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
(16611, 19067, 21127, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:31:36', '2021-12-15 15:31:36'),
(16612, 19067, 21127, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:25:41', '2021-12-16 12:25:41'),
(16613, 19067, 21127, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:54', '2021-12-29 14:37:54'),
(16614, 19067, 21127, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:18:04', '2022-01-10 13:18:04'),
(16615, 19067, 21127, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:16:06', '2022-01-30 13:16:06'),
(16616, 19067, 21127, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:52', '2022-02-08 14:23:52'),
(16617, 19067, 21127, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:50', '2022-03-09 14:56:50'),
(16618, 19067, 21127, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:50:02', '2022-03-10 10:50:02'),
(16619, 22077, 21127, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:54:59', '2022-04-04 13:54:59'),
(16620, 1006, 21128, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:32:08', '2021-03-15 14:32:08'),
(16621, 1019, 21128, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:42:03', '2021-04-19 10:42:03'),
(16622, 1019, 21128, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 13:02:47', '2021-04-20 13:02:47'),
(16623, 3046, 21129, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:36:56', '2021-03-15 14:36:56'),
(16624, 1006, 21129, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:38', '2021-04-06 14:56:38'),
(16625, 3046, 21130, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:36:57', '2021-03-15 14:36:57'),
(16626, 1006, 21130, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:43', '2021-04-06 14:56:43'),
(16627, 3046, 21131, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:36:59', '2021-03-15 14:36:59'),
(16628, 1006, 21131, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:47', '2021-04-06 14:56:47'),
(16629, 3046, 21132, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:37:00', '2021-03-15 14:37:00'),
(16630, 1006, 21132, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:51', '2021-04-06 14:56:51'),
(16631, 3046, 21133, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:37:02', '2021-03-15 14:37:02'),
(16632, 1006, 21133, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:56:56', '2021-04-06 14:56:56'),
(16633, 3046, 21134, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:37:03', '2021-03-15 14:37:03'),
(16634, 1006, 21134, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:00', '2021-04-06 14:57:00'),
(16635, 3046, 21135, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:37:05', '2021-03-15 14:37:05'),
(16636, 1006, 21135, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:05', '2021-04-06 14:57:05'),
(16637, 3046, 21136, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:37:06', '2021-03-15 14:37:06'),
(16638, 1006, 21136, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:09', '2021-04-06 14:57:09'),
(16639, 3046, 21137, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:37:08', '2021-03-15 14:37:08'),
(16640, 1006, 21137, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:14', '2021-04-06 14:57:14'),
(16641, 3046, 21138, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:32', '2021-03-15 14:40:32'),
(16642, 3040, 21138, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email: dmarley@ghn-mci.com  This location has been input effective 6-24-19.   Thanks, for your time and consideration in this matter,   Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124  (F) 817-633-5729', NULL, NULL, '2021-03-29 16:19:16', '2021-03-29 16:19:16'),
(16643, 3046, 21139, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:34', '2021-03-15 14:40:34'),
(16644, 3040, 21139, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:47:52', '2021-03-29 16:47:52'),
(16645, 3046, 21140, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:36', '2021-03-15 14:40:36'),
(16646, 3040, 21140, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:45:12', '2021-03-29 16:45:12'),
(16647, 3046, 21141, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:38', '2021-03-15 14:40:38'),
(16648, 3040, 21141, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:16:58', '2021-03-29 16:16:58'),
(16649, 3046, 21142, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:39', '2021-03-15 14:40:39'),
(16650, 3040, 21142, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:22:28', '2021-03-29 16:22:28'),
(16651, 3046, 21143, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:41', '2021-03-15 14:40:41'),
(16652, 3040, 21143, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:25:55', '2021-03-29 16:25:55'),
(16653, 3046, 21144, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:42', '2021-03-15 14:40:42'),
(16654, 3040, 21144, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:34:06', '2021-03-29 16:34:06'),
(16655, 3046, 21145, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:44', '2021-03-15 14:40:44'),
(16656, 3040, 21145, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:38:37', '2021-03-29 16:38:37'),
(16657, 3046, 21146, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:40:46', '2021-03-15 14:40:46'),
(16658, 3040, 21146, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:42:22', '2021-03-29 16:42:22'),
(16659, 3046, 21147, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:49:01', '2021-03-15 14:49:01'),
(16660, 1006, 21147, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"   ', NULL, NULL, '2021-04-07 12:02:45', '2021-04-07 12:02:45'),
(16661, 1006, 21147, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Michal requested more documents for the credentialing process, sent the following email to her @ Simms, Michal michal.simms@christushealth.org:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Michal,  Here\'s the CLIA for both groups as well, do let me know if there\'s anything else that\'s needed to continue with our request. \"', NULL, NULL, '2021-04-12 12:00:57', '2021-04-12 12:00:57'),
(16662, 1006, 21147, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:39', '2021-04-27 12:41:39'),
(16663, 1006, 21147, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:57:48', '2021-04-28 07:57:48'),
(16664, 9057, 21147, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:29:38', '2021-05-26 08:29:38'),
(16665, 9057, 21147, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:33:31', '2021-05-26 08:33:31'),
(16666, 3040, 21147, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:34', '2021-06-15 16:24:34'),
(16667, 1006, 21147, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:19:52', '2021-07-05 13:19:52'),
(16668, 1006, 21147, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:52:17', '2021-08-12 16:52:17'),
(16669, 1006, 21147, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:17', '2021-08-23 09:47:17'),
(16670, 1006, 21147, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:40', '2021-08-30 14:23:40'),
(16671, 1006, 21147, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:40', '2021-08-30 14:23:40'),
(16672, 11056, 21147, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:56:03', '2021-09-21 16:56:03'),
(16673, 11056, 21147, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 08:59:33', '2021-09-28 08:59:33'),
(16674, 11056, 21147, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:01:27', '2021-10-12 14:01:27'),
(16675, 11056, 21147, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:52', '2021-10-25 12:33:52'),
(16676, 11056, 21147, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:15:27', '2021-11-11 14:15:27'),
(16677, 11056, 21147, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:40:44', '2021-11-24 17:40:44'),
(16678, 11056, 21147, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:23:07', '2021-12-10 17:23:07'),
(16679, 11056, 21147, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:05:37', '2021-12-23 14:05:37'),
(16680, 3046, 21148, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:34', '2021-03-15 14:51:34'),
(16681, 1006, 21148, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:03:50', '2021-04-07 12:03:50'),
(16682, 1006, 21148, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:33', '2021-04-27 12:41:33'),
(16683, 1006, 21148, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:58:00', '2021-04-28 07:58:00'),
(16684, 9057, 21148, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:30:09', '2021-05-26 08:30:09'),
(16685, 3040, 21148, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:30', '2021-06-15 16:24:30'),
(16686, 1006, 21148, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:19:58', '2021-07-05 13:19:58'),
(16687, 1006, 21148, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:52:14', '2021-08-12 16:52:14'),
(16688, 1006, 21148, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:13', '2021-08-23 09:47:13'),
(16689, 1006, 21148, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:32', '2021-08-30 14:23:32'),
(16690, 11056, 21148, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:52', '2021-09-21 16:55:52'),
(16691, 11056, 21148, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:58', '2021-09-21 16:55:58'),
(16692, 11056, 21148, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:03:24', '2021-09-28 09:03:24'),
(16693, 11056, 21148, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:02:57', '2021-10-12 14:02:57'),
(16694, 11056, 21148, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:46', '2021-10-25 12:33:46'),
(16695, 11056, 21148, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:15:22', '2021-11-11 14:15:22'),
(16696, 11056, 21148, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:40:50', '2021-11-24 17:40:50');
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
(16697, 11056, 21148, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:23:00', '2021-12-10 17:23:00'),
(16698, 19067, 21148, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:35:41', '2021-12-22 15:35:41'),
(16699, 11056, 21148, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:13:24', '2021-12-23 14:13:24'),
(16700, 3046, 21149, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:36', '2021-03-15 14:51:36'),
(16701, 1006, 21149, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:03:55', '2021-04-07 12:03:55'),
(16702, 1006, 21149, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:28', '2021-04-27 12:41:28'),
(16703, 1006, 21149, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:58:07', '2021-04-28 07:58:07'),
(16704, 9057, 21149, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:30:19', '2021-05-26 08:30:19'),
(16705, 3040, 21149, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:27', '2021-06-15 16:24:27'),
(16706, 1006, 21149, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:04', '2021-07-05 13:20:04'),
(16707, 1006, 21149, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:52:11', '2021-08-12 16:52:11'),
(16708, 1006, 21149, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:09', '2021-08-23 09:47:09'),
(16709, 1006, 21149, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:26', '2021-08-30 14:23:26'),
(16710, 11056, 21149, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:42', '2021-09-21 16:55:42'),
(16711, 11056, 21149, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:57', '2021-09-28 09:02:57'),
(16712, 11056, 21149, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:03:07', '2021-10-12 14:03:07'),
(16713, 11056, 21149, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:03:52', '2021-10-12 14:03:52'),
(16714, 11056, 21149, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:40', '2021-10-25 12:33:40'),
(16715, 11056, 21149, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:15:17', '2021-11-11 14:15:17'),
(16716, 11056, 21149, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:40:55', '2021-11-24 17:40:55'),
(16717, 11056, 21149, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:54', '2021-12-10 17:22:54'),
(16718, 19067, 21149, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:35:30', '2021-12-22 15:35:30'),
(16719, 11056, 21149, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:13:17', '2021-12-23 14:13:17'),
(16720, 3046, 21150, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:38', '2021-03-15 14:51:38'),
(16721, 1006, 21150, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:01', '2021-04-07 12:04:01'),
(16722, 1006, 21150, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:23', '2021-04-27 12:41:23'),
(16723, 1006, 21150, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:00:16', '2021-04-28 08:00:16'),
