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
(24665, 1006, 22436, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Location addition request submitted to Medicaid, need to attach providers after location has been added:  \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action   17675950	PIMS Address		3/26/2021	Provider Information Change (PIC) Form	In Progress	View\" ', NULL, NULL, '2021-03-26 16:11:49', '2021-03-26 16:11:49'),
(24666, 1006, 22436, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The location has been added. Location confirmation is attached for reference. ', NULL, NULL, '2021-06-03 17:01:35', '2021-06-03 17:01:35'),
(24667, 3046, 22437, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:21:01', '2021-03-16 16:21:01'),
(24668, 1006, 22437, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Location addition request submitted to Medicaid, need to attach providers after location has been added:  \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action   17675950	PIMS Address		3/26/2021	Provider Information Change (PIC) Form	In Progress	View\" ', NULL, NULL, '2021-03-26 16:12:29', '2021-03-26 16:12:29'),
(24669, 1006, 22437, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The location has been added. Location confirmation is attached for reference. ', NULL, NULL, '2021-06-03 16:59:53', '2021-06-03 16:59:53'),
(24670, 3046, 22438, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:21:03', '2021-03-16 16:21:03'),
(24671, 1006, 22438, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Location addition request submitted to Medicaid, need to attach providers after location has been added:  \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action   17675950	PIMS Address		3/26/2021	Provider Information Change (PIC) Form	In Progress	View\" ', NULL, NULL, '2021-03-26 16:12:33', '2021-03-26 16:12:33'),
(24672, 1006, 22438, NULL, '2021-05-25 00:00:00.000', 'Approved', 'The provider has been enrolled in Medicaid, approval and location confirmation are attached: Eff: 01/01/2021 TPI# 372072404', NULL, NULL, '2021-05-18 11:54:26', '2021-05-18 11:54:26'),
(24673, 3046, 22439, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:21:05', '2021-03-16 16:21:05'),
(24674, 1006, 22439, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Location addition request submitted to Medicaid, need to attach providers after location has been added:  \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action   17675950	PIMS Address		3/26/2021	Provider Information Change (PIC) Form	In Progress	View\" ', NULL, NULL, '2021-03-26 16:12:37', '2021-03-26 16:12:37'),
(24675, 1006, 22439, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The location has been added. Location confirmation is attached for reference. ', NULL, NULL, '2021-06-03 16:59:18', '2021-06-03 16:59:18'),
(24676, 3046, 22440, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:14', '2021-03-16 16:24:14'),
(24677, 1005, 22440, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:52:31', '2021-03-25 14:52:31'),
(24678, 3046, 22441, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:17', '2021-03-16 16:24:17'),
(24679, 1005, 22441, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:52:43', '2021-03-25 14:52:43'),
(24680, 3046, 22442, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:19', '2021-03-16 16:24:19'),
(24681, 1005, 22442, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:52:45', '2021-03-25 14:52:45'),
(24682, 3046, 22443, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:21', '2021-03-16 16:24:21'),
(24683, 1005, 22443, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:52:48', '2021-03-25 14:52:48'),
(24684, 3046, 22444, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:23', '2021-03-16 16:24:23'),
(24685, 1005, 22444, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:52:52', '2021-03-25 14:52:52'),
(24686, 3046, 22445, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:25', '2021-03-16 16:24:25'),
(24687, 1005, 22445, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:55:25', '2021-03-25 14:55:25'),
(24688, 3046, 22446, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:27', '2021-03-16 16:24:27'),
(24689, 1005, 22446, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:55:27', '2021-03-25 14:55:27'),
(24690, 3046, 22447, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:29', '2021-03-16 16:24:29'),
(24691, 1005, 22447, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:55:31', '2021-03-25 14:55:31'),
(24692, 3046, 22448, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:31', '2021-03-16 16:24:31'),
(24693, 1005, 22448, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:55:34', '2021-03-25 14:55:34'),
(24694, 3046, 22449, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:24:33', '2021-03-16 16:24:33'),
(24695, 1005, 22449, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:55:37', '2021-03-25 14:55:37'),
(24696, 1006, 22460, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:11', '2021-03-16 16:33:11'),
(24697, 1006, 22460, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Requested submitted via Multiplan provider nomination portal: Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 0401212W7 ', NULL, NULL, '2021-04-01 14:32:08', '2021-04-01 14:32:08'),
(24698, 1006, 22460, NULL, '2021-05-19 00:00:00.000', 'In Process', 'We received the following reply from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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.  We have included a sample fee schedule for your review. 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 REPLY to this email and COMPLETE or correct your information by typing into the form below.  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  Group Provider Demographic Information Legal Name:	Right Step Medical Center LLC DBA Name:	 Tax Id/EIN:	853252700	NPI #:	1063008084 Specialty:	Unknown	# of Providers:	 Primary Service Address:	11925 Southwest Freeway, Suite 12 City:	Stafford	State:	TX	Zip:	77477 Phone:	2817419145	Fax:	 Credentialing Contact Information Name:		Title:	 Phone:		Fax:		Email:	 Authorized Signator Information Name:		Title:	 Phone:		Fax:		Email:	 If your providers already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If your providers do not participate in CAQH, you may initiate the process by clicking the following link:CAQH  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\"  Gave them the update they required.', NULL, NULL, '2021-05-03 10:29:50', '2021-05-03 10:29:50'),
(24699, 1006, 22460, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Enrollment Status - Multiplan - RSM  \"Hello,  I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers.  Thank you.\"', NULL, NULL, '2021-05-31 13:51:53', '2021-05-31 13:51:53'),
(24700, 1006, 22460, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent f/u email @ PIF@multiplan.com & registrar@multiplan.com: Sub; Enrollment Status - RSM - Multiplan  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers, their information is as follows: Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-17 17:28:33', '2021-06-17 17:28:33'),
(24701, 1006, 22460, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Opened new service case to get an update regarding the enrollment status for the group:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7662779    Submitter Name: Brad Peterson Date of Submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-07 13:26:40', '2021-07-07 13:26:40'),
(24702, 1006, 22460, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following reply from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear  Brad Peterson,  Thank you for contacting our Service Department for MultiPlan/PHCS.  Please supply us with the additional information in order to assist you with your request:  Was the request to add Maria Jardeleza to group contract held with Right Step Medical Center LLC, if so there is no active contract for this group at this time.  Can you confirm if the provider\'s were nominated at www.multiplan.com,  because I was unable to locate a Provider Nomination Tracking # with either of the NPI\'s listed.  I would recommend to contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704.  Please re-open your case and respond via the portal or you may contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704 at your earliest convenience.  Thank You,  Marta Service Level II Advisor MultiPlan\"  Reopened task on Multiplan website and replied with:  \"Hello,  The nomination tracking number we received from the portal was 0401212W7.  Please let me know how we should proceed.  Thank you.\"', NULL, NULL, '2021-07-13 11:02:56', '2021-07-13 11:02:56'),
(24703, 1006, 22460, NULL, '2021-07-23 00:00:00.000', 'In Process', 'We received the following update from noreplycustserv@multiplan.com:  Sub; Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  New Group nom  id 2143248132 Right Step Medical Center LLC  The completed PIF has been received and is currently in process. Please allow more time to complete the creation of the contract.  Case Number: 7662779    Submitter Name: Brad Peterson Date of submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-16 15:55:35', '2021-07-16 15:55:35'),
(24704, 1006, 22460, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following update from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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\"  Replied with: \"Hello,   Please find the attached information, do let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-08-05 16:59:17', '2021-08-05 16:59:17'),
(24705, 1006, 22460, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Submitted f/u via multiplan provider portal @ provider.multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"Hello,   I wanted to get an update on the status of our enrollment request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-18 16:03:20', '2021-08-18 16:03:20'),
(24706, 1006, 22460, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Received the following reply from Multiplan:  \"The MultiPlan / PHCS Network Nomination for Right Step Medical Center currently under review.  This has been referred to the appropriate team for priority processing.  Did you know: It is not necessary to create multiple cases if you are checking on multiple providers. Simply note all of your providers, or attach a roster with the providers in question to the case.  If you have any questions regarding your current inquiry, please contact our Customer Service department by calling 800-950-7040 with reference to your Case #7662779. You may re-open a closed case using the Portal if you have further inquiry on the same case. Thank you for your interest in participating with the MultiPlan and PHCS Networks.  Sincerely, Samuel Service Advisor II Multiplan\"  Reopened the case and sent f/u:  Service Case #7662779  \"Hello,   We\'re still waiting for an update regarding the enrollment status for our group and providers. Please get back to us as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-08-31 15:45:32', '2021-08-31 15:45:32'),
(24707, 11056, 22460, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.   Call rep. : Shanda  REF CODE. : 09082021SN  Application completely received on 10 of August,2021. From that it will take 90-120 days. The applications are under review by credentialing department.', NULL, NULL, '2021-09-08 10:18:25', '2021-09-08 10:18:25'),
(24708, 11056, 22460, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep name : Teather T  Status : finalised the case just Q/A reviewing is remaining  Contact no. : 800-950-7040  Ref code : 7662779  Please see the attachment too.', NULL, NULL, '2021-09-17 09:56:34', '2021-09-17 09:56:34'),
(24709, 11056, 22460, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : Mariana.Juarez@multiplan.com, Mark.Sokel@multiplan.com & registrar@multiplan.com  Sub : Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-09-27 13:28:04', '2021-09-27 13:28:04'),
(24710, 11056, 22460, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub  : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks. We have received your signed agreement.  The purpose of this email is to collect a provider roster and W9 IRS Form for the group referenced above. We have attached the documents in the requested format for your review. Please complete and return to us by replying to this email.  Sincerely,  Gloria Esplana', NULL, NULL, '2021-10-04 15:00:16', '2021-10-04 15:00:16'),
(24711, 11056, 22460, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from: luis.mariscal@multiplan.com & Mark.Sokel@multiplan.com  Sub : Completed: Multiplan Agreement For Signature Right Step Medical Center LLC - Multiplan network participation contracting   Luis Mariscal luis.mariscal@multiplan.com All parties have completed Multiplan Agreement For Signature.  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan’s provider networks.  An agreement for electronic signature is enclosed and includes instructions on how to sign electronically.    Credentialing documents will be sent to you in a separate communication. You will be notified of your effective date upon acceptance into the network(s).  If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Among other things, Service Operations can answer your credentialing questions, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely,  Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-10-12 12:56:01', '2021-10-12 12:56:01'),
(24712, 11056, 22460, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : Mark.Sokel@multiplan.com  Sub : Right Step Medical Center LLC - Multiplan network participation contracting - received completed Roster & W9 - submitting contract packet for Approval for processing - Hold Claims Letter attached  Hello Ahmed,     This is to confirm for you that I received your completed Roster and W9.  Thank you.  We had previously received your signed Multiplan network participation contract for Right Step Medical Center LLC.  Given that I have your signed contract, your Roster and your W9, I believe I have a complete contract packet.  I am working on getting it processed but given I just received the Roster and W9, I am a little behind the 10/1/2021 effective date on the contract.   It is now slightly a retro situation.  If you can, try to hold any known Multiplan claims for a couple of weeks to allow us to get the contract processed/executed/loaded.  I have attached above a formal “Please hold claims letter”.    Do the best you can.     Today I am submitting your Multiplan contract packet to our QA Folks for review/Approval for processing.  If they kick it back to me for any reason, I will immediately contact you to work out whatever the issue might be.  (But I am hoping it will sail through QA).  As long as there are no issues with the contract packet, as soon as the contract is executed, a copy of the countersigned contract will be automatically be emailed back to your office.        Mark J. Sokel  Provider Contracting Representative  mark.sokel@multiplan.com     MultiPlan  25550 Commercentre Drive, Suite 200  Lake Forest, CA 92630  ph: 949-639-3832  fx: 630-245-2491  Interoffice: *23 3832', NULL, NULL, '2021-10-20 13:46:09', '2021-10-20 13:46:09'),
(24713, 11056, 22460, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : nominations@multiplan.com & registrar registrar@multiplan.com & Mark.Sokel@multiplan.com  Sub : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132 Right Step Medical Center LLC - Multiplan network participation contracting - please credential/add new providers to group contract   Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed week ahead!', NULL, NULL, '2021-11-01 09:07:59', '2021-11-01 09:07:59'),
(24714, 11056, 22460, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep: James D  Ref code:  7811556  Status: Shybi Varghese eff date will be: 11/1/2021 Welcome letter expected.  Ramegowda:  Still in process. Credentialing and contracting dept. ', NULL, NULL, '2021-11-12 17:26:07', '2021-11-12 17:26:07'),
(24715, 11056, 22460, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  welcomepackets@multiplan.com  Sub:  SECURE: MultiPlan Network Participation (12689838-10378588)  Dear Provider/Administrator,   Welcome! Your application has been processed, effective 10/25/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.  Please review the attached documents regarding the participation of Belakere, Ramegowda, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  Please see the attached agreement.', NULL, NULL, '2021-11-29 10:31:36', '2021-11-29 10:31:36'),
(24716, 11056, 22460, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  welcomepackets@multiplan.com  Sub:  SECURE: MultiPlan Network Participation (12689838-10378588)  Dear Provider/Administrator,  Eff date : 10/1/2021  Welcome! Your application has been processed, effective 10/25/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.  Please review the attached documents regarding the participation of Belakere, Ramegowda, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  Please see the attached agreement.', NULL, NULL, '2021-11-29 10:33:34', '2021-11-29 10:33:34'),
(24717, 1006, 22461, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:13', '2021-03-16 16:33:13'),
(24718, 1006, 22461, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Requested submitted via Multiplan provider nomination portal: Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 0401212W7 ', NULL, NULL, '2021-04-01 14:32:14', '2021-04-01 14:32:14'),
(24719, 1006, 22461, NULL, '2021-05-19 00:00:00.000', 'In Process', 'We received the following reply from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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.  We have included a sample fee schedule for your review. 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 REPLY to this email and COMPLETE or correct your information by typing into the form below.  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  Group Provider Demographic Information Legal Name:	Right Step Medical Center LLC DBA Name:	 Tax Id/EIN:	853252700	NPI #:	1063008084 Specialty:	Unknown	# of Providers:	 Primary Service Address:	11925 Southwest Freeway, Suite 12 City:	Stafford	State:	TX	Zip:	77477 Phone:	2817419145	Fax:	 Credentialing Contact Information Name:		Title:	 Phone:		Fax:		Email:	 Authorized Signator Information Name:		Title:	 Phone:		Fax:		Email:	 If your providers already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If your providers do not participate in CAQH, you may initiate the process by clicking the following link:CAQH  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\"  Gave them the update they required.', NULL, NULL, '2021-05-03 10:29:44', '2021-05-03 10:29:44'),
(24720, 1006, 22461, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Enrollment Status - Multiplan - RSM  \"Hello,  I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers.  Thank you.\"', NULL, NULL, '2021-05-31 13:52:02', '2021-05-31 13:52:02'),
(24721, 1006, 22461, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent f/u email @ PIF@multiplan.com & registrar@multiplan.com: Sub; Enrollment Status - RSM - Multiplan  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers, their information is as follows: Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-17 17:28:29', '2021-06-17 17:28:29'),
(24722, 1006, 22461, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Opened new service case to get an update regarding the enrollment status for the group:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7662779    Submitter Name: Brad Peterson Date of Submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-07 13:26:37', '2021-07-07 13:26:37'),
(24723, 1006, 22461, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following reply from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear  Brad Peterson,  Thank you for contacting our Service Department for MultiPlan/PHCS.  Please supply us with the additional information in order to assist you with your request:  Was the request to add Maria Jardeleza to group contract held with Right Step Medical Center LLC, if so there is no active contract for this group at this time.  Can you confirm if the provider\'s were nominated at www.multiplan.com,  because I was unable to locate a Provider Nomination Tracking # with either of the NPI\'s listed.  I would recommend to contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704.  Please re-open your case and respond via the portal or you may contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704 at your earliest convenience.  Thank You,  Marta Service Level II Advisor MultiPlan\"  Reopened task on Multiplan website and replied with:  \"Hello,  The nomination tracking number we received from the portal was 0401212W7.  Please let me know how we should proceed.  Thank you.\"', NULL, NULL, '2021-07-13 11:02:52', '2021-07-13 11:02:52'),
(24724, 1006, 22461, NULL, '2021-07-23 00:00:00.000', 'In Process', 'We received the following update from noreplycustserv@multiplan.com:  Sub; Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  New Group nom  id 2143248132 Right Step Medical Center LLC  The completed PIF has been received and is currently in process. Please allow more time to complete the creation of the contract.  Case Number: 7662779    Submitter Name: Brad Peterson Date of submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-16 15:55:41', '2021-07-16 15:55:41'),
(24725, 1006, 22461, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following update from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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\"  Replied with: \"Hello,   Please find the attached information, do let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-08-05 16:59:28', '2021-08-05 16:59:28'),
(24726, 1006, 22461, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Submitted f/u via multiplan provider portal @ provider.multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"Hello,   I wanted to get an update on the status of our enrollment request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-18 16:03:24', '2021-08-18 16:03:24'),
(24727, 1006, 22461, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Received the following reply from Multiplan:  \"The MultiPlan / PHCS Network Nomination for Right Step Medical Center currently under review.  This has been referred to the appropriate team for priority processing.  Did you know: It is not necessary to create multiple cases if you are checking on multiple providers. Simply note all of your providers, or attach a roster with the providers in question to the case.  If you have any questions regarding your current inquiry, please contact our Customer Service department by calling 800-950-7040 with reference to your Case #7662779. You may re-open a closed case using the Portal if you have further inquiry on the same case. Thank you for your interest in participating with the MultiPlan and PHCS Networks.  Sincerely, Samuel Service Advisor II Multiplan\"  Reopened the case and sent f/u:  Service Case #7662779  \"Hello,   We\'re still waiting for an update regarding the enrollment status for our group and providers. Please get back to us as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-08-31 15:45:29', '2021-08-31 15:45:29'),
(24728, 11056, 22461, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.   Call rep. : Shanda  REF CODE. : 09082021SN  Application completely received on 10 of August,2021. From that it will take 90-120 days. The applications are under review by credentialing department.', NULL, NULL, '2021-09-08 10:18:20', '2021-09-08 10:18:20'),
(24729, 11056, 22461, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep name : Teather T  Status : finalised the case just Q/A reviewing is remaining  Contact no. : 800-950-7040  Ref code : 7662779  Please see the attachment too.', NULL, NULL, '2021-09-17 09:56:22', '2021-09-17 09:56:22'),
(24730, 11056, 22461, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : Mariana.Juarez@multiplan.com, Mark.Sokel@multiplan.com & registrar@multiplan.com  Sub : Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-09-27 13:27:57', '2021-09-27 13:27:57'),
(24731, 11056, 22461, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub  : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks. We have received your signed agreement.  The purpose of this email is to collect a provider roster and W9 IRS Form for the group referenced above. We have attached the documents in the requested format for your review. Please complete and return to us by replying to this email.  Sincerely,  Gloria Esplana', NULL, NULL, '2021-10-04 15:00:06', '2021-10-04 15:00:06'),
