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
(2105, 3040, 375, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:54', '2021-07-06 09:58:54'),
(2106, 3040, 375, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:41', '2021-07-26 15:24:41'),
(2107, 11056, 375, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:11:41', '2021-08-13 14:11:41'),
(2108, 3040, 375, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:11', '2021-08-25 15:00:11'),
(2109, 3040, 375, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:52', '2021-09-09 13:07:52'),
(2110, 3040, 375, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:53', '2021-09-09 13:07:53'),
(2111, 10057, 375, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:16:32', '2021-10-18 15:16:32'),
(2112, 10057, 375, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:01:14', '2021-11-11 13:01:14'),
(2113, 10057, 375, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:52', '2021-11-30 10:48:52'),
(2114, 10057, 375, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:05:06', '2021-12-06 16:05:06'),
(2115, 10057, 375, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:58', '2021-12-13 10:48:58'),
(2116, 10057, 375, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:55:09', '2021-12-20 13:55:09'),
(2117, 10057, 375, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:55:06', '2021-12-27 09:55:06'),
(2118, 10057, 375, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:31', '2021-12-30 09:22:31'),
(2119, 19067, 375, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:04:45', '2022-01-04 16:04:45'),
(2120, 20067, 375, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:33:17', '2022-01-14 10:33:17'),
(2121, 20067, 375, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of Directory  Effective date: 11/11/2021', NULL, NULL, '2022-01-24 12:53:30', '2022-01-24 12:53:30'),
(2122, 2027, 376, NULL, NULL, 'In Process', 'To:	TCHPNetworkManagemen@texaschildrens.org  Email to insurance for Credentialing status of Provider Odette Tiranke Kourouma  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Odette Tiranke Kourouma NPI# 1134525868 Group Name: Normandy Urgent Care Center Tax-ID: 27-0796429  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-17 12:54:12', '2020-06-17 12:54:12'),
(2123, 2027, 376, NULL, NULL, 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: Need status update of Provider Odette Tiranke Kourouma  Hello,  Hope you are doing great, I want to know about the current status of the provider. Following are the details: Provider Name: Odette Tiranke Kourouma NPI# 1134525868 Group Name: Normandy Urgent Care Center Tax-ID: 27-0796429  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-24 09:54:16', '2020-06-24 09:54:16'),
(2124, 2027, 376, NULL, NULL, 'In Process', 'To: 	TCHPNetworkManagemen@texaschildrens.org  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Texas Children Health Plan - TCHP)  Hello,  Hope you are doing great, I want to know about the current status of the provider. Following are the details: Provider Name: Odette Tiranke Kourouma NPI# 1134525868 Group Name: Normandy Urgent Care Center Tax-ID: 27-0796429  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-07-14 17:21:24', '2020-07-14 17:21:24'),
(2125, 2027, 376, NULL, NULL, 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Hello, I was not able to find an LOI for provider Odette Tiranke Kourouma. Please provide LOI and current W9. Thank you', NULL, NULL, '2020-07-15 10:15:46', '2020-07-15 10:15:46'),
(2126, 2027, 376, NULL, NULL, 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Please find the attached documents which you have requested LOI and W9 for Odette   Thanks.', NULL, NULL, '2020-07-15 10:17:10', '2020-07-15 10:17:10'),
(2127, 2027, 376, NULL, '2020-09-08 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-09-01 09:40:22', '2020-09-01 09:40:22'),
(2128, 2027, 376, NULL, '2020-10-19 00:00:00.000', 'Approved', 'This provider is now showing linked with the insurance and effective date is 03/29/2020', NULL, NULL, '2020-10-12 15:52:37', '2020-10-12 15:52:37'),
(2129, 2027, 384, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  I want to enroll this provider in scott&white. Details are mentioned below: Provider Name- George, Jeemol Provider NPI# 1497219067  Thanks.', NULL, NULL, '2020-10-11 15:20:56', '2020-10-11 15:20:56'),
(2130, 2037, 384, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent for the procedure', NULL, NULL, '2020-10-26 16:40:23', '2020-10-26 16:40:23'),
(2131, 2037, 384, NULL, '2020-11-26 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2020-11-19 15:46:54', '2020-11-19 15:46:54'),
(2132, 2027, 385, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  (Kourouma , Odette Tiranke)-(Longpoint Medical Center)-(Scott & White)  I want to enroll this provider with Scott & White please assist me how I can start the process. Details of the provider are mentioned below:  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Thanks. ', NULL, NULL, '2020-10-11 16:05:56', '2020-10-11 16:05:56'),
(2133, 2037, 385, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent for the process', NULL, NULL, '2020-10-26 17:15:29', '2020-10-26 17:15:29'),
(2134, 2037, 385, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follw up email sent to HPCREDENTIALINGEXPEDITE@bswhealth.org', NULL, NULL, '2020-11-16 12:32:47', '2020-11-16 12:32:47'),
(2135, 2037, 385, NULL, '2020-11-26 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2020-11-19 15:47:04', '2020-11-19 15:47:04'),
(2136, 2027, 386, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  I want to enroll this provider with Scott & White please assist me how I can start the process. Details of the provider are mentioned below:  Provider Name: Jose, Julie  Provider NPI# 1447883061  Thanks. ', NULL, NULL, '2020-10-11 15:49:15', '2020-10-11 15:49:15'),
(2137, 2037, 386, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Follow up email sent for the process', NULL, NULL, '2020-10-26 17:09:43', '2020-10-26 17:09:43'),
(2138, 2037, 386, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Application submitted online . form submission identifier is: a9622949-ed00-4618-aa0b-3706ffb52133', NULL, NULL, '2020-11-18 15:41:40', '2020-11-18 15:41:40'),
(2139, 2037, 386, NULL, '2020-11-26 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2020-11-19 15:47:12', '2020-11-19 15:47:12'),
(2140, 2027, 387, NULL, NULL, 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org   Last Name  First Name  NPI  TIN  ORG name  George  Jeemol  1497219067  27-0796429  Normandy Urgent Care Center PA  Jose  Julie  1447883061  27-0796429  Normandy Urgent Care Center PA  Joseph  Vibitha  1952931560  27-0796429  Normandy Urgent Care Center PA        Need information in the next 10 days (July 24, 2020).  No follow up email will be sent.     Here at Scott & White Health Plan (SWHP) and First Care Health Plan (FCHP) we take pride in working expeditiously to provide you with quality service in a timely and accurate manner. We have recently received a request to add a provider(s) to your existing SWHP or FCHP group agreement. In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept. and our Credentialing Verification Organization (CVO), Aperture Credentialing.     Please forward, via email to HPCREDENTIALINGEXPEDITE@BSWHealth.org, with the subject line EXPEDITED and the attached documents before the above date so we can initiate the process to start your credentialing process.     Required:  1.      Provider Information Spreadsheet – This is not your credentialing application.  This provides us information to send to Aperture to get you started with their request.  If you use CAQH please ensure your information and attestations are up to date and that you have designated SWHP and/or FCHP as an authorized provider.  If you do not use CAQH please send us your Texas Standardized Credentialing Application (TSCA) and attachments.   2.       Copy of the W-9  If applicable:  3.       Privilege Exception/Mid-Level Form - If applicable  4.       CME Acknowledgement:  For any non-boarded PHYSICIANs, who are no longer in the eligibility period for certification, SWHP and FCHP requires additional CMEs annually.  To acknowledge this requirement please sign, date, and return the attached CME form.     This will be the only request sent from SWHP and FCHP requesting these items above to initiate the credentialing process. If the information above has not been received within 10 days, you will be required to re-apply through www.swhp.org     Once we have processed the initial information the Credentialing process will begin. Once credentialing is complete, we will contact you with your effective date. If you have any questions or concerns please contact your provider relations representatives.     Thank you,   ', NULL, NULL, '2020-07-13 14:47:55', '2020-07-13 14:47:55'),
(2141, 2027, 387, NULL, NULL, 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub: EXPEDITED  Please Find the attached documents which you have requested for credentialing of these providers.  Name            NP#                      Tax-ID                           Group george  -  1497219067 -   27-0796429 -   Normandy Urgent Care Center PA   Jeemol    Jose     -    1447883061 -  27-0796429 -   Normandy Urgent Care Center PA    Julie    Joseph -    1952931560 -   27-0796429 -  Normandy Urgent Care Center PA    Vibitha        Thanks.', NULL, NULL, '2020-07-13 14:48:45', '2020-07-13 14:48:45'),
(2142, 2027, 387, NULL, '2020-09-15 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Scott & White)  May I know the current status of the provider mentioned below: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-08 16:55:29', '2020-09-08 16:55:29'),
(2143, 2027, 387, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From: SWHPEXPEDITES@bswhealth.org  The provider information for Cini Thomas and Julie Jose to be added to Normandy Urgent Care Center has been received and is in process.     He/she has an effective date of 10/12/2020.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.     Thank you and have a great day.        Provider Relations  Scott & White/FirstCare Health Plan', NULL, NULL, '2020-10-12 17:35:56', '2020-10-12 17:35:56'),
(2144, 1006, 387, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Sent a follow-up email to SWHPEXPEDITES@bswhealth.org regarding enrollment status. ', NULL, NULL, '2020-10-26 13:38:47', '2020-10-26 13:38:47'),
(2145, 2027, 387, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Scott & White)  May I know the current status of the provider mentioned below: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-10-30 13:36:26', '2020-10-30 13:36:26'),
(2146, 2027, 387, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 14:32:59', '2020-11-06 14:32:59'),
(2147, 2037, 387, NULL, '2020-11-20 00:00:00.000', 'In Process', ' Follow up email sent for confirmation.SWHPEXPEDITES@bswhealth.org  (Jose, Julie)-(Normandy Urgent Care Center)-(Scott & White)  Greetings, We received an email on 10/12/2020 for Julie Jose mentioning that the provider has an effective date of 10/12/2020 however we need to wait 3 to 4 weeks before sending claims.It has been 4 weeks since we received that notification just wanted to double check has the provider been completely loaded and If we may start billing now. Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 A prompt response will be greatly appreciated.', NULL, NULL, '2020-11-13 17:12:21', '2020-11-13 17:12:21'),
(2148, 2037, 387, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Welcome Letter Requested. --------------------------------------------- From: HP CREDENTIALING EXPEDITE HPCREDENTIALINGEXPEDITE@bswhealth.org Date: Wed, Nov 18, 2020 at 3:00 PM Subject: RE: Re: (Jose, Julie)-(Normandy Urgent Care Center)-(Scott & White) To: Martin Rodriguez mk@claimsmedinc.com   Provider is effective 10.12.2020.     Thank you,', NULL, NULL, '2020-11-19 17:13:31', '2020-11-19 17:13:31'),
(2149, 2037, 387, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Waiting for the welcome letter', NULL, NULL, '2020-11-30 17:52:17', '2020-11-30 17:52:17'),
(2150, 2037, 387, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent for the welcome letter', NULL, NULL, '2020-12-08 14:45:38', '2020-12-08 14:45:38'),
(2151, 2037, 387, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Follow up email sent for the welcome letter', NULL, NULL, '2020-12-16 17:12:06', '2020-12-16 17:12:06'),
(2152, 2037, 387, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Follow up email sent for the welcome letter', NULL, NULL, '2020-12-29 16:51:40', '2020-12-29 16:51:40'),
(2153, 1006, 387, NULL, '2021-02-17 00:00:00.000', 'Approved', 'The provider has been approved since 10/12/2020, approval confirmation has been attached for reference. ', NULL, NULL, '2021-02-10 17:25:32', '2021-02-10 17:25:32'),
(2154, 2027, 388, NULL, NULL, 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: Need Status Update For The Provider Odette Tiranke Kourouma  Hello,   Hope you are doing great, I want to know about the current status of the provider.  Following are the details:  Provider Name: Odette Tiranke Kourouma  NPI# 1134525868  Group Name: Normandy Urgent Care Center  Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-18 12:56:54', '2020-06-18 12:56:54'),
(2155, 2027, 388, NULL, NULL, 'In Process', 'To: 	SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: Need Status Update For The Provider Odette Tiranke Kourouma  Hello,   Hope you are doing great, I want to know about the current status of the provider.  Following are the details:  Provider Name: Odette Tiranke Kourouma  NPI# 1134525868  Group Name: Normandy Urgent Care Center  Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-24 13:21:51', '2020-06-24 13:21:51'),
(2156, 2027, 388, NULL, '2020-08-18 00:00:00.000', 'In Process', 'To: 	SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Scott & White)  Hope you are doing great, I want to know about the current status of the provider.  Following are the details:  Provider Name: Odette Tiranke Kourouma  NPI# 1134525868  Group Name: Normandy Urgent Care Center  Tax ID: 27-0796429  Thanks.  ', NULL, NULL, '2020-08-11 12:49:47', '2020-08-11 12:49:47'),
(2157, 1006, 388, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Tried calling in @ 254-298-3064 and left a VM.  Sent a followup email @ swhpproviderrepresentative@bwshealth.org for status update. ', NULL, NULL, '2020-10-16 13:40:40', '2020-10-16 13:40:40'),
(2158, 2037, 388, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent a followup email @ swhpproviderrepresentative@bwshealth.org for status update. ', NULL, NULL, '2020-10-26 17:27:30', '2020-10-26 17:27:30'),
(2159, 2027, 388, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: swhpproviderrepresentative@bwshealth.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-10 13:37:33', '2020-11-10 13:37:33'),
(2160, 2037, 388, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-18 15:44:44', '2020-11-18 15:44:44'),
(2161, 2037, 388, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-11-30 17:52:40', '2020-11-30 17:52:40'),
(2162, 2037, 388, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:46:00', '2020-12-08 14:46:00'),
(2163, 2037, 388, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org', NULL, NULL, '2020-12-17 17:14:40', '2020-12-17 17:14:40'),
(2164, 2037, 388, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Response received : Filled online form and re-submitted as they do not have any previous records of request submission ----------  SWHP PROVIDER NETWORK DEVELOPMENT Dec 18, 2020, 5:11 AM (4 days ago) to me  Dear Provider,  As your predecessor was told dozens of times via email and voicemail, to add this provider to an existing contract you must use the link below: https://swhp.org/forms/html/add-provider-to-contract-request.html  Until this is done, the request is not receive and cannot be processed. Thank you ---------------- .Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 80e380f3-b7ec-4b5c-9d86-47ca402ddb92', NULL, NULL, '2020-12-22 09:57:09', '2020-12-22 09:57:09'),
(2165, 1006, 388, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Received following email form S&W: \"Good Morning/Afternoon,  Here at Scott & White/FirstCare Health Plan we take pride in working expediently to provide you with quality service in a timely and accurate manner.  We have recently received a request to add a provider(s) to your existing Scott & White/FirstCare Health Plan group agreement.  In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept.     Please return the documents (to us via email swhpexpedites@bswhealth.org) listed below to us within 5 business days:     Provider Information Form (attached) ***NEW PIF TEMPLATE (Dated 3/23/2020); PLEASE DISCARD ALL PREVIOUS VERSION.***  Copy of the W- 9 (attached)     This will be the only request sent.  Any documents received after 30 calendar days, will not be processed and will require you re-apply through www.swhp.org     Thank You,  Provider Relations  Provider Service Specialist\"  Forms were filled and sent back, attached for reference. ', NULL, NULL, '2021-01-06 12:07:45', '2021-01-06 12:07:45'),
(2166, 1006, 388, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Received the following reply from @ SWHP EXPEDITES SWHPEXPEDITES@bswhealth.org:  \"The provider information for Odette Kourouma to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 2/19/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.   Thank you and have a great day.  Provider Relations Scott & White/FirstCare Health Plan\"', NULL, NULL, '2021-02-09 15:35:41', '2021-02-09 15:35:41'),
(2167, 1006, 388, NULL, '2021-02-16 00:00:00.000', 'Approved', NULL, NULL, NULL, '2021-02-09 16:45:55', '2021-02-09 16:45:55'),
(2168, 2027, 397, NULL, NULL, 'Approved', 'talk to the representative her name is cheryl ref# 1000147335813 this provider is already in network and e.d is 12/18/2018 link letter attached', NULL, NULL, '2020-07-01 13:40:21', '2020-07-01 13:40:21'),
(2169, 2027, 411, NULL, NULL, 'Approved', '	 Effective Date: 10/23/2018.', NULL, NULL, '2020-06-12 17:11:00', '2020-06-12 17:11:00'),
(2170, 3040, 419, NULL, NULL, 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Type of Contract || Valley Med Urgent Care PLLC ||Health Smart ||  Greetings,   Hope you are doing well. Can you please advise me the type of contract we have under the Tax ID# 81-5123542 and also verify me that below locations are updated in the contract. Would it be possible for you to send the provider roster if not at least send me the list of the providers coming up under the system.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-25 12:22:44', '2021-03-25 12:22:44');
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
(2171, 3040, 419, NULL, NULL, 'Revalidated', 'Email sent to: pr.south@healthsmart.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. I wanted to add the below mentioned group and providers in Health smart for our group Valley Med Urgent Care PLLC under the below mentioned locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Effective Date: 07/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Effective Date: 02/01/2013 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Effective Date: 03/01/2020 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 4: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852 Effective Date: 05/01/2018 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 5: Provider Name: Garcia, Homero Provider NPI# 1730564857 Effective Date: 02/01/2019 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 6: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Effective Date: 08/01/2020 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:08:22', '2021-04-14 13:08:22'),
(2172, 3040, 425, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:45:17', '2021-04-26 10:45:17'),
(2173, 3040, 425, NULL, NULL, 'Revalidated', 'Email rcvd from: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Good Afternoon Brad  I reviewed each of the PCP’s individual NPI numbers.  The majority of the providers are not contracted or affiliated to Valley Med.  Please fill out the contract request form to add or affiliate them to the group and to get them contracted, please review the attached spreadsheet.  I have attached the Contract request form, please fill out the form for each provider and email or fax it in, information located at the top of the form.   Please call me if you have any questions.    Provider Name               NPI#                Contract  Eder Hernandez      1386956852         Affiliated         Yes  Thank you David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc.', NULL, NULL, '2021-04-26 11:16:08', '2021-04-26 11:16:08'),
(2174, 2027, 429, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To; 	HumanaHoustonPD@humana.com, Yvonne Wyatt ywyatt@humana.com  May I know the current enrollment status of the below mentioned provider:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560   Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-08 10:56:36', '2020-10-08 10:56:36'),
(2175, 2037, 429, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent to HumanaHoustonPD@humana.com ---------------- May I know the current enrollment status of the below mentioned provider:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560   Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-28 17:07:21', '2020-10-28 17:07:21'),
(2176, 2027, 429, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  Please find the roster along with the w9 attached in this email for provider addition purposes in the existing group contract.  Thanks.', NULL, NULL, '2020-11-19 10:41:14', '2020-11-19 10:41:14'),
(2177, 2027, 429, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  May I know the current status of this request?', NULL, NULL, '2020-11-30 13:07:38', '2020-11-30 13:07:38'),
(2178, 2037, 429, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Request is in process need to allow more time', NULL, NULL, '2020-12-08 13:48:19', '2020-12-08 13:48:19'),
(2179, 1006, 429, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD HumanaHoustonPD@humana.com', NULL, NULL, '2020-12-15 17:42:30', '2020-12-15 17:42:30'),
(2180, 2037, 429, NULL, '2020-12-28 00:00:00.000', 'Approved', 'Email received! Columbus is contracted as an Ancillary facility. We do not load/link individual physicians to this TIN.  Yes.   However, we recommend that you list the Billing NPI in both the billing and rendering fields.  --------------------- Contract uploaded and Notification sent to the billing. Par Plans: ------------ Commercial PPO Plans. Commercial HMO Plans. Commercial POS Plans. Commercial EPO Plans. Commercial Open Access Plans. Medicare PPO Plans. Medicare Network PFFS Plans. Traditional Plans. Choice POS Plans. ', NULL, NULL, '2020-12-21 17:45:40', '2020-12-21 17:45:40'),
(2181, 3040, 429, NULL, NULL, 'Revalidation', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Greetings,   Hope you are doing well. Please find the attached roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-11 15:59:46', '2021-05-11 15:59:46'),
(2182, 3040, 429, NULL, '2021-06-16 00:00:00.000', 'Revalidation', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment Status - CUCC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-09 17:04:05', '2021-06-09 17:04:05'),
(2183, 3040, 429, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  No previous record of receipt of a request to add these practitioners.   Follow the below instructions to add new practitioners to an existing group.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the standard roster, on the Practitioner Adds tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-06-21 13:45:31', '2021-06-21 13:45:31'),
(2184, 3040, 429, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID#  Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as possible.  Thank you. ', NULL, NULL, '2021-06-21 13:47:23', '2021-06-21 13:47:23'),
(2185, 3040, 429, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: mduffee@humana.com  Subject: Provider Roster  Hello Micheal,   Hope you are doing well. I reviewed all the corrections that you mentioned on roster. Can you please advise rather than panel assignment if we added the providers in group contract so can we bill those provider under the group.   Please get back to me as soon as  you can get a chance. Waiting to hear from you soon.   Thank you    On 9 June 2021, \"Michael Duffee\"  wrote: > Hello Adil, I have review the roster and only one provider is eligible for credentialing at this time, the remainder are not at this time.  Please review my comments and make the necessary updates.  Once all have been updated, please notify me when the documents are viewable and I will review further at this time.  One provider Jaya Jacob is not eligible until December 2022 and provider Ani Stephen  had a incorrect CAQH number on the roster and that also needs to be corrected for further review.  Any questions, please let me know.  Thank you.  ', NULL, NULL, '2021-06-21 14:27:12', '2021-06-21 14:27:12'),
(2186, 3040, 429, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Hello,   Hope you are doing well. As per Michael Dufee email please find the attached updated roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 10:11:41', '2021-07-09 10:11:41'),
(2187, 3040, 429, NULL, '2021-09-02 00:00:00.000', 'Revalidation', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster Hello,   Hope you are doing well. As per Micheal email I updated the information in CAQH for the below mentioned providers. I added the remarks below for your review.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  **** DEA and Medical License needed. Incomplete education listed, No Medicare, Full Hospital privileges needed.   Doesn\'t have DEA Education lited updated Medicare Updated Hospital Privileges under supervising physician   Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  **** No DEA or State License indicated. No Medicare, Full Hospital privileges needed  Doesn\'t have DEA State license updated  Medicare Updated Hospital Privileges under supervising physician   Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  **** No State License or Medicare. Full Hospital privileges needed  State license updated Medciare updated  Hospital Privileges under supervising physician   Provider 4: Provider Name: Abraham, Glory Provider NPI# 1194206490  **** Full Medical License needed with expiration date needed, No DEA   DEA updated in the system  Full medical license updated   Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  *** Full Medical License needed with expiration date needed,  No Medicare, Full Hospital privileges needed.  Updated medical license  Medicare updated Hospital Privileges under supervising physician   Provider 7: Provider Name: PAUL, SIGI Provider NPI# 1033623616  **** Liability insurance can not be used as its for a different location. Employment gap January 2017-January 2021. Any gaps greater than 6 months, need a explanation.  Full Hospital privileges needed  Hospital Privileges under supervising physician  Liability insurance updated  Employment details updated in CAQH  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-26 10:31:38', '2021-08-26 10:31:38'),
(2188, 3040, 429, NULL, '2021-09-02 00:00:00.000', 'Revalidation', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster Hello,   Hope you are doing well. As per Micheal email I updated the information in CAQH for the below mentioned providers. I added the remarks below for your review.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  **** DEA and Medical License needed. Incomplete education listed, No Medicare, Full Hospital privileges needed.   Doesn\'t have DEA Education lited updated Medicare Updated Hospital Privileges under supervising physician   Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  **** No DEA or State License indicated. No Medicare, Full Hospital privileges needed  Doesn\'t have DEA State license updated  Medicare Updated Hospital Privileges under supervising physician   Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  **** No State License or Medicare. Full Hospital privileges needed  State license updated Medciare updated  Hospital Privileges under supervising physician   Provider 4: Provider Name: Abraham, Glory Provider NPI# 1194206490  **** Full Medical License needed with expiration date needed, No DEA   DEA updated in the system  Full medical license updated   Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  *** Full Medical License needed with expiration date needed,  No Medicare, Full Hospital privileges needed.  Updated medical license  Medicare updated Hospital Privileges under supervising physician   Provider 7: Provider Name: PAUL, SIGI Provider NPI# 1033623616  **** Liability insurance can not be used as its for a different location. Employment gap January 2017-January 2021. Any gaps greater than 6 months, need a explanation.  Full Hospital privileges needed  Hospital Privileges under supervising physician  Liability insurance updated  Employment details updated in CAQH  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-26 10:31:39', '2021-08-26 10:31:39'),
