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
(37837, 1006, 29515, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:09:43', '2021-08-13 16:09:43'),
(37838, 1006, 29515, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:49:46', '2021-08-23 15:49:46'),
(37839, 11056, 29515, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:33:07', '2021-09-21 10:33:07'),
(37840, 11056, 29515, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:20:47', '2021-09-30 12:20:47'),
(37841, 1006, 29520, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:34:07', '2021-05-10 12:34:07'),
(37842, 1005, 29520, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:37:50', '2021-06-02 14:37:50'),
(37843, 1006, 29521, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:34:10', '2021-05-10 12:34:10'),
(37844, 1005, 29521, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Awaiting Superior Health Enrollment.', NULL, NULL, '2021-06-02 12:05:31', '2021-06-02 12:05:31'),
(37845, 1006, 29521, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:02:55', '2021-07-15 11:02:55'),
(37846, 1006, 29521, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:26', '2021-07-20 13:49:26'),
(37847, 1006, 29521, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:31:02', '2021-08-23 09:31:02'),
(37848, 1006, 29521, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:43:38', '2021-09-01 15:43:38'),
(37849, 1006, 29522, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:34:10', '2021-05-10 12:34:10'),
(37850, 1006, 29522, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:33:46', '2021-06-02 16:33:46'),
(37851, 11056, 29522, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:07:20', '2021-06-21 14:07:20'),
(37852, 1006, 29522, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:41:00', '2021-07-05 13:41:00'),
(37853, 1006, 29522, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:09:30', '2021-08-13 16:09:30'),
(37854, 1006, 29522, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:49:42', '2021-08-23 15:49:42'),
(37855, 11056, 29522, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:33:13', '2021-09-21 10:33:13'),
(37856, 11056, 29522, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:20:39', '2021-09-30 12:20:39'),
(37857, 1006, 29527, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:34:11', '2021-05-10 12:34:11'),
(37858, 1005, 29527, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:37:35', '2021-06-02 14:37:35'),
(37859, 1006, 29528, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37860, 1005, 29528, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:55', '2021-06-02 14:23:55'),
(37861, 1006, 29528, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:50:01', '2021-07-20 12:50:01'),
(37862, 1006, 29528, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:24', '2021-07-20 13:49:24'),
(37863, 1006, 29528, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:33', '2021-08-23 09:38:33'),
(37864, 1006, 29528, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:22', '2021-09-01 15:46:22'),
(37865, 1006, 29529, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37866, 1006, 29529, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:40', '2021-06-02 16:40:40'),
(37867, 11056, 29529, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:07:03', '2021-06-21 14:07:03'),
(37868, 1006, 29529, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:45:17', '2021-07-05 13:45:17'),
(37869, 1006, 29529, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:18', '2021-08-13 16:12:18'),
(37870, 1006, 29529, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:49', '2021-08-23 15:46:49'),
(37871, 11056, 29529, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:33:18', '2021-09-21 10:33:18'),
(37872, 11056, 29529, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:20:12', '2021-09-30 12:20:12'),
(37873, 1006, 29534, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37874, 1005, 29534, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:36:10', '2021-06-02 14:36:10'),
(37875, 1006, 29535, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37876, 1005, 29535, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:49', '2021-06-02 14:23:49'),
(37877, 1006, 29535, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:58', '2021-07-20 12:49:58'),
(37878, 1006, 29535, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:21', '2021-07-20 13:49:21'),
(37879, 1006, 29535, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:30', '2021-08-23 09:38:30'),
(37880, 1006, 29535, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:19', '2021-09-01 15:46:19'),
(37881, 1006, 29536, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37882, 1006, 29536, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:43', '2021-06-02 16:40:43'),
(37883, 11056, 29536, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:06:43', '2021-06-21 14:06:43'),
(37884, 1006, 29536, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:45:13', '2021-07-05 13:45:13'),
(37885, 1006, 29536, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:14', '2021-08-13 16:12:14'),
(37886, 1006, 29536, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:44', '2021-08-23 15:46:44'),
(37887, 11056, 29536, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:33:24', '2021-09-21 10:33:24'),
(37888, 11056, 29536, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:20:05', '2021-09-30 12:20:05'),
(37889, 1006, 29541, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37890, 1005, 29541, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:35:58', '2021-06-02 14:35:58'),
(37891, 1006, 29542, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37892, 1005, 29542, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:44', '2021-06-02 14:23:44'),
(37893, 1006, 29542, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:54', '2021-07-20 12:49:54'),
(37894, 1006, 29542, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:18', '2021-07-20 13:49:18'),
(37895, 1006, 29542, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:26', '2021-08-23 09:38:26'),
(37896, 1006, 29542, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:16', '2021-09-01 15:46:16'),
(37897, 1006, 29543, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:41', '2021-05-10 12:36:41'),
(37898, 1006, 29543, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:46', '2021-06-02 16:40:46'),
(37899, 11056, 29543, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:05:35', '2021-06-21 14:05:35'),
(37900, 1006, 29543, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:45:09', '2021-07-05 13:45:09'),
(37901, 1006, 29543, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:11', '2021-08-13 16:12:11'),
(37902, 1006, 29543, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:41', '2021-08-23 15:46:41'),
(37903, 11056, 29543, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:33:30', '2021-09-21 10:33:30'),
(37904, 11056, 29543, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:59', '2021-09-30 12:19:59'),
(37905, 1006, 29548, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:42', '2021-05-10 12:36:42'),
(37906, 1005, 29548, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:35:29', '2021-06-02 14:35:29'),
(37907, 1006, 29549, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:42', '2021-05-10 12:36:42'),
(37908, 1005, 29549, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:38', '2021-06-02 14:23:38'),
(37909, 1006, 29549, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:51', '2021-07-20 12:49:51'),
(37910, 1006, 29549, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:15', '2021-07-20 13:49:15'),
(37911, 1006, 29549, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:23', '2021-08-23 09:38:23'),
(37912, 1006, 29549, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:12', '2021-09-01 15:46:12'),
(37913, 1006, 29550, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:42', '2021-05-10 12:36:42'),
(37914, 1006, 29550, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:51', '2021-06-02 16:40:51'),
(37915, 11056, 29550, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:03:17', '2021-06-21 14:03:17'),
(37916, 1006, 29550, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:45:06', '2021-07-05 13:45:06'),
(37917, 1006, 29550, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:07', '2021-08-13 16:12:07'),
(37918, 1006, 29550, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:37', '2021-08-23 15:46:37'),
(37919, 11056, 29550, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:33:37', '2021-09-21 10:33:37'),
(37920, 11056, 29550, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:48', '2021-09-30 12:19:48'),
(37921, 1006, 29555, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:42', '2021-05-10 12:36:42'),
(37922, 1005, 29555, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:35:14', '2021-06-02 14:35:14'),
(37923, 1006, 29556, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:42', '2021-05-10 12:36:42'),
(37924, 1005, 29556, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:33', '2021-06-02 14:23:33'),
(37925, 1006, 29556, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:48', '2021-07-20 12:49:48'),
(37926, 1006, 29556, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:13', '2021-07-20 13:49:13'),
(37927, 1006, 29556, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:08', '2021-08-23 09:38:08'),
(37928, 1006, 29556, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:09', '2021-09-01 15:46:09'),
(37929, 1006, 29557, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:42', '2021-05-10 12:36:42'),
(37930, 1006, 29557, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:55', '2021-06-02 16:40:55'),
(37931, 11056, 29557, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:02:53', '2021-06-21 14:02:53'),
(37932, 1006, 29557, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:45:03', '2021-07-05 13:45:03'),
(37933, 1006, 29557, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:04', '2021-08-13 16:12:04'),
(37934, 1006, 29557, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:33', '2021-08-23 15:46:33'),
(37935, 11056, 29557, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:45', '2021-09-21 10:36:45'),
(37936, 11056, 29557, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:42', '2021-09-30 12:19:42'),
(37937, 1006, 29562, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:43', '2021-05-10 12:36:43'),
(37938, 1005, 29562, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:34:52', '2021-06-02 14:34:52'),
(37939, 1006, 29563, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:43', '2021-05-10 12:36:43'),
(37940, 1005, 29563, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:28', '2021-06-02 14:23:28'),
(37941, 1006, 29563, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:44', '2021-07-20 12:49:44'),
(37942, 1006, 29563, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:10', '2021-07-20 13:49:10'),
(37943, 1006, 29563, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:04', '2021-08-23 09:38:04'),
(37944, 1006, 29563, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:06', '2021-09-01 15:46:06'),
(37945, 1006, 29564, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:43', '2021-05-10 12:36:43'),
(37946, 1006, 29564, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:58', '2021-06-02 16:40:58'),
(37947, 11056, 29564, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:02:18', '2021-06-21 14:02:18'),
(37948, 1006, 29564, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:45:00', '2021-07-05 13:45:00'),
(37949, 1006, 29564, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:01', '2021-08-13 16:12:01'),
(37950, 1006, 29564, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:29', '2021-08-23 15:46:29'),
(37951, 11056, 29564, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:39', '2021-09-21 10:36:39');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(37952, 11056, 29564, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:36', '2021-09-30 12:19:36'),
(37953, 1006, 29569, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:43', '2021-05-10 12:36:43'),
(37954, 1005, 29569, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:34:36', '2021-06-02 14:34:36'),
(37955, 1006, 29570, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:43', '2021-05-10 12:36:43'),
(37956, 1005, 29570, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:23', '2021-06-02 14:23:23'),
(37957, 1006, 29570, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:40', '2021-07-20 12:49:40'),
(37958, 1006, 29570, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:07', '2021-07-20 13:49:07'),
(37959, 1006, 29570, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:38:01', '2021-08-23 09:38:01'),
(37960, 1006, 29570, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:03', '2021-09-01 15:46:03'),
(37961, 1006, 29571, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:43', '2021-05-10 12:36:43'),
(37962, 1006, 29571, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:41:01', '2021-06-02 16:41:01'),
(37963, 11056, 29571, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:02:31', '2021-06-21 14:02:31'),
(37964, 1006, 29571, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:56', '2021-07-05 13:44:56'),
(37965, 1006, 29571, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:11:57', '2021-08-13 16:11:57'),
(37966, 1006, 29571, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:26', '2021-08-23 15:46:26'),
(37967, 11056, 29571, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:32', '2021-09-21 10:36:32'),
(37968, 11056, 29571, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:29', '2021-09-30 12:19:29'),
(37969, 1006, 29576, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:44', '2021-05-10 12:36:44'),
(37970, 1005, 29576, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:34:23', '2021-06-02 14:34:23'),
(37971, 1006, 29577, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:44', '2021-05-10 12:36:44'),
(37972, 1005, 29577, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:17', '2021-06-02 14:23:17'),
(37973, 1006, 29577, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:49:36', '2021-07-20 12:49:36'),
(37974, 1006, 29577, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:05', '2021-07-20 13:49:05'),
(37975, 1006, 29577, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:37:57', '2021-08-23 09:37:57'),
(37976, 1006, 29577, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:46:00', '2021-09-01 15:46:00'),
(37977, 1006, 29578, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:44', '2021-05-10 12:36:44'),
(37978, 1006, 29578, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:41:04', '2021-06-02 16:41:04'),
(37979, 11056, 29578, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:01:45', '2021-06-21 14:01:45'),
(37980, 1006, 29578, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:53', '2021-07-05 13:44:53'),
(37981, 1006, 29578, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:11:54', '2021-08-13 16:11:54'),
(37982, 1006, 29578, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:23', '2021-08-23 15:46:23'),
(37983, 11056, 29578, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:25', '2021-09-21 10:36:25'),
(37984, 11056, 29578, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:20', '2021-09-30 12:19:20'),
(37985, 1006, 29583, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:44', '2021-05-10 12:36:44'),
(37986, 1005, 29583, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:34:01', '2021-06-02 14:34:01'),
(37987, 1006, 29584, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:44', '2021-05-10 12:36:44'),
(37988, 1005, 29584, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:09', '2021-06-02 14:23:09'),
(37989, 1006, 29584, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:43:17', '2021-07-20 12:43:17'),
(37990, 1006, 29584, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:02', '2021-07-20 13:49:02'),
(37991, 1006, 29584, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:37:53', '2021-08-23 09:37:53'),
(37992, 1006, 29584, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:56', '2021-09-01 15:45:56'),
(37993, 1006, 29585, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:44', '2021-05-10 12:36:44'),
(37994, 1006, 29585, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:31', '2021-06-02 16:40:31'),
(37995, 11056, 29585, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:01:29', '2021-06-21 14:01:29'),
(37996, 1006, 29585, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:50', '2021-07-05 13:44:50'),
(37997, 1006, 29585, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:11:51', '2021-08-13 16:11:51'),
(37998, 1006, 29585, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:19', '2021-08-23 15:46:19'),
(37999, 11056, 29585, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:18', '2021-09-21 10:36:18'),
(38000, 11056, 29585, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:08', '2021-09-30 12:19:08'),
(38001, 1006, 29590, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:45', '2021-05-10 12:36:45'),
(38002, 1005, 29590, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:33:40', '2021-06-02 14:33:40'),
(38003, 1006, 29591, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:45', '2021-05-10 12:36:45'),
(38004, 1005, 29591, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:23:03', '2021-06-02 14:23:03'),
(38005, 1006, 29591, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:43:14', '2021-07-20 12:43:14'),
(38006, 1006, 29591, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:49:00', '2021-07-20 13:49:00'),
(38007, 1006, 29591, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:37:49', '2021-08-23 09:37:49'),
(38008, 1006, 29591, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:53', '2021-09-01 15:45:53'),
(38009, 1006, 29592, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:45', '2021-05-10 12:36:45'),
(38010, 1006, 29592, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:27', '2021-06-02 16:40:27'),
(38011, 11056, 29592, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:01:14', '2021-06-21 14:01:14'),
(38012, 1006, 29592, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:47', '2021-07-05 13:44:47'),
(38013, 1006, 29592, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:11:47', '2021-08-13 16:11:47'),
(38014, 1006, 29592, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:16', '2021-08-23 15:46:16'),
(38015, 11056, 29592, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:12', '2021-09-21 10:36:12'),
(38016, 11056, 29592, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:19:01', '2021-09-30 12:19:01'),
(38017, 1006, 29597, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:45', '2021-05-10 12:36:45'),
(38018, 1005, 29597, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:33:13', '2021-06-02 14:33:13'),
(38019, 1006, 29598, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:47', '2021-05-10 12:36:47'),
(38020, 1005, 29598, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:22:55', '2021-06-02 14:22:55'),
(38021, 1006, 29598, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:02:50', '2021-07-15 11:02:50'),
(38022, 1006, 29598, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:58', '2021-07-20 13:48:58'),
(38023, 1006, 29598, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:37:44', '2021-08-23 09:37:44'),
(38024, 1006, 29598, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:50', '2021-09-01 15:45:50'),
(38025, 1006, 29599, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:47', '2021-05-10 12:36:47'),
(38026, 1006, 29599, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:40:22', '2021-06-02 16:40:22'),
(38027, 11056, 29599, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:00:56', '2021-06-21 14:00:56'),
(38028, 1006, 29599, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:44', '2021-07-05 13:44:44'),
(38029, 1006, 29599, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:11:37', '2021-08-13 16:11:37'),
(38030, 1006, 29599, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:46:12', '2021-08-23 15:46:12'),
(38031, 11056, 29599, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:06', '2021-09-21 10:36:06'),
(38032, 11056, 29599, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:18:53', '2021-09-30 12:18:53'),
(38033, 1006, 29604, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:36:48', '2021-05-10 12:36:48'),
(38034, 1005, 29604, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approved under ancillary contract. To review the complete contract please review the original Group task.', NULL, NULL, '2021-06-02 14:31:45', '2021-06-02 14:31:45'),
(38035, 1006, 29605, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:02', '2021-05-10 12:39:02'),