(24732, 11056, 22461, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from: luis.mariscal@multiplan.com & Mark.Sokel@multiplan.com  Sub : Completed: Multiplan Agreement For Signature Right Step Medical Center LLC - Multiplan network participation contracting   Luis Mariscal luis.mariscal@multiplan.com All parties have completed Multiplan Agreement For Signature.  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan’s provider networks.  An agreement for electronic signature is enclosed and includes instructions on how to sign electronically.    Credentialing documents will be sent to you in a separate communication. You will be notified of your effective date upon acceptance into the network(s).  If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Among other things, Service Operations can answer your credentialing questions, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely,  Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-10-12 12:55:51', '2021-10-12 12:55:51'),
(24733, 11056, 22461, NULL, '2021-10-22 00:00:00.000', 'Approved', 'Approval Email received from : welcomepackets@multiplan.com  Sub : SECURE: MultiPlan Network Participation (13745970-10378588)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Abraham, Glory, MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information   Please see the attached welcome letter.', NULL, NULL, '2021-10-15 12:34:00', '2021-10-15 12:34:00'),
(24734, 1006, 22462, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:14', '2021-03-16 16:33:14'),
(24735, 1006, 22462, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Requested submitted via Multiplan provider nomination portal: Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 0401212W7 ', NULL, NULL, '2021-04-01 14:32:18', '2021-04-01 14:32:18'),
(24736, 1006, 22462, NULL, '2021-05-19 00:00:00.000', 'In Process', 'We received the following reply from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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.  We have included a sample fee schedule for your review. 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 REPLY to this email and COMPLETE or correct your information by typing into the form below.  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  Group Provider Demographic Information Legal Name:	Right Step Medical Center LLC DBA Name:	 Tax Id/EIN:	853252700	NPI #:	1063008084 Specialty:	Unknown	# of Providers:	 Primary Service Address:	11925 Southwest Freeway, Suite 12 City:	Stafford	State:	TX	Zip:	77477 Phone:	2817419145	Fax:	 Credentialing Contact Information Name:		Title:	 Phone:		Fax:		Email:	 Authorized Signator Information Name:		Title:	 Phone:		Fax:		Email:	 If your providers already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If your providers do not participate in CAQH, you may initiate the process by clicking the following link:CAQH  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\"  Gave them the update they required.', NULL, NULL, '2021-05-03 10:29:38', '2021-05-03 10:29:38'),
(24737, 1006, 22462, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Enrollment Status - Multiplan - RSM  \"Hello,  I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers.  Thank you.\"', NULL, NULL, '2021-05-31 13:52:09', '2021-05-31 13:52:09'),
(24738, 1006, 22462, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent f/u email @ PIF@multiplan.com & registrar@multiplan.com: Sub; Enrollment Status - RSM - Multiplan  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers, their information is as follows: Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-17 17:28:21', '2021-06-17 17:28:21'),
(24739, 1006, 22462, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Opened new service case to get an update regarding the enrollment status for the group:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7662779    Submitter Name: Brad Peterson Date of Submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-07 13:26:45', '2021-07-07 13:26:45'),
(24740, 1006, 22462, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following reply from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear  Brad Peterson,  Thank you for contacting our Service Department for MultiPlan/PHCS.  Please supply us with the additional information in order to assist you with your request:  Was the request to add Maria Jardeleza to group contract held with Right Step Medical Center LLC, if so there is no active contract for this group at this time.  Can you confirm if the provider\'s were nominated at www.multiplan.com,  because I was unable to locate a Provider Nomination Tracking # with either of the NPI\'s listed.  I would recommend to contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704.  Please re-open your case and respond via the portal or you may contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704 at your earliest convenience.  Thank You,  Marta Service Level II Advisor MultiPlan\"  Reopened task on Multiplan website and replied with:  \"Hello,  The nomination tracking number we received from the portal was 0401212W7.  Please let me know how we should proceed.  Thank you.\"', NULL, NULL, '2021-07-13 11:02:48', '2021-07-13 11:02:48'),
(24741, 1006, 22462, NULL, '2021-07-23 00:00:00.000', 'In Process', 'We received the following update from noreplycustserv@multiplan.com:  Sub; Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  New Group nom  id 2143248132 Right Step Medical Center LLC  The completed PIF has been received and is currently in process. Please allow more time to complete the creation of the contract.  Case Number: 7662779    Submitter Name: Brad Peterson Date of submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-16 15:55:44', '2021-07-16 15:55:44');
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
(24742, 1006, 22462, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following update from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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\"  Replied with: \"Hello,   Please find the attached information, do let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-08-05 16:59:42', '2021-08-05 16:59:42'),
(24743, 1006, 22462, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Submitted f/u via multiplan provider portal @ provider.multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"Hello,   I wanted to get an update on the status of our enrollment request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-18 16:03:27', '2021-08-18 16:03:27'),
(24744, 1006, 22462, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Received the following reply from Multiplan:  \"The MultiPlan / PHCS Network Nomination for Right Step Medical Center currently under review.  This has been referred to the appropriate team for priority processing.  Did you know: It is not necessary to create multiple cases if you are checking on multiple providers. Simply note all of your providers, or attach a roster with the providers in question to the case.  If you have any questions regarding your current inquiry, please contact our Customer Service department by calling 800-950-7040 with reference to your Case #7662779. You may re-open a closed case using the Portal if you have further inquiry on the same case. Thank you for your interest in participating with the MultiPlan and PHCS Networks.  Sincerely, Samuel Service Advisor II Multiplan\"  Reopened the case and sent f/u:  Service Case #7662779  \"Hello,   We\'re still waiting for an update regarding the enrollment status for our group and providers. Please get back to us as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-08-31 15:45:23', '2021-08-31 15:45:23'),
(24745, 11056, 22462, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.   Call rep. : Shanda  REF CODE. : 09082021SN  Application completely received on 10 of August,2021. From that it will take 90-120 days. The applications are under review by credentialing department.', NULL, NULL, '2021-09-08 10:18:14', '2021-09-08 10:18:14'),
(24746, 11056, 22462, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep name : Teather T  Status : finalised the case just Q/A reviewing is remaining  Contact no. : 800-950-7040  Ref code : 7662779  Please see the attachment too.  ', NULL, NULL, '2021-09-17 09:55:57', '2021-09-17 09:55:57'),
(24747, 11056, 22462, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : Mariana.Juarez@multiplan.com, Mark.Sokel@multiplan.com & registrar@multiplan.com  Sub : Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-09-27 13:27:49', '2021-09-27 13:27:49'),
(24748, 11056, 22462, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : Mariana.Juarez@multiplan.com, Mark.Sokel@multiplan.com & registrar@multiplan.com  Sub : Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-09-27 13:27:50', '2021-09-27 13:27:50'),
(24749, 11056, 22462, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub  : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks. We have received your signed agreement.  The purpose of this email is to collect a provider roster and W9 IRS Form for the group referenced above. We have attached the documents in the requested format for your review. Please complete and return to us by replying to this email.  Sincerely,  Gloria Esplana', NULL, NULL, '2021-10-04 14:59:59', '2021-10-04 14:59:59'),
(24750, 11056, 22462, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from: luis.mariscal@multiplan.com & Mark.Sokel@multiplan.com  Sub : Completed: Multiplan Agreement For Signature Right Step Medical Center LLC - Multiplan network participation contracting   Luis Mariscal luis.mariscal@multiplan.com All parties have completed Multiplan Agreement For Signature.  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan’s provider networks.  An agreement for electronic signature is enclosed and includes instructions on how to sign electronically.    Credentialing documents will be sent to you in a separate communication. You will be notified of your effective date upon acceptance into the network(s).  If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Among other things, Service Operations can answer your credentialing questions, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely,  Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-10-12 12:55:32', '2021-10-12 12:55:32'),
(24751, 11056, 22462, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : Mark.Sokel@multiplan.com  Sub : Right Step Medical Center LLC - Multiplan network participation contracting - received completed Roster & W9 - submitting contract packet for Approval for processing - Hold Claims Letter attached  Hello Ahmed,     This is to confirm for you that I received your completed Roster and W9.  Thank you.  We had previously received your signed Multiplan network participation contract for Right Step Medical Center LLC.  Given that I have your signed contract, your Roster and your W9, I believe I have a complete contract packet.  I am working on getting it processed but given I just received the Roster and W9, I am a little behind the 10/1/2021 effective date on the contract.   It is now slightly a retro situation.  If you can, try to hold any known Multiplan claims for a couple of weeks to allow us to get the contract processed/executed/loaded.  I have attached above a formal “Please hold claims letter”.    Do the best you can.     Today I am submitting your Multiplan contract packet to our QA Folks for review/Approval for processing.  If they kick it back to me for any reason, I will immediately contact you to work out whatever the issue might be.  (But I am hoping it will sail through QA).  As long as there are no issues with the contract packet, as soon as the contract is executed, a copy of the countersigned contract will be automatically be emailed back to your office.        Mark J. Sokel  Provider Contracting Representative  mark.sokel@multiplan.com     MultiPlan  25550 Commercentre Drive, Suite 200  Lake Forest, CA 92630  ph: 949-639-3832  fx: 630-245-2491  Interoffice: *23 3832', NULL, NULL, '2021-10-20 13:46:02', '2021-10-20 13:46:02'),
(24752, 11056, 22462, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : nominations@multiplan.com & registrar registrar@multiplan.com & Mark.Sokel@multiplan.com  Sub : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132 Right Step Medical Center LLC - Multiplan network participation contracting - please credential/add new providers to group contract   Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed week ahead!', NULL, NULL, '2021-11-01 09:07:52', '2021-11-01 09:07:52'),
(24753, 11056, 22462, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep: James D  Ref code:  7811556  Status: Shybi Varghese eff date will be: 11/1/2021 Welcome letter expected.  Ramegowda:  Still in process. Credentialing and contracting dept. ', NULL, NULL, '2021-11-12 17:25:59', '2021-11-12 17:25:59'),
(24754, 11056, 22462, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Dear Provider/Administrator,   Welcome! Your application has been processed, effective 10/25/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.  Please review the attached documents regarding the participation of Belakere, Ramegowda, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  Please see the attachment', NULL, NULL, '2021-11-29 10:30:05', '2021-11-29 10:30:05'),
(24755, 11056, 22462, NULL, '2021-12-06 00:00:00.000', 'Approved', 'Email received from:  welcomepackets@multiplan.com  Sub:  SECURE: MultiPlan Network Participation (12689838-10378588)  Dear Provider/Administrator,   Welcome! Your application has been processed, effective 10/25/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.  Please review the attached documents regarding the participation of Belakere, Ramegowda, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  Please see the attached Welcome Letter.', NULL, NULL, '2021-11-29 10:32:43', '2021-11-29 10:32:43'),
(24756, 1006, 22463, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:15', '2021-03-16 16:33:15'),
(24757, 1006, 22463, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Requested submitted via Multiplan provider nomination portal: Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 0401212W7 ', NULL, NULL, '2021-04-01 14:32:22', '2021-04-01 14:32:22'),
(24758, 1006, 22463, NULL, '2021-05-19 00:00:00.000', 'In Process', 'We received the following reply from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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.  We have included a sample fee schedule for your review. 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 REPLY to this email and COMPLETE or correct your information by typing into the form below.  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  Group Provider Demographic Information Legal Name:	Right Step Medical Center LLC DBA Name:	 Tax Id/EIN:	853252700	NPI #:	1063008084 Specialty:	Unknown	# of Providers:	 Primary Service Address:	11925 Southwest Freeway, Suite 12 City:	Stafford	State:	TX	Zip:	77477 Phone:	2817419145	Fax:	 Credentialing Contact Information Name:		Title:	 Phone:		Fax:		Email:	 Authorized Signator Information Name:		Title:	 Phone:		Fax:		Email:	 If your providers already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If your providers do not participate in CAQH, you may initiate the process by clicking the following link:CAQH  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\"  Gave them the update they required.', NULL, NULL, '2021-05-03 10:29:27', '2021-05-03 10:29:27'),
(24759, 1006, 22463, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Enrollment Status - Multiplan - RSM  \"Hello,  I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers.  Thank you.\"', NULL, NULL, '2021-05-31 13:52:17', '2021-05-31 13:52:17'),
(24760, 1006, 22463, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent f/u email @ PIF@multiplan.com & registrar@multiplan.com: Sub; Enrollment Status - RSM - Multiplan  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers, their information is as follows: Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-17 17:28:18', '2021-06-17 17:28:18'),
(24761, 1006, 22463, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Opened new service case to get an update regarding the enrollment status for the group:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7662779    Submitter Name: Brad Peterson Date of Submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-07 13:26:32', '2021-07-07 13:26:32'),
(24762, 1006, 22463, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following reply from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear  Brad Peterson,  Thank you for contacting our Service Department for MultiPlan/PHCS.  Please supply us with the additional information in order to assist you with your request:  Was the request to add Maria Jardeleza to group contract held with Right Step Medical Center LLC, if so there is no active contract for this group at this time.  Can you confirm if the provider\'s were nominated at www.multiplan.com,  because I was unable to locate a Provider Nomination Tracking # with either of the NPI\'s listed.  I would recommend to contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704.  Please re-open your case and respond via the portal or you may contact our Customer Service Team at 800-950-7040 with reference to your Case # 7662704 at your earliest convenience.  Thank You,  Marta Service Level II Advisor MultiPlan\"  Reopened task on Multiplan website and replied with:  \"Hello,  The nomination tracking number we received from the portal was 0401212W7.  Please let me know how we should proceed.  Thank you.\"', NULL, NULL, '2021-07-13 11:02:30', '2021-07-13 11:02:30'),
(24763, 1006, 22463, NULL, '2021-07-23 00:00:00.000', 'In Process', 'We received the following update from noreplycustserv@multiplan.com:  Sub; Closed Customer Service Case 7662779  \"MultiPlan has closed Customer Service Case 7662779.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  New Group nom  id 2143248132 Right Step Medical Center LLC  The completed PIF has been received and is currently in process. Please allow more time to complete the creation of the contract.  Case Number: 7662779    Submitter Name: Brad Peterson Date of submission: 07/07/2021    TIN: 85-3252700    Provider Name: UNKNOWN, UNKNOWN Group Name: Right Step Medical Center LLC Inquiry Type: Credentialing Status • Application Status    Priority: Standard\"', NULL, NULL, '2021-07-16 15:55:47', '2021-07-16 15:55:47'),
(24764, 1006, 22463, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following update from pif@multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"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\"  Replied with: \"Hello,   Please find the attached information, do let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-08-05 16:59:48', '2021-08-05 16:59:48'),
(24765, 1006, 22463, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Submitted f/u via multiplan provider portal @ provider.multiplan.com:  Sub: Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  \"Hello,   I wanted to get an update on the status of our enrollment request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-18 16:03:30', '2021-08-18 16:03:30'),
(24766, 1006, 22463, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Received the following reply from Multiplan:  \"The MultiPlan / PHCS Network Nomination for Right Step Medical Center currently under review.  This has been referred to the appropriate team for priority processing.  Did you know: It is not necessary to create multiple cases if you are checking on multiple providers. Simply note all of your providers, or attach a roster with the providers in question to the case.  If you have any questions regarding your current inquiry, please contact our Customer Service department by calling 800-950-7040 with reference to your Case #7662779. You may re-open a closed case using the Portal if you have further inquiry on the same case. Thank you for your interest in participating with the MultiPlan and PHCS Networks.  Sincerely, Samuel Service Advisor II Multiplan\"  Reopened the case and sent f/u:  Service Case #7662779  \"Hello,   We\'re still waiting for an update regarding the enrollment status for our group and providers. Please get back to us as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-08-31 15:45:16', '2021-08-31 15:45:16'),
(24767, 11056, 22463, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.   Call rep. : Shanda  REF CODE. : 09082021SN  Application completely received on 10 of August,2021. From that it will take 90-120 days. The applications are under review by credentialing department.', NULL, NULL, '2021-09-08 10:17:53', '2021-09-08 10:17:53'),
(24768, 11056, 22463, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep name : Teather T  Status : finalised the case just Q/A reviewing is remaining  Contact no. : 800-950-7040  Ref code : 7662779  Please see the attachment too.', NULL, NULL, '2021-09-17 09:56:57', '2021-09-17 09:56:57'),
(24769, 11056, 22463, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : Mariana.Juarez@multiplan.com, Mark.Sokel@multiplan.com & registrar@multiplan.com  Sub : Multiplan Request for Information for Right Step Medical Center LLC - State: TX - SEID: 2143248132  Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-27 13:27:20', '2021-09-27 13:27:20'),
(24770, 11056, 22463, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub  : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks. We have received your signed agreement.  The purpose of this email is to collect a provider roster and W9 IRS Form for the group referenced above. We have attached the documents in the requested format for your review. Please complete and return to us by replying to this email.  Sincerely,  Gloria Esplana', NULL, NULL, '2021-10-04 14:58:58', '2021-10-04 14:58:58'),
(24771, 11056, 22463, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from: luis.mariscal@multiplan.com & Mark.Sokel@multiplan.com  Sub : Completed: Multiplan Agreement For Signature Right Step Medical Center LLC - Multiplan network participation contracting   Luis Mariscal luis.mariscal@multiplan.com All parties have completed Multiplan Agreement For Signature.  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan’s provider networks.  An agreement for electronic signature is enclosed and includes instructions on how to sign electronically.    Credentialing documents will be sent to you in a separate communication. You will be notified of your effective date upon acceptance into the network(s).  If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Among other things, Service Operations can answer your credentialing questions, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely,  Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-10-12 12:54:48', '2021-10-12 12:54:48'),
(24772, 11056, 22463, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : Mark.Sokel@multiplan.com  Sub : Right Step Medical Center LLC - Multiplan network participation contracting - received completed Roster & W9 - submitting contract packet for Approval for processing - Hold Claims Letter attached  Hello Ahmed,     This is to confirm for you that I received your completed Roster and W9.  Thank you.  We had previously received your signed Multiplan network participation contract for Right Step Medical Center LLC.  Given that I have your signed contract, your Roster and your W9, I believe I have a complete contract packet.  I am working on getting it processed but given I just received the Roster and W9, I am a little behind the 10/1/2021 effective date on the contract.   It is now slightly a retro situation.  If you can, try to hold any known Multiplan claims for a couple of weeks to allow us to get the contract processed/executed/loaded.  I have attached above a formal “Please hold claims letter”.    Do the best you can.     Today I am submitting your Multiplan contract packet to our QA Folks for review/Approval for processing.  If they kick it back to me for any reason, I will immediately contact you to work out whatever the issue might be.  (But I am hoping it will sail through QA).  As long as there are no issues with the contract packet, as soon as the contract is executed, a copy of the countersigned contract will be automatically be emailed back to your office.        Mark J. Sokel  Provider Contracting Representative  mark.sokel@multiplan.com     MultiPlan  25550 Commercentre Drive, Suite 200  Lake Forest, CA 92630  ph: 949-639-3832  fx: 630-245-2491  Interoffice: *23 3832', NULL, NULL, '2021-10-20 13:45:20', '2021-10-20 13:45:20'),
(24773, 11056, 22463, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : nominations@multiplan.com & registrar registrar@multiplan.com & Mark.Sokel@multiplan.com  Sub : Multiplan Roster Request for - Right Step Medical Center LLC - State: TX - SEID: 2143248132 Right Step Medical Center LLC - Multiplan network participation contracting - please credential/add new providers to group contract   Good afternoon!  Hope you had a great and safe weekend. I would appreciate it if you could please let me know the latest enrollment status of the following providers under the Facility.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Ramegowda Belakere	1235166687 Glory Abraham	1194206490 Shybi Varghese	1285270991  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed week ahead!', NULL, NULL, '2021-11-01 09:07:33', '2021-11-01 09:07:33'),
(24774, 11056, 22463, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep: James D  Ref code:  7811556  Status: Shybi Varghese eff date will be: 11/1/2021 Welcome letter expected.  Ramegowda:  Still in process. Credentialing and contracting dept.  ', NULL, NULL, '2021-11-12 17:25:32', '2021-11-12 17:25:32'),