(2189, 3040, 429, NULL, '2021-09-02 00:00:00.000', 'Revalidation', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster Hello,   Hope you are doing well. As per Micheal email I updated the information in CAQH for the below mentioned providers. I added the remarks below for your review.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  **** DEA and Medical License needed. Incomplete education listed, No Medicare, Full Hospital privileges needed.   Doesn\'t have DEA Education lited updated Medicare Updated Hospital Privileges under supervising physician   Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  **** No DEA or State License indicated. No Medicare, Full Hospital privileges needed  Doesn\'t have DEA State license updated  Medicare Updated Hospital Privileges under supervising physician   Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  **** No State License or Medicare. Full Hospital privileges needed  State license updated Medciare updated  Hospital Privileges under supervising physician   Provider 4: Provider Name: Abraham, Glory Provider NPI# 1194206490  **** Full Medical License needed with expiration date needed, No DEA   DEA updated in the system  Full medical license updated   Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  *** Full Medical License needed with expiration date needed,  No Medicare, Full Hospital privileges needed.  Updated medical license  Medicare updated Hospital Privileges under supervising physician   Provider 7: Provider Name: PAUL, SIGI Provider NPI# 1033623616  **** Liability insurance can not be used as its for a different location. Employment gap January 2017-January 2021. Any gaps greater than 6 months, need a explanation.  Full Hospital privileges needed  Hospital Privileges under supervising physician  Liability insurance updated  Employment details updated in CAQH  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-26 10:31:39', '2021-08-26 10:31:39'),
(2190, 10057, 429, NULL, '2021-10-19 00:00:00.000', 'Revalidation', 'Email Received From : mduffee@humana.com  Sub : Provider Enrollment Request - CUCC - Humana  Hi Steve, All are loaded and linked to the TIN provided. Please see below, take care and enjoy your day.  Effective Date : 07/09/2021', NULL, NULL, '2021-10-12 10:05:38', '2021-10-12 10:05:38'),
(2191, 10057, 429, NULL, '2021-11-24 00:00:00.000', 'Revalidated', 'Email Received From : mduffee@humana.com  Sub : Provider Enrollment Request - CUCC - Humana  Hi Steve, All are loaded and linked to the TIN provided. Please see below, take care and enjoy your day.  Effective Date : 07/09/2021', NULL, NULL, '2021-11-17 17:41:47', '2021-11-17 17:41:47'),
(2192, 2027, 440, NULL, NULL, 'In Process', 'To: appmissinginfo@multiplan.com  Sub: Final Request for credentialing material application form for Mini Chnemkara  Hello,  Hope you are doing great. Please find the attached application form  for the provider Mini Chnemkara.  Thanks.', NULL, NULL, '2020-06-17 17:52:44', '2020-06-17 17:52:44'),
(2193, 2027, 441, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com  Sub: Need Status Update Of Provider Mini philip Chennemkara  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Mini philip Chennemkara NPI# 1841755956  Group Name: Columbus Urgent Care PA Tax-ID: 471914151  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-18 15:20:48', '2020-06-18 15:20:48'),
(2194, 2027, 441, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com  To: mk@claimsmedinc.com  Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5344954  Received On: Jun 18, 2020 3:24:22 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,', NULL, NULL, '2020-06-18 16:45:36', '2020-06-18 16:45:36'),
(2195, 2027, 441, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com  UnitedHealthcare Insurance Company  We’ve reviewed the provider/group updates you requested on Jun 18, 2020 3:24:21 PM. Your request was assigned reference number PR-5344954.    We determined that your request can’t be completed.   Action May Be Needed Please see the attached report and review the Comments column for details. If comments indicate resubmission or missing information is needed, resubmit your original request with all indicated information.    The original submission is attached for your reference.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2020-07-23 09:25:09', '2020-07-23 09:25:09'),
(2196, 2027, 441, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com   We’ve reviewed the provider/group updates you requested on Jun 18, 2020 3:24:21 PM. Your request was assigned reference number PR-5344954.    We determined that your request can’t be completed.   Action May Be Needed Please see the attached report and review the Comments column for details. If comments indicate resubmission or missing information is needed, resubmit your original request with all indicated information.    The original submission is attached for your reference.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2020-07-23 10:15:14', '2020-07-23 10:15:14'),
(2197, 2027, 441, NULL, NULL, 'In Process', 'This is an urgent care contract and we have already requested to make it a group contract so we have to wait until they change it into a group contract and then we will request to link this provider in their network.', NULL, NULL, '2020-07-23 10:18:41', '2020-07-23 10:18:41'),
(2198, 2027, 441, NULL, NULL, 'In Process', 'To: 	corey_j_ford@uhc.com  Sub: (Chennemkara, Mini Philip)-(Columbus Urgent Care PA)-(United HealthCare - UHC)  Hello, Hope you are doing great, I have received an email from UHC in which they said they could not complete the enrollment process of the provider (Chennemkara, Mini Philip-NPI# 1841755956-Tax ID#471914151) with the ref# PR-5344954 but they didn\'t gave me the reason why they could not complete it and they asked me to contact the network account manager, so kindly look into this and reply me as soon as you get this email.  Thanks.', NULL, NULL, '2020-07-30 10:15:40', '2020-07-30 10:15:40'),
(2199, 2027, 441, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:57:54', '2020-10-12 17:57:54'),
(2200, 1006, 441, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:48:58', '2020-10-26 13:48:58'),
(2201, 2027, 441, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks. ', NULL, NULL, '2020-11-06 10:14:56', '2020-11-06 10:14:56'),
(2202, 2027, 441, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:52:10', '2020-11-13 16:52:10'),
(2203, 2027, 441, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:31:26', '2020-11-20 12:31:26'),
(2204, 2027, 441, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:31:38', '2020-11-20 12:31:38'),
(2205, 2027, 441, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:52:54', '2020-11-30 15:52:54'),
(2206, 2037, 441, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:59', '2020-12-08 17:17:59'),
(2207, 1006, 441, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:39:34', '2020-12-15 17:39:34'),
(2208, 1006, 441, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:39:41', '2020-12-15 17:39:41'),
(2209, 2037, 441, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 18:00:21', '2020-12-22 18:00:21'),
(2210, 1006, 441, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:55:13', '2021-02-02 17:55:13'),
(2211, 1006, 441, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:24:29', '2021-02-11 10:24:29'),
(2212, 3040, 441, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:44:17', '2021-05-20 14:44:17'),
(2213, 2027, 444, NULL, NULL, 'In Process', 'Talked to the representative of multiplan he said issue date for this provider has already issued by them the issue date is 05/21/2020 i asked for the welcome letter he said he will send by e-mail with in 6 days from now', NULL, NULL, '2020-06-17 10:22:26', '2020-06-17 10:22:26'),
(2214, 2027, 444, NULL, NULL, 'In Process', 'welcome letter received from insurance but the address is wrong waiting for change in address on the welcome letter  ', NULL, NULL, '2020-06-17 17:41:47', '2020-06-17 17:41:47'),
(2215, 2027, 444, NULL, NULL, 'In Process', 'today we received the welcome letter but the address is still wrong so i called again to multiplan and talked to the representative she said she will send the welcome letter again with the correct address in 5 business days.', NULL, NULL, '2020-06-18 10:29:56', '2020-06-18 10:29:56'),
(2216, 2027, 444, NULL, NULL, 'In Process', 'To: 	pif@multiplan.com  Sub: Received the welcome letter but the address is still wrong  Hello, Hope you are doing great, We have received the welcome letter for this provider but the address mentioned  on it is wrong. Can you just change the address on it and send it back to us. Provider\'s Details are as follows: Provider Name: Mini philip Chennemkara NPI# 1841755956 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-23 17:59:05', '2020-06-23 17:59:05'),
(2217, 2027, 444, NULL, NULL, 'In Process', 'Talk to the representative she said we will receive the welcome letter with in 5 business days with the correct address', NULL, NULL, '2020-07-10 14:13:01', '2020-07-10 14:13:01'),
(2218, 2027, 444, NULL, NULL, 'In Process', 'From: welcomepackets multiplan.com notification@multiplan-secure.com  Sub: SECURE: MultiPlan Network Participation (13824822-9629758)  Again they sent the welcome letter with wrong address so we have to follow up again with them until they sent us with with correct address.  ', NULL, NULL, '2020-07-13 09:35:05', '2020-07-13 09:35:05'),
(2219, 2027, 444, NULL, NULL, 'In Process', 'Talk to the representative she said we will sent again the welcome letter in 5 business days with the correct address', NULL, NULL, '2020-07-13 09:57:56', '2020-07-13 09:57:56'),
(2220, 2027, 444, NULL, NULL, 'In Process', 'From: noreplycustserv@multiplan.com  MultiPlan has added the following update to your Customer Service Case 7150345. We will keep you informed of further updates and resolution. You can check status and make updates to this case online.  Case has been Re-opened.  Case Number: 7150345    Submitter Name: Ahmed Khan    Date of submission: 03/09/2020    TIN: 27-0796429    Provider Name: Chennemkara, Mini Group Name: Normandy Urgent Care Center PA Inquiry Type: Credentialing Status • Request to add Provider to existing group    Priority: Standard', NULL, NULL, '2020-07-13 10:44:20', '2020-07-13 10:44:20'),
(2221, 2027, 444, NULL, NULL, 'In Process', 'Call to insurance talk to the representative she said now they have updated the address so we may get the welcome letter in 4 or 5 days', NULL, NULL, '2020-07-14 09:57:35', '2020-07-14 09:57:35'),
(2222, 2027, 444, NULL, NULL, 'Approved', 'Call To insurance: Talk to the representative her name is jenifer she said this provider is in network and the effective date is 3/10/2020 also welcome letter is received and attached', NULL, NULL, '2020-07-15 14:07:41', '2020-07-15 14:07:41'),
(2223, 1006, 483, NULL, '2021-09-09 00:00:00.000', 'Revalidation', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:35', '2021-09-02 10:26:35'),
(2224, 11056, 483, NULL, '2021-10-04 00:00:00.000', 'Revalidation', 'Disenrolled  Portal Ticket #Ascending	Application Name	NPI	Status Update Date	Transction Type	Status   15122518	Cynthia Malowitz	1336173244	6/22/2018	Enrollment - First Time Applicant	Closed', NULL, NULL, '2021-09-27 15:52:49', '2021-09-27 15:52:49'),
(2225, 11056, 483, NULL, '2021-12-08 00:00:00.000', 'Revalidated', 'Disenrolled  Portal Ticket #Ascending	Application Name	NPI	Status Update Date	Transction Type	Status   15122518	Cynthia Malowitz	1336173244	6/22/2018	Enrollment - First Time Applicant	Closed', NULL, NULL, '2021-12-01 12:23:23', '2021-12-01 12:23:23'),
(2226, 1006, 485, NULL, '2021-09-09 00:00:00.000', 'Revalidation', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:31', '2021-09-02 10:26:31'),
(2227, 11056, 485, NULL, '2021-10-04 00:00:00.000', 'Revalidation', 'Disenrolled  Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	 18058684	PIMS Enrollment Information 	9/14/2021	Provider Information Change (PIC) Form	Closed', NULL, NULL, '2021-09-27 15:59:16', '2021-09-27 15:59:16'),
(2228, 11056, 485, NULL, '2021-12-08 00:00:00.000', 'Revalidated', 'Disenrolled  Portal Ticket #Ascending	Application Name	NPI	Status Update Date	Transction Type	Status   15122518	Cynthia Malowitz	1336173244	6/22/2018	Enrollment - First Time Applicant	Closed', NULL, NULL, '2021-12-01 12:23:28', '2021-12-01 12:23:28'),
(2229, 1006, 486, NULL, NULL, 'Revalidation', 'Already submitted updated license on TMHP on 12/10/2020, it is still processing. Need to allow more time. ', NULL, NULL, '2021-01-06 16:03:22', '2021-01-06 16:03:22'),
(2230, 1006, 486, NULL, NULL, 'Revalidated', 'Kynda has been revalidated. Screenshot attached for reference.   ', NULL, NULL, '2021-04-23 16:12:32', '2021-04-23 16:12:32'),
(2231, 1006, 486, NULL, '2021-09-09 00:00:00.000', 'Revalidated', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:24', '2021-09-02 10:26:24'),
(2232, 11056, 486, NULL, '2021-10-04 00:00:00.000', 'Revalidated', 'Disenrolled =   Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	 18058723	PIMS Enrollment Information	9/15/2021	Provider Information Change (PIC) Form	Closed', NULL, NULL, '2021-09-27 16:05:57', '2021-09-27 16:05:57'),
(2233, 2028, 488, NULL, NULL, 'Rejected', 'No more active With NASA', NULL, NULL, '2020-06-29 09:53:02', '2020-06-29 09:53:02'),
(2234, 1006, 527, NULL, NULL, 'Revalidation', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  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, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:44:55', '2021-04-08 18:44:55'),
(2235, 3040, 527, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-06-10 12:36:40', '2021-06-10 12:36:40'),
(2236, 1006, 527, NULL, '2021-06-18 00:00:00.000', 'Revalidation', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:33', '2021-06-11 14:13:33'),
(2237, 3040, 527, NULL, '2021-07-07 00:00:00.000', 'Revalidation', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  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, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:18', '2021-06-30 15:21:18'),
(2238, 1006, 527, NULL, '2021-07-08 00:00:00.000', 'Revalidation', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:44', '2021-07-01 13:46:44'),
(2239, 1006, 527, NULL, '2021-07-19 00:00:00.000', 'Revalidation', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:29:39', '2021-07-12 13:29:39'),
(2240, 1006, 527, NULL, '2021-08-09 00:00:00.000', 'Revalidation', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:06', '2021-08-02 17:07:06'),
(2241, 1006, 527, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:33', '2021-08-05 09:46:33');
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
(2242, 11056, 527, NULL, '2021-09-28 00:00:00.000', 'Revalidation', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  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  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:54:00', '2021-09-21 16:54:00'),
(2243, 11056, 527, NULL, '2021-10-07 00:00:00.000', 'Revalidated', 'Email received from : michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello,  The additional service locations were loaded in our system on 8/23/21.  Facility contracting is completed.  Eff date is : 09/1/2021   Confirmed with rep.  Rep. : Jackie P  Ref code : JackieP  Please see the attachment.', NULL, NULL, '2021-09-30 13:24:50', '2021-09-30 13:24:50'),
(2244, 1006, 540, NULL, NULL, 'Revalidation', 'Location addition request has been submitted to Multiplan:  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: 7561594    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Ayarzagoitia, Patrick Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 16:50:14', '2021-03-30 16:50:14'),
(2245, 1006, 540, NULL, NULL, 'Revalidated', '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 14:17:48', '2021-04-29 14:17:48'),
(2246, 1006, 546, NULL, NULL, 'In Process', 'Request to get CCN contract for Triwest:   Sent following email to providercontractrequest@triwest.com:   Sub: CRM rhc@claimsmedinc.com>  \"Hello,   Our group is already enrolled with the Triwest PC3 but we wish to also enroll into CCN as soon as possible. Group information is as follows:   Group Name: Statcare Minor Emergency Clinic  NPI# 1689924904 TIN# 46-0575924  Please get back to me as soon as you\'re able.   Thank you!\"', NULL, NULL, '2020-07-28 15:22:00', '2020-07-28 15:22:00'),
(2247, 2037, 546, NULL, '2020-08-30 00:00:00.000', 'In Process', 'Called Triwest provider services @ 866-284-3743 and spoke to Allysa. As per her one location is CCN contracted and the other 2 locations contracting is still under process and will be completed soon.There is no estimated turn around as of now.Below are the details : 500 E CAESAR  KINGSVILLE , TX 78363. CCN Contracted Effective Date: 06/01/2020. ------- Secondary Location: 4042 River Hill Drive Nueces County Corpus Christi TX  78410-5606. -------- Tertiary Location:  6646 S Staples St #122 Nueces County  Corpus Christi TX 78413-5426. Call  Reference #: PH-667741-F4Q4F8', NULL, NULL, '2020-08-19 09:46:03', '2020-08-19 09:46:03'),
(2248, 2037, 546, NULL, '2020-09-18 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract. Approval email sent to the billing and contract uploaded and placed on the server.', NULL, NULL, '2020-09-11 12:33:15', '2020-09-11 12:33:15'),
(2249, 1006, 562, 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 09:37:45', '2021-07-20 09:37:45'),
(2250, 1006, 562, 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 16:14:17', '2021-08-18 16:14:17'),
(2251, 1006, 562, 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 14:08:46', '2021-08-27 14:08:46'),
(2252, 11056, 562, 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 14:24:00', '2021-09-21 14:24:00'),
(2253, 11056, 562, 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 10:27:07', '2021-10-12 10:27:07'),
(2254, 2027, 571, NULL, NULL, 'In Process', 'Rajika.Reid@communityhealthchoice.org  Adding new service location  \"Hello, Hope you are doing great, I want to know about the current status of the email we have sent to you for adding the Alton Gloor  location also we have already sent you the LOI for the group. so kindly update me regarding the expected time for completion of this request.  Thanks\" ', NULL, NULL, '2020-06-12 15:19:07', '2020-06-12 15:19:07'),
(2255, 2027, 571, NULL, NULL, 'In Process', 'To; Rajika.Reid@communityhealthchoice.org  Sub: Need Status Update Of Group Valley Med Urgent Care PLLC (Brownsville)  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Group Name: Valley Med Urgent Care PLLC (Brownsville) NPI# 1518404631 Tax-ID: 81-5123542  Kindly update me how much time is required for the completion of this request.  Thanks. ', NULL, NULL, '2020-06-19 17:10:19', '2020-06-19 17:10:19'),
(2256, 2027, 571, NULL, NULL, 'Rejected', 'From: Rajika.Reid@communityhealthchoice.org  To: mk@claimsmedinc.com  Good afternoon:  Unfortunately, we cannot honor your request due to you not being in Community’s service area.  A denial letter was sent regarding this request.  Best Regards,', NULL, NULL, '2020-06-26 16:02:53', '2020-06-26 16:02:53'),
(2257, 2027, 572, NULL, NULL, 'In Process', 'MHTXProviderServices@molinahealthcare.com  Adding new service location  \"Hello, Hope you are doing great, I want to know about the current status of the email we have sent to you for adding the new service location Alton Gloor also we have already sent you the LOI for the group. so kindly update me regarding the expected time for completion of this request.  Thanks\" ', NULL, NULL, '2020-06-12 15:21:17', '2020-06-12 15:21:17'),
(2258, 2027, 572, NULL, NULL, 'In Process', 'MHTX Provider Services [mailto:MHTXProviderServices@MolinaHealthCare.Com]   Adding new service location  \"Good afternoon, please provide change of information so we may verify\"  Sent reply:  \"Good afternoon,  Attached are the change of information form and the w9 of the facility.  Please let us know if you need any other information.  Thanks\" ', NULL, NULL, '2020-06-12 17:02:35', '2020-06-12 17:02:35'),
(2259, 2027, 572, NULL, NULL, 'In Process', 'To:  MHTXProviderServices@molinahealthcare.com  Sub: Need Status Update Of Group Valley Med Urgent Care PLLC (Brownsville)  Hello,   Hope you are doing great, I want to know about the current status of the Group. Following are the details:  Group Name: Valley Med Urgent Care PLLC (Brownsville) NPI# 1518404631 Tax-ID: 81-5123542  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-19 17:16:29', '2020-06-19 17:16:29'),
(2260, 2027, 572, NULL, NULL, 'In Process', 'Sent email to insurance to add new location for group also, as they have only submitted the request for Abdur rauf  individually  ', NULL, NULL, '2020-06-22 17:15:57', '2020-06-22 17:15:57'),
(2261, 2027, 572, NULL, NULL, 'In Process', 'To: MHTXProviderServices@molinahealthcare.com  Sub: Need Status Update Of Group Valley Med Urgent Care PLLC (Brownsville) To Add New Service Location AG  Hello,  Hope you are doing well, May I know the status update of the request we have sent to add the new service location Alton Gloor for the group. Following are the details of the group: Group Name: Valley Med Urgent Care PLLC (Brownsville) NPI# 1518404631 Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-06-26 15:23:43', '2020-06-26 15:23:43'),
(2262, 2027, 572, NULL, NULL, 'In Process', 'From: David.Balli@molinahealthcare.com  To: mk@claimsmedinc.com  Good Morning Mr. Martin Rodriguez     Molina Healthcare has the following information on file.      Tax id # 815123542  Group NPI# 1518404631  VALLEY MED URGENT CARE PLLC  2534 BOCA CHICA BLVD  Brownsivlle, TX  78520  (956)546-2000     Please let me know if you need further information or assistances.     Thank you     David Balli', NULL, NULL, '2020-06-29 09:22:58', '2020-06-29 09:22:58'),
(2263, 2027, 572, NULL, NULL, 'In Process', 'To: David.Balli@molinahealthcare.com  Sub: Need Status Update Of Group Valley Med Urgent Care PLLC (Brownsville) To Add New Service Location AG  Hello, The information you have on file is correct but i need to add a new location under this group. Kindly add alton gloor location under this group.  Thanks.  ', NULL, NULL, '2020-06-29 09:24:27', '2020-06-29 09:24:27'),
(2264, 2027, 572, NULL, NULL, 'In Process', 'From: David.Balli@molinahealthcare.com  To: mk@claimsmedinc.com  Good Morning Mr. Martin Rodriguez     To add a new service location, please fax or email this change form and supporting documentation (W-9)  to: MHT Provider Services at (877) 900-8452 or MHTXProviderServices@MolinaHealthCare.Com and Carbon Copy me.       Thank you', NULL, NULL, '2020-06-29 10:57:47', '2020-06-29 10:57:47'),
(2265, 2027, 572, NULL, NULL, 'In Process', 'To: MHTXProviderServices@molinahealthcare.com  Sub: Need to add new service location Alton Gloor under Valley Med Urgent Care PLLC (Brownsville)  Hello, Please find attached the documents which you have requested to add the location alton gloor in this group. Group details are as follows: Group Name: Valley Med Urgent Care PLLC (Brownsville) NPI# 1518404631 Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-06-29 10:59:22', '2020-06-29 10:59:22'),
(2266, 2027, 572, NULL, NULL, 'In Process', 'David.Balli@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com  Sub: Group status,Valley Med Urgent Care PLLC (Brownsville),Molina Health  Hello, On 06/29/2020 you have asked to send the change form and W9 to add a new location alton gloor under this group and we have already sent those documents on the same date. May i know the current status of this request. Following are the details of the group: Group Name: Valley Med Urgent Care PLLC  Group NPI# 1518404631 Tax ID: 81-5123542  Thanks.', NULL, NULL, '2020-07-06 12:11:49', '2020-07-06 12:11:49'),
(2267, 2027, 572, NULL, NULL, 'Approved', 'Address updated ', NULL, NULL, '2020-07-06 14:35:19', '2020-07-06 14:35:19'),
(2268, 1006, 573, NULL, NULL, 'Approved', 'Received following email from Daniel Velez Daniel.Velez@superiorhealthplan.com:  Sub: Adding new service location Ticket ID=14555  \"Hello Ahmed,  The Service location: 800 E ALTON GLOOR BLVD, BROWNSVILLE, TX 78526 has been added.\"', NULL, NULL, '2020-06-03 14:48:03', '2020-06-03 14:48:03'),
(2269, 2027, 575, NULL, NULL, 'In Process', '\'ywyatt@humana.com.\'  Request to Add AG location  \"Hello, Hope you are doing great, I want to know about the current status of the email we have sent to you for adding the new service location Alton Gloor also we have already sent you the LOI for the group. so kindly update me regarding the expected time for completion of this request.  Thanks\" ', NULL, NULL, '2020-06-12 15:24:11', '2020-06-12 15:24:11'),
(2270, 2027, 575, NULL, NULL, 'In Process', 'To: ywyatt@humana.com  Sub: Request to Add AG location  Hello,																									 Hope you are doing great, I want to know about the current status of the email we have sent to you  for adding the new service location Alton Gloor also we have already sent you the LOI for the group. so kindly update me regarding the expected time for completion of this request. Group Name: Valley Med Urgent Care PLLC (Brownsville)   Group NPI:  1518404631   Group Tax ID:  81-5123542 Thanks.', NULL, NULL, '2020-06-19 17:44:26', '2020-06-19 17:44:26'),
(2271, 2027, 575, NULL, NULL, 'In Process', 'From: ywyatt@humana.com  To: mk@claimsmedinc.com  Hello Martin,     We show this location as network, you can check network status by creating a log in on the provider portal of the humanamilitary.com.     Brownville, Texas is not in my area the Tricare Liaison for this area is Katherine Moten. I have include her on this email for any additional questions. If you have any issues with the Houston/Galveston area I will be happy to assist.', NULL, NULL, '2020-06-26 14:39:28', '2020-06-26 14:39:28'),
(2272, 2027, 575, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub; Request to Add AG location  Hello,          The screenshot in this email of Valley Med Urgent Care is showing the wrong address, Actually we have requested to add the alton gloor location for the group with this address           800 E Alton Gloor BlvdBrownsville , TX 78526-4248. kindly look into this and check again. Please reply to me as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-26 14:40:43', '2020-06-26 14:40:43'),
(2273, 2027, 575, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub: Request to Add AG location For Group Valley Med Urgent Care PLLC  Hello,          Actually we have requested to add the alton gloor location for the group with this address          800 E Alton Gloor BlvdBrownsville , TX 78526-4248. kindly look into this and check again.                        Please reply to me as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-29 17:18:26', '2020-06-29 17:18:26'),
(2274, 2027, 575, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub: For group status,Valley Med Urgent Care PLLC,Tricare  Hello, Actually we have requested to add the alton gloor location for the group with this address 800 E Alton Gloor BlvdBrownsville , TX 78526-4248. Kindly look into this and check again. Please reply to me as soon as you get this email.  Thanks.', NULL, NULL, '2020-07-06 12:27:06', '2020-07-06 12:27:06'),
(2275, 2027, 575, NULL, NULL, 'Approved', 'Call to insurance talk to the representative her name is asyah ref# 9584674 she said the new location alton gloor has already updated under VMUC ', NULL, NULL, '2020-07-06 15:09:50', '2020-07-06 15:09:50'),
(2276, 2027, 575, NULL, '2020-09-29 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Martin,     You can provide this updated information with this form attached.     Thank you.', NULL, NULL, '2020-09-22 12:09:43', '2020-09-22 12:09:43'),
(2277, 2027, 575, NULL, '2020-09-29 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hello,  Hope you are doing great, I want to add one more location in one of our existing practice(Valley Med Urgent Care) with tricare and the details of the location are mentioned below:  Location Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496.  Please guide me how I can do this.     Thanks.      ', NULL, NULL, '2020-09-22 12:10:44', '2020-09-22 12:10:44'),