(38036, 1005, 29605, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:20:20', '2021-06-02 14:20:20'),
(38037, 1006, 29605, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:43:11', '2021-07-20 12:43:11'),
(38038, 1006, 29605, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:55', '2021-07-20 13:48:55'),
(38039, 1006, 29605, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:36:06', '2021-08-23 09:36:06'),
(38040, 1006, 29605, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:18', '2021-09-01 15:45:18'),
(38041, 1006, 29606, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:02', '2021-05-10 12:39:02'),
(38042, 1006, 29606, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:58', '2021-06-02 16:39:58'),
(38043, 11056, 29606, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:00:26', '2021-06-21 14:00:26'),
(38044, 1006, 29606, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:17', '2021-07-05 13:44:17'),
(38045, 1006, 29606, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:34', '2021-08-13 16:13:34'),
(38046, 1006, 29606, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:51', '2021-08-23 15:47:51'),
(38047, 11056, 29606, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:36:00', '2021-09-21 10:36:00'),
(38048, 11056, 29606, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:50', '2021-09-30 12:23:50'),
(38049, 1006, 29611, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:03', '2021-05-10 12:39:03'),
(38050, 1005, 29611, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:46:01', '2021-06-02 14:46:01'),
(38051, 1006, 29611, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:07', '2021-08-24 10:32:07'),
(38052, 1006, 29612, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:03', '2021-05-10 12:39:03'),
(38053, 1005, 29612, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:20:15', '2021-06-02 14:20:15'),
(38054, 1006, 29612, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:43:08', '2021-07-20 12:43:08'),
(38055, 1006, 29612, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:53', '2021-07-20 13:48:53'),
(38056, 1006, 29612, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:36:02', '2021-08-23 09:36:02'),
(38057, 1006, 29612, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:15', '2021-09-01 15:45:15'),
(38058, 1006, 29613, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:03', '2021-05-10 12:39:03'),
(38059, 1006, 29613, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:54', '2021-06-02 16:39:54'),
(38060, 11056, 29613, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 14:00:06', '2021-06-21 14:00:06'),
(38061, 1006, 29613, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:13', '2021-07-05 13:44:13'),
(38062, 1006, 29613, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:30', '2021-08-13 16:13:30'),
(38063, 1006, 29613, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:56', '2021-08-23 15:47:56'),
(38064, 11056, 29613, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:35:52', '2021-09-21 10:35:52'),
(38065, 11056, 29613, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:41', '2021-09-30 12:23:41'),
(38066, 1006, 29618, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:03', '2021-05-10 12:39:03'),
(38067, 1005, 29618, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:57', '2021-06-02 14:45:57'),
(38068, 1006, 29618, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:25', '2021-08-24 10:32:25'),
(38069, 1006, 29619, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:03', '2021-05-10 12:39:03'),
(38070, 1005, 29619, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:20:11', '2021-06-02 14:20:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(38071, 1006, 29619, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:43:04', '2021-07-20 12:43:04'),
(38072, 1006, 29619, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:50', '2021-07-20 13:48:50'),
(38073, 1006, 29619, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:59', '2021-08-23 09:35:59'),
(38074, 1006, 29619, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:11', '2021-09-01 15:45:11'),
(38075, 1006, 29620, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:03', '2021-05-10 12:39:03'),
(38076, 1006, 29620, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:50', '2021-06-02 16:39:50'),
(38077, 11056, 29620, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:59:45', '2021-06-21 13:59:45'),
(38078, 1006, 29620, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:10', '2021-07-05 13:44:10'),
(38079, 1006, 29620, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:27', '2021-08-13 16:13:27'),
(38080, 1006, 29620, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:45', '2021-08-23 15:47:45'),
(38081, 11056, 29620, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:35:44', '2021-09-21 10:35:44'),
(38082, 11056, 29620, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:34', '2021-09-30 12:23:34'),
(38083, 1006, 29625, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38084, 1005, 29625, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:46', '2021-06-02 14:45:46'),
(38085, 1005, 29625, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:52', '2021-06-02 14:45:52'),
(38086, 1006, 29625, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:30', '2021-08-24 10:32:30'),
(38087, 1006, 29626, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38088, 1005, 29626, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:20:06', '2021-06-02 14:20:06'),
(38089, 1006, 29626, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:43:01', '2021-07-20 12:43:01'),
(38090, 1006, 29626, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:46', '2021-07-20 13:48:46'),
(38091, 1006, 29626, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:56', '2021-08-23 09:35:56'),
(38092, 1006, 29626, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:04', '2021-09-01 15:45:04'),
(38093, 1006, 29627, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38094, 1006, 29627, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:46', '2021-06-02 16:39:46'),
(38095, 11056, 29627, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:59:33', '2021-06-21 13:59:33'),
(38096, 1006, 29627, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:06', '2021-07-05 13:44:06'),
(38097, 1006, 29627, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:24', '2021-08-13 16:13:24'),
(38098, 1006, 29627, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:42', '2021-08-23 15:47:42'),
(38099, 11056, 29627, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:35:01', '2021-09-21 10:35:01'),
(38100, 11056, 29627, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:28', '2021-09-30 12:23:28'),
(38101, 1006, 29632, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38102, 1005, 29632, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:41', '2021-06-02 14:45:41'),
(38103, 1006, 29632, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:33', '2021-08-24 10:32:33'),
(38104, 1006, 29633, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38105, 1005, 29633, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:20:02', '2021-06-02 14:20:02'),
(38106, 1006, 29633, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:42:58', '2021-07-20 12:42:58'),
(38107, 1006, 29633, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:43', '2021-07-20 13:48:43'),
(38108, 1006, 29633, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:53', '2021-08-23 09:35:53'),
(38109, 1006, 29633, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:45:00', '2021-09-01 15:45:00'),
(38110, 1006, 29634, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38111, 1006, 29634, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:42', '2021-06-02 16:39:42'),
(38112, 11056, 29634, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:59:16', '2021-06-21 13:59:16'),
(38113, 1006, 29634, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:03', '2021-07-05 13:44:03'),
(38114, 1006, 29634, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:20', '2021-08-13 16:13:20'),
(38115, 1006, 29634, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:39', '2021-08-23 15:47:39'),
(38116, 11056, 29634, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:37:20', '2021-09-21 10:37:20'),
(38117, 11056, 29634, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:19', '2021-09-30 12:23:19'),
(38118, 1006, 29639, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38119, 1005, 29639, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:36', '2021-06-02 14:45:36'),
(38120, 1006, 29639, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:37', '2021-08-24 10:32:37'),
(38121, 1006, 29640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38122, 1005, 29640, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:19:57', '2021-06-02 14:19:57'),
(38123, 1006, 29640, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:42:54', '2021-07-20 12:42:54'),
(38124, 1006, 29640, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:41', '2021-07-20 13:48:41'),
(38125, 1006, 29640, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:49', '2021-08-23 09:35:49'),
(38126, 1006, 29640, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:44:57', '2021-09-01 15:44:57'),
(38127, 1006, 29641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:04', '2021-05-10 12:39:04'),
(38128, 1006, 29641, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:37', '2021-06-02 16:39:37'),
(38129, 11056, 29641, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:58:46', '2021-06-21 13:58:46'),
(38130, 1006, 29641, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:44:00', '2021-07-05 13:44:00'),
(38131, 1006, 29641, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:13', '2021-08-13 16:13:13'),
(38132, 1006, 29641, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:36', '2021-08-23 15:47:36'),
(38133, 11056, 29641, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:34:56', '2021-09-21 10:34:56'),
(38134, 11056, 29641, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:12', '2021-09-30 12:23:12'),
(38135, 1006, 29646, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:05', '2021-05-10 12:39:05'),
(38136, 1005, 29646, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:30', '2021-06-02 14:45:30'),
(38137, 1006, 29646, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:40', '2021-08-24 10:32:40'),
(38138, 1006, 29647, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:05', '2021-05-10 12:39:05'),
(38139, 1005, 29647, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:19:52', '2021-06-02 14:19:52'),
(38140, 1006, 29647, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:42:35', '2021-07-20 12:42:35'),
(38141, 1006, 29647, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:39', '2021-07-20 13:48:39'),
(38142, 1006, 29647, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:46', '2021-08-23 09:35:46'),
(38143, 1006, 29647, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:44:49', '2021-09-01 15:44:49'),
(38144, 1006, 29648, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:05', '2021-05-10 12:39:05'),
(38145, 1006, 29648, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:32', '2021-06-02 16:39:32'),
(38146, 11056, 29648, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:58:32', '2021-06-21 13:58:32'),
(38147, 1006, 29648, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:43:57', '2021-07-05 13:43:57'),
(38148, 1006, 29648, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:09', '2021-08-13 16:13:09'),
(38149, 1006, 29648, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:33', '2021-08-23 15:47:33'),
(38150, 11056, 29648, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:34:50', '2021-09-21 10:34:50'),
(38151, 11056, 29648, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:23:05', '2021-09-30 12:23:05'),
(38152, 1006, 29653, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:05', '2021-05-10 12:39:05'),
(38153, 1005, 29653, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:25', '2021-06-02 14:45:25'),
(38154, 1006, 29653, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:44', '2021-08-24 10:32:44'),
(38155, 1006, 29654, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:05', '2021-05-10 12:39:05'),
(38156, 1005, 29654, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:19:46', '2021-06-02 14:19:46'),
(38157, 1006, 29654, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:42:29', '2021-07-20 12:42:29'),
(38158, 1006, 29654, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:35', '2021-07-20 13:48:35'),
(38159, 1006, 29654, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:43', '2021-08-23 09:35:43'),
(38160, 1006, 29654, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:44:46', '2021-09-01 15:44:46'),
(38161, 1006, 29655, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:05', '2021-05-10 12:39:05'),
(38162, 1006, 29655, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:28', '2021-06-02 16:39:28'),
(38163, 11056, 29655, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:58:09', '2021-06-21 13:58:09'),
(38164, 1006, 29655, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:43:53', '2021-07-05 13:43:53'),
(38165, 1006, 29655, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:13:03', '2021-08-13 16:13:03'),
(38166, 1006, 29655, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:30', '2021-08-23 15:47:30'),
(38167, 11056, 29655, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:34:43', '2021-09-21 10:34:43'),
(38168, 11056, 29655, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:22:58', '2021-09-30 12:22:58'),
(38169, 1006, 29660, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:06', '2021-05-10 12:39:06'),
(38170, 1005, 29660, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:20', '2021-06-02 14:45:20'),
(38171, 1006, 29660, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:47', '2021-08-24 10:32:47'),
(38172, 1006, 29661, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:06', '2021-05-10 12:39:06'),
(38173, 1005, 29661, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:19:41', '2021-06-02 14:19:41'),
(38174, 1006, 29661, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:41:40', '2021-07-20 12:41:40'),
(38175, 1006, 29661, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:33', '2021-07-20 13:48:33'),
(38176, 1006, 29661, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:39', '2021-08-23 09:35:39'),
(38177, 1006, 29661, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:44:41', '2021-09-01 15:44:41'),
(38178, 1006, 29662, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:06', '2021-05-10 12:39:06'),
(38179, 1006, 29662, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:24', '2021-06-02 16:39:24'),
(38180, 11056, 29662, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:57:56', '2021-06-21 13:57:56'),
(38181, 1006, 29662, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:43:50', '2021-07-05 13:43:50'),
(38182, 1006, 29662, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:59', '2021-08-13 16:12:59'),
(38183, 1006, 29662, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:27', '2021-08-23 15:47:27'),
(38184, 11056, 29662, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:34:36', '2021-09-21 10:34:36'),
(38185, 11056, 29662, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:22:50', '2021-09-30 12:22:50'),
(38186, 1006, 29667, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:06', '2021-05-10 12:39:06'),
(38187, 1005, 29667, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:16', '2021-06-02 14:45:16'),
(38188, 1006, 29667, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:50', '2021-08-24 10:32:50'),
(38189, 1006, 29668, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:06', '2021-05-10 12:39:06'),
(38190, 1005, 29668, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:19:36', '2021-06-02 14:19:36'),
(38191, 1006, 29668, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 12:41:11', '2021-07-20 12:41:11'),
(38192, 1006, 29668, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:30', '2021-07-20 13:48:30'),
(38193, 1006, 29668, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:36', '2021-08-23 09:35:36');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(38194, 1006, 29668, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:44:38', '2021-09-01 15:44:38'),
(38195, 1006, 29669, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:06', '2021-05-10 12:39:06'),
(38196, 1006, 29669, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:20', '2021-06-02 16:39:20'),
(38197, 11056, 29669, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:57:30', '2021-06-21 13:57:30'),
(38198, 1006, 29669, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:43:47', '2021-07-05 13:43:47'),
(38199, 1006, 29669, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:56', '2021-08-13 16:12:56'),
(38200, 1006, 29669, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:24', '2021-08-23 15:47:24'),
(38201, 11056, 29669, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:34:31', '2021-09-21 10:34:31'),
(38202, 11056, 29669, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:22:39', '2021-09-30 12:22:39'),
(38203, 1006, 29674, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:07', '2021-05-10 12:39:07'),
(38204, 1005, 29674, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:10', '2021-06-02 14:45:10'),
(38205, 1006, 29674, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:54', '2021-08-24 10:32:54'),
(38206, 1006, 29675, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:09', '2021-05-10 12:39:09'),
(38207, 1005, 29675, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'Awaiting Superior health enrollment completion.', NULL, NULL, '2021-06-02 14:19:31', '2021-06-02 14:19:31'),
(38208, 1006, 29675, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:02:45', '2021-07-15 11:02:45'),
(38209, 1006, 29675, NULL, '2021-07-27 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-07-20 13:48:27', '2021-07-20 13:48:27'),
(38210, 1006, 29675, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time.', NULL, NULL, '2021-08-23 09:35:30', '2021-08-23 09:35:30'),
(38211, 1006, 29675, NULL, '2021-09-08 00:00:00.000', 'On Hold', 'The request is still pending due to the enrollment for superior health, need to allow more time. ', NULL, NULL, '2021-09-01 15:44:35', '2021-09-01 15:44:35'),
(38212, 1006, 29676, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:09', '2021-05-10 12:39:09'),
(38213, 1006, 29676, NULL, '2021-06-09 00:00:00.000', 'Initiated', 'Sent initiation request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RHC - Cigna Healthspring  \"Hello,   Please find the attached enrollment request for our group, please let me know if anything else is required to proceed with this request.  Thank you. \"  Enrollment request is attached on the main group task. ', NULL, NULL, '2021-06-02 16:39:13', '2021-06-02 16:39:13'),
(38214, 11056, 29676, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Update - RHC - Cigna Healthspring  Greetings,  Hope you are doing well. Kindly, inform me about the status of our request sent on 06/2/2021. Please let me know if anything is required to proceed in our enrollment process.  PRACTICE: Practice Name : Statcare Minor Emergency Clinic Practice TIN# : 46-0575924 Practice NPI# : 1689924904 Main Address : 500 E CAESAR, KINGSVILLE , TX 78363 Secondary Address : 6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Address : 3817 South Padre Island Drive, Corpus Christi , TX 78415 Quaternary Address : 4042 River Hill, Corpus Christi , TX 78410  Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-21 13:57:06', '2021-06-21 13:57:06'),
(38215, 1006, 29676, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub; Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group:  PRACTICE: Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904 Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:43:42', '2021-07-05 13:43:42'),
(38216, 1006, 29676, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   I wanted to get an update regarding the enrollment status for the below-mentioned group:  Practice Name: Statcare Minor Emergency Clinic Practice TIN# 46-0575924 Practice NPI# 1689924904  Main Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Quaternary Address: 4042 River Hill, Corpus Christi, TX 78410  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-13 16:12:52', '2021-08-13 16:12:52'),
(38217, 1006, 29676, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Sent another f/u email since there\'s no other way to get in touch with Cigna Healthspring @  TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status Update - RHC - Cigna Healthspring  \"Hello,   We are still waiting for an update regarding the enrollment status for our group. Please get back to me as soon as possible as this request has been ongoing for the past few months and we are unable to get in touch with anyone..  Thank you.\"', NULL, NULL, '2021-08-23 15:47:20', '2021-08-23 15:47:20'),