(24775, 11056, 22463, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email received from: ProviderServices@multiplan.com  Sub : E-mailing: arghese, Shybi PAR letter.zipx   Dear Ahmad,     We received your request to email the participation status letter. Please find the attached documents for Varghese, Shybi.  Password will be in the second email     You may check the status of your current inquiry by calling 800-950-7040 with reference to your Case # 7811556.   Eff date is : 11/01/2021', NULL, NULL, '2021-11-15 14:29:35', '2021-11-15 14:29:35'),
(24776, 1006, 22464, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:32', '2021-03-16 16:33:32'),
(24777, 1006, 22464, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The Contracting form is filled and currently pending Medicare/Medicaid enrollment to proceed. ', NULL, NULL, '2021-04-01 13:29:37', '2021-04-01 13:29:37'),
(24778, 1006, 22464, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Contracting form has been filled out and sent, contract and proof attached for reference. ', NULL, NULL, '2021-04-02 18:18:52', '2021-04-02 18:18:52'),
(24779, 1006, 22464, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello,  I hope you\'re doing well, I want to get an update on the status of enrollment for our group. We submitted an ancillary contract on 04/02/2021, I\'d appreciate it if I could get an update on the status of it. The group info is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 08:21:36', '2021-05-03 08:21:36'),
(24780, 1006, 22464, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from @ ProviderMarketingInfo ProviderMarketingInfo@usamco.com & Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Brad,   The most recent update I have on the record for Right Step Medical Center is from 4/26; our rep Kirsten spoke with Adil about the Exhibit B that we need for the contract.  I have CC’ed Kirsten on this email also.  Sarah Cozzetto Network Development Coordinator\"  Sent following reply:   \"Hello Sarah & Kirsten,  I haven\'t received any information regarding an Exhibit B, could you please forward it to me? Awaiting your response. Thank you. \"', NULL, NULL, '2021-05-31 13:28:43', '2021-05-31 13:28:43'),
(24781, 1006, 22464, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Received an email from MCO requesting information:  \"Good Morning Brad,     Here is all the emails that have been sent over including the Exhibit B.  Can you please let me know that you are receiving these?     Thanks        Kirsten Bailey  Provider Network Development Rep\"  Sent back all the requested info.', NULL, NULL, '2021-06-01 16:38:34', '2021-06-01 16:38:34'),
(24782, 1006, 22464, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from Kirsten Bailey baileyk@usamco.com:  Sub: Right Step Medical  \"Good Morning,  The application for the above provider is complete and has been forwarded to provider relations for credentialing. You will receive a welcome email with effective date once processed.  Thank you, J\"', NULL, NULL, '2021-06-09 16:44:03', '2021-06-09 16:44:03'),
(24783, 1006, 22464, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Kirsten,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-29 17:27:49', '2021-06-29 17:27:49'),
(24784, 1006, 22464, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Received following approval confirmation from Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Good  Morning Brad,  This is complete with an effective date of 06/04/21, provider ID is 1318174  The notes state the final packet was emailed to you, let me know if you did not receive it.  It may have gone to the email  rsm@claimsmedinc.com  Kirsten Bailey Provider Network Development Rep\"  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-07-08 16:29:42', '2021-07-08 16:29:42'),
(24785, 1006, 22465, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:34', '2021-03-16 16:33:34'),
(24786, 1006, 22465, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The Contracting form is filled and currently pending Medicare/Medicaid enrollment to proceed. ', NULL, NULL, '2021-04-01 13:29:42', '2021-04-01 13:29:42'),
(24787, 1006, 22465, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Contracting form has been filled out and sent, contract and proof attached for reference. ', NULL, NULL, '2021-04-02 18:18:57', '2021-04-02 18:18:57'),
(24788, 1006, 22465, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello,  I hope you\'re doing well, I want to get an update on the status of enrollment for our group. We submitted an ancillary contract on 04/02/2021, I\'d appreciate it if I could get an update on the status of it. The group info is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 08:21:32', '2021-05-03 08:21:32'),
(24789, 1006, 22465, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from @ ProviderMarketingInfo ProviderMarketingInfo@usamco.com & Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Brad,   The most recent update I have on the record for Right Step Medical Center is from 4/26; our rep Kirsten spoke with Adil about the Exhibit B that we need for the contract.  I have CC’ed Kirsten on this email also.  Sarah Cozzetto Network Development Coordinator\"  Sent following reply:   \"Hello Sarah & Kirsten,  I haven\'t received any information regarding an Exhibit B, could you please forward it to me? Awaiting your response. Thank you. \"', NULL, NULL, '2021-05-31 13:29:01', '2021-05-31 13:29:01'),
(24790, 1006, 22465, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Received an email from MCO requesting information:  \"Good Morning Brad,     Here is all the emails that have been sent over including the Exhibit B.  Can you please let me know that you are receiving these?     Thanks        Kirsten Bailey  Provider Network Development Rep\"  Sent back all the requested info.', NULL, NULL, '2021-06-01 16:38:44', '2021-06-01 16:38:44'),
(24791, 1006, 22465, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from Kirsten Bailey baileyk@usamco.com:  Sub: Right Step Medical  \"Good Morning,  The application for the above provider is complete and has been forwarded to provider relations for credentialing. You will receive a welcome email with effective date once processed.  Thank you, J\"', NULL, NULL, '2021-06-09 16:43:59', '2021-06-09 16:43:59'),
(24792, 1006, 22465, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Kirsten,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-29 17:27:46', '2021-06-29 17:27:46'),
(24793, 1006, 22465, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Received following approval confirmation from Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Good  Morning Brad,  This is complete with an effective date of 06/04/21, provider ID is 1318174  The notes state the final packet was emailed to you, let me know if you did not receive it.  It may have gone to the email  rsm@claimsmedinc.com  Kirsten Bailey Provider Network Development Rep\"  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-07-08 16:29:53', '2021-07-08 16:29:53'),
(24794, 1006, 22466, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:35', '2021-03-16 16:33:35'),
(24795, 1006, 22466, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The Contracting form is filled and currently pending Medicare/Medicaid enrollment to proceed. ', NULL, NULL, '2021-04-01 13:29:45', '2021-04-01 13:29:45'),
(24796, 1006, 22466, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Contracting form has been filled out and sent, contract and proof attached for reference. ', NULL, NULL, '2021-04-02 18:19:00', '2021-04-02 18:19:00'),
(24797, 1006, 22466, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello,  I hope you\'re doing well, I want to get an update on the status of enrollment for our group. We submitted an ancillary contract on 04/02/2021, I\'d appreciate it if I could get an update on the status of it. The group info is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 08:21:28', '2021-05-03 08:21:28'),
(24798, 1006, 22466, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from @ ProviderMarketingInfo ProviderMarketingInfo@usamco.com & Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Brad,   The most recent update I have on the record for Right Step Medical Center is from 4/26; our rep Kirsten spoke with Adil about the Exhibit B that we need for the contract.  I have CC’ed Kirsten on this email also.  Sarah Cozzetto Network Development Coordinator\"  Sent following reply:   \"Hello Sarah & Kirsten,  I haven\'t received any information regarding an Exhibit B, could you please forward it to me? Awaiting your response. Thank you. \"', NULL, NULL, '2021-05-31 13:29:07', '2021-05-31 13:29:07'),
(24799, 1006, 22466, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Received an email from MCO requesting information:  \"Good Morning Brad,     Here is all the emails that have been sent over including the Exhibit B.  Can you please let me know that you are receiving these?     Thanks        Kirsten Bailey  Provider Network Development Rep\"  Sent back all the requested info.', NULL, NULL, '2021-06-01 16:38:39', '2021-06-01 16:38:39'),
(24800, 1006, 22466, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from Kirsten Bailey baileyk@usamco.com:  Sub: Right Step Medical  \"Good Morning,  The application for the above provider is complete and has been forwarded to provider relations for credentialing. You will receive a welcome email with effective date once processed.  Thank you, J\"', NULL, NULL, '2021-06-09 16:43:53', '2021-06-09 16:43:53'),
(24801, 1006, 22466, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Kirsten,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-29 17:27:42', '2021-06-29 17:27:42'),
(24802, 1006, 22466, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Received following approval confirmation from Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Good  Morning Brad,  This is complete with an effective date of 06/04/21, provider ID is 1318174  The notes state the final packet was emailed to you, let me know if you did not receive it.  It may have gone to the email  rsm@claimsmedinc.com  Kirsten Bailey Provider Network Development Rep\"  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-07-08 16:29:59', '2021-07-08 16:29:59'),
(24803, 1006, 22467, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:36', '2021-03-16 16:33:36'),
(24804, 1006, 22467, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The Contracting form is filled and currently pending Medicare/Medicaid enrollment to proceed. ', NULL, NULL, '2021-04-01 13:29:49', '2021-04-01 13:29:49'),
(24805, 1006, 22467, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Contracting form has been filled out and sent, contract and proof attached for reference.  ', NULL, NULL, '2021-04-02 18:19:43', '2021-04-02 18:19:43'),
(24806, 1006, 22467, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello,  I hope you\'re doing well, I want to get an update on the status of enrollment for our group. We submitted an ancillary contract on 04/02/2021, I\'d appreciate it if I could get an update on the status of it. The group info is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 08:21:15', '2021-05-03 08:21:15'),
(24807, 1006, 22467, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from @ ProviderMarketingInfo ProviderMarketingInfo@usamco.com & Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Brad,   The most recent update I have on the record for Right Step Medical Center is from 4/26; our rep Kirsten spoke with Adil about the Exhibit B that we need for the contract.  I have CC’ed Kirsten on this email also.  Sarah Cozzetto Network Development Coordinator\"  Sent following reply:   \"Hello Sarah & Kirsten,  I haven\'t received any information regarding an Exhibit B, could you please forward it to me? Awaiting your response. Thank you. \"', NULL, NULL, '2021-05-31 13:29:12', '2021-05-31 13:29:12'),
(24808, 1006, 22467, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Received an email from MCO requesting information:  \"Good Morning Brad,     Here is all the emails that have been sent over including the Exhibit B.  Can you please let me know that you are receiving these?     Thanks        Kirsten Bailey  Provider Network Development Rep\"  Sent back all the requested info.', NULL, NULL, '2021-06-01 16:38:29', '2021-06-01 16:38:29'),
(24809, 1006, 22467, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from Kirsten Bailey baileyk@usamco.com:  Sub: Right Step Medical  \"Good Morning,  The application for the above provider is complete and has been forwarded to provider relations for credentialing. You will receive a welcome email with effective date once processed.  Thank you, J\"', NULL, NULL, '2021-06-09 16:43:44', '2021-06-09 16:43:44'),
(24810, 1006, 22467, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Hello Kirsten,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-29 17:27:33', '2021-06-29 17:27:33'),
(24811, 1006, 22467, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Received following approval confirmation from Kirsten Bailey baileyk@usamco.com:  Sub: Enrollment Status - RSM - MCO  \"Good  Morning Brad,  This is complete with an effective date of 06/04/21, provider ID is 1318174  The notes state the final packet was emailed to you, let me know if you did not receive it.  It may have gone to the email  rsm@claimsmedinc.com  Kirsten Bailey Provider Network Development Rep\"  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-07-08 16:30:02', '2021-07-08 16:30:02'),
(24812, 1006, 22469, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:53', '2021-03-16 16:33:53'),
(24813, 1006, 22469, NULL, '2021-05-31 00:00:00.000', 'Initiated', 'Enrollment request has been submitted for Group and Ramegowda:  \"Enrollment Application Status   Application Status PEP Ticket Number Submitted		17802658\"', NULL, NULL, '2021-05-24 17:17:22', '2021-05-24 17:17:22'),
(24814, 1005, 22469, NULL, '2021-06-12 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-04 15:00:25', '2021-06-04 15:00:25'),
(24815, 1005, 22469, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-09 15:24:17', '2021-06-09 15:24:17'),
(24816, 1006, 22469, NULL, '2021-06-21 00:00:00.000', 'Approved', 'The group and provider have been enrolled with Medicaid. Attached confirmation for reference.   Eff date: 02/01/2021 TPI# 423525101', NULL, NULL, '2021-06-14 09:35:08', '2021-06-14 09:35:08'),
(24817, 1006, 22470, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:55', '2021-03-16 16:33:55'),
(24818, 1006, 22470, NULL, '2021-05-31 00:00:00.000', 'On Hold', 'Pending group enrollment completion to add as performing provider. ', NULL, NULL, '2021-05-24 17:18:25', '2021-05-24 17:18:25'),
(24819, 1006, 22470, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Submitted enrollment request via Medicaid portal: Application Status PEP Ticket Number Submitted		17846641 ', NULL, NULL, '2021-06-14 10:00:28', '2021-06-14 10:00:28'),
(24820, 1006, 22470, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The provider is approved, approval confirmation is attached for reference.   Eff# 02/01/2021 TPI# 394731904', NULL, NULL, '2021-06-21 08:35:08', '2021-06-21 08:35:08'),
(24821, 1006, 22471, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:57', '2021-03-16 16:33:57'),
(24822, 1006, 22471, NULL, '2021-05-31 00:00:00.000', 'Initiated', 'Enrollment request has been submitted for Group and Ramegowda:  \"Enrollment Application Status   Application Status PEP Ticket Number Submitted		17802658\"', NULL, NULL, '2021-05-24 17:17:49', '2021-05-24 17:17:49'),
(24823, 1005, 22471, NULL, '2021-06-12 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-04 15:00:31', '2021-06-04 15:00:31');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(24824, 1006, 22471, NULL, '2021-06-21 00:00:00.000', 'Approved', 'The group and provider have been enrolled with Medicaid. Attached confirmation for reference.   Eff date: 02/01/2021 TPI# 193703914 ', NULL, NULL, '2021-06-14 09:36:41', '2021-06-14 09:36:41'),
(24825, 1006, 22472, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:33:58', '2021-03-16 16:33:58'),
(24826, 1006, 22472, NULL, '2021-05-31 00:00:00.000', 'On Hold', 'Pending group enrollment completion to add as performing provider. ', NULL, NULL, '2021-05-24 17:18:41', '2021-05-24 17:18:41'),
(24827, 1006, 22472, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Enrollment request submitted via TMHP website:  \"Application Status PEP Ticket Number Submitted		17846758\"', NULL, NULL, '2021-06-14 10:14:03', '2021-06-14 10:14:03'),
(24828, 1005, 22472, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Checked online and the application is currently \"In Progress\".', NULL, NULL, '2021-06-29 11:40:00', '2021-06-29 11:40:00'),
(24829, 1006, 22472, NULL, '2021-07-16 00:00:00.000', 'Approved', 'The provider has been enrolled with Medicaid.   Eff: 02/01/2021 TPI# 424393301', NULL, NULL, '2021-07-09 13:35:31', '2021-07-09 13:35:31'),
(24830, 1006, 22473, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:35:25', '2021-03-16 16:35:25'),
(24831, 3040, 22473, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-05 09:47:26', '2021-04-05 09:47:26'),
(24832, 1006, 22473, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:18:11', '2021-05-25 10:18:11'),
(24833, 1006, 22473, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in the main group task for reference. ', NULL, NULL, '2021-06-14 15:06:44', '2021-06-14 15:06:44'),
(24834, 1006, 22473, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent corrected email & form @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in main group task for reference. ', NULL, NULL, '2021-07-02 16:19:39', '2021-07-02 16:19:39'),
(24835, 1006, 22473, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Ramegowda Belakere  \"Good Afternoon,  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 (Ramegowda Belakere ) to contract under TAX ID number (85-3252700).  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.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com Please see your designated Coordinators information below: JEFFERSON Evelin Suazo Evelin.Suazo@molinahealthcare.com 888-562-5442 x207438   Have a wonderful day! Thank you,  Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"  Sent f/u email @ \"Suazo, Evelin\" Evelin.Suazo@molinahealthcare.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-27 17:16:49', '2021-07-27 17:16:49'),
(24836, 1006, 22473, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: Enrollment Status - RSM - Molina Health  \"Good Afternoon Brad,  The contract packet was sent on July 8, 2021 and still have not received it back. Please find the status of your requested providers  Provider Name: Ramegowda Belakere  Contract request was received for this provider still waiting for contract packet NPI# 1235166687  Provider Name: Glory Abraham  No Contract request was received for this provider NPI# 1194206490  Provider Name: Shybi Varghese  No Contract request was received for this provider NPI# 1285270991  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family\"  Replied:  \"Hello Evelin,  I appreciate the update and apologize for the delay, I\'ve signed and sent back the contract for Dr. Ram. Also, we submitted the request for group enrollment under our MD, do we also need to send the CRF for the other two providers to proceed?  Thank you. \"', NULL, NULL, '2021-08-02 10:47:40', '2021-08-02 10:47:40'),
(24837, 1006, 22473, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Yes, please go ahead and submit the contract request for the other two providers, also could please kindly sent me the additional forms to resume the contracting process, still missing the sample claim and data collection. Thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Replied with the information requested:  \"Hello Evelin,  Please find the attached information, let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-08-02 15:57:18', '2021-08-02 15:57:18'),
(24838, 1006, 22473, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Could you please kindly complete the supervising physician for your providers Glory Abraham and Shybi Varghese and sent it back to me once completed. Your help will be greatly appreciated. thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Sent requested information to her. ', NULL, NULL, '2021-08-12 16:01:21', '2021-08-12 16:01:21'),
(24839, 1006, 22473, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ Evelin.Suazo@molinahealthcare.com;  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Hello Evelin,   I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status for our group and providers.  Thank you. \"', NULL, NULL, '2021-08-31 14:46:47', '2021-08-31 14:46:47'),
(24840, 11056, 22473, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Status - RSM - Molina Health PDL 180032  Good Morning!  Hope this email finds you well. I want to know an update regarding the credentialing & contracting status of the following providers and practice soon. Please provide me with the latest updates soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!    Left out a voice mail regarding the enrollment status too!', NULL, NULL, '2021-09-08 13:45:24', '2021-09-08 13:45:24'),
(24841, 11056, 22473, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : evelin.suazo@molinahealthcare.com, mhtxproviderservices@molinahealthcare.com  Sub : Re: Enrollment Issue | Group & Providers | RSM | Molina 2nd ATTEMPT  Hello, I need an update on the applications of our providers and group for enrollment, with Molina as it has been while our applications are pending with Molina Credentialing/Contracting Dept, as of today we have entertain 100+ patients of Molina, as we are an Urgent care and we have to see the patients as its in emergency situation, due to Covid so if someone can get back to discuss on this issue, if there is a way we can get reimburse for our claims, or if we can get authorization from Molina to see those patients unless we are fully credentialed as it is impacting our financials now. Below are the details you can reach me at   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084 Phone: (713) 893-6214    Regards, Alex Garrett', NULL, NULL, '2021-09-21 11:03:00', '2021-09-21 11:03:00'),
(24842, 11056, 22473, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : evelin.suazo@molinahealthcare.com  Sub : [SEND SECURE] FW: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Ramegowda Belakere Provider is officially loaded please find a copy of the welcome letter along with a copy of the executed contract and effective date  Glory Abraham Provider is on the last step of contracting I am just waiting to received the notification that provider is officially loaded  Shybi Varghese Provider is on the first step of contracting with our credentialing department, request was recently received, please check status again within 30 days.  Thank you for doing Business with Molina Healthcare of Texas.   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family   Agreement has been received and attached in the group task.', NULL, NULL, '2021-09-28 08:29:07', '2021-09-28 08:29:07'),
(24843, 11056, 22473, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021 Good afternoon!  Hope all is well with you. Please provide me with the latest updates of enrollment status on the below mentioned providers and facility with Molina Health & Marketplace.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Glory Abraham	1194206490   If you have any questions or concerns feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-04 14:38:30', '2021-10-04 14:38:30'),
(24844, 11056, 22473, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Shybi Varghese  1285270991 The provider is on the last step of contracting with our loading department please kindly check status with me again within 30 days.  Glory Abraham 1194206490 provider still not loaded but check status again within 2 weeks. Thank you   Evelin Suazo  Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-10-13 10:31:05', '2021-10-13 10:31:05'),
(24845, 11056, 22473, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning Evelin!  Hope this email finds you well. Any update on the provider Glory Abraham - 1194206490? Please respond to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-20 14:43:30', '2021-10-20 14:43:30'),
(24846, 11056, 22473, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good afternoon Evelin!  Hope you are doing great. Please provide me with the latest updates credentialing process of the following providers with the Molina Health & Marketplace soon.  Glory Abraham - 1194206490 =  Shybi Varghese  1285270991 =  Please get back to my query soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-01 08:20:28', '2021-11-01 08:20:28'),
(24847, 11056, 22473, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers at your earliest convenience. Kindly, just do respond timely to our queries.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Glory Abraham  	1194206490  Varghese	1285270991     In the meantime, please do not hesitate to reach out if you have any questions or concerns. Eagerly, waiting for the updates and response.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-11-11 17:50:28', '2021-11-11 17:50:28'),
