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
(50943, 12062, 39662, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email received from :Valerie J. Gomez Valerie.J.Gomez@centene.com  Subject : [SECURE]      -       VALLEY MED URGENT CARE PLLC   Dear LUYANDO, MARIANA,                We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to shp.networkdevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.        To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:   http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/       For Re-Credentialing, please email your information to credentialing@superiorhealthplan.com.    ', NULL, NULL, '2021-09-21 12:46:32', '2021-09-21 12:46:32'),
(50944, 12062, 39662, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Responded to email:  TO : shp.networkdevelopment@superiorhealthplan.com subject :Add Provider- LUYANDO, MARIANA  Greetings,  Hope you are doing well. Please find the attached provider contracting form as per previous email requested.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon. Thank you   ', NULL, NULL, '2021-09-21 13:58:24', '2021-09-21 13:58:24'),
(50945, 10057, 39662, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:25:16', '2021-10-21 16:25:16'),
(50946, 10057, 39662, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good afternoon,  Here is the status for the requested providers-  MARIANA LUYANDO- We received your completed application on 09/24/2021.  Your effective date is 11/01/2021 and you will be receiving a welcome packet shortly.  JUAN HERNANDEZ-  We received your completed application on 09/13/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2021-10-22 08:53:48', '2021-10-22 08:53:48'),
(50947, 10057, 39662, NULL, '2021-11-10 00:00:00.000', 'Approved', 'MARIANA LUYANDO  VALLEY MED URGENT CARE PLLC  vmuc@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   11/01/2021 ', NULL, NULL, '2021-11-03 10:44:36', '2021-11-03 10:44:36'),
(50948, 1019, 39663, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-21 08:31:46', '2021-09-21 08:31:46'),
(50949, 1019, 39663, NULL, '2021-09-28 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-09-21 08:32:09', '2021-09-21 08:32:09'),
(50950, 1019, 39664, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-22 08:16:41', '2021-09-22 08:16:41'),
(50951, 1019, 39664, NULL, '2021-09-29 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-09-22 08:16:51', '2021-09-22 08:16:51'),
(50952, 1019, 39665, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-22 08:38:39', '2021-09-22 08:38:39'),
(50953, 1019, 39665, NULL, '2021-09-29 00:00:00.000', 'Not Eligible', 'Medicaid is named under Masshealth in MA,', NULL, NULL, '2021-09-22 08:41:01', '2021-09-22 08:41:01'),
(50954, 1019, 39666, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-22 08:49:26', '2021-09-22 08:49:26'),
(50955, 1019, 39666, NULL, '2021-09-29 00:00:00.000', 'Not Eligible', 'Medicaid is named under Masshealth in MA, ', NULL, NULL, '2021-09-22 08:49:45', '2021-09-22 08:49:45'),
(50956, 1019, 39667, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(50957, 1019, 39667, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Request Initiated Online thru Website, ref  ID is 42905437 ', NULL, NULL, '2021-09-24 08:27:42', '2021-09-24 08:27:42'),
(50958, 1019, 39667, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:06:00', '2021-11-01 08:06:00'),
(50959, 1019, 39667, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Sent the following email to Laura,  Good Morning Laura,  Can you please get an update on the following provider credentialing?   Group Name Spectrum Neuro Behavioral Care LLC Tax ID 83-4482753 Group NPI 1356906572  DiCostanzo, Allie NPI:1669045738   Regards, Alex ', NULL, NULL, '2021-11-16 09:20:22', '2021-11-16 09:20:22'),
(50960, 1019, 39667, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin,  Good morning,  Allie DiCostanzo, 6792883 has recently completed the credentialing process and is waiting to be linked to the group contract.  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 10:03:32', '2021-11-16 10:03:32'),
(50961, 11056, 39667, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:06', '2021-12-01 17:07:06'),
(50962, 11056, 39667, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Rep: Mars   Status:  Sent a FAX to (859)455-8650 with W9, LOI. Attn Provider Demographic.   Refcode: 6062405839  Please see the attachment.', NULL, NULL, '2021-12-09 10:30:12', '2021-12-09 10:30:12'),
(50963, 19067, 39667, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:12:37', '2021-12-15 17:12:37'),
(50964, 19067, 39667, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:01', '2021-12-16 10:56:01'),
(50965, 19067, 39667, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:51', '2021-12-20 10:30:51'),
(50966, 19067, 39667, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:04', '2021-12-28 13:21:04'),
(50967, 19067, 39667, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:26', '2022-01-10 11:33:26'),
(50968, 19067, 39667, NULL, '2022-01-31 00:00:00.000', 'Approved', 'See attachment for provider directory & accepted plans.', NULL, NULL, '2022-01-24 17:19:15', '2022-01-24 17:19:15'),
(50969, 1019, 39668, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(50970, 1019, 39668, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Faxed the CAQH Application to (866) 612-7790. Attached is the application for reference. ', NULL, NULL, '2021-09-24 08:54:02', '2021-09-24 08:54:02'),
(50971, 1019, 39668, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:45:52', '2021-11-01 08:45:52'),
(50972, 1019, 39668, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:12:17', '2021-11-30 09:12:17'),
(50973, 11056, 39668, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:40:50', '2021-12-14 14:40:50'),
(50974, 19067, 39668, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:16:47', '2021-12-20 12:16:47'),
(50975, 19067, 39668, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:07', '2021-12-20 15:09:07'),
(50976, 19067, 39668, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:38:12', '2021-12-22 13:38:12'),
(50977, 19067, 39668, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:04:41', '2021-12-28 17:04:41'),
(50978, 19067, 39668, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:36:09', '2022-01-05 15:36:09'),
(50979, 19067, 39668, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:38:53', '2022-01-12 15:38:53'),
(50980, 19067, 39668, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:34:15', '2022-01-25 09:34:15'),
(50981, 19067, 39668, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:50:08', '2022-02-04 08:50:08'),
(50982, 19067, 39668, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:03:47', '2022-02-07 10:03:47'),
(50983, 19067, 39668, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:21', '2022-02-14 09:50:21'),
(50984, 19067, 39668, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com   Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099_02142022-4542489   Good Morning,     Please see notes below.     Helena Halterman  1801473749  Welcome letter for BHO plans sent to SNBC@claimsmedinc.com on 2.10.22 – still processing for MBHP, Fallon, BMC and Unicare – event 9303674 – allow more time  Allie DiCostanzo  1669045738  Still being worked under event 9306743 – allow more time  Eliza Rodrigues  1821751405  Still being worked under event 9309562 – allow more time  Lauren Powell  1285304980  Welcome letters sent on 2.7.22 and 2.9.22 to SNBC@Claimsmedinc.com with effective date – please check email        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-14 10:50:30', '2022-02-14 10:50:30'),
(50985, 19067, 39668, NULL, '2022-03-04 00:00:00.000', 'Approved', 'Received email from: dataentry@beaconhealthoptions.com  Subject: Beacon Health Options Alert for DICOSTANZO, ALLIE M-DE08 - GROUP PROVIDER WELCOME LETTER - BH{C1876364} zx      IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1876364}', NULL, NULL, '2022-02-25 11:07:45', '2022-02-25 11:07:45'),
(50986, 1019, 39669, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(50987, 1019, 39669, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Faxed the CAQH Application to (866) 612-7790. Attached is the application for reference. ', NULL, NULL, '2021-09-24 08:54:32', '2021-09-24 08:54:32'),
(50988, 1019, 39669, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:46:01', '2021-11-01 08:46:01'),
(50989, 1019, 39669, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:12:27', '2021-11-30 09:12:27'),
(50990, 11056, 39669, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:30', '2021-12-14 14:41:30'),
(50991, 19067, 39669, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:45', '2021-12-20 12:17:45'),
(50992, 19067, 39669, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:17', '2021-12-20 15:09:17'),
(50993, 19067, 39669, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:38:20', '2021-12-22 13:38:20'),
(50994, 19067, 39669, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:04:49', '2021-12-28 17:04:49'),
(50995, 19067, 39669, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:39:54', '2022-01-05 15:39:54'),
(50996, 19067, 39669, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:38:58', '2022-01-12 15:38:58'),
(50997, 19067, 39669, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:34:19', '2022-01-25 09:34:19'),
(50998, 19067, 39669, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:50:24', '2022-02-04 08:50:24'),
(50999, 19067, 39669, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:03:52', '2022-02-07 10:03:52'),
(51000, 19067, 39669, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:51:02', '2022-02-14 09:51:02');
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
(51001, 19067, 39669, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com   Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099_02142022-4542489   Good Morning,     Please see notes below.     Helena Halterman  1801473749  Welcome letter for BHO plans sent to SNBC@claimsmedinc.com on 2.10.22 – still processing for MBHP, Fallon, BMC and Unicare – event 9303674 – allow more time  Allie DiCostanzo  1669045738  Still being worked under event 9306743 – allow more time  Eliza Rodrigues  1821751405  Still being worked under event 9309562 – allow more time  Lauren Powell  1285304980  Welcome letters sent on 2.7.22 and 2.9.22 to SNBC@Claimsmedinc.com with effective date – please check email        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-14 10:50:25', '2022-02-14 10:50:25'),
(51002, 19067, 39669, NULL, '2022-03-04 00:00:00.000', 'Approved', 'Received email from: dataentry@beaconhealthoptions.com  Subject: Beacon Health Options Alert for DICOSTANZO, ALLIE M-DE08 - GROUP PROVIDER WELCOME LETTER - BH{C1876364} zx      IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1876364}', NULL, NULL, '2022-02-25 11:07:56', '2022-02-25 11:07:56'),
(51003, 1019, 39670, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51004, 1019, 39670, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Submitted the enrollment application via website, below is the confirmation for request. \"Thank you for your enrollment request. Within four business days of the submission of this form, you should receive an email that will serve to confirm receipt of your request. The email will also include an attachment that contains a packet of important forms such as a provider agreement, W9, EFT instructions, etc., as well as information that will help guide you through the initial credentialing process. Those forms should be completed and returned to Database.Credentialing@bcbsri.org as soon as possible. It is important to note that your application will not be considered complete until all of the required documents have been returned. Additionally, BCBSRI utilizes the CAQH application to credential providers. It is very important to ensure that you have made your CAQH accessible to BCBSRI and updated and attested to the information in CAQH within the last 120 days. If you do not receive an email response within two days after submitting this form please email Database.Credentialing@bcbsri.org to confirm the status of your submission and request that the packet be resent to you. We appreciate your interest in joining the BCBSRI network and will work to begin prompt processing of your request. However, please note the credentialing process may be discontinued if we are unable to access your CAQH application or if your CAQH application is not updated and attested to in the required timeframe, or if you do not return the provider agreement and required forms.\"\"', NULL, NULL, '2021-09-24 09:08:21', '2021-09-24 09:08:21'),
(51005, 1019, 39670, NULL, '2021-11-05 00:00:00.000', 'Not Eligible', 'Received the following email from BCBS.  This is to let you know that the we do not credential the specialty Clinical Social Worker (LCSW), we apologize that we cannot make participation for the Specialty provided below.  ', NULL, NULL, '2021-10-29 10:33:00', '2021-10-29 10:33:00'),
(51006, 1019, 39671, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51007, 1019, 39671, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', 'Cigna doesn\'t enroll LCSW providers.', NULL, NULL, '2021-09-24 09:19:05', '2021-09-24 09:19:05'),
(51008, 1019, 39672, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51009, 1019, 39672, NULL, '2021-10-05 00:00:00.000', 'On Hold', 'Waiting for Aetna to get enrolled first.', NULL, NULL, '2021-09-28 08:09:15', '2021-09-28 08:09:15'),
(51010, 1019, 39673, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51011, 1019, 39673, NULL, '2021-10-05 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Good morning Alyssa,  Can you please add the following providers under our group and also let me know if they need to fill out the credentialing application or not.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767.   Regards, Alex -- Alex G. | Claims Med | Office: 713-893-6214 Ext. 405 | Fax: 718-6402-713 | mu@claimsmedinc.com  CONFIDENTIALITY NOTICE: This e-mail and any files transmitted with it are the property of Claims Med or its affiliates, are confidential, and are intended solely for the use of the individual or entity to whom this e-mail is addressed. If you are not one of the named recipients or otherwise have reason to believe that you have received this e-mail in error, please notify the sender and delete this message immediately from your computer. Any other use, retention, dissemination, forwarding, printing or copying of this e-mail is strictly prohibited.', NULL, NULL, '2021-09-28 08:34:28', '2021-09-28 08:34:28'),
(51012, 1019, 39673, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:29', '2021-10-07 01:18:29'),
(51013, 11056, 39673, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:34:29', '2021-12-09 17:34:29'),
(51014, 19067, 39673, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:54', '2021-12-15 15:32:54'),
(51015, 19067, 39673, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:13', '2021-12-16 12:26:13'),
(51016, 19067, 39673, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:09', '2021-12-29 14:37:09'),
(51017, 19067, 39673, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:13', '2022-01-10 13:17:13'),
(51018, 19067, 39673, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:17:20', '2022-01-30 13:17:20'),
(51019, 19067, 39673, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:24:13', '2022-02-08 14:24:13'),