(38218, 11056, 29676, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Call Rep. : Maria M  Status : Non participating . Waiting for the fax. They gonna provide us form to fill that out for network participation.  Contact no. : 877-653-0331  Ref code : 22800347', NULL, NULL, '2021-09-21 10:34:25', '2021-09-21 10:34:25'),
(38219, 11056, 29676, NULL, '2021-10-07 00:00:00.000', 'Not Eligible', 'Email received from : Cigna-Healthspring_Contracting@healthspring.com  Sub : Cigna-HeatlthSpring Network Interest Notice  Thank you for your interest in participating with Cigna-HealthSpring®. Reference the enclosed letter for our decision on your recent network interest form submission.  We appreciate your interest in Cigna-HealthSpring.  All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. © 2018 Cigna    Also confirmed from the Rep.  Rep : Ana M Issue:  They have so many providers with the same speciality in the area. They don\'t need more.  Ref code : 22853963  Please see the attachment', NULL, NULL, '2021-09-30 12:22:33', '2021-09-30 12:22:33'),
(38220, 1006, 29681, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 12:39:10', '2021-05-10 12:39:10'),
(38221, 1005, 29681, NULL, '2021-06-10 00:00:00.000', 'On Hold', 'In Process under main \"Molina\" Task. Will be updated once Molina get processed', NULL, NULL, '2021-06-02 14:45:02', '2021-06-02 14:45:02'),
(38222, 1006, 29681, NULL, '2021-08-31 00:00:00.000', 'On Hold', 'Address addition request is still in-process in main Molina task, need to allow more time. ', NULL, NULL, '2021-08-24 10:32:57', '2021-08-24 10:32:57'),
(38223, 1006, 29682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:57', '2021-05-10 15:26:57'),
(38224, 3040, 29682, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TCHP ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TCHP for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 12:40:49', '2021-06-07 12:40:49'),
(38225, 1006, 29682, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request/Status - CBUC/GWMC - TCHP  \"Hello,   I hope you\'re doing well, we want to enroll the following group and providers with TCHP, please let me know what is required to complete this request, the information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 17:01:33', '2021-06-24 17:01:33'),
(38226, 1006, 29682, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following email from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request/Status - CBUC/GWMC - TCHP  \"Please submit a letter of interest questionnaire with a w9. The application is on our website www.texaschildrenshealthplan.org *for providers\"  Replied with:  \"Hello,   Please find the attached LOI for our urgent care, do let me know if anything else is required to proceed.   Thank you. \"  The form is attached in group task for reference. ', NULL, NULL, '2021-07-14 12:48:07', '2021-07-14 12:48:07'),
(38227, 1006, 29682, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from jointchp@texaschildrens.org:  Sub: Letter of Interest Questionnaire - CBUC - TCHP  \"Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.\"', NULL, NULL, '2021-08-03 16:00:49', '2021-08-03 16:00:49'),
(38228, 11056, 29682, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : jointchp@texaschildrens.org  &  tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Good evening!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Have my applications of the below mentioned providers been reviewed or not yet?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 15:25:29', '2021-08-18 15:25:29'),
(38229, 11056, 29682, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Hello,     I was able to find a submission of an LOI (attached) for provider Mercedita Flynn and a denial letter that was sent.  Please see attachments.     Let me know if you have any more questions  -Liz        Self Note  20210802037174969  Mercedita N Flynn', NULL, NULL, '2021-08-24 17:01:27', '2021-08-24 17:01:27'),
(38230, 11056, 29682, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP   Good morning Liz!  Hope this email finds you well. We have confirmed the NPI of the provider Mercedita Flynn from TMHP & is also attested. Therefore, please consider this application. Please see the attachment below.  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-17 13:13:09', '2021-09-17 13:13:09'),
(38231, 11056, 29682, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Hello,  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.   Thank you  Liz Ramirez Contract Specialist Texas Children’s Health Plan', NULL, NULL, '2021-09-28 09:46:40', '2021-09-28 09:46:40'),
(38232, 11056, 29682, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : tchpnetworkmanagement@texaschildrens.org & bxgupta@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Group- Coastal Bend Urgent Care, LLC   Katherine Paterson         1164776548 Please see attached denial letter  20211001038052743     Mercedita Flynn               1619166188 Please see attached denial letter  20210930038036249     Monica Gonzalez             1871132811 Please see attached denial letter  20210930038036263   No TCHP does not work with BEE county. Our apologies.  You can also check yourself on website at texaschildrens.org yourself which county TCHP serves.', NULL, NULL, '2021-10-07 10:38:04', '2021-10-07 10:38:04'),
(38233, 1006, 29683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:57', '2021-05-10 15:26:57'),
(38234, 3040, 29683, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Amerigroup for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 09:56:49', '2021-06-07 09:56:49'),
(38235, 1006, 29683, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Good Day to you.  Is this a PCP clinic or a true Urgent Care?  The latter option means that the entity bills globally.\"  Sent reply:  \"Hello,   This is a true Urgent care, please let me know how we can proceed with the request.  Thank you!\"', NULL, NULL, '2021-06-24 14:38:45', '2021-06-24 14:38:45'),
(38236, 11056, 29683, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment Query || Coastal Bend Urgent Care & George West Medical Clinic - Amerigroup   Please send us a letterhead with the following and include a w9:   **Legal name / DBA  **NPI#  **Taxonomy Code  **Service locations  **Billing location  **phone / Fax / office hours / age limits  **TPI / Medicare #  **CLIA #', NULL, NULL, '2021-07-06 17:05:08', '2021-07-06 17:05:08'),
(38237, 11056, 29683, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group  Greetings,  Hope you are doing well. Here is the information you requested for and kindly see the attachments.  Practice Details: Practice  Legal name / DBA  : Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349 Taxonomy Code :  261QU0200X - Clinic/Center Urgent Care  Main practice & billing location : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address : 504A Houston Street George West , TX 78022-3663  Practice phone : 361-226-1126 Practice  Fax :  361 542-4076 TPI / Medicare # : 588832 CLIA # : 45D2132336 Practice age limits : 0 till 100  Practice  office hours :   Monday 9AM–5PM Tuesday 9AM–5PM Wednesday 9AM–5PM Thursday 9AM–5PM Friday 9AM–5PM Saturday Closed Sunday Closed  If you have any questions or concerns feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-07-07 09:09:56', '2021-07-07 09:09:56'),
(38238, 1006, 29683, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Sent f/u email @ txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349  Main practice & billing location: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Name: Katherine Moten Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-06 13:50:59', '2021-08-06 13:50:59'),
(38239, 1006, 29683, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Hello,   I hope you\'re doing well, I am still waiting on the status of my application. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-16 16:00:40', '2021-08-16 16:00:40'),
(38240, 11056, 29683, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com, latoyna.henry@amerigroup.com, Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 16:33:53', '2021-08-23 16:33:53'),
(38241, 11056, 29683, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good morning!  Hope all is well with you. It had been a long since our email got responded back. We are still waiting to get the latest updates related our enrollment applications for the following providers under the Practice Tax I.D mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  Provider Name: Mercedita N Flynn Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!  I had words with Kim U at 800-454-3730. She said that there is no contact no. of Amerigroup Credentialing dept. they only contact through emails.  Ref code : i-140308714', NULL, NULL, '2021-09-20 12:22:40', '2021-09-20 12:22:40'),
(38242, 11056, 29683, NULL, '2021-10-06 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good Morning,     Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.      Those areas are managed by other Medicaid Managed Care Organizations.     Thank you again for your interest.     Sincerely,', NULL, NULL, '2021-09-29 16:44:17', '2021-09-29 16:44:17'),
(38243, 11056, 29683, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good evening!  Hope this email finds you well. Please see the location again. Please note that our facilities are located in BEEVILLE , TX & George West , TX, not in Corpus Christi.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-30 15:36:10', '2021-09-30 15:36:10'),
(38244, 11056, 29683, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good Morning,  Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.   Hi There, those locations are within the Corpus Christi service delivery area, Amerigroup currently does not have membership down in that region.   Those areas are managed by other Medicaid Managed Care Organizations.   Thank you again for your interest.  Sincerely,', NULL, NULL, '2021-10-07 15:35:07', '2021-10-07 15:35:07'),
(38245, 1006, 29684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:57', '2021-05-10 15:26:57'),
(38246, 1006, 29684, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Hello,  I wanted to verify if the following group and providers were enrolled with Community Health Choice or not? The group and provider information are as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  I appreciate all the help, please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-08 16:48:24', '2021-06-08 16:48:24'),
(38247, 1006, 29684, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Hello,   I\'m still waiting for an update ​on this request, please get back to me as soon as possible as we\'re still waiting on this request.  Thank you!\"', NULL, NULL, '2021-06-25 17:13:46', '2021-06-25 17:13:46'),
(38248, 1006, 29684, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 14:59:07', '2021-07-14 14:59:07'),
(38249, 1006, 29685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:57', '2021-05-10 15:26:57'),
(38250, 3040, 29685, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Waiting for Aetna Approval ', NULL, NULL, '2021-06-07 10:43:01', '2021-06-07 10:43:01'),
(38251, 1006, 29685, NULL, '2021-06-16 00:00:00.000', 'Not Eligible', 'The provider only works in main CBUC location, no need to enroll with GWMC as per our discussion with Ryan.', NULL, NULL, '2021-06-09 10:21:58', '2021-06-09 10:21:58'),
(38252, 1006, 29685, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-09 10:29:22', '2021-08-09 10:29:22'),
(38253, 1006, 29685, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \" ', NULL, NULL, '2021-08-16 12:18:31', '2021-08-16 12:18:31'),
(38254, 11056, 29685, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com, \"Sidley, Jeanette\" SidleyJ1@firsthealth.com, PDS Dallas  pdsdallas@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059   Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 17:02:15', '2021-08-23 17:02:15'),
(38255, 11056, 29685, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  Good afternoon!  Hope you are doing well. It has been so long since you haven\'t responded to our emails. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice. Please provide me with the latest updates soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great weekend! ', NULL, NULL, '2021-09-03 14:16:05', '2021-09-03 14:16:05'),
(38256, 11056, 29685, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : DillikarA@aetna.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hi,  Please find the status of below provider as per requested.   S.no  Provider Name  NPI  Cpd Id  TIN  Effective Date  Status  1  Paterson, Katherine D  1164776548  2815476  811890349  -  Tax Id not found  2  Monica Gonzalez  1871132811  811890349  -  Provider not found    Regards, Bharath', NULL, NULL, '2021-09-24 14:07:40', '2021-09-24 14:07:40'),
(38257, 11056, 29685, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : DillikarA@aetna.com  Sub  : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hey Bharath!  Hope this email finds you well. Please guide and assist me regarding how to solve the below highlighted issues.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 12:39:50', '2021-09-28 12:39:50'),
(38258, 11056, 29685, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,  I hope that this email finds you well! I apologize that I have not been able to respond sooner, my son has been ill so I have been in and out of the office.  This is the new group agreement that we established that will become effective 11/1/21. It is still in the implementation stages but will be complete before the effective date. All providers listed on the roster you provided to me will be linked to the new agreement once effective.   I hope that this helps clarify.  Take care!  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-06 15:02:11', '2021-10-06 15:02:11'),
(38259, 11056, 29685, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Ahmed,  I hope that this email finds you well! Thank you for the well wishes, we are hoping he starts to feel better soon.  I have attached a copy of the signed agreement to this email. I apologize if the system did not automatically send it to you when it was signed on our side.  The contract is currently in implementation with our Data Team. I will send over the welcome letter once I have your group ID.  As always, please do not hesitate to reach out if you have any questions or concerns.  Take care! Jeanette', NULL, NULL, '2021-10-14 15:37:22', '2021-10-14 15:37:22'),
(38260, 11056, 29685, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Re: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Jeanette!  Hope this email finds you well. He will feel better soon. He is in my prayers.  Bundle of thanks for your prompt responses. And I am grateful to you for that.  Whenever the implementation is completed, please provide the welcome letter soon.   Thank you! Have a wonderful & blessed weekend ahead!', NULL, NULL, '2021-10-22 12:10:33', '2021-10-22 12:10:33'),
(38261, 11056, 29685, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning Jeanette!  Hope you & your son both are doing great. Please provide me with the latest updates about the implementation as well as on the welcome letters too. Kindly do the needful soon.  Please get back to me soon.  Thank you! Take Care!', NULL, NULL, '2021-11-09 15:27:25', '2021-11-09 15:27:25'),
(38262, 11056, 29685, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sidleyj1@firsthealth.com  Sub:  Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1073945 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,  Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605  Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-24 10:38:51', '2021-11-24 10:38:51'),
(38263, 11056, 29685, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email received from:  SidleyJ1@firsthealth.com  Sub:  RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning,     I hope that this email finds you well!     I have attached the welcome letter that I sent over last Tuesday. I apologize if you did not receive it.     Have a wonderful week!     Take care,     Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605 Phone: 916-374-4876  SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-12-09 14:22:32', '2021-12-09 14:22:32'),
(38264, 11056, 29685, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,     I hope that this email finds you well!     The feedback that I have received on my request to add the providers to the group is:  Mercedita Flynn is already participating under the TIN on an individual agreement effective 12/1/2019. She is now linked to the group and will still show effective as of 12/1/2019. For Monica Gonzalez, they are needing her CAQH number as she is not credentialed through Aetna yet and they handle that part for us in order to link her to the group contract.    Please send over the CAQH number for Monica Gonzalez and I can get her part finalized.     Thank you and take care!  Jeanette', NULL, NULL, '2021-12-22 10:17:35', '2021-12-22 10:17:35'),
(38265, 19067, 29685, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Query || CBUC & GWMC || Providers || First Health ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following provider with First Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 12:39:35', '2021-12-30 12:39:35'),
(38266, 19067, 29685, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers || First Health ||   Greetings!  You have not responded yet.  Kindly give updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 23:03:13', '2022-01-09 23:03:13'),
(38267, 19067, 29685, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers || First Health ||    Greetings!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad.', NULL, NULL, '2022-01-26 15:12:50', '2022-01-26 15:12:50'),
(38268, 20067, 29685, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Sub: Urgent || Demographic Update || Providers || First Health  Good Evening!  Hope you had a great weekend. I would like to add the secondary location of the listed providers. Attach is the W9 of the location  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663  Thank you,', NULL, NULL, '2022-03-07 17:32:59', '2022-03-07 17:32:59'),
(38269, 22077, 29685, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: 	Re: Urgent || Demographic Update || Providers || First Health  Hi,  Any updates on the request mentioned previously?  Thanks.', NULL, NULL, '2022-04-13 14:05:08', '2022-04-13 14:05:08'),
(38270, 22077, 29685, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email received from: BharathB@aetna.com  Subject: RE: [EXTERNAL] Re: Urgent || Demographic Update || Providers || First Health Case Number : 28606866  Hi Alex,     The below request is processed.     Regards,  Bharath', NULL, NULL, '2022-04-25 12:29:09', '2022-04-25 12:29:09'),
(38271, 22077, 29685, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com  Subject: Re: [EXTERNAL] Re: Urgent || Demographic Update || Providers || First Health Case Number : 28606866  Hi,  Can I get the effective date for the providers for the mentioned locations?  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 14:39:10', '2022-04-25 14:39:10'),
(38272, 1006, 29686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:57', '2021-05-10 15:26:57'),
(38273, 3040, 29686, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:13:36', '2021-06-07 12:13:36'),
(38274, 1006, 29686, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Memorial Hermann ||  \"Good Morning,  You will need to complete the Request for Application form online. You can do that by going here https://healthplan.memorialhermann.org/-/media/memorial-hermann/healthplan/files/providers/health-plan-request-to-participate.ashx?la=en&hash=27F819BE45E95E2EA8789FB1902B4D2F and completing the request to participate form online and forwarding to the email on the form.  Regards, Jo\"  The form is filled out and sent out to them and attached to the main group task for reference.   Sent to MHHP Contracting MHHPContracting@memorialhermann.org:  \"Hello,   Please find the attached network participation form for our group, please let me know if anything else is needed for this request.  Thank you!\"', NULL, NULL, '2021-06-24 16:50:00', '2021-06-24 16:50:00'),