(24848, 11056, 22473, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from:  Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Morning,   Please find the copy of the welcome letter for your requested providers along with the effective date. Thank you  The effective date for each provider is listed on the welcome letter, please kindly refer to them. Provider were loaded for all lines of business including Marketplace. Please find a copy of your executed contract.  Thank you    Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com  1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com  Your Extended Family  Please see the attachment.', NULL, NULL, '2021-11-16 15:57:15', '2021-11-16 15:57:15'),
(24849, 1006, 22474, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:35:26', '2021-03-16 16:35:26'),
(24850, 3040, 22474, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-05 09:47:34', '2021-04-05 09:47:34'),
(24851, 1006, 22474, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:18:18', '2021-05-25 10:18:18'),
(24852, 1006, 22474, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in the main group task for reference. ', NULL, NULL, '2021-06-14 15:06:56', '2021-06-14 15:06:56'),
(24853, 1006, 22474, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent corrected email & form @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in main group task for reference.  ', NULL, NULL, '2021-07-02 16:19:57', '2021-07-02 16:19:57'),
(24854, 1006, 22474, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Ramegowda Belakere  \"Good Afternoon,  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 (Ramegowda Belakere ) to contract under TAX ID number (85-3252700).  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.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com Please see your designated Coordinators information below: JEFFERSON Evelin Suazo Evelin.Suazo@molinahealthcare.com 888-562-5442 x207438   Have a wonderful day! Thank you,  Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"  Sent f/u email @ \"Suazo, Evelin\" Evelin.Suazo@molinahealthcare.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-27 17:16:45', '2021-07-27 17:16:45'),
(24855, 1006, 22474, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: Enrollment Status - RSM - Molina Health  \"Good Afternoon Brad,  The contract packet was sent on July 8, 2021 and still have not received it back. Please find the status of your requested providers  Provider Name: Ramegowda Belakere  Contract request was received for this provider still waiting for contract packet NPI# 1235166687  Provider Name: Glory Abraham  No Contract request was received for this provider NPI# 1194206490  Provider Name: Shybi Varghese  No Contract request was received for this provider NPI# 1285270991  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family\"  Replied:  \"Hello Evelin,  I appreciate the update and apologize for the delay, I\'ve signed and sent back the contract for Dr. Ram. Also, we submitted the request for group enrollment under our MD, do we also need to send the CRF for the other two providers to proceed?  Thank you. \" ', NULL, NULL, '2021-08-02 10:56:53', '2021-08-02 10:56:53'),
(24856, 1006, 22474, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Yes, please go ahead and submit the contract request for the other two providers, also could please kindly sent me the additional forms to resume the contracting process, still missing the sample claim and data collection. Thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Replied with the information requested:  \"Hello Evelin,  Please find the attached information, let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-08-02 15:57:24', '2021-08-02 15:57:24'),
(24857, 1006, 22474, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Could you please kindly complete the supervising physician for your providers Glory Abraham and Shybi Varghese and sent it back to me once completed. Your help will be greatly appreciated. thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Sent requested information to her. ', NULL, NULL, '2021-08-12 16:01:16', '2021-08-12 16:01:16'),
(24858, 1006, 22474, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ Evelin.Suazo@molinahealthcare.com;  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Hello Evelin,   I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status for our group and providers.  Thank you. \"', NULL, NULL, '2021-08-31 14:46:43', '2021-08-31 14:46:43'),
(24859, 11056, 22474, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Status - RSM - Molina Health PDL 180032  Good Morning!  Hope this email finds you well. I want to know an update regarding the credentialing & contracting status of the following providers and practice soon. Please provide me with the latest updates soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!    Left out a voice mail regarding the enrollment status too!', NULL, NULL, '2021-09-08 13:45:16', '2021-09-08 13:45:16'),
(24860, 11056, 22474, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : evelin.suazo@molinahealthcare.com, mhtxproviderservices@molinahealthcare.com  Sub : Re: Enrollment Issue | Group & Providers | RSM | Molina 2nd ATTEMPT  Hello, I need an update on the applications of our providers and group for enrollment, with Molina as it has been while our applications are pending with Molina Credentialing/Contracting Dept, as of today we have entertain 100+ patients of Molina, as we are an Urgent care and we have to see the patients as its in emergency situation, due to Covid so if someone can get back to discuss on this issue, if there is a way we can get reimburse for our claims, or if we can get authorization from Molina to see those patients unless we are fully credentialed as it is impacting our financials now. Below are the details you can reach me at   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084 Phone: (713) 893-6214    Regards, Alex Garrett', NULL, NULL, '2021-09-21 11:02:54', '2021-09-21 11:02:54'),
(24861, 11056, 22474, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : evelin.suazo@molinahealthcare.com  Sub : [SEND SECURE] FW: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Ramegowda Belakere Provider is officially loaded please find a copy of the welcome letter along with a copy of the executed contract and effective date  Glory Abraham Provider is on the last step of contracting I am just waiting to received the notification that provider is officially loaded  Shybi Varghese Provider is on the first step of contracting with our credentialing department, request was recently received, please check status again within 30 days.  Thank you for doing Business with Molina Healthcare of Texas.   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family   Agreement has been received and attached in the group task.', NULL, NULL, '2021-09-28 08:28:56', '2021-09-28 08:28:56'),
(24862, 11056, 22474, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021 Good afternoon!  Hope all is well with you. Please provide me with the latest updates of enrollment status on the below mentioned providers and facility with Molina Health & Marketplace.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Glory Abraham	1194206490   If you have any questions or concerns feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-04 14:38:23', '2021-10-04 14:38:23'),
(24863, 11056, 22474, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Shybi Varghese  1285270991 The provider is on the last step of contracting with our loading department please kindly check status with me again within 30 days.  Glory Abraham 1194206490 provider still not loaded but check status again within 2 weeks. Thank you   Evelin Suazo  Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-10-13 10:31:00', '2021-10-13 10:31:00'),
(24864, 11056, 22474, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning Evelin!  Hope this email finds you well. Any update on the provider Glory Abraham - 1194206490? Please respond to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-20 14:43:23', '2021-10-20 14:43:23'),
(24865, 11056, 22474, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good afternoon Evelin!  Hope you are doing great. Please provide me with the latest updates credentialing process of the following providers with the Molina Health & Marketplace soon.  Glory Abraham - 1194206490 =  Shybi Varghese  1285270991 =  Please get back to my query soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-01 08:20:20', '2021-11-01 08:20:20'),
(24866, 11056, 22474, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers at your earliest convenience. Kindly, just do respond timely to our queries.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Glory Abraham  	1194206490  Varghese	1285270991     In the meantime, please do not hesitate to reach out if you have any questions or concerns. Eagerly, waiting for the updates and response.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-11-11 17:50:22', '2021-11-11 17:50:22'),
(24867, 11056, 22474, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from:  Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Morning,   Please find the copy of the welcome letter for your requested providers along with the effective date. Thank you  The effective date for each provider is listed on the welcome letter, please kindly refer to them. Provider were loaded for all lines of business including Marketplace. Please find a copy of your executed contract.  Thank you    Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com  1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com  Your Extended Family  Please see the attachment.', NULL, NULL, '2021-11-16 15:54:42', '2021-11-16 15:54:42'),
(24868, 1006, 22475, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:35:28', '2021-03-16 16:35:28'),
(24869, 3040, 22475, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-05 09:47:37', '2021-04-05 09:47:37'),
(24870, 1006, 22475, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:18:22', '2021-05-25 10:18:22'),
(24871, 1006, 22475, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in the main group task for reference. ', NULL, NULL, '2021-06-14 15:06:54', '2021-06-14 15:06:54'),
(24872, 1006, 22475, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent corrected email & form @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in main group task for reference.  ', NULL, NULL, '2021-07-02 16:19:52', '2021-07-02 16:19:52'),
(24873, 1006, 22475, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Ramegowda Belakere  \"Good Afternoon,  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 (Ramegowda Belakere ) to contract under TAX ID number (85-3252700).  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.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com Please see your designated Coordinators information below: JEFFERSON Evelin Suazo Evelin.Suazo@molinahealthcare.com 888-562-5442 x207438   Have a wonderful day! Thank you,  Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"  Sent f/u email @ \"Suazo, Evelin\" Evelin.Suazo@molinahealthcare.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-27 17:16:42', '2021-07-27 17:16:42'),
(24874, 1006, 22475, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: Enrollment Status - RSM - Molina Health  \"Good Afternoon Brad,  The contract packet was sent on July 8, 2021 and still have not received it back. Please find the status of your requested providers  Provider Name: Ramegowda Belakere  Contract request was received for this provider still waiting for contract packet NPI# 1235166687  Provider Name: Glory Abraham  No Contract request was received for this provider NPI# 1194206490  Provider Name: Shybi Varghese  No Contract request was received for this provider NPI# 1285270991  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family\"  Replied:  \"Hello Evelin,  I appreciate the update and apologize for the delay, I\'ve signed and sent back the contract for Dr. Ram. Also, we submitted the request for group enrollment under our MD, do we also need to send the CRF for the other two providers to proceed?  Thank you. \" ', NULL, NULL, '2021-08-02 10:56:49', '2021-08-02 10:56:49'),
(24875, 1006, 22475, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Yes, please go ahead and submit the contract request for the other two providers, also could please kindly sent me the additional forms to resume the contracting process, still missing the sample claim and data collection. Thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Replied with the information requested:  \"Hello Evelin,  Please find the attached information, let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-08-02 15:57:28', '2021-08-02 15:57:28'),
(24876, 1006, 22475, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Could you please kindly complete the supervising physician for your providers Glory Abraham and Shybi Varghese and sent it back to me once completed. Your help will be greatly appreciated. thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Sent requested information to her. ', NULL, NULL, '2021-08-12 16:01:09', '2021-08-12 16:01:09'),
(24877, 1006, 22475, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ Evelin.Suazo@molinahealthcare.com;  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Hello Evelin,   I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status for our group and providers.  Thank you. \"', NULL, NULL, '2021-08-31 14:46:39', '2021-08-31 14:46:39'),
(24878, 11056, 22475, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Status - RSM - Molina Health PDL 180032  Good Morning!  Hope this email finds you well. I want to know an update regarding the credentialing & contracting status of the following providers and practice soon. Please provide me with the latest updates soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!    Left out a voice mail regarding the enrollment status too!', NULL, NULL, '2021-09-08 13:45:10', '2021-09-08 13:45:10'),
(24879, 11056, 22475, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : evelin.suazo@molinahealthcare.com, mhtxproviderservices@molinahealthcare.com  Sub : Re: Enrollment Issue | Group & Providers | RSM | Molina 2nd ATTEMPT  Hello, I need an update on the applications of our providers and group for enrollment, with Molina as it has been while our applications are pending with Molina Credentialing/Contracting Dept, as of today we have entertain 100+ patients of Molina, as we are an Urgent care and we have to see the patients as its in emergency situation, due to Covid so if someone can get back to discuss on this issue, if there is a way we can get reimburse for our claims, or if we can get authorization from Molina to see those patients unless we are fully credentialed as it is impacting our financials now. Below are the details you can reach me at   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084 Phone: (713) 893-6214    Regards, Alex Garrett', NULL, NULL, '2021-09-21 11:02:48', '2021-09-21 11:02:48'),
(24880, 11056, 22475, NULL, '2021-10-05 00:00:00.000', 'Approved', 'Email received from : evelin.suazo@molinahealthcare.com  Sub : [SEND SECURE] FW: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Ramegowda Belakere Provider is officially loaded please find a copy of the welcome letter along with a copy of the executed contract and effective date  Glory Abraham Provider is on the last step of contracting I am just waiting to received the notification that provider is officially loaded  Shybi Varghese Provider is on the first step of contracting with our credentialing department, request was recently received, please check status again within 30 days.  Thank you for doing Business with Molina Healthcare of Texas.   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family   Eff date is : 10/01/2021', NULL, NULL, '2021-09-28 08:30:14', '2021-09-28 08:30:14'),
(24881, 1006, 22476, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:35:29', '2021-03-16 16:35:29'),
(24882, 3040, 22476, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-05 09:47:40', '2021-04-05 09:47:40'),
(24883, 1006, 22476, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:18:28', '2021-05-25 10:18:28'),
(24884, 1006, 22476, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  The form is attached in the main group task for reference. ', NULL, NULL, '2021-06-14 15:06:50', '2021-06-14 15:06:50'),
(24885, 1006, 22476, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent corrected email & form @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Enrollment Request - RSM - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"', NULL, NULL, '2021-07-02 16:18:19', '2021-07-02 16:18:19'),
(24886, 1006, 22476, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Ramegowda Belakere  \"Good Afternoon,  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 (Ramegowda Belakere ) to contract under TAX ID number (85-3252700).  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.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com Please see your designated Coordinators information below: JEFFERSON Evelin Suazo Evelin.Suazo@molinahealthcare.com 888-562-5442 x207438   Have a wonderful day! Thank you,  Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"  Sent f/u email @ \"Suazo, Evelin\" Evelin.Suazo@molinahealthcare.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-27 17:16:38', '2021-07-27 17:16:38'),
(24887, 1006, 22476, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: Enrollment Status - RSM - Molina Health  \"Good Afternoon Brad,  The contract packet was sent on July 8, 2021 and still have not received it back. Please find the status of your requested providers  Provider Name: Ramegowda Belakere  Contract request was received for this provider still waiting for contract packet NPI# 1235166687  Provider Name: Glory Abraham  No Contract request was received for this provider NPI# 1194206490  Provider Name: Shybi Varghese  No Contract request was received for this provider NPI# 1285270991  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family\"  Replied:  \"Hello Evelin,  I appreciate the update and apologize for the delay, I\'ve signed and sent back the contract for Dr. Ram. Also, we submitted the request for group enrollment under our MD, do we also need to send the CRF for the other two providers to proceed?  Thank you. \" ', NULL, NULL, '2021-08-02 10:56:56', '2021-08-02 10:56:56'),
(24888, 1006, 22476, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Yes, please go ahead and submit the contract request for the other two providers, also could please kindly sent me the additional forms to resume the contracting process, still missing the sample claim and data collection. Thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Replied with the information requested:  \"Hello Evelin,  Please find the attached information, let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-08-02 15:57:31', '2021-08-02 15:57:31'),
(24889, 1006, 22476, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received the following update from Evelin.Suazo@molinahealthcare.com:  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Good Morning Brad,  Could you please kindly complete the supervising physician for your providers Glory Abraham and Shybi Varghese and sent it back to me once completed. Your help will be greatly appreciated. thank you  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family\"  Sent requested information to her. ', NULL, NULL, '2021-08-12 15:59:59', '2021-08-12 15:59:59'),
(24890, 1006, 22476, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ Evelin.Suazo@molinahealthcare.com;  Sub: RE: Enrollment Status - RSM - Molina Health PDL 180032  \"Hello Evelin,   I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status for our group and providers.  Thank you. \"', NULL, NULL, '2021-08-31 14:46:31', '2021-08-31 14:46:31'),
(24891, 11056, 22476, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Status - RSM - Molina Health PDL 180032  Good Morning!  Hope this email finds you well. I want to know an update regarding the credentialing & contracting status of the following providers and practice soon. Please provide me with the latest updates soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!    Left out a voice mail regarding the enrollment status too!', NULL, NULL, '2021-09-08 13:44:09', '2021-09-08 13:44:09'),
(24892, 11056, 22476, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : evelin.suazo@molinahealthcare.com, mhtxproviderservices@molinahealthcare.com  Sub : Re: Enrollment Issue | Group & Providers | RSM | Molina 2nd ATTEMPT  Hello, I need an update on the applications of our providers and group for enrollment, with Molina as it has been while our applications are pending with Molina Credentialing/Contracting Dept, as of today we have entertain 100+ patients of Molina, as we are an Urgent care and we have to see the patients as its in emergency situation, due to Covid so if someone can get back to discuss on this issue, if there is a way we can get reimburse for our claims, or if we can get authorization from Molina to see those patients unless we are fully credentialed as it is impacting our financials now. Below are the details you can reach me at   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084 Phone: (713) 893-6214    Regards, Alex Garrett', NULL, NULL, '2021-09-21 11:02:36', '2021-09-21 11:02:36');
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
(24893, 11056, 22476, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : evelin.suazo@molinahealthcare.com  Sub : [SEND SECURE] FW: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Ramegowda Belakere Provider is officially loaded please find a copy of the welcome letter along with a copy of the executed contract and effective date  Glory Abraham Provider is on the last step of contracting I am just waiting to received the notification that provider is officially loaded  Shybi Varghese Provider is on the first step of contracting with our credentialing department, request was recently received, please check status again within 30 days.  Thank you for doing Business with Molina Healthcare of Texas.   Group: Right Step Medical Center LLC Tax ID: 853252700 NPI: 1063008084  Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438  www.MolinaHealthcare.com Your Extended Family   Agreement has been received and attached in the group task.', NULL, NULL, '2021-09-28 08:28:34', '2021-09-28 08:28:34'),
(24894, 11056, 22476, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021 Good afternoon!  Hope all is well with you. Please provide me with the latest updates of enrollment status on the below mentioned providers and facility with Molina Health & Marketplace.   Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Glory Abraham	1194206490   If you have any questions or concerns feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-04 14:38:04', '2021-10-04 14:38:04'),
(24895, 11056, 22476, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Afternoon,  Please find the status of your requested providers:  Shybi Varghese  1285270991 The provider is on the last step of contracting with our loading department please kindly check status with me again within 30 days.  Glory Abraham 1194206490 provider still not loaded but check status again within 2 weeks. Thank you   Evelin Suazo  Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com 1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-10-13 10:30:40', '2021-10-13 10:30:40'),
(24896, 11056, 22476, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning Evelin!  Hope this email finds you well. Any update on the provider Glory Abraham - 1194206490? Please respond to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-20 14:42:41', '2021-10-20 14:42:41'),
(24897, 11056, 22476, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning Evelin!  Hope this email finds you well. Any update on the provider Glory Abraham - 1194206490? Please respond to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-20 14:43:15', '2021-10-20 14:43:15'),
(24898, 11056, 22476, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good afternoon Evelin!  Hope you are doing great. Please provide me with the latest updates credentialing process of the following providers with the Molina Health & Marketplace soon.  Glory Abraham - 1194206490 =  Shybi Varghese  1285270991 =  Please get back to my query soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-01 08:20:04', '2021-11-01 08:20:04'),
(24899, 11056, 22476, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good morning!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers at your earliest convenience. Kindly, just do respond timely to our queries.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300 Provider Name	NPI Glory Abraham  	1194206490  Varghese	1285270991     In the meantime, please do not hesitate to reach out if you have any questions or concerns. Eagerly, waiting for the updates and response.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-11-11 17:50:06', '2021-11-11 17:50:06'),
