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
(54323, 20067, 49745, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   Hello! The below-mentioned providers are not in the BCBSTX Provider Directory. Can you please provide me with a copy of the contract or welcome letter?  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jaya Jacob	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Odette Kourouma	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	779 Normandy St Ste 114 Houston, TX 77015-3441  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:29:47', '2022-01-18 17:29:47'),
(54324, 20067, 49745, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  I have requested copies of the Credentialing Approval letters for George Jeemol, Vibitha A. Jospeh, Odette T. Kourouma and Jaya Jacob.   Any V. Kurian credentialing is still in process.    Thank you  Marina', NULL, NULL, '2022-01-27 15:19:42', '2022-01-27 15:19:42'),
(54325, 20067, 49745, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645    Good Afternoon Marina! Hope this email finds you in good health. Thanks for the update, kindly send me the letters once you received them.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:55:26', '2022-02-02 14:55:26'),
(54326, 20067, 49745, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   I sent you the letters on 1/24/22.     Group# 0032WN – TAX ID# 270796429 does have Par Plan and every time a new provider gets added to this TAX ID# the Par Plan is automatically added.     Thank you  Marina', NULL, NULL, '2022-03-01 17:42:52', '2022-03-01 17:42:52'),
(54327, 20067, 49745, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, txproviderupdatesubmission@bcbstx.com, marina_machuca@bcbstx.com    Sub: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS ||   Hello,  Hope you are doing great. Can you please confirm for me that the listed locations are linked to the provider\'s profile?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ancy Kurian	1407171077	779 Normandy St Ste 114 Houston , TX 77015-3441 Ancy Kurian	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Odette Kourouma	1134525868	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you,', NULL, NULL, '2022-03-22 17:23:43', '2022-03-22 17:23:43'),
(54328, 22077, 49745, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: TXProviderUpdateSubmission@bcbstx.com  Subject: Re: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS || : Case Number - 03723317  Hi,  I would like to know the enrollment status for the following providers,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Primary & Billing Location	799 Normandy St Ste 114 Houston, TX 77015-3441 Provider Name	NPI	Location Ancy Kurian	1316558935	799 Normandy St Ste 114 Houston, TX 77015-3441 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Looking forward to hearing from you,  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 14:56:21', '2022-04-14 14:56:21'),
(54329, 22077, 49745, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS || : Case Number - 03886132  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03886132.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.  As of Jan. 18, 2022, , please use the Provider Data Management module in Availity ®  or our Demographic Change Form  to update your demographic information or to attest to your data. To enable us to meet the two-day provider update requirement defined under the Consolidated Appropriations Act , we will no longer accept provider demographic updates via email, phone or fax. Any demographic updates requested through these channels will be rejected and closed. Facilities should continue to use the Demographic Change Form . Learn more about updating your information .  To apply to join our networks or to add a provider to your current group, individuals and medical groups/clinics should use the Provider Onboarding Form . Learn more about applying to join our networks , including information for facilities.  We welcome your continued correspondence for non-demographic change purposes. If you have opted out of electronic communications, please continue to send correspondence, including demographic updates, via US Mail.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2022-04-14 15:09:05', '2022-04-14 15:09:05'),
(54330, 19067, 49746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 13:58:06', '2021-12-14 13:58:06'),
(54331, 19067, 49746, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Initiated via BCBS TX Portal. Application ID# 360826', NULL, NULL, '2021-12-14 13:59:39', '2021-12-14 13:59:39'),
(54332, 19067, 49746, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183    RE: ANCY V KURIAN, APN   Dear Provider,  Thank you for submitting the Provider Onboarding Form.  Please make sure the provider\'s CAQH is updated to ensure the next steps go smoothly.   Credentialing will be initiated through the Council for Affordable Quality Healthcare (CAQH) for the Universal Provider Datasource (UPD) once the agreement and all required documentation is received by BlueCross and BlueShield of Texas. If you are not registered with CAQH, please visit their site to complete the process: https://proview.caqh.org/Login/Index?ReturnUrl=%2fpr. If you are already registered with CAQH, please verify: Your CAQH profile and supporting documents are current  Authorization has either been assigned globally or add HCSC (BCBSTX).   TX is either the primary or a practicing state. Provider Status = Provider Data Submitted is not a complete CAQH record.  This status indicates CAQH is awaiting supporting documentation.  It does not identify what is missing or failed the review process Image_2021-12-17_13-15-29.png   NEEDS UPDATE.   An incomplete profile application with CAQH will delay credentialing and network participation.  For more information regarding CAQH, please visit our website or call the CAQH help desk at (888) 599-1771.   Sincerely,  Standard Contracting Team TX_Standard_Contracting_Team@bcbstx.com ', NULL, NULL, '2021-12-17 14:34:48', '2021-12-17 14:34:48'),
(54333, 19067, 49746, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183   Hello,  Hope you are having a productive day and you are staying healthy.  I have just updated Ancy Kurian\'s CAQH.  Let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 14:37:20', '2021-12-17 14:37:20'),
(54334, 19067, 49746, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || NUCC, IVUC || Ancy Kurian || BCBS TX ||   Hello,  I would like to know the enrollment status of the provider with mentioned locations with BCBS TX.   Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:42:51', '2021-12-23 17:42:51'),
(54335, 19067, 49746, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Status || NUCC, IVUC || Ancy Kurian || BCBS TX || : Case Number - 03279654  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03279654.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-12-28 12:32:56', '2021-12-28 12:32:56'),
(54336, 20067, 49746, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: connie_traylor@bcbstx.com,  Noemi_Diaz@bcbstx.com, carol_delao@bcbstx.com & txproviderupdatesubmission@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  Hope all is well with you. Any updates on the previously mentioned request?  I would also like to know the updates on case Number# 03279654  Looking Forward to hearing from you.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-10 14:10:19', '2022-01-10 14:10:19'),
(54337, 20067, 49746, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   Hello! The below-mentioned providers are not in the BCBSTX Provider Directory. Can you please provide me with a copy of the contract or welcome letter?  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jaya Jacob	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Odette Kourouma	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	779 Normandy St Ste 114 Houston, TX 77015-3441  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:29:40', '2022-01-18 17:29:40'),
(54338, 20067, 49746, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  I have requested copies of the Credentialing Approval letters for George Jeemol, Vibitha A. Jospeh, Odette T. Kourouma and Jaya Jacob.   Any V. Kurian credentialing is still in process.    Thank you  Marina', NULL, NULL, '2022-01-27 15:19:33', '2022-01-27 15:19:33'),
(54339, 20067, 49746, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645    Good Afternoon Marina! Hope this email finds you in good health. Thanks for the update, kindly send me the letters once you received them.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:55:32', '2022-02-02 14:55:32'),
(54340, 20067, 49746, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   I sent you the letters on 1/24/22.     Group# 0032WN – TAX ID# 270796429 does have Par Plan and every time a new provider gets added to this TAX ID# the Par Plan is automatically added.     Thank you  Marina', NULL, NULL, '2022-03-01 17:42:45', '2022-03-01 17:42:45'),
(54341, 20067, 49746, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, txproviderupdatesubmission@bcbstx.com, marina_machuca@bcbstx.com    Sub: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS ||   Hello,  Hope you are doing great. Can you please confirm for me that the listed locations are linked to the provider\'s profile?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ancy Kurian	1407171077	779 Normandy St Ste 114 Houston , TX 77015-3441 Ancy Kurian	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Odette Kourouma	1134525868	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you,', NULL, NULL, '2022-03-22 17:23:27', '2022-03-22 17:23:27'),
(54342, 22077, 49746, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: TXProviderUpdateSubmission@bcbstx.com  Subject: Re: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS || : Case Number - 03723317  Hi,  I would like to know the enrollment status for the following providers,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Primary & Billing Location	799 Normandy St Ste 114 Houston, TX 77015-3441 Provider Name	NPI	Location Ancy Kurian	1316558935	799 Normandy St Ste 114 Houston, TX 77015-3441 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Looking forward to hearing from you,  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 14:56:06', '2022-04-14 14:56:06'),
(54343, 22077, 49746, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS || : Case Number - 03886132  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03886132.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.  As of Jan. 18, 2022, , please use the Provider Data Management module in Availity ®  or our Demographic Change Form  to update your demographic information or to attest to your data. To enable us to meet the two-day provider update requirement defined under the Consolidated Appropriations Act , we will no longer accept provider demographic updates via email, phone or fax. Any demographic updates requested through these channels will be rejected and closed. Facilities should continue to use the Demographic Change Form . Learn more about updating your information .  To apply to join our networks or to add a provider to your current group, individuals and medical groups/clinics should use the Provider Onboarding Form . Learn more about applying to join our networks , including information for facilities.  We welcome your continued correspondence for non-demographic change purposes. If you have opted out of electronic communications, please continue to send correspondence, including demographic updates, via US Mail.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2022-04-14 15:08:48', '2022-04-14 15:08:48'),
(54344, 19067, 49747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 14:08:12', '2021-12-14 14:08:12'),
(54345, 19067, 49747, NULL, '2021-12-21 00:00:00.000', 'New/Not Initiated', 'Email to: intake_pdm@cigna.com cc: rsm@claimsmedinc.com  Subject: Ancy Kurian, NPI: 1316558935  Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Right Step Medical Center LLC. Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300  	  Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad.', NULL, NULL, '2021-12-14 14:11:24', '2021-12-14 14:11:24'),
(54346, 19067, 49747, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Email to: intake_pdm@cigna.com cc: rsm@claimsmedinc.com  Subject: Ancy Kurian, NPI: 1316558935  Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Right Step Medical Center LLC. Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300  	  Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad.', NULL, NULL, '2021-12-14 14:54:55', '2021-12-14 14:54:55'),
(54347, 19067, 49747, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: discovercigna@information.cigna.com  Subject: Cigna Credentialing Status Update: Application Received   CREDENTIALING STATUS UPDATE	 Status: Application received	 Re:	Reference number 12829636 Application to participate in the Cigna medical network Dear ANCY KURIAN,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely,  Cigna   	WE’RE HERE TO HELP We’ll send you status updates throughout the application review and credentialing process. You may also call Cigna Customer Service if you have any questions at 1.800.882.4462 (select the credentialing option), or email OnboardingStatus@Cigna.com.  Together, all the way.	 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.  931143‍‍ ‌07/19 © 2019 Cigna. All rights reserved  PCOMM-2019-474	 Unsubscribe from all Cigna marketing communications. ', NULL, NULL, '2021-12-17 14:58:30', '2021-12-17 14:58:30'),
(54348, 19067, 49747, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to:  OnboardingStatus@Cigna.com  Subject: Cigna Credentialing Status Update: Application Received    Good Morning!  Hope you\'re staying healthy,  I would like to know the enrollment status of Ancy Kurian. The reference number is 12829636.  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 10:24:52', '2021-12-23 10:24:52'),
(54349, 19067, 49747, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: OnboardingStatus@cigna.com  Subject: Re: Cigna Credentialing Status Update: Application Received   Hello!  Any updates on the previous request?  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 21:21:14', '2022-01-09 21:21:14'),
(54350, 19067, 49747, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: OnboardingStatus@cigna.com, discovercigna@information.cigna.com, intake_pdm@cigna.com, psscentral@cigna.com  Subject: Provider Enrollment || RSM || Ancy Kurian || Cigna ||  Hello,  This is my SECOND REMINDER on the below request.  Kindly respond in a timely manner!  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 17:29:40', '2022-01-25 17:29:40'),
(54351, 19067, 49747, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Subject: FW: [External] Provider Enrollment || RSM || Ancy Kurian || Cigna ||   Hi,     We have forwarded your request to the Providers Service Unit which is the correct department for proper handling.  For all future status request please submit directly to  PSSCentral@Cigna.com.     Sincerely,         Data Management.', NULL, NULL, '2022-02-08 13:49:48', '2022-02-08 13:49:48'),
(54352, 19067, 49747, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Maria.Edwards@cigna.com  Subject: RE: [External] Re: FW: Cigna Credentialing for Ancy Kurian    Sorry. I do not understand. The Practice location needed is the one where provider will be working for the tin requested.  ', NULL, NULL, '2022-02-17 11:44:53', '2022-02-17 11:44:53'),
(54353, 19067, 49747, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: maria.edwards@cigna.com  Subject: Re: FW: [External] Re: FW: Cigna Credentialing for Ancy Kurian   Hello!  Practice Name: Right Step Medical Center LLC TAX ID: 85-3252700 Practice location: 11925 Southwest Freeway, Suite 12 Stafford, TX 77477 Provider Name: Ancy Kurian NPI: 1316558935', NULL, NULL, '2022-02-17 11:45:25', '2022-02-17 11:45:25'),
(54354, 19067, 49747, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email received from: Maria.Edwards@cigna.com  Subject: RE: FW: [External] Re: FW: Cigna Credentialing for Ancy Kurian    Hello. I believe this was sent to me in error as I do not have an open request for this provider. All requests are showing closed for CAQH or missing info they were not able to obtain in the required 5 day turnaround time.  Please contact Provider Services at 800-882-4462.', NULL, NULL, '2022-02-18 09:54:55', '2022-02-18 09:54:55'),
(54355, 19067, 49747, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Dominique.Clermont@cigna.com  Subject: RE: TX_Ancy Kurian_MLP_Credentialing 3rd req     Please advise if you had an opportunity to review the outreach below so that we can move forward with the credentialing request.  I will be closing the file 02/11/2022.     For Status updates or to restart the credentialing process after close date please contact 800.882.4462. To restart credentialing process with required documentation, please send to MedicalOnboarding@Cigna.com. Thank you.     Provider SOLUTIONS & OPERATIONS  Dominique Clermont  Network Solutions & Operations | Network Operations | Provider Relations Senior Associate  “See it. Feel it. Believe it. Achieve it!”  For status updates, please contact psscentral@Cigna.com or at 1.800.882.4462  For initial credentialing requests, please contact MedicalOnboarding@Cigna.com or 1.800.882.4462  For demographic updates not requiring credentialing, please contact Intake_PDM@Cigna.com   For any other questions, please contact Provider Support & Solutions at 1.800.882.4462', NULL, NULL, '2022-02-21 15:52:04', '2022-02-21 15:52:04'),
(54356, 19067, 49747, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: dominique.clermont@cigna.com  Subject: RE: TX_Ancy Kurian_MLP_Credentialing 3rd req    Hello!  Sorry for the delay in responding to you.  Can we continue the credentialing process?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-22 17:32:55', '2022-02-22 17:32:55'),
(54357, 19067, 49747, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: Dominique.Clermont@cigna.com  Subject: RE: [External] Re: TX_Ancy Kurian_MLP_Credentialing 3rd req    I am still waiting for the provider’s specialty and role. Who is her supervising physician?  ', NULL, NULL, '2022-02-22 17:34:20', '2022-02-22 17:34:20'),
(54358, 19067, 49747, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: dominique.clermont@cigna.com  Subject: Re: [External] Re: TX_Ancy Kurian_MLP_Credentialing 3rd req    Hello!  Ancy Kurian\'s Specialty: 363LF0000X: Nurse Practitioner - Family, Her role is as a specialist. Supervising physician: Dr. Ramegowda Belakere.  Regards,', NULL, NULL, '2022-02-22 17:35:23', '2022-02-22 17:35:23'),
(54359, 19067, 49747, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: dominique.clermont@cigna.com  Subject: RE: TX_Ancy Kurian_CAQH_Credentialing 2nd req    Please advise if you had an opportunity to review the outreach below so that we can move forward with the credentialing request.  I will be closing the file 02/11/2022.     For Status updates or to restart the credentialing process after close date please contact 800.882.4462. To restart credentialing process with required documentation, please send to MedicalOnboarding@Cigna.com. Thank you.     Provider SOLUTIONS & OPERATIONS  Dominique Clermont  Network Solutions & Operations | Network Operations | Provider Relations Senior Associate  “See it. Feel it. Believe it. Achieve it!”  For status updates, please contact psscentral@Cigna.com or at 1.800.882.4462  For initial credentialing requests, please contact MedicalOnboarding@Cigna.com or 1.800.882.4462  For demographic updates not requiring credentialing, please contact Intake_PDM@Cigna.com   For any other questions, please contact Provider Support & Solutions at 1.800.882.4462   ', NULL, NULL, '2022-02-24 11:06:06', '2022-02-24 11:06:06'),
(54360, 19067, 49747, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: dominique.clermont@cigna.com  Subject: RE: TX_Ancy Kurian_CAQH_Credentialing 2nd req    Hello!  Sorry for the delay in responding to you.  The CAQH of Ancy Kurian has been updated. Kindly continue the credentialing process.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-24 11:06:36', '2022-02-24 11:06:36'),
(54361, 19067, 49747, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: DiscoverCigna@information.cigna.com  Subject: Cigna Credentialing Status Update: Credentialing Verification    Re:	Reference number 12882732 Application complete: Credentialing process to begin Dear ANCY KURIAN,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely,  Cigna', NULL, NULL, '2022-02-24 17:45:20', '2022-02-24 17:45:20'),
(54362, 19067, 49747, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Spoke with Mauric and the provider got the effective date as of 03/03/2022. It will now take 15 business days to get loaded.', NULL, NULL, '2022-03-07 10:30:44', '2022-03-07 10:30:44'),