(16724, 9057, 21150, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:30:30', '2021-05-26 08:30:30'),
(16725, 3040, 21150, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:23', '2021-06-15 16:24:23'),
(16726, 1006, 21150, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:10', '2021-07-05 13:20:10'),
(16727, 1006, 21150, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:52:08', '2021-08-12 16:52:08'),
(16728, 1006, 21150, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:05', '2021-08-23 09:47:05'),
(16729, 1006, 21150, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:21', '2021-08-30 14:23:21'),
(16730, 11056, 21150, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:35', '2021-09-21 16:55:35'),
(16731, 11056, 21150, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:50', '2021-09-28 09:02:50'),
(16732, 11056, 21150, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:03:57', '2021-10-12 14:03:57'),
(16733, 11056, 21150, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:34', '2021-10-25 12:33:34'),
(16734, 11056, 21150, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:15:11', '2021-11-11 14:15:11'),
(16735, 11056, 21150, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:00', '2021-11-24 17:41:00'),
(16736, 11056, 21150, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:49', '2021-12-10 17:22:49'),
(16737, 19067, 21150, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:35:51', '2021-12-22 15:35:51'),
(16738, 11056, 21150, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:13:12', '2021-12-23 14:13:12'),
(16739, 3046, 21151, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:40', '2021-03-15 14:51:40'),
(16740, 1006, 21151, NULL, '2021-04-14 00:00:00.000', 'Not Eligible', 'This provider is no longer active with RHC, ', NULL, NULL, '2021-04-07 11:32:19', '2021-04-07 11:32:19'),
(16741, 3040, 21151, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:19', '2021-06-15 16:24:19'),
(16742, 1006, 21151, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:13', '2021-07-05 13:20:13'),
(16743, 1006, 21151, NULL, '2021-08-19 00:00:00.000', 'Not Eligible', 'The provider is no longer with the group. ', NULL, NULL, '2021-08-12 16:49:05', '2021-08-12 16:49:05'),
(16744, 3046, 21152, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:42', '2021-03-15 14:51:42'),
(16745, 1006, 21152, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:05', '2021-04-07 12:04:05'),
(16746, 1006, 21152, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:19', '2021-04-27 12:41:19'),
(16747, 1006, 21152, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:00:23', '2021-04-28 08:00:23'),
(16748, 9057, 21152, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:30:39', '2021-05-26 08:30:39'),
(16749, 3040, 21152, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:15', '2021-06-15 16:24:15'),
(16750, 1006, 21152, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:17', '2021-07-05 13:20:17'),
(16751, 1006, 21152, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:52:04', '2021-08-12 16:52:04'),
(16752, 1006, 21152, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:01', '2021-08-23 09:47:01'),
(16753, 1006, 21152, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:15', '2021-08-30 14:23:15');
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
(16754, 11056, 21152, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:30', '2021-09-21 16:55:30'),
(16755, 11056, 21152, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:44', '2021-09-28 09:02:44'),
(16756, 11056, 21152, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:07', '2021-10-12 14:04:07'),
(16757, 11056, 21152, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:29', '2021-10-25 12:33:29'),
(16758, 11056, 21152, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:15:06', '2021-11-11 14:15:06'),
(16759, 11056, 21152, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:37', '2021-11-24 17:41:37'),
(16760, 11056, 21152, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:43', '2021-12-10 17:22:43'),
(16761, 19067, 21152, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:51', '2021-12-22 15:36:51'),
(16762, 11056, 21152, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:13:01', '2021-12-23 14:13:01'),
(16763, 3046, 21153, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:43', '2021-03-15 14:51:43'),
(16764, 1006, 21153, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:09', '2021-04-07 12:04:09'),
(16765, 1006, 21153, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:15', '2021-04-27 12:41:15'),
(16766, 1006, 21153, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:00:28', '2021-04-28 08:00:28'),
(16767, 9057, 21153, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:31:08', '2021-05-26 08:31:08'),
(16768, 3040, 21153, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:11', '2021-06-15 16:24:11'),
(16769, 1006, 21153, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:20', '2021-07-05 13:20:20'),
(16770, 1006, 21153, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:51:35', '2021-08-12 16:51:35'),
(16771, 1006, 21153, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:46:55', '2021-08-23 09:46:55'),
(16772, 1006, 21153, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:11', '2021-08-30 14:23:11'),
(16773, 11056, 21153, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:24', '2021-09-21 16:55:24'),
(16774, 11056, 21153, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:38', '2021-09-28 09:02:38'),
(16775, 11056, 21153, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:15', '2021-10-12 14:04:15'),
(16776, 11056, 21153, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:22', '2021-10-25 12:33:22'),
(16777, 11056, 21153, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:14:59', '2021-11-11 14:14:59'),
(16778, 11056, 21153, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:32', '2021-11-24 17:41:32'),
(16779, 11056, 21153, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:38', '2021-12-10 17:22:38'),
(16780, 19067, 21153, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:40', '2021-12-22 15:36:40'),
(16781, 11056, 21153, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:57', '2021-12-23 14:12:57'),
(16782, 3046, 21154, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:47', '2021-03-15 14:51:47'),
(16783, 1006, 21154, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:12', '2021-04-07 12:04:12'),
(16784, 1006, 21154, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:11', '2021-04-27 12:41:11'),
(16785, 1006, 21154, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:01:41', '2021-04-28 08:01:41'),
(16786, 9057, 21154, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:31:47', '2021-05-26 08:31:47'),
(16787, 3040, 21154, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:08', '2021-06-15 16:24:08'),
(16788, 1006, 21154, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:24', '2021-07-05 13:20:24'),
(16789, 1006, 21154, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:51:30', '2021-08-12 16:51:30'),
(16790, 1006, 21154, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:46:52', '2021-08-23 09:46:52'),
(16791, 1006, 21154, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:06', '2021-08-30 14:23:06'),
(16792, 11056, 21154, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:19', '2021-09-21 16:55:19'),
(16793, 11056, 21154, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:34', '2021-09-28 09:02:34'),
(16794, 11056, 21154, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:23', '2021-10-12 14:04:23'),
(16795, 11056, 21154, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:15', '2021-10-25 12:33:15'),
(16796, 11056, 21154, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:14:53', '2021-11-11 14:14:53'),
(16797, 11056, 21154, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:27', '2021-11-24 17:41:27'),
(16798, 11056, 21154, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:32', '2021-12-10 17:22:32'),
(16799, 19067, 21154, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:02', '2021-12-22 15:36:02'),
(16800, 11056, 21154, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:49', '2021-12-23 14:12:49'),
(16801, 3046, 21155, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:49', '2021-03-15 14:51:49'),
(16802, 1006, 21155, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:16', '2021-04-07 12:04:16'),
(16803, 1006, 21155, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:07', '2021-04-27 12:41:07'),
(16804, 1006, 21155, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:01:55', '2021-04-28 08:01:55'),
(16805, 9057, 21155, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:31:38', '2021-05-26 08:31:38'),
(16806, 3040, 21155, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:05', '2021-06-15 16:24:05'),
(16807, 1006, 21155, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:27', '2021-07-05 13:20:27');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(16808, 1006, 21155, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:51:26', '2021-08-12 16:51:26'),
(16809, 1006, 21155, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:46:50', '2021-08-23 09:46:50'),
(16810, 1006, 21155, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:23:02', '2021-08-30 14:23:02'),
(16811, 11056, 21155, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:14', '2021-09-21 16:55:14'),
(16812, 11056, 21155, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:27', '2021-09-28 09:02:27'),
(16813, 11056, 21155, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:28', '2021-10-12 14:04:28'),
(16814, 11056, 21155, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:09', '2021-10-25 12:33:09'),
(16815, 11056, 21155, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:14:31', '2021-11-11 14:14:31'),
(16816, 11056, 21155, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:22', '2021-11-24 17:41:22'),
(16817, 11056, 21155, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:26', '2021-12-10 17:22:26'),
(16818, 19067, 21155, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:31', '2021-12-22 15:36:31'),
(16819, 11056, 21155, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:43', '2021-12-23 14:12:43'),
(16820, 3046, 21156, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:49', '2021-03-15 14:51:49'),
(16821, 1006, 21156, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:20', '2021-04-07 12:04:20'),
(16822, 1006, 21156, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:41:02', '2021-04-27 12:41:02'),
(16823, 1006, 21156, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:02:03', '2021-04-28 08:02:03'),
(16824, 9057, 21156, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:31:30', '2021-05-26 08:31:30'),
(16825, 3040, 21156, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:24:02', '2021-06-15 16:24:02'),
(16826, 1006, 21156, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:30', '2021-07-05 13:20:30'),
(16827, 1006, 21156, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:51:22', '2021-08-12 16:51:22'),
(16828, 1006, 21156, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:46:47', '2021-08-23 09:46:47'),
(16829, 1006, 21156, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:22:56', '2021-08-30 14:22:56'),
(16830, 11056, 21156, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:08', '2021-09-21 16:55:08'),
(16831, 11056, 21156, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:02:05', '2021-09-28 09:02:05'),
(16832, 11056, 21156, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:35', '2021-10-12 14:04:35'),
(16833, 11056, 21156, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:33:04', '2021-10-25 12:33:04'),
(16834, 11056, 21156, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:14:25', '2021-11-11 14:14:25'),
(16835, 11056, 21156, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:17', '2021-11-24 17:41:17'),
(16836, 11056, 21156, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:20', '2021-12-10 17:22:20'),
(16837, 19067, 21156, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:12', '2021-12-22 15:36:12'),
(16838, 11056, 21156, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:38', '2021-12-23 14:12:38'),
(16839, 3046, 21157, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:51', '2021-03-15 14:51:51'),
(16840, 1006, 21157, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:24', '2021-04-07 12:04:24'),
(16841, 1006, 21157, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:40:56', '2021-04-27 12:40:56'),