(38275, 1006, 29686, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org  MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub; Network Participation Form - CBUC/GWMC - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers. Their information is as follows:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\'', NULL, NULL, '2021-07-13 17:22:39', '2021-07-13 17:22:39');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(38276, 1006, 29686, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following response from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Coastal Bend Urgent Care’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services?  Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.\"  Responded to the queries.', NULL, NULL, '2021-07-26 13:19:53', '2021-07-26 13:19:53'),
(38277, 1006, 29686, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'We received  the following denial notification from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"At this time, the cities listed below are out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\" ', NULL, NULL, '2021-08-16 11:04:32', '2021-08-16 11:04:32'),
(38278, 1006, 29688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38279, 3040, 29688, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Molina Health||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Molina Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:31:35', '2021-06-07 12:31:35'),
(38280, 1006, 29688, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Attn: Contracting Team - CBUC/GWMC - Molina   \"Good Afternoon Mr. Adil Abbas  I am doing fine, how do are you doing?  I did research for Coastal Bend Urgent Care and it does not show up in our system.  I tried both the Tax id and Group NPI. Please complete this contract request form and return along with a current W-9 to fax number: 877-900-5655 Attn: Contracting Team or email form to: mhtcontractrequest@molinahealthcare.com  Please let me know if you need further information or assistances.  Thank you  David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc. 4316 South McColl Road Edinburg, TX  78539 I Phone: (956) 532-5211 Righ tfax: (877) 900-8454 Email: david.balli@molinahealthcare.com\"  The form was filled out and sent to mhtcontractrequest@molinahealthcare.com, form is attached in the main group task for reference. ', NULL, NULL, '2021-06-25 12:43:20', '2021-06-25 12:43:20'),
(38281, 1006, 29688, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Coastal Bend Urgent Care, LLC  \"Good Afternoon,  Happy Wednesday! Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Coastal Bend Urgent Care, LLC ) to contract under TAX ID number (81-1890349).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below: EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com 888-562-5442 x200249   Have a wonderful day! Thank you, Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"', NULL, NULL, '2021-07-01 15:54:54', '2021-07-01 15:54:54'),
(38282, 1006, 29688, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Monday!!  Hope you are doing well.  I am following up to my previous email. Please be advised unless all forms are returned, we will not be able to continue contracting process.  any assistance will be greatly appreciated.  Thank you in advance  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Replied with the requested information:  \"Hello Juliana,   I apologize for the delay, here\'s the requested information hopefully it suffices. We also have a secondary location and the address is as follows: 504A Houston Street, George West, TX 78022-3663  Do let me know if anything else is required to proceed.\"', NULL, NULL, '2021-08-03 14:05:44', '2021-08-03 14:05:44'),
(38283, 1006, 29688, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following email Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Thank you for your assistance filling out forms.  Could you please assist with correction needed in claim sample?  Box 33 we are missing pay to name  could you please update and submit back to me?  For secondary location, could you please fill out a credentialing application?  Please see attached.  Once information is received back, we will be able to continue  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Responded with the requested information:  \"Hello,   Please find the requested documents attached. Do let me know if anything else is needed.  Thank you. \"', NULL, NULL, '2021-08-05 16:01:14', '2021-08-05 16:01:14'),
(38284, 11056, 29688, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good evening!  Hope all is well. Please provide me with the latest updates of the enrollment status of following providers & practice and the secondary location too. Kindly also update me about the applications and forms submitted to you regarding enrollment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Furthermore,if documents and information is needed please let me know. Please don\'t hesitate to contact me directly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 15:51:13', '2021-08-18 15:51:13'),
(38285, 11056, 29688, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning,  Happy Thursday!!  Hope you are doing well.  Per information on our system, service location  301 S. Hillside Drive is in process  of credentialing.  Service location 504  A  Houston Street, we are missing a contract request form, could you please fill out form and submit back to me at your earliest convenience?  Individual providers are not contracted under Urgent Care Facility.  Molina contracts facility directly.     Hope this information helps.  Thank you        Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (888) 562-5442 ext 200249', NULL, NULL, '2021-08-24 14:04:50', '2021-08-24 14:04:50'),
(38286, 11056, 29688, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope all is well. Here is the filled contract request form for the secondary service location 504-A, Houston Street. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Furthermore, if any additional information is required please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 15:05:46', '2021-09-03 15:05:46'),
(38287, 11056, 29688, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-09-24 11:46:38', '2021-09-24 11:46:38'),
(38288, 11056, 29688, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-06 12:37:48', '2021-10-06 12:37:48'),
(38289, 11056, 29688, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-10-14 15:48:41', '2021-10-14 15:48:41'),
(38290, 11056, 29688, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-10-22 10:21:46', '2021-10-22 10:21:46'),
(38291, 11056, 29688, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-09 14:11:36', '2021-11-09 14:11:36'),
(38292, 11056, 29688, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-11-24 12:13:46', '2021-11-24 12:13:46'),
(38293, 11056, 29688, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 17:01:57', '2021-12-06 17:01:57'),
(38294, 11056, 29688, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts', NULL, NULL, '2021-12-21 17:28:54', '2021-12-21 17:28:54'),
(38295, 19067, 29688, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Subject: Enrollment Query || Providers & Group || GWMC || Molina Health ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:01:34', '2022-01-04 12:01:34'),
(38296, 19067, 29688, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Subject: Enrollment Query || Providers & Group || GWMC || Molina Health ||    Good afternoon,  Happy Monday!!  Hope you are doing well. per information on our system, TIN 81-1890349 is loaded into network billing system with effective date 12/15/2021.  Since contract on file is for urgent care clinic, we will not be able to link individual providers to group.  Facility is contracted already.  Should you have any additional questions, please reach out to your provider service representative directly at MHTXProviderServices@MolinaHealthCare.Com.  Thank you in advance, hope you have a great day.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (972)346-0603', NULL, NULL, '2022-01-11 13:13:29', '2022-01-11 13:13:29'),
(38297, 19067, 29688, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Subject: Re: Enrollment Query || Providers & Group || GWMC || Molina Health ||   Greetings!  Can you please confirm the location, it is 504A Houston Street, Live Oak County, George West, TX 78022.   Regards, Hammad.', NULL, NULL, '2022-01-26 15:04:46', '2022-01-26 15:04:46'),
(38298, 19067, 29688, NULL, '2022-02-22 00:00:00.000', 'Approved', 'Received the following email from: Juliana.Mata@molinahealthcare.com  Subject: RE: Enrollment Query || Providers & Group || GWMC || Molina Health ||   Good afternoon,  Happy Monday!!  Hope you are doing well. per information on our system, TIN 81-1890349 is loaded into network billing system with effective date 12/15/2021.  Since contract on file is for urgent care clinic, we will not be able to link individual providers to group.  Facility is contracted already.  Should you have any additional questions, please reach out to your provider service representative directly at MHTXProviderServices@MolinaHealthCare.Com.  Thank you in advance, hope you have a great day.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (972)346-0603', NULL, NULL, '2022-02-15 13:12:56', '2022-02-15 13:12:56'),
(38299, 1006, 29689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38300, 1006, 29689, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'We submitted a group enrollment request via the Wellcare website:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Enrollment form is attached in the group task for reference. ', NULL, NULL, '2021-06-08 16:31:17', '2021-06-08 16:31:17'),
(38301, 1006, 29689, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Dear Provider:  Thank you for your interest in joining our network, please allow 30 Calendar days for us to review your request.  Sincerely, Network Management – Texas | www.wellcare.com\"  Sent f/u email:   \"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.  Thank you!\"', NULL, NULL, '2021-06-25 10:19:15', '2021-06-25 10:19:15'),
(38302, 1006, 29689, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent another f/u email @ ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Hello,   I hope you\'re doing well, I\'m still waiting on the status of this enrollment request.  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-14 17:15:44', '2021-07-14 17:15:44'),
(38303, 1006, 29689, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received response from Superior, requesting the form. The form is filled and sent out @ SHP-Network Development shp.networkdevelopment@superiorhealthplan.com:  Sub:  Add Provider- Mercedita Flynn - CBUC  \"Hello,   I hope you\'re doing well, please find the attached contract form for our provider to add them to our group. Do let me know if anything else is required.   Thank you.\" ', NULL, NULL, '2021-07-26 10:06:46', '2021-07-26 10:06:46'),
(38304, 11056, 29689, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com  Sub : Add Provider- Mercedita Flynn - CBUC  Good evening!  Hope all is well. Please provide me with the latest updates regarding the enrollment status of the following provider under the Tax ID mentioned below.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 16:58:07', '2021-08-18 16:58:07'),
(38305, 11056, 29689, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com  Sub : Add Provider- Mercedita Flynn - CBUC  Good evening!  Hope all is well. Please provide me with the latest updates regarding the enrollment status of the following provider under the Tax ID mentioned below.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 13:48:52', '2021-08-24 13:48:52'),
(38306, 11056, 29689, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com  Sub : Add Provider- Mercedita Flynn - CBUC  Good evening!  Hope all is well. Please provide me with the latest updates regarding the enrollment status of the following provider under the Tax ID mentioned below.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!  Also left out a voice mail related to get the credentialing status.  ', NULL, NULL, '2021-09-01 14:32:26', '2021-09-01 14:32:26'),
(38307, 11056, 29689, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep : Rose S  Katherine Paterson in network 07/01/2021 participating with wellcare  Mercedita Flynn in network 07/01/2021 participating with wellcare  interaction code : 1296311845  application needed for the group.', NULL, NULL, '2021-09-17 17:12:11', '2021-09-17 17:12:11'),
(38308, 11056, 29689, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : TERESA.Argueta@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   Good afternoon!  Hope all is well with you. I want to get the latest update regarding the enrollment status of the below mentioned providers under the facility TIN with Wellcare.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  If you have any questions or concerns feel free to reach out to me soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 13:26:07', '2021-09-29 13:26:07'),
(38309, 11056, 29689, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   New Providers for Costal Bend Urgent Care  Hello,   The providers below are PAR effective 7/1/2021.   Hi Ahmed,  Here is the spreadsheet on your providers for Coastal Bend Urgent Care.  Take care.  Cyn  Please see the attachment.', NULL, NULL, '2021-09-30 14:01:29', '2021-09-30 14:01:29'),
(38310, 11056, 29689, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   We are in process of loading the contract and provider.   We will let you know once complete.   Signed contract was sent to configuration to load to WellCare 9.10.2021.   Thanks  Network Development', NULL, NULL, '2021-10-07 14:55:41', '2021-10-07 14:55:41'),
(38311, 11056, 29689, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good afternoon!  Hope this email finds you well. Yes, this request is to add an additional provider highlighted below. And add a secondary location for an already approved provider with the main address.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188 : Please list the secondary location below this provider.  If you have any questions or require additional information or documents please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-10-14 16:49:47', '2021-10-14 16:49:47'),
(38312, 11056, 29689, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good Afternoon,   To add an additional provider please submit all requests via our website. Also, this inbox is for contract change requests only. If you need to update demographic or location information, please reach out to your Account Manager.    https://www.wellcare.com/en/Texas/Become-a-Provider', NULL, NULL, '2021-10-22 09:21:14', '2021-10-22 09:21:14'),
(38313, 11056, 29689, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Thank you for the information.  We have already submitted an online application for the provider, Monica Gonzalez.  Please see the attachment.  Thank you!  Application has been submitted and attached.', NULL, NULL, '2021-11-09 16:45:02', '2021-11-09 16:45:02'),
(38314, 11056, 29689, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC   Good morning!  Hope all is well with you. Please let us know the credentialing status of the below-mentioned providers with Wellcare.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188:  Please list the secondary location below this provider in your systems.  Please let us know the Account Manager of our area. And do provide his email & contact no. too.  Thank you! Have a great weekend!', NULL, NULL, '2021-11-24 14:08:07', '2021-11-24 14:08:07'),
(38315, 11056, 29689, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   This provider is still being processed. You will be notified once completed.     Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-12-06 17:42:44', '2021-12-06 17:42:44'),
(38316, 11056, 29689, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub:  Add Provider- Katherine Paterson - CBUC & GWMC  Good morning!  Hope all is well with you. Please do provide the welcome letter for the provider, Monica Gonzalez. And also confirm about the locations, Have both of the locations been mentioned and listed under the provider? Also, list the provider in the Wellcare provider directory as soon a possible.  Eagerly, waiting for your response.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-21 17:18:14', '2021-12-21 17:18:14'),
(38317, 19067, 29689, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider and Groups.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S Hillside DR STE 4, Beeville, TX 78102-5324 Provider Name	NPI	Location Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663  Eagerly waiting for your response.    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:23:26', '2022-01-04 10:23:26'),
(38318, 19067, 29689, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||   Greetings!  Any updates on the previously mentioned request?  Waiting to hear from you soon.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:33:03', '2022-01-09 22:33:03'),
(38319, 19067, 29689, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||  Good Morning,   Here are the providers that are active and par for HMO and PPO lines of business   ACCEPT NEW PATIENTS	LINE OF BUSINESS	EFFECTIVE DATE	TERM DATE	PCP FLAG	MEMB COUNT	PROVIDER ID	LAST NAME	FIRST NAME	PROVIDER TYPE	SPECIALTY TYPE	PRIMARY SPECIALTY	IPA ID	IPA AFFIL	NATIONAL PROVIDER ID	PRIMARY NPI	DEFAULT VENDOR ADDR	VENDOR ID	VENDOR NAME	IRS TAX ID Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-01-20 23:49:10', '2022-01-20 23:49:10'),
(38320, 19067, 29689, NULL, '2022-04-21 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||  Good Morning,   Here are the providers that are active and par for HMO and PPO lines of business   ACCEPT NEW PATIENTS	LINE OF BUSINESS	EFFECTIVE DATE	TERM DATE	PCP FLAG	MEMB COUNT	PROVIDER ID	LAST NAME	FIRST NAME	PROVIDER TYPE	SPECIALTY TYPE	PRIMARY SPECIALTY	IPA ID	IPA AFFIL	NATIONAL PROVIDER ID	PRIMARY NPI	DEFAULT VENDOR ADDR	VENDOR ID	VENDOR NAME	IRS TAX ID Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-04-14 10:04:25', '2022-04-14 10:04:25'),
(38321, 1006, 29690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38322, 1005, 29690, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approval confirmation attached.', NULL, NULL, '2021-06-03 13:03:17', '2021-06-03 13:03:17'),
(38323, 1006, 29691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38324, 3040, 29691, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Galaxy Health ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:47:30', '2021-06-07 10:47:30'),
(38325, 1006, 29691, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent a f/u email @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - CBUC/GWMC - Galaxy Health  \"Hello,    We wish to enroll the following group and providers with Galaxy Health, their information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Provider Name: Katherine Paterson Provider NPI# 1164776548  Please get back to me as soon as possible regarding how we should proceed.  Thank you!\"', NULL, NULL, '2021-06-24 15:40:29', '2021-06-24 15:40:29'),
(38326, 1006, 29691, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email to Daniel Marley dmarley@ghn-mci.com:  Sub: Enrollment Request - CBUC/GWMC - Galaxy Health  \"Hello,   I wanted to get an update on this request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-13 17:05:35', '2021-07-13 17:05:35'),
(38327, 11056, 29691, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 12:43:00', '2021-08-18 12:43:00'),
(38328, 11056, 29691, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com,  contracting@ghn-mci.com &  providers@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  Provider Name: Katherine Paterson Provider NPI# : 1164776548  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 10:29:53', '2021-08-24 10:29:53'),
(38329, 11056, 29691, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Ahmed,     After review, I show a personal agreement for Dr. Mercedita Flynn effective 7-1-2021. I do not show Katherine Paterson as participating under the information you provided.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-09-01 13:37:59', '2021-09-01 13:37:59'),
(38330, 11056, 29691, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Ahmed,     After review, I show a personal agreement for Dr. Mercedita Flynn effective 7-1-2021. I do not show Katherine Paterson as participating under the information you provided.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-09-01 13:37:59', '2021-09-01 13:37:59'),
(38331, 11056, 29691, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good morning!  Hope this email finds you well. Could you provide me with a signed copy of that agreement of the provider Dr. Mercedita Flynn? And inform me the procedure by which the provider Katherine Paterson shows as participating under the Group TIN.  If you need any documents or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-17 14:50:39', '2021-09-17 14:50:39'),
