I would like to get an update on it.  Group Name	Best Health Medical Center Tax ID	874075725 Group NPI	1922752500 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 101YA0400X	Counselor Addiction (Substance Use Disorder)   I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 12:12:00', '2022-04-25 12:12:00'),
(55706, 22077, 58797, NULL, '2022-05-03 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: Enrollment Query || Group || BHMC || Aetna  Please remove me as your contact for the state of IN—I am not the contact, you will need to reach out to provider services to be routed, 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, '2022-04-26 09:38:21', '2022-04-26 09:38:21'),
(55707, 19067, 58798, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-14 10:50:23', '2022-04-14 10:50:23'),
(55708, 19067, 58798, NULL, '2022-04-21 00:00:00.000', 'Initiated', 'Email sent to: psscentral@cigna.com  Subject: Enrollment Request || BHMC || Cigna   Hi,  Hope this email finds you well. We would like to enroll the following facility with Cigna,  Group Name	Best Health Medical Center Tax ID	874075725 Group NPI	1922752500 Primary & Billing Location	9385 East Washington Street, Indianapolis, IN 46229   Contact Information:   Contact Person: Hammad Ahmed Phone# 713-893-6214  Thanks,', NULL, NULL, '2022-04-14 11:07:03', '2022-04-14 11:07:03'),
(55709, 19067, 58798, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email received from: 9PSSCENT@cigna.com  Subject: Auto Response    Thank you for contacting Cigna Provider Services Unit. Your email is important to us and will be responded to in the order in which it was received.     Please allow up to 60 days.        Thank You.        ConnectedCare PROVIDER RELATIONS & OPERATIONS  Provider Service Unit  1-800-88CIGNA   PSSCentral@Cigna.com', NULL, NULL, '2022-04-14 11:20:54', '2022-04-14 11:20:54'),
(55710, 19067, 58799, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-15 12:52:27', '2022-04-15 12:52:27'),
(55711, 19067, 58799, NULL, '2022-04-22 00:00:00.000', 'Initiated', '', NULL, NULL, '2022-04-15 12:52:42', '2022-04-15 12:52:42'),
(55712, 19067, 58799, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email received from: no-reply@hioscar.com  Subject: Thank you for your interest in joining the Oscar network.    Thank you for your interest in joining the Oscar network.     Please note that completion of this form is not a guarantee of contract. Our Direct Contracting team reviews requests on an ongoing basis and will be in touch if there is an opportunity to partner.  Please note that due to our rigorous expansion efforts in combination with the high volume of submissions we receive, there may be a delay in response. We appreciate your understanding.     Best,  Oscar Direct Contracting Team', NULL, NULL, '2022-04-15 12:57:59', '2022-04-15 12:57:59'),
(55713, 22077, 58800, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-19 11:27:37', '2022-04-19 11:27:37'),
(55714, 22077, 58800, NULL, '2022-04-22 00:00:00.000', 'Initiated', 'Tracking ID: T041820220003607 ', NULL, NULL, '2022-04-19 11:29:59', '2022-04-19 11:29:59'),
(55715, 22077, 58801, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-19 11:49:19', '2022-04-19 11:49:19'),
(55716, 22077, 58801, NULL, '2022-04-26 00:00:00.000', 'Initiated', 'Application initiated through the portal', NULL, NULL, '2022-04-19 11:50:36', '2022-04-19 11:50:36'),
(55717, 22077, 58801, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: 	Enrollment Query || Group || BHMUC || Aetna  Hi,  We initiated the application through the portal on 04/19/2022 and I would like to get an update on it.   Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 261QU0200X	Clinic/Center Urgent Care  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 10:10:41', '2022-04-25 10:10:41'),
(55718, 22077, 58802, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-19 12:06:12', '2022-04-19 12:06:12'),
(55719, 22077, 58802, NULL, '2022-04-26 00:00:00.000', 'Initiated', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Query || BHMUC || Cigna  Hi,  I would like to enroll the following Urgent care facility, below is the information  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 261QU0200X	Clinic/Center Urgent Care  Don\'t hesitate to reach out if you have any questions,  Thanks & Regards.', NULL, NULL, '2022-04-19 12:15:50', '2022-04-19 12:15:50'),