(16842, 1006, 21157, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:02:12', '2021-04-28 08:02:12'),
(16843, 9057, 21157, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:31:20', '2021-05-26 08:31:20'),
(16844, 3040, 21157, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:57', '2021-06-15 16:23:57'),
(16845, 1006, 21157, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:33', '2021-07-05 13:20:33'),
(16846, 1006, 21157, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:51:18', '2021-08-12 16:51:18'),
(16847, 1006, 21157, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:46:43', '2021-08-23 09:46:43'),
(16848, 1006, 21157, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:22:51', '2021-08-30 14:22:51'),
(16849, 11056, 21157, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:55:03', '2021-09-21 16:55:03'),
(16850, 11056, 21157, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:01:53', '2021-09-28 09:01:53'),
(16851, 11056, 21157, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:41', '2021-10-12 14:04:41'),
(16852, 11056, 21157, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:59', '2021-10-25 12:32:59'),
(16853, 11056, 21157, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:14:18', '2021-11-11 14:14:18'),
(16854, 11056, 21157, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:12', '2021-11-24 17:41:12'),
(16855, 11056, 21157, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:14', '2021-12-10 17:22:14'),
(16856, 19067, 21157, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:22', '2021-12-22 15:36:22'),
(16857, 11056, 21157, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:33', '2021-12-23 14:12:33'),
(16858, 3046, 21158, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:51:53', '2021-03-15 14:51:53');
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
(16859, 1006, 21158, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 12:04:29', '2021-04-07 12:04:29'),
(16860, 1006, 21158, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:40:50', '2021-04-27 12:40:50'),
(16861, 1006, 21158, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 08:02:20', '2021-04-28 08:02:20'),
(16862, 9057, 21158, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  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 current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:34:27', '2021-05-26 08:34:27'),
(16863, 3040, 21158, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:50', '2021-06-15 16:23:50'),
(16864, 3040, 21158, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:54', '2021-06-15 16:23:54'),
(16865, 1006, 21158, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:20:36', '2021-07-05 13:20:36'),
(16866, 1006, 21158, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:51:12', '2021-08-12 16:51:12'),
(16867, 1006, 21158, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:46:30', '2021-08-23 09:46:30'),
(16868, 1006, 21158, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:22:43', '2021-08-30 14:22:43'),
(16869, 1006, 21158, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:22:44', '2021-08-30 14:22:44'),
(16870, 11056, 21158, NULL, '2021-09-28 00:00:00.000', 'In Process', '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 16:54:54', '2021-09-21 16:54:54'),
(16871, 11056, 21158, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:01:04', '2021-09-28 09:01:04'),
(16872, 11056, 21158, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:04:46', '2021-10-12 14:04:46'),
(16873, 11056, 21158, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:53', '2021-10-25 12:32:53'),
(16874, 11056, 21158, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:14:12', '2021-11-11 14:14:12'),
(16875, 11056, 21158, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:41:06', '2021-11-24 17:41:06'),
(16876, 11056, 21158, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:22:06', '2021-12-10 17:22:06'),
(16877, 19067, 21158, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:37:06', '2021-12-22 15:37:06'),
(16878, 11056, 21158, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Facility contract. Please see group tasks for the attachments', NULL, NULL, '2021-12-23 14:12:28', '2021-12-23 14:12:28'),
(16879, 3046, 21159, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:59:02', '2021-03-15 14:59:02'),
(16880, 3040, 21159, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Email sent to: SWHPRegion4@bswhealth.org  Subject: Contract Information Request || Statcare Minor Emergency Clinic || Group & Providers || Scott & White ||  Greetings,   Hope you are doing well. Can you please advise me the type of contract for the below mentioned practice and I wanted to verify the locations that all of the four locations are updated under the contract.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quantetry Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  --', NULL, NULL, '2021-03-31 14:00:44', '2021-03-31 14:00:44'),
(16881, 1006, 21159, NULL, '2021-04-14 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals. ', NULL, NULL, '2021-04-07 15:45:20', '2021-04-07 15:45:20'),
(16882, 3046, 21160, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:24', '2021-03-15 15:01:24'),
(16883, 1006, 21160, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:55:53', '2021-04-08 08:55:53'),
(16884, 3046, 21161, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:26', '2021-03-15 15:01:26'),
(16885, 1006, 21161, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:56:24', '2021-04-08 08:56:24'),
(16886, 3046, 21162, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:28', '2021-03-15 15:01:28'),
(16887, 1006, 21162, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:56:32', '2021-04-08 08:56:32'),
(16888, 3046, 21163, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:30', '2021-03-15 15:01:30'),
(16889, 1006, 21163, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:56:40', '2021-04-08 08:56:40'),
(16890, 3046, 21164, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:32', '2021-03-15 15:01:32'),
(16891, 1006, 21164, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:56:53', '2021-04-08 08:56:53'),
(16892, 3046, 21165, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:35', '2021-03-15 15:01:35'),
(16893, 1006, 21165, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:57:02', '2021-04-08 08:57:02'),
(16894, 3046, 21166, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:38', '2021-03-15 15:01:38'),
(16895, 1006, 21166, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:57:10', '2021-04-08 08:57:10'),
(16896, 3046, 21167, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:46', '2021-03-15 15:01:46'),
(16897, 1006, 21167, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:57:19', '2021-04-08 08:57:19'),
(16898, 3046, 21168, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:01:49', '2021-03-15 15:01:49'),
(16899, 1006, 21168, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:57:30', '2021-04-08 08:57:30'),
(16900, 3046, 21169, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:02:03', '2021-03-15 15:02:03'),
(16901, 1006, 21169, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group tasks.  ', NULL, NULL, '2021-04-08 08:57:41', '2021-04-08 08:57:41'),
(16902, 3046, 21170, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:42', '2021-03-15 15:25:42'),
(16903, 3040, 21170, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled with Health Smart.   Effective date: 11/01/2019 ', NULL, NULL, '2021-03-29 14:01:40', '2021-03-29 14:01:40'),
(16904, 3046, 21171, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:45', '2021-03-15 15:25:45'),
(16905, 3040, 21171, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email from: pr.south@healthsmart.com  Sub: Provider Credentialing Status Request  Hi,  Provider \" Juan Miguel Capupus, NP \" is effective \" 03/01/2019 \".  ', NULL, NULL, '2021-03-29 14:05:58', '2021-03-29 14:05:58'),
(16906, 3046, 21172, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:47', '2021-03-15 15:25:47'),
(16907, 3040, 21172, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email from: pr.south@healthsmart.com  Sub: Provider Network Status Request  Hi,  Please see the below providers effective date.  Providers Name       Effective Date Mari Capupus     03/01/2019  ', NULL, NULL, '2021-03-29 14:12:09', '2021-03-29 14:12:09'),
(16908, 3046, 21173, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:49', '2021-03-15 15:25:49'),
(16909, 3040, 21173, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:48:22', '2021-03-29 15:48:22'),
(16910, 3040, 21173, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:31:41', '2021-04-16 07:31:41'),
(16911, 9057, 21173, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to pr.south@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 09:11:09', '2021-05-26 09:11:09'),
(16912, 9057, 21173, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We Received an email from mdiprsupport@healthsmart.com  They asked for the submission of form for this provider, now we have submitted it. Attached is reference', NULL, NULL, '2021-05-28 09:48:20', '2021-05-28 09:48:20'),
(16913, 1006, 21173, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:45:16', '2021-06-15 16:45:16'),
(16914, 1006, 21173, NULL, '2021-06-24 00:00:00.000', 'Approved', 'William Francis - Eff: 01/01/2021 Ref# 2046862  Location addition has been completed, it has been attached for reference. ', NULL, NULL, '2021-06-17 13:56:15', '2021-06-17 13:56:15'),
(16915, 3046, 21174, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:50', '2021-03-15 15:25:50'),
(16916, 3040, 21174, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:48:41', '2021-03-29 15:48:41'),
(16917, 3040, 21174, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:34:56', '2021-04-16 07:34:56'),
(16918, 1006, 21174, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Leslie.Perez@healthsmart.com:  Sub: Fwd: Mary Gonzalez NPI 1952713083  \"Hello,  I need the following information on Mary Gonzalez NPI 1952713083.  Once, I\'ve obtained this information I will continue to credential this provider.    Copy of current board of specialty --   American Academy of Nurse Practitioners   Thank you,  Leslie Perez Credentialing Specialist 222 W. Las Colinas Blvd., Suite 500N Irving, TX 75039 PH:  214-574-1152   FAX 214-574-2368 Leslie.Perez@HealthSmart.com www.HealthSmart.com\"  We submitted the reply and attached the provider\'s AANP.', NULL, NULL, '2021-04-28 07:32:07', '2021-04-28 07:32:07'),
(16919, 9057, 21174, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to pr.south@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 09:11:16', '2021-05-26 09:11:16'),
(16920, 1006, 21174, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:45:11', '2021-06-15 16:45:11'),
(16921, 1006, 21174, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted demographic update request @ Provider Relations - South pr.south@healthsmart.com:  Sub: Demographic Update - RHC - HealthSmart  \"Hello,   Please find the attached demographic update request form for our providers, please let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-06-17 17:15:37', '2021-06-17 17:15:37'),
(16922, 1006, 21174, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hi,  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 77954)  Thanks Healthsmart Provider Relations.\"  Sent f/u email:  \"Hello,   When will these be updated on the provider directory?  Thank you!\" ', NULL, NULL, '2021-06-21 09:05:25', '2021-06-21 09:05:25'),
(16923, 1006, 21174, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, location confirmation is attached for reference.   Eff: 06/01/2021', NULL, NULL, '2021-07-05 16:07:22', '2021-07-05 16:07:22'),
(16924, 3046, 21175, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:52', '2021-03-15 15:25:52'),
(16925, 3040, 21175, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email from: pr.south@healthsmart.com  Hello,   Traci S Mason PID: 13658699 is currently loaded in the system with the following addresses: 500 E  CESAR AVE KINGSVILLE, TX 78363 4042 RIVER HILL DR CORPUS CHRISTI, TX 78410 6646 S STAPLES ST #122 CORPUS CHRISTI, TX 78413   Thank you kindly, Heather W.  Provider Relations Healthsmart Network Solutions 6303 Commerce Drive, Suite 180 Irving, Texas 75063 Ph: 800.687.0500 Fax: 214.574.2368', NULL, NULL, '2021-03-29 14:17:21', '2021-03-29 14:17:21'),
(16926, 3046, 21176, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:56', '2021-03-15 15:25:56'),