(38332, 11056, 29691, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hi Ahmed,  I am sorry, however, the below statement that Dr. Flynn is under a personal agreement shows to be incorrect. I show this provider, Dr. Flynn  is under a group agreement.  To confirm I do not show Katherine Paterson as presently participating with Galaxy under the Coastal Bend Urgent Care Group agreement. If the group wishes to add Katherine Paterson to their existing agreement then please see the attached.  If your company wishes a copy of the group agreement you will need to fax written authorization signed by an authorized signatory of the CBUS group stating your company Claims Med Inc is representing the group and that Galaxy is authorized to send you a copy of their agreement. That can be faxed to 817-633-5729.   Further, I show that the same information above on how to obtain a copy of the group agreement was sent to Mr. Brad Peterson who is with you company and he may already have a copy of the group agreement.', NULL, NULL, '2021-09-29 12:52:55', '2021-09-29 12:52:55'),
(38333, 11056, 29691, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good afternoon Daniel!  Hope this email finds you well. Here is the filled Physician agreement form for the provider Katherine Paterson, to add her with Galaxy under the Coastal Bend Urgent Care Group agreement. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-07 15:05:51', '2021-10-07 15:05:51'),
(38334, 11056, 29691, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good morning!  Hope this email finds you well.  Please provide us with the latest updates regarding the following providers under the below mentioned practice with Galaxy health as soon as possible.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-18 16:46:11', '2021-10-18 16:46:11'),
(38335, 11056, 29691, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from : kavalos@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hello please,     provide providers specialty, phone/fax number effective date you will like.     Thanks;     Karen A  Have provided them with details', NULL, NULL, '2021-11-09 12:15:47', '2021-11-09 12:15:47'),
(38336, 11056, 29691, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good afternoon Karen!  Hope this email finds you well. Please find the information below which you have requested.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name & Specialities	NPI  & COntact & Fax no.  Katherine Paterson  (FNP)	1164776548           Ph # : 361-226-1126          fax no. : 361 542-4076 Mercedita Flynn (FNP)	1619166188          Ph # : 361-226-1126          fax no. : 361 542-4076 Monica Gonzalez (FNP)	1871132811          Ph # : 361-226-1126          fax no. : 361 542-4076  If you have any additional questions or need documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:54:24', '2021-11-24 13:54:24'),
(38337, 11056, 29691, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-06 15:32:20', '2021-12-06 15:32:20'),
(38338, 11056, 29691, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub:  Enrollment Query - CBUC & GWMC - Galaxy Health  Enrollment Status Query - Galaxy Health - CBUC/GWMC   Is this eff date is for all of the providers or not? Provide me with welcome letters too.', NULL, NULL, '2021-12-17 14:25:26', '2021-12-17 14:25:26'),
(38339, 11056, 29691, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Enrollment Status Query - Galaxy Health - CBUC/GWMC  Enrollment Query - CBUC & GWMC - Galaxy Health   Good evening Karen!  Hope this email finds you well. Please list the highlighted location under the following provider as soon as possible. And also list all of the providers with both locations on your provider directory. I am unable to find the providers, I only found Mercedita Flynn. I have attached the SS for your concerns.    Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name & Specialities	NPI  & COntact & Fax no.  Katherine Paterson  (FNP)	1164776548              Unable to find provider on the directory Mercedita Flynn (FNP)	1619166188               Only Primary location is listed Monica Gonzalez (FNP)	1871132811              Unable to find provider on the directory  If you have any additional questions or need documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 10:10:34', '2021-12-23 10:10:34'),
(38340, 19067, 29691, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Hello!  Hope you\'re doing well,  I would like to know the enrollment status of the following Providers & Groups with Galaxy Health.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:24:37', '2021-12-30 13:24:37');
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
(38341, 19067, 29691, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, kavalos@ghn-mci.com, dmarley@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Greetings!  You haven\'t responded yet.  Still waiting to get the updates about the previously mentioned request.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:28:38', '2022-01-09 22:28:38'),
(38342, 19067, 29691, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||   Good Morning!  Hope this email finds you well.  This is my SECOND REMINDER on the below mentioned request. Kindly look into this.  Kindly respond as per your convenience.   Regards, Hammad.', NULL, NULL, '2022-01-26 11:10:17', '2022-01-26 11:10:17'),
(38343, 19067, 29691, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: kavalos@ghn-mci.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||    Hello Ahmed;     There is no welcome letters this is not a personal agreement.', NULL, NULL, '2022-02-21 16:26:48', '2022-02-21 16:26:48'),
(38344, 20067, 29691, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Sub: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Good Afternoon!  Hope you had a great weekend. I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Monica Gonzalez	1871132811	504A Houston Street Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Katherine Paterson	1164776548	504A Houston Street Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street Live Oak County, George West, TX 78022-3663  Eagerly waiting to hear from you.  Thank you, ', NULL, NULL, '2022-03-07 16:56:16', '2022-03-07 16:56:16'),
(38345, 22077, 29691, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Galaxy Health ||  Hi,  I would like to know the credentialing status of the listed providers with locations. If any of them are credentialed, kindly send the roster with effective dates.  Waiting to hear from you soon.  Thanks. Alex', NULL, NULL, '2022-04-13 14:26:22', '2022-04-13 14:26:22'),
(38346, 1006, 29692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38347, 1005, 29692, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval confirmation.', NULL, NULL, '2021-06-07 17:34:40', '2021-06-07 17:34:40'),
(38348, 1006, 29692, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent following enrollment query @ AM.Austin@SuperiorHealthPlan.com & SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Enrollment Query - CBUC/GWMC -  Superior Health/Ambetter  \"Hello,  I wanted to verify if the following group and providers were enrolled with Superior Healthplan & Ambetter under the mentioned addresses:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able. Thank you. \"', NULL, NULL, '2021-06-09 09:49:46', '2021-06-09 09:49:46'),
(38349, 1006, 29692, NULL, '2021-07-06 00:00:00.000', 'Not Eligible', 'The provider only works in CBUC main location, no need to enroll her in GWMC location as per our discussion with Ryan.  ', NULL, NULL, '2021-06-29 14:37:31', '2021-06-29 14:37:31'),
(38350, 1006, 29692, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Sent email @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Provider Address Addition - GWMC - Ambetter  \"Hello,   I hope you\'re doing well, we wish to add the following provider under the given addresses for our group.   Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349 Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188  Please let me know what is required to proceed with this request.  Thank you.  \"', NULL, NULL, '2021-08-06 13:03:18', '2021-08-06 13:03:18'),
(38351, 1006, 29692, NULL, '2021-08-23 00:00:00.000', 'In Process', 'We received the following response :  \"Hello, please see link below to add provider to existing group:  https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html  Thank you, Deidra Hernandez Provider Account Manager cid:image002.jpg@01D4921D.61E12940 Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.Houston@SuperiorHealthPlan.com | SuperiorHealthPlan.com\"  Sent requested, attached for reference.', NULL, NULL, '2021-08-16 15:52:21', '2021-08-16 15:52:21'),
(38352, 11056, 29692, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Call Rep : Yesenia P  Status : Application is closed & discontinued on 8-2-2021. Because of not submitting documents since the end of June.  Interaction code : 59315  Contact no : 800-656-4817  Another Application has been submitted.', NULL, NULL, '2021-09-20 09:47:10', '2021-09-20 09:47:10'),
(38353, 11056, 29692, NULL, '2021-10-01 00:00:00.000', 'In Process', '[Secure] 59576 - Secondary Location Addition needed - CBUC / GWMC - Ambetter', NULL, NULL, '2021-09-24 13:30:16', '2021-09-24 13:30:16'),
(38354, 11056, 29692, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Rep. : Yesenia P  Status:    Mercedita flynn = is in processing & reviewing.  Monica = is in credentialing. Received on 09/28/2021 It will take 100 days.  Secondary location has been listed under the group Tax ID.  Ref : 60964  Contact no : 800-656-4817', NULL, NULL, '2021-09-29 16:05:26', '2021-09-29 16:05:26'),
(38355, 11056, 29692, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : Credentialing@superiorhealthplan.com  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good morning!  Hope you are doing well. Please update me with the enrollment status of below mentioned providers at your earliest opportunity..  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Mercedita Flynn 	1619166188 : for secondary location Monica Gonzalez  	1871132811 : for both locations   If you need any documents or information feel free to contact me.  Thank you!', NULL, NULL, '2021-10-07 13:36:17', '2021-10-07 13:36:17'),
(38356, 11056, 29692, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Credentialing@superiorhealthplan.com  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon,             I am able to locate the following information per the status request below for the providers:  1619166188 - Re-credential date will be 07/31/2022.  1871132811 -I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  Thank you,   Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-14 16:14:32', '2021-10-14 16:14:32'),
(38357, 11056, 29692, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : Credentialing@superiorhealthplan.com>  Sub : Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon!  Hope this email finds you well. Please respond to the below at your earliest convenience.   TIN - 81-1890349 1619166188 - Are both locations listed under this NPI and also, please do provide the welcome letter.  1871132811 - Please provide the latest updates on this NPI.  Waiting to hear from you soon.  Thank you! Take Care!', NULL, NULL, '2021-10-22 12:32:26', '2021-10-22 12:32:26'),
(38358, 11056, 29692, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: Credentialing@superiorhealthplan.com  Sub: Enrollment Query - CBUC & GWMC - AMBETTER  Good morning,              1619166188 -Please contact your account manager for assistance in obtaining the welcome letter. I have attached the providers approval letter from credentialing team. Please go to https://www.superiorhealthplan.com/ , for providers, and find my account manager, to locate your account manager. Your Account Manager can better assist you with your question and direct your request to the correct Department.      1871132811-I am currently reflecting that this provider is awaiting approval by the medical director. If all goes well, the anticipated effective date will be 12/01/2021', NULL, NULL, '2021-11-09 16:35:42', '2021-11-09 16:35:42'),
(38359, 11056, 29692, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  Credentialing@superiorhealthplan.com  Sub:   Enrollment Query - CBUC & GWMC - AMBETTER  Good afternoon!  Hope you are doing well. I want to get the latest updates regarding the enrollment process of the following provider under the facility.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you have any questions or concerns feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 13:31:50', '2021-11-24 13:31:50'),
(38360, 11056, 29692, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email received from: Credentialing@superiorhealthplan.com  Sub: Enrollment Query - CBUC & GWMC - AMBETTER  Good Afternoon,              I am able to locate the following information per the status request below for the provider:  The provider credentialing was completed on the effective date is 02/01/2021 and the re-credential date is 01/01/2024.  Provider\'s second location has been updated.  Ref# I57969070  Please see the attachment', NULL, NULL, '2021-12-10 12:24:03', '2021-12-10 12:24:03'),
(38361, 1006, 29693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38362, 1006, 29693, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'The provider only works in CBUC, no need to separately enroll her in GWMC. ', NULL, NULL, '2021-06-08 15:06:48', '2021-06-08 15:06:48'),
(38363, 1006, 29694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38364, 1005, 29694, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Cigna\'s approval.', NULL, NULL, '2021-06-07 17:33:47', '2021-06-07 17:33:47'),
(38365, 1006, 29694, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent enrollment request @ TXMAContracting@cigna.com:  Sub: Network Interest Form - CBUC/GWMC - Cigna Healthspring  \"Hello,   Please find the attached network interest form, do let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-23 12:52:04', '2021-07-23 12:52:04'),
(38366, 11056, 29694, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 13:28:37', '2021-08-18 13:28:37'),
(38367, 11056, 29694, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope you are doing well. Please provide me with the latest updates soon. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 11:14:04', '2021-08-24 11:14:04'),
(38368, 11056, 29694, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates soon. I am still waiting to get enrollment status and about the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Eagerly, waiting to hear back from you soon.  Thank you! Have a great week ahead!   Call didn\'t received. Left out the voice mail regarding the enrollment status', NULL, NULL, '2021-09-02 11:19:34', '2021-09-02 11:19:34'),
(38369, 11056, 29694, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', '	 Email received from : lerensa.crain@careallies.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  George West, Texas and Beeville, Texas are not in the Cigna MA medical plan service area.', NULL, NULL, '2021-09-24 13:07:51', '2021-09-24 13:07:51'),
(38370, 1006, 29695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38371, 1006, 29695, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ providerdevelopment@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello,  We submitted an enrollment request last month for our group and wanted to get a status update on it, the group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please get back to me as soon as you\'re able to. Thank you. \"', NULL, NULL, '2021-06-08 16:15:43', '2021-06-08 16:15:43'),
(38372, 1006, 29695, NULL, '2021-07-02 00:00:00.000', 'In Process', 'The previous email was sent to an incorrect address, sent corrected email @ providerdevelopment@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello,    We submitted an enrollment request last month for our group and wanted to get a status update on it, the group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please get back to me as soon as you\'re able to.  Thank you.\"  ', NULL, NULL, '2021-06-25 17:05:45', '2021-06-25 17:05:45'),
(38373, 1006, 29695, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Received following notification from email:  \"Your message to providerdevelopment@anci-care.com couldn\'t be delivered. The group providerdevelopment only accepts messages from people in its organization or on its allowed senders list, and your email address isn\'t on the list.\"  Sent corrected email @ ACS VIP Providers vipproviders@anci-care.com.', NULL, NULL, '2021-07-14 14:55:50', '2021-07-14 14:55:50'),
(38374, 1006, 29695, NULL, '2021-08-13 00:00:00.000', 'In Process', 'We received the following update from jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Good Morning,  I show that Coastal Bend Urgent Care, LLC And ACS are currently contracted since 7/20/2017. Records indicate that you are due for credentialing.  Please see the attached Re-credentialing Profile.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com\"  Replied with:  \"Hello Jennifer,  Please find the attached information, do let me know if you need anything else.  Thank you. \"', NULL, NULL, '2021-08-06 15:11:57', '2021-08-06 15:11:57'),
(38375, 1006, 29695, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,  I hope you\'re doing well, I just wanted to check in on the status of enrollment for our group. Can you please get back to me on this?  Thank you.\"', NULL, NULL, '2021-08-16 16:07:38', '2021-08-16 16:07:38'),
(38376, 11056, 29695, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.     Recredentialing is complete just waiting on the approval meeting on 9/16.     No further action is necessary.  Claims are still being processing for this provider.     Jennifer Maligaya is no longer with ACS/HealthSmart.     Please continue to use VIPproviders@anci-care.com for updates.     New provider agreements please email me:  patti.davidson@healthsmart.com     Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-24 09:37:30', '2021-08-24 09:37:30'),
(38377, 11056, 29695, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates,effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 14:25:52', '2021-09-03 14:25:52'),
(38378, 11056, 29695, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates, effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-14 14:30:07', '2021-09-14 14:30:07'),
(38379, 11056, 29695, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates, effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-14 14:30:08', '2021-09-14 14:30:08'),
(38380, 11056, 29695, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.  Recredentialing is complete just waiting on the approval meeting on 9/16.  No further action is necessary.  Claims are still being processing for this provider.    Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-27 10:34:40', '2021-09-27 10:34:40'),
(38381, 11056, 29695, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Hi.   The provider below is already contracted.  We are only recredentialing the site.     You will receive the recredentialing approval letter from our credentialing department after 2 weeks.', NULL, NULL, '2021-10-06 14:48:58', '2021-10-06 14:48:58'),
(38382, 11056, 29695, NULL, '2021-10-14 00:00:00.000', 'Approved', 'Ancillary contract has been completed.  There is no need of the providers to be credentialed.', NULL, NULL, '2021-10-07 10:56:23', '2021-10-07 10:56:23'),
(38383, 1006, 29696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38384, 3040, 29696, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Triwest for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 13:00:10', '2021-06-07 13:00:10'),
(38385, 11056, 29696, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email sent to : providerservices@triwest.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers with Triwest for our group under the below locations.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548    Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# : 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a blessed day!', NULL, NULL, '2021-06-24 13:10:44', '2021-06-24 13:10:44'),
(38386, 1006, 29696, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for our group and providers mentioned in the previous email.   Please get back to me as soon as possible.  Thank you.', NULL, NULL, '2021-07-13 17:28:20', '2021-07-13 17:28:20'),
(38387, 1006, 29696, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Spoke with the representative (Margo Rose, O: (916) 389-6334) and she said that the request is in-process and we should send an email to credentialing@triwest.com, sent f/u email. ', NULL, NULL, '2021-07-26 16:05:59', '2021-07-26 16:05:59'),