(2278, 2027, 575, NULL, '2020-09-29 00:00:00.000', 'Approved', 'To: kmoten4@humana.com  Please find the provider info update form attached in this email.  Thanks.', NULL, NULL, '2020-09-22 13:14:00', '2020-09-22 13:14:00'),
(2279, 3040, 575, NULL, NULL, 'Revalidation', 'Greetings,  Hope you are doing well. Please note that I checked on the website our primary address for the facility under the below Tax ID is not updated also I need to add the providers under all three locations. Please let me know the procedure of adding our primary address under the below Tax ID as well as for the providers.   Practice Name: Valley Med Urgent Care PLLC  Practice NPI # 1518404631 Practice Tax ID # 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   If you have questions please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-13 13:54:46', '2021-01-13 13:54:46'),
(2280, 3040, 575, NULL, NULL, 'Revalidated', 'Group showing on provider directory.   See attachment. ', NULL, NULL, '2021-05-05 10:35:37', '2021-05-05 10:35:37'),
(2281, 1006, 576, NULL, NULL, 'In Process', 'Received following reply from Amerigroup:  Sub: RE: {EXTERNAL} Adding new service location   \"Amerigroup currently does not service the hidalgo region, however we do have the group set up as out of network.  The address change will be done soon.\"', NULL, NULL, '2020-06-04 14:57:50', '2020-06-04 14:57:50'),
(2282, 2027, 576, NULL, NULL, 'In Process', 'txcredentialing@amerigroup.com  Request to add new service location  \"Hello,  Hope you are doing great, I want to know about the current status of the Change of location request. May I know the expected completion time for this request.       Group. Valley Med Urgent Care PLLC (Brownsville)  NPI# 1518404631  Tax ID# 81-5123542       Thanks\" ', NULL, NULL, '2020-06-15 15:13:24', '2020-06-15 15:13:24'),
(2283, 2027, 576, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  Sub: Request to add new service location  Hello,														 Hope you are doing great, I want to know about the current status of the Change of location request for the group. May I know the expected completion time for this request.    														 Group. Valley Med Urgent Care PLLC (Brownsville)										 NPI# 1518404631													 Tax ID# 81-5123542  												  														 Thanks.', NULL, NULL, '2020-06-19 17:54:10', '2020-06-19 17:54:10'),
(2284, 2027, 576, NULL, NULL, 'Rejected', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  ', NULL, NULL, '2020-06-22 09:23:48', '2020-06-22 09:23:48'),
(2285, 1006, 585, NULL, NULL, 'Revalidation', '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 17:00:26', '2021-03-30 17:00:26'),
(2286, 1006, 585, NULL, '2021-05-17 00:00:00.000', 'Revalidated', 'Dear Provider: Welcome! Your application has been processed, effective 3/30/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.)', NULL, NULL, '2021-05-10 14:14:23', '2021-05-10 14:14:23'),
(2287, 1006, 587, NULL, NULL, 'Revalidation', 'Sent following email @ Credentialing Committee CredentialingCommittee@bcbstx.com for Juan\'s re-credentialing application:  Sub: Attn: Roshundra Flanders, Credentialing Coordinator  \"Hello Roshundra,  We received the following letter for one of our providers requesting an updated copy of their COI, please find the attached COI with the updated limits.   Let me know if you have any questions.  Thank you.\"', NULL, NULL, '2021-04-23 15:31:44', '2021-04-23 15:31:44'),
(2288, 3040, 587, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email sent to: CredentialingCommittee@bcbstx.com  Subject:  Roshundra Flanders, Credentialing Coordinator   Hello,     The provider has been approved.  You will need to contact your network representative for effective dates.  Thank you.', NULL, NULL, '2021-06-10 10:56:39', '2021-06-10 10:56:39'),
(2289, 1006, 587, NULL, '2021-07-07 00:00:00.000', 'Revalidation', 'Still waiting for the effective dates.', NULL, NULL, '2021-06-30 16:57:22', '2021-06-30 16:57:22'),
(2290, 1006, 587, NULL, '2021-07-19 00:00:00.000', 'Revalidation', 'Sent f/u email @ Credentialing Committee CredentialingCommittee@bcbstx.com:  Sub: Attn: Roshundra Flanders, Credentialing Coordinator  \"Hello,   Can you please let me know who our network representative is so we can get in touch with them?  Thank you. \"', NULL, NULL, '2021-07-12 12:53:53', '2021-07-12 12:53:53'),
(2291, 1006, 587, NULL, '2021-08-20 00:00:00.000', 'Revalidation', 'Sent f/u email @ connie_traylor@bcbstx.com:  Sub: Enrollment/Location Status - RHC - BCBS  \"Hello Connie,   I wanted to get an update regarding the enrollment status for the following provider under the mentioned addresses for our group:  Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924  Addresses:Primary Location: 500 E CAESAR, KINGSVILLE, TX 78363 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  Provider Name: Juan Capupus NPI# 1891168597  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-08-13 12:49:10', '2021-08-13 12:49:10'),
(2292, 1006, 587, NULL, '2021-08-24 00:00:00.000', 'Revalidated', 'Received the following confirmation from connie_traylor@bcbstx.com:  Sub: Enrollment/Location Status - RHC - BCBS  \"Good morning,  Juan Capupus has all of the below addresses added. 4042 River Hill Dr is showing as primary physical with 500 E. Caesar Ave, 3817 S. Padre Island Dr., and 6646 S Staples St, Ste 122, as satellite locations.  Thanks, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317 Fax: 806-783-4666 Helpful Links:  Availity -  800-282-4548 BCBSTX Provider Website -  http://www.bcbstx.com/provider/ Claims Adjustment -  800-451-0287 COVID-19/ Telehealth & Telemedicine - https://www.bcbstx.com/provider/covid-19-preparedness.html Provider Training -  https://www.bcbstx.com/provider/training/faqs.html\"', NULL, NULL, '2021-08-17 13:29:45', '2021-08-17 13:29:45'),
(2293, 1006, 602, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'We received the following email from donotreplyemail@aperturecvo.com:  Sub; Important Credentialing Information Requested: MASON, TRACI SMITH - 8C3PT  \"Aperture Credentialing, LLC, a national credentials verification organization, has been contracted to handle primary source verification of your credentials.  Documentation needed to complete your credentialing application is missing, incomplete, or expired.  In order to continue the credentialing process with the Health Plan(s) requesting information, you will need to provide the requested information within three (3) business days from the date of this notice so that the processing of your application can be completed.  Health Plan(s) Requesting Information: United HealthCare of Houston  Credentials Request for: MASON, TRACI SMITH  Attention: Traci Mason Credentialing Contact  Information Requested: Please provide who admits on your behalf, or the name of the covering colleague, or hospitalist group name?  How to Respond: Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested.  NOTE: This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information. Aperture Supporting Documentation website: https://outreach.aperturecvo.com/445a83f7-ea0e-4a82-b59c-1b46e53d50b0\"  Replied with request information as Rolando Perez is her supervising physican. ', NULL, NULL, '2021-08-30 14:59:02', '2021-08-30 14:59:02'),
(2294, 1006, 602, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'We received the following email from donotreplyemail@aperturecvo.com:  Sub; Important Credentialing Information Requested: MASON, TRACI SMITH - 8C3PT  \"Aperture Credentialing, LLC, a national credentials verification organization, has been contracted to handle primary source verification of your credentials.  Documentation needed to complete your credentialing application is missing, incomplete, or expired.  In order to continue the credentialing process with the Health Plan(s) requesting information, you will need to provide the requested information within three (3) business days from the date of this notice so that the processing of your application can be completed.  Health Plan(s) Requesting Information: United HealthCare of Houston  Credentials Request for: MASON, TRACI SMITH  Attention: Traci Mason Credentialing Contact  Information Requested: Please provide who admits on your behalf, or the name of the covering colleague, or hospitalist group name?  How to Respond: Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested.  NOTE: This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information. Aperture Supporting Documentation website: https://outreach.aperturecvo.com/445a83f7-ea0e-4a82-b59c-1b46e53d50b0\"  Replied with request information as Rolando Perez is her supervising physican. ', NULL, NULL, '2021-08-30 14:59:02', '2021-08-30 14:59:02'),
(2295, 11056, 602, NULL, '2021-09-28 00:00:00.000', 'Revalidation', '	 Email sent to : networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC  Good evening!  Hope all is well with you. Please provide me with the recredentialing status for the below mentioned provider under the facility TIN. And also confirm if all of the locations are listed below that provider or not?  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 Details:  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  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 17:12:31', '2021-09-21 17:12:31'),
(2296, 11056, 602, NULL, '2021-10-01 00:00:00.000', 'Revalidation', 'Secure Message from david.c.cliff@optum.com', NULL, NULL, '2021-09-24 13:54:02', '2021-09-24 13:54:02'),
(2297, 11056, 602, NULL, '2021-10-19 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider is currently in a recredentialing process that is due 11/2021 (the CAQH application has been accessed and the recredentialing will complete before the end of 11/2021).  The only service locations loaded for this provider are  3817 S PADRE ISLAND DR CORPUS CHRISTI, TX 78415-2913 and 4042 RIVER HILL DR CORPUS CHRISTI, TX 78410-5606   David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-12 10:59:11', '2021-10-12 10:59:11'),
(2298, 11056, 602, NULL, '2021-10-25 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good afternoon!  Hope this email finds you well. What about the other 2 mentioned below 1. Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 2. Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413', NULL, NULL, '2021-10-18 12:53:47', '2021-10-18 12:53:47'),
(2299, 11056, 602, NULL, '2021-11-01 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : RE: Secure Message from david.c.cliff@optum.com  The 500 E CAESAR  KINGSVILLE , TX 78363 and 6646 S. Staples St. # 122 Corpus Christi , TX 78413 are currently not loaded as service locations for this provider.  A request to add these locations would need to be submitted to our demographics group for processing   Request has been submitted', NULL, NULL, '2021-10-25 13:14:04', '2021-10-25 13:14:04'),
(2300, 11056, 602, NULL, '2021-11-18 00:00:00.000', 'Revalidation', 'Email sent to: hpdemo@uhc.com,  networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC - Statcare Minor Emergency Clinic   Good afternoon!  Hope you are having a great day. Has the re-credentialing been completed of the provider, Traci Mason? Have all the below mention locations been listed under the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Traci Mason	1497127831  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-11 13:58:58', '2021-11-11 13:58:58'),
(2301, 11056, 602, NULL, '2021-11-23 00:00:00.000', 'Revalidated', 'Email received from: networkhelp@uhc.com  Sub : Secure Message from cameron_l_pickett@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested.      Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.    If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.       Sincerely,       *--SecureDelivery--*    All locations are added. Please see the roster.', NULL, NULL, '2021-11-16 14:39:52', '2021-11-16 14:39:52'),
(2302, 11056, 623, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Request - NASA Urgent Care - Cigna Health spring  Good Evening,  Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:25:00', '2021-06-25 16:25:00'),
(2303, 11056, 623, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Request - NASA Urgent Care - Cigna Health spring  Good Evening,  Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:25:20', '2021-06-25 16:25:20'),
(2304, 11056, 623, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Request - NASA Urgent Care - Cigna Health spring  Good Evening,  Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:27:42', '2021-06-25 16:27:42'),
(2305, 1006, 623, NULL, '2021-07-21 00:00:00.000', 'Revalidation', 'Sent f/u email to same email:  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned facility.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-14 17:31:41', '2021-07-14 17:31:41'),
(2306, 11056, 623, NULL, '2021-08-10 00:00:00.000', 'Revalidation', 'Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:32:00', '2021-08-03 09:32:00'),
(2307, 11056, 623, NULL, '2021-08-24 00:00:00.000', 'Revalidation', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:36:56', '2021-08-17 09:36:56'),
(2308, 11056, 623, NULL, '2021-09-03 00:00:00.000', 'Revalidation', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub  : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hey Jennifer!  For sure. Here is the LOI of the facility. Please see the attachment.  If you need any information or documents further, feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-26 15:59:48', '2021-08-26 15:59:48'),
(2309, 11056, 623, NULL, '2021-09-22 00:00:00.000', 'Revalidation', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmad,   Thank you for sending this over. In order to be credentialed we will need our letter of interest to be filled out. Once completed for all 3 facilities, may you send them back to me.   Jennifer Perez  Filled and submitted.', NULL, NULL, '2021-09-15 10:37:35', '2021-09-15 10:37:35'),
(2310, 11056, 623, NULL, '2021-10-05 00:00:00.000', 'Revalidation', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmed,  I saw you replied to another email I sent, may you fill out the letter of interest using the following form and send back to me at your earliest convenience.   Thank you   Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare 2800 North Loop West, Suite 400 | Houston, Texas 77092  New LOI has been filled and submitted.', NULL, NULL, '2021-09-28 16:05:50', '2021-09-28 16:05:50'),
(2311, 11056, 623, NULL, '2021-10-15 00:00:00.000', 'Revalidation', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 13:37:53', '2021-10-08 13:37:53'),
(2312, 11056, 623, NULL, '2021-10-25 00:00:00.000', 'Revalidation', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:42', '2021-10-18 14:30:42'),
(2313, 11056, 623, NULL, '2021-11-01 00:00:00.000', 'Revalidation', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Eamiled at : txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:43:18', '2021-10-25 16:43:18'),
(2314, 11056, 623, NULL, '2021-11-01 00:00:00.000', 'Revalidation', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:43:40', '2021-10-25 16:43:40'),
(2315, 11056, 623, NULL, '2021-11-18 00:00:00.000', 'Revalidation', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:43', '2021-11-11 12:53:43'),
(2316, 11056, 623, NULL, '2021-11-26 00:00:00.000', 'Revalidation', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:52', '2021-11-19 11:29:52'),
(2317, 11056, 623, NULL, '2021-12-10 00:00:00.000', 'Revalidation', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:43:04', '2021-12-03 16:43:04'),
(2318, 11056, 623, NULL, '2021-12-29 00:00:00.000', 'Revalidation', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:20', '2021-12-22 17:22:20'),
(2319, 2028, 638, NULL, NULL, 'Approved', 'Address is been updated email received', NULL, NULL, '2020-06-29 09:56:38', '2020-06-29 09:56:38'),
(2320, 2028, 639, NULL, NULL, 'In Process', 'TO: r.south@healthsmart.com SUB: Adeoye, Segun P - Health Smart - NHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider and also let us know which address has been added for Adeoye, Segun P  The details are as follows: Group Name: Nasa Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655 NPI# 1629418025  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-06 11:59:38', '2020-07-06 11:59:38'),
(2321, 2028, 639, NULL, NULL, 'In Process', 'From: mdiprsupport@healthsmart.com Sub: Adeoye, Segun P - Health Smart - NHC  Hi,  Provider \'\' ADEOYE, SEGUN P \'\' is Effective \'\' 11/01/2018 \'\'.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 58812 )  Thanks HealthSmart Provider Relations.', NULL, NULL, '2020-07-07 12:38:25', '2020-07-07 12:38:25'),
(2322, 2028, 639, NULL, NULL, 'In Process', 'TO: 	pr.south@healthsmart.com SUB: Adeoye, Segun P - Health Smart - NHC  Hello,  Thank you for sending us the effective date 11/01/2018 of the provider ADEOYE, SEGUN P which we have received from mdiprsupport@healthsmart.com. We would also like to know which address has been added for the provider? Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-07 12:40:34', '2020-07-07 12:40:34'),
(2323, 2028, 639, NULL, NULL, 'In Process', 'rep:K she said 985 NASA Parkway Houston , TX 77058-3039 address is been added and for additional address or updates you have to contact  pr.south@healthsmart.com for further assistance  Ref: 2016611', NULL, NULL, '2020-07-15 16:46:51', '2020-07-15 16:46:51'),
(2324, 2028, 639, NULL, NULL, 'In Process', 'From: pr.south@healthsmart.com Sub: (Reminder)Adeoye, Segun P - Health Smart - NHC  Sharon, this is the address we have in our system. 985 NASA PKWY HOUSTON,TX 77058', NULL, NULL, '2020-07-16 09:11:35', '2020-07-16 09:11:35'),
(2325, 2028, 639, NULL, NULL, 'In Process', 'To: RE pr.south@healthsmart.com Sub: (Reminder)Adeoye, Segun P - Health Smart - NHC  Hello, I would also like to add these two addresses for the provider 3623 S. Main St. Suite 109 Stafford Texas 77477 2101 Raspberry Lane Pasadena Texas 77502  Please get back to me as soon as Your able  Thank you', NULL, NULL, '2020-07-16 09:14:47', '2020-07-16 09:14:47'),
(2326, 2028, 639, NULL, NULL, 'Approved', 'From: pr.south@healthsmart.com Sub: (Reminder) Adeoye, Segun P - Health Smart - NHC  I found those 2 locations. They are already active.', NULL, NULL, '2020-07-16 14:11:34', '2020-07-16 14:11:34'),
(2327, 2028, 655, NULL, NULL, 'In Process', 'Rep: Noel As per rep, This is not Tricare it is Humana, So I took the address verification for the group and provider and got to know that the address for the group is updated but for the provider, the secondary address does not show on their system as it\'s not updated, provided the email address of CBUC. The agent said he will send a roster we have to fill it and send it on stxnm@humana.com for secondary address update. Ref: 23000139786272', NULL, NULL, '2020-07-28 16:51:51', '2020-07-28 16:51:51'),
(2328, 2037, 655, NULL, '2020-10-19 00:00:00.000', 'Approved', 'As per live call to Humana Provider is participating with Medicare PPO, Humana PPO, ChoiceCare PPO With the effective date 06/01/2019 Interaction# 2000149781420', NULL, NULL, '2020-10-12 13:57:38', '2020-10-12 13:57:38'),
(2329, 1006, 665, NULL, NULL, 'Approved', 'Medicaid Approved: Eff: 05/07/2020', NULL, NULL, '2020-06-04 12:44:56', '2020-06-04 12:44:56'),
(2330, 2037, 666, NULL, '2020-10-26 00:00:00.000', 'In Process', 'The department did not see any documentation submitted. However they have requested the credentialing department to give a call back to us with an update . Waiting for the call back . Inquiry email : dhpcontracting@dchstx.org Reference#433954', NULL, NULL, '2020-10-12 15:11:42', '2020-10-12 15:11:42'),
(2331, 2037, 666, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follow up email and voice mail sent', NULL, NULL, '2020-10-26 13:49:59', '2020-10-26 13:49:59'),
(2332, 2037, 666, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Email sent to Ryan to Verify general Liability coverage.', NULL, NULL, '2020-11-30 16:35:53', '2020-11-30 16:35:53'),
(2333, 2037, 666, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Inquiry sent to Karla along with the signed contract for CBUC', NULL, NULL, '2020-12-08 13:32:41', '2020-12-08 13:32:41'),
(2334, 2037, 666, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Request submitted to Karla for group\'s GW location . Document uploaded in the attachments. Communicating with Karla regarding the applications for both the group and Frank D', NULL, NULL, '2020-12-16 14:50:54', '2020-12-16 14:50:54'),
(2335, 3040, 666, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954   Greetings,   Hope you are doing well. I just wanted to follow up regarding the location update for the group George West Medical Clinic.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-03 17:30:59', '2021-02-03 17:30:59'),
(2336, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  Thank you Adil,  Frank Dehnisch is now back in process.   The credentialing process ranges from 60 to 90 days but in some instances may take up to 180 days.  You will receive a Welcome Packet along with a copy of the executed agreement when complete.  If anything is needed, someone will contact you.  Be sure the CAQH is complete, current and accurate to avoid delays in processing.  If Aperture contacts you regarding any missing information, please respond to them promptly.', NULL, NULL, '2021-02-10 12:20:29', '2021-02-10 12:20:29'),
(2337, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  Greetings,  Hope you are doing well. Please find the attached requested form along with the W9 as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:21:21', '2021-02-10 12:21:21'),
(2338, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  Sure!  No problem.  I have also attached our addendum and disclosure statement.  We will also need a more current W9.  Send those along with the request.  I can get him started as soon as I get all of them.  I still have the signed contract and it should be ok.   Karla Claunch', NULL, NULL, '2021-02-10 12:22:46', '2021-02-10 12:22:46'),
(2339, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Subject: Re: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  Greetings,  Hope you are doing well. Can you please send me the contract request form for Fran R Dehnishg Jr MD. I already updated his CAQH as per your previous email.  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:23:38', '2021-02-10 12:23:38');
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
(2340, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  No problem Adil,  I appreciate your patience and understanding.  It looks like Angela Guerrero from our credentialing department sent out a letter 1/26/2021 at 1:43 pm to cbuc@claimmedinc.com to advise application withdrawn due to being incomplete for Frank R Dehnish Jr MD.   I have attached everything she sent in that email.  I can start him back in process but, you must make sure his CAQH is complete, accurate and current.  This will avoid delays and an additional possible withdrawal.  If you would like to start him back in process, please send a new, Request for contract with the current date and I will be glad to start him back in process.', NULL, NULL, '2021-02-10 12:24:20', '2021-02-10 12:24:20'),
(2341, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  Greetings,  I am really sorry for the inconvenience. Please find below the practice details for location update.   Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street  George West , TX 78022-3663  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-10 12:25:20', '2021-02-10 12:25:20'),
(2342, 3040, 666, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Location Update || Group || George West Medical Clinic || Driscoll || Reference#433954  Happy Thursday Adil,  I need a little more clarification please.  Your name and George West is familiar but, not specific enough for me remember completely and to look it up.   ', NULL, NULL, '2021-02-10 12:26:09', '2021-02-10 12:26:09'),
(2343, 3040, 666, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-17 09:24:47', '2021-02-17 09:24:47'),
(2344, 3046, 666, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org Subject: Credentialing & Location Status || George West Medical Clinic || Driscoll || Reference#433954 Hello,  Hope my email finds you well. Kindly advise the credentialing & location status of the below mentioned practice. Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street  George West , TX 78022-3663  I hope to hear from you soon. Thank you.', NULL, NULL, '2021-02-25 13:47:32', '2021-02-25 13:47:32'),
(2345, 3046, 666, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Reply from: Karla.Claunch@dchstx.org Subject: Credentialing & Location Status || George West Medical Clinic || Driscoll || Reference#433954 This practice is not being credentialed and will only be active once the providers have completed credentialing.  ', NULL, NULL, '2021-02-25 16:43:10', '2021-02-25 16:43:10'),
(2346, 3046, 666, NULL, '2021-03-04 00:00:00.000', 'New/Not Initiated', 'Reply from: Karla.Claunch@dchstx.org Subject: Credentialing & Location Status || George West Medical Clinic || Driscoll || Reference#433954  Good afternoon,  Frank Dehnisch was just sent to CVO  Aperture for initial processing.  Please allow 60-90 to complete.', NULL, NULL, '2021-02-25 16:44:03', '2021-02-25 16:44:03'),
(2347, 1006, 666, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll  for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you    ', NULL, NULL, '2021-06-08 17:02:46', '2021-06-08 17:02:46'),
(2348, 1006, 666, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following email from dhpcontracting@dchstx.org:  Sub: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  \"Good afternoon,  Please complete the attached documents for each provider and email them to dhpcontracting@dchstx.org.  We will also need a current PAA or Collaborative agreement for each of the mid-level practitioners.  Thank you Karla Claunch\"  Requested Ryan to send us copies of the PAA/Collaborative agreement to avoid any delays.   \"Hello Ryan,  We need updated copies of the following documents for the mentioned providers: Mercedita Flynn An updated copy of AANP CertificationFrank Dehnisch An updated copy of Malpractice Also, we would like copies of current PAA or Collaborative agreements for all the mid-level providers, please send these over as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-25 13:49:09', '2021-06-25 13:49:09'),
(2349, 1006, 666, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Still waiting on Ryan to send us PAA/Collab agreement for all providers to proceed with this request, sent another reminder via hangouts/google chat:  \"Hello Ryan,  I just wanted to ask if it would be possible for you to get us the following information: We need updated copies of the following documents for the mentioned providers:  Mercedita Flynn An updated copy of AANP Certification Frank Dehnisch An updated copy of Malpractice  Also, we would like copies of current PAA or Collaborative agreements for all the mid-level providers, please send these over as soon as you\'re able to.  Thank you!  Also, if you could send us the update CLIA of both CBUC & GWMC\"', NULL, NULL, '2021-07-14 16:27:52', '2021-07-14 16:27:52'),
(2350, 11056, 666, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Still waiting for the  Updated MALPRACTICE : Frank Dehnisch  Updated  AANP Certification : Mercedita Flynn  by Ryan.', NULL, NULL, '2021-08-24 17:09:05', '2021-08-24 17:09:05'),
(2351, 11056, 666, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to : Karla.Claunch@dchstx.org  Sub  : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good evening Karla!  Hope this email finds you well. Here are the forms with attached documents in the Pdf too with W9s, which you requested for in the previous email for enrollment process. Please find the attachments.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# 1164776548  Provider Name: Flynn, Mercedita  Provider NPI# 1619166188  Provider Name: Gonzalez, Monica Provider NPI# 1427509264  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day', NULL, NULL, '2021-09-17 12:22:33', '2021-09-17 12:22:33'),
(2352, 11056, 666, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  Thank you for these requests but, the disclosure statements were not attached for Monica Gonzalez NP and Katherine Paterson NP.  Please email these directly to me when completed.  They are all now in the credentialing process.  Please allow 60-90 days to complete.  Once complete, you will receive a welcome letter with their effective date.  Thank you  Karla Claunch   ', NULL, NULL, '2021-09-28 16:59:08', '2021-09-28 16:59:08'),