(16927, 3040, 21176, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider Participating Effective Date: 06/01/2019 ', NULL, NULL, '2021-03-29 14:31:04', '2021-03-29 14:31:04'),
(16928, 3046, 21177, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:25:58', '2021-03-15 15:25:58'),
(16929, 3040, 21177, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || Health Smart ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:34:14', '2021-03-29 15:34:14'),
(16930, 1006, 21177, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - RHC - Health Smart  \"Hello,  I wanted to get an update regarding the enrollment status for the following provider under our group:  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Petina Rogers NPI# 1801443916  Please get back to me as soon as you\'re able regarding the status.  Thank you. \"', NULL, NULL, '2021-06-03 11:49:33', '2021-06-03 11:49:33'),
(16931, 1006, 21177, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - RHC - Health Smart  \"Hello,  I wanted to get an update regarding the enrollment status for the following provider under our group:  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Petina Rogers NPI# 1801443916  Please get back to me as soon as you\'re able regarding the status.  Thank you. \"', NULL, NULL, '2021-06-03 11:49:40', '2021-06-03 11:49:40'),
(16932, 1006, 21177, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent another f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - RHC - Health Smart  \"Hello,   Thank you for the information regarding the effective date, could you please verify if the locations listed are added under the given provider?  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  Thank you. \"', NULL, NULL, '2021-06-09 08:26:55', '2021-06-09 08:26:55'),
(16933, 1006, 21177, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:45:08', '2021-06-15 16:45:08'),
(16934, 1006, 21177, NULL, '2021-06-24 00:00:00.000', 'Approved', 'The location has been added for the provider. Location confirmation is attached for reference.   Eff: 01/01/2020 ', NULL, NULL, '2021-06-17 13:21:46', '2021-06-17 13:21:46'),
(16935, 3046, 21178, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:26:00', '2021-03-15 15:26:00'),
(16936, 3040, 21178, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled with Health smart   Eff: 03/01/2019', NULL, NULL, '2021-03-29 14:42:34', '2021-03-29 14:42:34'),
(16937, 3046, 21179, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:26:01', '2021-03-15 15:26:01'),
(16938, 3040, 21179, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:49:05', '2021-03-29 15:49:05'),
(16939, 3040, 21179, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:36:45', '2021-04-16 07:36:45'),
(16940, 9057, 21179, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to pr.south@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 09:11:24', '2021-05-26 09:11:24');
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
(16941, 1006, 21179, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:45:06', '2021-06-15 16:45:06'),
(16942, 1006, 21179, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted demographic update request @ Provider Relations - South pr.south@healthsmart.com:  Sub: Demographic Update - RHC - HealthSmart  \"Hello,   Please find the attached demographic update request form for our providers, please let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-06-17 17:15:22', '2021-06-17 17:15:22'),
(16943, 1006, 21179, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hi,  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 77954)  Thanks Healthsmart Provider Relations.\"  Sent f/u email:  \"Hello,   When will these be updated on the provider directory?  Thank you!\" ', NULL, NULL, '2021-06-21 09:05:21', '2021-06-21 09:05:21'),
(16944, 1006, 21179, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, location confirmation is attached for reference.   Eff: 06/01/2021', NULL, NULL, '2021-07-05 16:06:22', '2021-07-05 16:06:22'),
(16945, 3046, 21180, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:29:57', '2021-03-15 15:29:57'),
(16946, 1006, 21180, NULL, '2021-04-05 00:00:00.000', 'Approved', 'The Group has an Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.  All Three Locations Added. ', NULL, NULL, '2021-03-29 16:14:55', '2021-03-29 16:14:55'),
(16947, 3046, 21181, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:36:45', '2021-03-15 15:36:45'),
(16948, 1006, 21181, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Request submitted via TMHP website:  Enrollment Application Status  Application Status PEP Ticket Number Submitted		17675965 ', NULL, NULL, '2021-03-26 15:27:53', '2021-03-26 15:27:53'),
(16949, 1006, 21181, NULL, '2021-05-25 00:00:00.000', 'Approved', 'The provider has been enrolled in Medicaid, approval and location confirmation are attached: Eff: 01/01/2021 TPI# 372072404', NULL, NULL, '2021-05-18 11:54:20', '2021-05-18 11:54:20'),
(16950, 3046, 21182, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:36:51', '2021-03-15 15:36:51'),
(16951, 1006, 21182, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The provider is enrolled with TMHP and the location is updated for the provider, attached for reference. ', NULL, NULL, '2021-03-26 16:01:01', '2021-03-26 16:01:01'),
(16952, 1006, 21183, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:39:29', '2021-03-15 15:39:29'),
(16953, 1006, 21183, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:57:54', '2021-04-09 14:57:54'),
(16954, 1019, 21183, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:43:44', '2021-10-25 10:43:44'),
(16955, 1006, 21184, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:39:30', '2021-03-15 15:39:30'),
(16956, 1019, 21184, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:45:08', '2021-04-19 10:45:08'),
(16957, 1019, 21184, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 13:28:31', '2021-04-20 13:28:31'),
(16958, 1006, 21185, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:39:31', '2021-03-15 15:39:31'),
(16959, 1019, 21185, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:44:33', '2021-04-19 10:44:33'),
(16960, 1019, 21185, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com SUB: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We haven\'t received any welcome letters for the following providers and our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632   Regards, Alex ', NULL, NULL, '2021-04-20 14:32:59', '2021-04-20 14:32:59'),
(16961, 1019, 21185, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to ask you guys for the welcome letters. Can you please send us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Regards, Alex', NULL, NULL, '2021-04-23 15:11:27', '2021-04-23 15:11:27'),
(16962, 1019, 21185, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:10', '2021-06-10 09:43:10'),
(16963, 1019, 21185, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:50:19', '2021-06-11 11:50:19'),
(16964, 1006, 21186, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:39:32', '2021-03-15 15:39:32'),
(16965, 1019, 21186, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:44:51', '2021-04-19 10:44:51'),
(16966, 1019, 21186, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com SUB: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We haven\'t received any welcome letters for the following providers and our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632   Regards, Alex ', NULL, NULL, '2021-04-20 14:33:08', '2021-04-20 14:33:08'),
(16967, 1019, 21186, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to ask you guys for the welcome letters. Can you please send us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Regards, Alex', NULL, NULL, '2021-04-23 15:10:38', '2021-04-23 15:10:38'),
(16968, 1019, 21186, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:03', '2021-06-10 09:43:03'),
(16969, 1019, 21186, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:58:09', '2021-06-11 11:58:09'),
(16970, 1006, 21187, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:39:33', '2021-03-15 15:39:33'),
(16971, 1019, 21187, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:40:05', '2021-04-19 10:40:05'),
(16972, 1019, 21187, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 12:33:43', '2021-04-20 12:33:43'),
(16973, 1006, 21188, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:39:34', '2021-03-15 15:39:34'),
(16974, 1019, 21188, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Sent the following email to : behavioralhealthproviderservices  Sub: Enroll Provider || SNBCARE || Justin Souliere || MBHP Hello, We wanted to enroll the below mentioned provider in Humana, under our group. Can you let us know if you do enroll these types of provider.  Group Information: Spectrum Neuro Behavioral Care LLC Tax ID: 834482753 NPI: 1356906572  Individual Provider: Souliere, Justin R NPI: 1710576004', NULL, NULL, '2021-04-02 14:51:05', '2021-04-02 14:51:05'),
(16975, 1019, 21188, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:49:11', '2021-06-10 09:49:11'),
(16976, 1019, 21188, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:59:15', '2021-06-11 11:59:15'),
(16977, 3046, 21189, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:25', '2021-03-15 15:41:25'),
(16978, 1005, 21189, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefit got reassigned to the group.', NULL, NULL, '2021-03-25 14:35:32', '2021-03-25 14:35:32'),
(16979, 3046, 21190, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:26', '2021-03-15 15:41:26'),
(16980, 1005, 21190, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefit got reassigned to the group.', NULL, NULL, '2021-03-25 14:36:05', '2021-03-25 14:36:05'),
(16981, 3046, 21191, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:28', '2021-03-15 15:41:28'),
(16982, 1005, 21191, NULL, '2021-04-01 00:00:00.000', 'New/Not Initiated', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:39:26', '2021-03-25 14:39:26'),
(16983, 1005, 21191, NULL, '2021-04-01 00:00:00.000', 'Approved', NULL, NULL, NULL, '2021-03-25 14:44:32', '2021-03-25 14:44:32'),
(16984, 3046, 21192, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:30', '2021-03-15 15:41:30'),
(16985, 1005, 21192, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:40:16', '2021-03-25 14:40:16'),
(16986, 3046, 21193, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:31', '2021-03-15 15:41:31'),
(16987, 1005, 21193, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:41:07', '2021-03-25 14:41:07'),
(16988, 3046, 21194, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:33', '2021-03-15 15:41:33'),
(16989, 1005, 21194, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:41:36', '2021-03-25 14:41:36'),
(16990, 3046, 21195, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:35', '2021-03-15 15:41:35'),
(16991, 1005, 21195, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:42:15', '2021-03-25 14:42:15'),
(16992, 1006, 21196, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:37', '2021-03-15 15:41:37'),
(16993, 1006, 21196, NULL, '2021-04-29 00:00:00.000', 'In Process', 'We received the following information from Humana Behavioral Health on-call @ 844-291-2162:  RI Addresses and both MA addresses are updated in the system for the group as in-network. Eff: 04/01/2021  RI Plans:  Commercial Network Medicare PPO   MA-Framingham Plans:  Commercial Network  Medicare PPO GoldPlus HMO  MA-Raynham Plans:  Commercial Network  Medicare PPO  Sent the following email to behavioralhealthproviderservices@humana.com:  Sub: Executed Contract & Effective Dates - SNBCare  \"Hello,  We wanted to get copies of our group and providers executed contracts and their effective dates, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Please get back to me on the status of these providers and their welcome letter/executed contracts as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-22 14:52:01', '2021-04-22 14:52:01'),
(16994, 1019, 21196, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:42:57', '2021-06-10 09:42:57'),
(16995, 11056, 21196, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:36:29', '2021-12-09 17:36:29'),
(16996, 19067, 21196, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:31:44', '2021-12-15 15:31:44'),
(16997, 19067, 21196, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:38:09', '2021-12-29 14:38:09'),
(16998, 19067, 21196, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:59', '2022-01-10 13:17:59'),
(16999, 19067, 21196, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:17:09', '2022-01-30 13:17:09'),