(55720, 22077, 58802, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Query || Group || BHMUC || Cigna  Hi,  We initiated the application through the portal on 04/19/2022 and I would like to get an update on it.  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 261QU0200X	Clinic/Center Urgent Care  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-25 10:33:09', '2022-04-25 10:33:09'),
(55721, 22077, 58802, NULL, '2022-05-03 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Subject: Enrollment Query || Group || BHMUC || Cigna  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. Please find the Status below.     HCP Name  TAX ID  Status  Best Health Medical Urgent Care LLC  874737975  Non -Contracted        If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202204252313039).     Sincerely,  PDM .', NULL, NULL, '2022-04-26 07:09:12', '2022-04-26 07:09:12'),
(55722, 22077, 58802, NULL, '2022-05-03 00:00:00.000', 'In Process', 'Email sent to: Intake_PDM@cigna.com  Subject: 	Enrollment Query || Group || BHMUC || Cigna  Hi,  We initiated the application through the portal on 04/19/2022 and I would like to get an update on it.  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 261QU0200X	Clinic/Center Urgent Care  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-26 07:19:03', '2022-04-26 07:19:03'),
(55723, 22077, 58803, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-20 10:41:37', '2022-04-20 10:41:37'),
(55724, 22077, 58803, NULL, '2022-04-27 00:00:00.000', 'Initiated', 'Application initiated through Portal.', NULL, NULL, '2022-04-20 10:42:18', '2022-04-20 10:42:18'),
(55725, 22077, 58803, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Enrollment Query || Group || BHMUC || HUMANA  Hi,  We initiated the application through the portal on 04/20/2022 and I would like to get an update on it.  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 261QU0200X	Clinic/Center Urgent Care   I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 10:54:41', '2022-04-25 10:54:41'),
(55726, 22077, 58803, NULL, '2022-05-03 00:00:00.000', 'In Process', 'Email received from: inproviderupdates@humana.com  Subject: Enrollment Query || Group || BHMUC || HUMANA  Hello,     I have forwarded your request to the National Ancillary Contracting Team and have included them within this email to assist for Facility – Marion County request. For status inquiries, please submit them directly to NationalAncillaryContracting@humana.com for assistance.        Thank you,     Phorn (Nammi) Rentmeester  Network Operations Coordinator 4| East Central Region  HUMANA', NULL, NULL, '2022-04-26 07:00:53', '2022-04-26 07:00:53'),
(55727, 22077, 58804, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-20 11:05:06', '2022-04-20 11:05:06'),
(55728, 22077, 58804, NULL, '2022-04-27 00:00:00.000', 'Initiated', 'Application initiated through Portal.', NULL, NULL, '2022-04-20 11:05:33', '2022-04-20 11:05:33'),
(55729, 22077, 58804, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || Group || BHMUC || UHC  Hi,  We initiated the application through the portal on 04/20/2022 and I would like to get an update on it.  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Specialty 261QU0200X	Clinic/Center Urgent Care  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-25 10:42:51', '2022-04-25 10:42:51'),
(55730, 19067, 58805, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-20 11:20:01', '2022-04-20 11:20:01'),
(55731, 19067, 58805, NULL, '2022-04-27 00:00:00.000', 'Initiated', 'Application initiated through Portal.', NULL, NULL, '2022-04-20 11:20:41', '2022-04-20 11:20:41'),
(55732, 22077, 58805, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Query || Group || BHMUC || Multiplan  Hi,  We initiated the application through the portal on 04/20/2022 and I would like to get an update on it.  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Address	9385 East Washington Street Indianapolis, IN 46229-3029 Taxonomy	Speciality 261QU0200X	Clinic/Center Urgent Care   I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-25 11:04:48', '2022-04-25 11:04:48'),
(55733, 22077, 58805, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: pif@multiplan.com  Subject: Multiplan Request for Information for Best Health Medical Urgent Care LLC - State: IN - SEID: 220421180984  Hi,  Attach is the contract for our facility don\'t hesitate to reach me if you have any questions.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-27 10:34:05', '2022-04-27 10:34:05'),