(2353, 11056, 666, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  My apologies,  I am just noticing that this practice is currently not participating with us.  All providers requested are mid-level who will need a supervising physician.  The physician will also need to be a Driscoll Health Plan participating physician.  If their supervising physician is not already credentialed with us, we will also need to credential them.  We will also need the current PAA or Collaborative agreement between the NP’s and supervising physician.  They should have one on file within the practice.  We are withdrawing these providers  due to not currently having a supervising physician on file for this practice.  We can re-activate them once the remaining, required information is received and they have an established, participating, supervising physician.  We look forward to working with you and eager to hear from you again soon.  Please let me know if you need any further assistance.  Karla Claunch  ', NULL, NULL, '2021-10-06 16:31:28', '2021-10-06 16:31:28'),
(2354, 11056, 666, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : Karla.Claunch@dchstx.org  Sub : Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Hey Karla!  Hope you had a great weekend. You don\'t need to apologise. We do have a supervising physician for this practice and want to let him participate with Driscoll Health Plan. Please suggest to me the procedure to credential the supervising physician as soon as possible.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  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, '2021-10-14 15:44:02', '2021-10-14 15:44:02'),
(2355, 11056, 666, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  I wish the weekend was much longer but, here we are.  We will need the same documents for the supervising physician and he must carry them on his license.  Please send a Request for Contact as well as the DHP addendum and disclosure as below.', NULL, NULL, '2021-10-22 08:49:52', '2021-10-22 08:49:52'),
(2356, 11056, 666, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Please find the attached forms for the Supervising physician enrollment with Driscoll. Please accept my apology for the delay. If any corrections are required please let me know.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  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 day!', NULL, NULL, '2021-11-09 14:34:09', '2021-11-09 14:34:09'),
(2357, 11056, 666, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Hello,  Thank you for this request.  Before I begin, the addendum needs to be completed with all information.  The disclosure is named and signed by Mercedita Flynn so, we will need his own, signed by him please.  This provider will not be processed until this information is received.  Your prompt attention will avoid delays and withdrawal.  I look forward to hearing from you soon.  Thank you  Karla Claunch   Provided them with their requirement.', NULL, NULL, '2021-11-24 10:03:54', '2021-11-24 10:03:54'),
(2358, 11056, 666, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good morning!  Hope this email finds you well. Here you go. Please find the corrected one in the attachment.  If anything else is needed feel free to reach out to me.  Take Care!  Thank you!', NULL, NULL, '2021-12-06 16:40:35', '2021-12-06 16:40:35'),
(2359, 11056, 666, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from:  Karla.Claunch@dchstx.org  Sub:  Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good afternoon,  You only sent one disclosure, it was for Mercedita which I already have.   I am needing one for both of these providers please-Monica Gonzalez NP and Katherine Paterson NP  They are now in process.  Please allow 60-90 days to complete the process.  I am looking forward to hearing back from you soon with these disclosures and all of their PAA/Collaborative Agreements  Thank you', NULL, NULL, '2021-12-17 14:48:11', '2021-12-17 14:48:11'),
(2360, 11056, 666, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from:  Karla.Claunch@dchstx.org  Sub:  Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good afternoon,  You only sent one disclosure, it was for Mercedita which I already have.   I am needing one for both of these providers please-Monica Gonzalez NP and Katherine Paterson NP  They are now in process.  Please allow 60-90 days to complete the process.  I am looking forward to hearing back from you soon with these disclosures and all of their PAA/Collaborative Agreements  Thank you', NULL, NULL, '2021-12-17 14:48:11', '2021-12-17 14:48:11'),
(2361, 11056, 666, NULL, '2021-12-29 00:00:00.000', 'In Process', '	 Email sent to: Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope you are having a blessed day. Please find the attached disclosure for Monica Gonzalez and Katherine Paterson. We will provide you with their PAA/Collaborative Agreements near in the future.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Take Care!  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 11:11:53', '2021-12-22 11:11:53'),
(2362, 19067, 666, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Kindly do provide me with the recent accomplishments of the credentialing process of the below-mentioned providers under facility TIN.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   Please get back to me soon with the updates and if credentialing is completed do provide me with effective dates and welcome letters.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-12-30 11:01:32', '2021-12-30 11:01:32'),
(2363, 19067, 666, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Greetings!  Any updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:22:56', '2022-01-09 22:22:56'),
(2364, 19067, 666, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||    Good morning,  I sent the welcome packet and contract 12/28/2021 to the credentialing contact email we have on file.  I have attached everything to this email for you.    ', NULL, NULL, '2022-01-10 09:25:06', '2022-01-10 09:25:06'),
(2365, 19067, 666, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Sent a fax of W9 for GWMC @ 956-992-0392 / 361-808-2079', NULL, NULL, '2022-02-17 17:40:11', '2022-02-17 17:40:11'),
(2366, 20067, 666, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: Esmie.Silva@dchstx.org  Sub: Location Query || George West Medical Clinic || Group || Driscoll  Good Afternoon Silva!  Can you please confirm that the listed locations are linked under TIN# 81-1890349?  Group Name	Beville Medical Clinic Tax ID	81-1890349 Group NPI	1689924904 Primary & Billing Location	301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street Live Oak County George West, TX 78022-3663  Thank you,', NULL, NULL, '2022-03-07 15:58:10', '2022-03-07 15:58:10'),
(2367, 19067, 666, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: Esmie.Silva@dchstx.org  Subject: Location Query || George West Medical Clinic || Group || Driscoll   My first name is Esmie.      The only address we have is Coastal Bend Urgent Care at 301 S. Hillside Dr. Ste. 4 Beeville, Tx 78102', NULL, NULL, '2022-03-09 10:02:32', '2022-03-09 10:02:32'),
(2368, 19067, 666, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: esmie.silva@dchstx.org  Subject: Re: Location Query || George West Medical Clinic || Group || Driscoll    Hi,  We would like to add the secondary location under the tax id: 81-1890349.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-03-09 10:06:53', '2022-03-09 10:06:53'),
(2369, 19067, 666, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: Esmie.Silva@dchstx.org  Subject: Location Query || George West Medical Clinic || Group || Driscoll    I need more information.      A request to add the following: Address, city, clinic name, w9 phone# fax# Tax id#', NULL, NULL, '2022-03-10 14:00:21', '2022-03-10 14:00:21'),
(2370, 19067, 666, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: esmie.silva@dchstx.org  Subject: Re: Location Query || George West Medical Clinic || Group || Driscoll   Hello Esmie,  Hope this email finds you well.  Tax ID# 81-1890349 Clinic Name: Beeville Medical Clinic Primary & Billing Address:301 S Hillside DR STE 4 Beeville, TX 78102 Secondary Address: 504A Houston Street Live Oak County George West, TX 78022 Phone# 361-226-1219 Fax# 361-542-4076  Thanks, Hammad Ahmed. ', NULL, NULL, '2022-03-10 15:25:14', '2022-03-10 15:25:14'),
(2371, 22077, 666, NULL, '2022-04-19 00:00:00.000', 'In Process', 'Email sent to: Esmie.Silva@dchstx.org  Subject: Re: Location Query || George West Medical Clinic || Group || Driscoll  Hi,  This tax id belongs to George West Medical Clinic and Beeville Medical Clinic is DBN.  Thanks.', NULL, NULL, '2022-04-12 10:48:22', '2022-04-12 10:48:22'),
(2372, 22077, 666, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email received from: Esmie.Silva@dchstx.org  Subject: 	RE: Location Query || George West Medical Clinic || Group || Driscoll  Alex,  So you want DHP to add the George West and Beeville Clinic to that tax id which we have as Coastal Bend Urgent Care?', NULL, NULL, '2022-04-15 15:12:10', '2022-04-15 15:12:10'),
(2373, 22077, 666, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: Esmie.Silva@dchstx.org  Subject: Re: Location Query || George West Medical Clinic || Group || Driscoll  Hello,  Yes, we would like to add both locations.  Coastal Bend Urgent Care DBA is Beeville Medical Clinic while George West is the secondary location.  Thanks, ', NULL, NULL, '2022-04-15 15:13:23', '2022-04-15 15:13:23'),
(2374, 2037, 667, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Spoke to Burnadett from Christus Health and got a confirmation of the location addition . email sent for written confirmation.Reference email as follows: ----------------- Greetings, We got a confirmation over the call that the secondary location has been added.If we may get a confirmation over the email of the same that would be great.Reference # FL01225667  Coastal Bend Urgent Care, LLC Tax ID                       : 81-1890349 NPI                            : 1427509264 Primary Location     : 301 S HILLSIDE DR STE 4                                     County BEE                                    BEEVILLE , TX 78102-5324Secondary Location: 504A Houston Street                                     Live Oak County                                      George West , TX 78022-3663.Thank you.', NULL, NULL, '2020-10-05 10:04:07', '2020-10-05 10:04:07'),
(2375, 2037, 667, NULL, '2020-11-02 00:00:00.000', 'Approved', 'Location Addition Confirmation Received: ------------------------------------------- CHRISTUS.HP.Credentialing 9:11 AM (1 hour ago) to me, Coastal  I checked the reference number and the second location has been added to Coastal Bend Urgent Care. Thank you!   Credentialing Verification Unit  CHRISTUS Health Plan - US Family Health Plan  919 Hidden Ridge Irving, TX 75038  Phone: (469)-282-0368  Fax: 210-766-8857  CHRISTUS.HP.Credentialing@christushealth.org', NULL, NULL, '2020-10-26 10:37:35', '2020-10-26 10:37:35'),
(2376, 2027, 668, NULL, NULL, 'In Process', 'SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Provider-Cini Thomas-NPI# 1134777238-Need Status Update  Hello,  Hope you are doing great, I want to know about the current status of the Provider, Following are the details. Provider Name: Cini Thomas  NPI# 1134777238    Online application has been submitted successfully for this provider, Please let me know the completion time for this request.    Thanks.', NULL, NULL, '2020-06-16 17:52:32', '2020-06-16 17:52:32'),
(2377, 2027, 668, NULL, NULL, 'In Process', 'SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org To: Martin Rodriguez mk@claimsmedinc.com  RE: {EXTERNAL} Provider-Cini Thomas-NPI# 1134777238-Need Status Update  Dear Provider,     Your request has been forwarded to a contracting manager.  You will get a response within 7 days.  If you do not please let us know.  Thank you  ', NULL, NULL, '2020-06-17 10:35:07', '2020-06-17 10:35:07'),
(2378, 2027, 668, NULL, NULL, 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub; Need Status Update Of The Provider Thomas, Cini  Hello,  Hope you are doing great, I want to know about the current status of the Provider, Following are the details. Provider Name: Thomas, Cini NPI# 1134777238 Group Name:  Normandy Urgent Care Center  Group Tax ID: 27-0796429   Last time when I did follow up for this provider you replied to me that, \"You will get a response within 7 days. If you do not please let us know\" So 7 days have been passed now and our request is still in process. Kindly reply as soon as you get this email   Thanks. ', NULL, NULL, '2020-06-24 10:13:40', '2020-06-24 10:13:40'),
(2379, 2027, 668, NULL, NULL, 'In Process', 'From: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  To: mk@claimsmedinc.com  Dear Provider,     Thank you for contacting us and letting us know you issue is still outstanding.  This request will be escalated.', NULL, NULL, '2020-06-24 12:31:39', '2020-06-24 12:31:39'),
(2380, 2027, 668, NULL, NULL, 'In Process', 'From: Richard.Hinkley@bswhealth.org  To: mk@claimsmedinc.com  Good afternoon Martin,     I have checked with our provider services team and there is not current request to add this provider to the group mentioned below that has been pulled from the website prior to this week.     Provider Name: Thomas, Cini  NPI# 1134777238  Group Name:  Normandy Urgent Care Center  Group Tax ID: 27-0796429     Please be aware that all provider adds to existing agreements must come through the website at the following link if you wish to add or term a provider to an existing agreement for SWHP or FirstCare: https://swhp.org/forms/html/add-provider-to-contract-request.html     Thank you,', NULL, NULL, '2020-06-24 13:06:07', '2020-06-24 13:06:07'),
(2381, 2027, 668, NULL, NULL, 'In Process', 'To: Richard.Hinkley@bswhealth.org  Sub: Need Status Update Of The Provider Thomas, Cini  Hello, Hope you are doing well, we have sent this request on 05/15/2020 and submitted the online application. Also we have communicated many times for the updates with you, kindly check again and reply to me as soon as you get this email.  Thanks', NULL, NULL, '2020-06-24 13:15:19', '2020-06-24 13:15:19'),
(2382, 2027, 668, NULL, NULL, 'Initiated', 'online application submitted again and attached', NULL, NULL, '2020-06-24 14:35:42', '2020-06-24 14:35:42'),
(2383, 2027, 668, NULL, NULL, 'In Process', 'To; HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub: SWHP/FCHP Expedite-Add Provider Request  Please find attached the documents you have requested for.  Thanks.', NULL, NULL, '2020-06-26 09:16:47', '2020-06-26 09:16:47'),
(2384, 2027, 668, NULL, NULL, 'In Process', 'From: SWHPEXPEDITES@bswhealth.org  Need information in the next 10 days (7/21/2020).  No follow up email will be sent.     Here at Scott & White Health Plan (SWHP) and First Care Health Plan (FCHP) we take pride in working expeditiously to provide you with quality service in a timely and accurate manner. We have recently received a request to add a provider(s) to your existing SWHP or FCHP group agreement. In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept. and our Credentialing Verification Organization (CVO), Aperture Credentialing.     Please forward, via email to HPCREDENTIALINGEXPEDITE@BSWHealth.org, with the subject line EXPEDITED and the attached documents before the above date so we can initiate the process to start your credentialing process.     Required:  1.      Provider Information Spreadsheet – This is not your credentialing application.  This provides us information to send to Aperture to get you started with their request.  If you use CAQH please ensure your information and attestations are up to date and that you have designated SWHP and/or FCHP as an authorized provider.  If you do not use CAQH please send us your Texas Standardized Credentialing Application (TSCA) and attachments.   2.       Copy of the W-9  If applicable:  3.       Privilege Exception/Mid-Level Form - If applicable  4.       CME Acknowledgement:  For any non-boarded PHYSICIANs, who are no longer in the eligibility period for certification, SWHP and FCHP requires additional CMEs annually.  To acknowledge this requirement please sign, date, and return the attached CME form.     This will be the only request sent from SWHP and FCHP requesting these items above to initiate the credentialing process. If the information above has not been received within 10 days, you will be required to re-apply through www.swhp.org     Once we have processed the initial information the Credentialing process will begin. Once credentialing is complete, we will contact you with your effective date. If you have any questions or concerns please contact your provider relations representatives.     Thank you,', NULL, NULL, '2020-07-08 13:19:52', '2020-07-08 13:19:52'),
(2385, 2027, 668, NULL, NULL, 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  EXPEDITED  Please find the attached four documents which you have requested to start the credentialing process for the provider-Cini Thomas-Group(NUCC).  Thanks.', NULL, NULL, '2020-07-08 13:20:58', '2020-07-08 13:20:58'),
(2386, 2027, 668, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Thomas, Cini Provider NPI# 1134777238 Group Name: Normandy Urgent Care Center    Tax ID:  27-0796429    Thanks. ', NULL, NULL, '2020-10-11 16:19:48', '2020-10-11 16:19:48'),
(2387, 2027, 668, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From: SWHPEXPEDITES@bswhealth.org  The provider information for Cini Thomas and Julie Jose to be added to Normandy Urgent Care Center has been received and is in process.     He/she has an effective date of 10/12/2020.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.     Thank you and have a great day.        Provider Relations  Scott & White/FirstCare Health Plan', NULL, NULL, '2020-10-12 17:34:45', '2020-10-12 17:34:45'),
(2388, 1006, 668, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Sent a follow-up email to SWHPEXPEDITES@bswhealth.org regarding enrollment status. ', NULL, NULL, '2020-10-26 13:38:57', '2020-10-26 13:38:57'),
(2389, 2027, 668, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  Sub: (Thomas, Cini)-(Normandy Urgent Care Center)-(Scott & White)  May I know the current application status of this provider. Details are mentioned below: Provider Name: Thomas, Cini Provider NPI# 1134777238 Group Name: Normandy Urgent Care Center   Tax ID:  27-0796429    Thanks.', NULL, NULL, '2020-10-30 14:12:59', '2020-10-30 14:12:59'),
(2390, 2027, 668, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  Hi,  What is the current status of this request? please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-06 16:47:46', '2020-11-06 16:47:46'),
(2391, 2027, 668, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 10/12/2020. Confirmation screenshot is attached.', NULL, NULL, '2020-11-09 12:26:46', '2020-11-09 12:26:46'),
(2392, 2027, 669, NULL, NULL, 'In Process', 'Talk to the representative her name is renee j ref#7166515   she said this provider is now in network under this group and the effective date is 06/10/2020 i asked for the welcome letter she said it is with group office ', NULL, NULL, '2020-06-30 13:31:14', '2020-06-30 13:31:14'),
(2393, 2027, 669, NULL, NULL, 'In Process', 'To: registrar@multiplan.com, christos.ziogas@multiplan.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Multiplan)  Can I have the welcome letter for this provider as the effective date has already issued 6/10/2020  Provider details are mentioned below: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks. ', NULL, NULL, '2020-07-16 17:05:02', '2020-07-16 17:05:02'),
(2394, 2027, 669, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Provider is now showing linked with insurance and effective date is 06/10/2020. Screenshot from provider directory is attached ', NULL, NULL, '2020-09-09 17:17:08', '2020-09-09 17:17:08'),
(2395, 2027, 670, NULL, NULL, 'Approved', 'Received welcome letter for jeemol george ', NULL, NULL, '2020-06-30 16:43:12', '2020-06-30 16:43:12'),
(2396, 2027, 671, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com  Sub: Need Status Update For Group Columbus Urgent Care PA  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Group Name: Columbus Urgent Care PA Tax-ID: 471914151  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-19 12:52:33', '2020-06-19 12:52:33'),
(2397, 2027, 671, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com  To: mk@claimsmedinc.com  Sub: Need Status Update For Group Columbus Urgent Care PA  Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5346547  Received On: Jun 19, 2020 12:55:06 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2020-06-22 09:35:21', '2020-06-22 09:35:21'),
(2398, 1006, 671, NULL, NULL, 'In Process', 'Sent following email to \"Plummer, Kimberly W\" kimberly.plummer@uhc.com>:  Sub: Ancillary/Group Contract Issue  \"Good morning Kimberly,   I\'ve been trying to reach you via phone but wasn\'t able to, our clinic is facing a weird issue in regards to the contracting that\'s currently in place. As per my discussion with Gary (Ref# 01713901) this morning our clinic has both an ancillary contract and a group contract in place and most of our providers are also linked to the group.   What we want to do is to first get all of our providers loaded under the group contract and then remove the ancillary contract as it\'s been causing issues with billing, could you let me know what we need to do to get this moving along?  Group Name: Columbus Urgent Care PA NPI# 1215330501 TIN# 47-1914151  Thank you!\"', NULL, NULL, '2020-07-02 10:34:07', '2020-07-02 10:34:07'),
(2399, 1006, 671, NULL, NULL, 'In Process', 'Received following update from Ford, Corey J corey_j_ford@uhc.com>:  Sub: Ancillary/Group Contract Issue  \"Good morning Brad,     I reviewed your request that was sent to Kim.  Are you having claim issues?  If so, can you send me claim examples?      UnitedHealth Care does not contract individual providers under an urgent care contract which is what you are contracted as.  To have your physicians linked to a group your contract  will need to be under a different specialty.  In regards to billing, ALL billing should be done under the facility, providers should not be on the claim.  Thanks.        Kind regards,  ___________________________________________________  Corey Ford | Network Account Manager  Ph: 763.361.3267 Fax: 844.733.0471 | corey_j_ford@uhc.com\"', NULL, NULL, '2020-07-16 09:42:41', '2020-07-16 09:42:41'),
(2400, 2027, 671, NULL, NULL, 'In Process', 'from: corey_j_ford@uhc.com  Hi,     Just to be clear, you no longer want the Urgent Care contract to be active correct?     Can you send me claim examples of some claims that have been denied?        Kind regards,', NULL, NULL, '2020-07-22 16:33:36', '2020-07-22 16:33:36'),
(2401, 2027, 671, NULL, NULL, 'In Process', 'To: corey_j_ford@uhc.com  Hello Corey,   Yes, we wish to get the ancillary contract removed and get all of the providers added under the group contract that is currently in place.   As I\'ve mentioned before, we haven\'t had any denials on the ancillary contract but it has been harder to bill under which is why we wish to move forward with only a group contract. Please let me know how we should proceed.   Thanks.  ', NULL, NULL, '2020-07-22 16:34:13', '2020-07-22 16:34:13'),
(2402, 2027, 671, NULL, NULL, 'In Process', 'From: corey_j_ford@uhc.com  Hi Brad,     I will go ahead and remove ancillary contract at your request.  The group contract will remain the same.  I don’t need anything else from you at this time. Thanks.        Kind regards,', NULL, NULL, '2020-07-24 10:53:29', '2020-07-24 10:53:29'),
(2403, 1006, 671, NULL, NULL, 'In Process', 'Sent following reply to Corey corey_j_ford@uhc.com:   Sub: Ancillary/Group Contract Issue  \"Hey Corey,   Appreciate the help, who should I get in touch with regarding the group contract and adding the rest of our providers under it?   Thanks. \"', NULL, NULL, '2020-07-27 09:27:52', '2020-07-27 09:27:52'),
(2404, 1006, 671, NULL, NULL, 'In Process', 'Sent another followup email to Corey Ford asking to for a contact so we can discuss how to add our remaining providers under the group contract. ', NULL, NULL, '2020-07-31 03:48:21', '2020-07-31 03:48:21'),
(2405, 1006, 671, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent following email to \"Motsney, Amber L\" amber_l_motsney@uhc.com>:  Sub: Ancillary/Group Contract Issue  \"Hey Amber,   Hope you\'re doing well, I just wanted to check in with you to get a bunch of our providers contracted under our existing group? Could you let me know how we should proceed?  Thanks.\"', NULL, NULL, '2020-08-06 14:09:13', '2020-08-06 14:09:13'),
(2406, 1004, 671, NULL, '2020-09-11 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-10 16:06:29', '2020-09-10 16:06:29'),
(2407, 2027, 671, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:58:45', '2020-10-12 17:58:45'),
(2408, 1006, 671, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:49:35', '2020-10-26 13:49:35'),
(2409, 2027, 671, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks. ', NULL, NULL, '2020-11-06 10:16:00', '2020-11-06 10:16:00'),
(2410, 2027, 671, NULL, '2020-11-20 00:00:00.000', 'In Process', 'From: Lori Emmert     Good Morning,   You can reach out to the Network Account manager for your area, and they should be able to send a new contract.  Their information is as follows:    Corey Ford (713) 232-3297 corey_j_ford@uhc.com   Please let us know if we can help with anything else.   Thank you,   Lori Emmert UnitedHealthcare Network Management', NULL, NULL, '2020-11-13 10:28:33', '2020-11-13 10:28:33'),
(2411, 2027, 671, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 10:29:19', '2020-11-13 10:29:19'),
(2412, 2027, 671, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:32:57', '2020-11-20 12:32:57'),
(2413, 2027, 671, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:33:06', '2020-11-20 12:33:06'),
(2414, 2027, 671, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:55:30', '2020-11-30 15:55:30'),
(2415, 2037, 671, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:01', '2020-12-08 17:17:01'),
(2416, 1006, 671, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:40:00', '2020-12-15 17:40:00'),
(2417, 2037, 671, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 18:00:30', '2020-12-22 18:00:30'),
(2418, 2037, 671, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Response from Network help: ---------------------- From:    NMRT networkhelp@uhc.com To:      \"sd@claimsmedinc.com\" sd@claimsmedinc.com Date:    12/23/2020 04:24:03 PM GMT Subject: Secure Message from david.c.cliff@optum.com  Good Morning,  I am showing the request for a contract under GD-18696333 was closed and was for a different TIN from 471914151.  I was unable to locate any contract requests in process for TIN 471914151.  David Cliff UnitedHealthcare Network Management ---------------------------- Responded back to David: --------------- Good Morning David,  Thank you for the response. The mentioned TIN 471914151 is owned by \"COLUMBUS URGENT CARE, PA\" which is also the mentioned in the subject line of the secure email being sent to us by UHC. Apart from that the email to which the \"CONTRACT-GD-18696333\" was sent multiple times by UHC belongs to \"COLUMBUS URGENT CARE, PA\" email: cucc@claimsmedinc.com My question is how this is a possibility and also if you could recheck the contract and let us know the name of the clinic or group to which the contract was directed to.  As you mentioned there is no contract request in process for the TIN then could you please assist me to request a group contract for the TIN: 471914151. One more thing is that one of our MD is having an individual contract with UHC through the same TIN is it a possibility to amend the same contract to a group?Details of the individual are as follows:  Abdur Rauf NPI: 1497726202 Specialty: 207R00000X - Internal Medicine', NULL, NULL, '2020-12-23 12:36:28', '2020-12-23 12:36:28'),
(2419, 2037, 671, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Response received from David I have requested provider roster and executed copy of the contract. -------------------- Good Afternoon,  I have reviewed the record under TIN 471914151 and found a medical group record for COLUMBUS URGENT CARE.  I am showing there is a medical group contract and I have attached a product report listing all the plans the group is participating with. ', NULL, NULL, '2020-12-23 15:55:36', '2020-12-23 15:55:36'),
(2420, 1006, 671, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:13:17', '2021-01-05 18:13:17'),
(2421, 1006, 671, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:55:06', '2021-02-02 17:55:06');