(51020, 19067, 39673, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:57:16', '2022-03-09 14:57:16'),
(51021, 19067, 39673, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:48:49', '2022-03-10 10:48:49'),
(51022, 22077, 39673, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:52:27', '2022-04-04 13:52:27'),
(51023, 1019, 39674, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51024, 1019, 39674, NULL, '2021-10-01 00:00:00.000', 'Initiated', 'Application submitted thru Magellan provider portal. ', NULL, NULL, '2021-09-24 09:18:34', '2021-09-24 09:18:34'),
(51025, 19067, 39674, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:19:04', '2021-12-15 14:19:04'),
(51026, 19067, 39674, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:40:42', '2021-12-15 16:40:42'),
(51027, 19067, 39674, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 13:59:58', '2021-12-29 13:59:58'),
(51028, 19067, 39674, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:16', '2022-01-10 13:22:16'),
(51029, 19067, 39674, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-04 18:01:36', '2022-02-04 18:01:36'),
(51030, 19067, 39674, NULL, '2022-02-18 00:00:00.000', 'Not Eligible', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:07:29', '2022-02-11 10:07:29'),
(51031, 1019, 39675, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51032, 1019, 39675, NULL, '2021-09-30 00:00:00.000', 'Initiated', 'Initiated the application through PECOS.', NULL, NULL, '2021-09-23 11:12:53', '2021-09-23 11:12:53'),
(51033, 1019, 39675, NULL, '2021-09-30 00:00:00.000', 'Approved', 'Received the following email from customerservice-donotreply@cms.hhs.gov  To:  allie.dicostanzo@gmail.com,snbc@claimsmedinc.com  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T091520210002782)  Date:  09/22/2021 10:16 AM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T091520210002782. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T091520210002782   NPI ID: 1669045738   Medicare ID: U400783753   Name: ALLIE DICOSTANZO  State: RI   Form Type: 855I  Date: 09/22/2021  Status: APPROVED  ---------------------------------------------------------', NULL, NULL, '2021-09-23 11:13:50', '2021-09-23 11:13:50'),
(51034, 1019, 39676, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51035, 1019, 39676, NULL, '2021-10-05 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in their systems', NULL, NULL, '2021-09-28 08:35:19', '2021-09-28 08:35:19'),
(51036, 1019, 39676, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN request initiated via railroad website ref - 21280000003', NULL, NULL, '2021-10-07 01:36:38', '2021-10-07 01:36:38'),
(51037, 1019, 39676, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 09/01/2021, Approval letter for reference.', NULL, NULL, '2021-11-16 15:51:40', '2021-11-16 15:51:40'),
(51038, 1019, 39677, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51039, 1019, 39677, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Tricare doesn\'t enroll LCSW.', NULL, NULL, '2021-10-06 23:47:51', '2021-10-06 23:47:51'),
(51040, 1019, 39678, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51041, 1019, 39678, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', 'Tufts doesn\'t enroll LCSW.', NULL, NULL, '2021-09-24 09:24:22', '2021-09-24 09:24:22'),
(51042, 1019, 39679, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51043, 1019, 39679, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', 'Tufts doesn\'t enroll LCSW.', NULL, NULL, '2021-09-24 09:24:32', '2021-09-24 09:24:32'),
(51044, 1019, 39680, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:12:02', '2021-09-23 11:12:02'),
(51045, 1019, 39680, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Submitted the application thru provider express, below is the email we received for refence. Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Allie DiCostanzo has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-11-04 08:24:37', '2021-11-04 08:24:37'),
(51046, 1019, 39680, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from UBH, attached is the location confirmation  11/18/2021    001112548    Allie DiCostanzo  snbc@claimsmedinc.com  snbc@claimsmedinc.com    Dear Allie DiCostanzo:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 11/17/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.  ', NULL, NULL, '2021-11-30 17:05:47', '2021-11-30 17:05:47'),
(51047, 1019, 39681, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-09-23 11:13:50', '2021-09-23 11:13:50'),
(51048, 1019, 39681, NULL, '2021-10-29 00:00:00.000', 'Initiated', 'Mailed out the attached application thru mail from RI office.', NULL, NULL, '2021-10-22 10:53:20', '2021-10-22 10:53:20'),
(51049, 19067, 39681, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Enrollment Status || SNBCARE || Allie DiCostanzo || MEDICAID ||  Hello!  Hope you are doing well and you are in the best health.  I would like to know the enrollment status of the following Provider with Medicaid.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:49:59', '2021-12-29 15:49:59'),
(51050, 19067, 39681, NULL, '2022-04-07 00:00:00.000', 'In Process', 'Email sent to: Dana.Wood@gainwelltechnologies.com  Subject: RE: RI Medicaid Revalidation NPI 1356906572    Good Morning Dana!  Hope you are having a beautiful day, kindly see the attached application to add new providers to the group.  Don\'t hesitate to contact me if you have any questions.  Thanks,', NULL, NULL, '2022-03-31 10:32:15', '2022-03-31 10:32:15'),
(51051, 1019, 39682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51052, 1019, 39682, NULL, '2021-10-08 00:00:00.000', 'Initiated', 'Submitted the online application thru website.  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-10-01 10:16:09', '2021-10-01 10:16:09'),
(51053, 1019, 39682, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:06:32', '2021-11-01 08:06:32'),
(51054, 1019, 39682, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:15:39', '2021-11-16 09:15:39'),
(51055, 11056, 39682, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:01', '2021-12-01 17:07:01'),
(51056, 19067, 39682, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:12:50', '2021-12-15 17:12:50'),
(51057, 19067, 39682, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:13', '2021-12-16 10:56:13'),
(51058, 19067, 39682, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:31:00', '2021-12-20 10:31:00'),
(51059, 19067, 39682, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:14', '2021-12-28 13:21:14'),
(51060, 19067, 39682, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:19', '2022-01-10 11:33:19'),
(51061, 19067, 39682, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:12:55', '2022-01-30 12:12:55'),
(51062, 1019, 39682, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:38', '2022-02-01 12:19:38'),
(51063, 19067, 39682, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:13:01', '2022-02-10 15:13:01'),
(51064, 19067, 39682, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:00:34', '2022-02-10 16:00:34'),
(51065, 19067, 39682, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:02:29', '2022-02-14 14:02:29'),
(51066, 19067, 39682, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:06:47', '2022-02-14 14:06:47'),
(51067, 1019, 39683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51068, 1019, 39683, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Faxed the attached CAQH application to (866) 612-7790 ', NULL, NULL, '2021-10-04 08:41:21', '2021-10-04 08:41:21'),
(51069, 1019, 39683, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:46:34', '2021-11-01 08:46:34'),
(51070, 1019, 39683, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:13:50', '2021-11-30 09:13:50'),
(51071, 11056, 39683, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:39:32', '2021-12-14 14:39:32'),
(51072, 19067, 39683, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:16:58', '2021-12-20 12:16:58'),
(51073, 19067, 39683, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:51', '2021-12-20 15:09:51');
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
(51074, 19067, 39683, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:43:22', '2021-12-22 13:43:22'),
(51075, 19067, 39683, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email received from:  praccredpsv@beaconhealthoptions.com  subject: Fwd: Beacon Health Options Alert for RODRIGUES, ELIZA C-CS06 - INITIAL CRE TERM FOR NON-RESPONSIVE{C1853362} zx   IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1853362}  PLEASE NOTE:  To prevent the unauthorized or inadvertent disclosure of sensitive company or personal health (PHI) information encrypted emails are only permitted to be replied/forwarded to Beacon Health Options’ domains, Beaconhealthoptions.com, ValueOptions.com and Beaconhs.com', NULL, NULL, '2021-12-22 13:45:14', '2021-12-22 13:45:14'),
(51076, 19067, 39683, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Submitted application through Portal, see attachment. ', NULL, NULL, '2021-12-22 13:46:04', '2021-12-22 13:46:04'),
(51077, 19067, 39683, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:04:02', '2021-12-28 17:04:02'),
(51078, 19067, 39683, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:36:05', '2022-01-05 15:36:05'),
(51079, 19067, 39683, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:40', '2022-01-12 15:39:40'),
(51080, 19067, 39683, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:35:35', '2022-01-25 09:35:35'),
(51081, 19067, 39683, NULL, '2022-02-01 00:00:00.000', 'Not Eligible', 'Not eligible due to ANCC.', NULL, NULL, '2022-01-25 09:36:09', '2022-01-25 09:36:09'),
(51082, 1019, 39684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51083, 1019, 39684, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Faxed the attached CAQH application to (866) 612-7790 ', NULL, NULL, '2021-10-04 08:41:56', '2021-10-04 08:41:56'),
(51084, 1019, 39684, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:46:53', '2021-11-01 08:46:53'),
(51085, 1019, 39684, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:14:05', '2021-11-30 09:14:05'),
(51086, 11056, 39684, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:36', '2021-12-14 14:41:36'),
(51087, 19067, 39684, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:59', '2021-12-20 12:17:59'),
(51088, 19067, 39684, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:02', '2021-12-20 15:10:02'),
(51089, 19067, 39684, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:42:43', '2021-12-22 13:42:43'),
(51090, 19067, 39684, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email received from:  praccredpsv@beaconhealthoptions.com  subject: Fwd: Beacon Health Options Alert for RODRIGUES, ELIZA C-CS06 - INITIAL CRE TERM FOR NON-RESPONSIVE{C1853362} zx   IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1853362}  PLEASE NOTE:  To prevent the unauthorized or inadvertent disclosure of sensitive company or personal health (PHI) information encrypted emails are only permitted to be replied/forwarded to Beacon Health Options’ domains, Beaconhealthoptions.com, ValueOptions.com and Beaconhs.com', NULL, NULL, '2021-12-22 13:45:31', '2021-12-22 13:45:31'),
(51091, 19067, 39684, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Submitted application through Portal, see attachment. ', NULL, NULL, '2021-12-22 13:46:36', '2021-12-22 13:46:36'),
(51092, 19067, 39684, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:04:13', '2021-12-28 17:04:13'),
(51093, 19067, 39684, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:39:46', '2022-01-05 15:39:46'),
(51094, 19067, 39684, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:53', '2022-01-12 15:39:53'),
(51095, 19067, 39684, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:35:44', '2022-01-25 09:35:44'),
(51096, 19067, 39684, NULL, '2022-02-01 00:00:00.000', 'Not Eligible', 'Not eligible due to ANCC.', NULL, NULL, '2022-01-25 09:36:20', '2022-01-25 09:36:20'),
(51097, 1019, 39685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51098, 1019, 39685, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Application Faxed to 617-246-5053, attached is the application for ref', NULL, NULL, '2021-10-04 10:10:03', '2021-10-04 10:10:03'),
(51099, 1019, 39685, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Spoken with Chris Ref 11/01/2021 - Chris  As per her they received our AANP on 10/29 as they were requesting for her ANCC but she doesn\'t have it. So they will review her AANP and the decide.', NULL, NULL, '2021-11-01 09:17:13', '2021-11-01 09:17:13'),
(51100, 1019, 39685, NULL, '2021-11-23 00:00:00.000', 'On Hold', 'Received the following email from BCBS MA,  Dear Provider: Blue Cross Blue Shield of Massachusetts (BCBSMA*) has received your request for Dina Filoteo-Nichols. Unfortunately, we are unable to process your request due to the following;  Incomplete - A copy of the providers ANCC Certification is missing from the application submission.  Please note; the complete application/update form and all required documentation must be resubmitted for processing.  If you have any questions regarding credentialing or enrollment, please email providerapplicationstatus@bcbsma.com for further assistance.   Sincerely, Contract Operations Blue Cross Blue Shield of Massachusetts  As Dina will get her ANCC after her PMHNP. ', NULL, NULL, '2021-11-16 10:14:46', '2021-11-16 10:14:46'),
(51101, 1019, 39686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51102, 1019, 39686, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Application Submitted online thru website, see below for ref.  Thank you for your interest in joining the Evernorth Behavioral Health network. We have received your application. Please note down your Application-ID CBP-0000239302. An Evernorth Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@evernorth.com or call Provider Services at 1.800.926.2273.', NULL, NULL, '2021-10-04 10:29:17', '2021-10-04 10:29:17'),
(51103, 1019, 39686, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Received the following email from Cigna/Evernorth  Hello,     Please see below for the provider status update.     Allie DiCostanzo  Status- Unable to locate an application for this provider     Diana Filoteo- Nichols  Your clinic application has been received, a recruiter will be outreaching you to follow up.     Helena Halterman  Status- Packet Received  Recruiter contact- Kristen.McCanlies@evernorth.com     Jessica Hartman  Status- Contracted- Effective date: 06/09/2021     Erin Oliva  Status- Contracted- Effective date: 05/19/2021', NULL, NULL, '2021-11-02 07:18:49', '2021-11-02 07:18:49'),