(54363, 19067, 49747, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Email received from: DiscoverCigna@information.cigna.com  Subject: Welcome to the Cigna network    WELCOME TO CIGNA We’re happy to have you in our network Dear ANCY KURIAN MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 03/03/2022. Your provider identification number is‍ ‌3244692. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2022-03-07 10:40:27', '2022-03-07 10:40:27'),
(54364, 19067, 49747, NULL, '2022-03-21 00:00:00.000', 'Approved', 'Following email received from Cigna  Subject: Completion notification W202203102231862    Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. This request has been completed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference #  W202203102231862     Provider Name  CPF  Provider ID  Completed:  Yes / No.  Transaction type  Effective Date  Ancy Kurian  3244692  Yes  Add  03/03/2022        \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future request should be sent to Intake_PDM@cigna.com\"     Regards,  PDM', NULL, NULL, '2022-03-14 10:53:06', '2022-03-14 10:53:06'),
(54365, 19067, 49748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 14:13:03', '2021-12-14 14:13:03'),
(54366, 19067, 49748, NULL, '2021-12-21 00:00:00.000', 'Initiated', ' Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston , TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad.', NULL, NULL, '2021-12-14 14:21:21', '2021-12-14 14:21:21'),
(54367, 19067, 49748, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Email sent to: intake_pdm@cigna.com CC: nucc@claimsmedinc.com  Subject: Ancy Kurian, NPI: 1316558935 (NUCC, IVUC)   Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston , TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad.', NULL, NULL, '2021-12-14 14:22:52', '2021-12-14 14:22:52'),
(54368, 19067, 49748, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status || NUCC, IVUC || Ancy Kurian || Cigna ||   Hello,  I would like to know the enrollment status of the provider with mentioned locations with Cigna.   Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:52:47', '2021-12-23 17:52:47'),
(54369, 19067, 49748, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || Cigna ||    Greetings!  Any updates on previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:25:42', '2022-01-10 14:25:42'),
(54370, 20067, 49748, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || Cigna ||  Good Afternoon! Hope this email finds you well. Any updates on the below mentioned request?  Your Early response will be highly appreciated.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-18 17:39:13', '2022-01-18 17:39:13'),
(54371, 20067, 49748, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Called cigna and spoke to Jose  Application was in pending because CAQH was not updated CAQH updated Yesterday so now the application is still in process and it will take 90-100 Days from 12/28/2021 Application# 12840683 Ref# Jose01272022 ', NULL, NULL, '2022-01-27 17:54:31', '2022-01-27 17:54:31'),
(54372, 20067, 49748, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Called Cigna for the application status  Application is in process please allow more time. Ref# 7896494 Rep: Jennifer', NULL, NULL, '2022-02-02 15:57:17', '2022-02-02 15:57:17'),
(54373, 20067, 49748, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Called Cigna and spoke to Diego  Application closed on 02/11/2022 because the CAQH was not updated Application is reprocessed over the call please allow 90-120 days from today.  For Follow-ups call after 15 days. Ref# Diego03022022 ', NULL, NULL, '2022-03-02 09:30:59', '2022-03-02 09:30:59'),
(54374, 20067, 49748, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email received from: Karla.Payton@cigna.com  Sub: Ancy Kurian NP - Cigna Status 02252022  Good afternoon,     Hope your day is going well.  The provider has been sent to be reviewed by our credentialing department.      For status updates, please contact psscentral@Cigna.com or call Provider Support & Solutions Unit at 800.882.4462.     Have a great day.     Thank you,', NULL, NULL, '2022-03-11 09:54:24', '2022-03-11 09:54:24'),
(54375, 20067, 49748, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Call cigna at 800-882-4462 ref# Sanecia03212022  Provider is In-Network and the effective date is 03/03/2022.  Provider ID# 3244692  Both locations has been added to provider\'s profile', NULL, NULL, '2022-03-21 14:25:43', '2022-03-21 14:25:43'),
(54376, 19067, 49749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 14:26:01', '2021-12-14 14:26:01'),
(54377, 19067, 49749, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Email sent to: intake_pdm@cigna.com  Subject: Ancy Kurian, NPI: 1316558935 (NUCC, IVUC)    Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston , TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad. ', NULL, NULL, '2021-12-14 14:28:17', '2021-12-14 14:28:17'),
(54378, 19067, 49749, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status || NUCC, IVUC || Ancy Kurian || Cigna ||   Hello,  I would like to know the enrollment status of the provider with mentioned locations with Cigna.   Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:52:39', '2021-12-23 17:52:39'),
(54379, 19067, 49749, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || Cigna ||    Greetings!  Any updates on previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:25:31', '2022-01-10 14:25:31'),
(54380, 20067, 49749, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || Cigna ||  Good Afternoon! Hope this email finds you well. Any updates on the below mentioned request?  Your Early response will be highly appreciated.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-18 17:39:06', '2022-01-18 17:39:06'),
(54381, 20067, 49749, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Called cigna and spoke to Jose  Application was in pending because CAQH was not updated CAQH updated Yesterday so now the application is still in process and it will take 90-100 Days from 12/28/2021 Application# 12840683 Ref# Jose01272022 ', NULL, NULL, '2022-01-27 17:54:23', '2022-01-27 17:54:23'),
(54382, 20067, 49749, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Called Cigna for the application status  Application is in process please allow more time. Ref# 7896494 Rep: Jennifer', NULL, NULL, '2022-02-02 15:57:34', '2022-02-02 15:57:34'),
(54383, 20067, 49749, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Called Cigna and spoke to Diego  Application closed on 02/11/2022 because the CAQH was not updated Application is reprocessed over the call please allow 90-120 days from today.  For Follow-ups call after 15 days. Ref# Diego03022022', NULL, NULL, '2022-03-02 09:28:20', '2022-03-02 09:28:20'),
(54384, 20067, 49749, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email received from: Karla.Payton@cigna.com  Sub: Ancy Kurian NP - Cigna Status 02252022  Good afternoon,     Hope your day is going well.  The provider has been sent to be reviewed by our credentialing department.      For status updates, please contact psscentral@Cigna.com or call Provider Support & Solutions Unit at 800.882.4462.     Have a great day.     Thank you,', NULL, NULL, '2022-03-11 09:54:16', '2022-03-11 09:54:16'),
(54385, 20067, 49749, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Call cigna at 800-882-4462 ref# Sanecia03212022  Provider is In-Network and the effective date is 03/03/2022.  Provider ID# 3244692  Both locations has been added to provider\'s profile', NULL, NULL, '2022-03-21 14:25:59', '2022-03-21 14:25:59'),
(54386, 19067, 49750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 14:49:40', '2021-12-14 14:49:40'),
(54387, 19067, 49750, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Email sent to: intake_pdm@cigna.com  Subject: Ancy Kurian, NPI: 1316558935 (CUCC)   Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Columbus Urgent Care PA. Tax ID	47-1914151 Group NPI	1215330501 Primary & Billing Location	926 Walnut St, Columbus, TX 78934-2215   Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad.', NULL, NULL, '2021-12-14 14:53:29', '2021-12-14 14:53:29'),
(54388, 19067, 49750, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status || CUCC || Ancy Kurian || Cigna||   Hi,  I would like to know the enrollment status of the following provider with Cigna.  Group Name	Columbus Urgent Care PA. Tax ID	47-1914151 Group NPI	1215330501 Primary & Billing Location	926 Walnut St, Columbus, TX 78934-2215   Provider Name	Ancy Kurian NPI 1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:50:14', '2021-12-23 17:50:14'),
(54389, 19067, 49750, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Query || CUCC || Ancy Kurian || Cigna ||    Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 14:11:56', '2022-01-04 14:11:56'),
(54390, 20067, 49750, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Called Cigna at 860-226-1848 Spoke to Danny V The application was opened on 12-28-2021 Credentialing is Inprocess and it will take 90-100 days. Application #12840683 Rep said you will not receive any response from  intake_pdm@cigna.com the only way to do the follow-ups  is over the call Ref# DannyV01192022 Rep: Danny V', NULL, NULL, '2022-01-19 14:05:09', '2022-01-19 14:05:09'),
(54391, 20067, 49750, NULL, '2022-02-03 00:00:00.000', 'Approved', 'Called cigna at: (800) 244-6224 Spoke to Paul Application received on: 12/28/2021 Allow more time- 90-100 Days  Ref# Paul01272022', NULL, NULL, '2022-01-27 10:06:50', '2022-01-27 10:06:50'),
(54392, 19067, 49751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 15:00:44', '2021-12-14 15:00:44'),
(54393, 19067, 49751, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Email sent to: intake_pdm@claimsmedinc.com  Subject: Ancy Kurian, NPI: 1316558935 (LPMC)   Hi,  Hope you\'re having a productive day.  I want to enroll the following provider under an existing group:  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary & Billing Location	9504 Long Point RD STE E Houston, TX 77055-4226   Provider Name	Ancy Kurian NPI	1316558935 SSN	512-08-7073 DOB	7/18/1970 Speciality	Nurse Practitioner Degree	Master of Science in Nursing Effective Date	12/1/2021  W9 is also attached.  Kindly get back to me as soon as you can.  Thanks & Regards, Ahmed,Hammad.', NULL, NULL, '2021-12-14 15:06:17', '2021-12-14 15:06:17'),
(54394, 19067, 49751, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status || LPMC || Ancy Kurian || Cigna ||   Hi,  I would like to know the enrollment status of the following provider with Cigna.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary & Billing Location	9504 Long Point RD STE E Houston, TX 77055-4226   Provider Name	NPI Ancy Kurian	1316558935   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:47:15', '2021-12-23 17:47:15'),
(54395, 19067, 49751, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Re: Enrollment Status || LPMC || Ancy Kurian || Cigna ||   Greetings!  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:21:50', '2022-01-10 14:21:50'),
(54396, 20067, 49751, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Called Cigna at (800) 244-6224 Rep: Diana Ref# Diana01202022 Application was not receive for this tax id. I request Diana to add this provider under Longpoint Medical Center She said it will take 90-120 Days. Application# 12861386  Do the follow-ups over the call at 800-882-4462', NULL, NULL, '2022-01-20 12:47:33', '2022-01-20 12:47:33'),
(54397, 20067, 49751, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub:Re: Enrollment Status || LPMC || Ancy Kurian || Cigna ||   Good Afternoon!  Hope this email finds you well. I have updated the CAQH of Ancy Kurian Kindly continue the credentialing process. CAQH: 15187581  Thank you,', NULL, NULL, '2022-02-18 16:34:01', '2022-02-18 16:34:01'),
(54398, 20067, 49751, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email received from: Karla.Payton@cigna.com  Sub: Ancy Kurian NP - Cigna Status 02252022  Good afternoon,     Hope your day is going well.  The provider has been sent to be reviewed by our credentialing department.      For status updates, please contact psscentral@Cigna.com or call Provider Support & Solutions Unit at 800.882.4462.     Have a great day.     Thank you,', NULL, NULL, '2022-03-11 09:53:42', '2022-03-11 09:53:42'),
(54399, 20067, 49751, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Call Cigna at 800-233-2148  Provider ID# 3244692 Effective Date:  03/03/2022  Plans: PPO Open Access Plus HMO  Welcome letter has not been send yet. We will receive the letter within a week Ref# Santiana A 03222022 Rep: Santiana A', NULL, NULL, '2022-03-22 15:32:53', '2022-03-22 15:32:53'),
(54400, 19067, 49752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 15:37:38', '2021-12-14 15:37:38'),
(54401, 19067, 49752, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Submit application via Portal, Application ID: 360876', NULL, NULL, '2021-12-14 15:40:12', '2021-12-14 15:40:12'),
(54402, 19067, 49752, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183    RE: ANCY V KURIAN, APN   Dear Provider,  Thank you for submitting the Provider Onboarding Form.  Please make sure the provider\'s CAQH is updated to ensure the next steps go smoothly.   Credentialing will be initiated through the Council for Affordable Quality Healthcare (CAQH) for the Universal Provider Datasource (UPD) once the agreement and all required documentation is received by BlueCross and BlueShield of Texas. If you are not registered with CAQH, please visit their site to complete the process: https://proview.caqh.org/Login/Index?ReturnUrl=%2fpr. If you are already registered with CAQH, please verify: Your CAQH profile and supporting documents are current  Authorization has either been assigned globally or add HCSC (BCBSTX).   TX is either the primary or a practicing state. Provider Status = Provider Data Submitted is not a complete CAQH record.  This status indicates CAQH is awaiting supporting documentation.  It does not identify what is missing or failed the review process Image_2021-12-17_13-15-29.png   NEEDS UPDATE.   An incomplete profile application with CAQH will delay credentialing and network participation.  For more information regarding CAQH, please visit our website or call the CAQH help desk at (888) 599-1771.   Sincerely,  Standard Contracting Team TX_Standard_Contracting_Team@bcbstx.com ', NULL, NULL, '2021-12-17 14:34:34', '2021-12-17 14:34:34'),
(54403, 19067, 49752, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183   Hello,  Hope you are having a productive day and you are staying healthy.  I have just updated Ancy Kurian\'s CAQH.  Let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 14:37:06', '2021-12-17 14:37:06'),
(54404, 19067, 49752, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || CUCC || Ancy Kurian || BCBS TX ||   Hi,  I would like to know the enrollment status of the mentioned provider with BCBS TX.  Group Name	Columbus Urgent Care PA. Tax ID	47-1914151 Group NPI	1215330501 Primary & Billing Location	926 Walnut St, Columbus, TX 78934-2215   Provider Name	NPI Ancy Kurian	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:39:00', '2021-12-23 17:39:00'),
(54405, 19067, 49752, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Status || CUCC || Ancy Kurian || BCBS TX || : Case Number - 03279645  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03279645.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-12-28 12:30:23', '2021-12-28 12:30:23'),
(54406, 19067, 49752, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Query || CUCC || Ancy Kurian || Case# 03279645 || BCBS TX ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider.  Case# 03279645  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 14:08:25', '2022-01-04 14:08:25');
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
(54407, 19067, 49752, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Query || CUCC || Ancy Kurian || Case# 03279645 || BCBS TX || : Case Number - 03307794   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03307794.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2022-01-05 16:22:31', '2022-01-05 16:22:31'),
(54408, 20067, 49752, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Checked status through Credentialing status checker and status is IN process See the attachment.', NULL, NULL, '2022-01-19 14:21:47', '2022-01-19 14:21:47'),
(54409, 20067, 49752, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Checked the status through credentialing status checker, Application is in process. See the attachment', NULL, NULL, '2022-01-27 09:55:34', '2022-01-27 09:55:34'),
(54410, 20067, 49752, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Checked status through Credentialing status checker. Your application is in the credentialing or re-credentialing process', NULL, NULL, '2022-02-02 11:58:22', '2022-02-02 11:58:22'),
(54411, 20067, 49752, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Checked status through Credentialing status checker. Your application is in the credentialing or re-credentialing process', NULL, NULL, '2022-02-17 14:22:10', '2022-02-17 14:22:10'),
(54412, 20067, 49752, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Checked status through BCBS Credentialing status checker.  Your application has been approved. COMPLETION OF THE CREDENTIALING PROCESS DOES NOT MEAN THAT YOU ARE A CONTRACTED PROVIDER. Please await notification via letter or email.  Waiting for the confirmation Email', NULL, NULL, '2022-03-01 10:15:51', '2022-03-01 10:15:51'),
(54413, 20067, 49752, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Checked status through case status checker Application is in progress See the attachment  ', NULL, NULL, '2022-03-09 15:17:36', '2022-03-09 15:17:36'),
(54414, 20067, 49752, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Checked status through case status checker, Application still in process', NULL, NULL, '2022-03-21 12:35:08', '2022-03-21 12:35:08'),
(54415, 19067, 49753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 15:55:59', '2021-12-14 15:55:59'),
(54416, 19067, 49753, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Submitted application via Portal, Application ID: 360910', NULL, NULL, '2021-12-14 15:57:17', '2021-12-14 15:57:17'),
(54417, 19067, 49753, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Submitted application via Portal, Application ID: 360910', NULL, NULL, '2021-12-14 15:58:00', '2021-12-14 15:58:00'),
(54418, 19067, 49753, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183    RE: ANCY V KURIAN, APN   Dear Provider,  Thank you for submitting the Provider Onboarding Form.  Please make sure the provider\'s CAQH is updated to ensure the next steps go smoothly.   Credentialing will be initiated through the Council for Affordable Quality Healthcare (CAQH) for the Universal Provider Datasource (UPD) once the agreement and all required documentation is received by BlueCross and BlueShield of Texas. If you are not registered with CAQH, please visit their site to complete the process: https://proview.caqh.org/Login/Index?ReturnUrl=%2fpr. If you are already registered with CAQH, please verify: Your CAQH profile and supporting documents are current  Authorization has either been assigned globally or add HCSC (BCBSTX).   TX is either the primary or a practicing state. Provider Status = Provider Data Submitted is not a complete CAQH record.  This status indicates CAQH is awaiting supporting documentation.  It does not identify what is missing or failed the review process Image_2021-12-17_13-15-29.png   NEEDS UPDATE.   An incomplete profile application with CAQH will delay credentialing and network participation.  For more information regarding CAQH, please visit our website or call the CAQH help desk at (888) 599-1771.   Sincerely,  Standard Contracting Team TX_Standard_Contracting_Team@bcbstx.com ', NULL, NULL, '2021-12-17 14:34:15', '2021-12-17 14:34:15'),
(54419, 19067, 49753, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX: CAQH Update Needed for ANCY V KURIAN, APN : Case Number - 03248183   Hello,  Hope you are having a productive day and you are staying healthy.  I have just updated Ancy Kurian\'s CAQH.  Let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-17 14:36:54', '2021-12-17 14:36:54'),
(54420, 19067, 49753, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || LPMC || Provider || BCBS TX ||   Hi,  I would like to know the enrollment status of the following provider with Aetna.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary & Billing Location	9504 Long Point RD STE E Houston, TX 77055-4226   Provider Name	Ancy Kurian NPI	1316558935   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:34:32', '2021-12-23 17:34:32'),
(54421, 19067, 49753, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email: tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status || LPMC || Provider || BCBS TX ||  Greetings!  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:39:32', '2022-01-10 13:39:32'),