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
(2422, 1006, 671, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:23:16', '2021-02-11 10:23:16'),
(2423, 3040, 671, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: latresha_m_coles@uhc.com  Subject: Contracting Query  Greetings Latresha,   Hope you are doing well. As per your last email we updated the taxonomy in the system as a Clinic/center. As we already have a group contact with the facility under this taxonomy.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-26 08:57:29', '2021-04-26 08:57:29'),
(2424, 3040, 671, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Email sent to: latresha_m_coles@uhc.com  Subject: Contracting Query  Hello Latresha,  Has there been any update?  Thanks  ', NULL, NULL, '2021-05-07 09:19:08', '2021-05-07 09:19:08'),
(2425, 1006, 671, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ \"Coles, Latresha M\" latresha_m_coles@uhc.com:  Sub: Contracting Query  \"Hello Latresha,   I hope you\'re doing well, I wanted to follow up with you on this. Can we move forward with this request now since the taxonomy has been updated?   Thanks.\"', NULL, NULL, '2021-06-01 15:30:05', '2021-06-01 15:30:05'),
(2426, 3040, 671, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: latresha_m_coles@uhc.com  Subject: Contracting Query  Hello Latresha,   Can you please advise the taxonomy for Medical groups?   Thank you ', NULL, NULL, '2021-06-22 10:58:47', '2021-06-22 10:58:47'),
(2427, 11056, 671, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : latresha_m_coles@uhc.com  Sub : Re: Contracting Query  Hey Latresha!  Could you please advise the taxonomy for Medical groups? Please respond to us soon.    Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:59:14', '2021-08-05 14:59:14'),
(2428, 10057, 671, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : latresha_m_coles@uhc.com  Sub : Contracting Query  Hey Latresha!  Hope you are doing well. I\'m writing this email to check the status of taxonomy for Medical groups.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Primary Location	926 Walnut St, Columbus , TX 78934-2215 Taxonomy	  Your prompt response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-06 13:10:51', '2021-10-06 13:10:51'),
(2429, 10057, 671, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : latresha_m_coles@uhc.com & networkhelp@uhc.com  Sub : Contracting Query  Hello,  Greetings for the day!  I\'m writing this email to get the latest updates on the below mentioned request for group taxonomy.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-18 09:35:47', '2021-11-18 09:35:47'),
(2430, 10057, 671, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from nathan_riojas@uhc.com  Hello  We have provided the taxonomy codes for this group listed below please let us know if there\'s anything else we can assist with.  261QM1300X  Nathan Riojas UnitedHealthcare', NULL, NULL, '2021-11-23 15:02:13', '2021-11-23 15:02:13'),
(2431, 10057, 671, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : latresha_m_coles@uhc.com & networkhelp@uhc.com  Sub : Contracting Query  Hello,  Hope this email finds you well. Can I get the facility group contract or agreement?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 16:37:27', '2021-12-03 16:37:27'),
(2432, 10057, 671, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : Matthew_J_Murphy@uhc.com  Sub : Contracting Query  Hello,  Hope this email finds you in good health. Can you provide me with the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-10 15:04:52', '2021-12-10 15:04:52'),
(2433, 10057, 671, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : matthew_j_murphy@optum.com  Sub : Contracting Query  Steve,  You reached the incorrect contact for your inquire. Please contact provider relations with United Healthcare for information on claims.  Warm Regards  Matt Murphy | OptumServe', NULL, NULL, '2021-12-17 15:35:48', '2021-12-17 15:35:48'),
(2434, 10057, 671, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latresha_m_coles@uhc.com & networkhelp@uhc.com  Sub : Contracting Query  Good Afternoon,  Hope this email finds you well. I\'m writing this email to get the latest updates on the below mentioned group enrollment status.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Kindly revert back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 14:48:56', '2021-12-27 14:48:56'),
(2435, 10057, 671, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from japarker@uhc.com  Greetings,  Thank you for contacting the Network Management Resource Team. The provider has been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.  The last four digits of taxonomy code is (200X). Please submit the request to the demographic department (hpdemo@uhc.com) for assistance.  You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.  Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.  Sincerely,  Janice P Associate Network Contractor Provider Operations', NULL, NULL, '2021-12-28 10:20:15', '2021-12-28 10:20:15'),
(2436, 1006, 1673, NULL, NULL, 'New/Not Initiated', 'Submitted initiation request via Fax. ', NULL, NULL, '2020-05-20 09:01:42', '2020-05-20 09:01:42'),
(2437, 1006, 1673, NULL, NULL, 'Approved', 'Effective Date: 03/17/2020', NULL, NULL, '2020-05-20 09:09:23', '2020-05-20 09:09:23'),
(2438, 1006, 1675, NULL, NULL, 'New/Not Initiated', 'Online enrollment request submitted via Optum portal. ', NULL, NULL, '2020-05-20 10:12:08', '2020-05-20 10:12:08'),
(2439, 1006, 1675, NULL, NULL, 'Approved', 'Eff: 04/01/2020', NULL, NULL, '2020-05-20 10:26:00', '2020-05-20 10:26:00'),
(2440, 1006, 1676, NULL, NULL, 'New/Not Initiated', 'Online enrollment request submitted via Optum portal.  ', NULL, NULL, '2020-05-20 10:36:32', '2020-05-20 10:36:32'),
(2441, 1006, 1676, NULL, NULL, 'Approved', 'Eff: 04/01/2020 ', NULL, NULL, '2020-05-20 10:38:42', '2020-05-20 10:38:42'),
(2442, 1006, 1677, NULL, NULL, 'New/Not Initiated', 'LOI submitted to Tufts to initiate enrollment. ', NULL, NULL, '2020-05-20 10:57:21', '2020-05-20 10:57:21'),
(2443, 1006, 1677, NULL, NULL, 'Approved', 'Tufts_Health_Plan_Provider_Technical_Support@tufts-health.com  Re: Need Status - Spectrum Neuro Behavioral Care LLC - TIN# 83-4482753  Good Morning,   I\'ve forwarded your request to have your providers attached to payee npi 1144285081 (Spectrum Neuro Behavioral Care LLC) to our Provider Information Department yesterday and see in our claims processing profile that the update has been done with an effective date of 5.9.2019.  Thank you, Provider Services Web Access Management Tufts Health Plan 705 Mt. Auburn Street Watertown, MA 02472-1508                                                        Phone:  888-884-2404 Fax:       617-673-0312 Email:    network_tech@tufts-health.com www.tuftshealthplan.com', NULL, NULL, '2020-05-20 10:59:54', '2020-05-20 10:59:54'),
(2444, 2027, 1678, NULL, '2020-08-21 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com,       PDMCOGZ@cigna.com  Sub: (Abraham, Glory)-(Columbus Urgent Care PA)-(Cigna)  May I know the current status of the below mentioned provider. Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-14 16:48:58', '2020-08-14 16:48:58'),
(2445, 2027, 1678, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Call to insurance talk to the representative her name is gigi and ref#gigi17/8/2020 she said currently the panels are closed so we have to check again next month but we have already submitted the request it will be forwarded once the panel will be open', NULL, NULL, '2020-08-17 10:22:51', '2020-08-17 10:22:51'),
(2446, 2027, 1678, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: PDM COGZ  Hi,     The below provider non-contacted with cigna network.     Regards,  PDM', NULL, NULL, '2020-08-17 10:24:18', '2020-08-17 10:24:18'),
(2447, 1005, 1678, NULL, '2020-10-15 00:00:00.000', 'On Hold', 'Panels are closed.', NULL, NULL, '2020-09-24 13:40:42', '2020-09-24 13:40:42'),
(2448, 2037, 1678, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent for panels: ------------ Greetings, May I know if the panels are now open for taking the below mentioned med-level.  Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-10-23 17:07:09', '2020-10-23 17:07:09'),
(2449, 2027, 1678, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Contract has been signed and sent to insurance', NULL, NULL, '2020-11-03 17:04:05', '2020-11-03 17:04:05'),
(2450, 2027, 1678, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com  May I know the current status of the below mentioned provider: Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks.  ', NULL, NULL, '2020-11-10 12:27:36', '2020-11-10 12:27:36'),
(2451, 2027, 1678, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com  May I know the current status of this provider as I have already signed the contract and sent it back to cigna.  Thanks.', NULL, NULL, '2020-11-18 09:37:41', '2020-11-18 09:37:41'),
(2452, 2027, 1678, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com  May I know the status of my request? I have already signed the contract and returned it back to you.', NULL, NULL, '2020-11-25 10:15:43', '2020-11-25 10:15:43'),
(2453, 2027, 1678, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com  I have already signed the contract as per your request. May I know the current status? ', NULL, NULL, '2020-12-02 10:19:02', '2020-12-02 10:19:02'),
(2454, 2027, 1678, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 12:58:19', '2020-12-10 12:58:19'),
(2455, 2037, 1678, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Called Cigna to verify the reason of the contract that was recent twice. As per Andy we can disregard the contract and allow a bit more time as the request is currently being processed.', NULL, NULL, '2020-12-17 16:58:14', '2020-12-17 16:58:14'),
(2456, 1006, 1678, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Sent a follow-up email @ intake_pdm@cigna.com', NULL, NULL, '2021-01-04 18:10:01', '2021-01-04 18:10:01'),
(2457, 1006, 1678, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Sent a follow-up email @ intake_pdm@cigna.com', NULL, NULL, '2021-02-01 16:52:14', '2021-02-01 16:52:14'),
(2458, 1006, 1678, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received an update that the provider is not showing up under the group TIN, sent following email to Intake_PDM:  \"Hello,   We received an update that the following provider is not active under the group TIN, please let me know what is required to get her added ASAP as we signed and submitted her contract for enrollment back in November of 2020.   Provider Name: Glory Abraham NPI# 1194206490 TIN# 471914151  Please get back to me as soon as possible. Thanks.\"', NULL, NULL, '2021-02-11 12:01:16', '2021-02-11 12:01:16'),
(2459, 3040, 1678, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: psscentral@cigna.com, intake_pdm@cigna.com  Subject: Cigna Internal Reference # (W202101041437690).  Greetings,  Has there been any update?  Thanks', NULL, NULL, '2021-02-18 17:56:28', '2021-02-18 17:56:28'),
(2460, 1006, 1678, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received a copy of the executed contract, attached for reference. ', NULL, NULL, '2021-02-25 10:29:54', '2021-02-25 10:29:54'),
(2461, 3040, 1678, NULL, '2021-03-18 00:00:00.000', 'Approved', 'Dear Healthcare Professional,   PID: 4048834 HCP Name: Glory Abraham Effective Date: 02/01/2021 Tax ID: 47-1914151   We received your recent request. This request has been completed under Cigna Internal Reference#: W202102041510832   Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\".   Regards, PDM', NULL, NULL, '2021-03-11 12:29:10', '2021-03-11 12:29:10'),
(2462, 2037, 1679, NULL, '2020-10-19 00:00:00.000', 'Approved', 'As per the Novitas enrollment application Tracker .It got approved and got confirmation that the location is now reflecting. approved status uploaded over the EMRBS', NULL, NULL, '2020-10-12 14:07:39', '2020-10-12 14:07:39'),
(2463, 2028, 1681, NULL, NULL, 'Rejected', 'Limy Fernandus  is no more working with Nasa Health Clinic.', NULL, NULL, '2020-06-25 17:30:27', '2020-06-25 17:30:27'),
(2464, 1006, 1682, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-05-28 09:12:05', '2020-05-28 09:12:05'),
(2465, 1006, 1682, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-05-28 09:14:15', '2020-05-28 09:14:15'),
(2466, 1006, 1682, NULL, NULL, 'Approved', 'Hi Peggy Pionke,  Welcome to the provider network effective 7/1/2020. Your Provider Identification Number (PIN) is: 6507988', NULL, NULL, '2020-06-19 14:25:02', '2020-06-19 14:25:02'),
(2467, 1006, 1684, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-05-28 09:25:50', '2020-05-28 09:25:50'),
(2468, 1006, 1684, NULL, NULL, 'Approved', 'Received following reply from Judith:  \"Katie has been credentialed and is in network linked to your group effective date 5/18/2020.  Judy\"', NULL, NULL, '2020-05-28 09:26:19', '2020-05-28 09:26:19'),
(2469, 1006, 1685, NULL, NULL, 'New/Not Initiated', 'Sent following email to Luke:  \"Hey Luke,  Here are all the forms for Mahreen, her Medicare is currently in process but otherwise we\'re good to go. Please expedite this request.  Thank you!\" ', NULL, NULL, '2020-05-28 09:43:48', '2020-05-28 09:43:48'),
(2470, 1006, 1685, NULL, NULL, 'Approved', '\"Hi Brad,   She is enrolled 05/27/2020 PIDSL 110161537A.\"  ', NULL, NULL, '2020-05-28 12:13:06', '2020-05-28 12:13:06'),
(2471, 2027, 1686, NULL, NULL, 'In Process', 'From: SHP.NetworkDevelopment@superiorhealthplan.com  To: ma@claimsmedinc.com  Hello,     We received your completed application on (6/2/20).  It is currently in credentialing.  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,  Sasha Henry  ', NULL, NULL, '2020-06-29 09:32:48', '2020-06-29 09:32:48'),
(2472, 2027, 1686, NULL, NULL, 'In Process', 'to: Daniel.Velez@superiorhealthplan.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Superior Health)  Hello, Hope you are doing great, I want to know about the current status of the provider Brown, Brittany  Following are the details: Group Name: Normandy Urgent Care Center   Provider NPI: 1275163537   Group Tax ID: 27-0796429      Thanks.', NULL, NULL, '2020-07-31 11:24:39', '2020-07-31 11:24:39'),
(2473, 2027, 1686, NULL, '2020-08-17 00:00:00.000', 'In Process', 'From: Daniel.Velez@superiorhealthplan.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Superior Health)  Good Morning Martin,     Brittany Brown NPI: 1275163537 TIN: 270796429 is currently under Credentialing.     Please allow additional time to process, feel free to request status updates.     Respectfully,', NULL, NULL, '2020-08-10 15:37:11', '2020-08-10 15:37:11'),
(2474, 2027, 1686, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: Daniel.Velez@superiorhealthplan.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Superior Health)  May I know the current enrollment status of the provider mention below: Provider Name: Brown, Brittany   Provider NPI# 1275163537   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks.  ', NULL, NULL, '2020-09-21 10:49:28', '2020-09-21 10:49:28'),
(2475, 2027, 1686, NULL, '2020-09-29 00:00:00.000', 'In Process', 'From: Daniel.Velez@superiorhealthplan.com  Good Afternoon AM Team,     Can you please assist answering Martin Rodriguez inquiry.     Respectfully,     Daniel Velez', NULL, NULL, '2020-09-22 14:26:55', '2020-09-22 14:26:55'),
(2476, 2027, 1686, NULL, '2020-09-29 00:00:00.000', 'In Process', 'To: 	AM.Houston@superiorhealthplan.com  May I know the current enrollment status of the provider mention below: Provider Name: Brown, Brittany   Provider NPI# 1275163537   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks.    ', NULL, NULL, '2020-09-22 14:27:24', '2020-09-22 14:27:24'),
(2477, 2027, 1686, NULL, '2020-09-30 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good Afternoon Martin     I hope you are doing well. I wanted to follow-up on your request for Brittany Brown. The provider is still in the credentialing process and there are no new updates at this time. Please keep in mind the credentialing process could take up to 90-120 days to complete from the day we receive the application from CVO. Our credentialing department receives a high volume of applications and work them separately in the order they are received in there bucket. Your patience is greatly appreciated in advance and you can follow-up the end of next month for an update.     Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks', NULL, NULL, '2020-09-23 09:16:37', '2020-09-23 09:16:37'),
(2478, 2027, 1686, NULL, '2020-10-20 00:00:00.000', 'In Process', 'From: Denise.Martinez@superiorhealthplan.com  Sub: 1st Request: Credentialing Request; Brittney Brown, FNP_NPI 1275163537  Hello,           Credentialing Request; Brittney Brown, FNP_NPI 1275163537  We received a credentialing application for however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below:                      Page 11 Disclosure Statement Form – complete top, answer Question #2                      Page 12 Disclosure Statement Form – needs signature/date                      Signed and dated attestations pages                      Copy of your Current CLIA                      Certificate of Insurance for Normandy Urgent Care Center PA – certificate must list provider’s name or roster     Please fax or email the requested information to the contact information listed below within 3 days.        Thank you,  Denise Martinez  Credentialing Specialist     cid:image001.jpg@01D541FF.1E22F110  5900 E. Ben White Blvd.  Austin, TX 78741  Toll-Free: 1-800-218-7453  Fax: 1-866-702-4831  Denise.Martinez@superiorhealthplan.com', NULL, NULL, '2020-10-13 13:14:53', '2020-10-13 13:14:53'),
(2479, 2027, 1686, NULL, '2020-10-20 00:00:00.000', 'In Process', 'To: Denise.Martinez@superiorhealthplan.com  Please find the requested documents attached in this email.  Thanks.', NULL, NULL, '2020-10-13 13:15:56', '2020-10-13 13:15:56'),
(2480, 1006, 1686, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Sent a followup email @ Denise.Martinez@superiorhealthplan.com regarding enrollment status. ', NULL, NULL, '2020-10-26 15:10:07', '2020-10-26 15:10:07'),
(2481, 2027, 1686, NULL, '2020-11-03 00:00:00.000', 'Approved', 'Provider is now linked with the insurance and the effective date is 11/01/2020. Welcome letter is attached.', NULL, NULL, '2020-10-27 10:29:25', '2020-10-27 10:29:25'),
(2482, 2027, 1687, NULL, NULL, 'In Process', 'To: MHTContractrequest@molinahealthcare.com  Sub: (Brown, Brittany-(Normandy Urgent Care Center)-(Molina Health)  May I know the current status of the contracting application which we have submitted in the last communication for this provider. Her details are mentioned below: Provider Name:  Brown, Brittany  Provider NPI# 1275163537 Group Name: Normandy Urgent Care Center Tax ID: 27-0796429 Thanks. ', NULL, NULL, '2020-07-14 16:59:39', '2020-07-14 16:59:39'),
(2483, 2027, 1687, NULL, NULL, 'In Process', 'From: MHTContractrequest@molinahealthcare.com  Good morning,     Per the email below I see the record is in credentialing status. Please reach out to your coordinator for further assistance. Thank you!', NULL, NULL, '2020-07-28 09:25:52', '2020-07-28 09:25:52'),
(2484, 2027, 1687, NULL, '2020-08-25 00:00:00.000', 'In Process', 'From: Margaret.White@molinahealthcare.com   August 18, 2020     Brittany Brown, NP  779 Normandy St Ste 114  Houston, TX 77015        Dear Brittany Brown, NP:     Your credentialing file was reviewed by the Molina Healthcare of Texas Credentialing Committee on 8/14/2020.  After careful consideration of the information in your file, I am pleased to inform you that the Committee has approved your credentialing application in the primary specialty of Nurse Practitioner - Family.     Upon execution of your contract with Molina, you will receive under separate cover, a letter informing you of your effective date as a contracted, participating network provider.  Until that time, Molina will reimburse you for services provided to Molina members at the out-of-network rate subject to Title I, Part 15, Chapter 353, Subchapter A, Rule  §353.4 of the Texas Administrative Code  (c) Reasonable reimbursement methodology.       For questions regarding the contracting process please contact Contract Coordination at: 855-322-4080 or email: TexasExpansionContracting@MolinaHealthCare.Com     For Molina’s authorization requirements please refer to the forms at the link below: https://www.molinahealthcare.com/providers/tx/medicaid/forms/pages/fuf.aspx     Thank you for your commitment to joining with Molina Healthcare in providing our members with the best quality health care possible.  We look forward to our continuing successful partnership.     Sincerely,       Lawrence O’Brien, MD  Medical Director  Molina Healthcare of Texas', NULL, NULL, '2020-08-18 12:17:22', '2020-08-18 12:17:22'),
(2485, 2027, 1687, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: MHTContractrequest@molinahealthcare.com, Margaret.White@molinahealthcare.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Molina Health)  May i know the current status of the provider mentioned below: Provider Name-Brown, Brittany Provider NPI#1275163537 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429  Thanks.', NULL, NULL, '2020-09-01 17:36:02', '2020-09-01 17:36:02'),
(2486, 2027, 1687, NULL, '2020-09-09 00:00:00.000', 'In Process', 'From: MHTContractrequest@molinahealthcare.com  Good morning,     Per the email below I see the provider is current being loaded for lines of business. Please reach out to your coordinator for further assistance- Thank you!     HARRIS  Michele Thomas Martin  Michele.Thomas-Martin@MolinaHealthcare.com  888-562-5442 x200042', NULL, NULL, '2020-09-02 10:09:00', '2020-09-02 10:09:00'),
(2487, 2027, 1687, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  May i know the current status of the provider mentioned below: Provider Name-Brown, Brittany Provider NPI#1275163537 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429  Thanks.', NULL, NULL, '2020-09-02 10:12:10', '2020-09-02 10:12:10'),
(2488, 2027, 1687, NULL, '2020-09-09 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 167800     Good Afternoon,     Thank you for your inquiry.  The request has been sent for loading in the billing system, please allow 30 days for processing.     Thank You', NULL, NULL, '2020-09-02 14:52:44', '2020-09-02 14:52:44'),
(2489, 2027, 1687, NULL, '2020-09-10 00:00:00.000', 'In Process', 'From: Margaret.White@molinahealthcare.com  Good morning, please see approval letter attached.', NULL, NULL, '2020-09-03 10:34:49', '2020-09-03 10:34:49'),
(2490, 2027, 1687, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: TexasExpansionContracting@molinahealthcare.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Molina Health)  May I know the current enrollment status of the provider mention below: Provider Name: Brown, Brittany   Provider NPI# 1275163537   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks.  ', NULL, NULL, '2020-09-21 10:54:54', '2020-09-21 10:54:54'),
(2491, 2027, 1687, NULL, '2020-10-08 00:00:00.000', 'In Process', 'From: TexasExpansionContracting@molinahealthcare.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Molina Health)  Hello,     As of 10/01/2020, Molina\'s Corporate Loading Department; final stages; in process.     Please follow up with designated coordinator and reference record#167800.  HARRIS  Michele Thomas-Martin  Michele.thomas-martin@Molinahealthcare.com  888.562.5442 X 200042     Thanks,  Texas Expansion Contracting, RC', NULL, NULL, '2020-10-01 10:02:22', '2020-10-01 10:02:22'),
(2492, 2027, 1687, NULL, '2020-11-02 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 09/15/2020', NULL, NULL, '2020-10-26 15:10:06', '2020-10-26 15:10:06'),
(2493, 2027, 1688, NULL, NULL, 'In Process', 'To: jason.hughes@amerigroup.com  Sub: Need Status update of provider Brittany Brown  Hello, Hope you are doing great, May i know the status of Brittany Brown. Following are her details: Provider NPI# 1275163537 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429 In the last email on 06/16/2020 you asked for the new W 9 form to complete the contract and on the same date we sent that W9 to you. Please reply to me as soon as u get this email.  Thanks.', NULL, NULL, '2020-06-30 10:56:13', '2020-06-30 10:56:13'),
(2494, 2027, 1688, NULL, NULL, 'In Process', 'From: jason.hughes@amerigroup.com  To: mk@claimsmedinc.com  Effective date 05/29/2020', NULL, NULL, '2020-06-30 12:12:55', '2020-06-30 12:12:55'),
(2495, 2027, 1688, NULL, NULL, 'In Process', 'To: jason.hughes@amerigroup.com  Hello, May I have the welcome letter for this provider.  Thanks.', NULL, NULL, '2020-06-30 12:14:15', '2020-06-30 12:14:15'),
(2496, 2027, 1688, NULL, NULL, 'In Process', 'From: jason.hughes@amerigroup.com  To: mk@claimsmedinc.com  Provider was assigned a provision / in-network effective date while credentialing is pending approval.     If a provider is joining a group with an executed contract, Provisional Status allows for providers to bill as an in-network provider while the credentialing process is going on at the same time.  This allows providers to see members as in-network and be paid for services rendered.  Provisional effective dates are determined normally by the day we get the request.     Provisional effective dates can be issued contingent upon:     **Provider having an active TPI with TMHP  **Valid State license #', NULL, NULL, '2020-06-30 12:27:27', '2020-06-30 12:27:27'),
(2497, 2027, 1688, NULL, NULL, 'In Process', 'To: jason.hughes@amerigroup.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Amerigroup)  Can I have the welcome letter for this provider as the effective date has already issued 5/29/2020 Provider details are mentioned below: Provider Name:  Brown, Brittany  Provider NPI# 1275163537 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks. ', NULL, NULL, '2020-07-16 16:56:13', '2020-07-16 16:56:13'),
(2498, 2027, 1688, NULL, NULL, 'In Process', 'To: jason.hughes@amerigroup.com latoyna.henry@amerigroup.com  Sub; (Brown, Brittany)-(Normandy Urgent Care Center)-(Amerigroup)  Can I have the welcome letter for this provider as the effective date has already issued 5/29/2020 Provider details are mentioned below: Provider Name:  Brown, Brittany Provider NPI# 1275163537 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.  ', NULL, NULL, '2020-07-22 14:25:39', '2020-07-22 14:25:39'),
(2499, 2027, 1688, NULL, NULL, 'In Process', 'From: jason.hughes@amerigroup.com  Hi Martin,     The provider is actually fully credentialed as of 07/06/2020 and you should be getting the approval letter soon, but the provider was considered in network as of The 05/29/2020 effective date is what we call a Provisional effective date.        If a provider is joining a group with an executed contract, Provisional Status allows for providers to bill as an in-network provider while the credentialing process is going on at the same time.  This allows providers to see members as in-network and be paid for services rendered.  Provisional effective dates are determined normally by the day we get the request.     Provisional effective dates can be issued contingent upon:     **Provider having an active TPI with TMHP  **Valid State license #', NULL, NULL, '2020-07-22 15:14:37', '2020-07-22 15:14:37'),
(2500, 2027, 1688, NULL, '2020-08-20 00:00:00.000', 'Approved', 'The provider is now showing in network with the effective date of 07/06/2020 with welcome letter attached and a screenshot showing all the plans from provider directory is also attached', NULL, NULL, '2020-08-13 10:25:57', '2020-08-13 10:25:57'),
(2501, 1022, 1692, NULL, NULL, 'New/Not Initiated', 'Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	20157000423 NPI :	1255676151 ', NULL, NULL, '2020-06-05 10:31:27', '2020-06-05 10:31:27'),
(2502, 2027, 1692, NULL, NULL, 'Initiated', 'initiated on 6/5/2020 request is still processing,need more time', NULL, NULL, '2020-06-12 10:23:54', '2020-06-12 10:23:54'),
(2503, 2027, 1692, NULL, NULL, 'Approved', 'Task approved e.d 04/24/2020 welcome letter Ptan attached ', NULL, NULL, '2020-06-26 13:55:32', '2020-06-26 13:55:32'),
(2504, 1022, 1693, NULL, NULL, 'New/Not Initiated', 'Enrollment form has been submitted to tricare insurance', NULL, NULL, '2020-06-05 13:23:29', '2020-06-05 13:23:29'),
(2505, 2027, 1693, NULL, NULL, 'Initiated', 'KMoten4@humana.com  Provider-Teresa saavedra Need Status update   \"Hello, Hope you are doing great, I want know about the current status of the provider Teressa Saavedra - NPI# 1255676151. We have already submitted the enrollment form for this provider. so kindly update me regarding the expected time for completion of this request.  Thanks\"   ', NULL, NULL, '2020-06-12 12:28:17', '2020-06-12 12:28:17'),