(17000, 19067, 21196, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:25:34', '2022-02-08 14:25:34'),
(17001, 19067, 21196, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:57:42', '2022-03-09 14:57:42'),
(17002, 19067, 21196, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:52', '2022-03-10 10:49:52'),
(17003, 22077, 21196, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:47:48', '2022-04-04 13:47:48'),
(17004, 3046, 21197, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:37', '2021-03-15 15:41:37'),
(17005, 1005, 21197, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:42:54', '2021-03-25 14:42:54'),
(17006, 3046, 21198, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:40', '2021-03-15 15:41:40'),
(17007, 1005, 21198, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:43:00', '2021-03-25 14:43:00'),
(17008, 3046, 21199, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:41:42', '2021-03-15 15:41:42'),
(17009, 1005, 21199, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Location added. Task Approved.', NULL, NULL, '2021-03-25 14:31:36', '2021-03-25 14:31:36'),
(17010, 1006, 21200, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:34', '2021-03-15 15:43:34'),
(17011, 1006, 21200, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:57:59', '2021-04-09 14:57:59'),
(17012, 1019, 21200, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:43:53', '2021-10-25 10:43:53'),
(17013, 1006, 21201, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:36', '2021-03-15 15:43:36'),
(17014, 1006, 21201, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Submitted request via Magellan portal to update RI license for provider as well as to add RI location. ', NULL, NULL, '2021-04-16 13:48:05', '2021-04-16 13:48:05'),
(17015, 1019, 21201, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:14:15', '2021-05-20 10:14:15'),
(17016, 1019, 21201, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Submitted online request to Add NSF location thru Magellan Provider Portal.', NULL, NULL, '2021-05-27 08:43:32', '2021-05-27 08:43:32'),
(17017, 19067, 21201, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  JWright@magellanhealth.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	63 Eddie Dowling Hwy, Suite 8 North Smithfield , RI 02896-7322   Provider Name	NPI Fauzia Khan	1699761965  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:11:36', '2021-12-13 15:11:36'),
(17018, 19067, 21201, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Query || Provider || SNBCARE || Magellan    Hello,  Hope you had a great weekend.  I would like to know the enrollment status of the following provider.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 12:51:12', '2021-12-20 12:51:12'),
(17019, 19067, 21201, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 14:00:13', '2021-12-29 14:00:13'),
(17020, 19067, 21201, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:31', '2022-01-10 13:22:31'),
(17021, 19067, 21201, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Re: Enrollment Query || Provider || SNBCARE || Magellan    The provider has been linked to your group since 4/3/2020.  Locations:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Judy', NULL, NULL, '2022-02-07 15:40:14', '2022-02-07 15:40:14'),
(17022, 19067, 21201, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: Enrollment Query || Provider || SNBCARE || Magellan   Hello!  I want to enroll Fauzia Khan in a territory location.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-07 15:40:47', '2022-02-07 15:40:47'),
(17023, 19067, 21201, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: Enrollment Query || Provider || SNBCARE || Magellan   Hello,     If you are talking about adding a service location, you would add the location on the Magellan website.     Go to www.magellanprovider.com  Sign in Using username and password  On the left hand side of the screen go to My Practice  Click on Display Edit Practice Information   Go to roster maintenance  Select the provider that needs the address added  It will take you to another page, select service addresss, hours, & Medicaid ID Information.  Click on Add a New Service Address and add the information of the new address.  Click Save to submit changes', NULL, NULL, '2022-02-11 10:02:47', '2022-02-11 10:02:47'),
(17024, 19067, 21201, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello Judy!  Hope this email finds you well.  Any updates on the enrollment process of the providers, Barbara Arnold, Eliza Rodrigues & Lauren Powell.  Kindly make an update on it.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 11:43:06', '2022-03-17 11:43:06'),
(17025, 22077, 21201, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: FW: Enrollment Status || Providers || SNBCARE || || Magellan |  Hello,  Any updates on the credentialing process of the provider,  Barbara Arnold NPI: 1922432053  Eliza Rodrigues NPI: 1821751405  Fauzia Khan NPI: 1699761965  Thanks', NULL, NULL, '2022-04-04 14:28:44', '2022-04-04 14:28:44'),
(17026, 22077, 21201, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||  Good afternoon,  Barbara Arnold NPI: 1922432053: The provider is at the end of the credentialing process and should be active by next week. Please check next week, towards the end of the week.  Eliza Rodrigues NPI: 1821751405: Provider has been linked to your group effective date 1/18/2022  Fauzia Khan NPI: 1699761965: This provider has been linked to your group since 4/3/2020  Judy', NULL, NULL, '2022-04-05 14:21:07', '2022-04-05 14:21:07'),
(17027, 22077, 21201, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||  Hello,  Can you confirm the locations for the providers mentioned below  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Fauzia Khan	1699761965	63 EDDIE DOWLING HWY, SUITE 8 NORTH SMITHFIELD, RI 02896-7322   Thanks,', NULL, NULL, '2022-04-05 14:44:15', '2022-04-05 14:44:15'),
(17028, 3046, 21202, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:37', '2021-03-15 15:43:37'),
(17029, 1006, 21202, NULL, '2021-04-02 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-03-26 09:38:12', '2021-03-26 09:38:12'),
(17030, 1006, 21202, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations for Statcare are listed under only one PTAN.   Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 GROUP NPI	1689924904 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 09:39:37', '2021-03-26 09:39:37'),
(17031, 1006, 21203, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:38', '2021-03-15 15:43:38'),
(17032, 1006, 21203, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with all 3 practices, proof of enrollment and locations is attached for reference.  ', NULL, NULL, '2021-04-16 14:18:33', '2021-04-16 14:18:33'),
(17033, 3046, 21204, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:39', '2021-03-15 15:43:39'),
(17034, 1006, 21204, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MAEGAN J SVATEK NP PROVIDER PTAN	P02133470 PROVIDER NPI	1639670250 EFFECTIVE DATE	06/08/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-26 10:05:13', '2021-03-26 10:05:13'),
(17035, 1006, 21205, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:40', '2021-03-15 15:43:40'),
(17036, 1006, 21205, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with all 3 practices, proof of enrollment and locations is attached for reference. ', NULL, NULL, '2021-04-16 13:24:09', '2021-04-16 13:24:09'),
(17037, 3046, 21206, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:41', '2021-03-15 15:43:41'),
(17038, 1006, 21206, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	PATRICK A AYARZAGOITIA NP PROVIDER PTAN	P02173892 PROVIDER NPI	1649568239 EFFECTIVE DATE	10/31/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-26 10:16:36', '2021-03-26 10:16:36'),
(17039, 3046, 21207, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:42', '2021-03-15 15:43:42'),
(17040, 1006, 21207, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under group PTAN, which provider is linked to.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUAN M CAPUPUS NP PROVIDER PTAN	P02418072 PROVIDER NPI	1891168597 EFFECTIVE DATE	07/20/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-26 10:19:43', '2021-03-26 10:19:43'),
(17041, 1006, 21208, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:43', '2021-03-15 15:43:43'),
(17042, 1019, 21208, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Submitted enrollment request via online portal  ', NULL, NULL, '2021-03-25 11:09:19', '2021-03-25 11:09:19'),
(17043, 1019, 21208, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com  Hello, we tried pulling for CAQH Credentialing Application is not listing Magellan as authorized to pull. Can they please update their CAQH APP so they can go through credentialing process?        Angela Viviano  Data Management Specialist II  Contracting, Network Operations  Magellan Healthcare', NULL, NULL, '2021-04-01 15:06:04', '2021-04-01 15:06:04'),
(17044, 1019, 21208, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Sent the following message to ARViviano@magellanhealth.com  Hello Angela, Upon my checking Magellan should be able to view CAQH for Credentialing purposes for Justin Souliere, Let me know if you still have any issues.', NULL, NULL, '2021-04-01 15:06:46', '2021-04-01 15:06:46'),
(17045, 1019, 21208, NULL, '2021-04-09 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-04-02 14:33:54', '2021-04-02 14:33:54'),
(17046, 1006, 21208, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Sent a f/u email @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com:  Sub: Enrollment Query - SNBCare - Magellan  \"Hello Judith,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Justin Souliere NPI# 1710576004  Provider Name: Kerry Smith NPI# 1275083230  Please get back to me as soon as you\'re able.   Thank you.\"', NULL, NULL, '2021-04-16 13:01:49', '2021-04-16 13:01:49'),
(17047, 1006, 21208, NULL, '2021-04-23 00:00:00.000', 'In Process', 'I received the following update from July:  \"Good Afternoon,  Provider Name: Justin Souliere: Almost there. The provider is at the end of the process, but has not yet been made active. I anticipate by the end of next week. NPI# 1710576004  Provider Name: Kerry Smith: The provider is in process. NPI# 1275083230  Judy\"', NULL, NULL, '2021-04-16 13:09:45', '2021-04-16 13:09:45'),
(17048, 1019, 21208, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Sent the following email to JJonesWright@magellanhealth.com Sub: Enrollment Query - SNBCare - Magellan   Hello Judith,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Justin Souliere NPI# 1710576004  Provider Name: Kerry Smith NPI# 1275083230  Please get back to us as soon as you\'re able.  Thank you.', NULL, NULL, '2021-04-22 14:58:04', '2021-04-22 14:58:04'),
(17049, 1019, 21208, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to JJonesWright@magellanhealth.com  Hello Judith, We wanted to check on the enrollment status for the following providers under our group, if they are enrolled with Magellan then can you please send me a copy of executed contracts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230  Rodesia Edmundson NPI: 1124622667  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-04-26 07:26:02', '2021-04-26 07:26:02'),
(17050, 1019, 21208, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Received the following email from JWright@magellanhealth.com  Good Morning, Individuals aren’t contracted, they are credentialed and linked to your Tax ID. Only Spectrum is contracted.  Kerry Smith: The provider is in process NPI: 1275083230  Rodesia Edmundson: The provider is in process. NPI: 1124622667   Justin Souliere: The provider has been linked to your group effective date 4/12/2021 NPI: 1710576004  Judy See attachments for ref', NULL, NULL, '2021-04-26 07:49:42', '2021-04-26 07:49:42'),
(17051, 1006, 21209, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:44', '2021-03-15 15:43:44'),
(17052, 1006, 21209, NULL, '2021-04-26 00:00:00.000', 'Approved', 'We received the following approval confirmation from @ Wright, Judith JWright@magellanhealth.com:  Sub: Group Enrollment Query - SNBCare  \"Good Morning,   Your group for MA was executed 4/3/2020 and for Rhode Island 10/23/2019.  Please see the executed agreement attached.  Judy\"  Executed Contract is attached for confirmation as well. ', NULL, NULL, '2021-04-19 11:27:03', '2021-04-19 11:27:03'),
(17053, 3046, 21210, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:46', '2021-03-15 15:43:46'),