(38388, 1006, 29696, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Sent f/u email @ credentialing@triwest.com:  Sub: Enrollment Status - CBUC/GWMC - Triwest  \"Hello,   We\'re still waiting on an update on this request. Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-03 16:13:16', '2021-08-03 16:13:16'),
(38389, 11056, 29696, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	credentialing@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I wanted to get an update regarding the status of enrollment for our group and providers mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 16:15:33', '2021-08-18 16:15:33'),
(38390, 11056, 29696, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	credentialing@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I wanted to get an update regarding the status of enrollment for our group and providers mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 16:16:20', '2021-08-18 16:16:20'),
(38391, 11056, 29696, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : credentialing@triwest.com, providerservices@triwest.com, jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I am still waiting to get an update regarding the status of enrollment for our group and providers mentioned below. Please respond to me as soon as possible.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 10:41:40', '2021-08-24 10:41:40'),
(38392, 11056, 29696, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening Jess!  Hope this email finds you well. Thank you so much for the prompt response. Please provide me with the welcome or approval letters for the below mentioned providers and practice as soon as possible.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-03 14:44:34', '2021-09-03 14:44:34'),
(38393, 11056, 29696, NULL, '2021-10-01 00:00:00.000', 'In Process', 'mail received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-09-24 14:52:12', '2021-09-24 14:52:12'),
(38394, 11056, 29696, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-10-06 12:56:27', '2021-10-06 12:56:27'),
(38395, 11056, 29696, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : providerdataupdate@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates regarding the providers and facility credentialing applications mentioned below under Tax I.D and both locations. And still waiting for the welcome letters for the providers.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663  Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   If you have any questions or concerns or require any information or documents please let me know. Eagerly, waiting for the response.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-14 15:55:27', '2021-10-14 15:55:27'),
(38396, 11056, 29696, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential   Talha,  I removed Michelle from the email as she is no longer in the same department.   We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.  The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548        Cecilia Carroll Direct Contract Manager TriWest Healthcare Alliance  O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com', NULL, NULL, '2021-10-22 12:03:21', '2021-10-22 12:03:21'),
(38397, 11056, 29696, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential     Talha,     Reminder, Michelle is no longer in this department.      See below status of your urgent care and providers in question.     We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.     The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548              Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance  O:  (623) 435-3343  F:  (866) 549-4618  ccarroll@triwest.com  www.triwest.com', NULL, NULL, '2021-11-09 11:14:13', '2021-11-09 11:14:13'),
(38398, 11056, 29696, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sbachman@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Julie,  Please process the provider in Pending status and provider the effective dates for all three providers.     Group Name  Coastal Bend Urgent Care, LLC  Tax ID  81-1890349  Group NPI  1427509264  Primary Location  301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Secondary Location  504A Houston Street, George West , TX 78022-3663  Provider Name  NPI  Katherine Paterson  1164776548  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Sincerely,  Sandra Bachman  Team Lead, Provider Data Ops / TriWest Healthcare Alliance  P: 1 (855) 722-2838  F: (866) 589-7693  www.triwest.com', NULL, NULL, '2021-11-24 13:02:35', '2021-11-24 13:02:35'),
(38399, 11056, 29696, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  	jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest   Good morning Julie!  Hope this email finds you well. Please respond to this query at your earliest convenience. Provide us with the effective dates and welcome letters for all three providers soon.  Eagerly, waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 18:02:52', '2021-12-06 18:02:52'),
(38400, 11056, 29696, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Good Morning,  Please direct all credentialing questions, data updates and issues to the Credentialing team.  The urgent care facility below is not found in our data at this point, you will need to request info from the Credentialing team for this one.     The individual providers below have been processed out to all systems, eff Oct 2021.           Thank You,     Julie Miller  Provider Data & Credentialing Specialist  TriWest Healthcare Alliance  P: (602) 564-2024  F: (866) 589-7693  Contact Center (855) 722-2838  www.triwest.com', NULL, NULL, '2021-12-14 16:41:05', '2021-12-14 16:41:05'),
(38401, 11056, 29696, NULL, '2021-12-24 00:00:00.000', 'Approved', 'Email received from:  jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Good Morning,  The two providers below have been processed for the second address, 504A Houston Street, George West, TX 78022-3663   Here is the provider information that you have requested  Providers - Effective dates   Flynn – 9/29/21  - 504A Houston Street, George West  Gonzalez – 10/5/21 - 504A Houston Street, George West  Thank you.    Julie Miller Provider Data & Credentialing Specialist TriWest Healthcare Alliance  P: (602) 564-2024 F: (866) 589-7693 Contact Center (855) 722-2838 www.triwest.com  Please see the attachments.', NULL, NULL, '2021-12-17 10:16:27', '2021-12-17 10:16:27'),
(38402, 1006, 29697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:58', '2021-05-10 15:26:58'),
(38403, 1005, 29697, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-06-01 14:20:54', '2021-06-01 14:20:54'),
(38404, 1006, 29708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38405, 3040, 29708, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Renaissance Physicians ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:35:17', '2021-06-07 12:35:17'),
(38406, 1006, 29708, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email to correct email address @ txgqproviderrelations@healthspring.com:  Sub: Enrollment Request - CBUC/GWMC - Renaissance Physician  \"Hello,  I hope you\'re doing well, we want to enroll the following group and providers with Renaissance Physicians, please let me know what is required to complete this request, the information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 16:55:35', '2021-06-24 16:55:35'),
(38407, 1006, 29708, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ txgqproviderrelations@healthspring.com:  Sub: Enrollment Request - CBUC/GWMC - Renaissance Physician  \"Hello,   I wanted to get an update regarding the status of our request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-13 17:24:43', '2021-07-13 17:24:43'),
(38408, 11056, 29708, NULL, '2021-08-25 00:00:00.000', 'In Process', '	 Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 13:01:07', '2021-08-18 13:01:07'),
(38409, 11056, 29708, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to :  txgqproviderrelations@healthspring.com, joann.alanis@careallies.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  Good afternoon!  Hope you are doing well. I am still waiting to get an update regarding the enrollment status of the below mentioned practice and providers since july.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 14:44:02', '2021-08-24 14:44:02'),
(38410, 11056, 29708, NULL, '2021-09-02 00:00:00.000', 'Not Eligible', 'Email received from : cresta.smith@careallies.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  These providers are not in the renaissance service area. We are only in the greater Houston area.     Thanks  Cresta', NULL, NULL, '2021-08-25 14:22:54', '2021-08-25 14:22:54'),
(38411, 1006, 29709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38412, 1005, 29709, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Awaiting Molina\'s enrollment.', NULL, NULL, '2021-06-07 10:16:12', '2021-06-07 10:16:12'),
(38413, 1006, 29710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38414, 3040, 29710, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TCHP ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TCHP for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 12:40:53', '2021-06-07 12:40:53'),
(38415, 1006, 29710, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request/Status - CBUC/GWMC - TCHP  \"Hello,   I hope you\'re doing well, we want to enroll the following group and providers with TCHP, please let me know what is required to complete this request, the information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 17:01:30', '2021-06-24 17:01:30'),
(38416, 1006, 29710, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following email from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request/Status - CBUC/GWMC - TCHP  \"Please submit a letter of interest questionnaire with a w9. The application is on our website www.texaschildrenshealthplan.org *for providers\"  Replied with:  \"Hello,   Please find the attached LOI for our urgent care, do let me know if anything else is required to proceed.   Thank you. \"  The form is attached in group task for reference. ', NULL, NULL, '2021-07-14 12:48:03', '2021-07-14 12:48:03'),
(38417, 1006, 29710, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:00:58', '2021-07-26 09:00:58'),
(38418, 1006, 29711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38419, 3040, 29711, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Amerigroup for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 09:56:53', '2021-06-07 09:56:53'),
(38420, 1006, 29711, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Good Day to you.  Is this a PCP clinic or a true Urgent Care?  The latter option means that the entity bills globally.\"  Sent reply:  \"Hello,   This is a true Urgent care, please let me know how we can proceed with the request.  Thank you!\"', NULL, NULL, '2021-06-24 14:38:41', '2021-06-24 14:38:41');
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
(38421, 11056, 29711, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment Query || Coastal Bend Urgent Care & George West Medical Clinic - Amerigroup   Please send us a letterhead with the following and include a w9:   **Legal name / DBA  **NPI#  **Taxonomy Code  **Service locations  **Billing location  **phone / Fax / office hours / age limits  **TPI / Medicare #  **CLIA #', NULL, NULL, '2021-07-06 17:05:30', '2021-07-06 17:05:30'),
(38422, 11056, 29711, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group  Greetings,  Hope you are doing well. Here is the information you requested for and kindly see the attachments.  Practice Details: Practice  Legal name / DBA  : Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349 Taxonomy Code :  261QU0200X - Clinic/Center Urgent Care  Main practice & billing location : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address : 504A Houston Street George West , TX 78022-3663  Practice phone : 361-226-1126 Practice  Fax :  361 542-4076 TPI / Medicare # : 588832 CLIA # : 45D2132336 Practice age limits : 0 till 100  Practice  office hours :   Monday 9AM–5PM Tuesday 9AM–5PM Wednesday 9AM–5PM Thursday 9AM–5PM Friday 9AM–5PM Saturday Closed Sunday Closed  If you have any questions or concerns feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-07-07 09:09:50', '2021-07-07 09:09:50'),
(38423, 1006, 29711, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:57:46', '2021-07-26 08:57:46'),
(38424, 1006, 29712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38425, 1006, 29712, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Hello,  I wanted to verify if the following group and providers were enrolled with Community Health Choice or not? The group and provider information are as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  I appreciate all the help, please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-08 16:48:20', '2021-06-08 16:48:20'),
(38426, 1006, 29712, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Hello,   I\'m still waiting for an update ​on this request, please get back to me as soon as possible as we\'re still waiting on this request.  Thank you!\"', NULL, NULL, '2021-06-25 17:13:42', '2021-06-25 17:13:42'),
(38427, 1006, 29712, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 14:59:03', '2021-07-14 14:59:03'),
(38428, 1006, 29713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38429, 1006, 29713, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Waiting for Aetna Approval ', NULL, NULL, '2021-06-08 17:03:40', '2021-06-08 17:03:40'),
(38430, 1006, 29713, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com cc \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello Bollu,   The requested information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Jennifer Tudor NPI# 1720455835 License Number: AP128673  Please let me know how long it will take to add these providers to our TIN with the mentioned addresses, also is Mercedita Flynn already added under both mentioned service locations?  Thank you.\"', NULL, NULL, '2021-06-09 10:21:12', '2021-06-09 10:21:12'),
(38431, 1006, 29713, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   I wanted to check in on the status of this request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-29 16:59:27', '2021-06-29 16:59:27'),
(38432, 1006, 29713, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:59:21', '2021-07-26 08:59:21'),
(38433, 1006, 29714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38434, 3040, 29714, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:13:40', '2021-06-07 12:13:40'),
(38435, 1006, 29714, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Memorial Hermann ||  \"Good Morning,  You will need to complete the Request for Application form online. You can do that by going here https://healthplan.memorialhermann.org/-/media/memorial-hermann/healthplan/files/providers/health-plan-request-to-participate.ashx?la=en&hash=27F819BE45E95E2EA8789FB1902B4D2F and completing the request to participate form online and forwarding to the email on the form.  Regards, Jo\"  The form is filled out and sent out to them and attached to the main group task for reference.   Sent to MHHP Contracting MHHPContracting@memorialhermann.org:  \"Hello,   Please find the attached network participation form for our group, please let me know if anything else is needed for this request.  Thank you!\"', NULL, NULL, '2021-06-24 16:49:57', '2021-06-24 16:49:57'),
(38436, 1006, 29714, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org  MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub; Network Participation Form - CBUC/GWMC - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers. Their information is as follows:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\'', NULL, NULL, '2021-07-13 17:22:35', '2021-07-13 17:22:35'),
(38437, 1006, 29714, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:00:20', '2021-07-26 09:00:20'),
(38438, 1006, 29716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38439, 3040, 29716, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Molina Health||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Molina Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:31:38', '2021-06-07 12:31:38'),
(38440, 1006, 29716, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Attn: Contracting Team - CBUC/GWMC - Molina   \"Good Afternoon Mr. Adil Abbas  I am doing fine, how do are you doing?  I did research for Coastal Bend Urgent Care and it does not show up in our system.  I tried both the Tax id and Group NPI. Please complete this contract request form and return along with a current W-9 to fax number: 877-900-5655 Attn: Contracting Team or email form to: mhtcontractrequest@molinahealthcare.com  Please let me know if you need further information or assistances.  Thank you  David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc. 4316 South McColl Road Edinburg, TX  78539 I Phone: (956) 532-5211 Righ tfax: (877) 900-8454 Email: david.balli@molinahealthcare.com\"  The form was filled out and sent to mhtcontractrequest@molinahealthcare.com, form is attached in the main group task for reference. ', NULL, NULL, '2021-06-25 12:43:17', '2021-06-25 12:43:17'),
(38441, 1006, 29716, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Coastal Bend Urgent Care, LLC  \"Good Afternoon,  Happy Wednesday! Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Coastal Bend Urgent Care, LLC ) to contract under TAX ID number (81-1890349).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below: EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com 888-562-5442 x200249   Have a wonderful day! Thank you, Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"', NULL, NULL, '2021-07-01 15:54:51', '2021-07-01 15:54:51'),
(38442, 1006, 29716, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:00:32', '2021-07-26 09:00:32'),
(38443, 1006, 29717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38444, 1006, 29717, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'We submitted a group enrollment request via the Wellcare website:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Enrollment form is attached in the group task for reference. ', NULL, NULL, '2021-06-08 16:31:14', '2021-06-08 16:31:14'),
(38445, 1006, 29717, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Dear Provider:  Thank you for your interest in joining our network, please allow 30 Calendar days for us to review your request.  Sincerely, Network Management – Texas | www.wellcare.com\"  Sent f/u email:   \"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.  Thank you!\"', NULL, NULL, '2021-06-25 10:19:12', '2021-06-25 10:19:12'),
(38446, 1006, 29717, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent another f/u email @ ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Hello,   I hope you\'re doing well, I\'m still waiting on the status of this enrollment request.  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-14 17:15:41', '2021-07-14 17:15:41'),
(38447, 1006, 29717, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:01:38', '2021-07-26 09:01:38'),
(38448, 1006, 29718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38449, 3040, 29718, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Galaxy Health ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:47:33', '2021-06-07 10:47:33'),
(38450, 1006, 29718, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent a f/u email @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - CBUC/GWMC - Galaxy Health  \"Hello,    We wish to enroll the following group and providers with Galaxy Health, their information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Provider Name: Katherine Paterson Provider NPI# 1164776548  Please get back to me as soon as possible regarding how we should proceed.  Thank you!\"', NULL, NULL, '2021-06-24 15:40:27', '2021-06-24 15:40:27'),
(38451, 1006, 29718, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email to Daniel Marley dmarley@ghn-mci.com:  Sub: Enrollment Request - CBUC/GWMC - Galaxy Health  \"Hello,   I wanted to get an update on this request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-13 17:05:32', '2021-07-13 17:05:32'),
(38452, 1006, 29718, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:59:37', '2021-07-26 08:59:37'),
(38453, 1006, 29719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:26:59', '2021-05-10 15:26:59'),
(38454, 1005, 29719, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval confirmation.', NULL, NULL, '2021-06-07 17:34:36', '2021-06-07 17:34:36'),
(38455, 1006, 29719, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent following enrollment query @ AM.Austin@SuperiorHealthPlan.com & SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Enrollment Query - CBUC/GWMC -  Superior Health/Ambetter  \"Hello,  I wanted to verify if the following group and providers were enrolled with Superior Healthplan & Ambetter under the mentioned addresses:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able. Thank you. \"', NULL, NULL, '2021-06-09 09:49:42', '2021-06-09 09:49:42'),