(55734, 19067, 58806, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-20 11:30:26', '2022-04-20 11:30:26'),
(55735, 19067, 58806, NULL, '2022-04-27 00:00:00.000', 'Initiated', 'Application initiated through portal.', NULL, NULL, '2022-04-20 11:32:10', '2022-04-20 11:32:10'),
(55736, 19067, 58806, NULL, '2022-04-27 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@SuperiorHealthPlan.com  Subject: W9 || BHMUC || Superior Healthplan   Hi,  I have initiated the application for our facility details mentioned below, also see the attachment of the completed IRS W9 form,  Group Name	Best Health Medical Urgent Care LLC Tax ID	874737975 Group NPI	1245987296 Primary & Billing Location	9385 East Washington Street, Indianapolis, IN 46229-3029 Taxonomy & Specialty	261QU0200X - Clinic\\Center Urgent Care   Thanks,', NULL, NULL, '2022-04-20 12:00:18', '2022-04-20 12:00:18'),
(55737, 22077, 58806, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: W9 || BHMUC || Superior Healthplan  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 10:22:58', '2022-04-25 10:22:58'),
(55738, 22077, 58807, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-25 15:22:58', '2022-04-25 15:22:58'),
(55739, 22077, 58807, NULL, '2022-05-02 00:00:00.000', 'Initiated', 'Email received from: ustomerservice-donotreply@cms.hhs.gob  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042520220003645)   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: T042520220003645        NPI: 1689924904        Medicare ID: 369376        Name: RABAGOS HEALTH CARE PLLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2022-04-25 15:27:25', '2022-04-25 15:27:25'),
(55740, 19067, 58807, NULL, '2022-05-03 00:00:00.000', 'In Process', 'Medicare E-signed.', NULL, NULL, '2022-04-26 07:34:55', '2022-04-26 07:34:55'),
(55741, 22077, 58808, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-25 16:09:25', '2022-04-25 16:09:25'),
(55742, 22077, 58808, NULL, '2022-05-02 00:00:00.000', 'Initiated', 'Application initiated through the portal', NULL, NULL, '2022-04-25 16:10:25', '2022-04-25 16:10:25'),
(55743, 1019, 58809, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:46', '2022-04-26 06:44:46'),
(55744, 1019, 58809, NULL, '2022-05-03 00:00:00.000', 'Initiated', 'CAQH Application faxed to Beacon at (866) 612-7790', NULL, NULL, '2022-04-26 07:26:56', '2022-04-26 07:26:56'),
(55745, 1019, 58810, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55746, 1019, 58810, NULL, '2022-05-03 00:00:00.000', 'Initiated', 'CAQH Application faxed to Beacon at (866) 612-7790', NULL, NULL, '2022-04-26 07:27:05', '2022-04-26 07:27:05'),
(55747, 1019, 58811, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55748, 1019, 58811, NULL, '2022-05-03 00:00:00.000', 'Initiated', 'Application Initiated thru Cigna website.', NULL, NULL, '2022-04-26 08:19:25', '2022-04-26 08:19:25'),
(55749, 1019, 58812, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55750, 1019, 58813, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55751, 1019, 58814, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55752, 1019, 58815, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55753, 1019, 58816, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55754, 1019, 58817, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55755, 1019, 58818, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 06:44:47', '2022-04-26 06:44:47'),
(55756, 22077, 58819, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-04-26 09:34:39', '2022-04-26 09:34:39'),
(55757, 22077, 58819, NULL, '2022-05-03 00:00:00.000', 'Initiated', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Query || Christopher DeMatt || Cigna  Hi,  I would like to enroll the following provider in our existing group,  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 Christopher DeMatt	1134737158   I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-26 09:35:59', '2022-04-26 09:35:59'),
(55758, 1011, 58820, NULL, NULL, 'New/Not Initiated', 'test', NULL, NULL, '2022-04-29 00:11:16', '2022-04-29 00:11:16'),
(55759, 1011, 58821, NULL, NULL, 'New/Not Initiated', 'test', NULL, NULL, '2022-04-29 00:11:16', '2022-04-29 00:11:16');

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