(17054, 1006, 21210, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under group PTAN, and provider is added under group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	M A CAPUPUS PA PROVIDER PTAN	P02133478 PROVIDER NPI	1740517945 EFFECTIVE DATE	08/05/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-26 10:22:33', '2021-03-26 10:22:33'),
(17055, 3046, 21211, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:47', '2021-03-15 15:43:47'),
(17056, 1006, 21211, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	TRACI SMITH MASON NP PROVIDER PTAN	P02133482 PROVIDER NPI	1497127831 EFFECTIVE DATE	08/10/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	  ', NULL, NULL, '2021-03-26 10:25:53', '2021-03-26 10:25:53'),
(17057, 3046, 21212, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:49', '2021-03-15 15:43:49'),
(17058, 1006, 21212, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under one PTAN for the group which providers are added under.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	KATHERINE C RABAGOS NP PROVIDER PTAN	P01596057 PROVIDER NPI	1134415631 EFFECTIVE DATE	04/12/2014 END DATE 	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE ', NULL, NULL, '2021-03-26 10:13:06', '2021-03-26 10:13:06'),
(17059, 3046, 21213, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:43:51', '2021-03-15 15:43:51'),
(17060, 1006, 21213, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are already listed under group PTAN and the provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	PETINA L ROGERS NP PROVIDER PTAN	P02405363 PROVIDER NPI	1801443916 EFFECTIVE DATE	10/10/2019 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-26 10:29:25', '2021-03-26 10:29:25'),
(17061, 3046, 21214, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:43', '2021-03-15 15:53:43'),
(17062, 3040, 21214, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider.  ', NULL, NULL, '2021-03-30 14:38:02', '2021-03-30 14:38:02'),
(17063, 3046, 21215, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:45', '2021-03-15 15:53:45'),
(17064, 3040, 21215, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider.', NULL, NULL, '2021-03-30 14:40:14', '2021-03-30 14:40:14'),
(17065, 3046, 21216, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:47', '2021-03-15 15:53:47'),
(17066, 3040, 21216, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   ', NULL, NULL, '2021-03-30 14:43:17', '2021-03-30 14:43:17'),
(17067, 3046, 21217, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:49', '2021-03-15 15:53:49'),
(17068, 3040, 21217, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-30 14:46:33', '2021-03-30 14:46:33'),
(17069, 3046, 21218, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:50', '2021-03-15 15:53:50'),
(17070, 3040, 21218, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-30 14:48:49', '2021-03-30 14:48:49'),
(17071, 3046, 21219, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:52', '2021-03-15 15:53:52'),
(17072, 3040, 21219, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider. ', NULL, NULL, '2021-03-30 14:51:02', '2021-03-30 14:51:02'),
(17073, 3046, 21220, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:53', '2021-03-15 15:53:53'),
(17074, 3040, 21220, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.  ', NULL, NULL, '2021-03-30 14:58:25', '2021-03-30 14:58:25'),
(17075, 3046, 21221, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:55', '2021-03-15 15:53:55'),
(17076, 3040, 21221, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.  ', NULL, NULL, '2021-03-30 15:01:14', '2021-03-30 15:01:14');
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
(17077, 3046, 21222, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:53:57', '2021-03-15 15:53:57'),
(17078, 3040, 21222, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.', NULL, NULL, '2021-03-30 15:02:35', '2021-03-30 15:02:35'),
(17079, 3046, 21223, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:54:00', '2021-03-15 15:54:00'),
(17080, 3040, 21223, NULL, '2021-04-06 00:00:00.000', 'Approved', ' Group has ancillary contract. No need to add the individual provider.    ', NULL, NULL, '2021-03-30 15:05:03', '2021-03-30 15:05:03'),
(17081, 1006, 21224, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:00', '2021-03-15 15:57:00'),
(17082, 1006, 21224, NULL, '2021-04-26 00:00:00.000', 'Approved', 'We received the following approval confirmation from @ Wright, Judith JWright@magellanhealth.com:  Sub: Group Enrollment Query - SNBCare  \"Good Morning,   Your group for MA was executed 4/3/2020 and for Rhode Island 10/23/2019.  Please see the executed agreement attached.  Judy\"  Executed Contract is attached for confirmation as well. ', NULL, NULL, '2021-04-19 11:27:09', '2021-04-19 11:27:09'),
(17083, 1006, 21225, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:02', '2021-03-15 15:57:02'),
(17084, 1019, 21225, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted enrollment request via online portal. ', NULL, NULL, '2021-03-25 11:30:31', '2021-03-25 11:30:31'),
(17085, 1019, 21225, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com  Sub: SECURE1/601509-645 KERRY SMITH NPI 1275083230 Hello, we tried pulling for CAQH Credentialing Application is not listing Magellan as authorized to pull. Can they please update their CAQH APP so they can go through credentialing process?        Angela Viviano  Data Management Specialist II  Contracting, Network Operations  Magellan Healthcare', NULL, NULL, '2021-04-01 15:18:09', '2021-04-01 15:18:09'),
(17086, 1019, 21225, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Sent the following message to ARViviano@magellanhealth.com  Sub: SECURE1/601509-645 KERRY SMITH NPI 1275083230 Hello Angela, Upon my checking Magellan should be able to view CAQH for Credentialing purposes for Justin Souliere, Let me know if you still have any issues.', NULL, NULL, '2021-04-01 15:19:46', '2021-04-01 15:19:46'),
(17087, 1019, 21225, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to JJonesWright@magellanhealth.com  Hello Judith, We wanted to check on the enrollment status for the following providers under our group, if they are enrolled with Magellan then can you please send me a copy of executed contracts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230  Rodesia Edmundson NPI: 1124622667  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-04-26 07:27:01', '2021-04-26 07:27:01'),
(17088, 1019, 21225, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from JWright@magellanhealth.com  Good Morning, Individuals aren’t contracted, they are credentialed and linked to your Tax ID. Only Spectrum is contracted.  Kerry Smith: The provider is in process NPI: 1275083230  Rodesia Edmundson: The provider is in process. NPI: 1124622667   Justin Souliere: The provider has been linked to your group effective date 4/12/2021 NPI: 1710576004  Judy', NULL, NULL, '2021-04-26 07:48:07', '2021-04-26 07:48:07'),
(17089, 1019, 21225, NULL, '2021-05-15 00:00:00.000', 'In Process', 'Received the following email from ADRose@magellanhealth.com          Good Morning,     MIS# 601509645     Magellan is in the process of Kerry Smith’s credentialing.  We need the following information to be returned to complete your credentialing.     Verification of her degree. The information on her CAQH application reflects MSN.  Magellan requires a degree in social work for all social workers.  Verification of her degree, what college/university she attended to obtain it and the year of graduation is required in order to complete her credentialing.    This information can be faxed back to Magellan at 888-656-1121, within 7 days of receiving this notice.     *Here is our provider services number 1-800-788-4005.  Keep the number handy in case you have questions regarding credentialing or claims.  Thank you,  Autumn Rose-Gonda', NULL, NULL, '2021-05-07 10:25:53', '2021-05-07 10:25:53'),
(17090, 1019, 21225, NULL, '2021-05-15 00:00:00.000', 'In Process', 'Sent the following email to ADRose@magellanhealth.com   Hello Autumn, Hope you\'re doing well, we have faxed her MSW Degree to you, can you please see if you have received it or not.   Regards, Alex', NULL, NULL, '2021-05-07 10:29:44', '2021-05-07 10:29:44'),
(17091, 1019, 21225, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Received the following email from ADRose@magellanhealth.com Good Morning Alex,  Kerry Smith’s diploma has been received and Magellan will continue to process her application for credentialing.  Thank you, Autumn   ', NULL, NULL, '2021-05-12 11:19:39', '2021-05-12 11:19:39'),
(17092, 1019, 21225, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:13:38', '2021-05-20 10:13:38'),
(17093, 1019, 21225, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from  JWright@magellanhealth.com Good Morning,  Kerry Smith: The provider is about 1-2 weeks from completion. NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson: Credentialing in process NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman: Has been linked to your group effective date 10/26/2020. Previously informed on 11/9/2020 NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020. NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons: Credentialing in process. NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan: Has been linked to your group effective date 4/3/2020. NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-05-27 08:45:57', '2021-05-27 08:45:57'),
(17094, 1019, 21225, NULL, '2021-06-13 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 05/17/2021. See attachment for approval confirmation', NULL, NULL, '2021-06-06 07:02:09', '2021-06-06 07:02:09'),
(17095, 1006, 21226, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:03', '2021-03-15 15:57:03'),
(17096, 1006, 21226, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with all 3 practices, proof of enrollment and locations is attached for reference. ', NULL, NULL, '2021-04-16 13:24:19', '2021-04-16 13:24:19'),
(17097, 1006, 21227, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:05', '2021-03-15 15:57:05'),
(17098, 1006, 21227, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with all 3 practices, proof of enrollment and locations is attached for reference.  ', NULL, NULL, '2021-04-16 14:18:39', '2021-04-16 14:18:39'),
(17099, 1006, 21228, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:06', '2021-03-15 15:57:06'),
(17100, 1006, 21228, NULL, '2021-03-26 00:00:00.000', 'Approved', 'The provider is enrolled, approval confirmation is attached.   Eff: 08/22/2019', NULL, NULL, '2021-03-19 17:49:39', '2021-03-19 17:49:39'),
(17101, 1006, 21229, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:08', '2021-03-15 15:57:08'),
(17102, 1006, 21229, NULL, '2021-04-29 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of locations is attached for reference.  ', NULL, NULL, '2021-04-22 15:58:22', '2021-04-22 15:58:22'),
(17103, 1006, 21230, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 15:57:10', '2021-03-15 15:57:10'),
(17104, 1019, 21230, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Initiated thru Provider Portal', NULL, NULL, '2021-04-06 16:33:51', '2021-04-06 16:33:51'),
(17105, 1019, 21230, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Received the following message from Angela: ARViviano@magellanhealth.com  Outreach for CAQH: Thank you for your interest in the Magellan Health Services (Magellan)* provider network. We received a request via the web access to add the following providers to your group. 601511-661     RODESIA EDMUNDSON CAQH ID: 15091874   In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  Thank you, Magellan Contracting Team', NULL, NULL, '2021-04-12 10:52:02', '2021-04-12 10:52:02'),
(17106, 1019, 21230, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Sent the following email to: ARViviano@magellanhealth.com  Hello Angela,  We have already granted permissions to Magellan Healthcare to view Rodesia Edmundson profile. Let us know if you have any issues viewing her profile on CAQH.   Regards, Alex', NULL, NULL, '2021-04-12 10:52:50', '2021-04-12 10:52:50'),
(17107, 1019, 21230, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to JJonesWright@magellanhealth.com  Hello Judith, We wanted to check on the enrollment status for the following providers under our group, if they are enrolled with Magellan then can you please send me a copy of executed contracts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230  Rodesia Edmundson NPI: 1124622667  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-04-26 07:27:51', '2021-04-26 07:27:51'),