(24900, 11056, 22476, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from:  Evelin.Suazo@molinahealthcare.com  Sub : RE: Enrollment Issue | Group & Providers | RSM | Molina 181023 180032 181021  Good Morning,   Please find the copy of the welcome letter for your requested providers along with the effective date. Thank you  The effective date for each provider is listed on the welcome letter, please kindly refer to them. Provider were loaded for all lines of business including Marketplace. Please find a copy of your executed contract.  Thank you    Evelin Suazo Associate Specialist,Provider Contracts Molina Healthcare of Texas, Inc. evelin.suazo@molinahealthcare.com  1660 Westridge Circle N Irving, Texas, 75038 1888-562-5442 Ext. 207438 www.MolinaHealthcare.com  Your Extended Family  Please see the attachment.', NULL, NULL, '2021-11-16 15:52:21', '2021-11-16 15:52:21'),
(24901, 1006, 22477, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:35:57', '2021-03-16 16:35:57'),
(24902, 1006, 22477, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Enrollment requests submitted for all providers @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   Please find the following enrollment requests for the following providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please let me know if you have any questions. Thank you. \"  Forms attached in individual providers for reference. ', NULL, NULL, '2021-04-02 17:08:06', '2021-04-02 17:08:06'),
(24903, 1006, 22477, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   I hope you\'re doing well, can you please let me know if our enrollment request was received? If so, what is the enrollment time frame?  Thank you\"', NULL, NULL, '2021-04-06 11:51:07', '2021-04-06 11:51:07'),
(24904, 1006, 22477, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Received the following update from Superior:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"We received the applications & are reviewing the forms. We will reach out to you if anything is missing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\"', NULL, NULL, '2021-04-06 13:01:10', '2021-04-06 13:01:10'),
(24905, 1006, 22477, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received a Participating Provider Agreement for signing, signed, and sent back. It is attached in the group task for reference.   Received the contract from @ Jeannie Lopez Jeannie.Lopez@superiorhealthplan.com:  Sub: Signature requested on \"Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)\"  \"Jeannie Lopez requests your signature on Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  Review and sign   Please review and sign this participating provider agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  JEANNIE LOPEZ Jeannie.Lopez@superiorhealthplan.com\"', NULL, NULL, '2021-04-14 08:15:17', '2021-04-14 08:15:17'),
(24906, 1006, 22477, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good Afternoon,  GLORY ABRAHAM/ 1194206490 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   RAMEGOWDA BELAKERE/ 1235166687 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   SHYBI VARGHESE/ 1285270991 Credentialing - We received your completed application on (4/14/21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   Thank you Valerie J. Gomez\"  Confirmed with her if this is also status for the group. ', NULL, NULL, '2021-04-19 09:53:12', '2021-04-19 09:53:12'),
(24907, 1006, 22477, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good morning Valerie,   I hope you\'re doing well, I wanted to check in on the status of enrollment for our group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 10:47:43', '2021-05-03 10:47:43'),
(24908, 1006, 22477, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent new f/u email @ AM Houston AM.Houston@superiorhealthplan.com ', NULL, NULL, '2021-05-03 12:54:18', '2021-05-03 12:54:18'),
(24909, 1006, 22477, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to check if there had been any new updates for the group and providers?  Thank you.\"', NULL, NULL, '2021-05-11 07:50:17', '2021-05-11 07:50:17'),
(24910, 1006, 22477, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Received a copy of the executed contract from Superior, attached for future reference. ', NULL, NULL, '2021-05-14 12:26:06', '2021-05-14 12:26:06'),
(24911, 1006, 22477, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 16:46:42', '2021-05-26 16:46:42'),
(24912, 1006, 22477, NULL, '2021-06-03 00:00:00.000', 'Approved', 'We received the following approval email from ECM Execution Team ECMExecutionTeam@superiorhealthplan.com:  Sub: [SECURE] RIGHT STEP MEDICAL CENTER LLC/WELCOME LETTER  \"RIGHT STEP MEDICAL CENTER LLC  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  5/1/2021                                                     YOUR AGREEMENT WAS AUTOMATICALLY SENT VIA EMAIL TO THE EMAIL ADDRESS ABOVE   Indicates where you are in the process.  GETTING STARTED  Please visit SuperiorHealthPlan.com to find the following Resources:    ·   Superior Overview  ·   Education & Training  ·   Provider Tools (see below)  ·   Contact Information   PROVIDER TOOLS provides you with resources such as:  ·   Provider Login  ·   Quality Resources  ·   Health Passport  ·   Provider Portal Resources  ·   Provider Forms (FAQ, Manual, QRG)  ·    Notifications (Operational, Clinical, Network Updates)  The Provider Manual is an integral part of your Provider Agreement and provides instructions regarding how to work with us.  Our Provider Portal Registration is quick and simple. Please visit:  Provider.SuperiorHealthPlan.com  ·        Check Eligibility | Find out if a member is eligible for service.  ·        Authorization Services | See if the service you provide is reimbursable.  ·        Manage Claims | Submit or track your claims and get paid fast.     Should you have any questions, please contact your Account Manager. You can find your Account Manager at: SuperiorHealthPlan.com/providers/resources/find-my-provider-rep.html  Thank you for your decision to partner with us in providing quality care to our Superior members.  Best Regards,  Superior HealthPlan  Contracting Department           SuperiorHealthPlan.com              SHP_20174332                                                                           SUPERIOR OFFICE LOCATIONS  AUSTIN  5900 E Ben White Blvd Austin, TX 78741  CORPUS CHRISTI  711 N Carancahua St Suite 600 Corpus Christi, TX 78401  DALLAS  4001 McEwen Rd 5th Floor Dallas, TX 75244  EL PASO  1575 N Resler Drive El Paso, TX 79912  HIDALGO-MCALLEN  3900 N 10TH Street 6th Floor McAllen, TX 78501  SAN ANTONIO  7990 IH 10 West Suite 300 San Antonio, TX 78230  TYLER  4411 Old Bullard Rd Suite 601 Tyler, TX 75703  LUBBOCK  7202 Slide Rd Suite 202 Lubbock, TX 79424     CLAIMS ADDRESSES  CLAIMS DEPARTMENT  CLAIMS APPEALS DEPARTMENT  PO BOX 3003 | Farmington, MO 63640  PO BOX 3000 | Farmington, MO 63640     MEDICAL MANAGEMENT  PRIOR AUTHORIZATION  PHONE: 1-800-218-7508  FAX:  1-800-690-7030     DEPARTMENTS                                                                                PROVIDER SERVICES     MEMBER SERVICES  STAR  1-877-391-5921     STAR  1-800-783-5386  CHIP / PERINATE / RSA  1-877-391-5921     CHIP / RSA / PERINATE  1-800-783-5386  AMBETTER  1-877-391-5921     AMBETTER  1-877-687-1196  STAR HEALTH  1-866-439-2042     STAR HEALTH  1-866-912-6283  STAR+PLUS  1-800-522-8923    STAR+PLUS 1-866-516-4501 MRSA 1-877-644-4494 MRSA 1-800-783-5386 ALLWELL (MEDICARE) 1-877-391-5921 ALLWELL (MEDICARE) 1-877-935-8023 MMP 1-877-391-5921 MMP 1-866-896-1844 SHP PARTNERS ENVOLVE VISION SERVICES 1-888-756-8768 DENTAQUEST 1-800-516-0165 MEDICAID/CHIP ENROLLMENT BROKER 1-800-964-2777 ENVOLVE PHARMACY SOLUTIONS 1-877-644-4494 PROVIDER COMPLAINTS 1-800-252-8263 NATIONAL IMAGING ASSOCIATES (NIA) 1-800-642-7554  Thank you, Tanya Rodriguez Contracts Coordinator, Contract Management Email-Block-6 7990 IH 10 West, Suite 300 San Antonio, TX 78230 ECMExecutionTeam@SuperiorHealthPlan.com | SuperiorHealthPlan.com\"', NULL, NULL, '2021-05-27 16:46:47', '2021-05-27 16:46:47'),
(24913, 1006, 22478, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:35:59', '2021-03-16 16:35:59'),
(24914, 1006, 22478, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Enrollment requests submitted for all providers @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   Please find the following enrollment requests for the following providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please let me know if you have any questions. Thank you. \"  Forms attached in individual providers for reference. ', NULL, NULL, '2021-04-02 17:07:39', '2021-04-02 17:07:39'),
(24915, 1006, 22478, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   I hope you\'re doing well, can you please let me know if our enrollment request was received? If so, what is the enrollment time frame?  Thank you\"', NULL, NULL, '2021-04-06 11:51:11', '2021-04-06 11:51:11'),
(24916, 1006, 22478, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Received the following update from Superior:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"We received the applications & are reviewing the forms. We will reach out to you if anything is missing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\"', NULL, NULL, '2021-04-06 13:01:15', '2021-04-06 13:01:15'),
(24917, 1006, 22478, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received a Participating Provider Agreement for signing, signed, and sent back. It is attached in the group task for reference.   Received the contract from @ Jeannie Lopez Jeannie.Lopez@superiorhealthplan.com:  Sub: Signature requested on \"Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)\"  \"Jeannie Lopez requests your signature on Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  Review and sign   Please review and sign this participating provider agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  JEANNIE LOPEZ Jeannie.Lopez@superiorhealthplan.com\"', NULL, NULL, '2021-04-14 08:15:48', '2021-04-14 08:15:48'),
(24918, 1006, 22478, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good Afternoon,  GLORY ABRAHAM/ 1194206490 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   RAMEGOWDA BELAKERE/ 1235166687 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   SHYBI VARGHESE/ 1285270991 Credentialing - We received your completed application on (4/14/21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   Thank you Valerie J. Gomez\"', NULL, NULL, '2021-04-19 09:53:18', '2021-04-19 09:53:18'),
(24919, 1006, 22478, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good morning Valerie,   I hope you\'re doing well, I wanted to check in on the status of enrollment for our group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 10:47:37', '2021-05-03 10:47:37'),
(24920, 1006, 22478, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent new f/u email @ AM Houston AM.Houston@superiorhealthplan.com ', NULL, NULL, '2021-05-03 12:54:15', '2021-05-03 12:54:15'),
(24921, 1006, 22478, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to check if there had been any new updates for the group and providers?  Thank you.\"', NULL, NULL, '2021-05-11 07:50:59', '2021-05-11 07:50:59'),
(24922, 1006, 22478, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 15:28:10', '2021-05-26 15:28:10'),
(24923, 1006, 22478, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:20:25', '2021-06-14 11:20:25'),
(24924, 1006, 22478, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:22', '2021-07-02 15:57:22'),
(24925, 1006, 22478, NULL, '2021-07-16 00:00:00.000', 'Approved', '\"RIGHT STEP MEDICAL CENTER LLC  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  5/1/2021                                                    YOUR AGREEMENT WAS AUTOMATICALLY SENT VIA EMAIL TO THE EMAIL ADDRESS ABOVE\"', NULL, NULL, '2021-07-09 12:48:49', '2021-07-09 12:48:49'),
(24926, 1006, 22479, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:00', '2021-03-16 16:36:00'),
(24927, 1006, 22479, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Enrollment requests submitted for all providers @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   Please find the following enrollment requests for the following providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please let me know if you have any questions. Thank you. \"  Forms attached in individual providers for reference. ', NULL, NULL, '2021-04-02 17:07:56', '2021-04-02 17:07:56'),
(24928, 1006, 22479, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   I hope you\'re doing well, can you please let me know if our enrollment request was received? If so, what is the enrollment time frame?  Thank you\"', NULL, NULL, '2021-04-06 11:51:16', '2021-04-06 11:51:16'),
(24929, 1006, 22479, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Received the following update from Superior:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"We received the applications & are reviewing the forms. We will reach out to you if anything is missing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\"', NULL, NULL, '2021-04-06 13:01:19', '2021-04-06 13:01:19'),
(24930, 1006, 22479, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received a Participating Provider Agreement for signing, signed, and sent back. It is attached in the group task for reference.   Received the contract from @ Jeannie Lopez Jeannie.Lopez@superiorhealthplan.com:  Sub: Signature requested on \"Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)\"  \"Jeannie Lopez requests your signature on Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  Review and sign   Please review and sign this participating provider agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  JEANNIE LOPEZ Jeannie.Lopez@superiorhealthplan.com\"', NULL, NULL, '2021-04-14 08:15:53', '2021-04-14 08:15:53'),
(24931, 1006, 22479, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good Afternoon,  GLORY ABRAHAM/ 1194206490 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   RAMEGOWDA BELAKERE/ 1235166687 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   SHYBI VARGHESE/ 1285270991 Credentialing - We received your completed application on (4/14/21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   Thank you Valerie J. Gomez\"', NULL, NULL, '2021-04-19 09:53:23', '2021-04-19 09:53:23'),
(24932, 1006, 22479, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good morning Valerie,   I hope you\'re doing well, I wanted to check in on the status of enrollment for our group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 10:47:27', '2021-05-03 10:47:27'),
(24933, 1006, 22479, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent new f/u email @ AM Houston AM.Houston@superiorhealthplan.com ', NULL, NULL, '2021-05-03 12:54:13', '2021-05-03 12:54:13'),
(24934, 1006, 22479, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to check if there had been any new updates for the group and providers?  Thank you.\"', NULL, NULL, '2021-05-11 07:50:44', '2021-05-11 07:50:44'),
(24935, 1006, 22479, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 15:28:15', '2021-05-26 15:28:15'),
(24936, 1006, 22479, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:20:17', '2021-06-14 11:20:17'),
(24937, 1006, 22479, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:27', '2021-07-02 15:57:27'),
(24938, 1006, 22479, NULL, '2021-07-16 00:00:00.000', 'Approved', '\"RIGHT STEP MEDICAL CENTER LLC  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  5/1/2021                                                    YOUR AGREEMENT WAS AUTOMATICALLY SENT VIA EMAIL TO THE EMAIL ADDRESS ABOVE\"', NULL, NULL, '2021-07-09 12:48:39', '2021-07-09 12:48:39'),
(24939, 1006, 22480, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:01', '2021-03-16 16:36:01'),
(24940, 1006, 22480, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Enrollment requests submitted for all providers @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   Please find the following enrollment requests for the following providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please let me know if you have any questions. Thank you. \"  Forms attached in individual providers for reference. ', NULL, NULL, '2021-04-02 17:08:01', '2021-04-02 17:08:01'),
(24941, 1006, 22480, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"Hello,   I hope you\'re doing well, can you please let me know if our enrollment request was received? If so, what is the enrollment time frame?  Thank you\"', NULL, NULL, '2021-04-06 11:51:20', '2021-04-06 11:51:20'),
(24942, 1006, 22480, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Received the following update from Superior:  Sub: Provider Enrollment - RSM - Superior Healthplan  \"We received the applications & are reviewing the forms. We will reach out to you if anything is missing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\"', NULL, NULL, '2021-04-06 13:01:23', '2021-04-06 13:01:23'),
(24943, 1006, 22480, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received a Participating Provider Agreement for signing, signed, and sent back. It is attached in the group task for reference.   Received the contract from @ Jeannie Lopez Jeannie.Lopez@superiorhealthplan.com:  Sub: Signature requested on \"Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)\"  \"Jeannie Lopez requests your signature on Superior HealthPlan Participating Provider Agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  Review and sign   Please review and sign this participating provider agreement - RIGHT STEP MEDICAL CENTER LLC (530266)  JEANNIE LOPEZ Jeannie.Lopez@superiorhealthplan.com\"', NULL, NULL, '2021-04-14 08:15:59', '2021-04-14 08:15:59'),
(24944, 1006, 22480, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good Afternoon,  GLORY ABRAHAM/ 1194206490 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   RAMEGOWDA BELAKERE/ 1235166687 We received your completed application on (4/14/21) Your projected effective date is (insert date).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   SHYBI VARGHESE/ 1285270991 Credentialing - We received your completed application on (4/14/21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.   Thank you Valerie J. Gomez\"', NULL, NULL, '2021-04-19 09:53:27', '2021-04-19 09:53:27'),
(24945, 1006, 22480, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ Valerie Gomez Valerie.J.Gomez@centene.com:  Sub: Reminder: Waiting for you to sign Superior HealthPlan Participating Provider Agreement - _PARTY## (529926)  \"Good morning Valerie,   I hope you\'re doing well, I wanted to check in on the status of enrollment for our group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-05-03 10:47:20', '2021-05-03 10:47:20'),
(24946, 1006, 22480, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent new f/u email @ AM Houston AM.Houston@superiorhealthplan.com ', NULL, NULL, '2021-05-03 12:54:05', '2021-05-03 12:54:05'),
(24947, 1006, 22480, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to check if there had been any new updates for the group and providers?  Thank you.\"', NULL, NULL, '2021-05-11 07:47:38', '2021-05-11 07:47:38'),
(24948, 1006, 22480, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 15:28:20', '2021-05-26 15:28:20'),
(24949, 1006, 22480, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:20:11', '2021-06-14 11:20:11'),
(24950, 1006, 22480, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:31', '2021-07-02 15:57:31'),
(24951, 1006, 22480, NULL, '2021-07-16 00:00:00.000', 'Approved', '\"SHYBI VARGHESE  RIGHT STEP MEDICAL CENTER LLC  rsm@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  07/01/2021                                                   C/ 50368\"', NULL, NULL, '2021-07-09 12:49:54', '2021-07-09 12:49:54'),
(24952, 1006, 22481, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:32', '2021-03-16 16:36:32'),
(24953, 1006, 22481, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Certification request has been submitted, request attached for reference. ', NULL, NULL, '2021-04-02 19:54:21', '2021-04-02 19:54:21'),
(24954, 1006, 22481, NULL, '2021-05-10 00:00:00.000', 'In Process', 'As per my discussion with Tricare the provider certification is set to expire at the end of the month, we need to submit an updated copy of her license to them @ 608-221-7535', NULL, NULL, '2021-05-03 13:28:42', '2021-05-03 13:28:42'),
(24955, 1006, 22481, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent updated copy of the license @ 608-221-7535.  ', NULL, NULL, '2021-05-26 12:03:21', '2021-05-26 12:03:21'),
(24956, 1006, 22481, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Sent following email to Yvonne @ Yvonne Wyatt ywyatt@humana.com as per my discussion with Tricare provider relations:  Sub: Enrollment Request - RSM - Tricare  \"Hello Yvonne, I hope you\'re doing well, we wanted to enroll our group and providers with Tricare, the information is as follows: Group Name: Right Step Medical Center LLC NPI# 1063008084 Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please let me know if you have any questions. Thank you.\"', NULL, NULL, '2021-05-27 11:37:24', '2021-05-27 11:37:24'),
(24957, 1006, 22481, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following enrollment denial from Tricare @ Yvonne Wyatt ywyatt@humana.com :  Sub: Enrollment Request - RSM - Tricare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194\"', NULL, NULL, '2021-05-31 09:40:35', '2021-05-31 09:40:35'),
(24958, 1006, 22482, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:33', '2021-03-16 16:36:33'),
(24959, 1006, 22482, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Enrollment request cannot be initiated as Tricare has the following reason stated:  \"At this time, Humana Military is experiencing limited adequacy for medical and surgical network providers and is not currently accepting requests to join the network. Please check back soon to find out if we are accepting network providers.\"  Screenshot attached for reference.', NULL, NULL, '2021-04-02 19:56:28', '2021-04-02 19:56:28'),
(24960, 1006, 22482, NULL, '2021-05-19 00:00:00.000', 'In Process', 'The same reason is still stated on the Tricare website:  \"At this time, Humana Military is experiencing limited adequacy for medical and surgical network providers and is not currently accepting requests to join the network. Please check back soon to find out if we are accepting network providers.\"', NULL, NULL, '2021-05-03 13:13:16', '2021-05-03 13:13:16'),
(24961, 1006, 22482, NULL, '2021-05-19 00:00:00.000', 'On Hold', NULL, NULL, NULL, '2021-05-03 13:13:26', '2021-05-03 13:13:26'),
(24962, 1006, 22482, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following enrollment denial from Tricare @ Yvonne Wyatt ywyatt@humana.com ​:  Sub: Enrollment Request - RSM - Tricare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-05-31 09:40:47', '2021-05-31 09:40:47'),
(24963, 1006, 22483, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:34', '2021-03-16 16:36:34'),
(24964, 1006, 22483, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Enrollment request cannot be initiated as Tricare has the following reason stated:  \"At this time, Humana Military is experiencing limited adequacy for medical and surgical network providers and is not currently accepting requests to join the network. Please check back soon to find out if we are accepting network providers.\"  Screenshot attached for reference.', NULL, NULL, '2021-04-02 19:56:36', '2021-04-02 19:56:36'),
(24965, 1006, 22483, NULL, '2021-05-19 00:00:00.000', 'On Hold', 'The same reason is still stated on the Tricare website:  \"At this time, Humana Military is experiencing limited adequacy for medical and surgical network providers and is not currently accepting requests to join the network. Please check back soon to find out if we are accepting network providers.\"', NULL, NULL, '2021-05-03 13:13:11', '2021-05-03 13:13:11');
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
(24966, 1006, 22483, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following enrollment denial from Tricare @ Yvonne Wyatt ywyatt@humana.com ​:  Sub: Enrollment Request - RSM - Tricare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-05-31 09:40:55', '2021-05-31 09:40:55'),
(24967, 1006, 22484, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:35', '2021-03-16 16:36:35'),
(24968, 1006, 22484, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Enrollment request cannot be initiated as Tricare has the following reason stated:  \"At this time, Humana Military is experiencing limited adequacy for medical and surgical network providers and is not currently accepting requests to join the network. Please check back soon to find out if we are accepting network providers.\"  Screenshot attached for reference.', NULL, NULL, '2021-04-02 19:56:41', '2021-04-02 19:56:41'),
(24969, 1006, 22484, NULL, '2021-05-19 00:00:00.000', 'On Hold', 'The same reason is still stated on the Tricare website:  \"At this time, Humana Military is experiencing limited adequacy for medical and surgical network providers and is not currently accepting requests to join the network. Please check back soon to find out if we are accepting network providers.\"', NULL, NULL, '2021-05-03 13:13:03', '2021-05-03 13:13:03'),