(2506, 2027, 1693, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub: Need Status Update For The Provider Teresa Saavedra  Hello,																									 Hope you are doing great, I want to know about the current status of the provider Teresa Saavedra Following are the details:  Group Name: Valley Med Urgent Care PLLC (Brownsville)   Provider NPI: 1255676151   Group Tax ID: 81-5123542 Thanks.', NULL, NULL, '2020-06-23 13:04:26', '2020-06-23 13:04:26'),
(2507, 2027, 1693, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  To: mk@claimsmedinc.com  Sub: Secured: RE: Need Status Update For The Provider Teresa Saavedra  Hi Martin,     This provider is certified in our system.     The provider was already credentialed on the Humana Inc. system and our system pulled that information over. I pushed it to over to reviewed for processing, so you DO NOT need to provide me a credentialing application.     Please allow 90 days for processing.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana', NULL, NULL, '2020-06-23 13:41:17', '2020-06-23 13:41:17'),
(2508, 2027, 1693, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care PLLC Brownsville)-(Tricare)  May i know the current enrollment status of the provider mention below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID:  81-5123542   Thanks. ', NULL, NULL, '2020-07-09 16:44:22', '2020-07-09 16:44:22'),
(2509, 2027, 1693, NULL, NULL, 'In Process', 'To: KMoten4@humana.com\\  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care PLLC Brownsville)-(Tricare)  May i know the current enrollment status of the provider mention below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID:  81-5123542  Thanks. ', NULL, NULL, '2020-07-17 13:59:13', '2020-07-17 13:59:13'),
(2510, 2027, 1693, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  Hi Martin,     This provider was forwarded to be reviewed for credentialing on 6/23/2020. Please allow 90 days for processing.     Thank you.', NULL, NULL, '2020-07-17 16:44:51', '2020-07-17 16:44:51'),
(2511, 2027, 1693, NULL, '2020-09-17 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care PLLC (Brownsville)-(Tricare)  May I know the current enrollment status of the provider mention below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID:  81-5123542  Thanks. ', NULL, NULL, '2020-09-10 16:57:02', '2020-09-10 16:57:02'),
(2512, 2027, 1693, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care PLLC (Brownsville)-(Tricare)  May I know the current enrollment status of the provider mention below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID:  81-5123542  Thanks.', NULL, NULL, '2020-09-21 10:00:50', '2020-09-21 10:00:50'),
(2513, 2027, 1693, NULL, '2020-10-14 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Tricare)  May I know the current enrollment status of the provider mention below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care  Tax ID:  81-5123542  Thanks.', NULL, NULL, '2020-10-07 12:36:54', '2020-10-07 12:36:54'),
(2514, 2027, 1693, NULL, '2020-10-14 00:00:00.000', 'Approved', 'Provider is now showing linked with insurance in all three locations of (VMUC) and the effective date is 09/14/2020', NULL, NULL, '2020-10-07 13:25:35', '2020-10-07 13:25:35'),
(2515, 1022, 1694, NULL, NULL, 'New/Not Initiated', 'Initiation request has been send  to Molina Health ', NULL, NULL, '2020-06-05 17:30:27', '2020-06-05 17:30:27'),
(2516, 2027, 1694, NULL, NULL, 'Initiated', 'MHTXProviderServices@molinahealthcare.com  Provider-Teresa saavedra Need Status update   \"Hello, Hope you are doing great, I want to know about the current status of the provider Teressa Saavedra - NPI# 1255676151. As we have already sent the initiation request for this provider. so kindly update me regarding the expected time for completion of this request.  Thanks\" ', NULL, NULL, '2020-06-12 12:50:30', '2020-06-12 12:50:30'),
(2517, 2027, 1694, NULL, NULL, 'In Process', 'To: MHTXProviderServices@molinahealthcare.com  Sub: Need Status Update For The Provider Teresa Saavedra  Hello,																									 Hope you are doing great, I want to know about the current status of the provider Teresa Saavedra Following are the details:  Group Name: Valley Med Urgent Care PLLC (Brownsville)   Provider NPI: 1255676151   Group Tax ID: 81-5123542 Thanks.', NULL, NULL, '2020-06-23 13:09:30', '2020-06-23 13:09:30'),
(2518, 2027, 1694, NULL, NULL, 'In Process', 'Call To insurance: talk to the representative her name is sasha, She said nothing showing against this provider in their records. So she gave me an email address to check for this provider.  To: 	mht.credentialing@molinahealthcare.com  Need Status Update For The Provider Teresa Saavedra  Hello, Hope you are doing great, I want to know about the current status of the provider Teresa Saavedra Following are the details: Group Name: Valley Med Urgent Care PLLC (Brownsville)   Provider NPI: 1255676151   Group Tax ID: 81-5123542 Thanks.', NULL, NULL, '2020-06-29 14:24:11', '2020-06-29 14:24:11'),
(2519, 2027, 1694, NULL, NULL, 'Approved', 'From: Jasmine.Guerrero@molinahealthcare.com  Good afternoon,     I’m following up on the email below. We have not received a contract request form to add Teresa Saavedra to the group. Please be advised that Valley Med Urgent Care has an urgent care contract, and we are unable to link individual providers to an urgent care contract.     Thank you in advance!        Thank you,', NULL, NULL, '2020-07-16 14:58:40', '2020-07-16 14:58:40'),
(2520, 3040, 1694, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:43', '2021-04-26 10:46:43'),
(2521, 3040, 1694, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:07:49', '2021-05-31 09:07:49'),
(2522, 1022, 1695, NULL, NULL, 'New/Not Initiated', 'Initiation  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 # 7252908', NULL, NULL, '2020-06-08 10:38:52', '2020-06-08 10:38:52'),
(2523, 2027, 1695, NULL, NULL, 'Initiated', 'Three forms sent to Fax# (888) 850-7604 ', NULL, NULL, '2020-06-15 12:27:09', '2020-06-15 12:27:09'),
(2524, 2027, 1695, NULL, NULL, 'In Process', 'To: 	christos.ziogas@multiplan.com  Sub: Need Status Update For The Provider Teresa Saavedra  Hello,																									 Hope you are doing great, I want to know about the current status of the provider Teresa Saavedra Following are the details:  Group Name: Valley Med Urgent Care PLLC (Brownsville)   Provider NPI: 1255676151   Group Tax ID: 81-5123542 We have already sent Three forms which you have asked to Fax# (888) 850-7604. Thanks. ', NULL, NULL, '2020-06-23 13:17:19', '2020-06-23 13:17:19'),
(2525, 2027, 1695, NULL, NULL, 'In Process', 'Talk to the representative she said you have sent the documents on the wrong fax id so she gave me a new fax# on which i am sending those documents again', NULL, NULL, '2020-06-29 14:55:57', '2020-06-29 14:55:57'),
(2526, 2027, 1695, NULL, NULL, 'In Process', 'Three Forms sent to Fax# 7814878273', NULL, NULL, '2020-06-29 15:07:33', '2020-06-29 15:07:33'),
(2527, 2027, 1695, NULL, NULL, 'In Process', 'To: registrar@multiplan.com  Sub: Resubmitting Enrollment Application For Saavedra, Teresa  Hello, Hope you are doing great, we have submitted this application last time on 06/15/2020 but unfortunately we sent these 3 forms on the wrong fax id, So now we are submitting these documents again. Please find attached forms for the provider: Saavedra, Teresa, NPI#  1255676151, Tax ID; 81-5123542 and Group Name is Valley Med Urgent Care PLLC. Thanks.', NULL, NULL, '2020-06-29 15:21:09', '2020-06-29 15:21:09'),
(2528, 2027, 1695, NULL, NULL, 'Approved', 'Received Welcome letter for Saavedra, Teresa from multiplan effective date is 06/29/2020', NULL, NULL, '2020-07-06 09:27:39', '2020-07-06 09:27:39'),
(2529, 1022, 1696, NULL, NULL, 'New/Not Initiated', 'initiation request submitted   Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon', NULL, NULL, '2020-06-08 14:53:33', '2020-06-08 14:53:33'),
(2530, 1006, 1696, NULL, NULL, 'Initiated', 'Sent email to SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Add Provider - Teresa Saavedra  \"Hello,   Please find the attached application form for our provider, please let me know if anything else is required to process this request and what the expected time-frame is.  Thank you. \"', NULL, NULL, '2020-06-10 15:39:34', '2020-06-10 15:39:34'),
(2531, 2027, 1696, NULL, NULL, 'Approved', 'Welcome letter received from insurance effective date is 07/01/2020  ', NULL, NULL, '2020-06-19 09:35:33', '2020-06-19 09:35:33'),
(2532, 1006, 1697, NULL, NULL, 'New/Not Initiated', 'Sent following email to SWHP RECRED SWHPRECRED@bswhealth.org:  Sub: Normandy Urgent Care Center, PA - NPI 1407171077  \"Hello,   Please find the attached application for recredentialing, please let me know if anything else is required.   Thanks.\"', NULL, NULL, '2020-06-09 15:46:38', '2020-06-09 15:46:38'),
(2533, 2027, 1697, NULL, NULL, 'In Process', 'SWHPRECRED@bswhealth.org  Group-Normandy Urgent Care Center,NPI# 1407171077 Need Status Update   \"Hello,Hope you are doing great, I want to know about the current status of the Group: Normandy Urgent Care Center. NPI# 1407171077. We have applied for recredentialing, may I know the expected completion time for this request.    Thanks\"', NULL, NULL, '2020-06-15 17:33:44', '2020-06-15 17:33:44'),
(2534, 2027, 1697, NULL, NULL, 'In Process', 'SWHPRECRED@bswhealth.org to: Martin Rodriguez mk@claimsmedinc.com  RE: Group-Normandy Urgent Care Center,NPI# 1407171077 Need Status Update  Good Morning Martin,     I received the missing information last week and forwarded to Aperture for the verification process, it usually takes around 30 days to do the verification process.     Thank you  Irene', NULL, NULL, '2020-06-17 12:13:31', '2020-06-17 12:13:31'),
(2535, 2027, 1697, NULL, NULL, 'In Process', 'To: 	SWHPRECRED@bswhealth.org  Sub: Need Status Update for Group Normandy Urgent Care Center  Hello, Hope you are doing well, May i know the current status Of the group. Following are the details: Group Name: Normandy Urgent Care Center Group NPI: 1407171077 Group Tax ID: 27-0796429.  Thanks.', NULL, NULL, '2020-06-24 09:27:58', '2020-06-24 09:27:58'),
(2536, 2027, 1697, NULL, NULL, 'In Process', 'From: SWHPRECRED@bswhealth.org  To: mk@claimsmedinc.com  Good Morning,     The application is still going through the verification process with the Aperture, it appears they have emailed for missing information and waiting for a response.           Thank you  Irene', NULL, NULL, '2020-06-25 09:55:22', '2020-06-25 09:55:22'),
(2537, 2027, 1697, NULL, NULL, 'In Process', 'To: SWHPRECRED@bswhealth.org  Sub: (For Group)-(Normandy Urgent Care Center)-(Scott & White)  Hello, Hope you are doing well, May i know the current status Of the group. Following are the details: Group Name: Normandy Urgent Care Center Group NPI: 1407171077 Group Tax ID: 27-0796429.  Thanks.', NULL, NULL, '2020-07-31 11:07:30', '2020-07-31 11:07:30'),
(2538, 2027, 1697, NULL, '2020-08-17 00:00:00.000', 'Approved', 'From: SWHPRECRED@bswhealth.org  Sub: (For Group)-(Normandy Urgent Care Center)-(Scott & White)  Good Morning,     Recredentialing was approved and completed on 7/17/20, please see the attached recred letter.        Thank you  Irene', NULL, NULL, '2020-08-10 14:30:37', '2020-08-10 14:30:37'),
(2539, 2027, 1699, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub: (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks.', NULL, NULL, '2020-08-17 14:02:16', '2020-08-17 14:02:16'),
(2540, 1005, 1699, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:13:18', '2020-09-24 14:13:18'),
(2541, 2037, 1699, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email Sent: --------------  Greetings, I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status.  Please find the list below:  Columbus Urgent Care   TIN # 471914151  Brown, Brittany	NPI:1275163537   George, JeemolNPI:1497219067  Piccione JR, James M	NPI:1356321509   Thomas, Cini	NPI:1134777238  Stephen, Ani	NPI:1588959118  Joseph, Vibitha	NPI:1952931560   Jose, Julie	NPI:1447883061  Thanks.', NULL, NULL, '2020-10-23 17:23:49', '2020-10-23 17:23:49'),
(2542, 2027, 1699, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  This is a follow up to my last email. Kindly reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:44:03', '2020-11-18 09:44:03'),
(2543, 2027, 1699, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     Please share the below information for providers. So that we can initiate to load the providers.  Practice location along with phone and fax number Date of birth and License information    Regards,  Bharath', NULL, NULL, '2020-11-18 12:56:45', '2020-11-18 12:56:45');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(2544, 2027, 1699, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  Please find the requested information below:   Providers	NPI	Tax-ID	Practice Location	Phone & Fax #	License Information Brown, Brittany	1275163537	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP141955) (Eff Date-6/20/2019) (Exp Date-5/10/2024) Chennemkara, Mini Philip	1841755956	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140439) (Eff Date-1/31/2019) (Exp Date-5/31/2022) George, Jeemol	1497219067	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140325) (Eff Date-1/25/2019) (Exp Date-4/30/2021) Jose, Julie	1447883061	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142708) (Eff Date-8/14/2019) (Exp Date-8/31/2021) Joseph, Vibitha	1952931560	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142857) (Eff Date-8/22/2019) (Exp Date-1/31/2022) Kourouma , Odette Tiranke	1134525868	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126172) (Eff Date-8/6/2014) (Exp Date-4/30/2021) Piccione JR, James M	1356321509	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#J2973) (Eff Date-2/27/1993) (Exp Date-10/31/2021) Stephen, Ani	1588959118	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126450) (Eff Date-9/16/2014) (Exp Date-1/31/2022) Thomas, Cini	1134777238	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142314) (Eff Date-7/18/2019) (Exp Date-5/31/2022)    Thanks.', NULL, NULL, '2020-11-18 12:57:12', '2020-11-18 12:57:12'),
(2545, 2027, 1699, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  May I know the current status of my request? as I have already provided you the requested information regarding the providers in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:27:21', '2020-11-25 10:27:21'),
(2546, 2027, 1699, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  I have already provided you the requested information in my last two emails. May I know the current status of this request?', NULL, NULL, '2020-12-02 12:24:37', '2020-12-02 12:24:37'),
(2547, 2027, 1699, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     If the contract is done I will receive a provider agreement forms along with rates information which needs to be signed by providers.', NULL, NULL, '2020-12-10 12:59:42', '2020-12-10 12:59:42'),
(2548, 2037, 1699, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Need to allow more time for the contract', NULL, NULL, '2020-12-17 17:00:00', '2020-12-17 17:00:00'),
(2549, 1006, 1699, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent enrollment request @ pdsdallas@aetna.com for providers. ', NULL, NULL, '2021-01-22 18:00:51', '2021-01-22 18:00:51'),
(2550, 1006, 1699, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent another enrollment request @ pdsdallas@aetna.com, LakkakulaS@aetna.com, BharathB@aetna.com ', NULL, NULL, '2021-02-02 18:08:17', '2021-02-02 18:08:17'),
(2551, 1006, 1699, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Received the following reply from thandapanim@aetna.com:  \"Hello,  We have received a request to add multiple providers under FTIN# 47-1914151, However there is no Location information. Kindly provide location information to proceed further.  Thanks, Meena.\"  Sent her the group information and address. ', NULL, NULL, '2021-02-05 13:55:41', '2021-02-05 13:55:41'),
(2552, 3040, 1699, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: thandapanim@aetna.com  Subject: Send Secure [EXTERNAL] First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Morning,  We wish to enroll the following providers to the given group, the information is as follows. We already sent the address to you.   Group Name: Columbus Urgent Care PA TIN# 47-1914151 Ph# (979) 942-9084 Fax# (979) 942-9085 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Julie Jose NPI# 1447883061  Provider Name: Brittany Brown NPI# 1275163537  Provider Name: Cini Thomas NPI# 1134777238  Provider Name: Ani Stephen NPI# 1588959118  Provider Name: Vibitha Joseph NPI# 1952931560  Provider Name: Jeemol George NPI# 1497219067  Please let me know what is required to get these providers enrolled as in-network with Firsthealth ASAP.   Thanks.', NULL, NULL, '2021-02-12 11:05:33', '2021-02-12 11:05:33'),
(2553, 1006, 1699, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com, \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  \"Hi Brad,  Please share practice location information of below providers so that we can initiate the further process.  Regards, Bharath\"  Sent group address to them. ', NULL, NULL, '2021-02-15 10:43:34', '2021-02-15 10:43:34'),
(2554, 1006, 1699, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com:  \"Hi,  The below provider are loaded as per requested.\"  Asked them to send me proof of enrollment via a roster or welcome letter. ', NULL, NULL, '2021-02-23 13:30:29', '2021-02-23 13:30:29'),
(2555, 3040, 1699, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, TalasilaB@aetna.com, MuchakurthiS@aetna.com  Subject: First Health Network - Enrollment Request Log #9266762103322409  Greetings,  Please advise me the enrollment status for the below mentioned providers. Find the attached reply that we get from your side in which you mentioned that all providers are loaded as per requested. Can you please send me the provider roster or welcome letter in which the provider is showing in the system.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 12:01:53', '2021-03-08 12:01:53'),
(2556, 3040, 1699, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers. ', NULL, NULL, '2021-03-16 16:30:41', '2021-03-16 16:30:41'),
(2557, 3040, 1699, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:43:16', '2021-06-15 10:43:16'),
(2558, 3040, 1699, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Online application submitted. Please see attachment.', NULL, NULL, '2021-06-29 16:57:40', '2021-06-29 16:57:40'),
(2559, 3040, 1699, NULL, '2021-07-26 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:55', '2021-07-19 11:31:55'),
(2560, 11056, 1699, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:23:11', '2021-08-04 16:23:11'),
(2561, 3040, 1699, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:25', '2021-08-30 12:01:25'),
(2562, 10057, 1699, NULL, '2021-11-12 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:07:05', '2021-11-02 14:07:05'),
(2563, 10057, 1699, NULL, '2021-11-24 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:09:38', '2021-11-17 17:09:38'),
(2564, 10057, 1699, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:35:52', '2021-11-22 17:35:52'),
(2565, 10057, 1699, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:42:01', '2021-11-22 17:42:01'),
(2566, 10057, 1699, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:05:35', '2021-12-09 11:05:35'),
(2567, 10057, 1699, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:33:54', '2021-12-16 14:33:54'),
(2568, 10057, 1699, NULL, '2021-12-30 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:55:10', '2021-12-22 10:55:10'),
(2569, 10057, 1699, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:52:38', '2021-12-29 15:52:38'),
(2570, 20067, 1699, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:20:13', '2022-01-19 12:20:13'),
(2571, 20067, 1699, NULL, '2022-02-03 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:34:47', '2022-01-27 12:34:47'),
(2572, 20067, 1699, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:17:11', '2022-02-02 11:17:11'),
(2573, 20067, 1699, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:11:47', '2022-02-17 17:11:47'),
(2574, 2027, 1700, NULL, NULL, 'In Process', 'To: SidleyJ1@firsthealth.com, LakkakulaS@aetna.com, AbhishekV@aetna.com, MuchakurthiS@aetna.com  Sub: (Brown, Brittany)-(Columbus Urgent Care PA)-(First Health)  May I know the current status of the provider Brown, Brittany as we have already submitted the online application on June 06/18/2020.  . Following are her details: Provider NPI# 1275163537 Tax ID: 471914151 Group Name: Columbus Urgent Care PA  Thanks.', NULL, NULL, '2020-07-09 11:01:48', '2020-07-09 11:01:48'),
(2575, 2027, 1700, NULL, NULL, 'In Process', 'From: LakkakulaS@aetna.com  Hello Martin,     The below provider “Brown, Brittany” is not contracted with the given FTIN#471914151 in our database.     Kindly, let us know if you need any additional information.     Regards,  Shruthi', NULL, NULL, '2020-07-09 12:30:34', '2020-07-09 12:30:34'),
(2576, 2027, 1700, NULL, NULL, 'In Process', 'To: LakkakulaS@aetna.com  We have already submitted the online application on 06/18/2020 and iam attaching the application form,loi and w9 as a proof that we have submitted this request to find the attached documents.  Thanks.', NULL, NULL, '2020-07-09 12:33:18', '2020-07-09 12:33:18'),
(2577, 2027, 1700, NULL, '2020-08-17 00:00:00.000', 'In Process', 'From: LakkakulaS@aetna.com  Hello Martin,        The provider is “Brown, Brittany” is now contracted with the given FTIN#471914151 in our database     Kindly, let us know if you need any additional information.     Regards,  Shruthi', NULL, NULL, '2020-08-10 12:11:34', '2020-08-10 12:11:34'),
(2578, 2027, 1700, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub: (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks.', NULL, NULL, '2020-08-17 13:50:49', '2020-08-17 13:50:49'),
(2579, 1005, 1700, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:12:21', '2020-09-24 14:12:21'),
(2580, 2037, 1700, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email Sent: --------------  Greetings, I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status.  Please find the list below:  Columbus Urgent Care   TIN # 471914151  Brown, Brittany	NPI:1275163537   George, JeemolNPI:1497219067  Piccione JR, James M	NPI:1356321509   Thomas, Cini	NPI:1134777238  Stephen, Ani	NPI:1588959118  Joseph, Vibitha	NPI:1952931560   Jose, Julie	NPI:1447883061  Thanks.', NULL, NULL, '2020-10-23 17:17:48', '2020-10-23 17:17:48'),
(2581, 2037, 1700, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email Sent: --------------  Greetings, I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status.  Please find the list below:  Columbus Urgent Care   TIN # 471914151  Brown, Brittany	NPI:1275163537   George, JeemolNPI:1497219067  Piccione JR, James M	NPI:1356321509   Thomas, Cini	NPI:1134777238  Stephen, Ani	NPI:1588959118  Joseph, Vibitha	NPI:1952931560   Jose, Julie	NPI:1447883061  Thanks.', NULL, NULL, '2020-10-23 17:24:07', '2020-10-23 17:24:07'),
(2582, 2027, 1700, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  This is a follow up to my last email. Kindly reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:44:28', '2020-11-18 09:44:28'),
(2583, 2027, 1700, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     Please share the below information for providers. So that we can initiate to load the providers.  Practice location along with phone and fax number Date of birth and License information    Regards,  Bharath  ', NULL, NULL, '2020-11-18 12:58:27', '2020-11-18 12:58:27'),
(2584, 2027, 1700, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Please find the requested information below:   Providers	NPI	Tax-ID	Practice Location	Phone & Fax #	License Information Brown, Brittany	1275163537	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP141955) (Eff Date-6/20/2019) (Exp Date-5/10/2024) Chennemkara, Mini Philip	1841755956	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140439) (Eff Date-1/31/2019) (Exp Date-5/31/2022) George, Jeemol	1497219067	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140325) (Eff Date-1/25/2019) (Exp Date-4/30/2021) Jose, Julie	1447883061	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142708) (Eff Date-8/14/2019) (Exp Date-8/31/2021) Joseph, Vibitha	1952931560	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142857) (Eff Date-8/22/2019) (Exp Date-1/31/2022) Kourouma , Odette Tiranke	1134525868	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126172) (Eff Date-8/6/2014) (Exp Date-4/30/2021) Piccione JR, James M	1356321509	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#J2973) (Eff Date-2/27/1993) (Exp Date-10/31/2021) Stephen, Ani	1588959118	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126450) (Eff Date-9/16/2014) (Exp Date-1/31/2022) Thomas, Cini	1134777238	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142314) (Eff Date-7/18/2019) (Exp Date-5/31/2022)    Thanks.', NULL, NULL, '2020-11-18 12:58:43', '2020-11-18 12:58:43'),
(2585, 2027, 1700, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  May I know the current status of my request? as I have already provided you the requested information regarding the providers in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:27:33', '2020-11-25 10:27:33'),
(2586, 2027, 1700, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  I have already provided you the requested information in my last two emails. May I know the current status of this request?', NULL, NULL, '2020-12-02 12:24:56', '2020-12-02 12:24:56'),
(2587, 2027, 1700, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     If the contract is done I will receive a provider agreement forms along with rates information which needs to be signed by providers.', NULL, NULL, '2020-12-10 13:01:00', '2020-12-10 13:01:00'),
(2588, 2037, 1700, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Need to allow more time for the contract', NULL, NULL, '2020-12-17 17:00:10', '2020-12-17 17:00:10'),
(2589, 1006, 1700, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent a follow-up email @ BharathB@aetna.com & \"Lakkakula, Shruthi\" LakkakulaS@aetna.com', NULL, NULL, '2021-01-04 18:31:31', '2021-01-04 18:31:31'),
(2590, 1006, 1700, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent enrollment request @ pdsdallas@aetna.com for providers. ', NULL, NULL, '2021-01-22 18:00:29', '2021-01-22 18:00:29'),
(2591, 1006, 1700, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent another enrollment request @ pdsdallas@aetna.com, LakkakulaS@aetna.com, BharathB@aetna.com ', NULL, NULL, '2021-02-02 18:08:22', '2021-02-02 18:08:22'),
(2592, 1006, 1700, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Received the following reply from thandapanim@aetna.com:  \"Hello,  We have received a request to add multiple providers under FTIN# 47-1914151, However there is no Location information. Kindly provide location information to proceed further.  Thanks, Meena.\"  Sent her the group information and address. ', NULL, NULL, '2021-02-05 13:55:47', '2021-02-05 13:55:47'),
(2593, 3040, 1700, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: thandapanim@aetna.com  Subject: Send Secure [EXTERNAL] First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Morning,  We wish to enroll the following providers to the given group, the information is as follows. We already sent the address to you.   Group Name: Columbus Urgent Care PA TIN# 47-1914151 Ph# (979) 942-9084 Fax# (979) 942-9085 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Julie Jose NPI# 1447883061  Provider Name: Brittany Brown NPI# 1275163537  Provider Name: Cini Thomas NPI# 1134777238  Provider Name: Ani Stephen NPI# 1588959118  Provider Name: Vibitha Joseph NPI# 1952931560  Provider Name: Jeemol George NPI# 1497219067  Please let me know what is required to get these providers enrolled as in-network with Firsthealth ASAP.   Thanks.', NULL, NULL, '2021-02-12 11:05:38', '2021-02-12 11:05:38'),
(2594, 1006, 1700, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com, \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  \"Hi Brad,  Please share practice location information of below providers so that we can initiate the further process.  Regards, Bharath\"  Sent group address to them. ', NULL, NULL, '2021-02-15 10:43:43', '2021-02-15 10:43:43'),
(2595, 1006, 1700, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com:  \"Hi,  The below provider are loaded as per requested.\"  Asked them to send me proof of enrollment via a roster or welcome letter. ', NULL, NULL, '2021-02-23 13:30:43', '2021-02-23 13:30:43'),