(17108, 1019, 21230, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from JWright@magellanhealth.com  Good Morning, Individuals aren’t contracted, they are credentialed and linked to your Tax ID. Only Spectrum is contracted.  Kerry Smith: The provider is in process NPI: 1275083230  Rodesia Edmundson: The provider is in process. NPI: 1124622667   Justin Souliere: The provider has been linked to your group effective date 4/12/2021 NPI: 1710576004  Judy', NULL, NULL, '2021-04-26 07:47:30', '2021-04-26 07:47:30'),
(17109, 1019, 21230, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:12:52', '2021-05-20 10:12:52'),
(17110, 1019, 21230, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Received the following email from, ADRose@magellanhealth.com  Good Afternoon,     MIS# 601511661     Magellan is in the process of  Rodesia Edmundson’s credentialing.  We need the following information to be returned to complete her credentialing.     An updated copy of her DEA (Drug Enforcement Administration). Magellan and CAQH don’t have a current copy on file. This information can be faxed back to Magellan at 888-656-1121, within 7 days of receiving this notice.     *Here is our provider services number 1-800-788-4005.  Keep the number handy in case you have questions regarding credentialing or claims.     Thank you,  Autumn Rose-Gonda  8621 Robert Fulton Drive, Columbia, MD 21046  F 888-656-1121 | E adrose@magellanhealth.com', NULL, NULL, '2021-05-21 09:10:55', '2021-05-21 09:10:55'),
(17111, 1019, 21230, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Good Morning Autumn,  I have faxed you the copy of the DEA, let me know if you received it.   Regards, Alex', NULL, NULL, '2021-05-21 09:13:03', '2021-05-21 09:13:03'),
(17112, 1019, 21230, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Received the following email from ADRose@magellanhealth.com Hi Alex,  Her DEA has been received and placed in her file.  Magellan will continue to process her application for credentialing.  Thank you,  Autumn', NULL, NULL, '2021-05-24 08:47:37', '2021-05-24 08:47:37'),
(17113, 1019, 21230, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from  JWright@magellanhealth.com Good Morning,  Kerry Smith: The provider is about 1-2 weeks from completion. NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson: Credentialing in process NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman: Has been linked to your group effective date 10/26/2020. Previously informed on 11/9/2020 NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020. NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons: Credentialing in process. NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan: Has been linked to your group effective date 4/3/2020. NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-05-27 08:51:01', '2021-05-27 08:51:01'),
(17114, 1019, 21230, NULL, '2021-06-13 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 06/01/2024. See attachment for approval confirmation', NULL, NULL, '2021-06-06 06:51:48', '2021-06-06 06:51:48'),
(17115, 3046, 21231, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:01', '2021-03-15 16:00:01'),
(17116, 1006, 21231, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Submitted request for address addition of SPID but also added request to add following addresses to the group:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard  Also, add the following addresses under the group and all practitioners that are participating under the group:  Secondary Service Address: 4042 River Hill, Corpus Christi, TX 78410 Phone# 361-933-5187 Fax# 361-933-5189  Tertiary Service Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025\"', NULL, NULL, '2021-03-30 13:40:37', '2021-03-30 13:40:37'),
(17117, 1006, 21231, NULL, '2021-05-05 00:00:00.000', 'In Process', 'The addresses haven\'t been added to the group profile but they are added to the individual providers. Need to allow more time for group to be updated.  Ref# 7560925    ', NULL, NULL, '2021-04-28 14:09:10', '2021-04-28 14:09:10'),
(17118, 9057, 21231, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: registrar@multiplan.com Sub: Additional location status request - RHC - Multiplan  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Group Details Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN#  46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details Provider Name: Capupus, Mari Provider NPI: 1740517945 Case Number: 7594352   Also we asked for the addition of below mentioned addresses to the group profile   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Case Number: 7560925   Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 12:04:28', '2021-05-26 12:04:28'),
(17119, 1006, 21231, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I wanted to follow up on the status of this request, have there been any updates?  Thank you. \"', NULL, NULL, '2021-06-03 11:52:29', '2021-06-03 11:52:29'),
(17120, 1006, 21231, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent another f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of our location addition?  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-21 16:08:50', '2021-06-21 16:08:50'),
(17121, 1006, 21231, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, proof of location addition is attached for reference.   Eff: 09/15/2015', NULL, NULL, '2021-07-05 14:30:44', '2021-07-05 14:30:44'),
(17122, 3046, 21232, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:04', '2021-03-15 16:00:04'),
(17123, 1006, 21232, NULL, '2021-04-06 00:00:00.000', 'Initiated', '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 16:51:59', '2021-03-30 16:51:59'),
(17124, 1006, 21232, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added to all addresses, attached location confirmation and welcome letter for reference in the primary address task. ', NULL, NULL, '2021-04-29 14:18:10', '2021-04-29 14:18:10'),
(17125, 3046, 21233, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:06', '2021-03-15 16:00:06'),
(17126, 1006, 21233, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Provider enrollment request submitted as per Multiplan they were termed in 2019, email attached:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561602    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 17:00:39', '2021-03-30 17:00:39'),
(17127, 1006, 21233, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email received from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7561602  \"MultiPlan has closed Customer Service Case 7561602.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear Brad Peterson,  Additional information is required for Juan Miguel Capupus  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees? Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.  Case Number: 7561602    Submitter Name: Brad Peterson Date of submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard\"  Opened the case again and replied back to them regarding their queries. ', NULL, NULL, '2021-04-28 14:51:05', '2021-04-28 14:51:05'),
(17128, 1006, 21233, NULL, '2021-05-17 00:00:00.000', 'Approved', 'The provider is approved with Multiplan, a welcome letter and proof of location are attached for reference.   Eff: 03/30/2021', NULL, NULL, '2021-05-10 14:17:58', '2021-05-10 14:17:58'),
(17129, 3046, 21234, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:08', '2021-03-15 16:00:08'),
(17130, 1006, 21234, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval. ', NULL, NULL, '2021-03-30 15:59:05', '2021-03-30 15:59:05'),
(17131, 3046, 21235, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:11', '2021-03-15 16:00:11'),
(17132, 1006, 21235, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:04:29', '2021-03-30 16:04:29'),
(17133, 3046, 21236, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:12', '2021-03-15 16:00:12'),
(17134, 1006, 21236, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Katherine is enrolled with Multiplan and PHCS, approval confirmation and location information is attached for reference.   MultiPlan Network 03/22/2016 - Present Product Effective Period MultiPlan	 03/22/2016 - 	Present MultiPlan Auto Medical	 03/22/2016 - 	Present MultiPlan Workers\' Compensation	 03/22/2016 - 	Present PHCS Network 02/01/2017 - Present Product Effective Period PHCS	 02/01/2017 - 	Present ', NULL, NULL, '2021-03-30 10:06:38', '2021-03-30 10:06:38'),
(17135, 3046, 21237, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:14', '2021-03-15 16:00:14'),
(17136, 1006, 21237, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:07:09', '2021-03-30 16:07:09'),
(17137, 3046, 21238, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:16', '2021-03-15 16:00:16'),
(17138, 1006, 21238, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:09:27', '2021-03-30 16:09:27'),
(17139, 1006, 21238, 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 09:37:53', '2021-07-20 09:37:53'),
(17140, 1006, 21238, 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 16:14:20', '2021-08-18 16:14:20'),
(17141, 1006, 21238, 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 14:08:43', '2021-08-27 14:08:43'),
(17142, 11056, 21238, NULL, '2021-09-28 00:00:00.000', 'Revalidation', 'Email sent to : registrar@multiplan.com  Sub : Recredentialing Request - Maegan Svatek  Good afternoon!  Hope all is well with you. Please provide me with the recredentialing status for the provider,Maegan Svatek ( NPI: 1639670250) under TIN (46-0575924). And also with addresses listed underneath her.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-21 14:23:55', '2021-09-21 14:23:55'),
(17143, 11056, 21238, 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 10:26:46', '2021-10-12 10:26:46'),
(17144, 3046, 21239, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:00:18', '2021-03-15 16:00:18'),
(17145, 1006, 21239, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Submitted enrollment request and group addition for provider for all addresses:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561360    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 14:30:17', '2021-03-30 14:30:17'),
(17146, 1006, 21239, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Multiplan @ PortalRegistrar PortalRegistrar@multiplan.com:  Sub: FW: Contract ID 9671500 Case # 7561360  \"Dear Brad Peterson,  Additional information is required for Rose Puentes  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees?  Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.\"  Reopened the case and submitted the answers. ', NULL, NULL, '2021-04-28 15:36:05', '2021-04-28 15:36:05'),
(17147, 1006, 21239, NULL, '2021-05-07 00:00:00.000', 'In Process', 'We received the following email from appmissinginfo fax7814878257@multiplan.com:  Sub: Regarding Trevino, Rose P., PAC\'s MultiPlan Application – Reference: APP0008202553  \"We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Sriyanka  D Provider Data Management appmissinginfo@multiplan.com  MultiPlan, Inc 16 Crosby Drive Bedford, MA 01730 Fax: 781-487-8257 Reference: APP0008202553\"  The form was filled out and sent to Multiplan.', NULL, NULL, '2021-04-30 08:28:54', '2021-04-30 08:28:54'),
(17148, 1006, 21239, NULL, '2021-05-20 00:00:00.000', 'In Process', 'We received an email from Multiplan stating that provider has a BHS degree and is unable to be credentialed but she would still be able to bill under the group contract, informed billing team to go ahead and do so. Will update task once claim status is received. ', NULL, NULL, '2021-05-10 13:39:19', '2021-05-10 13:39:19'),
(17149, 1006, 21239, NULL, '2021-07-03 00:00:00.000', 'In Process', 'Sent f/u email to billing team: \"Hello,  I wanted to check in with you to see if any claims were received and sent out for Rose Trevino yet?  Thank you.\"', NULL, NULL, '2021-06-03 10:35:38', '2021-06-03 10:35:38'),
(17150, 1006, 21239, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-06-21 16:06:12', '2021-06-21 16:06:12'),
(17151, 1006, 21239, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time. ', NULL, NULL, '2021-07-05 13:48:21', '2021-07-05 13:48:21'),
(17152, 1006, 21239, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time.  ', NULL, NULL, '2021-08-17 17:17:35', '2021-08-17 17:17:35'),
(17153, 11056, 21239, NULL, '2021-09-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-09-21 14:15:28', '2021-09-21 14:15:28'),
(17154, 11056, 21239, NULL, '2021-10-11 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-04 10:59:06', '2021-10-04 10:59:06'),
(17155, 11056, 21239, NULL, '2021-10-21 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-14 12:45:47', '2021-10-14 12:45:47'),