(54422, 20067, 49753, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Sub: Re: Enrollment Status || LPMC || Provider || BCBS TX ||  Good Morning!  Hope this email finds you in good health. Any updates on the below-mentioned request?  Thanks and regards Syed Ahad.', NULL, NULL, '2022-01-14 11:00:37', '2022-01-14 11:00:37'),
(54423, 20067, 49753, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Sub:  Re: Enrollment Status || LPMC || Provider || BCBS TX ||  Thank you for contacting Blue Cross and Blue Shield of Texas.  We have received your email for case number 03248183.  Since case 03248183 is closed, your request can not be processed at this time.  To open a new case for your request or for any questions, click https://www.bcbstx.com/provider/contact_us.html.  Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2022-01-14 12:44:44', '2022-01-14 12:44:44'),
(54424, 20067, 49753, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: txintaketeampiermailbox@bcbstx.com  Sub: Re: Enrollment Status || LPMC || Provider || BCBS TX ||   Good Morning!  Hope all is well with you. Can you please tell me the status of this case for the provider Ancy Kurian NPI: 1316558935  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 12:45:44', '2022-01-14 12:45:44'),
(54425, 20067, 49753, NULL, '2022-02-15 00:00:00.000', 'In Process', 'CAQH not updated yet. Will follow-up next week', NULL, NULL, '2022-02-08 13:24:07', '2022-02-08 13:24:07'),
(54426, 20067, 49753, NULL, '2022-02-28 00:00:00.000', 'In Process', 'CAQH has been updated  Check status through bcbs credentialing status check  Your application is in the credentialing or re-credentialing process.', NULL, NULL, '2022-02-21 17:40:10', '2022-02-21 17:40:10'),
(54427, 20067, 49753, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: Credentialing Status || Providers || LPMC || BCBSTX  Good Afternoon!  Hope you had a great weekend. Can you please confirm the credentialing status of the listed providers?  For Provider Sigi Paul I checked the status from the credentialing status check and it is showing the application has been approved since 07/29/2021 but we haven\'t received the approval letter yet.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Ancy Kurian	1316558935   Thank you,', NULL, NULL, '2022-03-14 14:26:28', '2022-03-14 14:26:28'),
(54428, 20067, 49753, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: marina_machuca@bcbstx.com  Sub: Credentialing Status  We have received a request for Network Status on  Sigi Paul - NPI# 1033623616 and Ancy Kurian NPI# 1316558935 under TAX ID# 76-0612416.  Sig Paul is In Network effective 8/10/21 for BAV, PPO, Blue Premier, HMO, Medicare HMO and Medicare PPO.  Ancy Kurian - We need the Case# for this provider in order to Add Networks to your TAX ID#.  Thank you', NULL, NULL, '2022-03-15 16:56:19', '2022-03-15 16:56:19'),
(54429, 20067, 49753, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Provider Onboarding Form has been submitted online  See the attachment', NULL, NULL, '2022-03-16 14:02:09', '2022-03-16 14:02:09'),
(54430, 20067, 49753, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Secure Email sent to: Marina_Machuca@BCBSTX.COM  Sub: RE: FW: PHI RE: Credentialing Status - Ancy V. Kurian, APN  Hey Marina!  I\'d submitted the provider onboarding Form for Ancy Kurian on 03/16/2022. Can you please confirm me whether the application is received or not?  NPI: 1316558935  TIN# 81-5123542  Thank you,', NULL, NULL, '2022-03-22 17:45:14', '2022-03-22 17:45:14'),
(54431, 11056, 49754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 17:22:09', '2021-12-14 17:22:09'),
(54432, 1019, 49754, NULL, '2021-12-21 00:00:00.000', 'On Hold', 'Waiting for the group to get enrolled with Medicaid ', NULL, NULL, '2021-12-14 17:48:55', '2021-12-14 17:48:55'),
(54433, 1019, 49754, NULL, '2022-01-11 00:00:00.000', 'Initiated', 'Your change request has been submitted and assigned the following tracking number. 301572  Please retain the tracking number for checking on the status of your change request. This change may require additional processes to verify data submitted. Use the Provider Maintenance Status page to check on the status of this change request.  A confirmation email has also been sent to the following contact person\'s email, associated with the provider: hcaps.payorrequest@hcahealthcare.com.', NULL, NULL, '2022-01-04 09:36:07', '2022-01-04 09:36:07'),
(54434, 19067, 49754, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: comedicaidenrollmentportal@dxc.com   Subject: Provider Revalidation Application: 309540    MARYEM KIANINEJAD,  Thank you for submitting your provider enrollment revalidation request. This email is to notify you that your request for revalidation has been submitted and is currently being processed. You can check the status of your application by accessing the Department’s Provider Portal. Your Tracking Number 309540 and Tax ID are required to access your application.  Thank you,  Colorado Medicaid  Provider Enrollment   Do not reply to this email; it is sent from an unmonitored mailbox. For additional support, please visit Colorado.gov/HCPF/Provider-Resources  MARYEM KIANINEJAD309540MARYEM KIANINEJAD309540', NULL, NULL, '2022-02-24 09:13:51', '2022-02-24 09:13:51'),
(54435, 19067, 49754, NULL, '2022-03-18 00:00:00.000', 'Approved', 'Dear Colorado Medicaid Provider,  Please review the attached letter regarding the status of your Provider Enrollment request. Be sure to keep a copy of the attached letter for your records.  Thank you,  Colorado Medicaid Provider Enrollment', NULL, NULL, '2022-03-11 15:35:23', '2022-03-11 15:35:23'),
(54436, 11056, 49755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 17:22:32', '2021-12-14 17:22:32'),
(54437, 1019, 49755, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Request Initiated thru their website, see attached for reference.', NULL, NULL, '2021-12-14 17:48:25', '2021-12-14 17:48:25'),
(54438, 1019, 49755, NULL, '2021-12-27 00:00:00.000', 'Not Eligible', 'Medicaid Rejected the application for the group as they require an MD to work with the practice for enrolling the group. Attached is the Denial Letter', NULL, NULL, '2021-12-20 12:06:58', '2021-12-20 12:06:58'),
(54439, 19067, 49756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 17:35:24', '2021-12-14 17:35:24'),
(54440, 19067, 49756, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Submitted application via Portal. ', NULL, NULL, '2021-12-14 17:38:29', '2021-12-14 17:38:29'),
(54441, 19067, 49756, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Submitted application via Portal. ', NULL, NULL, '2021-12-14 17:38:42', '2021-12-14 17:38:42'),
(54442, 19067, 49756, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: national_credentialing@uhc.com  Subject: Request for Credentialing   12/18/2021  Ancy Kurian rsm@claimsmedinc.com CAQH ID#: 15187581 MPIN#: 7891792  Re: ACTION NEEDED: Complete Your Credentialing Application  Dear Ancy Kurian:  Thank you for your interest in joining the UnitedHealthcare network. The next step in the process is to update your CAQH (Council for Affordable Quality Healthcare) credentialing application.  Here\'s what you need to do:  Update your CAQH application. We can see you’re already registered with CAQH, so you’ll just need to log into your account at proview.CAQH.org/pr. Then, you’ll need to complete your application. You’ll find a complete list of required materials that must be in your credentialing application at the bottom of this letter. Make sure your attestation is current: Attestation means that you’ve confirmed that the information you’ve provided is complete, current and accurate. Add United Healthcare as an authorized plan. You can either manually authorize UnitedHealthcare or select global authorization so that we can access your data. Submit your completed application. We’ll automatically be notified that your request is complete. What happens next? CAQH will notify you when your application is complete. We’ll also contact you when we’ve received your credentialing application from CAQH, and outline the next steps in the credentialing process. Please note that during the credentialing process, we may request more information from you than what was included in your application. If we ask for any additional information, we’ll supply the required forms and instructions.  If you haven’t heard from us within 45 days after completing your application, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request.  Questions? We\'re here to help. There are several resources available to help you:  CAQH Application: To learn more about CAQH and the credentialing application program, visit CAQH.org. If you have any questions on creating a CAQH account or completing the application, just call the CAQH Help Desk at 888-599-1771. United Healthcare Credentialing Process: If you have any questions, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join. Sincerely,', NULL, NULL, '2021-12-20 09:56:20', '2021-12-20 09:56:20'),
(54443, 19067, 49756, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Spoke with Minie at 877-842-3210, she said that the application is in the initial review and this process will take 5-7 days. Ref# 4393', NULL, NULL, '2021-12-20 09:59:15', '2021-12-20 09:59:15'),
(54444, 19067, 49756, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Status || RSM || Ancy Kurian || UHC ||   Hi,  I would like to know the enrollment status of the following provider with UHC.   Group Name	Right Step Medical Center LLC. Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300  	  Provider Name	NPI Ancy Kurian 1316558935  Kindly respond promptly.  Thanks & Regards. Ahmed, Hammad.', NULL, NULL, '2021-12-23 18:08:36', '2021-12-23 18:08:36'),
(54445, 19067, 49756, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: jamie_edmondson@uhc.com  Subject: Secure Message from jamie_edmondson@uhc.com   Thank you for contacting the Network Management Resource Team. The initial credentialing request for Ancy Kurian is currently in process. General turnaround time for initial credentialing is 30 days with an additional 30-45 days for contracting. Please allow more time for the request to process and complete.  Please let us know if we can assist further via email.     Jamie Edmondson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-30 17:28:24', '2021-12-30 17:28:24'),
(54446, 19067, 49756, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Re: Enrollment Status || RSM || Ancy Kurian || UHC ||   Greetings!  Any updates on the previously mentioned request.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 21:36:26', '2022-01-09 21:36:26'),
(54447, 19067, 49756, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Subject: Re: Enrollment Status || RSM || Ancy Kurian || UHC ||   Hi,  Hope this email finds you well.  Any updates on the below mentioned request?  Kindly respond as per your convenience.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 16:24:14', '2022-01-25 16:24:14'),
(54448, 19067, 49756, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Subject: Re Enrollment Status RSM Ancy Kurian UHC - [ref:_02693649:ref]    Thank you for contacting the Network Management Resource Team. I have verified credentialing for Ancy Kurian is showing as In Process - Application added to Repository. Credentialing approval does not imply or guarantee participation with the health plans. Approved and signed physician contracts are required for participation.    If you’re joining a medical group that already has a participation agreement with UnitedHealthcare, you won’t receive a contract directly. Instead, you’ll be added to the group agreement once your credentialing application has been approved. (This can take up to three weeks once credentialing is approved.)    If you are joining a medical group or practice that is wanting to join the network, once the agreement has been approved if you’ve given us an email address, we’ll send you the contract through the secure DocuSign application. If not, we’ll send it to you by U.S. mail.     For more information and resources, please visit https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-contracted.html.     Questions? We’re here to help   If we can further assist you, please respond to this email.     Sincerely,  UnitedHealthcare Network Management Resource Team', NULL, NULL, '2022-02-14 10:39:37', '2022-02-14 10:39:37'),
(54449, 19067, 49756, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Subject: Re: Re Enrollment Status  RSM  Ancy Kurian  UHC - [ref:_02693649:ref]   HI,  Any updates on the enrollment process of the provider, Ancy Kurian?  Kindly update as per your convenience.  Thanks,', NULL, NULL, '2022-03-11 10:19:15', '2022-03-11 10:19:15'),
(54450, 19067, 49756, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email received from: networkhelp@uhc.com  Subject: Secure Message from networkhelp=uhc.com__0-29waayabv3yscd.zhv6zvlvob0d7sok@mhzt2alz9xco90ya.t6p5p5.5-jldwea4.na123.bnc.salesforce.com     Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.       We have verified that credentialing for Ancy Kurian has been completed. Contract loading is currently in process under reference number PR6474418. I have reached out to find out a better timeframe as to when they will be completed.      Additionally, once contracts have been loaded this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1). Please see the attached handout for more information.    Please let us know if we can assist further.     Questions? We’re here to help  Please respond to this email if you need further assistance.     Sincerely,  UnitedHealthcare Network Management Resource Team', NULL, NULL, '2022-03-11 10:35:57', '2022-03-11 10:35:57'),
(54451, 19067, 49757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 17:54:12', '2021-12-14 17:54:12'),
(54452, 19067, 49757, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Application submitted via Portal.', NULL, NULL, '2021-12-14 17:58:23', '2021-12-14 17:58:23'),
(54453, 19067, 49757, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC ||   Hello,  I would like to know the enrollment status of the provider with mentioned locations with UHC.   Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 18:06:28', '2021-12-23 18:06:28'),
(54454, 19067, 49757, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: jamie_edmondson@uhc.com  Subject: Secure Message from jamie_edmondson@uhc.com     Thank you for contacting the Network Management Resource Team. The initial credentialing request for Ancy Kurian is currently in process. General turnaround time for initial credentialing is 30 days with an additional 30-45 days for contracting. Please allow more time for the request to process and complete.  Please let us know if we can assist further via email.        Jamie Edmondson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-30 17:30:55', '2021-12-30 17:30:55'),
(54455, 19067, 49757, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subjet: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC ||  Hello!  Hope you are doing well.  I would like to get the updates on the following Provider.  Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935    Thanks & Regards. Hammad Ahmed.', NULL, NULL, '2022-01-06 13:57:18', '2022-01-06 13:57:18'),
(54456, 20067, 49757, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Sub: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC ||  Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 09:49:19', '2022-01-18 09:49:19'),
(54457, 20067, 49757, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from:  networkhelpresponse@uhc.com  Sub: Re Enrollment Status NUCC, IVUC Ancy Kurian UHC - [ref:_02678067:ref]   Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.    We have verified that the Contract load is still In Process. Please allow more time for processing and completion.   Please let us know if we can assist further.  Questions? We’re here to help  Please respond to this email if you need further assistance.  Sincerely,  UnitedHealthcare Network Management Resource Team  Re- Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC || Good Morning! Hope this email finds you well. Any updates on the below-mentioned request? Your Early response will be highly appreciated Thanks & Regards,  This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or intended recipient’s authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2022-01-18 12:10:00', '2022-01-18 12:10:00'),
(54458, 20067, 49757, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Sub: Re Enrollment Status NUCC, IVUC Ancy Kurian UHC - [ref:_02678067:ref]  Good Morning!  Hope this email finds you in good spirits. Any update on the request?  Thanks and Regards  Syed Ahad', NULL, NULL, '2022-01-28 10:37:06', '2022-01-28 10:37:06'),
(54459, 20067, 49757, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Sub: Enrollment Status || Providers || NUCC & IVUC || UHC  Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of Ancy Kurian & the Demographic update for Jeny John, Information is listed below.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 13:00:49', '2022-03-02 13:00:49'),
(54460, 20067, 49757, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Demographic updates has been submitted through UHC Portal  Waiting for the address update', NULL, NULL, '2022-03-18 14:15:55', '2022-03-18 14:15:55'),
(54461, 22077, 49757, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Subject: 	Re: Enrollment Status || Providers || NUCC & IVUC || UHC  Hi,  I would like to know the enrollment process for the following providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Jeny John	1073019493  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-19 15:59:16', '2022-04-19 15:59:16'),
(54462, 19067, 49758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 17:54:29', '2021-12-14 17:54:29'),
(54463, 19067, 49758, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Application submitted via Portal.', NULL, NULL, '2021-12-14 17:57:45', '2021-12-14 17:57:45'),
(54464, 19067, 49758, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: national_credentialing@uhc.com  Subject: Request for Credentialing    12/18/2021  Ancy Kurian nucc@claimsmedinc.com  MPIN#: 7891792  Re: Update on your UnitedHealthcare Credentialing Application  Dear Ancy Kurian:  Thank you for your interest in joining the UnitedHealthcare network. We received your request for participation and have good news: Credentialing is not required because you meet the following requirements:  Practice exclusively in an inpatient setting or a freestanding facility, and Only provide care for members at this facility. If our information is inaccurate, and you need to be credentialed for an outpatient practice, please let us know. Just email us at Networkhelp@uhc.com. . Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request and make sure to include that you practice in both inpatient and outpatient settings. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join.  What happens next? We’ve automatically forwarded your request for participation to the contracting team. They’ll be in touch to follow up on your contract and any demographic updates that may be needed.  Questions? We\'re here to help. If you have any questions, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join.  Sincerely,  ', NULL, NULL, '2021-12-20 09:55:04', '2021-12-20 09:55:04'),
(54465, 19067, 49758, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Spoke with Minie at 877-842-3210, she said that the application is in the initial review and this process will take 5-7 days. Ref# 4393', NULL, NULL, '2021-12-20 09:58:23', '2021-12-20 09:58:23'),
(54466, 19067, 49758, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC ||   Hello,  I would like to know the enrollment status of the provider with mentioned locations with UHC.   Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 18:06:19', '2021-12-23 18:06:19'),
(54467, 19067, 49758, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: jamie_edmondson@uhc.com  Subject: Secure Message from jamie_edmondson@uhc.com     Thank you for contacting the Network Management Resource Team. The initial credentialing request for Ancy Kurian is currently in process. General turnaround time for initial credentialing is 30 days with an additional 30-45 days for contracting. Please allow more time for the request to process and complete.  Please let us know if we can assist further via email.        Jamie Edmondson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-30 17:30:48', '2021-12-30 17:30:48'),
(54468, 19067, 49758, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subjet: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC ||  Hello!  Hope you are doing well.  I would like to get the updates on the following Provider.  Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935    Thanks & Regards. Hammad Ahmed.', NULL, NULL, '2022-01-06 13:57:13', '2022-01-06 13:57:13'),