(2596, 3040, 1700, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, TalasilaB@aetna.com, MuchakurthiS@aetna.com  Subject: First Health Network - Enrollment Request Log #9266762103322409  Greetings,  Please advise me the enrollment status for the below mentioned providers. Find the attached reply that we get from your side in which you mentioned that all providers are loaded as per requested. Can you please send me the provider roster or welcome letter in which the provider is showing in the system.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 12:01:57', '2021-03-08 12:01:57'),
(2597, 3040, 1700, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers. ', NULL, NULL, '2021-03-16 16:30:46', '2021-03-16 16:30:46'),
(2598, 3040, 1700, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:43:10', '2021-06-15 10:43:10'),
(2599, 3040, 1700, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Online application submitted. Please see attachment.', NULL, NULL, '2021-06-29 16:57:38', '2021-06-29 16:57:38'),
(2600, 3040, 1700, NULL, '2021-07-26 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:55', '2021-07-19 11:31:55'),
(2601, 11056, 1700, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:22:34', '2021-08-04 16:22:34'),
(2602, 3040, 1700, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:25', '2021-08-30 12:01:25'),
(2603, 10057, 1700, NULL, '2021-11-09 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:06:58', '2021-11-02 14:06:58'),
(2604, 10057, 1700, NULL, '2021-11-24 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:09:32', '2021-11-17 17:09:32'),
(2605, 10057, 1700, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:35:47', '2021-11-22 17:35:47'),
(2606, 10057, 1700, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:41:55', '2021-11-22 17:41:55'),
(2607, 10057, 1700, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:05:30', '2021-12-09 11:05:30'),
(2608, 10057, 1700, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:33:48', '2021-12-16 14:33:48'),
(2609, 10057, 1700, NULL, '2021-12-30 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:55:01', '2021-12-22 10:55:01'),
(2610, 10057, 1700, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:52:34', '2021-12-29 15:52:34'),
(2611, 20067, 1700, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:20:08', '2022-01-19 12:20:08'),
(2612, 20067, 1700, NULL, '2022-02-03 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:34:40', '2022-01-27 12:34:40'),
(2613, 20067, 1700, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:11:24', '2022-02-02 11:11:24'),
(2614, 20067, 1700, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:11:42', '2022-02-17 17:11:42'),
(2615, 1006, 1704, NULL, NULL, 'New/Not Initiated', 'Received following email from sharbin3@humana.com:  \"HELLO   I AM CREDENTIALING _PRISCA HEFTI – NPI 1508133182 _FOR NETWORK  PARTICIPATION WITH HUMANA MILITARY.  I AM NEEDING THE FOLLOWING  INFORMATION TO CONTINUE THE CREDENTIALING PROCESS:   -WORK HISTORY 4/2015-11/2018, FORMATTED AS \"MM/YYYY\"  PLEASE RETURN THE REQUESTED INFORMATION TO ME VIA EMAIL OR FAX ASAP IN ORDER TO CONTINUE THE CREDENTIALING PROCESS.  IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ME.  THANK YOU,  SHENISE HARBIN  _CREDENTIALING ASSISTANT_| _CREDENTIALING DEPT__ _  HUMANA GOVERNMENT BUSINESS 301 N Hurstbourne Parkway | Louisville, KY 40222 [1] Forum  1-1B (502) 318-0890 FAX# (502)398-2471 sharbin3@humana.com\"', NULL, NULL, '2020-06-15 10:47:24', '2020-06-15 10:47:24'),
(2616, 1006, 1704, NULL, NULL, 'Approved', 'Received following reply from Anne:  \"I do not have a copy of a Welcome Letter to forward to you. The Welcome Letters are mailed approximately two weeks after Credentialing is approved and I expect you will receive it soon. The letter would be sent to the mailing address listed in the practitioner record which, in this case, is 61 Lincoln St Ste 203 Framingham, MA 01702.  As a credentialed, network provider she may treat either TRICARE Select or TRICARE Prime (Prime Remote) and submit claims for services rendered.   Thank you,   Anne Santulli Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com   Find us on the web at humanamilitary.com Customer Service (800) 444-5445\" ', NULL, NULL, '2020-06-15 10:47:47', '2020-06-15 10:47:47'),
(2617, 1006, 1707, NULL, NULL, 'New/Not Initiated', 'Sent attached fax to \'8666127790@myfax.com\':  Sub: Peggy Pionke - Group Application  \"Hello,   Please find the attached application for our provider, she needs to be attached to both MA & RI location.    Do let me know if anything else is needed to process the application.   Thanks!\" ', NULL, NULL, '2020-06-15 10:59:01', '2020-06-15 10:59:01'),
(2618, 1006, 1707, NULL, NULL, 'Approved', 'Received following reply from Cheryl:  \"Good morning,   A ticket was created to have an updated Welcome Letter for Peggy Pionke sent listing all MA Plans the clinician is credentialed for.  As for Katie Tawakols credentialing application is still in process.   Thank you,   Cheryl Williams.   Provider Relation Rep. I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 Office: 800.397.1630 Direct: 781-496-4014 www.beaconhealthoptions.com\" ', NULL, NULL, '2020-06-15 10:59:25', '2020-06-15 10:59:25'),
(2619, 1006, 1708, NULL, NULL, 'New/Not Initiated', 'Form fax @ 6082217535 to tricare for MA location ', NULL, NULL, '2020-06-15 16:39:28', '2020-06-15 16:39:28');
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
(2620, 1006, 1708, NULL, NULL, 'Rejected', 'Request rejected due to provider specialty of LCSW, Tricare suggested to submit claims under other providers.  ', NULL, NULL, '2020-06-15 16:40:07', '2020-06-15 16:40:07'),
(2621, 1006, 1709, NULL, NULL, 'New/Not Initiated', 'Form fax @ 6082217535 to tricare for MA location ', NULL, NULL, '2020-06-15 16:41:11', '2020-06-15 16:41:11'),
(2622, 1006, 1709, NULL, NULL, 'Rejected', 'Request could not be completed due to provider specialty of LCSW, but tricare recommended to submit claims under different providers.  ', NULL, NULL, '2020-06-15 16:41:46', '2020-06-15 16:41:46'),
(2623, 1006, 1711, NULL, NULL, 'New/Not Initiated', 'LOI faxed 8594558650@myfax.com ', NULL, NULL, '2020-06-15 16:47:55', '2020-06-15 16:47:55'),
(2624, 1006, 1711, NULL, NULL, 'Approved', 'Received following email from Laura Bevin:  Sub: Provider Status Update  \"Good morning,  Peggy Pionke, 6507988 will complete the credentialing process for RI and MA on 05/22/2020. The Network Relations Specialist has been informed so that she can assign an effective date and add Peggy Pionke to the group contract. Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\" ', NULL, NULL, '2020-06-15 16:48:13', '2020-06-15 16:48:13'),
(2625, 1006, 1712, NULL, NULL, 'New/Not Initiated', 'Sent following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  Sub: Provider Add Forms - RI & MA  \"Hello,    Please find the attached enrollment request, we wish to add the provider to both of our locations. Please let me know if anything else is needed.   Thanks!\" ', NULL, NULL, '2020-06-15 17:00:10', '2020-06-15 17:00:10'),
(2626, 1006, 1712, NULL, NULL, 'Approved', 'Received following reply from Allison:  \"Hi Brad,  I got confirmation on how this LCSW enrollment will work. The provider has been added to our system as an out-of-network provider effective 5/1/2020. The provider can render and bill for services as an out-of-network provider. Tufts is temporarily waiving authorization requirements for out-of-network outpatient behavioral health telehealth services.  Please refer to the Telehealth/Telemedicine Guidelines here:    https://tuftshealthplan.com/covid-19/provider/coronavirus-updates-for-providers\" ', NULL, NULL, '2020-06-15 17:01:26', '2020-06-15 17:01:26'),
(2627, 1006, 1713, NULL, NULL, 'New/Not Initiated', 'Sent following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  Sub: Provider Add Forms - RI & MA  \"Hello,    Please find the attached enrollment request, we wish to add the provider to both of our locations. Please let me know if anything else is needed.   Thanks!\" ', NULL, NULL, '2020-06-15 17:02:41', '2020-06-15 17:02:41'),
(2628, 1006, 1713, NULL, NULL, 'Approved', 'Received following reply from Allison:  \"Hi Brad,  I got confirmation on how this LCSW enrollment will work. The provider has been added to our system as an out-of-network provider effective 5/1/2020. The provider can render and bill for services as an out-of-network provider. Tufts is temporarily waiving authorization requirements for out-of-network outpatient behavioral health telehealth services.  Please refer to the Telehealth/Telemedicine Guidelines here:    https://tuftshealthplan.com/covid-19/provider/coronavirus-updates-for-providers\" ', NULL, NULL, '2020-06-15 17:03:00', '2020-06-15 17:03:00'),
(2629, 1006, 1714, NULL, NULL, 'New/Not Initiated', 'Cigna online application submitted ', NULL, NULL, '2020-06-15 17:04:12', '2020-06-15 17:04:12'),
(2630, 1006, 1714, NULL, NULL, 'Approved', 'Received following reply from Emily:  \"Hi Brad,   She’s fully credentialed and attached to both locations with a 4/15/2020 effective date:\" ', NULL, NULL, '2020-06-15 17:04:37', '2020-06-15 17:04:37'),
(2631, 1006, 1715, NULL, NULL, 'New/Not Initiated', 'Cigna online application submitted ', NULL, NULL, '2020-06-15 17:16:35', '2020-06-15 17:16:35'),
(2632, 1006, 1715, NULL, NULL, 'Approved', 'Received following reply from Emily:  \"Hi Brad,   She’s fully credentialed and attached to both locations with a 4/15/2020 effective date:\" ', NULL, NULL, '2020-06-15 17:16:48', '2020-06-15 17:16:48'),
(2633, 1006, 1716, NULL, NULL, 'New/Not Initiated', 'Submitted online application via provider express portal for optum.  ', NULL, NULL, '2020-06-15 17:21:05', '2020-06-15 17:21:05'),
(2634, 1006, 1716, NULL, NULL, 'Approved', '\"Hi Brad,   I do believe, on this Monday morning, I have been successful in having Fauzia Wali Khan’s provider profile loaded correctly for both RI and MA locations.    Please feel free to share with me any claims that have denied (via spreadsheet or fax) and I will work to have them reviewed/reprocessed.    Please let me know if you have any questions.   Thank you, Christine      Providers make it possible. Thank you! ', NULL, NULL, '2020-06-15 17:21:52', '2020-06-15 17:21:52'),
(2635, 1006, 1717, NULL, NULL, 'New/Not Initiated', 'Added address for MA location to providers NPPES, need to wait for it to update.  ', NULL, NULL, '2020-06-15 17:25:00', '2020-06-15 17:25:00'),
(2636, 1006, 1717, NULL, NULL, 'Approved', 'Approved Effective Date: 08/05/2019 PTAN: S100592314 ', NULL, NULL, '2020-06-15 17:25:13', '2020-06-15 17:25:13'),
(2637, 1006, 1718, NULL, NULL, 'New/Not Initiated', '8594558650@myfax.com  Attn: Provider Demographics - Adding three providers with TIN# 83-4482753   Good afternoon, Please find the attached Letter of Intent with Form W-9 we are requesting to add three individual providers with the group TIN as in network providers. Please let us know if you need any additional information. Thank you   -', NULL, NULL, '2020-06-15 17:27:39', '2020-06-15 17:27:39'),
(2638, 1006, 1718, NULL, NULL, 'Approved', 'Received following email from Delcorpo, Yvonne A DelcorpoY@aetna.com:  Sub: RE: PIN 6557417 Mahreen Rashid Rhode Island  \"Hello Brad,   Here is the Welcome letter for Mahreen Rashid that you requested   Thank you, Yvonne A. DelCorpo Network Relations Specialist Aetna Behavioral Health (OR, WA)\" ', NULL, NULL, '2020-06-15 17:29:28', '2020-06-15 17:29:28'),
(2639, 1006, 1719, NULL, NULL, 'New/Not Initiated', 'As per Firsthealth/Aetna, they require us to submit LOI to enroll the providers.  Sent LOI. ', NULL, NULL, '2020-06-15 17:40:20', '2020-06-15 17:40:20'),
(2640, 1006, 1719, NULL, NULL, 'Approved', 'Received following response from Hyacinth:   Sub: FW: Re: Re: Re: Re: FW: Re: Re: Re: Re: Re: Provider Status Update - Peggy Pionke, 6507988 and Prisca Hefti, 6846902  \"Good Afternoon,   Providers:  Provider Name: Katie Tawakol NPI# 1609222116 Is showing  for first health products effective 4/3/2020   Provider Name: Fauzia Wali-Khan NPI# 1699761965 Is showing effective for first health products effective 2/15/2020     Provider Name: Mahreen Rashid NPI# 1396393146 Is showing effective for first health products effective 2/15/2020   Thank you,  Hyacinth Reid NE Network Relations Specialist Aetna Behavioral Health\'\" ', NULL, NULL, '2020-06-15 17:40:34', '2020-06-15 17:40:34'),
(2641, 1006, 1720, NULL, NULL, 'New/Not Initiated', 'Initiated request online for Katie, Prisca & Nataliya.  ', NULL, NULL, '2020-06-15 17:43:51', '2020-06-15 17:43:51'),
(2642, 1006, 1720, NULL, NULL, 'Initiated', 'Initiated request online for Katie, Prisca & Nataliya.  ', NULL, NULL, '2020-06-15 17:46:13', '2020-06-15 17:46:13'),
(2643, 1006, 1720, NULL, NULL, 'Approved', 'Received following update from Laura:  Sub: Provider Status Update  \"Hello, Katie Tawakol, 6120037 – she has a 04/03/2020 effective date Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\" ', NULL, NULL, '2020-06-15 17:47:25', '2020-06-15 17:47:25'),
(2644, 1006, 1721, NULL, NULL, 'New/Not Initiated', 'You have successfully submitted your application. Please print a copy of this page for your records. CBP-0000117385 ', NULL, NULL, '2020-06-15 17:56:35', '2020-06-15 17:56:35'),
(2645, 1006, 1721, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-15 17:56:40', '2020-06-15 17:56:40'),
(2646, 1006, 1721, NULL, NULL, 'Approved', 'Sub: Mahreen Rashid-Packet received Cigna Beh  \"Dear Mahreen Rashid Thank you for completing your credentialing packet through DocuSign. Our next step in the credentialing process is to verify your credentials. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. While we are verifying your credentials, you will be considered a non-participating provider. CAQH must remain up to date while processing or your contract will be placed on hold.  No further action is needed from you at this time. Should we need additional information, we will contact you by means listed on your Cigna Behavioral Provider Application. Once we verify your credentials, we will send an email, which will include a copy of your final agreement. The subject line of this email will begin with “Status Update: Completed.” The agreement will include Cigna\'s countersignature and your effective date as a Cigna Behavioral Health contracted provider. Thank you for applying to the Cigna Behavioral Health network. We look forward to working with you and helping you realize your professional goals. Sincerely,    ConnectedCare PROVIDER OPERATIONS Paige Kinney Behavioral NCU | Provider Relations Analyst T: 903.337.2307 | F: 860.697.6192\"  ', NULL, NULL, '2020-06-15 17:58:08', '2020-06-15 17:58:08'),
(2647, 1006, 1722, NULL, NULL, 'New/Not Initiated', 'As per Firsthealth/Aetna, they require us to submit LOI to enroll the providers.   LOI sent ', NULL, NULL, '2020-06-16 09:31:57', '2020-06-16 09:31:57'),
(2648, 1006, 1722, NULL, NULL, 'Initiated', '\"As per Firsthealth/Aetna, they require us to submit LOI to enroll the providers.\"  LOI Submitted. ', NULL, NULL, '2020-06-16 09:32:31', '2020-06-16 09:32:31'),
(2649, 1006, 1722, NULL, NULL, 'Approved', 'Received following response from Hyacinth:   Sub: FW: Re: Re: Re: Re: FW: Re: Re: Re: Re: Re: Provider Status Update - Peggy Pionke, 6507988 and Prisca Hefti, 6846902  \"Good Afternoon,   Providers:   Provider Name: Mahreen Rashid NPI# 1396393146 Is showing effective for first health products effective 2/15/2020   Thank you,  Hyacinth Reid NE Network Relations Specialist Aetna Behavioral Health\'\" ', NULL, NULL, '2020-06-16 09:33:41', '2020-06-16 09:33:41'),
(2650, 1006, 1723, NULL, NULL, 'New/Not Initiated', 'Sent following fax to \'6082217535@myfax.com\':  Sub: Katie Tawakol - Certification Request  \"Hello,   Please find the certification request for our provider. Please let me know if anything else is required and how long the process will take.   Thank you! ', NULL, NULL, '2020-06-16 09:39:53', '2020-06-16 09:39:53'),
(2651, 1006, 1723, NULL, NULL, 'Initiated', 'Sent following fax to \'6082217535@myfax.com\':  Sub: Katie Tawakol - Certification Request  \"Hello,   Please find the certification request for our provider. Please let me know if anything else is required and how long the process will take.   Thank you! ', NULL, NULL, '2020-06-16 09:40:01', '2020-06-16 09:40:01'),
(2652, 1006, 1723, NULL, NULL, 'Approved', 'Received following respone from Chuck:  \"Hi, Brad!   Looks they’ve all got one each: Fauzia and Katie are in Ashland, and Prisca is in Natick. That should be fine; as long as they’re attached to the tax ID whatsoever, claims will process from any location. \" ', NULL, NULL, '2020-06-16 09:40:29', '2020-06-16 09:40:29'),
(2653, 1006, 1724, NULL, NULL, 'New/Not Initiated', 'John McGrew JMcGrew3@humana.com>  Re: Secured: RE: Need Status - SPECTRUM NEURO BEHAVIORAL CARE LLC  Thank you so much Chuck really appreciate that and just want to make sure that we are good to go with Syed, Right? And we can submit claims on his name?  And for Fauzia I faxed over TRICARE East Provider Certification Application at 6082217535 on August 13, 2019. ', NULL, NULL, '2020-06-16 09:51:24', '2020-06-16 09:51:24'),
(2654, 1006, 1724, NULL, NULL, 'Initiated', 'John McGrew JMcGrew3@humana.com>  Re: Secured: RE: Need Status - SPECTRUM NEURO BEHAVIORAL CARE LLC  Thank you so much Chuck really appreciate that and just want to make sure that we are good to go with Syed, Right? And we can submit claims on his name?  And for Fauzia I faxed over TRICARE East Provider Certification Application at 6082217535 on August 13, 2019. ', NULL, NULL, '2020-06-16 09:51:37', '2020-06-16 09:51:37'),
(2655, 1006, 1724, NULL, NULL, 'Approved', 'Received following respone from Chuck:  \"Hi, Brad!   Looks they’ve all got one each: Fauzia and Katie are in Ashland, and Prisca is in Natick. That should be fine; as long as they’re attached to the tax ID whatsoever, claims will process from any location. \" ', NULL, NULL, '2020-06-16 09:57:20', '2020-06-16 09:57:20'),
(2656, 1006, 1725, NULL, NULL, 'New/Not Initiated', 'You have successfully submitted your application. Please print a copy of this page for your records. CBP-0000109562 ', NULL, NULL, '2020-06-16 17:25:09', '2020-06-16 17:25:09'),
(2657, 1006, 1725, NULL, NULL, 'Initiated', 'You have successfully submitted your application. Please print a copy of this page for your records. CBP-0000109562 ', NULL, NULL, '2020-06-16 17:25:49', '2020-06-16 17:25:49'),
(2658, 1006, 1725, NULL, NULL, 'Approved', 'Approved In Network Location has been added With Fauzia with an Effective Date of 12/07/2017 ', NULL, NULL, '2020-06-16 17:26:08', '2020-06-16 17:26:08'),
(2659, 1006, 1726, NULL, NULL, 'New/Not Initiated', 'Received a fax for Mahreen BCBSMA need copy of a current ANCC accreditation certificate. ', NULL, NULL, '2020-06-16 17:38:55', '2020-06-16 17:38:55'),
(2660, 1006, 1726, NULL, NULL, 'Initiated', 'Received a fax for Mahreen BCBSMA need copy of a current ANCC accreditation certificate. ', NULL, NULL, '2020-06-16 17:40:01', '2020-06-16 17:40:01'),
(2661, 1006, 1726, NULL, NULL, 'Approved', 'Received following email:  \"June 10, 2020  Mahreen Rashid, PNP   Spectrum Neuro Behavioral Care   Dear Provider:   Welcome to Blue Cross Blue Shield of Massachusetts. We’re pleased to have you as a participating provider in the following products:     Product Effective date X PPO (preferred provider organization) 06/04/2020 X HMO Blue â (managed care) 06/04/2020 X Indemnity 06/04/2020 X Medicare HMO Blue â (Medicare Advantage health maintenance organization) 06/04/2020 X Medicare PPO BlueSM (Medicare Advantage preferred provider organization) 06/04/2020   Use your National Provider Identifier (NPI) on all correspondence To help ensure accurate and efficient service, please include your NPI on all correspondence with us.   Individual NPI: 1396393146   Organization NPI: 1356906572 \" ', NULL, NULL, '2020-06-16 17:40:27', '2020-06-16 17:40:27'),
(2662, 1006, 1727, NULL, NULL, 'New/Not Initiated', 'Received following reply from \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com>:  Sub: RE: Secure Message from wendy.hamel.sherzer@optum.com  \"Hello Brad,   Are you looking to have a contract added for Mahreen, was a Medicare number recently assigned and is this for RI networks?   For issue # 5 I will speak to Stacie who is the contact for United polices which the card appears to be associated with to see if it provides her with the information needed.   Thank you, \"', NULL, NULL, '2020-06-17 12:26:10', '2020-06-17 12:26:10'),
(2663, 1006, 1727, NULL, NULL, 'Initiated', 'Sent following email:  \"Hello Wendy,   Yes, we wish to add the provider to the Medicare plan for UBH. Her Medicare number was assigned way before her UBH enrollment and this is for both RI & MA.   Thank you, hopefully all the claims in Point# 5 can be sorted out.   Thanks again for all the help. \"', NULL, NULL, '2020-06-17 12:30:38', '2020-06-17 12:30:38'),
(2664, 1006, 1727, NULL, NULL, 'Initiated', 'Test', NULL, NULL, '2020-07-27 11:03:28', '2020-07-27 11:03:28'),
(2665, 1006, 1727, NULL, '2020-08-25 00:00:00.000', 'Approved', 'This is the email I sent to Farhan & my discussion with UBH:   \"As per my discussion with UBH, they are stating that the following providers are showing up as in-network with UBH Medicare with the following effective dates:  Mahreen - 12/19/2019 Fauzia - 03/01/2020 Katie - 03/01/2020 Prisca - 01/29/2020\"', NULL, NULL, '2020-08-18 13:50:15', '2020-08-18 13:50:15'),
(2666, 1006, 1728, NULL, NULL, 'New/Not Initiated', 'Received following email from Database Credentialing Database.Credentialing@bcbsri.org>:  Sub: [ENCR] Wali-Khan, Fauzia MD - Request for missing information  \"Good evening,         We are Credentialing your file and after reviewing your file. Unfortunately, necessary information is still missing. In order to meet regulatory requirement, we must receive this information or we will have to discontinue this process pending receipt of this information. I had attached the blank forms, once complete please fax to 401-459-1369 or email to database.credentialing@bcbsri.org ASAP. Thank you have a great day.    1) Contract Agreement 2) W9 form 3) Provider Primary & secondary specialty confirmation needed 4) Please provide the primary  Practice locations address with Phone#, Fax#, e-mail contact, Languages, Handicap Accessibility-Yes/No, Tax ID, Group NPI  and the mailing address to add provider to the group.   Regards, Loganathan R\" ', NULL, NULL, '2020-06-17 17:43:33', '2020-06-17 17:43:33'),
(2667, 1006, 1728, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-17 17:43:50', '2020-06-17 17:43:50'),
(2668, 1006, 1728, NULL, NULL, 'Approved', 'Received following email from ProvDB@Bcbsri.org:  Sub: [ENCR] Provider Fauzia Wali-Khan ,MD -Welcome Letter  \"Good Morning,                                                                        Provider setup done in our system for Provider Fauzia Wali-Khan ,MD . Please find the attached Welcome letter, Agreement and Contact sheet.   Please send email to ProvDB@Bcbsri.org in case of any questions or clarifications.   Thank you, Backiyalakshmi\" ', NULL, NULL, '2020-06-17 17:44:31', '2020-06-17 17:44:31'),
(2669, 1006, 1729, NULL, NULL, 'New/Not Initiated', 'Hello, This is to advise that Fauzia Wali-Khan, 7686597 will need to complete the initial credentialing process for RI to be added to the group Spectrum Neuro Behavioral Care LLC. I have verified this with our Credentialing Dept.  The application request can be found via the below link. Thank you    https://www.aetna.com/health-care-professionals/forms/behavioral-health-application.html   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\" ', NULL, NULL, '2020-06-17 17:46:12', '2020-06-17 17:46:12'),
(2670, 1006, 1729, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-17 17:46:19', '2020-06-17 17:46:19'),
(2671, 1006, 1729, NULL, NULL, 'Approved', 'Welcome letter received for Fauzia Wali-Khan.  Eff: 04/03/2020 ', NULL, NULL, '2020-06-17 17:46:35', '2020-06-17 17:46:35'),
(2672, 1006, 1730, NULL, NULL, 'New/Not Initiated', 'Your fax was successfully sent to 18606877257 by MyFax.  ', NULL, NULL, '2020-06-17 17:49:11', '2020-06-17 17:49:11'),
(2673, 1006, 1730, NULL, NULL, 'Initiated', 'Your fax was successfully sent to 18606877257 by MyFax.  ', NULL, NULL, '2020-06-17 17:49:19', '2020-06-17 17:49:19'),
(2674, 1006, 1730, NULL, NULL, 'Approved', 'Received following reply regarding Katie:  \"Good afternoon, I have reviewed CAQH – thank you for the quick update! I expect this provider to be contracted within the next 5 business days, possibly sooner. If you have any questions or would like to verify status at any time, please let me know.   Thank you,   ConnectedCare Provider Operations Lillian Smith Provider Relations Analyst | Cigna Behavioral Health NCU Phone: 903.337.2345 Recruitment code: 20LSH\" ', NULL, NULL, '2020-06-17 17:50:00', '2020-06-17 17:50:00'),
(2675, 1006, 2731, NULL, NULL, 'New/Not Initiated', 'Request submitted online via Railroad Medicare PTAN Lookup and Request Tool. ', NULL, NULL, '2020-06-19 17:06:23', '2020-06-19 17:06:23'),
(2676, 1006, 2731, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:06:33', '2020-06-19 17:06:33'),
(2677, 1006, 2731, NULL, NULL, 'Approved', 'GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0360 GROUP NPI	1356906572 BUSINESS STATE	RI EFFECTIVE DATE	07/29/2019 END DATE', NULL, NULL, '2020-07-13 17:19:34', '2020-07-13 17:19:34'),
(2678, 1006, 2732, NULL, NULL, 'New/Not Initiated', 'Request submitted online via Railroad Medicare PTAN Lookup and Request Tool. ', NULL, NULL, '2020-06-19 17:06:26', '2020-06-19 17:06:26'),
(2679, 1006, 2732, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:06:37', '2020-06-19 17:06:37'),
(2680, 1006, 2732, NULL, NULL, 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 GROUP NPI	1356906572 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2020-07-13 16:46:09', '2020-07-13 16:46:09'),
(2681, 1006, 2733, NULL, NULL, 'New/Not Initiated', 'Submitted request for enrollment via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:15:31', '2020-06-19 17:15:31'),
(2682, 1006, 2733, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:15:37', '2020-06-19 17:15:37'),
(2683, 1006, 2733, NULL, NULL, 'Approved', 'PROVIDER NAME	KATIE TAWAKOL NP PROVIDER PTAN	P02479252 PROVIDER NPI	1609222116 EFFECTIVE DATE	01/12/2020 END DATE	', NULL, NULL, '2020-07-13 17:14:22', '2020-07-13 17:14:22'),
(2684, 1006, 2734, NULL, NULL, 'New/Not Initiated', 'Initiated via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:18:22', '2020-06-19 17:18:22'),
(2685, 1006, 2734, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:18:54', '2020-06-19 17:18:54'),
(2686, 1006, 2734, NULL, NULL, 'Approved', 'PROVIDER NAME	PRISCA HEFTI LIC PROVIDER PTAN	P02479250 PROVIDER NPI	1508133182 EFFECTIVE DATE	02/24/2020 END DATE	', NULL, NULL, '2020-07-13 16:51:03', '2020-07-13 16:51:03'),
(2687, 1006, 2735, NULL, NULL, 'New/Not Initiated', 'Initiated request via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:23:28', '2020-06-19 17:23:28'),
(2688, 1006, 2735, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:23:39', '2020-06-19 17:23:39'),
(2689, 1006, 2735, NULL, NULL, 'Approved', 'PROVIDER NAME	MAHREEN RASHID PMH PROVIDER PTAN	P02479227 PROVIDER NPI	1396393146 EFFECTIVE DATE	05/13/2020 END DATE', NULL, NULL, '2020-07-13 17:08:01', '2020-07-13 17:08:01'),
(2690, 1006, 2736, NULL, NULL, 'New/Not Initiated', 'Initiated request via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:23:29', '2020-06-19 17:23:29'),
(2691, 1006, 2736, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:23:33', '2020-06-19 17:23:33'),
(2692, 1006, 2736, NULL, NULL, 'Approved', ' PROVIDER NAME	MAHREEN RASHID PMH PROVIDER PTAN	P02479242 PROVIDER NPI	1396393146 EFFECTIVE DATE	10/24/2019 END DATE', NULL, NULL, '2020-07-13 17:28:17', '2020-07-13 17:28:17'),
(2693, 1006, 2737, NULL, NULL, 'New/Not Initiated', 'Initiation request sent via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:31:41', '2020-06-19 17:31:41'),
(2694, 1006, 2737, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:31:55', '2020-06-19 17:31:55'),
(2695, 1006, 2737, NULL, NULL, 'Approved', 'PROVIDER NAME	FAUZIA WALI KHAN M.D PROVIDER PTAN	P02479248 PROVIDER NPI	1699761965 EFFECTIVE DATE	08/05/2019 END DATE', NULL, NULL, '2020-07-13 16:57:17', '2020-07-13 16:57:17'),
(2696, 1006, 2738, NULL, NULL, 'New/Not Initiated', 'Initiation request sent via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:31:46', '2020-06-19 17:31:46'),
(2697, 1006, 2738, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:31:51', '2020-06-19 17:31:51'),