(51104, 1019, 39686, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Received the following email from Julia.  Dear Dina Filoteo Nichols  Congratulations! Your Evernorth Behavioral Provider Application has been processed. As your Evernorth recruiter, I will assist you with credentialing, help to alleviate administrative burden, and answer any questions you may have.  Next steps Below are the next steps to become a fully contracted provider with Evernorth. Please take action where necessary to avoid delays in the credentialing process.  Electronic credentialing packet and agreement. This material will be sent via Docusign. Please review and sign. Note: Be sure to check your spam/junk folder.  Update your Council for Affordable Quality Healthcare (CAQH) account  Current and valid attestation of the CAQH profile. You must re-attest your CAQH application after making any changes in your account. Valid professional state license. Current expiration date must be at least 60 days from the receipt of this communication. Professional liability insurance. Current expiration date must be at least 60 days from the receipt of this communication. Work history and education. You must have minimum of five years of current experience without any gaps exceeding three months. Credentialing. Once all of the above is completed, your application will be sent to Evernorth\'s credentialing team. Please note that the credentialing process can take up to 90 days, depending on the response time of the respective institutions.  Contracting. Once we finish verifying your credentials, an email will be sent to you with a copy of your final agreement. The subject line of this email will begin with “Status Update: Completed.” The agreement will include Evernorth\'s countersignature and your effective date as a contracted provider.  Thank you for applying to participate in the Evernorth Behavioral Health network. We look forward to working with you and helping you realize your professional goals.           +  Julia Perkins  Provider Relations Analyst, Behavioral Health', NULL, NULL, '2021-11-09 11:30:50', '2021-11-09 11:30:50'),
(51105, 1019, 39686, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Cigna,  KERRY SMITH holds a Licensed Certified Social Worker which is Not accepted in the state of ma.     Helena Halterman– provider is in que for credentialing at current time there is no action needed from the provider or your office.     Dina Filoteo Nichols-Packet sent – your assigned Evernorth Recruiter has reviewed your Provider Information Form and has sent your onboarding packet via DocuSign. Please review, and sign.     Eliza Rodrigues- I do not show an application on file.     +  Julia Perkins', NULL, NULL, '2021-11-30 13:06:45', '2021-11-30 13:06:45'),
(51106, 11056, 39686, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  Behavioralcontracting@evernorth.com , Kristen.McCanlies@evernorth.com & Julia.Perkins@evernorth.com  Sub:  Re: [External] Enrollment Status || Providers || SNBCARE || CIGNA  Good Morning,     I need an update on the credentialing process for the following providers.     Group Name  Spectrum Neuro Behavioral Care LLC  Tax ID  2753  Group NPI  1356906572  Smith, Kerry  1275083230  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Smith, Kerry  1275083230  100 New State Highway, Raynham, MA, 02767.  Halterman, Helena  1801473749  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Halterman, Helena  1801473749  100 New State Highway, Raynham, MA, 02767.  Filoteo-Nichols, Dina  1770021099  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Filoteo-Nichols, Dina  1770021099  100 New State Highway, Raynham, MA, 02767.  Rodrigues, Eliza  1821751405  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Rodrigues, Eliza  1821751405  100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-12-02 17:53:18', '2021-12-02 17:53:18'),
(51107, 19067, 39686, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: behPWS@cigna.com, Romelyn.Lucar@evernorth.com, Kristen.McCanlies@evernorth.com, Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 13:30:43', '2021-12-16 13:30:43'),
(51108, 19067, 39686, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Behavioralcontracting@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||   Hello Hammad,     Dina Filoteo-Nichols is currently in process.  Julie is the recruiter that is currently assisting with the onboarding process.  I have included her in this email so you may reach out to her directly.  Helena Halterman is currently in process.  Kristen is currently assisting with the onboarding process. I have included her in this email so you may reach out to her directly.  Jessica Hartman is currently affiliated with 63 Eddie Dowling Hwy, Ste. 9 North Smithfield, RI 02896.  If Ste. 8 is the correct suite we will either need you to add that location or update that location.  I have included the change form.  Erin Oliva is currently in process.  Romelyn is currently assisting with the onboarding process.  I have included their email so you may reach out to them directly.        Rochelle  Provider Relations Analyst, Behavioral Health  E: BehavioralContracting@Evernorth.com', NULL, NULL, '2021-12-16 17:29:55', '2021-12-16 17:29:55'),
(51109, 19067, 39686, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: Kristen.McCanlies@evernorth.com  Subject: Automatic reply: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Thank you for your email.  Please note, due to a high volume of provider requests to join the network, it may take your Cigna Recruiter 3-5 days to respond to your email.     We appreciate your patience during this time.     Thank you,     Kristen McCanlies  Behavioral NCU | Provider Relations Associate Analyst  T: 903.337.2488 | F: 860.687.7181  Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.©Copyright 2021 Cigna.', NULL, NULL, '2021-12-17 15:02:40', '2021-12-17 15:02:40'),
(51110, 19067, 39686, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 18:02:49', '2021-12-28 18:02:49'),
(51111, 19067, 39686, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||    Both providers are in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  F:  860.697.6085  EVERNORTH.COM', NULL, NULL, '2021-12-29 09:12:33', '2021-12-29 09:12:33'),
(51112, 19067, 39686, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Re: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Greetings!  Any updates on the previously mentioned request?  Kindly respond as soon as you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:08:25', '2022-01-10 13:08:25'),
(51113, 19067, 39686, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||     Both providers are in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  EVERNORTH.COM', NULL, NULL, '2022-02-04 09:40:02', '2022-02-04 09:40:02'),
(51114, 19067, 39686, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Re: [External] Enrollment Status || SNBCARE || Dina Filoteo-Nichols || Cigna ||   Hi Julie!  Hope you are doing well.  Any updates on the credentialing process of the provider, Dina Nichols?   Regards, Hammad.', NULL, NULL, '2022-02-11 09:59:27', '2022-02-11 09:59:27'),
(51115, 19067, 39686, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: RE: [External] Enrollment Status || SNBCARE || Dina Filoteo-Nichols || Cigna ||    Dina Nichols is in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date.     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  EVERNORTH.COM', NULL, NULL, '2022-02-16 09:51:55', '2022-02-16 09:51:55'),
(51116, 19067, 39686, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Email received from: Julia.Perkins@evernorth.com  Subject: Completed: MA 14140252 Dina Filoteo Nichols Evernorth behavioral Contract BID    Congratulations! You are now a fully credentialed and contracted provider in the Cigna Behavioral Health network. You may access your signed agreement by clicking on the “Completed Documented” box below. No further action is required of you at this time.', NULL, NULL, '2022-03-10 15:30:19', '2022-03-10 15:30:19'),
(51117, 1019, 39687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51118, 1019, 39687, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  Hello, We want to enroll the following provider with CCA under our group, please see attached application. Let me know if anything else is required.', NULL, NULL, '2021-10-04 10:41:11', '2021-10-04 10:41:11'),
(51119, 1019, 39687, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from PNM CCA.  October 22, 2021     Dina Paula Filoteo-Nichols, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 10/22/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111', NULL, NULL, '2021-11-16 15:20:32', '2021-11-16 15:20:32'),
(51120, 1019, 39688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51121, 1019, 39688, NULL, '2021-10-11 00:00:00.000', 'On Hold', 'Waiting to get enrolled with Aetna first.', NULL, NULL, '2021-10-04 10:41:59', '2021-10-04 10:41:59'),
(51122, 1019, 39689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:14', '2021-10-01 08:08:14'),
(51123, 1019, 39689, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:21', '2021-10-07 01:18:21'),
(51124, 1019, 39689, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Provider roster was sent out to Monica at humana to add the providers under our group, attached is the group roster for reference.', NULL, NULL, '2021-10-28 10:55:54', '2021-10-28 10:55:54'),
(51125, 11056, 39689, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:34:23', '2021-12-09 17:34:23'),
(51126, 19067, 39689, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:33:00', '2021-12-15 15:33:00'),
(51127, 19067, 39689, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:31', '2021-12-16 12:26:31'),
(51128, 19067, 39689, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:04', '2021-12-29 14:37:04'),
(51129, 19067, 39689, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:06', '2022-01-10 13:17:06'),
(51130, 19067, 39689, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:14:03', '2022-01-30 13:14:03'),
(51131, 19067, 39689, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:08', '2022-02-08 14:23:08'),
(51132, 19067, 39689, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:14', '2022-03-09 14:56:14'),
(51133, 19067, 39689, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:48:42', '2022-03-10 10:48:42'),
(51134, 22077, 39689, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:52:07', '2022-04-04 13:52:07'),
(51135, 1019, 39690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51136, 1019, 39690, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Application Submmitted online thru provider portal.  ', NULL, NULL, '2021-10-04 11:03:24', '2021-10-04 11:03:24');
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
(51137, 1019, 39690, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Request Declined due to her ANCC. See below for reference.  Filoteo-Nichols, Dina  1770021099  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  The provider was delinked because there was no ANCC Psych Certification found.  Filoteo-Nichols, Dina  1770021099  100 New State Highway, Raynham, MA, 02767.  The provider was delinked because there was no ANCC Psych ', NULL, NULL, '2021-11-30 14:19:53', '2021-11-30 14:19:53'),
(51138, 1019, 39691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51139, 1019, 39691, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Application was emailed to MassHealth at pec@maximus.com', NULL, NULL, '2021-11-30 14:23:07', '2021-11-30 14:23:07'),
(51140, 11056, 39691, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Status:   Dina Nichols Application is in process     Application # ATN 226947.', NULL, NULL, '2021-12-09 14:25:27', '2021-12-09 14:25:27'),
(51141, 19067, 39691, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com Subject: Provider Enrollment Status - SNBC Raynham  Hello,  Hope you are having a productive day.  I want to know enrollment status for the following provider.  Practice name: Spectrum Neuro Behavioral Care LLC. - Raynham Tax ID: 83-4482753  Provider name: Dina Filoteo-Nichols Provider NPI: 1770021099  If the provider is enrolled then provide us the Effective date and Welcome letter.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 13:31:24', '2021-12-15 13:31:24'),
(51142, 19067, 39691, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com  Subject: Enrollment Status || SNBCARE || Dina Filoteo-Nichols || Mass Health ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider with Mass Health.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 15:38:04', '2021-12-29 15:38:04'),
(51143, 19067, 39691, NULL, '2022-01-06 00:00:00.000', 'Approved', 'Email received from: PEC@maximus.com  Subject: Enrollment Status || SNBCARE || Dina Filoteo-Nichols || Mass Health ||   Good Morning,     Thank you for your inquiry!     Dina Filoteo-Nichols, PID/SL 110180219A, has been enrolled as a Fee-For-Service provider linked to group SNBCARE, PID/SL 110159328A, with MassHealth effective 12/10/2021.     If you have any questions or concerns please feel free to contact us.     Best Regards,', NULL, NULL, '2021-12-30 15:42:37', '2021-12-30 15:42:37'),
(51144, 1019, 39692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51145, 1019, 39692, NULL, '2021-10-08 00:00:00.000', 'Initiated', 'Initiated thru Pecos.', NULL, NULL, '2021-10-01 08:12:53', '2021-10-01 08:12:53'),
(51146, 1019, 39692, NULL, '2021-10-08 00:00:00.000', 'On Hold', 'Waiting for Cultural Competency', NULL, NULL, '2021-10-01 08:13:29', '2021-10-01 08:13:29'),
(51147, 1019, 39693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51148, 1019, 39693, NULL, '2021-10-08 00:00:00.000', 'Initiated', 'Initiated thru Pecos.', NULL, NULL, '2021-10-01 08:14:19', '2021-10-01 08:14:19'),
(51149, 1019, 39693, NULL, '2021-10-08 00:00:00.000', 'Initiated', 'Initiated thru Pecos.', NULL, NULL, '2021-10-01 08:14:20', '2021-10-01 08:14:20'),
(51150, 1019, 39693, NULL, '2021-10-08 00:00:00.000', 'Approved', 'Eff date 09/01/2021, Attached is the approval confirmation. ', NULL, NULL, '2021-10-01 08:16:27', '2021-10-01 08:16:27'),
(51151, 1019, 39694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51152, 1019, 39694, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN has been provided waiting to get active as it take upto 3 days.', NULL, NULL, '2021-10-07 01:32:12', '2021-10-07 01:32:12'),
(51153, 1019, 39694, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 09/01/2021, see attached letter for approval.', NULL, NULL, '2021-11-16 15:46:30', '2021-11-16 15:46:30'),
(51154, 1019, 39695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51155, 1019, 39695, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Enrollment Application faxed at (608) 221-7535, attached is the application for ref ', NULL, NULL, '2021-10-06 23:45:21', '2021-10-06 23:45:21'),
(51156, 19067, 39695, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:09:45', '2021-12-16 14:09:45'),
(51157, 19067, 39695, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:06:43', '2021-12-29 12:06:43'),
(51158, 19067, 39695, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:13:39', '2022-01-10 14:13:39'),
(51159, 19067, 39695, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:49', '2022-01-11 09:37:49'),
(51160, 19067, 39695, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:46:39', '2022-01-11 10:46:39'),
(51161, 19067, 39695, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:30', '2022-02-11 11:16:30'),
(51162, 19067, 39695, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:22:39', '2022-02-11 11:22:39'),
(51163, 19067, 39695, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:48:40', '2022-03-17 09:48:40'),
(51164, 19067, 39695, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:33:38', '2022-03-17 10:33:38'),
(51165, 19067, 39695, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:35:57', '2022-03-17 10:35:57'),
(51166, 19067, 39695, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:57:44', '2022-03-17 13:57:44'),
(51167, 19067, 39695, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject: Enrollment Query || Dina Filoteo-Nichols || SNBCARE || Tricare    Hi,  Can you please provide me with the enrollment status of the following provider with Tricare,  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Dina Filoteo-Nichols	1770021099 Dina Filoteo-Nichols	1770021099  Regards,', NULL, NULL, '2022-03-17 15:24:49', '2022-03-17 15:24:49'),