(24970, 1006, 22484, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Sent following email to Yvonne @ Yvonne Wyatt ywyatt@humana.com as per my discussion with Tricare provider relations:  Sub: Enrollment Request - RSM - Tricare  \"Hello Yvonne, I hope you\'re doing well, we wanted to enroll our group and providers with Tricare, the information is as follows: Group Name: Right Step Medical Center LLC NPI# 1063008084 Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please let me know if you have any questions. Thank you.\"', NULL, NULL, '2021-05-27 11:37:03', '2021-05-27 11:37:03'),
(24971, 1006, 22484, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following enrollment denial from Tricare @ Yvonne Wyatt ywyatt@humana.com ​:  Sub: Enrollment Request - RSM - Tricare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-05-31 09:40:59', '2021-05-31 09:40:59'),
(24972, 3046, 22485, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:37', '2021-03-16 16:36:37'),
(24973, 3040, 22485, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:53:15', '2021-03-30 15:53:15'),
(24974, 1006, 22485, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:06', '2021-06-04 12:47:06'),
(24975, 1006, 22485, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:38:13', '2021-06-24 12:38:13'),
(24976, 1006, 22485, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:47:50', '2021-07-12 12:47:50'),
(24977, 1006, 22485, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:06', '2021-08-13 17:10:06'),
(24978, 1006, 22485, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:31:01', '2021-08-24 10:31:01'),
(24979, 11056, 22485, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:27', '2021-09-21 13:47:27'),
(24980, 11056, 22485, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:54:40', '2021-09-27 14:54:40'),
(24981, 11056, 22485, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:24:33', '2021-10-12 13:24:33'),
(24982, 11056, 22485, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:39', '2021-10-20 13:22:39'),
(24983, 11056, 22485, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the attachment.', NULL, NULL, '2021-11-10 14:42:55', '2021-11-10 14:42:55'),
(24984, 3046, 22486, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:39', '2021-03-16 16:36:39'),
(24985, 3040, 22486, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:56:27', '2021-03-30 15:56:27'),
(24986, 1006, 22486, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:10', '2021-06-04 12:47:10'),
(24987, 1006, 22486, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:38:09', '2021-06-24 12:38:09'),
(24988, 1006, 22486, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:47:53', '2021-07-12 12:47:53'),
(24989, 1006, 22486, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:09', '2021-08-13 17:10:09'),
(24990, 1006, 22486, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:58', '2021-08-24 10:30:58'),
(24991, 11056, 22486, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:34', '2021-09-21 13:47:34'),
(24992, 11056, 22486, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:54:54', '2021-09-27 14:54:54'),
(24993, 11056, 22486, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:24:24', '2021-10-12 13:24:24'),
(24994, 11056, 22486, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:31', '2021-10-20 13:22:31'),
(24995, 11056, 22486, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:42:05', '2021-11-10 14:42:05'),
(24996, 3046, 22487, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:40', '2021-03-16 16:36:40'),
(24997, 3040, 22487, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:56:22', '2021-03-30 15:56:22'),
(24998, 1006, 22487, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:14', '2021-06-04 12:47:14'),
(24999, 1006, 22487, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:38:04', '2021-06-24 12:38:04'),
(25000, 1006, 22487, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:47:57', '2021-07-12 12:47:57'),
(25001, 1006, 22487, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:12', '2021-08-13 17:10:12'),
(25002, 1006, 22487, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:55', '2021-08-24 10:30:55'),
(25003, 11056, 22487, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:40', '2021-09-21 13:47:40'),
(25004, 11056, 22487, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:54:34', '2021-09-27 14:54:34'),
(25005, 11056, 22487, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:24:18', '2021-10-12 13:24:18'),
(25006, 11056, 22487, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:25', '2021-10-20 13:22:25'),
(25007, 11056, 22487, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:57', '2021-11-10 14:41:57'),
(25008, 3046, 22488, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:41', '2021-03-16 16:36:41'),
(25009, 3040, 22488, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:56:18', '2021-03-30 15:56:18'),
(25010, 1006, 22488, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:17', '2021-06-04 12:47:17'),
(25011, 1006, 22488, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:55', '2021-06-24 12:37:55'),
(25012, 1006, 22488, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:01', '2021-07-12 12:48:01'),
(25013, 1006, 22488, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:15', '2021-08-13 17:10:15'),
(25014, 1006, 22488, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:51', '2021-08-24 10:30:51'),
(25015, 11056, 22488, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:46', '2021-09-21 13:47:46'),
(25016, 11056, 22488, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:54:15', '2021-09-27 14:54:15'),
(25017, 11056, 22488, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:24:10', '2021-10-12 13:24:10'),
(25018, 11056, 22488, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:18', '2021-10-20 13:22:18'),
(25019, 11056, 22488, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:51', '2021-11-10 14:41:51'),
(25020, 3046, 22489, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:42', '2021-03-16 16:36:42'),
(25021, 3040, 22489, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:56:03', '2021-03-30 15:56:03'),
(25022, 1006, 22489, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:21', '2021-06-04 12:47:21'),
(25023, 1006, 22489, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:51', '2021-06-24 12:37:51'),
(25024, 1006, 22489, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:04', '2021-07-12 12:48:04'),
(25025, 1006, 22489, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:18', '2021-08-13 17:10:18'),
(25026, 1006, 22489, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:47', '2021-08-24 10:30:47'),
(25027, 11056, 22489, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:51', '2021-09-21 13:47:51'),
(25028, 11056, 22489, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:54:08', '2021-09-27 14:54:08'),
(25029, 11056, 22489, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:24:03', '2021-10-12 13:24:03'),
(25030, 11056, 22489, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:13', '2021-10-20 13:22:13'),
(25031, 11056, 22489, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:43', '2021-11-10 14:41:43'),
(25032, 3046, 22490, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:44', '2021-03-16 16:36:44'),
(25033, 3040, 22490, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:55:59', '2021-03-30 15:55:59'),
(25034, 1006, 22490, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:24', '2021-06-04 12:47:24'),
(25035, 1006, 22490, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:48', '2021-06-24 12:37:48'),
(25036, 1006, 22490, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:07', '2021-07-12 12:48:07'),
(25037, 1006, 22490, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:24', '2021-08-13 17:10:24'),
(25038, 1006, 22490, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:44', '2021-08-24 10:30:44'),
(25039, 11056, 22490, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:56', '2021-09-21 13:47:56');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(25040, 11056, 22490, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:54:02', '2021-09-27 14:54:02'),
(25041, 11056, 22490, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:23:57', '2021-10-12 13:23:57'),
(25042, 11056, 22490, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:07', '2021-10-20 13:22:07'),
(25043, 11056, 22490, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:36', '2021-11-10 14:41:36'),
(25044, 3046, 22491, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:45', '2021-03-16 16:36:45'),
(25045, 3040, 22491, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:56:07', '2021-03-30 15:56:07'),
(25046, 1006, 22491, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:27', '2021-06-04 12:47:27'),
(25047, 1006, 22491, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:45', '2021-06-24 12:37:45'),
(25048, 1006, 22491, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:10', '2021-07-12 12:48:10'),
(25049, 1006, 22491, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:27', '2021-08-13 17:10:27'),
(25050, 1006, 22491, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:40', '2021-08-24 10:30:40'),
(25051, 11056, 22491, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:48:01', '2021-09-21 13:48:01'),
(25052, 11056, 22491, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:53:57', '2021-09-27 14:53:57'),
(25053, 11056, 22491, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:23:51', '2021-10-12 13:23:51'),
(25054, 11056, 22491, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:22:02', '2021-10-20 13:22:02'),
(25055, 11056, 22491, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:29', '2021-11-10 14:41:29'),
(25056, 3046, 22492, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:47', '2021-03-16 16:36:47'),
(25057, 3040, 22492, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:56:12', '2021-03-30 15:56:12'),
(25058, 1006, 22492, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:31', '2021-06-04 12:47:31'),
(25059, 1006, 22492, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:41', '2021-06-24 12:37:41'),
(25060, 1006, 22492, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:13', '2021-07-12 12:48:13'),
(25061, 1006, 22492, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:30', '2021-08-13 17:10:30'),
(25062, 1006, 22492, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:38', '2021-08-24 10:30:38'),
(25063, 11056, 22492, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:48:07', '2021-09-21 13:48:07'),
(25064, 11056, 22492, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:53:51', '2021-09-27 14:53:51'),
(25065, 11056, 22492, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:23:37', '2021-10-12 13:23:37'),
(25066, 11056, 22492, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:21:55', '2021-10-20 13:21:55'),
(25067, 11056, 22492, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:23', '2021-11-10 14:41:23'),
(25068, 3046, 22493, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:53', '2021-03-16 16:36:53'),
(25069, 3040, 22493, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:55:55', '2021-03-30 15:55:55'),
(25070, 1006, 22493, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:34', '2021-06-04 12:47:34'),
(25071, 1006, 22493, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:38', '2021-06-24 12:37:38'),
(25072, 1006, 22493, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:16', '2021-07-12 12:48:16'),
(25073, 1006, 22493, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:34', '2021-08-13 17:10:34'),
(25074, 1006, 22493, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:35', '2021-08-24 10:30:35'),
(25075, 11056, 22493, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:48:13', '2021-09-21 13:48:13'),
(25076, 11056, 22493, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:53:45', '2021-09-27 14:53:45'),
(25077, 11056, 22493, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:23:30', '2021-10-12 13:23:30'),
(25078, 11056, 22493, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:21:49', '2021-10-20 13:21:49'),
(25079, 11056, 22493, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:17', '2021-11-10 14:41:17'),
(25080, 3046, 22494, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:55', '2021-03-16 16:36:55'),
(25081, 3040, 22494, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:55:51', '2021-03-30 15:55:51'),
(25082, 1006, 22494, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:37', '2021-06-04 12:47:37'),
(25083, 1006, 22494, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:34', '2021-06-24 12:37:34'),
(25084, 1006, 22494, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:20', '2021-07-12 12:48:20'),
(25085, 1006, 22494, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:37', '2021-08-13 17:10:37'),
(25086, 1006, 22494, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:31', '2021-08-24 10:30:31'),
(25087, 11056, 22494, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:48:18', '2021-09-21 13:48:18'),
(25088, 11056, 22494, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:53:39', '2021-09-27 14:53:39'),
(25089, 11056, 22494, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:23:07', '2021-10-12 13:23:07'),
(25090, 11056, 22494, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:21:43', '2021-10-20 13:21:43'),
(25091, 11056, 22494, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the group for attachment and ancillary contract no need to add providers.', NULL, NULL, '2021-11-10 14:41:00', '2021-11-10 14:41:00'),
(25092, 3046, 22495, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:36:56', '2021-03-16 16:36:56'),
(25093, 3040, 22495, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: MHTXProviderServices@molinahealthcare.com  Subject: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Greetings,   Hope you are doing well. Please find the attached change of information form to add the group location in the Molina Health for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 15:55:47', '2021-03-30 15:55:47'),
(25094, 1006, 22495, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of our address addition request. Has it been completed?  Thank you.\"', NULL, NULL, '2021-06-04 12:47:41', '2021-06-04 12:47:41'),
(25095, 1006, 22495, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We wanted to get a status update regarding the location update request that was submitted to Molina for the following group:   Group Name; Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible as this request has been in process since March.   Thank you.\"', NULL, NULL, '2021-06-24 12:37:20', '2021-06-24 12:37:20'),
(25096, 1006, 22495, NULL, '2021-07-19 00:00:00.000', 'In Process', 'We received the following reply from MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Good Afternoon Brad,  We appreciate you reaching out with status request below. Our external representatives are actively working on getting these request submitted and processed. If you have a copy of the demo update request I can touch base with the rep to obtain status update.  Thank you and looking forward to hearing from you,  Provider Services Department | Houston/Jefferson & Bexar SDA- Jamie Llefi Molina Healthcare of Texas, Inc.\"  Replied with:  \"Hello,   Sure thing, we sent the following attached email on the 30th of March. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-12 12:48:23', '2021-07-12 12:48:23'),
(25097, 1006, 22495, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   I hope you\'re doing well, we\'re still waiting on the status of this request. Please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-13 17:10:41', '2021-08-13 17:10:41'),
(25098, 1006, 22495, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Left a VM @ (855) 322-4080 and also sent an email again @ MHTXProviderServices@molinahealthcare.com:  Sub: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  \"Hello,   We have been waiting for an update regarding our demographic update for the past year and still have not received any updates. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-24 10:30:28', '2021-08-24 10:30:28'),
(25099, 11056, 22495, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Re: Add Location || Statcare Minor Emergency Clinic || Group || Molina Health ||  Good afternoon!  Hope all is well with you. It has been a long time since our emails got responded back. We are still waiting to get an update on just adding an additional location since March,2021, And yet our additional location hasn\'t been updated yet.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help. Please get back to us as soon as possible.  Thank you! Have a great day!   Try to contact credentialing dept. But ain\'t able to. Have left out a Voice mail regarding the addition and updates.', NULL, NULL, '2021-09-21 13:47:04', '2021-09-21 13:47:04'),
(25100, 11056, 22495, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub :  Provider Information Change form  Good morning I am speaking to Ahmed on this matter, he stated he will forward me the form so I can get the address updated. Thank you    Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259    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, '2021-09-27 14:53:25', '2021-09-27 14:53:25'),
(25101, 11056, 22495, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hey Kiesha!  Hope this email finds you well. Please see the attachment. If any corrections are needed please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-10-12 13:22:49', '2021-10-12 13:22:49'),
(25102, 11056, 22495, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : MHTXProviderServices@molinahealthcare.com  Sub : Provider Information Change form  Good afternoon Ahmed and Brad,  Thank you for reaching out to us with attached Change requests. I have submitted these requests for processing, and your service ticket is RITM2301068.  Processing can take 14 days possibly earlier, I will follow-up with you once this ticket is completed in our system. We do apologize for the untimely request as we are working our best efforts to reply to all request at this time. Thank you for your business.     Kiesha Stovall | Provider Service Representative I | Harris/Jefferson SDAs Kiesha.Stovall@Molinahealthcare.com Phone #832-963-4259  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, '2021-10-20 13:21:03', '2021-10-20 13:21:03'),
(25103, 11056, 22495, NULL, '2021-11-17 00:00:00.000', 'Approved', 'Email received from : Kiesha.Stovall@molinahealthcare.com  Sub : Provider Information Change form  Hello Ahmed your ticket RITM2301068 has been fulfilled in our system. We do apologize for the delay at this time.  Location is effective- 6/24/2021  Good afternoon you won’t need a welcome letter for this process we are just adding the practice.  Good morning yes the location was added to your group and yes you’re a PAR provider which you can file thank you.   Please see the attachment', NULL, NULL, '2021-11-10 14:40:16', '2021-11-10 14:40:16'),
(25104, 1006, 22496, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:37:09', '2021-03-16 16:37:09'),
(25105, 3040, 22496, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare approval. ', NULL, NULL, '2021-04-05 09:46:39', '2021-04-05 09:46:39'),
(25106, 1006, 22496, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Medicare Railroad unable to be initiated yet, need to allow a few days for it to be updated on PalmettoGBA\'s system. ', NULL, NULL, '2021-05-25 09:10:45', '2021-05-25 09:10:45'),
(25107, 1006, 22496, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Enrollment request submitted:  \"Additional research is required to complete your request  Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	21152000249 NPI :	1285270991\"', NULL, NULL, '2021-06-01 09:18:19', '2021-06-01 09:18:19'),
(25108, 1006, 22496, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	SHYBI VARGHESE NP PROVIDER PTAN	P02613504 PROVIDER NPI	1285270991 EFFECTIVE DATE	02/01/2021 END DATE	 GROUP NAME	RIGHT STEP MED CTR LLC GROUP PTAN	EA8470 BUSINESS STATE	TX EFFECTIVE DATE	02/01/2021 END DATE	   ', NULL, NULL, '2021-06-18 16:51:00', '2021-06-18 16:51:00'),
(25109, 1006, 22497, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:37:10', '2021-03-16 16:37:10'),
(25110, 3040, 22497, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare approval. ', NULL, NULL, '2021-04-05 09:46:43', '2021-04-05 09:46:43'),
(25111, 1006, 22497, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Medicare Railroad unable to be initiated yet, need to allow a few days for it to be updated on PalmettoGBA\'s system. ', NULL, NULL, '2021-05-25 09:11:38', '2021-05-25 09:11:38'),
(25112, 1006, 22497, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'The request is still pending due to: We are unable to process your request because, according to the provider enrollment information on file with your local Medicare Administrative Contractor (MAC), the local MAC PTAN entered into this tool is a group PTAN. A group PTAN will be assigned when we receive a PTAN request for a group member. If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number:	21145000195 ', NULL, NULL, '2021-06-01 09:14:52', '2021-06-01 09:14:52'),
(25113, 1006, 22497, NULL, '2021-06-25 00:00:00.000', 'Initiated', 'Enrollment request submitted: \"Please allow three business days for the activation of this new PTAN.\"', NULL, NULL, '2021-06-18 16:56:36', '2021-06-18 16:56:36'),
(25114, 1006, 22497, NULL, '2021-07-06 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare Railroad:   Provider PTAN: Q00087871 Eff: 02/01/2021', NULL, NULL, '2021-06-29 09:09:55', '2021-06-29 09:09:55'),
(25115, 1006, 22498, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:37:11', '2021-03-16 16:37:11'),
(25116, 3040, 22498, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare approval. ', NULL, NULL, '2021-04-05 09:46:47', '2021-04-05 09:46:47'),
(25117, 1006, 22498, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Medicare Railroad unable to be initiated yet, need to allow a few days for it to be updated on PalmettoGBA\'s system. ', NULL, NULL, '2021-05-25 09:11:55', '2021-05-25 09:11:55'),
(25118, 1006, 22498, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'The request is still on hold due to the following reason:  \"At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number :	21152000254 \"', NULL, NULL, '2021-06-01 09:20:46', '2021-06-01 09:20:46'),
(25119, 1006, 22498, NULL, '2021-06-25 00:00:00.000', 'Initiated', 'Enrollment request submitted: \"Please allow three business days for the activation of this new PTAN.\"', NULL, NULL, '2021-06-18 16:57:51', '2021-06-18 16:57:51'),
(25120, 1006, 22498, NULL, '2021-07-06 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare Railroad:   Provider PTAN: Q00087872 Eff: 02/01/2021', NULL, NULL, '2021-06-29 09:08:49', '2021-06-29 09:08:49'),
(25121, 1006, 22499, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:37:13', '2021-03-16 16:37:13'),
(25122, 3040, 22499, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare approval. ', NULL, NULL, '2021-04-05 09:46:50', '2021-04-05 09:46:50'),
(25123, 1006, 22499, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Medicare Railroad unable to be initiated yet, need to allow a few days for it to be updated on PalmettoGBA\'s system. ', NULL, NULL, '2021-05-25 09:11:23', '2021-05-25 09:11:23'),
(25124, 1006, 22499, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'The request is still pending due to: We are unable to process your request because, according to the provider enrollment information on file with your local Medicare Administrative Contractor (MAC), the local MAC PTAN entered into this tool is a group PTAN. A group PTAN will be assigned when we receive a PTAN request for a group member. If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number:	21145000195 ', NULL, NULL, '2021-06-01 09:14:45', '2021-06-01 09:14:45'),
(25125, 1006, 22499, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	RIGHT STEP MED CTR LLC GROUP PTAN	EA8470 GROUP NPI	1063008084 BUSINESS STATE	TX EFFECTIVE DATE	02/01/2021 END DATE	 ', NULL, NULL, '2021-06-18 16:52:36', '2021-06-18 16:52:36'),
(25126, 1006, 22500, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:05', '2021-03-16 16:38:05'),
(25127, 1006, 22500, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Enrollment request submitted @ contracting@ghn-mci.com, providers@ghn-mci.com:  Sub: Provider Enrollment - Galaxy Health - RSM  \"Hello,   We wish to enroll/contract our group and providers with Galaxy Health, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-01 10:46:07', '2021-04-01 10:46:07'),
(25128, 1006, 22500, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Multiple provider group enrollment request submitted via fax @ (817) 633-5729  Attached the forms for reference in individual provider tasks.  ', NULL, NULL, '2021-04-02 10:08:44', '2021-04-02 10:08:44');
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
(25129, 1006, 22500, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent f/u @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers and group, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-05-03 08:06:19', '2021-05-03 08:06:19'),