(54469, 20067, 49758, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Sub: Re: Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC ||  Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 09:49:05', '2022-01-18 09:49:05'),
(54470, 20067, 49758, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from:  networkhelpresponse@uhc.com  Sub: Re Enrollment Status NUCC, IVUC Ancy Kurian UHC - [ref:_02678067:ref]   Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.    We have verified that the Contract load is still In Process. Please allow more time for processing and completion.   Please let us know if we can assist further.  Questions? We’re here to help  Please respond to this email if you need further assistance.  Sincerely,  UnitedHealthcare Network Management Resource Team  Re- Enrollment Status || NUCC, IVUC || Ancy Kurian || UHC || Good Morning! Hope this email finds you well. Any updates on the below-mentioned request? Your Early response will be highly appreciated Thanks & Regards,  This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or intended recipient’s authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2022-01-18 12:09:45', '2022-01-18 12:09:45'),
(54471, 20067, 49758, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Sub: Re Enrollment Status NUCC, IVUC Ancy Kurian UHC - [ref:_02678067:ref]  Good Morning!  Hope this email finds you in good spirits. Any update on the request?  Thanks and Regards  Syed Ahad', NULL, NULL, '2022-01-28 10:37:00', '2022-01-28 10:37:00'),
(54472, 20067, 49758, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Sub: Enrollment Status || Providers || NUCC & IVUC || UHC  Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of Ancy Kurian & the Demographic update for Jeny John, Information is listed below.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 13:00:42', '2022-03-02 13:00:42'),
(54473, 20067, 49758, NULL, '2022-03-18 00:00:00.000', 'Approved', 'Provider Has been successfully added to NUCC group  Effective Date: 02/16/2022 See the Attachment', NULL, NULL, '2022-03-11 12:15:01', '2022-03-11 12:15:01'),
(54474, 19067, 49759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 18:06:02', '2021-12-14 18:06:02'),
(54475, 19067, 49759, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Submitted application via Portal.', NULL, NULL, '2021-12-14 18:06:54', '2021-12-14 18:06:54'),
(54476, 19067, 49759, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Status || CUCC || Ancy Kurian || UHC ||   Hi,  I would like to know the enrollment status of the following provider with UHC.  Group Name	Columbus Urgent Care PA. Tax ID	47-1914151 Group NPI	1215330501 Primary & Billing Location	926 Walnut St, Columbus, TX 78934-2215   Provider Name	NPI Ancy Kurian 1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 18:04:09', '2021-12-23 18:04:09'),
(54477, 19067, 49759, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: jamie_edmondson@uhc.com  Subject: Secure Message from jamie_edmondson@uhc.com   Thank you for contacting the Network Management Resource Team. The initial credentialing request for Ancy Kurian is currently in process. General turnaround time for initial credentialing is 30 days with an additional 30-45 days for contracting. Please allow more time for the request to process and complete.  Please let us know if we can assist further via email.     Jamie Edmondson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-30 17:32:43', '2021-12-30 17:32:43'),
(54478, 20067, 49759, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Application initiated through UHC portal  See the attached Email', NULL, NULL, '2022-01-19 14:53:58', '2022-01-19 14:53:58'),
(54479, 20067, 49759, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Sub: Enrollment Query || Providers || CUCC || UHC    Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1316558935	Ancy Kurian 1073019493	Jeny John 1396380077	Molly Jospeh 1033623616	SIGI PAUL 1194336149	Jaya Jacob 1467901587	Jeena Abraham 1134777238	Cini Thomas 1497726202	Abdur Rauf 1972005189	Limy Fernandus 1841755956	Mini Chennemkara 1134525868	Odette Kourouma 1194206490	Glory Abraham 1497219067	Jeemol George 1447883061	julie Jose 1588959118	Ani Stephen 1275163537	Brittany Brown 1952931560	Vibitha Joseph  Thanks & Regards,', NULL, NULL, '2022-01-27 14:28:44', '2022-01-27 14:28:44'),
(54480, 20067, 49759, NULL, '2022-02-24 00:00:00.000', 'On Hold', '', NULL, NULL, '2022-02-17 17:40:58', '2022-02-17 17:40:58'),
(54481, 19067, 49760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-14 18:12:51', '2021-12-14 18:12:51'),
(54482, 19067, 49760, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Application submitted via Portal', NULL, NULL, '2021-12-14 18:14:06', '2021-12-14 18:14:06'),
(54483, 19067, 49760, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Status || LPMC || Provider || UHC ||  Hi,  I would like to know the enrollment status of the following provider with UHC.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary & Billing Location	9504 Long Point RD STE E Houston, TX 77055-4226   Provider Name	NPI Ancy Kurian	1316558935   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 18:01:42', '2021-12-23 18:01:42'),
(54484, 19067, 49760, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: jamie_edmondson@uhc.com  Subject: Secure Message from jamie_edmondson@uhc.com  Thank you for contacting the Network Management Resource Team. The initial credentialing request for Ancy Kurian is currently in process. General turnaround time for initial credentialing is 30 days with an additional 30-45 days for contracting. Please allow more time for the request to process and complete.  Please let us know if we can assist further via email.     Jamie Edmondson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-28 13:38:34', '2021-12-28 13:38:34'),
(54485, 19067, 49760, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Subject: Re: Enrollment Status || LPMC || Provider || UHC ||   Hi,  I would like to know the enrollment status of the following Provider with United Healthcare.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary & Billing Location	9504 Long Point RD STE E Houston, TX 77055-4226 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 14:04:37', '2022-01-06 14:04:37'),
(54486, 19067, 49760, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: jamie_edmondson@uhc.com, networkhealth@uhc.com   Subject: Enrollment Status || LPMC || Provider || UHC ||   Hi,  I would like to know the enrollment status of the following Provider with United Healthcare.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary & Billing Location	9504 Long Point RD STE E Houston, TX 77055-4226 Provider Name	NPI Ancy Kurian	1316558935  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 14:07:10', '2022-01-06 14:07:10'),
(54487, 20067, 49760, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Sub: Re: Enrollment Status || LPMC || Provider || UHC ||  Good Morning!  Hope this email finds you in good health. Any update on the previous request?  Your early response will be greatly appreciated. Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 09:55:35', '2022-01-18 09:55:35'),
(54488, 20067, 49760, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from:  networkhelpresponse@uhc.com  Sub: Re Enrollment Status LPMC Provider UHC - [ref:_02678096:ref]   Thank you for contacting the Network Management Resource Team. I have verified credentialing for [Ancy Kurian-] is showing as [ -processing -]. Credentialing approval does not imply or guarantee participation with the health plans. Approved and signed physician contracts are required for participation.( affiliated with group tax id as of 12/22/2021)    If you’re joining a medical group that already has a participation agreement with UnitedHealthcare, you won’t receive a contract directly. Instead, you’ll be added to the group agreement once your credentialing application has been approved. (This can take up to three weeks once credentialing is approved.)    If you are joining a medical group or practice that is wanting to join the network, once the agreement has been approved if you’ve given us an email address, we’ll send you the contract through the secure DocuSign application. If not, we’ll send it to you by U.S. mail.     For more information and resources, please visit https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-contracted.html.     Questions? We’re here to help   If we can further assist you, please respond to this email.     Sincerely,  UnitedHealthcare Network Management Resource Team              Re- Enrollment Status || LPMC || Provider || UHC || Good Morning! Hope this email finds you in good health. Any update on the previous request? Your early response will be greatly appreciated. Thanks and Regards,   This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or intended recipient’s authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2022-01-28 15:08:28', '2022-01-28 15:08:28'),
(54489, 20067, 49760, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Sub: Re: Enrollment Status LPMC Provider UHC - [ref:_02678096:ref]   Good afternoon!  Hope this email finds you well. I would like to know the enrollment status of these providers under the below-mentioned TIN#.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Ancy Kurian	1316558935 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jeny John	1073019493  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-21 17:56:49', '2022-02-21 17:56:49'),
(54490, 20067, 49760, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Sub: Re: Enrollment Status || LPMC || Provider || UHC ||  Good Evening!  Hope you are doing well. Can you please help me out with the credentialing status of the below mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149 Ancy Kurian	1316558935 Jeny John	1073019493   Thank you, Syed Ahad.', NULL, NULL, '2022-03-08 17:42:27', '2022-03-08 17:42:27'),
(54491, 20067, 49760, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Demographic updates has been submitted through UHC Portal  Waiting for the address update', NULL, NULL, '2022-03-18 14:16:02', '2022-03-18 14:16:02'),
(54492, 19067, 49761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 09:47:47', '2021-12-15 09:47:47'),
(54493, 19067, 49761, NULL, '2021-12-22 00:00:00.000', 'Initiated', 'Application submitted via Portal. Request ID: 64731797', NULL, NULL, '2021-12-15 09:48:32', '2021-12-15 09:48:32'),
(54494, 19067, 49761, NULL, '2021-12-23 00:00:00.000', 'In Process', 'You finished signing “TX03_IND_MidLevelProvider_85%AMFS-AMMFS_ Ancy V Kurian, NP”.  Next, Sylvia Machado-Petry will sign.  We will email the final agreement to all parties. You can also download a copy of what you just signed.', NULL, NULL, '2021-12-16 17:21:51', '2021-12-16 17:21:51'),
(54495, 19067, 49761, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Ancy Kurian, NPI: 1316558935    Hi,  I would like to know the enrollment status of the following provider with Cigna.  Group Name	Right Step Medical Center LLC. Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford , TX 77477-2300  	  Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:25:57', '2021-12-23 17:25:57'),
(54496, 19067, 49761, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Enrollment Status || RSM || Ancy Kurian || Aetna ||  Hi,  I would like to know the enrollment status of the following provider with Aetna.   Group Name	Right Step Medical Center LLC. Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300  	  Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards. Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:31:18', '2021-12-23 17:31:18'),
(54497, 19067, 49761, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: laura.bevin@aetna.com  Subject: Enrollment Status || RSM || Ancy Kurian || Aetna ||  Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Aetna.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ancy Kurian	1316558935	11925 Southwest Freeway, Suite 12, Stafford, TX 77477   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 14:59:50', '2021-12-28 14:59:50'),
(54498, 20067, 49761, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject:  Enrollment Status || RSM || Group & Provider || Aetna ||   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned Group and providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 Ramegowda Belakere	1235166687 Glory Abraham	1194206490  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:21:51', '2022-01-06 17:21:51'),
(54499, 20067, 49761, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Sub: Enrollment Status || RSM || Group & Provider || Aetna ||   Until the missing information is confirmed, this request will remain to be incomplete, please answer the missing information so I can complete this request for you.     can you please confirm the role of these providers, will they be practicing in a PCP role or Specialist role?  ', NULL, NULL, '2022-01-11 09:53:05', '2022-01-11 09:53:05'),
(54500, 20067, 49761, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||  Good Morning, Hope this email finds you well.   Ancy Vinoy Kurian is a Family Nurse Practitioner (363LF0000X) CAQH: 15187581  Ramegowda Belakere is a Family Medicine (207Q00000X) CAQH: 11817469  Glory Abraham is a Family Nurse Practitioner (363LF0000X) CAQH: 14381983  Kindly complete my request and update me ASAP.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 09:55:30', '2022-01-11 09:55:30');
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
(54501, 19067, 49761, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: RE: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Syed,  We do not have a group agreement to add these providers currently, we do not complete group agreements with only mid-level providers staffed.  I see however, in this request you have submitted includes a physician that was not submitted previously, I will need to send you a group agreement before any providers can be added, please make sure the group owner signs the agreement.     In the future, any request you submit to add providers will need to be submitted as our process is to submit online through the provider portal here.  ', NULL, NULL, '2022-01-12 11:17:17', '2022-01-12 11:17:17'),
(54502, 19067, 49761, NULL, '2022-01-24 00:00:00.000', 'Approved', 'See Attachment.', NULL, NULL, '2022-01-17 06:02:27', '2022-01-17 06:02:27'),
(54503, 19067, 49762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 10:26:59', '2021-12-15 10:26:59'),
(54504, 19067, 49762, NULL, '2021-12-22 00:00:00.000', 'Initiated', 'application submitted via portal, application id: 71741082', NULL, NULL, '2021-12-15 10:28:38', '2021-12-15 10:28:38'),
(54505, 19067, 49762, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Ancy Kurian, NPI: 1316558935 (NUCC, IVUC)    Hello,  I would like to know the enrollment status of the provider with mentioned locations.    Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:14:02', '2021-12-23 17:14:02'),
(54506, 19067, 49762, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || NUCC & IVUC || Ancy Kurian || Aetna ||   Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Aetna.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ancy Kurian	1316558935	779 Normandy St STE 114, Houston, TX 77015 Ancy Kurian	1316558935	16272 Imperial Valley Dr STE K, Houston, TX 77060   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 14:44:06', '2021-12-28 14:44:06'),
(54507, 10057, 49762, NULL, '2022-01-06 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-12-30 16:04:29', '2021-12-30 16:04:29'),
(54508, 19067, 49763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 10:27:10', '2021-12-15 10:27:10'),
(54509, 19067, 49763, NULL, '2021-12-22 00:00:00.000', 'Initiated', 'Application submitted via portal, application ID: 71741082', NULL, NULL, '2021-12-15 10:28:01', '2021-12-15 10:28:01'),
(54510, 19067, 49763, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Ancy Kurian, NPI: 1316558935 (NUCC, IVUC)    Hello,  I would like to know the enrollment status of the provider with mentioned locations.    Group Name	Normandy Urgent Care Center. Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Location	779 Normandy St Ste 114 Houston, TX 77015-344         Secondary Location	 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:14:21', '2021-12-23 17:14:21'),
(54511, 19067, 49763, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || NUCC & IVUC || Ancy Kurian || Aetna ||   Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Aetna.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ancy Kurian	1316558935	779 Normandy St STE 114, Houston, TX 77015 Ancy Kurian	1316558935	16272 Imperial Valley Dr STE K, Houston, TX 77060   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 14:44:14', '2021-12-28 14:44:14'),
(54512, 10057, 49763, NULL, '2022-01-06 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in main group task.  Facility new effective date: 03/01/2021  Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-12-30 16:06:06', '2021-12-30 16:06:06'),
(54513, 19067, 49764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 10:38:57', '2021-12-15 10:38:57'),
(54514, 19067, 49764, NULL, '2021-12-22 00:00:00.000', 'Initiated', 'Application submitted via portal, application id: 09828042', NULL, NULL, '2021-12-15 10:40:26', '2021-12-15 10:40:26'),
(54515, 19067, 49764, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Ancy Kurian, NPI: 1316558935 (CUCC)   Hi,  I would like to know the enrollment status of the mentioned provider with Aetna.  Group Name	Columbus Urgent Care PA. Tax ID	47-1914151 Group NPI	1215330501 Primary & Billing Location	926 Walnut St, Columbus, TX 78934-2215   Provider Name	Ancy Kurian NPI	1316558935  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:22:03', '2021-12-23 17:22:03'),
(54516, 19067, 49764, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com   Subject: Enrollment Status || CUCC || Ancy Kurian || Aetna ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following provider with Aetna.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Provider Name	NPI	Location Ancy Kurian	1316558935	926 Walnut St, Columbus, TX 78934  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 14:56:23', '2021-12-28 14:56:23'),
(54517, 10057, 49764, NULL, '2022-01-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.   Please see group task. ', NULL, NULL, '2021-12-30 16:08:24', '2021-12-30 16:08:24'),
(54518, 19067, 49765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 10:48:11', '2021-12-15 10:48:11'),
(54519, 19067, 49765, NULL, '2021-12-22 00:00:00.000', 'Initiated', 'Application submitted via portal, application id: 60352759', NULL, NULL, '2021-12-15 10:50:39', '2021-12-15 10:50:39'),
(54520, 19067, 49765, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com   Subject: Ancy Kurian, NPI: 1316558935 (LPMC)     Hi, I would like to know the enrollment status of the following provider with Aetna.  Group NameLongpoint Medical CenterTax ID76-0612416Group NPI1770763815Primary & Billing Location9504 Long Point RD STE E Houston, TX 77055-4226  Provider NameAncy KurianNPI1316558935  Kindly respond promptly. Thanks & Regards,Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:19:24', '2021-12-23 17:19:24'),
(54521, 19067, 49765, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: laura.bevin@aetna.com  Subject: Enrollment Status || LPMC || Ancy Kurian || Aetna ||  Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Aetna.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location Ancy Kurian	1316558935	9504 Long Point RD STE E, Houston, TX 77055    Thanks & Regards. Ahmed, Hammad.', NULL, NULL, '2021-12-28 14:48:13', '2021-12-28 14:48:13'),
(54522, 10057, 49765, NULL, '2022-01-06 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.  Facility new effective date: 03/01/2021  Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint  Ref# 6019877016', NULL, NULL, '2021-12-30 16:07:22', '2021-12-30 16:07:22'),
(54523, 11056, 49766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 14:14:41', '2021-12-15 14:14:41'),
(54524, 19067, 49766, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'TMHP portal is not working correctly, spoke with David, he asked me that they\'ll call us back in 5-10 business days.', NULL, NULL, '2021-12-16 17:36:37', '2021-12-16 17:36:37'),