(38456, 1006, 29719, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Approval confirmation:  Jennifer Tudor: Eff: 02/01/2021  Ref# I57969070', NULL, NULL, '2021-06-29 16:40:40', '2021-06-29 16:40:40'),
(38457, 1006, 29720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:00', '2021-05-10 15:27:00'),
(38458, 1006, 29720, NULL, '2021-06-15 00:00:00.000', 'Approved', 'The provider is enrolled with Texas Mutual Workers Comp, approval/location confirmation is attached for reference. ', NULL, NULL, '2021-06-08 15:05:44', '2021-06-08 15:05:44'),
(38459, 1006, 29721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:00', '2021-05-10 15:27:00'),
(38460, 1005, 29721, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Cigna\'s approval.', NULL, NULL, '2021-06-07 17:33:43', '2021-06-07 17:33:43'),
(38461, 1006, 29721, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent enrollment request @ TXMAContracting@cigna.com:  Sub: Network Interest Form - CBUC/GWMC - Cigna Healthspring  \"Hello,   Please find the attached network interest form, do let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-23 12:52:00', '2021-07-23 12:52:00'),
(38462, 1006, 29721, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:58:56', '2021-07-26 08:58:56'),
(38463, 1006, 29722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:00', '2021-05-10 15:27:00'),
(38464, 1006, 29722, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ providerdevelopment@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello,  We submitted an enrollment request last month for our group and wanted to get a status update on it, the group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please get back to me as soon as you\'re able to. Thank you. \"', NULL, NULL, '2021-06-08 16:15:39', '2021-06-08 16:15:39'),
(38465, 1006, 29722, NULL, '2021-07-02 00:00:00.000', 'In Process', 'The previous email was sent to an incorrect address, sent corrected email @ providerdevelopment@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello,    We submitted an enrollment request last month for our group and wanted to get a status update on it, the group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please get back to me as soon as you\'re able to.  Thank you.\"  ', NULL, NULL, '2021-06-25 17:05:42', '2021-06-25 17:05:42'),
(38466, 1006, 29722, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Received following notification from email:  \"Your message to providerdevelopment@anci-care.com couldn\'t be delivered. The group providerdevelopment only accepts messages from people in its organization or on its allowed senders list, and your email address isn\'t on the list.\"  Sent corrected email @ ACS VIP Providers vipproviders@anci-care.com.', NULL, NULL, '2021-07-14 14:55:47', '2021-07-14 14:55:47'),
(38467, 1006, 29722, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:58:21', '2021-07-26 08:58:21'),
(38468, 1006, 29723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:00', '2021-05-10 15:27:00'),
(38469, 3040, 29723, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Triwest for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 13:00:13', '2021-06-07 13:00:13'),
(38470, 11056, 29723, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email sent to : providerservices@triwest.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers with Triwest for our group under the below locations.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548    Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# : 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a blessed day!', NULL, NULL, '2021-06-24 13:11:41', '2021-06-24 13:11:41'),
(38471, 1006, 29723, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for our group and providers mentioned in the previous email.   Please get back to me as soon as possible.  Thank you.', NULL, NULL, '2021-07-13 17:28:15', '2021-07-13 17:28:15'),
(38472, 1006, 29723, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:01:28', '2021-07-26 09:01:28'),
(38473, 1006, 29724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:00', '2021-05-10 15:27:00'),
(38474, 1005, 29724, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-06-01 14:21:20', '2021-06-01 14:21:20'),
(38475, 1006, 29735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38476, 3040, 29735, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Renaissance Physicians ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:35:20', '2021-06-07 12:35:20'),
(38477, 1006, 29735, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email to correct email address @ txgqproviderrelations@healthspring.com:  Sub: Enrollment Request - CBUC/GWMC - Renaissance Physician  \"Hello,  I hope you\'re doing well, we want to enroll the following group and providers with Renaissance Physicians, please let me know what is required to complete this request, the information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 16:55:33', '2021-06-24 16:55:33'),
(38478, 1006, 29735, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ txgqproviderrelations@healthspring.com:  Sub: Enrollment Request - CBUC/GWMC - Renaissance Physician  \"Hello,   I wanted to get an update regarding the status of our request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-13 17:24:40', '2021-07-13 17:24:40'),
(38479, 1006, 29735, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:00:46', '2021-07-26 09:00:46'),
(38480, 1006, 29736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38481, 1005, 29736, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Awaiting Molina\'s enrollment.', NULL, NULL, '2021-06-07 10:16:07', '2021-06-07 10:16:07'),
(38482, 1006, 29736, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:02:09', '2021-07-26 09:02:09'),
(38483, 1006, 29737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38484, 3040, 29737, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TCHP ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TCHP for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 12:40:57', '2021-06-07 12:40:57'),
(38485, 1006, 29737, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request/Status - CBUC/GWMC - TCHP  \"Hello,   I hope you\'re doing well, we want to enroll the following group and providers with TCHP, please let me know what is required to complete this request, the information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 17:01:25', '2021-06-24 17:01:25'),
(38486, 1006, 29737, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following email from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request/Status - CBUC/GWMC - TCHP  \"Please submit a letter of interest questionnaire with a w9. The application is on our website www.texaschildrenshealthplan.org *for providers\"  Replied with:  \"Hello,   Please find the attached LOI for our urgent care, do let me know if anything else is required to proceed.   Thank you. \"  The form is attached in group task for reference. ', NULL, NULL, '2021-07-14 12:47:59', '2021-07-14 12:47:59'),
(38487, 1006, 29737, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from jointchp@texaschildrens.org:  Sub: Letter of Interest Questionnaire - CBUC - TCHP  \"Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.\"', NULL, NULL, '2021-08-03 16:00:45', '2021-08-03 16:00:45'),
(38488, 11056, 29737, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : jointchp@texaschildrens.org  &  tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Good evening!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Have my applications of the below mentioned providers been reviewed or not yet?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 15:25:16', '2021-08-18 15:25:16'),
(38489, 11056, 29737, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Hello,     I was able to find a submission of an LOI (attached) for provider Mercedita Flynn and a denial letter that was sent.  Please see attachments.     Let me know if you have any more questions  -Liz        Self Note  20210802037174969  Mercedita N Flynn', NULL, NULL, '2021-08-24 17:01:20', '2021-08-24 17:01:20'),
(38490, 11056, 29737, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP   Good morning Liz!  Hope this email finds you well. We have confirmed the NPI of the provider Mercedita Flynn from TMHP & is also attested. Therefore, please consider this application. Please see the attachment below.  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-17 13:12:58', '2021-09-17 13:12:58'),
(38491, 11056, 29737, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Hello,  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.   Thank you  Liz Ramirez Contract Specialist Texas Children’s Health Plan', NULL, NULL, '2021-09-28 09:46:31', '2021-09-28 09:46:31'),
(38492, 11056, 29737, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : tchpnetworkmanagement@texaschildrens.org & bxgupta@texaschildrens.org  Sub : Enrollment Status Query - CBUC/GWMC - TCHP  Group- Coastal Bend Urgent Care, LLC   Katherine Paterson         1164776548 Please see attached denial letter  20211001038052743     Mercedita Flynn               1619166188 Please see attached denial letter  20210930038036249     Monica Gonzalez             1871132811 Please see attached denial letter  20210930038036263   No TCHP does not work with BEE county. Our apologies.  You can also check yourself on website at texaschildrens.org yourself which county TCHP serves.', NULL, NULL, '2021-10-07 10:37:51', '2021-10-07 10:37:51'),
(38493, 1006, 29738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38494, 3040, 29738, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Amerigroup for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 09:56:56', '2021-06-07 09:56:56'),
(38495, 1006, 29738, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Good Day to you.  Is this a PCP clinic or a true Urgent Care?  The latter option means that the entity bills globally.\"  Sent reply:  \"Hello,   This is a true Urgent care, please let me know how we can proceed with the request.  Thank you!\"', NULL, NULL, '2021-06-24 14:38:38', '2021-06-24 14:38:38'),
(38496, 11056, 29738, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment Query || Coastal Bend Urgent Care & George West Medical Clinic - Amerigroup   Please send us a letterhead with the following and include a w9:   **Legal name / DBA  **NPI#  **Taxonomy Code  **Service locations  **Billing location  **phone / Fax / office hours / age limits  **TPI / Medicare #  **CLIA #', NULL, NULL, '2021-07-06 17:05:42', '2021-07-06 17:05:42'),
(38497, 11056, 29738, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group  Greetings,  Hope you are doing well. Here is the information you requested for and kindly see the attachments.  Practice Details: Practice  Legal name / DBA  : Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349 Taxonomy Code :  261QU0200X - Clinic/Center Urgent Care  Main practice & billing location : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address : 504A Houston Street George West , TX 78022-3663  Practice phone : 361-226-1126 Practice  Fax :  361 542-4076 TPI / Medicare # : 588832 CLIA # : 45D2132336 Practice age limits : 0 till 100  Practice  office hours :   Monday 9AM–5PM Tuesday 9AM–5PM Wednesday 9AM–5PM Thursday 9AM–5PM Friday 9AM–5PM Saturday Closed Sunday Closed  If you have any questions or concerns feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-07-07 09:09:12', '2021-07-07 09:09:12'),
(38498, 1006, 29738, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Sent f/u email @ txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349  Main practice & billing location: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Name: Katherine Moten Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-06 13:52:45', '2021-08-06 13:52:45'),
(38499, 1006, 29738, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Hello,   I hope you\'re doing well, I am still waiting on the status of my application. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-16 16:00:35', '2021-08-16 16:00:35'),
(38500, 11056, 29738, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com, latoyna.henry@amerigroup.com, Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 16:33:34', '2021-08-23 16:33:34'),
(38501, 11056, 29738, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good morning!  Hope all is well with you. It had been a long since our email got responded back. We are still waiting to get the latest updates related our enrollment applications for the following providers under the Practice Tax I.D mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  Provider Name: Mercedita N Flynn Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!  I had words with Kim U at 800-454-3730. She said that there is no contact no. of Amerigroup Credentialing dept. they only contact through emails.  Ref code : i-140308714', NULL, NULL, '2021-09-20 12:22:20', '2021-09-20 12:22:20'),
(38502, 11056, 29738, NULL, '2021-10-06 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good Morning,     Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.      Those areas are managed by other Medicaid Managed Care Organizations.     Thank you again for your interest.     Sincerely,', NULL, NULL, '2021-09-29 16:44:06', '2021-09-29 16:44:06'),
(38503, 11056, 29738, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good evening!  Hope this email finds you well. Please see the location again. Please note that our facilities are located in BEEVILLE , TX & George West , TX, not in Corpus Christi.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-30 15:36:02', '2021-09-30 15:36:02'),
(38504, 11056, 29738, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good Morning,  Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.   Hi There, those locations are within the Corpus Christi service delivery area, Amerigroup currently does not have membership down in that region.   Those areas are managed by other Medicaid Managed Care Organizations.   Thank you again for your interest.  Sincerely,', NULL, NULL, '2021-10-07 15:35:01', '2021-10-07 15:35:01'),
(38505, 1006, 29739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38506, 1006, 29739, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Hello,  I wanted to verify if the following group and providers were enrolled with Community Health Choice or not? The group and provider information are as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  I appreciate all the help, please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-08 16:48:16', '2021-06-08 16:48:16'),
(38507, 1006, 29739, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Hello,   I\'m still waiting for an update ​on this request, please get back to me as soon as possible as we\'re still waiting on this request.  Thank you!', NULL, NULL, '2021-06-25 17:13:19', '2021-06-25 17:13:19'),
(38508, 1006, 29739, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Received following rejection email from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Query - CBUC/GWMC - Community Health Choice  \"Good Morning Brad,  Please see attached letter and Service Area Map in reference to Coastal Bend Urgent Care’s application.  Thank you for your time and consideration.   Best Regards, Contracting Dept.\"  The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-14 14:58:58', '2021-07-14 14:58:58'),
(38509, 1006, 29740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38510, 3040, 29740, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Waiting for Aetna Approval ', NULL, NULL, '2021-06-07 10:43:06', '2021-06-07 10:43:06'),
(38511, 1006, 29740, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com cc \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello Bollu,   The requested information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Jennifer Tudor NPI# 1720455835 License Number: AP128673  Please let me know how long it will take to add these providers to our TIN with the mentioned addresses, also is Mercedita Flynn already added under both mentioned service locations?  Thank you.\"', NULL, NULL, '2021-06-09 10:21:08', '2021-06-09 10:21:08'),
(38512, 1006, 29740, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   I wanted to check in on the status of this request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-29 16:59:24', '2021-06-29 16:59:24');
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
(38513, 1006, 29740, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-09 10:29:07', '2021-08-09 10:29:07'),
(38514, 1006, 29740, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & TalasilaB@aetna.com:  Sub: RE: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  \"Hello,   We still have not received any updates regarding the status of enrollment for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188 License Number: AP118292  Provider Name: Katherine Paterson NPI# 1164776548 License Number: 517795  Provider Name: Monica Gonzalez NPI# 1871132811 License Number: AP144421  Please get back to me as soon as possible.  Thank you. \" ', NULL, NULL, '2021-08-16 12:18:28', '2021-08-16 12:18:28'),
(38515, 11056, 29740, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com, \"Sidley, Jeanette\" SidleyJ1@firsthealth.com, PDS Dallas  pdsdallas@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059   Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 17:02:09', '2021-08-23 17:02:09'),
(38516, 11056, 29740, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  Good afternoon!  Hope you are doing well. It has been so long since you haven\'t responded to our emails. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice. Please provide me with the latest updates soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great weekend! ', NULL, NULL, '2021-09-03 14:16:07', '2021-09-03 14:16:07'),
(38517, 11056, 29740, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email received from : DillikarA@aetna.com   Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hi,  Please find the status of below provider as per requested.   S.no  Provider Name  NPI  Cpd Id  TIN  Effective Date  Status  1  Paterson, Katherine D  1164776548  2815476  811890349  -  Tax Id not found  2  Monica Gonzalez  1871132811  811890349  -  Provider not found    Regards, Bharath', NULL, NULL, '2021-09-14 13:22:00', '2021-09-14 13:22:00'),
(38518, 11056, 29740, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : DillikarA@aetna.com  Sub  : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hey Bharath!  Hope this email finds you well. Please guide and assist me regarding how to solve the below highlighted issues.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 12:39:57', '2021-09-28 12:39:57'),
(38519, 11056, 29740, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello Ahmed,  I hope that this email finds you well! I apologize that I have not been able to respond sooner, my son has been ill so I have been in and out of the office.  This is the new group agreement that we established that will become effective 11/1/21. It is still in the implementation stages but will be complete before the effective date. All providers listed on the roster you provided to me will be linked to the new agreement once effective.   I hope that this helps clarify.  Take care!  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-06 15:02:05', '2021-10-06 15:02:05'),
(38520, 11056, 29740, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Ahmed,  I hope that this email finds you well! Thank you for the well wishes, we are hoping he starts to feel better soon.  I have attached a copy of the signed agreement to this email. I apologize if the system did not automatically send it to you when it was signed on our side.  The contract is currently in implementation with our Data Team. I will send over the welcome letter once I have your group ID.  As always, please do not hesitate to reach out if you have any questions or concerns.  Take care! Jeanette', NULL, NULL, '2021-10-14 15:37:14', '2021-10-14 15:37:14'),
(38521, 11056, 29740, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Re: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Jeanette!  Hope this email finds you well. He will feel better soon. He is in my prayers.  Bundle of thanks for your prompt responses. And I am grateful to you for that.  Whenever the implementation is completed, please provide the welcome letter soon.   Thank you! Have a wonderful & blessed weekend ahead!', NULL, NULL, '2021-10-22 12:10:28', '2021-10-22 12:10:28'),
(38522, 11056, 29740, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Sub : Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135   Good morning Jeanette!  Hope you & your son both are doing great. Please provide me with the latest updates about the implementation as well as on the welcome letters too. Kindly do the needful soon.  Please get back to me soon.  Thank you! Take Care!', NULL, NULL, '2021-11-09 15:27:17', '2021-11-09 15:27:17'),