(51168, 19067, 39695, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: DRussell16@humana.com  Subject: Enrollment Query || Dina Filoteo-Nichols || SNBCARE || Tricare    Hey there,     My apologies for having to redirect you, but in order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions. We have improved our features of the Humana Military Provider Portal, and are encouraging providers to use the Humana Military Provider Portal to take care of nearly all provider-related needs. Submitting credentialing documents, editing provider info, adding / removing providers from locations from your Tax ID, adding / removing group locations from your Tax ID, etc. It also has the capability for you to submit secure messages directly through the portal, and can submit questions or documents through the appropriate channel.     I have attached 2 documents that give valuable info on how to sign up for and utilize the provider portal. Please go to https://infocenter.humana-military.com/provider/service/Account/Login to start the sign-up process. I recommend signing up with the Tax Ids that you oversee. I do sincerely recommend this, as any questions and provider documents submitted through a secure message will be attended to by not just me, but our New England Market team.     Thanks,     Adam', NULL, NULL, '2022-03-18 13:30:28', '2022-03-18 13:30:28'),
(51169, 22077, 39695, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject: Enrollment Query || Dina Filoteo-Nichols || SNBCARE || Tricare  Hi,    Can you please provide me with the enrollment status of the following provider with Tricare,    Group Name: Spectrum Neuro Behavioral Care LLC   Tax ID: 834482753   Group NPI: 1356906572   Primary & Billing Address: 61 Lincoln St, Ste 203, Framingham, MA 01702   Secondary Address: 100 New State Highway, Raynham, MA 02767   Provider Name  NPI  Dina Filoteo-Nichols  1770021099  Dina Filoteo-Nichols  1770021099    Regards,', NULL, NULL, '2022-04-07 07:51:03', '2022-04-07 07:51:03'),
(51170, 1019, 39696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51171, 1019, 39696, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, provider_data_request@tufts-health.com  Good Morning,  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now. ', NULL, NULL, '2021-10-04 11:23:35', '2021-10-04 11:23:35'),
(51172, 1019, 39696, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application || Dina Nichols || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-10-04 12:19:43 EDT.  Please reference ticket number PRO0151068 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7669426', NULL, NULL, '2021-10-19 07:30:26', '2021-10-19 07:30:26'),
(51173, 1019, 39696, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Received the following email from Tufts.  Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and mailing address) and return to us so that we may countersign it.', NULL, NULL, '2021-11-18 09:48:56', '2021-11-18 09:48:56'),
(51174, 1019, 39696, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Sent the signed agreement back to tufts see attached for reference.', NULL, NULL, '2021-11-18 09:50:23', '2021-11-18 09:50:23'),
(51175, 11056, 39696, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:51:34', '2021-12-03 14:51:34'),
(51176, 19067, 39696, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:39:50', '2021-12-15 17:39:50'),
(51177, 19067, 39696, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:18', '2021-12-29 10:05:18'),
(51178, 19067, 39696, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:33', '2022-01-10 14:44:33'),
(51179, 19067, 39696, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:06', '2022-02-11 11:39:06'),
(51180, 22077, 39696, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:08:07', '2022-04-05 10:08:07'),
(51181, 1019, 39697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51182, 1019, 39697, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, provider_data_request@tufts-health.com  Good Morning,  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now. ', NULL, NULL, '2021-10-04 11:24:37', '2021-10-04 11:24:37'),
(51183, 1019, 39697, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application || Dina Nichols || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-10-04 12:19:43 EDT.  Please reference ticket number PRO0151068 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7669426', NULL, NULL, '2021-10-19 07:30:46', '2021-10-19 07:30:46'),
(51184, 11056, 39697, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:53:26', '2021-12-03 14:53:26'),
(51185, 19067, 39697, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:40:07', '2021-12-15 17:40:07'),
(51186, 19067, 39697, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:29', '2021-12-29 10:05:29'),
(51187, 19067, 39697, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:45:56', '2022-01-10 14:45:56'),
(51188, 19067, 39697, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:15', '2022-02-11 11:39:15'),
(51189, 22077, 39697, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:41:40', '2022-04-05 10:41:40'),
(51190, 1019, 39698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:08:15', '2021-10-01 08:08:15'),
(51191, 1019, 39698, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Received the following confirmation thru email for Application Submission.  Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Dina Filoteo-Nichols has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-10-04 14:24:28', '2021-10-04 14:24:28'),
(51192, 1019, 39698, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Received the following email from Optum.  10/25/2021   Attn:  Alex Garrett, Credentialing Contact  dfiloteonichols@gmail.com  snbc@claimsmedinc.com    RE:  Network Participation - Dina Filoteo Nichols    Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application; however, your license/board certification does not meet the Optum Behavioral Health credentialing criteria for nurses as listed below:   Nurses with prescriptive authority must be licensed and/or registered in Psychiatric / Mental Health as required by the state. State law also determines whether board certification through the American Nursing Credentialing Center (ANCC), the American Academy of Nurse Practitioners (AANP), or other national certification in behavioral health is required.  If you provide non-behavioral services, please visit UHCprovider.com, and click the link \'Join Our Network/Credentialing\' at the bottom of the screen under Service Links.  If you have questions, please call UnitedHealthcare Provider Service Voice Portal at 1-877-842-3210.  ', NULL, NULL, '2021-11-30 17:15:34', '2021-11-30 17:15:34'),
(51193, 1019, 39699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51194, 1019, 39699, NULL, '2021-10-08 00:00:00.000', 'Initiated', 'Submitted the online application thru website.  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-10-01 10:15:51', '2021-10-01 10:15:51'),
(51195, 1019, 39699, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:06:16', '2021-11-01 08:06:16'),
(51196, 1019, 39699, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:15:30', '2021-11-16 09:15:30'),
(51197, 11056, 39699, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:06:55', '2021-12-01 17:06:55'),
(51198, 19067, 39699, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:12:44', '2021-12-15 17:12:44'),
(51199, 19067, 39699, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:08', '2021-12-16 10:56:08'),
(51200, 19067, 39699, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:56', '2021-12-20 10:30:56'),
(51201, 19067, 39699, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:09', '2021-12-28 13:21:09'),
(51202, 19067, 39699, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:12', '2022-01-10 11:33:12'),
(51203, 19067, 39699, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:12:47', '2022-01-30 12:12:47'),
(51204, 1019, 39699, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:33', '2022-02-01 12:19:33'),
(51205, 19067, 39699, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:56', '2022-02-10 15:12:56'),
(51206, 19067, 39699, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:00:29', '2022-02-10 16:00:29'),
(51207, 19067, 39699, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:02:22', '2022-02-14 14:02:22'),
(51208, 19067, 39699, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:06:25', '2022-02-14 14:06:25'),
(51209, 1019, 39700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51210, 1019, 39700, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Faxed the attached CAQH application to (866) 612-7790 ', NULL, NULL, '2021-10-04 08:41:01', '2021-10-04 08:41:01'),
(51211, 1019, 39700, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:46:23', '2021-11-01 08:46:23'),
(51212, 1019, 39700, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:13:41', '2021-11-30 09:13:41'),
(51213, 11056, 39700, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:39:38', '2021-12-14 14:39:38'),
(51214, 19067, 39700, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:16:52', '2021-12-20 12:16:52');
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
(51215, 19067, 39700, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:47', '2021-12-20 15:09:47'),
(51216, 19067, 39700, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email received from:  praccredpsv@beaconhealthoptions.com  subject: Fwd: Beacon Health Options Alert for RODRIGUES, ELIZA C-CS06 - INITIAL CRE TERM FOR NON-RESPONSIVE{C1853362} zx   IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1853362}  PLEASE NOTE:  To prevent the unauthorized or inadvertent disclosure of sensitive company or personal health (PHI) information encrypted emails are only permitted to be replied/forwarded to Beacon Health Options’ domains, Beaconhealthoptions.com, ValueOptions.com and Beaconhs.com', NULL, NULL, '2021-12-22 13:31:17', '2021-12-22 13:31:17'),
(51217, 19067, 39700, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Submitted application through Portal, see attachment.', NULL, NULL, '2021-12-22 13:31:59', '2021-12-22 13:31:59'),
(51218, 19067, 39700, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:57', '2021-12-28 17:03:57'),
(51219, 19067, 39700, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:36:00', '2022-01-05 15:36:00'),
(51220, 19067, 39700, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:34', '2022-01-12 15:39:34'),
(51221, 19067, 39700, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:35:30', '2022-01-25 09:35:30'),
(51222, 19067, 39700, NULL, '2022-02-01 00:00:00.000', 'Not Eligible', 'Not eligible due to ANCC.', NULL, NULL, '2022-01-25 09:36:02', '2022-01-25 09:36:02'),
(51223, 1019, 39701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51224, 1019, 39701, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Faxed the attached CAQH application to (866) 612-7790 ', NULL, NULL, '2021-10-04 08:41:39', '2021-10-04 08:41:39'),
(51225, 1019, 39701, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Shashi.  Good afternoon,     We have looked into the providers listed below in table and have a few updates:     Jessica Hartman – Missing ANCC certification and the application has been denied. You will need to reapply for this provider on the online portal including the ANCC certification.     The other 3 providers listed below are currently in process.     Please let me know if you have any other questions.     Thank you', NULL, NULL, '2021-11-01 08:46:45', '2021-11-01 08:46:45'),
(51226, 1019, 39701, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:13:58', '2021-11-30 09:13:58'),
(51227, 11056, 39701, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:43', '2021-12-14 14:41:43'),
(51228, 19067, 39701, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:52', '2021-12-20 12:17:52'),
(51229, 19067, 39701, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:09:56', '2021-12-20 15:09:56'),
(51230, 19067, 39701, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:43:04', '2021-12-22 13:43:04'),
(51231, 19067, 39701, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email received from:  praccredpsv@beaconhealthoptions.com  subject: Fwd: Beacon Health Options Alert for RODRIGUES, ELIZA C-CS06 - INITIAL CRE TERM FOR NON-RESPONSIVE{C1853362} zx   IMPORTANT MESSAGE: Attached you will find correspondence from Beacon Health Options that may require information or action on your part. Please do not reply to this email address directly. This is an unmonitored address and replies to this address cannot be responded to or read. Should you have any questions regarding the attachment or cannot open it, please contact the National Provider Line at (800) 397-1630, between 8 A.M and 5 P.M EST, Monday through Friday. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, use or copying of this information is STRICTLY PROHIBITED. If you have received this information in error, please notify Beacon Health Options immediately and destroy or return the information.  For internal use only {C1853362}  PLEASE NOTE:  To prevent the unauthorized or inadvertent disclosure of sensitive company or personal health (PHI) information encrypted emails are only permitted to be replied/forwarded to Beacon Health Options’ domains, Beaconhealthoptions.com, ValueOptions.com and Beaconhs.com', NULL, NULL, '2021-12-22 13:45:21', '2021-12-22 13:45:21'),
(51232, 19067, 39701, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Submitted application through Portal, see attachment. ', NULL, NULL, '2021-12-22 13:46:19', '2021-12-22 13:46:19'),
(51233, 19067, 39701, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:04:08', '2021-12-28 17:04:08'),
(51234, 19067, 39701, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:39:39', '2022-01-05 15:39:39'),
(51235, 19067, 39701, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:47', '2022-01-12 15:39:47'),
(51236, 19067, 39701, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458   Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:35:39', '2022-01-25 09:35:39'),
(51237, 19067, 39701, NULL, '2022-02-01 00:00:00.000', 'Not Eligible', 'Not eligible due to ANCC.', NULL, NULL, '2022-01-25 09:36:14', '2022-01-25 09:36:14'),
(51238, 1019, 39702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51239, 1019, 39702, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Application Faxed to 617-246-5053, attached is the application for ref', NULL, NULL, '2021-10-04 10:09:40', '2021-10-04 10:09:40'),
(51240, 1019, 39702, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Spoken with Chris Ref 11/01/2021 - Chris  As per her they received our AANP on 10/29 as they were requesting for her ANCC but she doesn\'t have it. So they will review her AANP and the decide.', NULL, NULL, '2021-11-01 09:17:04', '2021-11-01 09:17:04'),
(51241, 1019, 39702, NULL, '2021-11-23 00:00:00.000', 'On Hold', 'Received the following email from BCBS MA,  Dear Provider: Blue Cross Blue Shield of Massachusetts (BCBSMA*) has received your request for Dina Filoteo-Nichols. Unfortunately, we are unable to process your request due to the following;  Incomplete - A copy of the providers ANCC Certification is missing from the application submission.  Please note; the complete application/update form and all required documentation must be resubmitted for processing.  If you have any questions regarding credentialing or enrollment, please email providerapplicationstatus@bcbsma.com for further assistance.   Sincerely, Contract Operations Blue Cross Blue Shield of Massachusetts  As Dina will get her ANCC after her PMHNP. ', NULL, NULL, '2021-11-16 10:14:37', '2021-11-16 10:14:37'),