(54525, 19067, 49766, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from: rsm@claimsmedinc.com  Subject: Signature Required for Texas State Health-Care Program Agreements   12/17/2021  Dear ANCY KURIAN,  Your signature on the following agreements is required to complete provider enrollment application number 20003950 : HHSC Provider Agreement  To sign and complete the agreement, please click the following link: https://texasmedicaid.na1.echosign.com/public/apiesign?pid=CBFCIBAA3AAABLblqZhBnFywFyqBQvdsFGpn-x9Y-b6K9Ag18c1nHivf-bUZiY8L3b_xaYy3mJiXF_OyzI5A%2A&client_id=CBJCHBCAABAAvcBYYOLHMu4kOA66zOhghCpOjhcDbASS and verify your identity by entering the last four digits of your Social Security Number to access the agreement.  For any questions about the provider enrollment application number 20003950, you must contact the provider administrator of your TMHP portal account, who is copied on this email.  If you received this email in error, please notify the provider administrator of your TMHP portal account and delete the email.  If you have any general questions about provider applications, please call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. ', NULL, NULL, '2021-12-17 14:19:10', '2021-12-17 14:19:10'),
(54526, 19067, 49766, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: pemsemailservice@tmhp.com  Subject: Enrollment Status || RSM || Ancy Kurian || Medicaid ||   Hi,  I would like to know the enrollment status of the following provider with Medicaid.   Group Name	Right Step Medical Center LLC. Tax ID	85-3252700 Group NPI	1063008084 Primary & Billing Location	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300  	  Provider Name	NPI Ancy Kurian	1316558935  Kindly respond promptly.  Thanks & Regards. Ahmed, Hammad.', NULL, NULL, '2021-12-23 17:58:25', '2021-12-23 17:58:25'),
(54527, 11056, 49767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 16:31:05', '2021-12-15 16:31:05'),
(54528, 11056, 49767, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Application Summary  Enrollment ID:           I20211214000901 Tracking ID:                T121520210003484 Enrollment Status:    AWAITING PROCESSING Submitted By:            Ancy Kurian', NULL, NULL, '2021-12-15 16:34:15', '2021-12-15 16:34:15'),
(54529, 11056, 49767, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Your E-Signature Has Been Accepted You have successfully e-signed the following document(s):  Web tracking ID: T121520210003485      View Submitted Application Opens a window for viewing the current enrollment application  Provider/Supplier Name: Normandy Urgent Care Center  Signer Name: Abdur Rauf  Role: AUTHORIZED OFFICIAL  Document: AUTHORIZATION STATEMENT FOR ORGANIZATIONS (855R)  Signed Date: Wed Dec 15 17:24:39 EST 2021', NULL, NULL, '2021-12-15 17:19:01', '2021-12-15 17:19:01'),
(54530, 11056, 49767, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Application Summary  Enrollment ID:         X12152021003821 Tracking ID:              T121520210003485 Enrollment Status:  AWAITING PROCESSING Submitted By:          Ancy Kurian', NULL, NULL, '2021-12-20 14:43:02', '2021-12-20 14:43:02'),
(54531, 11056, 49767, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Enrollment Record Summary  Enrollment ID:          I20211214000901 Enrollment Status:   APPROVED Submitted By:           Ancy Kurian   Please see the attached.', NULL, NULL, '2021-12-21 15:55:28', '2021-12-21 15:55:28'),
(54532, 11056, 49768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-15 16:31:18', '2021-12-15 16:31:18'),
(54533, 11056, 49768, NULL, '2021-12-22 00:00:00.000', 'Initiated', ' Application Summary  Enrollment ID:           I20211214000901 Tracking ID:                T121520210003484 Enrollment Status:    AWAITING PROCESSING Submitted By:            Ancy Kurian', NULL, NULL, '2021-12-15 16:33:50', '2021-12-15 16:33:50'),
(54534, 11056, 49768, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Your E-Signature Has Been Accepted You have successfully e-signed the following document(s):  Web tracking ID: T121520210003485      View Submitted Application Opens a window for viewing the current enrollment application  Provider/Supplier Name: Normandy Urgent Care Center  Signer Name: Abdur Rauf  Role: AUTHORIZED OFFICIAL  Document: AUTHORIZATION STATEMENT FOR ORGANIZATIONS (855R)  Signed Date: Wed Dec 15 17:24:39 EST 2021', NULL, NULL, '2021-12-15 17:18:33', '2021-12-15 17:18:33'),
(54535, 11056, 49768, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Application Summary  Enrollment ID:         X12152021003821 Tracking ID:              T121520210003485 Enrollment Status:  AWAITING PROCESSING Submitted By:          Ancy Kurian', NULL, NULL, '2021-12-20 14:42:39', '2021-12-20 14:42:39'),
(54536, 11056, 49768, NULL, '2021-12-28 00:00:00.000', 'Approved', ' Enrollment Record Summary  Enrollment ID:          I20211214000901 Enrollment Status:   APPROVED Submitted By:           Ancy Kurian   Please see the attached.', NULL, NULL, '2021-12-21 15:53:40', '2021-12-21 15:53:40'),
(54537, 11056, 49769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:57', '2021-12-16 10:18:57'),
(54538, 11056, 49769, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:57', '2021-12-16 10:21:57'),
(54539, 11056, 49769, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:23:17', '2021-12-16 10:23:17'),
(54540, 11056, 49769, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:39', '2021-12-16 10:24:39'),
(54541, 11056, 49769, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:33', '2021-12-16 10:26:33'),
(54542, 11056, 49769, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:51', '2021-12-16 10:27:51'),
(54543, 11056, 49769, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:46:51', '2021-12-16 10:46:51'),
(54544, 11056, 49770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:57', '2021-12-16 10:18:57'),
(54545, 11056, 49770, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:52', '2021-12-16 10:21:52'),
(54546, 11056, 49770, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:23:10', '2021-12-16 10:23:10'),
(54547, 11056, 49770, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:32', '2021-12-16 10:24:32'),
(54548, 11056, 49770, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:28', '2021-12-16 10:26:28'),
(54549, 11056, 49770, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:46', '2021-12-16 10:27:46'),
(54550, 11056, 49770, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:47:39', '2021-12-16 10:47:39'),
(54551, 11056, 49771, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:57', '2021-12-16 10:18:57'),
(54552, 11056, 49771, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:47', '2021-12-16 10:21:47'),
(54553, 11056, 49771, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:23:04', '2021-12-16 10:23:04'),
(54554, 11056, 49771, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:26', '2021-12-16 10:24:26'),
(54555, 11056, 49771, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:23', '2021-12-16 10:26:23'),
(54556, 11056, 49771, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:38', '2021-12-16 10:27:38'),
(54557, 11056, 49771, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:47:53', '2021-12-16 10:47:53'),
(54558, 11056, 49772, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:57', '2021-12-16 10:18:57'),
(54559, 11056, 49772, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:41', '2021-12-16 10:21:41'),
(54560, 11056, 49772, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:59', '2021-12-16 10:22:59'),
(54561, 11056, 49772, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:21', '2021-12-16 10:24:21'),
(54562, 11056, 49772, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:18', '2021-12-16 10:26:18'),
(54563, 11056, 49772, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:34', '2021-12-16 10:27:34'),
(54564, 11056, 49772, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:48:42', '2021-12-16 10:48:42'),
(54565, 11056, 49773, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54566, 11056, 49773, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:35', '2021-12-16 10:21:35'),
(54567, 11056, 49773, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:53', '2021-12-16 10:22:53'),
(54568, 11056, 49773, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:14', '2021-12-16 10:24:14'),
(54569, 11056, 49773, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:12', '2021-12-16 10:26:12'),
(54570, 11056, 49773, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:29', '2021-12-16 10:27:29'),
(54571, 11056, 49773, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:48:55', '2021-12-16 10:48:55'),
(54572, 11056, 49774, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54573, 11056, 49774, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:31', '2021-12-16 10:21:31'),
(54574, 11056, 49774, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:48', '2021-12-16 10:22:48'),
(54575, 11056, 49774, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:08', '2021-12-16 10:24:08'),
(54576, 11056, 49774, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:07', '2021-12-16 10:26:07'),
(54577, 11056, 49774, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:21', '2021-12-16 10:27:21'),
(54578, 11056, 49774, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:49:25', '2021-12-16 10:49:25'),
(54579, 11056, 49775, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54580, 11056, 49775, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:26', '2021-12-16 10:21:26'),
(54581, 11056, 49775, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:41', '2021-12-16 10:22:41'),
(54582, 11056, 49775, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:24:03', '2021-12-16 10:24:03'),
(54583, 11056, 49775, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:26:02', '2021-12-16 10:26:02'),
(54584, 11056, 49775, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:16', '2021-12-16 10:27:16'),
(54585, 11056, 49775, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:49:36', '2021-12-16 10:49:36'),
(54586, 11056, 49776, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54587, 11056, 49776, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:22', '2021-12-16 10:21:22'),
(54588, 11056, 49776, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:36', '2021-12-16 10:22:36'),
(54589, 11056, 49776, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:23:57', '2021-12-16 10:23:57'),
(54590, 11056, 49776, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:25:56', '2021-12-16 10:25:56'),
(54591, 11056, 49776, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:08', '2021-12-16 10:27:08'),
(54592, 11056, 49776, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:49:53', '2021-12-16 10:49:53'),
(54593, 11056, 49777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54594, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:17', '2021-12-16 10:21:17'),
(54595, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:30', '2021-12-16 10:22:30'),
(54596, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:23:52', '2021-12-16 10:23:52'),
(54597, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:25:51', '2021-12-16 10:25:51'),
(54598, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:27:03', '2021-12-16 10:27:03');
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
(54599, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:50:42', '2021-12-16 10:50:42'),
(54600, 11056, 49777, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:51:27', '2021-12-16 10:51:27'),
(54601, 11056, 49778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54602, 11056, 49778, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:12', '2021-12-16 10:21:12'),
(54603, 11056, 49778, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:25', '2021-12-16 10:22:25'),
(54604, 11056, 49778, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:23:47', '2021-12-16 10:23:47'),
(54605, 11056, 49778, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:25:46', '2021-12-16 10:25:46'),
(54606, 11056, 49778, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:26:57', '2021-12-16 10:26:57'),
(54607, 11056, 49778, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:51:39', '2021-12-16 10:51:39'),
(54608, 11056, 49779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54609, 11056, 49779, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:07', '2021-12-16 10:21:07'),
(54610, 11056, 49779, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:20', '2021-12-16 10:22:20'),
(54611, 11056, 49779, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:23:41', '2021-12-16 10:23:41'),
(54612, 11056, 49779, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:25:41', '2021-12-16 10:25:41'),
(54613, 11056, 49779, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:26:51', '2021-12-16 10:26:51'),
(54614, 11056, 49779, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:51:49', '2021-12-16 10:51:49'),
(54615, 11056, 49780, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:18:58', '2021-12-16 10:18:58'),
(54616, 11056, 49780, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Rep : Allison L   Status : unable to update through the portal. Emailed at intake_pdm@cigna.com with LOI and W-9 as recommended by the rep.   1800-853-2713 option   Contact no. : 800-926-2273', NULL, NULL, '2021-12-16 10:21:02', '2021-12-16 10:21:02'),
(54617, 11056, 49780, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to : 	intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good afternoon!  Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change. We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!  Again with correction of the address.', NULL, NULL, '2021-12-16 10:22:15', '2021-12-16 10:22:15'),
(54618, 11056, 49780, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: PDMCOGZ@cigna.com  Sub : FW: [External] Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been completed.     If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202110261974645).     Regards,  PDM ', NULL, NULL, '2021-12-16 10:23:31', '2021-12-16 10:23:31'),
(54619, 11056, 49780, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Sub : Demographic Updates - Adding a Location - CIGNA - StatCare Minor Emergency Clinic  Good morning!  Cigna Internal Reference # (W202110261974645). Hope all is well with you. We are unable to update through the portal. We don\'t have access to demographic change.  We want to add the below-highlighted location under the Tax I.D of the facility and all the providers under the TIN.  The correct address has been mentioned in this email. It is 2102 not 2101  in the starting. Kindly do the correction.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382  If you require any further documents don\'t hesitate to contact me. Please find the attached W-9 for the locations.   Thank you! Have a great day!', NULL, NULL, '2021-12-16 10:25:36', '2021-12-16 10:25:36'),
(54620, 11056, 49780, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Rep: Danny V   Status: Still on file with credentialing with the old address. Submitted request for the correction of address. Escalation has been sent from the rep.    Case no.: W202111041989460   Refcode: Danny11302021', NULL, NULL, '2021-12-16 10:26:45', '2021-12-16 10:26:45'),
(54621, 11056, 49780, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email received from PDM COGZ PDMCOGZ@cigna.com  Sub: Completion Notification Cigna Internal Reference # W202111192015174  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  Please find attached the completion notification for your reference.  Effective date:  11/30/2021    If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # W202111192015174     Thanks and Regards  PDM   Confirmed on call :  Rep :  Marco C  Status: Address is on file. 11/30/2021 effective.  contact no: 800-353-1232  Refcode: marcoc12152021', NULL, NULL, '2021-12-16 10:52:00', '2021-12-16 10:52:00'),
(54622, 11056, 49781, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:46:51', '2021-12-16 10:46:51'),
(54623, 11056, 49781, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:34:07', '2021-12-16 14:34:07'),
(54624, 11056, 49782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:47:39', '2021-12-16 10:47:39'),
(54625, 11056, 49782, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:34:01', '2021-12-16 14:34:01'),
(54626, 11056, 49783, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:47:53', '2021-12-16 10:47:53'),
(54627, 11056, 49783, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:55', '2021-12-16 14:33:55'),
(54628, 11056, 49784, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:48:42', '2021-12-16 10:48:42'),
(54629, 11056, 49784, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:50', '2021-12-16 14:33:50'),
(54630, 11056, 49785, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:48:55', '2021-12-16 10:48:55'),
(54631, 11056, 49785, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:43', '2021-12-16 14:33:43'),
(54632, 11056, 49786, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:49:25', '2021-12-16 10:49:25'),
(54633, 11056, 49786, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:36', '2021-12-16 14:33:36'),
(54634, 11056, 49787, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:49:36', '2021-12-16 10:49:36'),
(54635, 11056, 49787, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:30', '2021-12-16 14:33:30'),
(54636, 11056, 49788, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:49:53', '2021-12-16 10:49:53'),
(54637, 11056, 49788, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:24', '2021-12-16 14:33:24'),
(54638, 11056, 49789, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:50:41', '2021-12-16 10:50:41'),
(54639, 11056, 49789, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:19', '2021-12-16 14:33:19'),
(54640, 11056, 49790, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:51:39', '2021-12-16 10:51:39'),
(54641, 11056, 49790, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:13', '2021-12-16 14:33:13'),
(54642, 11056, 49791, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:51:49', '2021-12-16 10:51:49'),
(54643, 11056, 49791, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:33:08', '2021-12-16 14:33:08'),
(54644, 11056, 49792, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 10:52:00', '2021-12-16 10:52:00'),
(54645, 11056, 49792, NULL, '2021-12-23 00:00:00.000', 'Approved', '', NULL, NULL, '2021-12-16 14:32:58', '2021-12-16 14:32:58'),
(54646, 1019, 49793, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 11:47:33', '2021-12-16 11:47:33'),
(54647, 1019, 49793, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Address Change request initiated thru BCBSTX website, see attached email for reference.  Alex Garrett,  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 03254384, for GULF COAST IMAGING & ASSOCIATES, LLC.  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  To check the status of your case, please click on status checker or for any questions, contact 1-877-229-0719.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-12-16 11:48:56', '2021-12-16 11:48:56'),
(54648, 19067, 49793, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Query || GCIA || Group || BCBS TX || Case# 03254384 ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Group.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Practice Address	500 E Caesar Ave. Suite B, Kingsville, TX 78363  Thanks & Regards, Hammad Ahmed. ', NULL, NULL, '2022-01-04 14:53:06', '2022-01-04 14:53:06'),
(54649, 19067, 49793, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Query || GCIA || Group || BCBS TX || Case# 03254384 || : Case Number - 03308180    Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03308180.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2022-01-05 16:20:15', '2022-01-05 16:20:15'),
(54650, 19067, 49793, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Query || GCIA || Group || BCBS TX || Case# 03254384 || : Case Number - 03308180   Greetings!  Any updates on the request below?  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-13 11:43:27', '2022-01-13 11:43:27'),
(54651, 1009, 49793, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Checked BCBS Website and showing that we are approved ', NULL, NULL, '2022-01-20 14:06:47', '2022-01-20 14:06:47'),
(54652, 1009, 49793, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Banking information changed via availity ', NULL, NULL, '2022-01-20 14:08:01', '2022-01-20 14:08:01'),
(54653, 19067, 49793, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ancillarycontracting_n@bcbstx.com  Subject: Re: Enrollment Query || GCIA || Group || BCBS TX || Case# 03254384 || : Case Number - 03308180 : Case Number - 03345640    Good Morning!  Hope this email finds you well.  Upon checking the provider\'s directory I found the group is showing up. Kindly see the attached snap for reference. And provide us with the Effective date.    Have a wonderful day! Hammad Ahmed.', NULL, NULL, '2022-01-25 09:51:07', '2022-01-25 09:51:07'),
(54654, 1019, 49793, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Address Updated for GCIA attached is the email from BCBS for reference. ', NULL, NULL, '2022-02-02 17:02:48', '2022-02-02 17:02:48'),
(54655, 1019, 49794, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-16 17:41:56', '2021-12-16 17:41:56'),