(25130, 1006, 22500, NULL, '2021-05-10 00:00:00.000', 'Approved', 'Received the following approval email from Chris Guerue cguerue@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Good Morning,  Right Step Medical Center LLC along with the three provider applications were processed, completed and have been added to the network effective 4/1/21.  Karen Avalos is the provider rep for Texas, and can be reached at kavalos@ghn-mci.com to request a copy of the fully executed agreement for your files and for any additional inquiries you may have.    Thank you and have a good day!   Christine Guerue Credentialing Dept cguerue@ghn-mci.com 800-975-3322 x1130 817-633-5729 fax Galaxy Health Network 2261 Brookhollow Plaza Dr, Ste 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425\"  Sent f/u for executed contract @ Karen Avalos kavalos@ghn-mci.com :  Sub: Executed Agreement - RSM - Galaxy Health  \"Hello Karen,   I hope you\'re doing well, I wanted to know if you could please send us a copy of the executed agreement for our group and providers?  Group Name: Right Step Medical Center LLC NPI# 1063008084  Thank you. \"', NULL, NULL, '2021-05-03 15:55:15', '2021-05-03 15:55:15'),
(25131, 1006, 22501, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:06', '2021-03-16 16:38:06'),
(25132, 1006, 22501, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Enrollment request submitted @ contracting@ghn-mci.com, providers@ghn-mci.com:  Sub: Provider Enrollment - Galaxy Health - RSM  \"Hello,   We wish to enroll/contract our group and providers with Galaxy Health, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-01 10:46:13', '2021-04-01 10:46:13'),
(25133, 1006, 22501, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Multiple provider group enrollment request submitted via fax @ (817) 633-5729  Attached the form for reference.  ', NULL, NULL, '2021-04-02 10:00:24', '2021-04-02 10:00:24'),
(25134, 1006, 22501, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent f/u @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers and group, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-05-03 08:06:22', '2021-05-03 08:06:22'),
(25135, 1006, 22501, NULL, '2021-05-10 00:00:00.000', 'Approved', 'Received the following approval email from Chris Guerue cguerue@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Good Morning,  Right Step Medical Center LLC along with the three provider applications were processed, completed and have been added to the network effective 4/1/21.  Karen Avalos is the provider rep for Texas, and can be reached at kavalos@ghn-mci.com to request a copy of the fully executed agreement for your files and for any additional inquiries you may have.    Thank you and have a good day!   Christine Guerue Credentialing Dept cguerue@ghn-mci.com 800-975-3322 x1130 817-633-5729 fax Galaxy Health Network 2261 Brookhollow Plaza Dr, Ste 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425\"  Sent f/u for executed contract @ Karen Avalos kavalos@ghn-mci.com :  Sub: Executed Agreement - RSM - Galaxy Health  \"Hello Karen,   I hope you\'re doing well, I wanted to know if you could please send us a copy of the executed agreement for our group and providers?  Group Name: Right Step Medical Center LLC NPI# 1063008084  Thank you. \" ', NULL, NULL, '2021-05-03 15:55:44', '2021-05-03 15:55:44'),
(25136, 1006, 22502, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:08', '2021-03-16 16:38:08'),
(25137, 1006, 22502, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Enrollment request submitted @ contracting@ghn-mci.com, providers@ghn-mci.com:  Sub: Provider Enrollment - Galaxy Health - RSM  \"Hello,   We wish to enroll/contract our group and providers with Galaxy Health, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-01 10:46:17', '2021-04-01 10:46:17'),
(25138, 1006, 22502, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Multiple provider group enrollment request submitted via fax @ (817) 633-5729  Attached the form for reference.  ', NULL, NULL, '2021-04-02 10:01:38', '2021-04-02 10:01:38'),
(25139, 1006, 22502, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent f/u @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers and group, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-05-03 08:06:24', '2021-05-03 08:06:24'),
(25140, 1006, 22502, NULL, '2021-05-10 00:00:00.000', 'Approved', 'Received the following approval email from Chris Guerue cguerue@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Good Morning,  Right Step Medical Center LLC along with the three provider applications were processed, completed and have been added to the network effective 4/1/21.  Karen Avalos is the provider rep for Texas, and can be reached at kavalos@ghn-mci.com to request a copy of the fully executed agreement for your files and for any additional inquiries you may have.    Thank you and have a good day!   Christine Guerue Credentialing Dept cguerue@ghn-mci.com 800-975-3322 x1130 817-633-5729 fax Galaxy Health Network 2261 Brookhollow Plaza Dr, Ste 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425\"  Sent f/u for executed contract @ Karen Avalos kavalos@ghn-mci.com :  Sub: Executed Agreement - RSM - Galaxy Health  \"Hello Karen,   I hope you\'re doing well, I wanted to know if you could please send us a copy of the executed agreement for our group and providers?  Group Name: Right Step Medical Center LLC NPI# 1063008084  Thank you. \" ', NULL, NULL, '2021-05-03 15:55:54', '2021-05-03 15:55:54'),
(25141, 1006, 22503, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:09', '2021-03-16 16:38:09'),
(25142, 1006, 22503, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Enrollment request submitted @ contracting@ghn-mci.com, providers@ghn-mci.com:  Sub: Provider Enrollment - Galaxy Health - RSM  \"Hello,   We wish to enroll/contract our group and providers with Galaxy Health, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-01 10:46:21', '2021-04-01 10:46:21'),
(25143, 1006, 22503, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Multiple provider group enrollment request submitted via fax @ (817) 633-5729  Attached the form for reference.  ', NULL, NULL, '2021-04-02 10:01:43', '2021-04-02 10:01:43'),
(25144, 1006, 22503, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent f/u @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers and group, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-05-03 08:06:26', '2021-05-03 08:06:26'),
(25145, 1006, 22503, NULL, '2021-05-10 00:00:00.000', 'Approved', 'Received the following approval email from Chris Guerue cguerue@ghn-mci.com:  Sub: Enrollment Status - RSM - Galaxy Health  \"Good Morning,  Right Step Medical Center LLC along with the three provider applications were processed, completed and have been added to the network effective 4/1/21.  Karen Avalos is the provider rep for Texas, and can be reached at kavalos@ghn-mci.com to request a copy of the fully executed agreement for your files and for any additional inquiries you may have.    Thank you and have a good day!   Christine Guerue Credentialing Dept cguerue@ghn-mci.com 800-975-3322 x1130 817-633-5729 fax Galaxy Health Network 2261 Brookhollow Plaza Dr, Ste 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425\"  Sent f/u for executed contract @ Karen Avalos kavalos@ghn-mci.com :  Sub: Executed Agreement - RSM - Galaxy Health  \"Hello Karen,   I hope you\'re doing well, I wanted to know if you could please send us a copy of the executed agreement for our group and providers?  Group Name: Right Step Medical Center LLC NPI# 1063008084  Thank you. \" ', NULL, NULL, '2021-05-03 15:55:57', '2021-05-03 15:55:57'),
(25146, 1006, 22504, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:41', '2021-03-16 16:38:41'),
(25147, 1006, 22504, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Requested submitted via Scott & White provider enrollment form, attached for reference: \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 62abd8f0-299d-487d-8f1b-c879c602c302\"', NULL, NULL, '2021-04-02 14:10:20', '2021-04-02 14:10:20'),
(25148, 1006, 22504, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', 'We received the following rejection email from Scott & White @ SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 85-3252700  RE: Network Denial Letter    Dear Right Step Medical Center LLC  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.    After reviewing your online application to contract submitted on 04/02/2021, SWHP and FirstCare regretfully declines to contract with Right Step Medical Center LLC at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.    Thank you again for your interest in SWHP and FirstCare Health Plans.   Best Regards,     Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans   Network Development Department   1206 West Campus Dr.   Temple, Texas 76502 \"  ', NULL, NULL, '2021-04-19 13:08:04', '2021-04-19 13:08:04'),
(25149, 1006, 22505, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:42', '2021-03-16 16:38:42'),
(25150, 1006, 22505, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Requested submitted via Scott & White provider enrollment form, attached for reference: \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 62abd8f0-299d-487d-8f1b-c879c602c302\"', NULL, NULL, '2021-04-02 14:09:42', '2021-04-02 14:09:42'),
(25151, 1006, 22505, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'We received the following rejection email from @ SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 85-3252700  RE: Network Denial Letter    Dear Right Step Medical Center LLC  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.    After reviewing your online application to contract submitted on 04/02/2021, SWHP and FirstCare regretfully declines to contract with Right Step Medical Center LLC at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.    Thank you again for your interest in SWHP and FirstCare Health Plans.   Best Regards,    Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans   Network Development Department   1206 West Campus Dr.   Temple, Texas 76502 \"', NULL, NULL, '2021-05-03 10:33:18', '2021-05-03 10:33:18'),
(25152, 1006, 22506, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:44', '2021-03-16 16:38:44'),
(25153, 1006, 22506, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Requested submitted via Scott & White provider enrollment form, attached for reference: \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 62abd8f0-299d-487d-8f1b-c879c602c302\"', NULL, NULL, '2021-04-02 14:10:10', '2021-04-02 14:10:10'),
(25154, 1006, 22506, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'We received the following rejection email from @ SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 85-3252700  RE: Network Denial Letter    Dear Right Step Medical Center LLC  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.    After reviewing your online application to contract submitted on 04/02/2021, SWHP and FirstCare regretfully declines to contract with Right Step Medical Center LLC at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.    Thank you again for your interest in SWHP and FirstCare Health Plans.   Best Regards,    Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans   Network Development Department   1206 West Campus Dr.   Temple, Texas 76502 \"', NULL, NULL, '2021-05-03 10:33:13', '2021-05-03 10:33:13'),
(25155, 1006, 22507, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:38:45', '2021-03-16 16:38:45'),
(25156, 1006, 22507, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Requested submitted via Scott & White provider enrollment form, attached for reference: \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 62abd8f0-299d-487d-8f1b-c879c602c302\"', NULL, NULL, '2021-04-02 14:10:30', '2021-04-02 14:10:30'),
(25157, 1006, 22507, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'We received the following rejection email from @ SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 85-3252700  RE: Network Denial Letter    Dear Right Step Medical Center LLC  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.    After reviewing your online application to contract submitted on 04/02/2021, SWHP and FirstCare regretfully declines to contract with Right Step Medical Center LLC at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.    Thank you again for your interest in SWHP and FirstCare Health Plans.   Best Regards,    Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans   Network Development Department   1206 West Campus Dr.   Temple, Texas 76502 \"', NULL, NULL, '2021-05-03 10:33:08', '2021-05-03 10:33:08'),
(25158, 3046, 22508, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:03', '2021-03-16 16:39:03'),
(25159, 1006, 22508, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:15:33', '2021-03-30 13:15:33'),
(25160, 1006, 22508, NULL, '2021-05-05 00:00:00.000', 'In Process', 'The addresses haven\'t been added to the group profile but they are added to the individual providers. Need to allow more time for group to be updated.  Ref# 7560925    ', NULL, NULL, '2021-04-28 14:09:00', '2021-04-28 14:09:00'),
(25161, 9057, 22508, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: registrar@multiplan.com Sub: Additional location status request - RHC - Multiplan  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Group Details Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN#  46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details Provider Name: Capupus, Mari Provider NPI: 1740517945 Case Number: 7594352   Also we asked for the addition of below mentioned addresses to the group profile   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Case Number: 7560925   Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 12:05:18', '2021-05-26 12:05:18'),
(25162, 1006, 22508, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I wanted to follow up on the status of this request, have there been any updates?  Thank you. \" ', NULL, NULL, '2021-06-15 17:17:57', '2021-06-15 17:17:57'),
(25163, 1006, 22508, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent another f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of our location addition?  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-21 16:08:44', '2021-06-21 16:08:44'),
(25164, 1006, 22508, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, proof of location addition is attached for reference.   Eff: 09/15/2015', NULL, NULL, '2021-07-05 14:29:57', '2021-07-05 14:29:57'),
(25165, 3046, 22509, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:05', '2021-03-16 16:39:05'),
(25166, 1006, 22509, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:31:39', '2021-03-30 13:31:39'),
(25167, 1006, 22509, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added to all addresses, attached location confirmation and welcome letter for reference in the primary address task. ', NULL, NULL, '2021-04-29 14:18:36', '2021-04-29 14:18:36'),
(25168, 3046, 22510, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:07', '2021-03-16 16:39:07'),
(25169, 1006, 22510, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Provider enrollment request submitted as per Multiplan they were termed in 2019, email attached:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561602    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 17:00:47', '2021-03-30 17:00:47'),
(25170, 1006, 22510, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email received from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7561602  \"MultiPlan has closed Customer Service Case 7561602.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear Brad Peterson,  Additional information is required for Juan Miguel Capupus  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees? Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.  Case Number: 7561602    Submitter Name: Brad Peterson Date of submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard\"  Opened the case again and replied back to them regarding their queries. ', NULL, NULL, '2021-04-28 14:50:57', '2021-04-28 14:50:57'),
(25171, 1006, 22510, NULL, '2021-05-17 00:00:00.000', 'Approved', 'The provider is approved with Multiplan, a welcome letter and proof of location are attached for reference.   Eff: 03/30/2021', NULL, NULL, '2021-05-10 14:17:59', '2021-05-10 14:17:59'),
(25172, 3046, 22511, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:09', '2021-03-16 16:39:09'),
(25173, 1006, 22511, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:31:43', '2021-03-30 13:31:43'),
(25174, 1006, 22511, NULL, '2021-05-06 00:00:00.000', 'In Process', 'Submitted another request to Multiplan to have all the addresses listed on the provider directory:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7594352    Submitter Name: Brad Peterson Date of Submission: 04/29/2021    TIN: 46-0575924    Provider Name: Capupus, Mari Katrina Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Other    Priority: Standard\"', NULL, NULL, '2021-04-29 14:31:06', '2021-04-29 14:31:06'),
(25175, 9057, 22511, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: registrar@multiplan.com Sub: Additional location status request - RHC - Multiplan  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Group Details Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN#  46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details Provider Name: Capupus, Mari Provider NPI: 1740517945 Case Number: 7594352   Also we asked for the addition of below mentioned addresses to the group profile   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Case Number: 7560925   Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 12:03:54', '2021-05-26 12:03:54'),
(25176, 1006, 22511, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I wanted to follow up on the status of this request, have there been any updates?  Thank you. \" ', NULL, NULL, '2021-06-15 17:18:02', '2021-06-15 17:18:02'),
(25177, 1006, 22511, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent another f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of our location addition?  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-21 16:08:37', '2021-06-21 16:08:37'),
(25178, 1006, 22511, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent another f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of our location addition?  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-21 16:08:37', '2021-06-21 16:08:37'),
(25179, 1006, 22511, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added to Multiplan, location confirmation is attached for reference.   Eff: 09/14/2018', NULL, NULL, '2021-07-05 14:27:04', '2021-07-05 14:27:04'),
(25180, 1006, 22512, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:10', '2021-03-16 16:39:10'),
(25181, 1006, 22512, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Group enrollment request submitted online via Ambetter/Superior Portal: \"Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.\"  Attached for reference. ', NULL, NULL, '2021-04-02 18:12:48', '2021-04-02 18:12:48'),
(25182, 1006, 22512, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent a f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Hello,   I wanted to get an update regarding the credentialing status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-04-23 15:57:17', '2021-04-23 15:57:17'),
(25183, 1006, 22512, NULL, '2021-05-03 00:00:00.000', 'In Process', 'We received the following update from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Good morning,  I currently show the files are in progress and have not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.   Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"', NULL, NULL, '2021-04-26 08:29:02', '2021-04-26 08:29:02'),
(25184, 1006, 22512, NULL, '2021-05-10 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-05-03 07:47:34', '2021-05-03 07:47:34'),
(25185, 1006, 22512, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 16:47:08', '2021-05-26 16:47:08'),
(25186, 1006, 22512, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:19:47', '2021-06-14 11:19:47'),
(25187, 1006, 22512, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:34', '2021-07-02 15:57:34'),
(25188, 1006, 22512, NULL, '2021-07-16 00:00:00.000', 'Approved', '\"RIGHT STEP MEDICAL CENTER LLC\"        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:  5/1/2021                                                       YOUR AGREEMENT WAS AUTOMATICALLY SENT VIA EMAIL TO THE EMAIL ADDRESS ABOVE   ', NULL, NULL, '2021-07-09 12:57:02', '2021-07-09 12:57:02'),
(25189, 3046, 22513, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:11', '2021-03-16 16:39:11'),
(25190, 1006, 22513, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:31:47', '2021-03-30 13:31:47'),
(25191, 1006, 22513, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added to all addresses, attached location confirmation and welcome letter for reference. ', NULL, NULL, '2021-04-29 14:41:09', '2021-04-29 14:41:09'),
(25192, 3046, 22514, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:13', '2021-03-16 16:39:13'),
(25193, 1006, 22514, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:31:51', '2021-03-30 13:31:51'),
(25194, 1006, 22514, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added under the given location, proof of location addition and the welcome letter is attached for reference. ', NULL, NULL, '2021-04-29 15:07:17', '2021-04-29 15:07:17'),
(25195, 3046, 22515, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:15', '2021-03-16 16:39:15'),
(25196, 1006, 22515, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:31:55', '2021-03-30 13:31:55'),
(25197, 1006, 22515, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider is enrolled under all locations, proof of location addition is attached for reference.  Welcome letter attached in the main group task.   Eff: 7/21/2020', NULL, NULL, '2021-04-29 14:47:35', '2021-04-29 14:47:35'),
(25198, 3046, 22516, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:15', '2021-03-16 16:39:15'),
(25199, 1006, 22516, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:31:59', '2021-03-30 13:31:59'),
(25200, 1006, 22516, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added under the location, location confirmation is attached for reference. Provider enrollment confirmation is attached on the main group task for the provider.  Eff: 02/01/2017 ', NULL, NULL, '2021-04-29 15:14:25', '2021-04-29 15:14:25'),
(25201, 3046, 22517, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:17', '2021-03-16 16:39:17'),
(25202, 1006, 22517, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:32:03', '2021-03-30 13:32:03'),
(25203, 1006, 22517, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added to the location, location confirmation is attached for reference as well as a welcome letter.   Eff: 10/23/2019', NULL, NULL, '2021-04-29 15:17:19', '2021-04-29 15:17:19'),
(25204, 1006, 22518, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:18', '2021-03-16 16:39:18'),
(25205, 1006, 22518, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Enrollment request submitted online via Ambetter/Superior Portal for group, no option for NP: \"Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.\"  Attached for reference. ', NULL, NULL, '2021-04-02 18:13:55', '2021-04-02 18:13:55'),
(25206, 1006, 22518, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent a f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Hello,   I wanted to get an update regarding the credentialing status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-04-23 15:57:40', '2021-04-23 15:57:40'),
(25207, 1006, 22518, NULL, '2021-05-03 00:00:00.000', 'In Process', 'We received the following update from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Good morning,  I currently show the files are in progress and have not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.   Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"', NULL, NULL, '2021-04-26 08:29:09', '2021-04-26 08:29:09'),
(25208, 1006, 22518, NULL, '2021-05-10 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-05-03 07:47:30', '2021-05-03 07:47:30'),
(25209, 1006, 22518, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 16:47:19', '2021-05-26 16:47:19'),
(25210, 1006, 22518, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:19:44', '2021-06-14 11:19:44'),
(25211, 1006, 22518, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:37', '2021-07-02 15:57:37'),
(25212, 1006, 22518, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, our provider Glory Abraham is still not showing up on the provider directory for Ambetter or Superior Health. Could you please get back to me on this?  Thank you!\"', NULL, NULL, '2021-07-27 16:57:00', '2021-07-27 16:57:00'),