(51242, 1019, 39703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51243, 1019, 39703, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Application Submitted online thru website, see below for ref.  Thank you for your interest in joining the Evernorth Behavioral Health network. We have received your application. Please note down your Application-ID CBP-0000239302. An Evernorth Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@evernorth.com or call Provider Services at 1.800.926.2273.', NULL, NULL, '2021-10-04 10:29:09', '2021-10-04 10:29:09'),
(51244, 1019, 39703, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Received the following email from Cigna/Evernorth  Hello,     Please see below for the provider status update.     Allie DiCostanzo  Status- Unable to locate an application for this provider     Diana Filoteo- Nichols  Your clinic application has been received, a recruiter will be outreaching you to follow up.     Helena Halterman  Status- Packet Received  Recruiter contact- Kristen.McCanlies@evernorth.com     Jessica Hartman  Status- Contracted- Effective date: 06/09/2021     Erin Oliva  Status- Contracted- Effective date: 05/19/2021', NULL, NULL, '2021-11-02 07:18:37', '2021-11-02 07:18:37'),
(51245, 1019, 39703, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Received the following email from Julia.  Dear Dina Filoteo Nichols  Congratulations! Your Evernorth Behavioral Provider Application has been processed. As your Evernorth recruiter, I will assist you with credentialing, help to alleviate administrative burden, and answer any questions you may have.  Next steps Below are the next steps to become a fully contracted provider with Evernorth. Please take action where necessary to avoid delays in the credentialing process.  Electronic credentialing packet and agreement. This material will be sent via Docusign. Please review and sign. Note: Be sure to check your spam/junk folder.  Update your Council for Affordable Quality Healthcare (CAQH) account  Current and valid attestation of the CAQH profile. You must re-attest your CAQH application after making any changes in your account. Valid professional state license. Current expiration date must be at least 60 days from the receipt of this communication. Professional liability insurance. Current expiration date must be at least 60 days from the receipt of this communication. Work history and education. You must have minimum of five years of current experience without any gaps exceeding three months. Credentialing. Once all of the above is completed, your application will be sent to Evernorth\'s credentialing team. Please note that the credentialing process can take up to 90 days, depending on the response time of the respective institutions.  Contracting. Once we finish verifying your credentials, an email will be sent to you with a copy of your final agreement. The subject line of this email will begin with “Status Update: Completed.” The agreement will include Evernorth\'s countersignature and your effective date as a contracted provider.  Thank you for applying to participate in the Evernorth Behavioral Health network. We look forward to working with you and helping you realize your professional goals.           +  Julia Perkins  Provider Relations Analyst, Behavioral Health', NULL, NULL, '2021-11-09 11:30:34', '2021-11-09 11:30:34'),
(51246, 1019, 39703, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Cigna,  KERRY SMITH holds a Licensed Certified Social Worker which is Not accepted in the state of ma.     Helena Halterman– provider is in que for credentialing at current time there is no action needed from the provider or your office.     Dina Filoteo Nichols-Packet sent – your assigned Evernorth Recruiter has reviewed your Provider Information Form and has sent your onboarding packet via DocuSign. Please review, and sign.     Eliza Rodrigues- I do not show an application on file.     +  Julia Perkins', NULL, NULL, '2021-11-30 13:06:31', '2021-11-30 13:06:31'),
(51247, 11056, 39703, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  Behavioralcontracting@evernorth.com , Kristen.McCanlies@evernorth.com & Julia.Perkins@evernorth.com  Sub:  Re: [External] Enrollment Status || Providers || SNBCARE || CIGNA  Good Morning,     I need an update on the credentialing process for the following providers.     Group Name  Spectrum Neuro Behavioral Care LLC  Tax ID  2753  Group NPI  1356906572  Smith, Kerry  1275083230  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Smith, Kerry  1275083230  100 New State Highway, Raynham, MA, 02767.  Halterman, Helena  1801473749  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Halterman, Helena  1801473749  100 New State Highway, Raynham, MA, 02767.  Filoteo-Nichols, Dina  1770021099  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Filoteo-Nichols, Dina  1770021099  100 New State Highway, Raynham, MA, 02767.  Rodrigues, Eliza  1821751405  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Rodrigues, Eliza  1821751405  100 New State Highway, Raynham, MA, 02767.   ', NULL, NULL, '2021-12-02 17:53:00', '2021-12-02 17:53:00'),
(51248, 19067, 39703, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: behPWS@cigna.com, Romelyn.Lucar@evernorth.com, Kristen.McCanlies@evernorth.com, Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 13:25:01', '2021-12-16 13:25:01'),
(51249, 19067, 39703, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Behavioralcontracting@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||   Hello Hammad,     Dina Filoteo-Nichols is currently in process.  Julie is the recruiter that is currently assisting with the onboarding process.  I have included her in this email so you may reach out to her directly.  Helena Halterman is currently in process.  Kristen is currently assisting with the onboarding process. I have included her in this email so you may reach out to her directly.  Jessica Hartman is currently affiliated with 63 Eddie Dowling Hwy, Ste. 9 North Smithfield, RI 02896.  If Ste. 8 is the correct suite we will either need you to add that location or update that location.  I have included the change form.  Erin Oliva is currently in process.  Romelyn is currently assisting with the onboarding process.  I have included their email so you may reach out to them directly.        Rochelle  Provider Relations Analyst, Behavioral Health  E: BehavioralContracting@Evernorth.com', NULL, NULL, '2021-12-16 17:29:42', '2021-12-16 17:29:42'),
(51250, 19067, 39703, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: Kristen.McCanlies@evernorth.com  Subject: Automatic reply: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Thank you for your email.  Please note, due to a high volume of provider requests to join the network, it may take your Cigna Recruiter 3-5 days to respond to your email.     We appreciate your patience during this time.     Thank you,     Kristen McCanlies  Behavioral NCU | Provider Relations Associate Analyst  T: 903.337.2488 | F: 860.687.7181  Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.©Copyright 2021 Cigna.', NULL, NULL, '2021-12-17 15:02:34', '2021-12-17 15:02:34'),
(51251, 19067, 39703, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Behavioralcontracting@evernorth.com, Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 18:02:45', '2021-12-28 18:02:45'),
(51252, 19067, 39703, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||    Both providers are in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  F:  860.697.6085  EVERNORTH.COM', NULL, NULL, '2021-12-29 09:12:27', '2021-12-29 09:12:27'),
(51253, 19067, 39703, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Re: [External] Enrollment Status || SNBCARE || Providers || Cigna ||   Greetings!  Any updates on the previously mentioned request?  Kindly respond as soon as you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:08:30', '2022-01-10 13:08:30'),
(51254, 19067, 39703, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Status || SNBCARE || Providers || Cigna ||     Both providers are in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  EVERNORTH.COM', NULL, NULL, '2022-02-04 09:39:54', '2022-02-04 09:39:54'),
(51255, 19067, 39703, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Re: [External] Enrollment Status || SNBCARE || Dina Filoteo-Nichols || Cigna ||   Hi Julie!  Hope you are doing well.  Any updates on the credentialing process of the provider, Dina Nichols?   Regards, Hammad.', NULL, NULL, '2022-02-11 09:59:22', '2022-02-11 09:59:22'),
(51256, 19067, 39703, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: RE: [External] Enrollment Status || SNBCARE || Dina Filoteo-Nichols || Cigna ||    Dina Nichols is in que for credentialing at current time there is no action needed from the provider or your office. Please note that this may take up to 90 days, depending on the response time of the institutions we contact for this purpose. Once we have finished verifying her credentials, an email (Subject line will begin with \"Complete\") will be sent with a copy of the final agreement- the agreement will include the  countersignature and the effective date.     +  Julia Perkins  Provider Relations Analyst, Behavioral Health  O: 903.361.4513  EVERNORTH.COM', NULL, NULL, '2022-02-16 09:51:49', '2022-02-16 09:51:49'),
(51257, 19067, 39703, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Email received from: Julia.Perkins@evernorth.com  Subject: Completed: MA 14140252 Dina Filoteo Nichols Evernorth behavioral Contract BID    Congratulations! You are now a fully credentialed and contracted provider in the Cigna Behavioral Health network. You may access your signed agreement by clicking on the “Completed Documented” box below. No further action is required of you at this time.', NULL, NULL, '2022-03-10 15:29:47', '2022-03-10 15:29:47'),
(51258, 1019, 39704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51259, 1019, 39704, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  Hello, We want to enroll the following provider with CCA under our group, please see attached application. Let me know if anything else is required.', NULL, NULL, '2021-10-04 10:40:38', '2021-10-04 10:40:38'),
(51260, 1019, 39704, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from PNM CCA.  October 22, 2021     Dina Paula Filoteo-Nichols, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 10/22/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111', NULL, NULL, '2021-11-16 15:20:16', '2021-11-16 15:20:16'),
(51261, 1019, 39705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51262, 1019, 39705, NULL, '2021-10-11 00:00:00.000', 'On Hold', 'Waiting to get enrolled with Aetna first.', NULL, NULL, '2021-10-04 10:41:50', '2021-10-04 10:41:50'),
(51263, 1019, 39706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51264, 1019, 39706, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, We want to enroll the following providers under our group in the following locations. Let me know if anything else is required.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Abdul-Aziz, Kameelah	1518635291	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Abdul-Aziz, Kameelah	1518635291	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-10-07 01:18:12', '2021-10-07 01:18:12'),
(51265, 1019, 39706, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Provider roster was sent out to Monica at humana to add the providers under our group, attached is the group roster for reference.', NULL, NULL, '2021-10-28 10:55:32', '2021-10-28 10:55:32'),
(51266, 11056, 39706, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:34:19', '2021-12-09 17:34:19'),
(51267, 19067, 39706, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:33:06', '2021-12-15 15:33:06'),
(51268, 19067, 39706, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:22', '2021-12-16 12:26:22'),
(51269, 19067, 39706, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:36:58', '2021-12-29 14:36:58'),
(51270, 19067, 39706, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:00', '2022-01-10 13:17:00'),
(51271, 19067, 39706, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:13:50', '2022-01-30 13:13:50'),
(51272, 19067, 39706, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:01', '2022-02-08 14:23:01'),
(51273, 19067, 39706, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:08', '2022-03-09 14:56:08'),
(51274, 19067, 39706, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:48:34', '2022-03-10 10:48:34'),
(51275, 22077, 39706, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:51:44', '2022-04-04 13:51:44'),
(51276, 1019, 39707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:46', '2021-10-01 08:11:46'),
(51277, 1019, 39707, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Application Submmitted online thru provider portal.  ', NULL, NULL, '2021-10-04 11:03:13', '2021-10-04 11:03:13'),
(51278, 1019, 39707, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Request Declined due to her ANCC. See below for reference.  Filoteo-Nichols, Dina  1770021099  61 Lincoln Street, Suite 203, Framingham, MA, 01702.  The provider was delinked because there was no ANCC Psych Certification found.  Filoteo-Nichols, Dina  1770021099  100 New State Highway, Raynham, MA, 02767.  The provider was delinked because there was no ANCC Psych ', NULL, NULL, '2021-11-30 14:19:44', '2021-11-30 14:19:44'),
(51279, 1019, 39708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51280, 1019, 39708, NULL, '2021-12-07 00:00:00.000', 'Initiated', 'Application was emailed to MassHealth at pec@maximus.com', NULL, NULL, '2021-11-30 14:23:01', '2021-11-30 14:23:01'),
(51281, 11056, 39708, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Status:   Dina Nichols Application is in process     Application # ATN 226947.', NULL, NULL, '2021-12-09 14:25:17', '2021-12-09 14:25:17');
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
(51282, 19067, 39708, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email to: pec@maximus.com Subject: Provider Enrollment Status - SNBC Framingham  Hello,  Hope you are having a productive day.  I want to know enrollment status for the following provider.  Practice name: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753  Provider name: Dina Filoteo-Nichols Provider NPI: 1770021099  If the provider is enrolled then provide us the Effective date and Welcome letter.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 13:27:19', '2021-12-15 13:27:19'),
(51283, 19067, 39708, NULL, '2021-12-24 00:00:00.000', 'Approved', 'Email received from: PEC@maximus.com  Subject: Provider Enrollment Status - SNBC Framingham    Good Afternoon,     Thank you for contacting the MassHealth Provider Enrollment and Credentialing Department.     Dina Filoteo-Nichols, PID/SL 110180219A, has been linked to group SNBC Framingham, PID/SL 110159328A, effective 12/10/2021. We also have attached her Welcome Letter.     If you have any questions or concerns please feel free to contact us.     Best Regards,     PEC  Provider Enrollment and Credentialing Department  Business Support Services, US Services     MAXIMUS  Remote: Boston, MA  PEC@maximus.com', NULL, NULL, '2021-12-17 15:54:23', '2021-12-17 15:54:23'),