(54656, 1019, 49794, NULL, '2021-12-23 00:00:00.000', 'Initiated', 'Requested Initiated thru Pecos for Change of Address and EFT', NULL, NULL, '2021-12-16 17:43:03', '2021-12-16 17:43:03'),
(54657, 1019, 49794, NULL, '2022-01-14 00:00:00.000', 'In Process', 'Hello Alex,   I spoke with Alex from Medicare and I have already updated the EFT banking information. He said that he is now just waiting for the site visit inspection results which we already have that scheduled I believe January 13th and then once I get the results everything will be completed. You are the new contact person but if you need anything else or my help just let me know.  Regards,  Amanda', NULL, NULL, '2022-01-07 13:02:03', '2022-01-07 13:02:03'),
(54658, 19067, 49794, NULL, '2022-02-14 00:00:00.000', 'In Process', 'In Process. It will take 20-25 business days.', NULL, NULL, '2022-02-07 14:18:37', '2022-02-07 14:18:37'),
(54659, 19067, 49794, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: 	medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification GULF COAST IMAGING & ASSOCIATES LLC    Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS. ', NULL, NULL, '2022-02-21 09:12:24', '2022-02-21 09:12:24'),
(54660, 19067, 49794, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Medicare under review.   Ref# 061210542254824', NULL, NULL, '2022-02-23 16:19:41', '2022-02-23 16:19:41'),
(54661, 1019, 49795, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-17 16:55:46', '2021-12-17 16:55:46'),
(54662, 1019, 49795, NULL, '2021-12-24 00:00:00.000', 'Initiated', 'Sent an email to hpdemo@uhc.com, for Address change. Attached is the filled form for reference  Hello,  I have attached a demographic change form for our Practice location. Please process ir on your earliest convenience.  Let me know if you have any questions.', NULL, NULL, '2021-12-17 16:58:19', '2021-12-17 16:58:19'),
(54663, 1019, 49795, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Received the following email from United_Healthcare_Provider_Operations@uhc.com  UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6374749  Received On: Dec 17, 2021 9:06:49 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2021-12-17 16:59:15', '2021-12-17 16:59:15'),
(54664, 19067, 49795, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com  Subject: Enrollment Query || GCIA || Group || UHC ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Group.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Practice Address	500 E Caesar Ave. Suite B, Kingsville, TX 78363  Thanks & Regards Hammad Ahmed.', NULL, NULL, '2022-01-04 15:00:10', '2022-01-04 15:00:10'),
(54665, 19067, 49795, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Subject: Enrollment Query GCIA Group UHC - [ref:_02645814:ref]     Thank you for contacting UnitedHealthcare network. Our records show your group as out of network. Based on the nature of your inquiry a (Group Contract) your request will need to be handled by the demographic team. Please submit the request to the demographic department (hpdemo@uhc.com) for assistance.     You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.     For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to also check your status online. Additionally, the following hyperlink  (under no access to my practice profile) has the recommended forms for these types of requests if unable to use the Link App.     If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     Please let us know if we can assist further via email.', NULL, NULL, '2022-01-13 11:55:49', '2022-01-13 11:55:49'),
(54666, 19067, 49795, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Enrollment Query || GCIA || Group || UHC ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Group.  Ref# 02645814  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Practice Address	500 E Caesar Ave. Suite B, Kingsville, TX 78363  Thanks & Regards,', NULL, NULL, '2022-02-07 15:52:58', '2022-02-07 15:52:58'),
(54667, 19067, 49795, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: 	Enrollment Query || GCIA || Group || UHC ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Group.  Ref# 02645814  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Practice Address	500 E Caesar Ave. Suite B, Kingsville, TX 78363  Thanks & Regards,', NULL, NULL, '2022-02-07 17:26:26', '2022-02-07 17:26:26'),
(54668, 19067, 49795, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: katrina_hodge@uhc.com  Subject: Secure Message from katrina_hodge@uhc.com   Good morning Hammad,     We wanted to let you know that is group has been updated in our system as OUT record. This group is considered a Clinic/Center Rural Health and we do not credential or contract those types of groups, that has to be done by your Ancillary NAM.     Please do not reply directly to this email. Send all responses or questions pertaining to this email to submission_inquiry@uhc.com for further assistance. If sent to Katrina_hodge@uhc.com, it will be considered responded to already and will be deleted.     Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation.   For questions related to credentialing, benefits or claim status, please utilize www.uhcprovider.com. For all Mental Health contracting issues, please contact United Behavioral Health at 877-614-0484. For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.     Thank You,  Katrina UnitedHealthcare Operations  ', NULL, NULL, '2022-02-14 14:19:32', '2022-02-14 14:19:32'),
(54669, 19067, 49795, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: submission_inquiry@uhc.com  Subject: Re: Enrollment Query || GCIA || Group || UHC ||    Hi,  I received a secure email stating that we are out of network with UHC and our group is considered a Clinic/Center Rural Health and UHC does not credential or contract this type of group.  We actually are a Radiology and Imaging Center. Below are the details of the facility, kindly look into this so that we can get credentialed with UHC.  Regards, Hammad Ahmed ', NULL, NULL, '2022-02-14 14:29:52', '2022-02-14 14:29:52'),
(54670, 19067, 49795, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Secure email received from: united_healthcare_provider_operations@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6467079  Received On: Feb 7, 2022 9:06:55 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-02-15 17:49:17', '2022-02-15 17:49:17'),
(54671, 19067, 49795, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Secure email received from: networkhelp@uhc.com  Subject: Secure Message from networkhelp=uhc.com__29003a38mpzgdhmz.5o0tmjr7t5j5h8st@cagpdd75rornszow.cgzdk.5-jldwea4.na123.bnc.salesforce.com     Subject:  Correct contact information for your request Hello,  Thank you for contacting the UnitedHealthcare Network Management Resource Team. Your group is showing as Taxonomy for X-ray/Radiology group and out of network for UnitedHealthcare as the Texas market panels are closed for new contracts. The information submitted, appears to be related to a claim issue.  We are not the correct contact to answer your questions.  While we may not be able assist you directly, more information about claim payment options can be found via the following:     ·       Go to UHCprovider.com and click “Sign In” in the upper right corner.   ·       On your dashboard, go to “Claims & Payment” and select “Look up a Claim.”  ·       Phone: Call 877-842-3210, 7 a.m.-7 p.m., Monday-Friday CT     Sincerely,  UnitedHealthcare Network Management Resource Team', NULL, NULL, '2022-02-18 10:04:00', '2022-02-18 10:04:00'),
(54672, 20067, 49795, NULL, '2022-03-14 00:00:00.000', 'On Hold', 'Texas market panels are closed for new contracts', NULL, NULL, '2022-03-07 13:21:51', '2022-03-07 13:21:51'),
(54673, 1019, 49796, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 13:38:18', '2021-12-20 13:38:18'),
(54674, 1019, 49796, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Enrollment Application Faxed to Tricare west at 844 730 1373, attached is the copy of the application for reference.', NULL, NULL, '2021-12-20 13:40:20', '2021-12-20 13:40:20'),
(54675, 1019, 49797, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 14:35:23', '2021-12-20 14:35:23'),
(54676, 1019, 49797, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Faxed LOI to Aetna at (859) 455-8650, attached is the LOI for reference. ', NULL, NULL, '2021-12-20 14:38:46', '2021-12-20 14:38:46'),
(54677, 19067, 49797, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Enrollment Query || GCIA || Group || Aetna ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Group.  Group Name	Gulf Coast Imaging & Associates, LLC Tax ID	82-0701672 Group NPI	1750871414 Practice Address	500 E Caesar Ave. Suite B, Kingsville, TX 78363  Thanks & Regards Hammad Ahmed.', NULL, NULL, '2022-01-04 14:33:16', '2022-01-04 14:33:16'),
(54678, 19067, 49797, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: Enrollment Query || GCIA || Group || Aetna ||    Hammad, I am not sure what the inquiry is.     This tin is currently contracted as Ancillary.     I do not manage Ancillary, please reach out to provider service to have this routed accordingly, thank you,', NULL, NULL, '2022-01-13 11:37:35', '2022-01-13 11:37:35'),
(54679, 19067, 49797, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Faxed LOI to Aetna @ 859-455-8650 for address update. See attachment for reference.', NULL, NULL, '2022-02-07 10:14:14', '2022-02-07 10:14:14'),
(54680, 19067, 49797, NULL, '2022-02-22 00:00:00.000', 'Approved', 'Called @800-353-1232 and spoke with Kristen regarding address update confirmation and the effective date for address confirmation is 12/01/2022. Reference number for the call 6074946721.  Also see the attachment of updated address in provider\'s directory.', NULL, NULL, '2022-02-15 14:32:03', '2022-02-15 14:32:03'),
(54681, 11056, 49798, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:09:51', '2021-12-20 15:09:51'),
(54682, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-12-20 15:13:16', '2021-12-20 15:13:16'),
(54683, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you ', NULL, NULL, '2021-12-20 15:13:40', '2021-12-20 15:13:40'),
(54684, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-12-20 15:14:01', '2021-12-20 15:14:01'),
(54685, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', '	 Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-12-20 15:14:09', '2021-12-20 15:14:09'),
(54686, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-12-20 15:15:07', '2021-12-20 15:15:07'),
(54687, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-12-20 15:15:28', '2021-12-20 15:15:28'),
(54688, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-12-20 15:15:49', '2021-12-20 15:15:49'),
(54689, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-12-20 15:16:10', '2021-12-20 15:16:10'),
(54690, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-12-20 15:16:19', '2021-12-20 15:16:19'),
(54691, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-12-20 15:16:38', '2021-12-20 15:16:38'),
(54692, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-20 15:17:38', '2021-12-20 15:17:38'),
(54693, 11056, 49798, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:18:35', '2021-12-20 15:18:35'),
(54694, 11056, 49799, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:09:51', '2021-12-20 15:09:51'),
(54695, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-12-20 15:13:22', '2021-12-20 15:13:22'),
(54696, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you ', NULL, NULL, '2021-12-20 15:13:45', '2021-12-20 15:13:45'),
(54697, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-12-20 15:13:55', '2021-12-20 15:13:55'),
(54698, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', '	 Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-12-20 15:14:14', '2021-12-20 15:14:14'),
(54699, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-12-20 15:15:10', '2021-12-20 15:15:10'),
(54700, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-12-20 15:15:23', '2021-12-20 15:15:23');
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
(54701, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-12-20 15:15:56', '2021-12-20 15:15:56'),
(54702, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-12-20 15:16:06', '2021-12-20 15:16:06'),
(54703, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-12-20 15:16:26', '2021-12-20 15:16:26'),
(54704, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-12-20 15:16:44', '2021-12-20 15:16:44'),
(54705, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-20 15:17:30', '2021-12-20 15:17:30'),
(54706, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Please see the attachment.', NULL, NULL, '2021-12-20 15:18:05', '2021-12-20 15:18:05'),
(54707, 11056, 49799, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:18:43', '2021-12-20 15:18:43'),
(54708, 1019, 49800, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:23:24', '2021-12-20 15:23:24'),
(54709, 1019, 49800, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Faxed the W9 form to Point Comfort, at 3175051001, for address change request.', NULL, NULL, '2021-12-20 15:25:50', '2021-12-20 15:25:50'),
(54710, 19067, 49800, NULL, '2022-02-03 00:00:00.000', 'Approved', 'Email received from: ahill@pointcomfort.com  Subject: Fwd: Updated W-9 Confirmation    Good Afternoon,     We received your W-9 on 12-20-2021 and the address we currently have on file is 500 E Caesar Avenue Suite B, Kingsville, TX 78363 United States.     Thank you,     Alexa Hill Client Relations Specialist Point Comfort Underwriters  www.pointcomfort.com ahill@pointcomfort.com 306 Prospect Street, Indianapolis, IN 46225 317-210-2010', NULL, NULL, '2022-01-27 10:31:40', '2022-01-27 10:31:40'),
(54711, 19067, 49801, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:26:44', '2021-12-20 15:26:44'),
(54712, 19067, 49801, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Application submitted through Portal.', NULL, NULL, '2021-12-20 15:27:28', '2021-12-20 15:27:28'),
(54713, 19067, 49801, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email received from: mdiprsupport@healthsmart.com  subject: Fw: HealthSmart.com - Nominate a Provider Form - Ahmed    Hi,  We cannot process your request due to the following missing information.  W9 with Practice Location  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks HealthSmart Provider Relations.  ', NULL, NULL, '2021-12-22 15:20:01', '2021-12-22 15:20:01'),
(54714, 19067, 49801, NULL, '2021-12-29 00:00:00.000', 'In Process', 'email sent to: pr.south@healthsmart.com  subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian   Hello,  Received your email and it states that you need a W9 with a practice location.  Kindly see attached W9.  Stay safe, Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:21:02', '2021-12-22 15:21:02'),
(54715, 19067, 49801, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian     Hi,  Please fill out the attached CAQH Access form so that we can process your request.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   Thanks. HealthSmart Provider Relations.  ', NULL, NULL, '2021-12-23 09:12:54', '2021-12-23 09:12:54'),
(54716, 19067, 49801, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian   Good Morning!  Hope you\'re staying healthy.  Please find the filled CAQH Access form.  And do let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-23 09:31:33', '2021-12-23 09:31:33'),
(54717, 19067, 49801, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian    Hi,  We are returning your application due to missing information listed below.  * SSN # * Current state license * W9 Form * Current certificate of Insurance * Explain in Work History * Explain in Employment * Current Release and Attestation date * ALL Disclosure Questions Answered * CAQH not Updated please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-12-28 12:52:23', '2021-12-28 12:52:23'),
(54718, 19067, 49801, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian    Hi,  Texas State Credentialing Application Form / CAQH Application form is not listed on CAQH website. Please update CAQH and advise once complete to start credentialing.  All communication, including requested documents should be sent to pr.south.@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-01-06 10:04:45', '2022-01-06 10:04:45'),
(54719, 19067, 49801, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: HealthSmart.com - Nominate a Provider Form - Ancy Kurian   Good Morning!  Hope you are doing well.  Kindly see the attachment for the CAQH Form of Ancy Kurian and start the Credentialing process.  Don\'t hesitate to reach out in case you need anything else.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 11:04:52', '2022-01-06 11:04:52'),
(54720, 19067, 49801, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com, pr.south@healthsmart.com  Subject: Re: Fw: Fw: Fw: HealthSmart.com - Nominate a Provider Form - Ancy Kurian    Hello!  Any updates on this?  Regards.', NULL, NULL, '2022-01-25 15:26:13', '2022-01-25 15:26:13'),
(54721, 19067, 49801, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Re: Fw: Fw: Fw: Fw: HealthSmart.com - Nominate a Provider Form - Ancy Kurian - RSM   Hello!  Hope you are doing well.  I have updated her CAQH. You can get the necessary information from there. CAQH Number: 15187581.  Regards, Hammad.', NULL, NULL, '2022-02-08 14:07:09', '2022-02-08 14:07:09'),
(54722, 19067, 49801, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Re: Fw: Fw: Fw: Fw: HealthSmart.com - Nominate a Provider Form - Ancy Kurian - RSM   Hello!  Can I get an update on the enrolling of the provider, Ancy Kurian?  Thanks, Hammad Ahmed.', NULL, NULL, '2022-03-16 11:25:25', '2022-03-16 11:25:25'),
(54723, 19067, 49801, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Fw: Fw: Fw: HealthSmart.com - Nominate a Provider Form - Ancy Kurian - RSM    Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Document ID : 3549921  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-21 09:46:32', '2022-03-21 09:46:32'),
(54724, 22077, 49801, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: HealthSmart.com - Nominate a Provider Form - Ancy Kurian - RSM  Hello!  Can I get an update on the enrolling of the provider, Ancy Kurian?  Thanks,', NULL, NULL, '2022-04-04 10:43:32', '2022-04-04 10:43:32'),
(54725, 22077, 49801, NULL, '2022-04-19 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: 	Fw: Fw: Fw: Fw: Fw: Fw: HealthSmart.com - Nominate a Provider Form - Ancy Kurian - RSM  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Documents ID : 3555171)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-04-12 08:30:12', '2022-04-12 08:30:12'),
(54726, 19067, 49802, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:27:55', '2021-12-20 15:27:55'),
(54727, 19067, 49802, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Application submitted through Portal.', NULL, NULL, '2021-12-20 15:28:12', '2021-12-20 15:28:12'),
(54728, 19067, 49802, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: HealthSmart.com - Nominate a Provider Form - Ahmed  Hi,  We cannot process your request due to the following missing information.  Group Name Tax ID #  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-12-28 12:37:08', '2021-12-28 12:37:08'),
(54729, 19067, 49802, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||    Hello,  Hope you are doing well.  The missing information is below:  Group Name: Normandy Urgent Care Center Tax ID: 27-0796429   Do let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-28 12:44:49', '2021-12-28 12:44:49'),
(54730, 19067, 49802, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||    Hi,  Please fill out the attached CAQH Access form and send W9 so that we can process this update.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations. ', NULL, NULL, '2022-01-06 11:51:57', '2022-01-06 11:51:57'),
(54731, 19067, 49802, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||   Hello!  Hope you are doing really well.  Kindly see the attachment of CAQH Acces Form.  And don\'t hesitate to reach out in need of anything.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 14:23:54', '2022-01-06 14:23:54'),
(54732, 20067, 49802, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Fw: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Good Afternoon! Hope this email finds you well. Any update on the previous request?  Kindly respond promptly. Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-20 15:14:48', '2022-01-20 15:14:48'),
(54733, 20067, 49802, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||   Hi,  We are returning your application due to missing information listed below.  * SSN # * Current state license * Current certificate of Insurance * Explain in Work History * Explain in Employment * Current Release and Attestation date * ALL Disclosure Questions Answered * Credentialing Application form * CAQH not Updated please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2022-01-27 17:59:42', '2022-01-27 17:59:42'),