(17156, 11056, 21239, NULL, '2021-11-01 00:00:00.000', 'In Process', '	 We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-25 12:36:07', '2021-10-25 12:36:07'),
(17157, 11056, 21239, NULL, '2021-11-01 00:00:00.000', 'In Process', '	 We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-25 12:36:40', '2021-10-25 12:36:40'),
(17158, 11056, 21239, NULL, '2021-11-18 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-11 13:21:52', '2021-11-11 13:21:52'),
(17159, 11056, 21239, NULL, '2021-12-01 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-24 17:10:07', '2021-11-24 17:10:07'),
(17160, 11056, 21239, NULL, '2021-12-17 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-10 17:30:48', '2021-12-10 17:30:48'),
(17161, 11056, 21239, NULL, '2021-12-30 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-23 10:27:08', '2021-12-23 10:27:08'),
(17162, 19067, 21239, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:24:57', '2022-01-12 17:24:57'),
(17163, 19067, 21239, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:51', '2022-01-26 17:28:51'),
(17164, 19067, 21239, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:38:00', '2022-02-11 14:38:00'),
(17165, 19067, 21239, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:46', '2022-02-23 14:28:46'),
(17166, 19067, 21239, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:21', '2022-03-15 16:19:21'),
(17167, 1006, 21240, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:27', '2021-03-15 16:03:27'),
(17168, 1006, 21240, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-21 15:19:22', '2021-04-21 15:19:22'),
(17169, 1006, 21241, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:31', '2021-03-15 16:03:31'),
(17170, 1006, 21241, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Submitted email to Maribel for enrollment status and welcome letters for providers @ Maribel Perez Lorenzo/MAXIMUS MaribelPerezLorenzo@maximus.com:  Sub: Enrollment Query - SNBCare  \"Hello Maribel,   I hope you\'re doing well, I just wanted to know if you could please let me know what the effective dates are for the following providers as well as a copy of their executed contracts with our group, the information is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Please get back to me as soon as you\'re able and thank you for all the help!\"', NULL, NULL, '2021-04-22 16:33:07', '2021-04-22 16:33:07'),
(17171, 1019, 21241, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:48:18', '2021-08-10 22:48:18'),
(17172, 1006, 21242, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:33', '2021-03-15 16:03:33'),
(17173, 1006, 21242, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-21 15:19:15', '2021-04-21 15:19:15'),
(17174, 1006, 21243, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:34', '2021-03-15 16:03:34'),
(17175, 1006, 21243, NULL, '2021-04-29 00:00:00.000', 'Approved', 'Group is enrolled with Mass Health, approval letter and executed are attached for reference.   Eff: 01/30/2020', NULL, NULL, '2021-04-22 16:20:49', '2021-04-22 16:20:49'),
(17176, 1006, 21244, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:36', '2021-03-15 16:03:36'),
(17177, 1006, 21244, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-21 15:19:27', '2021-04-21 15:19:27'),
(17178, 1006, 21245, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:39', '2021-03-15 16:03:39'),
(17179, 1019, 21245, NULL, '2021-04-10 00:00:00.000', 'New/Not Initiated', 'Mass Health doesn\'t enroll LCSW.', NULL, NULL, '2021-04-03 14:01:56', '2021-04-03 14:01:56'),
(17180, 1006, 21245, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-21 15:19:33', '2021-04-21 15:19:33'),
(17181, 1006, 21246, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:41', '2021-03-15 16:03:41'),
(17182, 1006, 21246, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Submitted email to Maribel for enrollment status and welcome letters for providers @ Maribel Perez Lorenzo/MAXIMUS MaribelPerezLorenzo@maximus.com:  Sub: Enrollment Query - SNBCare  \"Hello Maribel,   I hope you\'re doing well, I just wanted to know if you could please let me know what the effective dates are for the following providers as well as a copy of their executed contracts with our group, the information is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Please get back to me as soon as you\'re able and thank you for all the help!\"', NULL, NULL, '2021-04-22 16:33:02', '2021-04-22 16:33:02'),
(17183, 1019, 21246, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:47:48', '2021-08-10 22:47:48'),
(17184, 1006, 21247, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:44', '2021-03-15 16:03:44'),
(17185, 1006, 21247, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-21 15:19:38', '2021-04-21 15:19:38'),
(17186, 3046, 21248, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:47', '2021-03-15 16:03:47'),
(17187, 1006, 21248, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The 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 regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:04:43', '2021-04-08 18:04:43'),
(17188, 9057, 21248, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  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  Thank You', NULL, NULL, '2021-05-25 16:16:40', '2021-05-25 16:16:40'),
(17189, 9057, 21248, NULL, '2021-06-02 00:00:00.000', 'In Process', '', NULL, NULL, '2021-05-25 16:18:27', '2021-05-25 16:18:27');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(17190, 9057, 21248, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  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  Thank You', NULL, NULL, '2021-05-25 16:18:38', '2021-05-25 16:18:38'),
(17191, 1006, 21248, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:32', '2021-06-11 16:44:32'),
(17192, 1006, 21248, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added 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  Providers 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: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:29:06', '2021-06-30 09:29:06'),
(17193, 1006, 21248, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:51:23', '2021-08-09 16:51:23'),
(17194, 1006, 21248, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:37', '2021-08-24 14:50:37'),
(17195, 11056, 21248, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  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: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:22', '2021-09-21 16:08:22'),
(17196, 11056, 21248, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:33', '2021-10-01 12:51:33'),
(17197, 11056, 21248, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:48', '2021-10-01 12:51:48'),
(17198, 11056, 21248, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:50:55', '2021-10-18 15:50:55'),
(17199, 11056, 21248, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:56:57', '2021-10-26 11:56:57'),
(17200, 11056, 21248, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:39:45', '2021-11-11 14:39:45'),
(17201, 11056, 21248, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:03:41', '2021-12-02 16:03:41'),
(17202, 11056, 21248, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:10:16', '2021-12-16 14:10:16'),
(17203, 11056, 21248, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Patrick Ayarzagoitia  Kingsville - 6/1/2017 Calallen - 6/1/2017 SPID - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 15:26:32', '2021-12-21 15:26:32'),
(17204, 3046, 21249, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:49', '2021-03-15 16:03:49'),
(17205, 1006, 21249, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The 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 regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:04:51', '2021-04-08 18:04:51'),
(17206, 9057, 21249, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  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  Thank You', NULL, NULL, '2021-05-25 16:16:30', '2021-05-25 16:16:30'),
(17207, 1006, 21249, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:29', '2021-06-11 16:44:29'),
(17208, 1006, 21249, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added 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  Providers 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: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:39:51', '2021-06-30 09:39:51'),
(17209, 1006, 21249, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:51:18', '2021-08-09 16:51:18'),
(17210, 1006, 21249, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:41', '2021-08-24 14:50:41'),
(17211, 11056, 21249, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  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: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:27', '2021-09-21 16:08:27'),
(17212, 11056, 21249, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:26', '2021-10-01 12:51:26'),
(17213, 11056, 21249, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:01', '2021-10-18 15:51:01'),
(17214, 11056, 21249, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:05', '2021-10-26 11:57:05'),
(17215, 11056, 21249, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:39:40', '2021-11-11 14:39:40'),
(17216, 11056, 21249, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:03:53', '2021-12-02 16:03:53'),
(17217, 11056, 21249, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:10:10', '2021-12-16 14:10:10'),
(17218, 11056, 21249, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective dates   Juan Miguel Capupus   Kingsville - 6/1/2017 CALLALEN - 6/1/2017 STAPLES  - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:45:45', '2021-12-21 13:45:45'),
(17219, 3046, 21250, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:50', '2021-03-15 16:03:50'),
(17220, 1006, 21250, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The 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 regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:04:56', '2021-04-08 18:04:56'),
(17221, 9057, 21250, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  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  Thank You', NULL, NULL, '2021-05-25 16:13:46', '2021-05-25 16:13:46'),
(17222, 9057, 21250, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  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  Thank You', NULL, NULL, '2021-05-25 16:13:59', '2021-05-25 16:13:59'),
(17223, 1006, 21250, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:25', '2021-06-11 16:44:25'),
(17224, 1006, 21250, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added 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  Providers 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: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:32:30', '2021-06-30 09:32:30'),
(17225, 1006, 21250, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:51:13', '2021-08-09 16:51:13'),
(17226, 1006, 21250, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   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 Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:45', '2021-08-24 14:50:45'),
(17227, 11056, 21250, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  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: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:32', '2021-09-21 16:08:32'),
(17228, 11056, 21250, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:20', '2021-10-01 12:51:20'),
(17229, 11056, 21250, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:08', '2021-10-18 15:51:08'),
(17230, 11056, 21250, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:12', '2021-10-26 11:57:12'),
(17231, 11056, 21250, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:39:34', '2021-11-11 14:39:34'),
(17232, 11056, 21250, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:04:06', '2021-12-02 16:04:06'),
(17233, 11056, 21250, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:10:03', '2021-12-16 14:10:03'),
(17234, 11056, 21250, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider       Effective dates   Mari K Capupus   Kingsville - 6/1/2017 CALLALEN - 6/1/2017 STAPLES  - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:35:49', '2021-12-21 13:35:49'),
(17235, 3046, 21251, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:51', '2021-03-15 16:03:51'),
(17236, 1006, 21251, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The 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 regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:05:01', '2021-04-08 18:05:01');