(51284, 1019, 39709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51285, 1019, 39709, NULL, '2021-10-08 00:00:00.000', 'On Hold', 'Waiting for Cultural Competency', NULL, NULL, '2021-10-01 08:13:42', '2021-10-01 08:13:42'),
(51286, 1019, 39710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51287, 1019, 39710, NULL, '2021-10-08 00:00:00.000', 'Initiated', 'Initiated thru Pecos.', NULL, NULL, '2021-10-01 08:12:39', '2021-10-01 08:12:39'),
(51288, 1019, 39710, NULL, '2021-10-08 00:00:00.000', 'Approved', 'Eff date 09/01/2021, Attached is the approval confirmation.', NULL, NULL, '2021-10-01 08:15:48', '2021-10-01 08:15:48'),
(51289, 1019, 39711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51290, 1019, 39711, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'PTAN has been provided waiting to get active as it take upto 3 days.', NULL, NULL, '2021-10-07 01:32:35', '2021-10-07 01:32:35'),
(51291, 1019, 39711, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 09/01/2021, see attached letter for approval.', NULL, NULL, '2021-11-16 15:46:13', '2021-11-16 15:46:13'),
(51292, 1019, 39712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51293, 1019, 39712, NULL, '2021-10-14 00:00:00.000', 'Initiated', 'Enrollment Application faxed at (608) 221-7535, attached is the application for ref ', NULL, NULL, '2021-10-06 23:44:57', '2021-10-06 23:44:57'),
(51294, 19067, 39712, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:09:06', '2021-12-16 14:09:06'),
(51295, 19067, 39712, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:06:38', '2021-12-29 12:06:38'),
(51296, 19067, 39712, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:13:33', '2022-01-10 14:13:33'),
(51297, 19067, 39712, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:54', '2022-01-11 09:37:54'),
(51298, 19067, 39712, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:46:33', '2022-01-11 10:46:33'),
(51299, 19067, 39712, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:24', '2022-02-11 11:16:24'),
(51300, 19067, 39712, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:22:24', '2022-02-11 11:22:24'),
(51301, 19067, 39712, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:48:35', '2022-03-17 09:48:35'),
(51302, 19067, 39712, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:33:30', '2022-03-17 10:33:30'),
(51303, 19067, 39712, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:35:52', '2022-03-17 10:35:52'),
(51304, 19067, 39712, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:57:36', '2022-03-17 13:57:36'),
(51305, 19067, 39712, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject: Enrollment Query || Dina Filoteo-Nichols || SNBCARE || Tricare    Hi,  Can you please provide me with the enrollment status of the following provider with Tricare,  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Dina Filoteo-Nichols	1770021099 Dina Filoteo-Nichols	1770021099  Regards,', NULL, NULL, '2022-03-17 15:24:44', '2022-03-17 15:24:44'),
(51306, 19067, 39712, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: DRussell16@humana.com  Subject: Enrollment Query || Dina Filoteo-Nichols || SNBCARE || Tricare    Hey there,     My apologies for having to redirect you, but in order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions. We have improved our features of the Humana Military Provider Portal, and are encouraging providers to use the Humana Military Provider Portal to take care of nearly all provider-related needs. Submitting credentialing documents, editing provider info, adding / removing providers from locations from your Tax ID, adding / removing group locations from your Tax ID, etc. It also has the capability for you to submit secure messages directly through the portal, and can submit questions or documents through the appropriate channel.     I have attached 2 documents that give valuable info on how to sign up for and utilize the provider portal. Please go to https://infocenter.humana-military.com/provider/service/Account/Login to start the sign-up process. I recommend signing up with the Tax Ids that you oversee. I do sincerely recommend this, as any questions and provider documents submitted through a secure message will be attended to by not just me, but our New England Market team.     Thanks,     Adam', NULL, NULL, '2022-03-18 13:30:22', '2022-03-18 13:30:22'),
(51307, 22077, 39712, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: DRussell16@humana.com  Subject: Enrollment Query || Dina Filoteo-Nichols || SNBCARE || Tricare  Hi,    Can you please provide me with the enrollment status of the following provider with Tricare,    Group Name: Spectrum Neuro Behavioral Care LLC   Tax ID: 834482753   Group NPI: 1356906572   Primary & Billing Address: 61 Lincoln St, Ste 203, Framingham, MA 01702   Secondary Address: 100 New State Highway, Raynham, MA 02767   Provider Name  NPI  Dina Filoteo-Nichols  1770021099  Dina Filoteo-Nichols  1770021099    Regards,', NULL, NULL, '2022-04-07 07:50:47', '2022-04-07 07:50:47'),
(51308, 1019, 39713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51309, 1019, 39713, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, provider_data_request@tufts-health.com  Good Morning,  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now. ', NULL, NULL, '2021-10-04 11:20:13', '2021-10-04 11:20:13'),
(51310, 1019, 39713, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application || Dina Nichols || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-10-04 12:19:43 EDT.  Please reference ticket number PRO0151068 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7669426', NULL, NULL, '2021-10-19 07:30:08', '2021-10-19 07:30:08'),
(51311, 1019, 39713, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Received the following email from Tufts.  Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and mailing address) and return to us so that we may countersign it.', NULL, NULL, '2021-11-18 09:48:46', '2021-11-18 09:48:46'),
(51312, 1019, 39713, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Sent the signed agreement back to tufts see attached for reference.', NULL, NULL, '2021-11-18 09:49:54', '2021-11-18 09:49:54'),
(51313, 11056, 39713, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749      ', NULL, NULL, '2021-12-03 14:51:17', '2021-12-03 14:51:17'),
(51314, 19067, 39713, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:39:35', '2021-12-15 17:39:35'),
(51315, 19067, 39713, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:08', '2021-12-29 10:05:08'),
(51316, 19067, 39713, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:28', '2022-01-10 14:44:28'),
(51317, 19067, 39713, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:01', '2022-02-11 11:39:01'),
(51318, 1019, 39713, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the following email from Tufts  Dear Provider,     Welcome to Tufts Health Plan! We are pleased to have you as part of our provider network.     Please find a copy of your fully executed Allied Health Services Provider Agreement attached.     Your in-network effective date is: 12/06/2021  Attached is the list of Plans, Location Confirmation, and Welcome Letter', NULL, NULL, '2022-02-16 12:19:38', '2022-02-16 12:19:38'),
(51319, 1019, 39714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51320, 1019, 39714, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, provider_data_request@tufts-health.com  Good Morning,  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now. ', NULL, NULL, '2021-10-04 11:23:59', '2021-10-04 11:23:59'),
(51321, 1019, 39714, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application || Dina Nichols || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-10-04 12:19:43 EDT.  Please reference ticket number PRO0151068 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7669426', NULL, NULL, '2021-10-19 07:30:36', '2021-10-19 07:30:36'),
(51322, 11056, 39714, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:53:19', '2021-12-03 14:53:19'),
(51323, 19067, 39714, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:40:01', '2021-12-15 17:40:01'),
(51324, 19067, 39714, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:23', '2021-12-29 10:05:23'),
(51325, 19067, 39714, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:45:50', '2022-01-10 14:45:50'),
(51326, 19067, 39714, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:10', '2022-02-11 11:39:10'),
(51327, 22077, 39714, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:34:06', '2022-04-05 10:34:06'),
(51328, 1019, 39715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:11:47', '2021-10-01 08:11:47'),
(51329, 1019, 39715, NULL, '2021-10-11 00:00:00.000', 'Initiated', 'Received the following confirmation thru email for Application Submission.  Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Dina Filoteo-Nichols has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-10-04 14:24:18', '2021-10-04 14:24:18'),
(51330, 1019, 39715, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Received the following email from Optum.  10/25/2021   Attn:  Alex Garrett, Credentialing Contact  dfiloteonichols@gmail.com  snbc@claimsmedinc.com    RE:  Network Participation - Dina Filoteo Nichols    Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application; however, your license/board certification does not meet the Optum Behavioral Health credentialing criteria for nurses as listed below:   Nurses with prescriptive authority must be licensed and/or registered in Psychiatric / Mental Health as required by the state. State law also determines whether board certification through the American Nursing Credentialing Center (ANCC), the American Academy of Nurse Practitioners (AANP), or other national certification in behavioral health is required.  If you provide non-behavioral services, please visit UHCprovider.com, and click the link \'Join Our Network/Credentialing\' at the bottom of the screen under Service Links.  If you have questions, please call UnitedHealthcare Provider Service Voice Portal at 1-877-842-3210.  ', NULL, NULL, '2021-11-30 17:15:27', '2021-11-30 17:15:27'),
(51331, 1019, 39716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:15:48', '2021-10-01 08:15:48'),
(51332, 1019, 39716, NULL, '2021-10-08 00:00:00.000', 'Not Eligible', 'It covers under Masshealth', NULL, NULL, '2021-10-01 08:17:10', '2021-10-01 08:17:10'),
(51333, 1019, 39717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-01 08:16:27', '2021-10-01 08:16:27'),
(51334, 1019, 39717, NULL, '2021-10-08 00:00:00.000', 'Not Eligible', 'It covers under Masshealth', NULL, NULL, '2021-10-01 08:16:53', '2021-10-01 08:16:53'),
(51335, 10057, 40682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-08 16:11:31', '2021-10-08 16:11:31'),
(51336, 10057, 40682, NULL, '2021-10-15 00:00:00.000', 'Initiated', 'Application Summary:  Tracking ID: T100820210002489 (Medicare) Enrollment Status: NEW Report Date: 10/08/2021', NULL, NULL, '2021-10-08 16:17:46', '2021-10-08 16:17:46'),
(51337, 10057, 40682, NULL, '2021-10-27 00:00:00.000', 'In Process', ' To: VGARCIA@VDNCLINIC.COM,VMUC@CLAIMSMEDINC.COM,EDNAMICHI@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102020210000587)   Sent: 10/20/2021 10:05 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T102020210000587        NPI: 1992293906        Medicare ID: 685086        Name: EDNA D MICHI          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-10-20 09:12:48', '2021-10-20 09:12:48'),
(51338, 10057, 40682, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Reference #: 3212930841  Dear Edna Michi PA:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: Edna Michi PA Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1992293906 Individual Provider Transaction Access Number (PTAN): 1V9161 Individual PTAN Effective Date: September 01, 2021 Employer Legal Business Name (LBN): Valley Med Urgent Care LLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343  Please see attachment:', NULL, NULL, '2021-11-05 12:15:43', '2021-11-05 12:15:43'),
(51339, 10057, 40683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-08 16:12:10', '2021-10-08 16:12:10'),
(51340, 10057, 40683, NULL, '2021-10-15 00:00:00.000', 'Initiated', 'Application Summary:  Tracking ID: T100820210002489 (Medicare) Enrollment Status: NEW Report Date: 10/08/2021', NULL, NULL, '2021-10-08 16:17:07', '2021-10-08 16:17:07'),
(51341, 10057, 40683, NULL, '2021-10-27 00:00:00.000', 'In Process', ' To: VGARCIA@VDNCLINIC.COM,VMUC@CLAIMSMEDINC.COM,EDNAMICHI@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102020210000587)   Sent: 10/20/2021 10:05 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T102020210000587        NPI: 1992293906        Medicare ID: 685086        Name: EDNA D MICHI          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-10-20 09:12:42', '2021-10-20 09:12:42'),
(51342, 10057, 40683, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Reference #: 3212930841  Dear Edna Michi PA:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: Edna Michi PA Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1992293906 Individual Provider Transaction Access Number (PTAN): 1V9161 Individual PTAN Effective Date: September 01, 2021 Employer Legal Business Name (LBN): Valley Med Urgent Care LLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-11-05 12:14:32', '2021-11-05 12:14:32'),
(51343, 10057, 40684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-08 16:12:26', '2021-10-08 16:12:26'),
(51344, 10057, 40684, NULL, '2021-10-15 00:00:00.000', 'Initiated', 'Application Summary:  Tracking ID: T100820210002489 (Medicare) Enrollment Status: NEW Report Date: 10/08/2021', NULL, NULL, '2021-10-08 16:16:17', '2021-10-08 16:16:17'),
(51345, 10057, 40684, NULL, '2021-10-27 00:00:00.000', 'In Process', ' To: VGARCIA@VDNCLINIC.COM,VMUC@CLAIMSMEDINC.COM,EDNAMICHI@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102020210000587)   Sent: 10/20/2021 10:05 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T102020210000587        NPI: 1992293906        Medicare ID: 685086        Name: EDNA D MICHI          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-10-20 09:12:34', '2021-10-20 09:12:34'),
(51346, 10057, 40684, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Reference #: 3212930841  Dear Edna Michi PA:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: Edna Michi PA Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1992293906 Individual Provider Transaction Access Number (PTAN): 1V9161 Individual PTAN Effective Date: September 01, 2021 Employer Legal Business Name (LBN): Valley Med Urgent Care LLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-11-05 12:14:01', '2021-11-05 12:14:01'),
(51347, 10057, 41682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-19 15:21:33', '2021-10-19 15:21:33'),
(51348, 10057, 41682, NULL, '2021-10-26 00:00:00.000', 'Initiated', 'We have initiated request through PECOS.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T101920210003297)   Sent: 10/19/2021 16:17 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T101920210003297        NPI: 1801371935        Medicare ID: 768616        Name: NUBIA  BENAVIDES          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2021-10-19 15:24:17', '2021-10-19 15:24:17'),