(54734, 20067, 49802, NULL, '2022-02-10 00:00:00.000', 'In Process', 'CAQH is in process, will do the follow up next week', NULL, NULL, '2022-02-03 14:22:18', '2022-02-03 14:22:18'),
(54735, 20067, 49802, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Good Morning!  Hope this email finds you well. I\'ve updated the CAQH of Ancy Kurian. Kindly process the application and let me know if anything else is required from my end. See attached.  Thank you,', NULL, NULL, '2022-03-02 09:40:31', '2022-03-02 09:40:31'),
(54736, 20067, 49802, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com   Sub:  Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Hello,  Hope you had a great weekend. Kindly update me about the current credentialing status of the provider Ancy Kurian. Tax Id: 27-0796429 NPI: 1316558935  Thank you,', NULL, NULL, '2022-03-21 15:41:29', '2022-03-21 15:41:29'),
(54737, 22077, 49802, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 10:16:22', '2022-04-15 10:16:22'),
(54738, 22077, 49802, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email received from: pr.south@healthsmart.com  Subject: RE: Fw: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Good Morning,     Please provide TIN and provider name with NPI for status checks        Valesia Glenn |Provider Relations  HealthSmart | Network Solutions  222 W Las Colinas Blvd | Suite 500N | Irving, TX 75039', NULL, NULL, '2022-04-15 12:05:24', '2022-04-15 12:05:24'),
(54739, 22077, 49802, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: 	Re: Fw: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Hi,  Tax id: 27-0796429  Provider Name: Ancy Kurian  NPI: 1316558935  Thanks.', NULL, NULL, '2022-04-15 12:06:49', '2022-04-15 12:06:49'),
(54740, 22077, 49802, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Nominate a Provider Form || NUCC, IVUC || Ancy Kurian || HealthSmart ||  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Documents ID : 3555171)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-04-25 07:08:13', '2022-04-25 07:08:13'),
(54741, 19067, 49803, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:28:31', '2021-12-20 15:28:31'),
(54742, 19067, 49803, NULL, '2021-12-27 00:00:00.000', 'Initiated', 'Application submitted through Portal.', NULL, NULL, '2021-12-20 15:28:50', '2021-12-20 15:28:50'),
(54743, 19067, 49803, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: HealthSmart.com - Nominate a Provider Form - Ahmed  Hi,  We cannot process your request due to the following missing information.  Group Name Tax ID #  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-12-28 12:47:01', '2021-12-28 12:47:01'),
(54744, 19067, 49803, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||   Hello,   Hope you are doing well.  The missing information is below:   Group name: Columbus Urgent Care PA Tax ID: 47-1914151  Do let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 12:49:58', '2021-12-28 12:49:58'),
(54745, 19067, 49803, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||   Hi,  Please complete the attached CAQH access form so that we may complete this process.  * Ahmed, Hammad.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-12-30 09:46:28', '2021-12-30 09:46:28'),
(54746, 19067, 49803, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Good morning!   Hope you are doing well.  Kindly see the attachment of CAQH access form for Ancy Kurian.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 09:53:32', '2021-12-30 09:53:32'),
(54747, 19067, 49803, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||    Hi,  We are returning your application due to missing information listed below.  * SSN # * Current state license * Current certificate of Insurance * Explain in Work History * Explain in Employment * Current Release and Attestation date * ALL Disclosure Questions Answered * CAQH not Updated please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2022-01-03 11:28:08', '2022-01-03 11:28:08'),
(54748, 20067, 49803, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Re Fw: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Good Afternoon! Hope this email finds you in good health. I have updated the CAQH: 15187581, Kindly complete the request.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-26 17:34:55', '2022-01-26 17:34:55'),
(54749, 20067, 49803, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Good Evening!  Hope this email finds you in good health. I have updated the CAQH of Ancy Kurian, kindly continue the credentialing process. Let me know if anything else is required from my end.  Thank you', NULL, NULL, '2022-02-17 17:19:22', '2022-02-17 17:19:22'),
(54750, 20067, 49803, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian ||   Hi,  Please provide the listed below information.  *Provider Name *Provider individual NPI #  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-01 12:01:45', '2022-03-01 12:01:45'),
(54751, 20067, 49803, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Good Morning!  Hope you are doing great. Kindly respond to the previous email.   Eagerly waiting to hear from you, Thank you, ', NULL, NULL, '2022-03-01 12:03:23', '2022-03-01 12:03:23'),
(54752, 20067, 49803, NULL, '2022-03-16 00:00:00.000', 'Approved', 'Email received from: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Document ID : 3559653  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-09 14:10:02', '2022-03-09 14:10:02'),
(54753, 20067, 49803, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Credentialing Status || CUCC || Ancy Kurian || HealthSmart ||  Good Afternoon!  Hope you had a great weekend. What\'s the current status of provider Ancy Kurian. If the provider is loaded, kindly send me the welcome letter.  Thank you,', NULL, NULL, '2022-03-21 12:45:34', '2022-03-21 12:45:34'),
(54754, 19067, 49804, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 15:29:06', '2021-12-20 15:29:06'),
(54755, 19067, 49804, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Application submitted through Portal.', NULL, NULL, '2021-12-20 15:29:22', '2021-12-20 15:29:22'),
(54756, 19067, 49804, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||   Hello!  Hope you are having a productive day.  I would like to know the current enrollment status of the following Provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location Ancy Kurian	1316558935	9504 Long Point RD STE E, Houston, TX 77055-4226  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 12:45:54', '2021-12-29 12:45:54'),
(54757, 20067, 49804, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||  Hi,  Please fill out the attached CAQH Access form and send W9 so that we can process this update.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-01-13 10:08:33', '2022-01-13 10:08:33'),
(54758, 20067, 49804, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Re: Fw: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||   Good Morning, Hope this email finds you in good health. Kindly see the attachment of CAQH access form and W9 for provider Ancy Kurian  Thanks and Regards, Syed Ahad ', NULL, NULL, '2022-01-13 17:33:19', '2022-01-13 17:33:19'),
(54759, 20067, 49804, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Fw: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||  Hi,  We are returning your application due to missing information listed below.  ALL Disclosure Questions Answered? Release and Attestation State License NPI # SSN # Current Certificate of Insurance Gaps in Work History Gaps in Employment.  Alternatively, Please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations', NULL, NULL, '2022-01-18 10:39:06', '2022-01-18 10:39:06'),
(54760, 20067, 49804, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||   Good Afternoon!  ACCORDING TO THE GUIDELINES, the CAQH of Ancy Kurian has been updated, Kindly continue the credentialing process, and attached are the documents.  Thank you,', NULL, NULL, '2022-02-18 16:55:24', '2022-02-18 16:55:24'),
(54761, 20067, 49804, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com  Sub: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||  Good Evening!  Hope you had a great weekend. I would like to know the current credentialing status of the provider Ancy Kurian 1316558935.  Thank you,', NULL, NULL, '2022-03-14 16:53:16', '2022-03-14 16:53:16'),
(54762, 20067, 49804, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Enrollment Query || LPMC || Ancy Kurian || HealthSmart ||  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-22 15:03:28', '2022-03-22 15:03:28'),
(54763, 19067, 49805, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 17:02:47', '2021-12-20 17:02:47'),
(54764, 19067, 49805, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana   Hello, Hope you had a nice weekend. I would like to enroll this group as In-Network with Humana. Group NameRight Step Medical Center LLCTax ID85-3252700 Group NPI1063008084Practice Location11925 Southwest Freeway, Suite 12 Stafford, TX 77477Provider NameNPIAni Stephen1588959118Ramegowda Belakere1235166687Glory Abraham1194206490Shybi Varghese1285270991Ancy Kurian1316558935  W9 is attached as well. Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 17:05:24', '2021-12-20 17:05:24'),
(54765, 19067, 49805, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status || Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ancy Kurian	1316558935	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:12:31', '2021-12-29 14:12:31'),
(54766, 19067, 49805, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana  Thank you for your interest in joining Humana as a participating provider.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the professional network roster, listing each service location on a separate line.     Please make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.     Completion of this information is not a guarantee of participation. Look forward to receiving your documents for review and determination.     HumanaHoustonPD', NULL, NULL, '2022-01-06 18:00:29', '2022-01-06 18:00:29'),
(54767, 19067, 49805, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Group & Provider || RSM || Humana   Greetings!  Hope this email finds you well.  Kindly see the attached Roster and W9 as requested.  Don\'t hesitate to contact me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 14:26:50', '2022-01-25 14:26:50'),
(54768, 19067, 49805, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.', NULL, NULL, '2022-02-08 16:27:46', '2022-02-08 16:27:46'),
(54769, 19067, 49805, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Good morning Hammad,  2 providers on your roster will need credentialing and each will need updates to their CAQH information. Please note the following:  Ancy Kurian – CAQH is not complete.  Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.   ', NULL, NULL, '2022-02-18 11:50:53', '2022-02-18 11:50:53'),
(54770, 19067, 49805, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Re: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Thanks for the update.   Shybi Varghese & Ancy Kurian\'s CAQH has been updated.   If you need any document or information don\'t hesitate to reach out to me directly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-24 10:53:45', '2022-02-24 10:53:45'),
(54771, 19067, 49805, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email received from: HumanaHoustonPD@humana.com  Subject: RE: Enrollment Query || Group & Provider || RSM || Humana    Your request has been in process for over 60 days (since 12/20/21) and the necessary information has not been supplied.     Shybi Varghese’s CAQH record still does not have a proper state license posted.  Ancy  Kurian is non par for Medicare and does not have full hospital privileges listed in the Provider Profile.  Humana’s credentialing department only uses CAQH, therefore these items must be updated and reflecting in CAQH.  This market office will not submit your request in this incomplete condition for credentialing as the providers will be denied.  Once denied, the process to resubmit becomes complicated.      If this information isn’t supplied and resolved by 2/28/2022, the file will be permanently closed and a new application will be required.  As always, it is the responsibility of the applicant to notify us if/when this is addressed as we do not audit applicants for follow up actions.     Thank you for your immediate attention to this matter,     HumanaHoustonPD   ', NULL, NULL, '2022-03-07 13:36:29', '2022-03-07 13:36:29'),
(54772, 19067, 49806, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 17:03:07', '2021-12-20 17:03:07'),
(54773, 19067, 49806, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana   Hello, Hope you had a nice weekend. I would like to enroll this group as In-Network with Humana. Group NameRight Step Medical Center LLCTax ID85-3252700 Group NPI1063008084Practice Location11925 Southwest Freeway, Suite 12 Stafford, TX 77477Provider NameNPIAni Stephen1588959118Ramegowda Belakere1235166687Glory Abraham1194206490Shybi Varghese1285270991Ancy Kurian1316558935  W9 is attached as well. Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 17:05:18', '2021-12-20 17:05:18'),
(54774, 19067, 49806, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status || Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ancy Kurian	1316558935	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:12:25', '2021-12-29 14:12:25'),
(54775, 19067, 49806, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana  Thank you for your interest in joining Humana as a participating provider.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the professional network roster, listing each service location on a separate line.     Please make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.     Completion of this information is not a guarantee of participation. Look forward to receiving your documents for review and determination.     HumanaHoustonPD', NULL, NULL, '2022-01-06 18:00:24', '2022-01-06 18:00:24'),
(54776, 19067, 49806, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Group & Provider || RSM || Humana   Greetings!  Hope this email finds you well.  Kindly see the attached Roster and W9 as requested.  Don\'t hesitate to contact me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 14:26:46', '2022-01-25 14:26:46'),
(54777, 19067, 49806, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.', NULL, NULL, '2022-02-08 16:27:40', '2022-02-08 16:27:40'),
(54778, 19067, 49806, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Good morning Hammad,  2 providers on your roster will need credentialing and each will need updates to their CAQH information. Please note the following:  Ancy Kurian – CAQH is not complete.  Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.   ', NULL, NULL, '2022-02-18 11:50:47', '2022-02-18 11:50:47'),
(54779, 19067, 49806, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Re: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Thanks for the update.   Shybi Varghese & Ancy Kurian\'s CAQH has been updated.   If you need any document or information don\'t hesitate to reach out to me directly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-24 10:53:39', '2022-02-24 10:53:39'),
(54780, 19067, 49806, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email received from: noreply@onlinesecuremail.com  Subject: RE: Enrollment Query || Group & Provider || RSM || Humana    Your request has been in process for over 60 days (since 12/20/21) and the necessary information has not been supplied.     Shybi Varghese’s CAQH record still does not have a proper state license posted.  Ancy  Kurian is non par for Medicare and does not have full hospital privileges listed in the Provider Profile.  Humana’s credentialing department only uses CAQH, therefore these items must be updated and reflecting in CAQH.  This market office will not submit your request in this incomplete condition for credentialing as the providers will be denied.  Once denied, the process to resubmit becomes complicated.      If this information isn’t supplied and resolved by 2/28/2022, the file will be permanently closed and a new application will be required.  As always, it is the responsibility of the applicant to notify us if/when this is addressed as we do not audit applicants for follow up actions.     Thank you for your immediate attention to this matter,     HumanaHoustonPD', NULL, NULL, '2022-03-11 13:44:01', '2022-03-11 13:44:01'),
(54781, 19067, 49806, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email sent to: HumanaHoustonPD@humana.com  Subject: Re: RE: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Shybi Varghese\'s CAQH has been updated.  Ancy Kurian is Par from Medicare. Her Medicare number is 1X8153. CAQH has been updated.  Thanks.', NULL, NULL, '2022-03-11 13:46:21', '2022-03-11 13:46:21'),
(54782, 19067, 49806, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:05:00', '2022-04-05 13:05:00'),
(54783, 19067, 49807, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-20 17:37:13', '2021-12-20 17:37:13'),
(54784, 19067, 49807, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Provider Link Request || RSM || Cigna   Hi,  Hope you had a great weekend,  I would like to link this provider to an existing group, the details are below:  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Specialty Ani Stephen	1588959118	363LF0000X: Nurse Practitioner - Family  Contact Information: Name: Hammad Ahmed Contact Number: (713)893-6214 Email: rsm@claimsmedinc.com  W9 is also attached.  Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 17:38:58', '2021-12-20 17:38:58'),
(54785, 19067, 49807, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: PDMCOGZ@cigna.com  Subject: FW: [External] Provider Link Request || RSM || Cigna   Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. This request has been completed.                                                                                                                                                                                                                                           If you have any questions, please send an email to Intake PDM@cigna.com and include:                                                                                                                                                                                                                                      Cigna Internal Reference # (W202112202063453).                                                                                                                                                                                                                                                                                                                           PID  HCP Name     Effective\\ Term  date  1465766  ANI, STEPHEN  12/01/2021                                                                                                                                                                                                                                                                                                                                  As per the source document the list of the above provider request has been completed.                                                                                                                                                                                                                                               Sincerely,  PDM .                                                                                                                                                                                          \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"   ', NULL, NULL, '2021-12-28 16:52:41', '2021-12-28 16:52:41'),
(54786, 19067, 49807, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Re: Provider Link Request || RSM || Cigna   Hello!  Hope this email finds you well.  I am writing this email for the welcome letter for provider, Ani Stephen.  Cigna Internal Reference # (W202112202063453).  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 21:26:34', '2022-01-09 21:26:34'),
(54787, 19067, 49807, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Secure email received from: PDMCOGZ@cigna.com  Subject: New Email Notice: You have a secure email from Cigna / Provider Link Request || RSM || Cigna     Dear Health Care Professional,     We received your recent request, a copy of which is enclosed. This request has been alreadycompleted.        If you have any questions, please send an email to Intake_PDM@cigna.com and include:     Cigna Internal Reference # (W202201092106691).     Work Item ID  Split Work Item ID  Provider Name / Group Name  CPF  Provider ID  Completed:  Yes / No.     Transaction Type  Effective / Termination Date  Additional Notes  (If No, select reason as to Why)  Misdirected to Department  W202201092106691  W202201092106691  ANI STEPHEN  1465766  yes     Update  12/01/2021     As per the source document the request has completed.     Sincerely,  PDM', NULL, NULL, '2022-01-13 10:39:40', '2022-01-13 10:39:40'),