(25213, 1006, 22518, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Received the following update from:  \"Hi, I have submitted the request to have Glory Abraham added to the provider directory and will let you know as soon as it is completed. Please reference ticket # 50553 if you have any questions.   Sincerely, Barbara McDonald Account Manager, Provider Relations Region 7 (Harris & Jefferson)          711 N. Carancahua Street, Ste. 600 Corpus Christi, TX 78401 Direct Line: 1 (800)656-4817 Press 1 for English or 2 for Spanish, then option #3 for Provider Relations Fax: 1-866-683-5630 AM.houston@superiorhealthplan.com | SuperiorHealthPlan.com\"', NULL, NULL, '2021-07-30 14:15:08', '2021-07-30 14:15:08'),
(25214, 1006, 22518, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Provider has been enrolled with Ambetter approval confirmation is attached for reference.   Eff: 05/01/2021 Provider ID# P10006726343', NULL, NULL, '2021-08-10 16:58:12', '2021-08-10 16:58:12'),
(25215, 3046, 22519, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:19', '2021-03-16 16:39:19'),
(25216, 1006, 22519, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Request submitted to Multiplan to add SPID address for group and all providers current enrolled under the group: MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 13:32:07', '2021-03-30 13:32:07'),
(25217, 1006, 22519, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been attached to the new location, welcome letter and location confirmation are attached for reference.   Eff: 10/15/2018', NULL, NULL, '2021-04-29 15:19:46', '2021-04-29 15:19:46'),
(25218, 1006, 22519, NULL, '2021-07-27 00:00:00.000', 'Revalidation', 'Received fax from Multiplan to re-credential the provider. Information provided to them, request is attached in task for reference. ', NULL, NULL, '2021-07-20 09:37:56', '2021-07-20 09:37:56'),
(25219, 1006, 22519, NULL, '2021-08-25 00:00:00.000', 'Revalidation', 'Opened new service case for the status of re-credentialing of provider:  Service Case Number:  7711003  \"I wanted to get an update regarding the recredentialing status for the mentioned provider under our group, also the provider should be listed under the following addresses as well:  Secondary Location: 4042 River Hill, Corpus Christi, TX 78410 Tertiary Location: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Quaternary Location: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-18 16:14:10', '2021-08-18 16:14:10'),
(25220, 1006, 22519, NULL, '2021-09-03 00:00:00.000', 'Revalidation', 'Received a recredentialing notice and emailed it @ registrar@multiplan.com. Attached for reference. ', NULL, NULL, '2021-08-27 14:08:19', '2021-08-27 14:08:19'),
(25221, 11056, 22519, NULL, '2021-09-28 00:00:00.000', 'Revalidation', 'Email sent to : registrar@multiplan.com  Sub : Recredentialing Request - Maegan Svatek  Good afternoon!  Hope all is well with you. Please provide me with the recredentialing status for the provider,Maegan Svatek ( NPI: 1639670250) under TIN (46-0575924). And also with addresses listed underneath her.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-21 14:23:48', '2021-09-21 14:23:48'),
(25222, 11056, 22519, NULL, '2021-10-19 00:00:00.000', 'Revalidated', 'Rep : James D  Status : Recredentialing has been completed.  Next recredentialing date:  06/07/2024  Ref code : 7711003  All locations are listed under the provider.  please see the attachments.', NULL, NULL, '2021-10-12 10:25:19', '2021-10-12 10:25:19'),
(25223, 3046, 22520, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:20', '2021-03-16 16:39:20'),
(25224, 1006, 22520, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Submitted enrollment request and group addition for provider for all addresses:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561360    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 14:30:26', '2021-03-30 14:30:26'),
(25225, 1006, 22520, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Multiplan @ PortalRegistrar PortalRegistrar@multiplan.com:  Sub: FW: Contract ID 9671500 Case # 7561360  \"Dear Brad Peterson,  Additional information is required for Rose Puentes  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees?  Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.\"  Reopened the case and submitted the answers. ', NULL, NULL, '2021-04-28 15:35:47', '2021-04-28 15:35:47'),
(25226, 1006, 22520, NULL, '2021-05-07 00:00:00.000', 'In Process', 'We received the following email from appmissinginfo fax7814878257@multiplan.com:  Sub: Regarding Trevino, Rose P., PAC\'s MultiPlan Application – Reference: APP0008202553  \"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.  Sriyanka  D Provider Data Management appmissinginfo@multiplan.com  MultiPlan, Inc 16 Crosby Drive Bedford, MA 01730 Fax: 781-487-8257 Reference: APP0008202553\"  The form was filled out and sent to Multiplan.', NULL, NULL, '2021-04-30 08:28:38', '2021-04-30 08:28:38');
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
(25227, 1006, 22520, NULL, '2021-05-20 00:00:00.000', 'In Process', 'We received an email from Multiplan stating that provider has a BHS degree and is unable to be credentialed but she would still be able to bill under the group contract, informed billing team to go ahead and do so. Will update task once claim status is received. ', NULL, NULL, '2021-05-10 13:39:32', '2021-05-10 13:39:32'),
(25228, 1006, 22520, NULL, '2021-07-03 00:00:00.000', 'In Process', 'Sent f/u email to billing team: \"Hello,  I wanted to check in with you to see if any claims were received and sent out for Rose Trevino yet?  Thank you.\"', NULL, NULL, '2021-06-03 10:35:20', '2021-06-03 10:35:20'),
(25229, 1006, 22520, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-06-21 16:05:52', '2021-06-21 16:05:52'),
(25230, 1006, 22520, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time. ', NULL, NULL, '2021-07-05 13:48:06', '2021-07-05 13:48:06'),
(25231, 1006, 22520, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time.  ', NULL, NULL, '2021-08-17 17:17:44', '2021-08-17 17:17:44'),
(25232, 11056, 22520, NULL, '2021-09-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-09-21 14:15:15', '2021-09-21 14:15:15'),
(25233, 11056, 22520, NULL, '2021-10-11 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-04 10:58:49', '2021-10-04 10:58:49'),
(25234, 11056, 22520, NULL, '2021-10-21 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-14 12:45:28', '2021-10-14 12:45:28'),
(25235, 11056, 22520, NULL, '2021-11-01 00:00:00.000', 'In Process', '	 We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-25 12:35:47', '2021-10-25 12:35:47'),
(25236, 11056, 22520, NULL, '2021-11-18 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-11 13:21:36', '2021-11-11 13:21:36'),
(25237, 11056, 22520, NULL, '2021-12-01 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-24 17:09:51', '2021-11-24 17:09:51'),
(25238, 11056, 22520, NULL, '2021-12-17 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-10 17:30:34', '2021-12-10 17:30:34'),
(25239, 11056, 22520, NULL, '2021-12-30 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-23 10:26:52', '2021-12-23 10:26:52'),
(25240, 19067, 22520, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:24:43', '2022-01-12 17:24:43'),
(25241, 19067, 22520, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:35', '2022-01-26 17:28:35'),
(25242, 19067, 22520, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:36:04', '2022-02-11 14:36:04'),
(25243, 19067, 22520, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:29:01', '2022-02-23 14:29:01'),
(25244, 19067, 22520, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:36', '2022-03-15 16:19:36'),
(25245, 1006, 22521, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:21', '2021-03-16 16:39:21'),
(25246, 1006, 22521, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Provider enrollment request submitted online via Ambetter/Superior Portal: \"Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.\"  Attached for reference. ', NULL, NULL, '2021-04-02 18:13:20', '2021-04-02 18:13:20'),
(25247, 1006, 22521, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent a f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Hello,   I wanted to get an update regarding the credentialing status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-04-23 15:57:34', '2021-04-23 15:57:34'),
(25248, 1006, 22521, NULL, '2021-05-03 00:00:00.000', 'In Process', 'We received the following update from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Good morning,  I currently show the files are in progress and have not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.   Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"', NULL, NULL, '2021-04-26 08:29:14', '2021-04-26 08:29:14'),
(25249, 1006, 22521, NULL, '2021-05-10 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-05-03 07:47:25', '2021-05-03 07:47:25'),
(25250, 1006, 22521, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 16:47:23', '2021-05-26 16:47:23'),
(25251, 1006, 22521, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:19:41', '2021-06-14 11:19:41'),
(25252, 1006, 22521, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:40', '2021-07-02 15:57:40'),
(25253, 1006, 22521, NULL, '2021-07-16 00:00:00.000', 'Approved', '\"RIGHT STEP MEDICAL CENTER LLC\"  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  5/1/2021                                                    YOUR AGREEMENT WAS AUTOMATICALLY SENT VIA EMAIL TO THE EMAIL ADDRESS ABOVE\"', NULL, NULL, '2021-07-09 12:57:49', '2021-07-09 12:57:49'),
(25254, 1006, 22522, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:39:23', '2021-03-16 16:39:23'),
(25255, 1006, 22522, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Enrollment request submitted online via Ambetter/Superior Portal for group, no option for NP: \"Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.\"  Attached for reference. ', NULL, NULL, '2021-04-02 18:14:08', '2021-04-02 18:14:08'),
(25256, 1006, 22522, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent a f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Hello,   I wanted to get an update regarding the credentialing status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-04-23 15:57:27', '2021-04-23 15:57:27'),
(25257, 1006, 22522, NULL, '2021-05-03 00:00:00.000', 'In Process', 'We received the following update from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Ambetter  \"Good morning,  I currently show the files are in progress and have not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.   Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"', NULL, NULL, '2021-04-26 08:29:19', '2021-04-26 08:29:19'),
(25258, 1006, 22522, NULL, '2021-05-10 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-05-03 07:47:18', '2021-05-03 07:47:18'),
(25259, 1006, 22522, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group: Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-26 16:47:27', '2021-05-26 16:47:27'),
(25260, 1006, 22522, NULL, '2021-06-21 00:00:00.000', 'In Process', 'rcvd following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - RSM - Superior Health  \"Good evening,              The below providers\' files are in progress and have not been completed at this time. The cred spec will contact you directly for any missing/incomplete information.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Sent another f/u email to them:   \"Hello,   I appreciate the update, could you please let me know if there have been any further updates for the enrollment of the providers under Superior Health & Ambetter?  Thank you. \"', NULL, NULL, '2021-06-14 11:19:30', '2021-06-14 11:19:30'),
(25261, 1006, 22522, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status Update - RSM - Superior Health  \"Hello Veronica,   I hope you\'re doing well, can you please get back to me on the status of enrollment for the providers? Also, if possible please send us the plans that they are all enrolled under as well.  Thank you!\"', NULL, NULL, '2021-07-02 15:57:43', '2021-07-02 15:57:43'),
(25262, 1006, 22522, NULL, '2021-07-16 00:00:00.000', 'Approved', '\"SHYBI VARGHESE  RIGHT STEP MEDICAL CENTER LLC  rsm@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  07/01/2021                                                   C/ 50368\"', NULL, NULL, '2021-07-09 12:58:29', '2021-07-09 12:58:29'),
(25263, 3046, 22523, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:26', '2021-03-16 16:41:26'),
(25264, 1006, 22523, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are already listed under group PTAN and provider is added under group.  Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	PATRICK A AYARZAGOITIA NP PROVIDER PTAN	P02173892 PROVIDER NPI	1649568239 EFFECTIVE DATE	10/31/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 11:13:50', '2021-03-26 11:13:50'),
(25265, 3046, 22524, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:28', '2021-03-16 16:41:28'),
(25266, 1006, 22524, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under group PTAN, which provider is linked to.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUAN M CAPUPUS NP PROVIDER PTAN	P02418072 PROVIDER NPI	1891168597 EFFECTIVE DATE	07/20/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 11:14:37', '2021-03-26 11:14:37'),
(25267, 3046, 22525, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:30', '2021-03-16 16:41:30'),
(25268, 1006, 22525, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under group PTAN, and provider is added under group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	M A CAPUPUS PA PROVIDER PTAN	P02133478 PROVIDER NPI	1740517945 EFFECTIVE DATE	08/05/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 11:15:13', '2021-03-26 11:15:13'),
(25269, 3046, 22526, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:31', '2021-03-16 16:41:31'),
(25270, 1006, 22526, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are updated in group PTAN and provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	WILLIAM R FRANCIS NP PROVIDER PTAN	P02533220 PROVIDER NPI	1457994436 EFFECTIVE DATE	08/01/2020 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	  ', NULL, NULL, '2021-03-26 11:03:05', '2021-03-26 11:03:05'),
(25271, 3046, 22527, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:33', '2021-03-16 16:41:33'),
(25272, 1006, 22527, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are added under group PTAN and provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MARY C GONZALEZ NP PROVIDER PTAN	P02490924 PROVIDER NPI	1952713083 EFFECTIVE DATE	05/01/2020 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	  ', NULL, NULL, '2021-03-26 11:17:10', '2021-03-26 11:17:10'),
(25273, 3046, 22528, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:35', '2021-03-16 16:41:35'),
(25274, 1006, 22528, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are added under group PTAN and the provider is linked to the group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	TRACI SMITH MASON NP PROVIDER PTAN	P02133482 PROVIDER NPI	1497127831 EFFECTIVE DATE	08/10/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 11:17:54', '2021-03-26 11:17:54'),
(25275, 3046, 22529, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:37', '2021-03-16 16:41:37'),
(25276, 1006, 22529, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under one PTAN for the group which providers are added under.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	KATHERINE C RABAGOS NP PROVIDER PTAN	P01596057 PROVIDER NPI	1134415631 EFFECTIVE DATE	04/12/2014 END DATE 	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE ', NULL, NULL, '2021-03-26 11:18:39', '2021-03-26 11:18:39'),
(25277, 3046, 22530, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:37', '2021-03-16 16:41:37'),
(25278, 1006, 22530, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are already listed under group PTAN and the provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	PETINA L ROGERS NP PROVIDER PTAN	P02405363 PROVIDER NPI	1801443916 EFFECTIVE DATE	10/10/2019 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 11:19:15', '2021-03-26 11:19:15'),
(25279, 3046, 22531, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:41:39', '2021-03-16 16:41:39'),
(25280, 1006, 22531, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group locations are all added under group PTAN and provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MAEGAN J SVATEK NP PROVIDER PTAN	P02133470 PROVIDER NPI	1639670250 EFFECTIVE DATE	06/08/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 11:19:47', '2021-03-26 11:19:47'),
(25281, 3046, 22532, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:42:05', '2021-03-16 16:42:05'),
(25282, 1006, 22532, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations for Statcare are listed under only one PTAN.   Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 GROUP NPI	1689924904 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 09:40:43', '2021-03-26 09:40:43'),
(25283, 3046, 22533, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:32', '2021-03-16 16:44:32'),
(25284, 1006, 22533, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:09', '2021-03-31 15:24:09'),
(25285, 3046, 22534, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:33', '2021-03-16 16:44:33'),
(25286, 1006, 22534, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:15', '2021-03-31 15:24:15'),
(25287, 3046, 22535, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:35', '2021-03-16 16:44:35'),
(25288, 1006, 22535, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:20', '2021-03-31 15:24:20'),
(25289, 3046, 22536, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:36', '2021-03-16 16:44:36'),
(25290, 1006, 22536, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:25', '2021-03-31 15:24:25'),
(25291, 3046, 22537, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:38', '2021-03-16 16:44:38'),
(25292, 1006, 22537, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:29', '2021-03-31 15:24:29'),
(25293, 3046, 22538, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:39', '2021-03-16 16:44:39'),
(25294, 1006, 22538, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:34', '2021-03-31 15:24:34'),
(25295, 3046, 22539, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:41', '2021-03-16 16:44:41'),
(25296, 1006, 22539, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:40', '2021-03-31 15:24:40'),
(25297, 3046, 22540, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:42', '2021-03-16 16:44:42'),
(25298, 1006, 22540, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:44', '2021-03-31 15:24:44'),
(25299, 3046, 22541, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:43', '2021-03-16 16:44:43'),
(25300, 1006, 22541, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:50', '2021-03-31 15:24:50'),
(25301, 3046, 22542, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:44:45', '2021-03-16 16:44:45'),
(25302, 1006, 22542, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:24:54', '2021-03-31 15:24:54'),
(25303, 3046, 22543, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:46:35', '2021-03-16 16:46:35'),
(25304, 3040, 22543, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:48:34', '2021-04-07 13:48:34'),
(25305, 3040, 22543, NULL, '2021-04-16 00:00:00.000', 'In Process', 'I had a word with (Veronica) Superior Healthplan representative and she said we need to enroll the group and after that enroll the provider.   Ref: i53972195  ', NULL, NULL, '2021-04-09 14:15:56', '2021-04-09 14:15:56'),
(25306, 3040, 22543, NULL, '2021-06-17 00:00:00.000', 'On Hold', 'I had a word with (Veronica) Superior Healthplan representative and she said we need to enroll the group and after that enroll the provider.   Ref: i53972195 ', NULL, NULL, '2021-06-10 10:27:09', '2021-06-10 10:27:09'),
(25307, 1006, 22543, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Received the following email from Superior @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com ​  Sub: [secure] RE: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health || ref#34556  \"Hello Adil,  To have the group enrolled with Superior Healthplan you would need to submit a request through our website. I have provided the link below. Every provider that will be participating and services members will need to also have a request submitted.  https://www.superiorhealthplan.com/providers/become-a-provider.html  Should you have any questions, please do let me know.  Thank you,  Patricia Torres Provider Account Manager II  SUPERIOR 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401 Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com\"   Submitted enrollment via the superior website, attached form for reference in main group tasks.', NULL, NULL, '2021-06-15 17:04:14', '2021-06-15 17:04:14'),
(25308, 11056, 22543, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to :    AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status Query - Superior Health - Statcare Minor Emergency Clinic  Greetings,  Hope you are doing well. I want to inquire about the enrollment status of the group and providers. We have submitted the enrollment via the superior website on 06/15/2021. How long it will take to complete the credentialing process?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please Respond soon. Waiting to hear from you soon. If you have any questions or concerns feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 15:44:14', '2021-07-01 15:44:14'),
(25309, 1006, 22543, NULL, '2021-07-12 00:00:00.000', 'In Process', 'We received the following reply from AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status Query - Superior Health - Statcare Minor Emergency Clinic  \"Good afternoon Ahmed  Can you kindly provide the following information so that way I can process your request  ·         Provider NPI#  ·         Provider TID#   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 \"  Sent following reply to them:  \"Hello,  Sure thing, the group information is as follows:  Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  The enrollment request was submitted back in June. Please let me know if it was received and is being processed.  Thank you.\"', NULL, NULL, '2021-07-05 16:33:47', '2021-07-05 16:33:47'),
(25310, 1006, 22543, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:01:57', '2021-07-15 11:01:57'),
(25311, 1006, 22543, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:10:02', '2021-08-17 17:10:02'),
(25312, 1006, 22543, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:35:18', '2021-09-01 15:35:18'),
(25313, 11056, 22543, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:04:33', '2021-09-22 12:04:33'),
(25314, 11056, 22543, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 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   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:06:34', '2021-09-29 17:06:34'),
(25315, 11056, 22543, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:31:40', '2021-10-12 14:31:40'),
(25316, 11056, 22543, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:56:10', '2021-10-20 12:56:10'),
(25317, 11056, 22543, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:39', '2021-11-10 17:30:39'),
(25318, 11056, 22543, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:38', '2021-11-19 17:38:38'),
(25319, 11056, 22543, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:46:10', '2021-12-01 12:46:10'),
(25320, 11056, 22543, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  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	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:41:20', '2021-12-16 16:41:20'),
(25321, 11056, 22543, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   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	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:33:57', '2021-12-23 15:33:57'),
(25322, 19067, 22543, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:03:58', '2022-01-10 18:03:58'),
(25323, 19067, 22543, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:17:15', '2022-01-26 17:17:15'),
(25324, 19067, 22543, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:53:46', '2022-02-11 14:53:46'),
(25325, 19067, 22543, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:31:52', '2022-02-21 17:31:52'),
(25326, 19067, 22543, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:46:14', '2022-03-15 17:46:14'),
(25327, 22077, 22543, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  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   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:41:18', '2022-04-22 14:41:18'),
(25328, 3046, 22544, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:46:37', '2021-03-16 16:46:37'),
(25329, 3040, 22544, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:26', '2021-04-07 13:51:26'),
(25330, 9057, 22544, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice 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 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:03:20', '2021-05-26 15:03:20'),
(25331, 1006, 22544, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:09:13', '2021-06-15 17:09:13'),
(25332, 1006, 22544, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:29:47', '2021-07-20 10:29:47'),
(25333, 1006, 22544, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:09:35', '2021-08-17 17:09:35'),
(25334, 1006, 22544, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:35:11', '2021-09-01 15:35:11'),
(25335, 11056, 22544, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:04:26', '2021-09-22 12:04:26');