(2698, 1006, 2738, NULL, NULL, 'Approved', ' PROVIDER NAME	FAUZIA WALI KHAN M.D PROVIDER PTAN	P02479326 PROVIDER NPI	1699761965 EFFECTIVE DATE	01/19/2020 END DATE', NULL, NULL, '2020-07-13 17:35:37', '2020-07-13 17:35:37'),
(2699, 1006, 2739, NULL, NULL, 'New/Not Initiated', 'Initiated via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:35:09', '2020-06-19 17:35:09'),
(2700, 1006, 2739, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:35:59', '2020-06-19 17:35:59'),
(2701, 1006, 2739, NULL, NULL, 'Approved', ' PROVIDER NAME	PEGGY PIONKE PROVIDER PTAN	P02479232 PROVIDER NPI	1699307322 EFFECTIVE DATE	01/21/2020 END DATE	', NULL, NULL, '2020-07-13 17:01:18', '2020-07-13 17:01:18'),
(2702, 1006, 2740, NULL, NULL, 'New/Not Initiated', 'Initiated via Railroad Medicare PTAN Lookup and Request Tool	', NULL, NULL, '2020-06-19 17:35:11', '2020-06-19 17:35:11'),
(2703, 1006, 2740, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-19 17:35:37', '2020-06-19 17:35:37'),
(2704, 1006, 2740, NULL, NULL, 'Approved', 'PROVIDER NAME	PEGGY PIONKE PROVIDER PTAN	P02479253 PROVIDER NPI	1699307322 EFFECTIVE DATE	01/21/2020 END DATE	', NULL, NULL, '2020-07-13 17:31:50', '2020-07-13 17:31:50'),
(2705, 2027, 3732, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub: (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks.', NULL, NULL, '2020-08-17 13:56:12', '2020-08-17 13:56:12'),
(2706, 1005, 3732, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:13:51', '2020-09-24 14:13:51'),
(2707, 2037, 3732, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com , Response received in secure message and forwarded to Martin', NULL, NULL, '2020-10-28 17:12:02', '2020-10-28 17:12:02'),
(2708, 2027, 3732, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To; bharathb@aetna.com  This is a follow up email. Please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-04 16:48:11', '2020-11-04 16:48:11'),
(2709, 2027, 3732, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com BharathB@aetna.com  I have submitted the online application. May I know the reason why this enrollment has not been completed yet? This secure email only shows the status not the reason for rejection.  Thanks.', NULL, NULL, '2020-11-11 13:25:32', '2020-11-11 13:25:32'),
(2710, 2027, 3732, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  This is a follow up to my last email. Kindly reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:44:51', '2020-11-18 09:44:51'),
(2711, 2027, 3732, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     Please share the below information for providers. So that we can initiate to load the providers.  Practice location along with phone and fax number Date of birth and License information    Regards,  Bharath', NULL, NULL, '2020-11-18 12:59:26', '2020-11-18 12:59:26'),
(2712, 2027, 3732, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  Please find the requested information below:   Providers	NPI	Tax-ID	Practice Location	Phone & Fax #	License Information Brown, Brittany	1275163537	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP141955) (Eff Date-6/20/2019) (Exp Date-5/10/2024) Chennemkara, Mini Philip	1841755956	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140439) (Eff Date-1/31/2019) (Exp Date-5/31/2022) George, Jeemol	1497219067	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140325) (Eff Date-1/25/2019) (Exp Date-4/30/2021) Jose, Julie	1447883061	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142708) (Eff Date-8/14/2019) (Exp Date-8/31/2021) Joseph, Vibitha	1952931560	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142857) (Eff Date-8/22/2019) (Exp Date-1/31/2022) Kourouma , Odette Tiranke	1134525868	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126172) (Eff Date-8/6/2014) (Exp Date-4/30/2021) Piccione JR, James M	1356321509	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#J2973) (Eff Date-2/27/1993) (Exp Date-10/31/2021) Stephen, Ani	1588959118	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126450) (Eff Date-9/16/2014) (Exp Date-1/31/2022) Thomas, Cini	1134777238	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142314) (Eff Date-7/18/2019) (Exp Date-5/31/2022)    Thanks.', NULL, NULL, '2020-11-18 13:00:43', '2020-11-18 13:00:43'),
(2713, 2027, 3732, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  May I know the current status of my request? as I have already provided you the requested information regarding the providers in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:27:52', '2020-11-25 10:27:52'),
(2714, 2027, 3732, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  I have already provided you the requested information in my last two emails. May I know the current status of this request?', NULL, NULL, '2020-12-02 12:25:32', '2020-12-02 12:25:32'),
(2715, 2027, 3732, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     If the contract is done I will receive a provider agreement forms along with rates information which needs to be signed by providers.', NULL, NULL, '2020-12-10 13:01:46', '2020-12-10 13:01:46'),
(2716, 2037, 3732, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Need to allow more time for the contract', NULL, NULL, '2020-12-17 17:00:17', '2020-12-17 17:00:17'),
(2717, 1006, 3732, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent a follow-up email @ BharathB@aetna.com & \"Lakkakula, Shruthi\" LakkakulaS@aetna.com', NULL, NULL, '2021-01-04 18:31:25', '2021-01-04 18:31:25'),
(2718, 1006, 3732, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent enrollment request @ pdsdallas@aetna.com for providers. ', NULL, NULL, '2021-01-22 18:00:34', '2021-01-22 18:00:34'),
(2719, 1006, 3732, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent another enrollment request @ pdsdallas@aetna.com, LakkakulaS@aetna.com, BharathB@aetna.com ', NULL, NULL, '2021-02-02 18:08:27', '2021-02-02 18:08:27'),
(2720, 1006, 3732, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Received the following reply from thandapanim@aetna.com:  \"Hello,  We have received a request to add multiple providers under FTIN# 47-1914151, However there is no Location information. Kindly provide location information to proceed further.  Thanks, Meena.\"  Sent her the group information and address. ', NULL, NULL, '2021-02-05 13:55:54', '2021-02-05 13:55:54'),
(2721, 3040, 3732, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: thandapanim@aetna.com  Subject: Send Secure [EXTERNAL] First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Morning,  We wish to enroll the following providers to the given group, the information is as follows. We already sent the address to you.   Group Name: Columbus Urgent Care PA TIN# 47-1914151 Ph# (979) 942-9084 Fax# (979) 942-9085 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Julie Jose NPI# 1447883061  Provider Name: Brittany Brown NPI# 1275163537  Provider Name: Cini Thomas NPI# 1134777238  Provider Name: Ani Stephen NPI# 1588959118  Provider Name: Vibitha Joseph NPI# 1952931560  Provider Name: Jeemol George NPI# 1497219067  Please let me know what is required to get these providers enrolled as in-network with Firsthealth ASAP.   Thanks.', NULL, NULL, '2021-02-12 11:05:44', '2021-02-12 11:05:44'),
(2722, 1006, 3732, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com, \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  \"Hi Brad,  Please share practice location information of below providers so that we can initiate the further process.  Regards, Bharath\"  Sent group address to them. ', NULL, NULL, '2021-02-15 10:43:51', '2021-02-15 10:43:51'),
(2723, 1006, 3732, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com:  \"Hi,  The below provider are loaded as per requested.\"  Asked them to send me proof of enrollment via a roster or welcome letter. ', NULL, NULL, '2021-02-23 13:30:54', '2021-02-23 13:30:54'),
(2724, 3040, 3732, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, TalasilaB@aetna.com, MuchakurthiS@aetna.com  Subject: First Health Network - Enrollment Request Log #9266762103322409  Greetings,  Please advise me the enrollment status for the below mentioned providers. Find the attached reply that we get from your side in which you mentioned that all providers are loaded as per requested. Can you please send me the provider roster or welcome letter in which the provider is showing in the system.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 12:02:04', '2021-03-08 12:02:04'),
(2725, 3040, 3732, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers. ', NULL, NULL, '2021-03-16 16:30:51', '2021-03-16 16:30:51'),
(2726, 3040, 3732, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:43:07', '2021-06-15 10:43:07'),
(2727, 3040, 3732, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Online application submitted. Please see attachment.', NULL, NULL, '2021-06-29 16:57:36', '2021-06-29 16:57:36'),
(2728, 3040, 3732, NULL, '2021-07-26 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:54', '2021-07-19 11:31:54'),
(2729, 11056, 3732, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:22:24', '2021-08-04 16:22:24'),
(2730, 3040, 3732, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:24', '2021-08-30 12:01:24'),
(2731, 10057, 3732, NULL, '2021-11-12 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:06:50', '2021-11-02 14:06:50'),
(2732, 10057, 3732, NULL, '2021-11-24 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:09:26', '2021-11-17 17:09:26'),
(2733, 10057, 3732, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:35:42', '2021-11-22 17:35:42'),
(2734, 10057, 3732, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:41:50', '2021-11-22 17:41:50'),
(2735, 10057, 3732, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:05:25', '2021-12-09 11:05:25'),
(2736, 10057, 3732, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:33:42', '2021-12-16 14:33:42'),
(2737, 10057, 3732, NULL, '2021-12-30 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:54:53', '2021-12-22 10:54:53'),
(2738, 10057, 3732, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:52:30', '2021-12-29 15:52:30'),
(2739, 20067, 3732, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:20:04', '2022-01-19 12:20:04'),
(2740, 20067, 3732, NULL, '2022-02-03 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:34:35', '2022-01-27 12:34:35'),
(2741, 20067, 3732, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:08:17', '2022-02-02 11:08:17'),
(2742, 20067, 3732, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:11:36', '2022-02-17 17:11:36'),
(2743, 2027, 3734, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub: (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks. ', NULL, NULL, '2020-08-17 13:58:39', '2020-08-17 13:58:39');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(2744, 1005, 3734, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:13:35', '2020-09-24 14:13:35'),
(2745, 2037, 3734, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email Sent: --------------  Greetings, I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status.  Please find the list below:  Columbus Urgent Care   TIN # 471914151  Brown, Brittany	NPI:1275163537   George, JeemolNPI:1497219067  Piccione JR, James M	NPI:1356321509   Thomas, Cini	NPI:1134777238  Stephen, Ani	NPI:1588959118  Joseph, Vibitha	NPI:1952931560   Jose, Julie	NPI:1447883061  Thanks.', NULL, NULL, '2020-10-23 17:24:18', '2020-10-23 17:24:18'),
(2746, 2027, 3734, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  This is a follow up to my last email. Kindly reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:45:21', '2020-11-18 09:45:21'),
(2747, 2027, 3734, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     Please share the below information for providers. So that we can initiate to load the providers.  Practice location along with phone and fax number Date of birth and License information    Regards,  Bharath', NULL, NULL, '2020-11-18 13:01:25', '2020-11-18 13:01:25'),
(2748, 2027, 3734, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  Please find the requested information below:   Providers	NPI	Tax-ID	Practice Location	Phone & Fax #	License Information Brown, Brittany	1275163537	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP141955) (Eff Date-6/20/2019) (Exp Date-5/10/2024) Chennemkara, Mini Philip	1841755956	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140439) (Eff Date-1/31/2019) (Exp Date-5/31/2022) George, Jeemol	1497219067	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140325) (Eff Date-1/25/2019) (Exp Date-4/30/2021) Jose, Julie	1447883061	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142708) (Eff Date-8/14/2019) (Exp Date-8/31/2021) Joseph, Vibitha	1952931560	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142857) (Eff Date-8/22/2019) (Exp Date-1/31/2022) Kourouma , Odette Tiranke	1134525868	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126172) (Eff Date-8/6/2014) (Exp Date-4/30/2021) Piccione JR, James M	1356321509	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#J2973) (Eff Date-2/27/1993) (Exp Date-10/31/2021) Stephen, Ani	1588959118	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126450) (Eff Date-9/16/2014) (Exp Date-1/31/2022) Thomas, Cini	1134777238	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142314) (Eff Date-7/18/2019) (Exp Date-5/31/2022)    Thanks.', NULL, NULL, '2020-11-18 13:02:07', '2020-11-18 13:02:07'),
(2749, 2027, 3734, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  May I know the current status of my request? as I have already provided you the requested information regarding the providers in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:28:28', '2020-11-25 10:28:28'),
(2750, 2027, 3734, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  I have already provided you the requested information in my last two emails. May I know the current status of this request?', NULL, NULL, '2020-12-02 12:26:01', '2020-12-02 12:26:01'),
(2751, 2027, 3734, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     If the contract is done I will receive a provider agreement forms along with rates information which needs to be signed by providers.', NULL, NULL, '2020-12-10 13:02:53', '2020-12-10 13:02:53'),
(2752, 2037, 3734, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Need to allow more time for the contract', NULL, NULL, '2020-12-17 17:00:25', '2020-12-17 17:00:25'),
(2753, 1006, 3734, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent a follow-up email @ BharathB@aetna.com & \"Lakkakula, Shruthi\" LakkakulaS@aetna.com', NULL, NULL, '2021-01-04 18:31:16', '2021-01-04 18:31:16'),
(2754, 1006, 3734, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent enrollment request @ pdsdallas@aetna.com for providers. ', NULL, NULL, '2021-01-22 18:00:39', '2021-01-22 18:00:39'),
(2755, 1006, 3734, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent another enrollment request @ pdsdallas@aetna.com, LakkakulaS@aetna.com, BharathB@aetna.com ', NULL, NULL, '2021-02-02 18:08:33', '2021-02-02 18:08:33'),
(2756, 1006, 3734, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Received the following reply from thandapanim@aetna.com:  \"Hello,  We have received a request to add multiple providers under FTIN# 47-1914151, However there is no Location information. Kindly provide location information to proceed further.  Thanks, Meena.\"  Sent her the group information and address. ', NULL, NULL, '2021-02-05 13:55:59', '2021-02-05 13:55:59'),
(2757, 3040, 3734, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: thandapanim@aetna.com  Subject: Send Secure [EXTERNAL] First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Morning,  We wish to enroll the following providers to the given group, the information is as follows. We already sent the address to you.   Group Name: Columbus Urgent Care PA TIN# 47-1914151 Ph# (979) 942-9084 Fax# (979) 942-9085 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Julie Jose NPI# 1447883061  Provider Name: Brittany Brown NPI# 1275163537  Provider Name: Cini Thomas NPI# 1134777238  Provider Name: Ani Stephen NPI# 1588959118  Provider Name: Vibitha Joseph NPI# 1952931560  Provider Name: Jeemol George NPI# 1497219067  Please let me know what is required to get these providers enrolled as in-network with Firsthealth ASAP.   Thanks.', NULL, NULL, '2021-02-12 11:05:50', '2021-02-12 11:05:50'),
(2758, 1006, 3734, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com, \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  \"Hi Brad,  Please share practice location information of below providers so that we can initiate the further process.  Regards, Bharath\"  Sent group address to them. ', NULL, NULL, '2021-02-15 10:43:58', '2021-02-15 10:43:58'),
(2759, 1006, 3734, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com:  \"Hi,  The below provider are loaded as per requested.\"  Asked them to send me proof of enrollment via a roster or welcome letter. ', NULL, NULL, '2021-02-23 13:31:06', '2021-02-23 13:31:06'),
(2760, 3040, 3734, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, TalasilaB@aetna.com, MuchakurthiS@aetna.com  Subject: First Health Network - Enrollment Request Log #9266762103322409  Greetings,  Please advise me the enrollment status for the below mentioned providers. Find the attached reply that we get from your side in which you mentioned that all providers are loaded as per requested. Can you please send me the provider roster or welcome letter in which the provider is showing in the system.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 12:02:10', '2021-03-08 12:02:10'),
(2761, 3040, 3734, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers. ', NULL, NULL, '2021-03-16 16:30:56', '2021-03-16 16:30:56'),
(2762, 3040, 3734, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:43:01', '2021-06-15 10:43:01'),
(2763, 3040, 3734, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Online application submitted. Please see attachment.', NULL, NULL, '2021-06-29 16:57:23', '2021-06-29 16:57:23'),
(2764, 3040, 3734, NULL, '2021-07-26 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:53', '2021-07-19 11:31:53'),
(2765, 11056, 3734, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:22:17', '2021-08-04 16:22:17'),
(2766, 3040, 3734, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:24', '2021-08-30 12:01:24'),
(2767, 10057, 3734, NULL, '2021-11-09 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:06:36', '2021-11-02 14:06:36'),
(2768, 10057, 3734, NULL, '2021-11-24 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:09:21', '2021-11-17 17:09:21'),
(2769, 10057, 3734, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:35:36', '2021-11-22 17:35:36'),
(2770, 10057, 3734, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:41:44', '2021-11-22 17:41:44'),
(2771, 10057, 3734, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:05:20', '2021-12-09 11:05:20'),
(2772, 10057, 3734, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:33:37', '2021-12-16 14:33:37'),
(2773, 10057, 3734, NULL, '2021-12-30 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:54:46', '2021-12-22 10:54:46'),
(2774, 10057, 3734, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:52:26', '2021-12-29 15:52:26'),
(2775, 20067, 3734, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:20:00', '2022-01-19 12:20:00'),
(2776, 20067, 3734, NULL, '2022-02-03 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:34:29', '2022-01-27 12:34:29'),
(2777, 20067, 3734, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:04:39', '2022-02-02 11:04:39'),
(2778, 20067, 3734, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:11:31', '2022-02-17 17:11:31'),
(2779, 2027, 3735, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub: (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks.', NULL, NULL, '2020-08-17 13:54:59', '2020-08-17 13:54:59'),
(2780, 2027, 3735, NULL, '2020-08-24 00:00:00.000', 'Approved', 'Call to insurance: Talk to a representative her name is ashley ref#5626764 she said this provider is already showing in network and the effective date is 10/01/2019 confirmation screenshot from provider directory is attached ', NULL, NULL, '2020-08-17 15:03:35', '2020-08-17 15:03:35'),
(2781, 2027, 3736, NULL, NULL, 'In Process', 'To: To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796430	First Health George, Jeemol	1497219067	27-0796431	First Health Jose, Julie	1447883061	27-0796432	First Health Joseph, Vibitha	1447883061	27-0796433	First Health Kourouma , Odette Tiranke	1134525868	27-0796434	First Health Piccione JR, James M	1356321509	27-0796435	First Health Stephen, Ani	1588959118	27-0796436	First Health Thomas, Cini	1134777238	27-0796437	First Health', NULL, NULL, '2020-07-20 12:52:51', '2020-07-20 12:52:51'),
(2782, 2027, 3736, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Online application has been submitted', NULL, NULL, '2020-09-22 16:57:55', '2020-09-22 16:57:55'),
(2783, 2027, 3736, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the below mentioned providers:  Providers	NPI#	Group Name	Group Tax-ID Joseph, Vibitha	1952931560	Normandy Urgent Care Center	27-0796429 Kourouma , Odette Tiranke	1134525868	Normandy Urgent Care Center	27-0796429 Piccione JR, James M	1356321509	Normandy Urgent Care Center	27-0796429 Stephen, Ani	1588959118	Normandy Urgent Care Center	27-0796429 Thomas, Cini	1134777238	Normandy Urgent Care Center	27-0796429    Thanks.', NULL, NULL, '2020-10-21 17:19:52', '2020-10-21 17:19:52'),
(2784, 2037, 3736, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:12:35', '2020-10-29 14:12:35'),
(2785, 2037, 3736, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:39', '2020-11-13 16:51:39'),
(2786, 2037, 3736, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:28', '2020-11-20 11:00:28'),
(2787, 2037, 3736, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:04:00', '2020-12-01 10:04:00'),
(2788, 2037, 3736, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:45:16', '2020-12-08 13:45:16'),
(2789, 2037, 3736, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:18:50', '2020-12-11 13:18:50'),
(2790, 3040, 3736, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to:  AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  Subject:   (Providers)-(Normandy Urgent Care Center)-(First Health)  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned providers.    If you need any additional information please feel free to email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-16 15:57:48', '2021-02-16 15:57:48'),
(2791, 3040, 3736, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:20', '2021-02-26 13:34:20'),
(2792, 3040, 3736, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:11', '2021-03-08 15:50:11'),
(2793, 3040, 3736, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:49:58', '2021-03-19 13:49:58'),
(2794, 3040, 3736, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:36', '2021-05-26 17:03:36'),
(2795, 2027, 3737, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796430	First Health George, Jeemol	1497219067	27-0796431	First Health Jose, Julie	1447883061	27-0796432	First Health Joseph, Vibitha	1447883061	27-0796433	First Health Kourouma , Odette Tiranke	1134525868	27-0796434	First Health Piccione JR, James M	1356321509	27-0796435	First Health Stephen, Ani	1588959118	27-0796436	First Health Thomas, Cini	1134777238	27-0796437	First Health ', NULL, NULL, '2020-07-20 12:27:25', '2020-07-20 12:27:25'),
(2796, 2027, 3737, NULL, '2020-09-21 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(First Health)  May I know the current enrollment status of the provider with first health. Details are mentioned below: Provider Name: Brown, Brittany   Provider NPI# 1275163537   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks.', NULL, NULL, '2020-09-14 12:10:33', '2020-09-14 12:10:33'),
(2797, 2027, 3737, NULL, '2020-09-28 00:00:00.000', 'In Process', 'Online application has been submitted ', NULL, NULL, '2020-09-21 17:23:42', '2020-09-21 17:23:42'),
(2798, 2027, 3737, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(First Health)  May I know the current enrollment status of the provider with first health. Details are mentioned below: Provider Name: Brown, Brittany   Provider NPI# 1275163537   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-21 13:10:01', '2020-10-21 13:10:01'),
(2799, 2037, 3737, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:11:25', '2020-10-29 14:11:25'),
(2800, 2037, 3737, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:44', '2020-11-13 16:51:44'),
(2801, 2037, 3737, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:40', '2020-11-20 11:00:40'),
(2802, 2037, 3737, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:03:53', '2020-12-01 10:03:53'),
(2803, 2037, 3737, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:45:25', '2020-12-08 13:45:25'),
(2804, 2037, 3737, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:19:04', '2020-12-11 13:19:04'),
(2805, 3040, 3737, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to:  AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  Subject:   (Providers)-(Normandy Urgent Care Center)-(First Health)  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned providers.    If you need any additional information please feel free to email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-16 15:57:49', '2021-02-16 15:57:49'),
(2806, 3040, 3737, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:24', '2021-02-26 13:34:24'),
(2807, 3040, 3737, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:15', '2021-03-08 15:50:15'),
(2808, 3040, 3737, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:50:32', '2021-03-19 13:50:32'),
(2809, 3040, 3737, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:40', '2021-05-26 17:03:40'),
(2810, 2027, 3738, NULL, NULL, 'In Process', 'To: 	Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com  Sub: (Piccione JR, James M)-(Normandy Urgent Care Center)-(First Health)  May I know the current status of the application for the provider which we have submitted on 6/23/2020. Provider details are mentioned below: Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429   I am attaching the application for your reference. Kindly look into this and reply to me as soon as you get it.  Thanks.', NULL, NULL, '2020-07-15 17:52:46', '2020-07-15 17:52:46'),
(2811, 2027, 3738, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796430	First Health George, Jeemol	1497219067	27-0796431	First Health Jose, Julie	1447883061	27-0796432	First Health Joseph, Vibitha	1447883061	27-0796433	First Health Kourouma , Odette Tiranke	1134525868	27-0796434	First Health Piccione JR, James M	1356321509	27-0796435	First Health Stephen, Ani	1588959118	27-0796436	First Health Thomas, Cini	1134777238	27-0796437	First Health ', NULL, NULL, '2020-07-20 12:45:26', '2020-07-20 12:45:26'),
(2812, 2027, 3738, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Online application has been submitted', NULL, NULL, '2020-09-22 16:51:04', '2020-09-22 16:51:04'),
(2813, 2027, 3738, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the below mentioned providers:  Providers	NPI#	Group Name	Group Tax-ID Joseph, Vibitha	1952931560	Normandy Urgent Care Center	27-0796429 Kourouma , Odette Tiranke	1134525868	Normandy Urgent Care Center	27-0796429 Piccione JR, James M	1356321509	Normandy Urgent Care Center	27-0796429 Stephen, Ani	1588959118	Normandy Urgent Care Center	27-0796429 Thomas, Cini	1134777238	Normandy Urgent Care Center	27-0796429    Thanks.', NULL, NULL, '2020-10-21 17:16:49', '2020-10-21 17:16:49'),
(2814, 2037, 3738, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:12:24', '2020-10-29 14:12:24'),
(2815, 2037, 3738, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:49', '2020-11-13 16:51:49'),
(2816, 2037, 3738, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:45', '2020-11-20 11:00:45'),
(2817, 2037, 3738, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:03:46', '2020-12-01 10:03:46'),
(2818, 2037, 3738, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:45:36', '2020-12-08 13:45:36'),
(2819, 2037, 3738, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:19:09', '2020-12-11 13:19:09'),
(2820, 3040, 3738, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to:  AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  Subject:   (Providers)-(Normandy Urgent Care Center)-(First Health)  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned providers.    If you need any additional information please feel free to email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-16 15:57:50', '2021-02-16 15:57:50'),
(2821, 3040, 3738, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:29', '2021-02-26 13:34:29'),
(2822, 3040, 3738, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:19', '2021-03-08 15:50:19');