(38523, 11056, 29740, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sidleyj1@firsthealth.com  Sub:  Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1073945 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,  Jeanette Sidley Network Relations Consultant  750 Riverpoint Drive West Sacramento, CA 95605  Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-24 10:38:46', '2021-11-24 10:38:46'),
(38524, 11056, 29740, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email received from:  sidleyj1@firsthealth.com  Sub:  RE: [SEND SECURE] RE: Status: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 16106135  Good morning Ahmed,   I hope that this email finds you well! I apologize  Paterson, Katherine – eff 11/1/21 – system ID #2815476  Please see the attachment', NULL, NULL, '2021-12-09 13:40:29', '2021-12-09 13:40:29'),
(38525, 1006, 29741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38526, 3040, 29741, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:13:43', '2021-06-07 12:13:43'),
(38527, 1006, 29741, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Memorial Hermann ||  \"Good Morning,  You will need to complete the Request for Application form online. You can do that by going here https://healthplan.memorialhermann.org/-/media/memorial-hermann/healthplan/files/providers/health-plan-request-to-participate.ashx?la=en&hash=27F819BE45E95E2EA8789FB1902B4D2F and completing the request to participate form online and forwarding to the email on the form.  Regards, Jo\"  The form is filled out and sent out to them and attached to the main group task for reference.   Sent to MHHP Contracting MHHPContracting@memorialhermann.org:  \"Hello,   Please find the attached network participation form for our group, please let me know if anything else is needed for this request.  Thank you!\"', NULL, NULL, '2021-06-24 16:49:52', '2021-06-24 16:49:52'),
(38528, 1006, 29741, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org  MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub; Network Participation Form - CBUC/GWMC - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers. Their information is as follows:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\'', NULL, NULL, '2021-07-13 17:22:26', '2021-07-13 17:22:26'),
(38529, 1006, 29741, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following response from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Coastal Bend Urgent Care’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services?  Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.\"  Responded to the queries.', NULL, NULL, '2021-07-26 13:19:47', '2021-07-26 13:19:47'),
(38530, 1006, 29741, NULL, '2021-08-23 00:00:00.000', 'Not Eligible', 'We received  the following denial notification from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"At this time, the cities listed below are out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\" ', NULL, NULL, '2021-08-16 11:04:28', '2021-08-16 11:04:28'),
(38531, 1006, 29743, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38532, 3040, 29743, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Molina Health||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Molina Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:31:41', '2021-06-07 12:31:41'),
(38533, 1006, 29743, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Attn: Contracting Team - CBUC/GWMC - Molina   \"Good Afternoon Mr. Adil Abbas  I am doing fine, how do are you doing?  I did research for Coastal Bend Urgent Care and it does not show up in our system.  I tried both the Tax id and Group NPI. Please complete this contract request form and return along with a current W-9 to fax number: 877-900-5655 Attn: Contracting Team or email form to: mhtcontractrequest@molinahealthcare.com  Please let me know if you need further information or assistances.  Thank you  David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc. 4316 South McColl Road Edinburg, TX  78539 I Phone: (956) 532-5211 Righ tfax: (877) 900-8454 Email: david.balli@molinahealthcare.com\"  The form was filled out and sent to mhtcontractrequest@molinahealthcare.com, form is attached in the main group task for reference. ', NULL, NULL, '2021-06-25 12:43:13', '2021-06-25 12:43:13'),
(38534, 1006, 29743, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Coastal Bend Urgent Care, LLC  \"Good Afternoon,  Happy Wednesday! Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Coastal Bend Urgent Care, LLC ) to contract under TAX ID number (81-1890349).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below: EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com 888-562-5442 x200249   Have a wonderful day! Thank you, Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"', NULL, NULL, '2021-07-01 15:54:48', '2021-07-01 15:54:48'),
(38535, 1006, 29743, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Monday!!  Hope you are doing well.  I am following up to my previous email. Please be advised unless all forms are returned, we will not be able to continue contracting process.  any assistance will be greatly appreciated.  Thank you in advance  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Replied with the requested information:  \"Hello Juliana,   I apologize for the delay, here\'s the requested information hopefully it suffices. We also have a secondary location and the address is as follows: 504A Houston Street, George West, TX 78022-3663  Do let me know if anything else is required to proceed.\"', NULL, NULL, '2021-08-03 14:06:34', '2021-08-03 14:06:34'),
(38536, 1006, 29743, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following email Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Thank you for your assistance filling out forms.  Could you please assist with correction needed in claim sample?  Box 33 we are missing pay to name  could you please update and submit back to me?  For secondary location, could you please fill out a credentialing application?  Please see attached.  Once information is received back, we will be able to continue  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Responded with the requested information:  \"Hello,   Please find the requested documents attached. Do let me know if anything else is needed.  Thank you. \"', NULL, NULL, '2021-08-05 16:01:22', '2021-08-05 16:01:22'),
(38537, 11056, 29743, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good evening!  Hope all is well. Please provide me with the latest updates of the enrollment status of following providers & practice and the secondary location too. Kindly also update me about the applications and forms submitted to you regarding enrollment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Furthermore,if documents and information is needed please let me know. Please don\'t hesitate to contact me directly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 15:51:59', '2021-08-18 15:51:59'),
(38538, 11056, 29743, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning,  Happy Thursday!!  Hope you are doing well.  Per information on our system, service location  301 S. Hillside Drive is in process  of credentialing.  Service location 504  A  Houston Street, we are missing a contract request form, could you please fill out form and submit back to me at your earliest convenience?  Individual providers are not contracted under Urgent Care Facility.  Molina contracts facility directly.     Hope this information helps.  Thank you        Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (888) 562-5442 ext 200249', NULL, NULL, '2021-08-24 14:04:29', '2021-08-24 14:04:29'),
(38539, 11056, 29743, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope all is well. Here is the filled contract request form for the secondary service location 504-A, Houston Street. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Furthermore, if any additional information is required please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 15:05:41', '2021-09-03 15:05:41'),
(38540, 11056, 29743, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-09-24 11:46:31', '2021-09-24 11:46:31'),
(38541, 11056, 29743, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-06 12:37:42', '2021-10-06 12:37:42'),
(38542, 11056, 29743, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-10-14 15:48:35', '2021-10-14 15:48:35'),
(38543, 11056, 29743, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-10-22 10:21:41', '2021-10-22 10:21:41'),
(38544, 11056, 29743, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-09 14:11:29', '2021-11-09 14:11:29'),
(38545, 11056, 29743, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-11-24 12:13:40', '2021-11-24 12:13:40'),
(38546, 11056, 29743, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 17:01:49', '2021-12-06 17:01:49'),
(38547, 11056, 29743, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts', NULL, NULL, '2021-12-21 17:28:48', '2021-12-21 17:28:48'),
(38548, 19067, 29743, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Subject: Enrollment Query || Providers & Group || GWMC || Molina Health ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Katherine Paterson	1164776548	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 12:01:29', '2022-01-04 12:01:29'),
(38549, 19067, 29743, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Subject: Enrollment Query || Providers & Group || GWMC || Molina Health ||    Good afternoon,  Happy Monday!!  Hope you are doing well. per information on our system, TIN 81-1890349 is loaded into network billing system with effective date 12/15/2021.  Since contract on file is for urgent care clinic, we will not be able to link individual providers to group.  Facility is contracted already.  Should you have any additional questions, please reach out to your provider service representative directly at MHTXProviderServices@MolinaHealthCare.Com.  Thank you in advance, hope you have a great day.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (972)346-0603', NULL, NULL, '2022-01-11 13:10:59', '2022-01-11 13:10:59'),
(38550, 19067, 29743, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Subject: Re: Enrollment Query || Providers & Group || GWMC || Molina Health ||   Greetings!  Can you please confirm the location, it is 504A Houston Street, Live Oak County, George West, TX 78022.   Regards, Hammad.', NULL, NULL, '2022-01-26 15:04:52', '2022-01-26 15:04:52'),
(38551, 19067, 29743, NULL, '2022-02-22 00:00:00.000', 'Approved', 'Received the following email from: Juliana.Mata@molinahealthcare.com  Subject: RE: Enrollment Query || Providers & Group || GWMC || Molina Health ||   Good afternoon,  Happy Monday!!  Hope you are doing well. per information on our system, TIN 81-1890349 is loaded into network billing system with effective date 12/15/2021.  Since contract on file is for urgent care clinic, we will not be able to link individual providers to group.  Facility is contracted already.  Should you have any additional questions, please reach out to your provider service representative directly at MHTXProviderServices@MolinaHealthCare.Com.  Thank you in advance, hope you have a great day.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (972)346-0603', NULL, NULL, '2022-02-15 13:12:48', '2022-02-15 13:12:48'),
(38552, 1006, 29744, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38553, 1006, 29744, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'We submitted a group enrollment request via the Wellcare website:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Enrollment form is attached in the group task for reference. ', NULL, NULL, '2021-06-08 16:31:11', '2021-06-08 16:31:11'),
(38554, 1006, 29744, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Dear Provider:  Thank you for your interest in joining our network, please allow 30 Calendar days for us to review your request.  Sincerely, Network Management – Texas | www.wellcare.com\"  Sent f/u email:   \"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.  Thank you!\"', NULL, NULL, '2021-06-25 10:19:04', '2021-06-25 10:19:04'),
(38555, 1006, 29744, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent another f/u email @ ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Hello,   I hope you\'re doing well, I\'m still waiting on the status of this enrollment request.  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-14 17:15:32', '2021-07-14 17:15:32'),
(38556, 1006, 29744, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received response from Superior, requesting the form. The form is filled and sent out @ SHP-Network Development shp.networkdevelopment@superiorhealthplan.com:  Sub:  Add Provider- Katherine Paterson - CBUC  \"Hello,   I hope you\'re doing well, please find the attached contract form for our provider to add them to our group. Do let me know if anything else is required.   Thank you.\" ', NULL, NULL, '2021-07-26 10:05:19', '2021-07-26 10:05:19'),
(38557, 1006, 29744, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: Add Provider- Katherine Paterson - CBUC  \"Hello  We received your completed application on 3/3/21. Your effective date is 6/1/21 and will be receiving a welcome packet shortly.   Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"', NULL, NULL, '2021-07-29 09:26:31', '2021-07-29 09:26:31'),
(38558, 11056, 29744, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Good evening Leslie!  Hope all is well. Please provide us with the welcome packet soon for the below mentioned provider:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 16:39:05', '2021-08-18 16:39:05'),
(38559, 11056, 29744, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Good evening Leslie!  Hope all is well. Please provide us with the welcome packet soon for the below mentioned provider:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 16:39:06', '2021-08-18 16:39:06'),
(38560, 11056, 29744, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com, M.CorpusChristi@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good evening!  Hope all is well.I have been waiting for the welcome packet since July, but haven\'t received it yet. Please provide us with the welcome packet soon for the below mentioned provider:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 13:44:53', '2021-08-24 13:44:53'),
(38561, 11056, 29744, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email sent to : shp.networkdevelopment@superiorhealthplan.com, M.CorpusChristi@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good evening!  Hope all is well.I have been waiting for the welcome packet since July, but haven\'t received it yet. Please provide us with the welcome packet soon for the below mentioned provider:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!    I have words with a Rep.  She can\'t able to find out the welcome packet and said they gonna contact me within 15 business days.', NULL, NULL, '2021-09-01 14:18:46', '2021-09-01 14:18:46'),
(38562, 11056, 29744, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep : Rose S  Katherine Paterson in network 07/01/2021 participating with wellcare  Mercedita Flynn in network 07/01/2021 participating with wellcare  interaction code : 1296311845  application needed for the group.', NULL, NULL, '2021-09-17 17:10:57', '2021-09-17 17:10:57'),
(38563, 11056, 29744, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : TERESA.Argueta@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   Good afternoon!  Hope all is well with you. I want to get the latest update regarding the enrollment status of the below mentioned providers under the facility TIN with Wellcare.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  If you have any questions or concerns feel free to reach out to me soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 13:25:55', '2021-09-29 13:25:55'),
(38564, 11056, 29744, NULL, '2021-10-07 00:00:00.000', 'Approved', 'Approval Email received from : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   New Providers for Costal Bend Urgent Care  Hello,   The providers below are PAR effective 7/1/2021.  Please see the attachment.', NULL, NULL, '2021-09-30 13:58:09', '2021-09-30 13:58:09'),
(38565, 1006, 29745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-10 15:27:01', '2021-05-10 15:27:01'),
(38566, 3040, 29745, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: contracting@ghn-mci.com, providers@ghn-mci.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Galaxy Health ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:47:37', '2021-06-07 10:47:37'),
(38567, 1006, 29745, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent a f/u email @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - CBUC/GWMC - Galaxy Health  \"Hello,    We wish to enroll the following group and providers with Galaxy Health, their information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Provider Name: Katherine Paterson Provider NPI# 1164776548  Please get back to me as soon as possible regarding how we should proceed.  Thank you!\"', NULL, NULL, '2021-06-24 15:40:24', '2021-06-24 15:40:24'),
(38568, 1006, 29745, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email to Daniel Marley dmarley@ghn-mci.com:  Sub: Enrollment Request - CBUC/GWMC - Galaxy Health  \"Hello,   I wanted to get an update on this request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-13 17:05:30', '2021-07-13 17:05:30'),
(38569, 11056, 29745, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 12:42:49', '2021-08-18 12:42:49'),
(38570, 11056, 29745, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com,  contracting@ghn-mci.com &  providers@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  Provider Name: Katherine Paterson Provider NPI# : 1164776548  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 10:29:47', '2021-08-24 10:29:47'),
(38571, 11056, 29745, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Ahmed,     After review, I show a personal agreement for Dr. Mercedita Flynn effective 7-1-2021. I do not show Katherine Paterson as participating under the information you provided.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-09-01 13:37:52', '2021-09-01 13:37:52'),
(38572, 11056, 29745, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good morning!  Hope this email finds you well. Could you provide me with a signed copy of that agreement of the provider Dr. Mercedita Flynn? And inform me the procedure by which the provider Katherine Paterson shows as participating under the Group TIN.  If you need any documents or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-17 14:50:33', '2021-09-17 14:50:33'),
(38573, 11056, 29745, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Hi Ahmed,  I am sorry, however, the below statement that Dr. Flynn is under a personal agreement shows to be incorrect. I show this provider, Dr. Flynn  is under a group agreement.  To confirm I do not show Katherine Paterson as presently participating with Galaxy under the Coastal Bend Urgent Care Group agreement. If the group wishes to add Katherine Paterson to their existing agreement then please see the attached.  If your company wishes a copy of the group agreement you will need to fax written authorization signed by an authorized signatory of the CBUS group stating your company Claims Med Inc is representing the group and that Galaxy is authorized to send you a copy of their agreement. That can be faxed to 817-633-5729.   Further, I show that the same information above on how to obtain a copy of the group agreement was sent to Mr. Brad Peterson who is with you company and he may already have a copy of the group agreement.', NULL, NULL, '2021-09-29 12:52:48', '2021-09-29 12:52:48'),
(38574, 11056, 29745, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC   Good afternoon Daniel!  Hope this email finds you well. Here is the filled Physician agreement form for the provider Katherine Paterson, to add her with Galaxy under the Coastal Bend Urgent Care Group agreement. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  If you have any questions or concerns or need documents please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-07 15:05:46', '2021-10-07 15:05:46'),
(38575, 11056, 29745, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Enrollment Status Query - Galaxy Health - CBUC/GWMC  Good morning!  Hope this email finds you well.  Please provide us with the latest updates regarding the following providers under the below mentioned practice with Galaxy health as soon as possible.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-18 16:46:06', '2021-10-18 16:46:06');