(51349, 10057, 41682, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Reference #: 3212920884  Dear NUBIA BENAVIDES:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: NUBIA BENAVIDES Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1801371935 Individual Provider Transaction Access Number (PTAN): 1V8347 Group Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Group NPI: 1518404631 Group PTAN: 578343 Reassignment Effective Date: SEPTEMBER 1, 2021 Changed Information: N/A  Please find attachments:', NULL, NULL, '2021-11-05 12:10:19', '2021-11-05 12:10:19'),
(51350, 10057, 41683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-19 15:21:58', '2021-10-19 15:21:58'),
(51351, 10057, 41683, NULL, '2021-10-26 00:00:00.000', 'Initiated', 'We have initiated request through PECOS.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T101920210003297)   Sent: 10/19/2021 16:17 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T101920210003297        NPI: 1801371935        Medicare ID: 768616        Name: NUBIA  BENAVIDES          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2021-10-19 15:24:10', '2021-10-19 15:24:10'),
(51352, 10057, 41683, NULL, '2021-11-12 00:00:00.000', 'Approved', '	 Reference #: 3212920884  Dear NUBIA BENAVIDES:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: NUBIA BENAVIDES Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1801371935 Individual Provider Transaction Access Number (PTAN): 1V8347 Group Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Group NPI: 1518404631 Group PTAN: 578343 Reassignment Effective Date: SEPTEMBER 1, 2021 Changed Information: N/A  Please find attachments:', NULL, NULL, '2021-11-05 12:09:15', '2021-11-05 12:09:15'),
(51353, 10057, 41684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-19 15:22:15', '2021-10-19 15:22:15'),
(51354, 10057, 41684, NULL, '2021-10-26 00:00:00.000', 'Initiated', 'We have initiated request through PECOS.  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T101920210003297)   Sent: 10/19/2021 16:17 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T101920210003297        NPI: 1801371935        Medicare ID: 768616        Name: NUBIA  BENAVIDES          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                MECHANICSBURG,PA,17055-1813 ', NULL, NULL, '2021-10-19 15:24:00', '2021-10-19 15:24:00'),
(51355, 10057, 41684, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Reference #: 3212920884  Dear NUBIA BENAVIDES:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: NUBIA BENAVIDES Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1801371935 Individual Provider Transaction Access Number (PTAN): 1V8347 Group Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Group NPI: 1518404631 Group PTAN: 578343 Reassignment Effective Date: SEPTEMBER 1, 2021 Changed Information: N/A  Please find attachments:', NULL, NULL, '2021-11-05 12:08:23', '2021-11-05 12:08:23'),
(51356, 10057, 42682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:37:04', '2021-10-20 09:37:04'),
(51357, 10057, 42682, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 09:53:58', '2021-10-20 09:53:58'),
(51358, 10057, 42683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:54:57', '2021-10-20 09:54:57'),
(51359, 10057, 42683, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:00:13', '2021-10-20 10:00:13'),
(51360, 10057, 42683, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:00:56', '2021-10-20 10:00:56'),
(51361, 10057, 42684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:55:10', '2021-10-20 09:55:10'),
(51362, 10057, 42684, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:01:24', '2021-10-20 10:01:24'),
(51363, 10057, 42685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:55:22', '2021-10-20 09:55:22'),
(51364, 10057, 42685, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:01:47', '2021-10-20 10:01:47'),
(51365, 10057, 42686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:56:09', '2021-10-20 09:56:09'),
(51366, 10057, 42686, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:02:27', '2021-10-20 10:02:27'),
(51367, 10057, 42687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:56:21', '2021-10-20 09:56:21'),
(51368, 10057, 42687, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:02:53', '2021-10-20 10:02:53'),
(51369, 10057, 42688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:56:42', '2021-10-20 09:56:42'),
(51370, 10057, 42688, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:03:14', '2021-10-20 10:03:14'),
(51371, 10057, 42689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:56:54', '2021-10-20 09:56:54'),
(51372, 10057, 42689, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:03:52', '2021-10-20 10:03:52'),
(51373, 10057, 42690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:57:04', '2021-10-20 09:57:04'),
(51374, 10057, 42690, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:04:16', '2021-10-20 10:04:16'),
(51375, 10057, 42691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:57:14', '2021-10-20 09:57:14'),
(51376, 10057, 42691, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:04:40', '2021-10-20 10:04:40'),
(51377, 10057, 42692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:57:30', '2021-10-20 09:57:30'),
(51378, 10057, 42692, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:05:01', '2021-10-20 10:05:01'),
(51379, 10057, 42693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 09:57:52', '2021-10-20 09:57:52'),
(51380, 10057, 42693, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  Please see attached welcome letter. Thank you.', NULL, NULL, '2021-10-20 10:05:28', '2021-10-20 10:05:28'),
(51381, 10057, 42694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 10:40:35', '2021-10-20 10:40:35'),
(51382, 10057, 42694, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  For Location & Welcome letter, please see the attachments. Thank you.', NULL, NULL, '2021-10-20 11:31:15', '2021-10-20 11:31:15'),
(51383, 10057, 42695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 10:40:53', '2021-10-20 10:40:53'),
(51384, 10057, 42695, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  For Location & Welcome letter, please see the attachments. Thank you.', NULL, NULL, '2021-10-20 11:30:39', '2021-10-20 11:30:39'),
(51385, 10057, 42696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 10:41:10', '2021-10-20 10:41:10'),
(51386, 10057, 42696, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/09/2021  For Location & Welcome letter, please see the attachments. Thank you.', NULL, NULL, '2021-10-20 11:28:41', '2021-10-20 11:28:41'),
(51387, 10057, 42697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 11:32:56', '2021-10-20 11:32:56'),
(51388, 10057, 42697, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/12/2021  After discussion with Corvel representatives she said some PA might not be listed in the provider directory. However after confirming via TIN she has confirmed that she is updated in the system with all three locations.  Please see the attachment. Thank you', NULL, NULL, '2021-10-20 13:20:30', '2021-10-20 13:20:30'),
(51389, 10057, 42698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 11:33:18', '2021-10-20 11:33:18'),
(51390, 10057, 42698, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/12/2021  After discussion with Corvel representatives she said some PA might not be listed in the provider directory. However after confirming via TIN she has confirmed that she is updated in the system with all three locations.  Please see the attachment. Thank you', NULL, NULL, '2021-10-20 13:20:08', '2021-10-20 13:20:08'),
(51391, 10057, 42699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-20 11:33:29', '2021-10-20 11:33:29'),
(51392, 10057, 42699, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Effective Date : 10/12/2021  After discussion with Corvel representatives she said some PA might not be listed in the provider directory. However after confirming via TIN she has confirmed that she is updated in the system with all three locations.  Please see the attachment. Thank you', NULL, NULL, '2021-10-20 13:19:45', '2021-10-20 13:19:45'),
(51393, 1019, 42700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51394, 1019, 42700, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:14:38', '2021-10-22 09:14:38'),
(51395, 1019, 42700, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request Initiated thru Aetna website. See below for reference  Request ID for this Submission: 91613299  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  ', NULL, NULL, '2021-10-28 09:00:53', '2021-10-28 09:00:53'),
(51396, 1019, 42700, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:16:03', '2021-11-16 09:16:03');
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
(51397, 11056, 42700, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:06:49', '2021-12-01 17:06:49'),
(51398, 19067, 42700, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:45', '2021-12-15 17:13:45'),
(51399, 19067, 42700, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:57:28', '2021-12-16 10:57:28'),
(51400, 19067, 42700, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:31:12', '2021-12-20 10:31:12'),
(51401, 19067, 42700, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:24', '2021-12-28 13:21:24'),
(51402, 19067, 42700, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:03', '2022-01-10 11:33:03'),
(51403, 19067, 42700, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:12:26', '2022-01-30 12:12:26'),
(51404, 1019, 42700, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:28', '2022-02-01 12:19:28'),
(51405, 19067, 42700, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:13:06', '2022-02-10 15:13:06'),
(51406, 19067, 42700, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:01:57', '2022-02-10 16:01:57'),
(51407, 19067, 42700, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:03:46', '2022-02-14 14:03:46'),
(51408, 19067, 42700, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:08:38', '2022-02-14 14:08:38'),
(51409, 1019, 42701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51410, 1019, 42701, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:14:59', '2021-10-22 09:14:59'),
(51411, 1019, 42701, NULL, '2021-11-04 00:00:00.000', 'New/Not Initiated', 'Faxed the enrollment application at 866-612-7790, attached is the copy of the application.', NULL, NULL, '2021-10-28 09:18:07', '2021-10-28 09:18:07'),
(51412, 1019, 42701, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Faxed the enrollment application at 866-612-7790, attached is the copy of the application.', NULL, NULL, '2021-10-28 09:18:27', '2021-10-28 09:18:27'),
(51413, 1019, 42701, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:15:18', '2021-11-30 09:15:18'),
(51414, 11056, 42701, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:39:44', '2021-12-14 14:39:44'),
(51415, 19067, 42701, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:12', '2021-12-20 12:17:12'),
(51416, 19067, 42701, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:11', '2021-12-20 15:10:11'),
(51417, 19067, 42701, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:11', '2021-12-22 13:39:11'),
(51418, 19067, 42701, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:42', '2021-12-28 17:03:42'),
(51419, 19067, 42701, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:35:55', '2022-01-05 15:35:55'),
(51420, 19067, 42701, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:38:37', '2022-01-12 15:38:37'),
(51421, 19067, 42701, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO ||   Greetings!  Kindly see the attachment for the provider, Eliza Rodrigues.  Don\'t hesitate to reach out if you need anything else!  Thank you, Hammad Ahmed', NULL, NULL, '2022-01-13 13:29:41', '2022-01-13 13:29:41'),
(51422, 19067, 42701, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Kindly see the attachment for the provider, Eliza Rodrigues.  Don\'t hesitate to reach out if you need anything else!  Thank you, Hammad Ahmed', NULL, NULL, '2022-01-13 17:26:09', '2022-01-13 17:26:09'),
(51423, 19067, 42701, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582_01192022-4265501    Good Afternoon,     I have received the CANS attestation and forwarded it to credentialing via email for processing. The credentialing specialist that was working your file is Jennifer Farino. I sent it to them for review and processing.        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:19:19', '2022-01-25 09:19:19'),
(51424, 19067, 42701, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Hello Jennifer Farino!  Hope you are doing well.  Any updates on the request below?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:22:15', '2022-02-04 09:22:15'),
(51425, 19067, 42701, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:04:52', '2022-02-07 10:04:52'),
(51426, 19067, 42701, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:10', '2022-02-14 09:50:10'),
(51427, 19067, 42701, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com   Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099_02142022-4542489   Good Morning,     Please see notes below.     Helena Halterman  1801473749  Welcome letter for BHO plans sent to SNBC@claimsmedinc.com on 2.10.22 – still processing for MBHP, Fallon, BMC and Unicare – event 9303674 – allow more time  Allie DiCostanzo  1669045738  Still being worked under event 9306743 – allow more time  Eliza Rodrigues  1821751405  Still being worked under event 9309562 – allow more time  Lauren Powell  1285304980  Welcome letters sent on 2.7.22 and 2.9.22 to SNBC@Claimsmedinc.com with effective date – please check email        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-14 10:50:35', '2022-02-14 10:50:35'),
(51428, 1019, 42701, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 02/01/2022,  See attached welcome letter  and location confirmation for ref', NULL, NULL, '2022-02-16 10:04:02', '2022-02-16 10:04:02'),
(51429, 1019, 42702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51430, 1019, 42702, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:15:23', '2021-10-22 09:15:23'),
(51431, 1019, 42702, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Faxed the enrollment application at 866-612-7790, attached is the copy of the application.', NULL, NULL, '2021-10-28 09:19:23', '2021-10-28 09:19:23'),
(51432, 1019, 42702, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:15:33', '2021-11-30 09:15:33'),
(51433, 11056, 42702, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:41:51', '2021-12-14 14:41:51'),
(51434, 19067, 42702, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:18:09', '2021-12-20 12:18:09'),
(51435, 19067, 42702, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:24', '2021-12-20 15:10:24'),
(51436, 19067, 42702, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:25', '2021-12-22 13:39:25'),
(51437, 19067, 42702, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:52', '2021-12-28 17:03:52'),
(51438, 19067, 42702, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:39:31', '2022-01-05 15:39:31'),
(51439, 19067, 42702, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:38:48', '2022-01-12 15:38:48'),
(51440, 19067, 42702, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Kindly see the attachment for the provider, Eliza Rodrigues.  Don\'t hesitate to reach out if you need anything else!  Thank you, Hammad Ahmed', NULL, NULL, '2022-01-13 17:26:20', '2022-01-13 17:26:20'),
(51441, 19067, 42702, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582_01192022-4265501    Good Afternoon,     I have received the CANS attestation and forwarded it to credentialing via email for processing. The credentialing specialist that was working your file is Jennifer Farino. I sent it to them for review and processing.        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:19:29', '2022-01-25 09:19:29'),
(51442, 19067, 42702, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Hello Jennifer Farino!  Hope you are doing well.  Any updates on the request below?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:22:26', '2022-02-04 09:22:26'),
(51443, 19067, 42702, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:04:41', '2022-02-07 10:04:41'),
(51444, 19067, 42702, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:50', '2022-02-14 09:50:50'),
(51445, 19067, 42702, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com   Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099_02142022-4542489   Good Morning,     Please see notes below.     Helena Halterman  1801473749  Welcome letter for BHO plans sent to SNBC@claimsmedinc.com on 2.10.22 – still processing for MBHP, Fallon, BMC and Unicare – event 9303674 – allow more time  Allie DiCostanzo  1669045738  Still being worked under event 9306743 – allow more time  Eliza Rodrigues  1821751405  Still being worked under event 9309562 – allow more time  Lauren Powell  1285304980  Welcome letters sent on 2.7.22 and 2.9.22 to SNBC@Claimsmedinc.com with effective date – please check email        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-14 10:50:39', '2022-02-14 10:50:39'),
(51446, 1019, 42702, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 02/01/2022,  See attached welcome letter  and location confirmation for ref', NULL, NULL, '2022-02-16 10:04:47', '2022-02-16 10:04:47'),
(51447, 1019, 42703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51448, 1019, 42703, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:15:42', '2021-10-22 09:15:42'),
(51449, 1019, 42703, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Sent the following email to Database and Credentialing Hello,  We need to enroll the following provider with BCBS MA, Eliza Rodrigues LCSW under our group Spectrum Neuro behavioral Care LLC. Let me know with the next steps.   Regards, Alex', NULL, NULL, '2021-10-28 09:39:21', '2021-10-28 09:39:21'),
(51450, 1019, 42703, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Received the following email from BCBS.  Please be advised that Blue Cross Blue Shield of Massachusetts does not currently credential LCSWs.  ', NULL, NULL, '2021-10-28 10:20:22', '2021-10-28 10:20:22'),
(51451, 1019, 42704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51452, 1019, 42704, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:16:01', '2021-10-22 09:16:01'),
(51453, 1019, 42704, NULL, '2021-11-04 00:00:00.000', 'Not Eligible', 'Cigna doesn\'t enroll LCSW.', NULL, NULL, '2021-10-28 10:17:14', '2021-10-28 10:17:14'),
(51454, 1019, 42705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51455, 1019, 42705, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:16:20', '2021-10-22 09:16:20'),
(51456, 1019, 42705, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Sent the enrollment application to PNM and Credentialing, see attached for reference.', NULL, NULL, '2021-10-28 10:32:29', '2021-10-28 10:32:29'),
(51457, 1019, 42705, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from PNM CCA.  Hello,     Provider Eliza Rodrigues, LCSW Is effective 10/28/2021 at Spectrum Neuro Behavioral Care LLC.     Thanks,           Venkateshlu Srinivasan  Provider Network Management', NULL, NULL, '2021-11-16 15:22:03', '2021-11-16 15:22:03'),
(51458, 1019, 42706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51459, 1019, 42706, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:16:37', '2021-10-22 09:16:37'),
(51460, 1019, 42707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51461, 1019, 42707, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:17:01', '2021-10-22 09:17:01'),
(51462, 1019, 42707, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Provider roster was sent out to Monica at humana to add the providers under our group, attached is the group roster for reference.', NULL, NULL, '2021-10-28 10:55:10', '2021-10-28 10:55:10'),
(51463, 11056, 42707, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:34:13', '2021-12-09 17:34:13'),
(51464, 19067, 42707, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:33:14', '2021-12-15 15:33:14'),
(51465, 19067, 42707, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:45', '2021-12-16 12:26:45');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(51466, 19067, 42707, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:36:53', '2021-12-29 14:36:53'),
(51467, 19067, 42707, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:16:52', '2022-01-10 13:16:52'),
(51468, 19067, 42707, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:13:27', '2022-01-30 13:13:27'),
(51469, 19067, 42707, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:14', '2022-02-08 14:23:14'),
(51470, 19067, 42707, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:55:56', '2022-03-09 14:55:56'),
(51471, 19067, 42707, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:48:26', '2022-03-10 10:48:26'),
(51472, 22077, 42707, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:51:12', '2022-04-04 13:51:12'),
(51473, 1019, 42708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51474, 1019, 42708, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:17:23', '2021-10-22 09:17:23'),
(51475, 1019, 42708, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request Initiated thru Magellan Provider Portal', NULL, NULL, '2021-10-28 11:15:27', '2021-10-28 11:15:27'),
(51476, 19067, 42708, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com Subject: Enrollment Status || Providers  || SNBCARE || || Magellan||  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:13:05', '2021-12-15 14:13:05'),
(51477, 19067, 42708, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:17:48', '2021-12-15 14:17:48'),
(51478, 19067, 42708, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:42:04', '2021-12-15 16:42:04'),
(51479, 19067, 42708, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 13:59:53', '2021-12-29 13:59:53'),
(51480, 19067, 42708, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:11', '2022-01-10 13:22:11'),
(51481, 19067, 42708, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:09:10', '2022-02-11 10:09:10'),
(51482, 19067, 42708, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Called @ 800-788-4005 spoke with Jackie and got the effective date as of 01/22/2022. Attached is the Approval letter. Ref# 731012737762', NULL, NULL, '2022-02-16 17:17:45', '2022-02-16 17:17:45'),
(51483, 1019, 42709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51484, 1019, 42709, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:18:33', '2021-10-22 09:18:33'),
(51485, 1019, 42710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51486, 1019, 42710, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:18:55', '2021-10-22 09:18:55'),
(51487, 1019, 42711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51488, 1019, 42711, NULL, '2021-10-29 00:00:00.000', 'Initiated', 'Application Initiated thru PECOS, below is the email for Reference   To: SNBC@CLAIMSMEDINC.COM,ELIZARODRIGUES4@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102120210000781)   Sent: 10/22/2021 09:43 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T102120210000781        NPI: 1821751405        Medicare ID:         Name: ELIZA  RODRIGUES          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message.    ', NULL, NULL, '2021-10-22 09:13:42', '2021-10-22 09:13:42'),
(51489, 1019, 42711, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Effective date 10/04/2021, attached is the determination letter from Medicare.', NULL, NULL, '2021-11-16 15:32:30', '2021-11-16 15:32:30'),
(51490, 1019, 42712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51491, 1019, 42712, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:19:31', '2021-10-22 09:19:31'),
(51492, 1019, 42712, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated thru Website see attached for reference.', NULL, NULL, '2021-11-16 15:43:31', '2021-11-16 15:43:31'),
(51493, 1019, 42712, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Approved eff date 10/14/2021 see attachment for Reference.', NULL, NULL, '2021-11-30 14:50:03', '2021-11-30 14:50:03'),
(51494, 1019, 42712, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Approved eff date 10/14/2021 see attachment for Reference.', NULL, NULL, '2021-11-30 14:50:07', '2021-11-30 14:50:07'),
(51495, 1019, 42713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51496, 1019, 42713, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:19:57', '2021-10-22 09:19:57'),
(51497, 1019, 42714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51498, 1019, 42714, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:20:23', '2021-10-22 09:20:23'),
(51499, 1019, 42715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:11', '2021-10-22 09:07:11'),
(51500, 1019, 42715, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:20:49', '2021-10-22 09:20:49'),
(51501, 1019, 42716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:07:12', '2021-10-22 09:07:12'),
(51502, 1019, 42716, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:21:07', '2021-10-22 09:21:07'),
(51503, 1019, 42716, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Submitted the application thru provider express, below is the email we received for refence.  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Eliza Rodrigues has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.    You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-11-04 08:23:26', '2021-11-04 08:23:26'),
(51504, 11056, 42716, NULL, '2021-12-16 00:00:00.000', 'Not Eligible', 'Email received from Optum Behavioral Health\' via Spectrum Neuro Behavioral Health  Sub: Fwd: Optum Credentialing Application Cancelled for Eliza Rodrigues RE:  Network Participation - Eliza Rodrigues  Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application and determined that your license level does not meet the Optum credentialing standards.       We encourage you to visit providerexpress.com to review credentialing criteria specific to your area.  If you have any questions, please call Behavioral Network Services at 1-877-614-0484 and select the following options for assistance: Credentialing > Network Services > Credentialing to reach Provider Relations.   Sincerely,    Optum Behavioral Health Credentialing Department', NULL, NULL, '2021-12-09 17:05:49', '2021-12-09 17:05:49'),
(51505, 1019, 42717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51506, 1019, 42717, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:14:26', '2021-10-22 09:14:26'),
(51507, 1019, 42717, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Request Initiated thru Aetna website. See below for reference  Request ID for this Submission: 91613299  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  ', NULL, NULL, '2021-10-28 09:00:43', '2021-10-28 09:00:43'),
(51508, 1019, 42717, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:15:54', '2021-11-16 09:15:54'),
(51509, 11056, 42717, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:06:31', '2021-12-01 17:06:31'),
(51510, 19067, 42717, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:39', '2021-12-15 17:13:39'),
(51511, 19067, 42717, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:57:22', '2021-12-16 10:57:22'),
(51512, 19067, 42717, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:31:05', '2021-12-20 10:31:05'),
(51513, 19067, 42717, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:18', '2021-12-28 13:21:18'),
(51514, 19067, 42717, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:32:56', '2022-01-10 11:32:56'),
(51515, 19067, 42717, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:12:35', '2022-01-30 12:12:35'),
(51516, 1019, 42717, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:22', '2022-02-01 12:19:22'),
(51517, 19067, 42717, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:13:20', '2022-02-10 15:13:20'),
(51518, 19067, 42717, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:01:53', '2022-02-10 16:01:53'),
(51519, 19067, 42717, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:03:51', '2022-02-14 14:03:51'),
(51520, 19067, 42717, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:08:50', '2022-02-14 14:08:50'),
(51521, 1019, 42718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-10-22 09:10:12', '2021-10-22 09:10:12'),
(51522, 1019, 42718, NULL, '2021-10-29 00:00:00.000', 'On Hold', 'Waiting for Medicare', NULL, NULL, '2021-10-22 09:14:48', '2021-10-22 09:14:48'),
(51523, 1019, 42718, NULL, '2021-11-04 00:00:00.000', 'Initiated', 'Faxed the enrollment application at 866-612-7790, attached is the copy of the application.', NULL, NULL, '2021-10-28 09:17:40', '2021-10-28 09:17:40'),
(51524, 1019, 42718, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Received the following email from Beacon.  Good morning Alex,   1. Allie DiCostanzo; NPI# 1669045738 – Credentialing application is in process.  2. Helena Halterman; NPI# 1801473749 -  Denied. Please see attached.  3. Dina Filoteo-Nichols; NPI# 1770021099 - Credentialing application is in process.  4. Eliza Rodrigues; NPI# 1821751405 - Credentialing application is in process.   Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-11-30 09:15:08', '2021-11-30 09:15:08'),
(51525, 11056, 42718, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:39:49', '2021-12-14 14:39:49'),
(51526, 19067, 42718, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:06', '2021-12-20 12:17:06'),
(51527, 19067, 42718, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:06', '2021-12-20 15:10:06'),
(51528, 19067, 42718, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:03', '2021-12-22 13:39:03'),
(51529, 19067, 42718, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:41:32', '2021-12-22 13:41:32'),
(51530, 19067, 42718, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:37', '2021-12-28 17:03:37'),
(51531, 19067, 42718, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:35:50', '2022-01-05 15:35:50'),
(51532, 19067, 42718, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:38:32', '2022-01-12 15:38:32'),
(51533, 19067, 42718, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Kindly see the attachment for the provider, Eliza Rodrigues.  Don\'t hesitate to reach out if you need anything else!  Thank you, Hammad Ahmed', NULL, NULL, '2022-01-13 17:26:03', '2022-01-13 17:26:03'),
(51534, 19067, 42718, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582_01192022-4265501    Good Afternoon,     I have received the CANS attestation and forwarded it to credentialing via email for processing. The credentialing specialist that was working your file is Jennifer Farino. I sent it to them for review and processing.        Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:19:14', '2022-01-25 09:19:14'),
(51535, 19067, 42718, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Requested Document || SNBC || Eliza Rodriguez || BHO/BHS || attn. Middlesex County 01052022-4114582    Hello Jennifer Farino!  Hope you are doing well.  Any updates on the request below?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:22:21', '2022-02-04 09:22:21'),
(51536, 19067, 42718, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:04:57', '2022-02-07 10:04:57');