(54788, 19067, 49807, NULL, '2022-01-20 00:00:00.000', 'In Process', 'See Attachment.', NULL, NULL, '2022-01-13 10:45:49', '2022-01-13 10:45:49'),
(54789, 19067, 49807, NULL, '2022-02-01 00:00:00.000', 'Approved', 'See attachment for Provider\'s Directory.', NULL, NULL, '2022-01-25 17:14:28', '2022-01-25 17:14:28'),
(54790, 11056, 50745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-21 15:53:40', '2021-12-21 15:53:40'),
(54791, 1019, 50745, NULL, '2022-01-03 00:00:00.000', 'On Hold', 'Issue in TMHP portal.', NULL, NULL, '2021-12-27 11:40:01', '2021-12-27 11:40:01'),
(54792, 11056, 50746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-21 15:55:28', '2021-12-21 15:55:28'),
(54793, 1019, 50746, NULL, '2022-01-03 00:00:00.000', 'On Hold', 'Issue in TMHP portal.', NULL, NULL, '2021-12-27 11:39:45', '2021-12-27 11:39:45'),
(54794, 19067, 50747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 10:12:29', '2021-12-22 10:12:29'),
(54795, 19067, 50747, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Sent fax at 8594558650, requesting to link provider to an existing group.', NULL, NULL, '2021-12-22 10:19:24', '2021-12-22 10:19:24'),
(54796, 19067, 50747, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Sent fax at 8594558650, requesting to link provider to an existing group.', NULL, NULL, '2021-12-22 10:19:30', '2021-12-22 10:19:30'),
(54797, 19067, 50747, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Sent fax at 8594558650, requesting to link provider to an existing group.', NULL, NULL, '2021-12-22 10:19:54', '2021-12-22 10:19:54');
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
(54798, 19067, 50747, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||  Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Aetna.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12, Stafford, TX 77477   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 15:07:11', '2021-12-28 15:07:11'),
(54799, 19067, 50747, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: furqan.syed@snbcare.com  Subject: FW: SNBCare mail - WRONG ADDRESS & Personal Info   Alex,     I think the attached mail pertains to credentialing, please review and answer following questions:     Why SNBCare name is missing and only this mail addressed to Prisca Hefti?  How this insurance got my house address? Why my personal information is being used for credentialing purposes?     Sufi/Ben/Farhan,     I am noticing on regular bases that my personal info including name, cellphone number and home address is being used un-necessarily for credentialing & for PA as well. Kindly look into this to ensure that strictly no one should be using any of my or Sania personal information at all.       Regards,  Furqan A. Syed  Director  Tel: (401) 414 - 3487  Fax: (781) 666 - 2712  www.SNBCare.com', NULL, NULL, '2022-01-03 10:50:02', '2022-01-03 10:50:02'),
(54800, 19067, 50747, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||   Hello,  I am not the correct contact since I only work with behavioral health providers. I have sent this to the medical contact at Aetna.  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2022-01-03 11:01:03', '2022-01-03 11:01:03'),
(54801, 19067, 50747, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: RE: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hammad,  I only received the request for Ancy Kurian under this tin, I did not receive the request for these 3 providers, can you please confirm the role of these providers, will they be practicing in a PCP role or Specialist role?', NULL, NULL, '2022-01-09 21:30:40', '2022-01-09 21:30:40'),
(54802, 19067, 50747, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||    Syed,  We do not have a group agreement to add these providers currently, we do not complete group agreements with only mid-level providers staffed.  I see however, in this request you have submitted includes a physician that was not submitted previously, I will need to send you a group agreement before any providers can be added, please make sure the group owner signs the agreement.     In the future, any request you submit to add providers will need to be submitted as our process is to submit online through the provider portal here.', NULL, NULL, '2022-01-25 13:14:53', '2022-01-25 13:14:53'),
(54803, 19067, 50747, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Hello!  Still waiting to get the group agreement from your side.   Kindly respond as per your convenience.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-08 11:53:35', '2022-02-08 11:53:35'),
(54804, 19067, 50747, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Hello!  I have updated the agreement, Kindly look into it.  Regards.', NULL, NULL, '2022-02-18 11:41:59', '2022-02-18 11:41:59'),
(54805, 19067, 50747, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hi Sylvia,  Did you receive the signed agreement? Kindly respond timely.  Regards, Hammad.', NULL, NULL, '2022-03-11 09:53:25', '2022-03-11 09:53:25'),
(54806, 22077, 50747, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Fwd: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hi,  Hope this email finds you well,  Did you receive the signed agreement? kindly respond timely.  Thanks,  Alex ', NULL, NULL, '2022-04-04 09:58:31', '2022-04-04 09:58:31'),
(54807, 19067, 50747, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:04:40', '2022-04-05 13:04:40'),
(54808, 19067, 50748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 10:43:56', '2021-12-22 10:43:56'),
(54809, 19067, 50748, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Application initiated through Portal.', NULL, NULL, '2021-12-22 10:44:25', '2021-12-22 10:44:25'),
(54810, 19067, 50748, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: HealthSmart.com - Join Our Network - Individual Provider - Stephen   Hi,  Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Ani Stephen,  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-12-28 12:54:57', '2021-12-28 12:54:57'),
(54811, 19067, 50748, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||  Hello,  Hope you are doing well.  Please find out the attached CAQH Access form and W9.  Do let me know if you need anything else.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 13:14:12', '2021-12-28 13:14:12'),
(54812, 19067, 50748, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||   Hi,  We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Stephen, Ani MSN  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-01-03 10:25:35', '2022-01-03 10:25:35'),
(54813, 19067, 50748, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Re: Fw: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||  Hello!  Hope you enjoyed the holidays and are in better health,  I have attached the demographic information form for Ani Stephen.  Don\'t hesitate to reach out if you need anything.  Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2022-01-03 10:27:20', '2022-01-03 10:27:20'),
(54814, 19067, 50748, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com  Subject: Re: Fw: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||   Hello!  Any update on this?  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 21:18:02', '2022-01-09 21:18:02'),
(54815, 19067, 50748, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||    Hi,  Provider \" Stephen, Ani MSN \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks Healthsmart Provider Relations', NULL, NULL, '2022-01-12 11:13:57', '2022-01-12 11:13:57'),
(54816, 19067, 50748, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com, pr.south@healthsmart.com  Subject: Re: Fw: Fw: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||   Hello!  Any Updates on the below mentioned request?    Regards, Hammad', NULL, NULL, '2022-01-25 15:22:03', '2022-01-25 15:22:03'),
(54817, 19067, 50748, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Fw: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||    Hi,  Provider \'\' STEPHEN, ANI FNP \'\' is Effective \'\' 12/01/2021 \'\'  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   Document ID : 3517837  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2022-02-08 13:53:22', '2022-02-08 13:53:22'),
(54818, 19067, 50748, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||   Hello!  Thanks for the effective date. Can I get the welcome kit for the provider, Ani Stephen?   Regards, Hammad.', NULL, NULL, '2022-02-08 13:53:50', '2022-02-08 13:53:50'),
(54819, 19067, 50748, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Provider Enrollment || RSM || Ani Stephen || HealthSmart ||    Hello,  I have not received the welcome kit yet. Kindly provide us with an approval letter for the provider, Ani Stephen.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 11:22:03', '2022-03-16 11:22:03'),
(54820, 19067, 50748, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:04:55', '2022-04-05 13:04:55'),
(54821, 19067, 50749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 11:09:53', '2021-12-22 11:09:53'),
(54822, 19067, 50749, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: networkhealth@uhc.com  Subject: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   Good Morning!  Hope you\'re having a productive day,  I would like to enroll the following provider in an existing group.  Practice Details: Name: Right Step Medical Center LLC Tax ID: 85-3252700 NPI: 1063008084 Location: 11925 Southwest Freeway, Suite 12 Stafford, TX 77477  Provider Details: Name: Ani Stephen NPI: 1588959118 Specialty: 363LF0000X: Nurse Practitioner - Family CAQH: 12327279  Contact Details: Name: Hammad Ahmed Role: Credentialing Specialist Phone: (713)893-6214  Kindly back to us as soon as possible.  Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-22 11:11:07', '2021-12-22 11:11:07'),
(54823, 19067, 50749, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: networkhelp@uhc.com  Subject: Automatic reply: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||     Hello,      Thank you for contacting the UnitedHealthcare Networkhelp team. We typically respond to all emails within 2 business days.  If you do not receive a response within this time, please check your spam/junk folders.        Please note that Networkhelp only supports our UnitedHealthcare medical network providers.      If you are a physical health professional with a different specialty, please use the information below to guide you to the correct contact for your inquiry:        ·         You will receive an email from OptumHealth Physical Health.  Also, you can call or virtual chat with a representative online using the following:        ·         Call: 800-873-4575 or 866-427-6845    ·         Click www.myoptumhealthphysicalhealth.com to chat online        Mental health, dental or vision professionals must contact the appropriate Optum Health partners using the information listed below:        ·  Optum Mental Health     ·    Call: 877-614-0484    ·    Visit: Optum Provider Express       · UnitedHealthcare Dental Provider   ·    Call: 800-822-5353    ·    Email: UnitedHealthcare Dental Provider Portal         ·    UnitedHealthcare Vision     ·    Call: 800-638-3120        Questions? We’re here to help      For more information about joining the UnitedHealthcare network, go to UHCprovider.com/join.          Sincerely,         UnitedHealthcare Networkhelp Team ', NULL, NULL, '2021-12-22 11:14:31', '2021-12-22 11:14:31'),
(54824, 19067, 50749, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: robin_joplin@uhc.com  Subject: Secure Message from robin_joplin@uhc.com  Good Afternoon,     Thank you for contacting United HealthCare regarding adding a new practitioner to your existing Medical Group Participation Agreement.      There are two ways you can submit your request:                  a. For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).                     b. If you don’t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to hpdemo@uhc.com.   You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.     Questions? We’re here to help  Please respond to this email if you need further assistance.     Sincerely,  UnitedHealthcare Network Management Resource Team', NULL, NULL, '2021-12-28 12:08:36', '2021-12-28 12:08:36'),
(54825, 19067, 50749, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   Hello,  Hope you are having a productive day.  I would like to enroll a provider in an existing group.  Please see the attachment for the Form.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 12:24:45', '2021-12-28 12:24:45'),
(54826, 19067, 50749, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Secure email received from: United_Healthcare_Provider_Operations@uhc.com  Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6389410  Received On: Dec 28, 2021 5:33:23 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2021-12-30 16:46:21', '2021-12-30 16:46:21'),
(54827, 19067, 50749, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Secure email received from: United_Healthcare_Provider_Operations@uhc.com   Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com    UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6389410  Received On: Dec 28, 2021 5:33:23 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-01-03 09:13:27', '2022-01-03 09:13:27'),
(54828, 19067, 50749, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   Greetings!  Any updates on the previously mentioned request?  Reference Number: PR-6389410   Kind regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 21:40:12', '2022-01-09 21:40:12'),
(54829, 19067, 50749, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: tremacie_a_stone@uhc.com  Subject: Secure Message from tremacie_a_stone@uhc.com   Good Morning Hammad Ahmed,     Your request for updates for provider Ani Stephen TAX ID 2700*  is currently in process and you will receive a response when it is completed.     Have a great day!        Tremacie  UnitedHealthcare Operations  *--SecureDelivery--*', NULL, NULL, '2022-01-11 09:23:59', '2022-01-11 09:23:59'),
(54830, 19067, 50749, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, tremacie_a_stone@uhc.com  Subject: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   Greetings,  Hope this email finds you well.  Any updates on the below mentioned request?  Reference number: PR-6389410   Regards, Hammad.', NULL, NULL, '2022-01-25 16:27:31', '2022-01-25 16:27:31'),
(54831, 19067, 50749, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, tremacie_a_stone@uhc.com, networkhelpresponse@uhc.com  Subject: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||  Hello!  I haven\'t heard from you and it\'s been a while now.  Kindly make an update on my request below.   Regards, Hammad.', NULL, NULL, '2022-02-14 10:43:02', '2022-02-14 10:43:02'),
(54832, 19067, 50749, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: united_healthcare_provider_operations@uhc.com  Subject:  Secure Message from united_healthcare_provider_operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6480221  Received On: Feb 14, 2022 3:52:02 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-02-14 10:54:02', '2022-02-14 10:54:02'),
(54833, 19067, 50749, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: united_healthcare_provider_operations@uhc.com  Subject:  Secure Message from united_healthcare_provider_operations@uhc.com   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-6480221  Received On: Feb 14, 2022 3:52:02 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2022-02-14 10:54:02', '2022-02-14 10:54:02'),
(54834, 19067, 50749, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: Secure Message from tremacie_a_stone@uhc.com  Subject: submission_inquiry@uhc.com    Good Morning Hammad Ahmed,     Your request for Ani Stephen TAX ID 2700* is still in process.  The process takes 30 days to load demographics, 30 days for credentialing and 30-90 days for contracting.  If any additional information is needed, you will be notified.     Have a great day!        Tremacie  UnitedHealthcare Operations', NULL, NULL, '2022-02-14 17:51:22', '2022-02-14 17:51:22'),
(54835, 19067, 50749, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Secure email received from: united_healthcare_provider_operations@uhc.com  Subject: Secure Message from united_healthcare_provider_operations@uhc.com    Good news! We’ve completed the provider/group updates you requested on Feb 14, 2022 3:52:01 PM. Your request was assigned reference number PR-6480221.  For your convenience, your original submission is attached.  If you have any questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations ', NULL, NULL, '2022-02-15 16:30:32', '2022-02-15 16:30:32'),
(54836, 19067, 50749, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, tremacie_a_stone@uhc.com, networkhelpresponse@uhc.com  Subject: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   Hi,  Any updates on the enrollment process of the provider, Ani Stephen?  Kindly respond timely.  Thanks. ', NULL, NULL, '2022-03-11 10:22:05', '2022-03-11 10:22:05'),
(54837, 19067, 50749, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email received from: submission_inquiry@uhc.com  Subject: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   Good Afternoon Hammad Ahmed,     Thank you for contacting the Submission Inquiry Team. We will be glad to assist regarding your inquiry.     Your request for updates is currently in process under PR-6389410 and has been escalated for completion.  You will receive a response when the updates have been made. Thank you for your patience and have a great day!     Please do not reply directly to this email. Send all responses or questions pertaining to this email to submission_inquiry@uhc.com for further assistance. If sent to zanetta_mccrimon@uhc.com, it will be considered responded to already and will be deleted.        Thank you,     Zanetta  UnitedHealthcare Operations', NULL, NULL, '2022-03-14 15:46:24', '2022-03-14 15:46:24'),
(54838, 19067, 50749, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Secure Message from united_healthcare_provider_operations@uhc.com   Subject: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||   UnitedHealthcare Insurance Company   We’ve reviewed the provider/group updates you requested on Mar 11, 2022 3:31:32 PM and determined that your updates could not be completed. The subject of your original email submission was: Re: Requesting Provider Enrollment || RSM || Ani Stephen || UHC ||.  The request was assigned this reference number: PR-6533598. Why couldn\'t we complete your request? We received a request for status in a mailbox designed for processing provider updates. We have forwarded your inquiry to a research team for further review. The team typically responds within 2 business days. Be sure to check your spam folder for the response should you not find it in your inbox. For further questions on status, feel free to reach out to the research team directly at submission_inquiry@uhc.com. inquiry.  Your original submission is attached for your reference.   Thank you.  UnitedHealthcare Provider Operations  *--SecureDelivery--*  ', NULL, NULL, '2022-03-14 17:18:11', '2022-03-14 17:18:11'),
(54839, 19067, 50749, NULL, '2022-04-07 00:00:00.000', 'In Process', 'Secure Message from united_healthcare_provider_operations@uhc.com   Good news! We’ve completed the provider/group updates you requested on Dec 28, 2021 5:33:21 PM. Your request was assigned reference number PR-6389410 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations', NULL, NULL, '2022-03-31 11:26:21', '2022-03-31 11:26:21'),
(54840, 19067, 50749, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:05:28', '2022-04-05 13:05:28'),
(54841, 11056, 50750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54842, 11056, 50750, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:39:33', '2021-12-22 15:39:33'),
(54843, 11056, 50750, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:46', '2021-12-22 15:40:46'),
(54844, 11056, 50750, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:42:00', '2021-12-22 15:42:00'),
(54845, 11056, 50750, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:43:13', '2021-12-22 15:43:13'),
(54846, 11056, 50750, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:44:17', '2021-12-22 15:44:17'),
(54847, 11056, 50750, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:51:06', '2021-12-22 15:51:06'),
(54848, 11056, 50751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54849, 11056, 50751, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:39:27', '2021-12-22 15:39:27'),
(54850, 11056, 50751, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:41', '2021-12-22 15:40:41'),
(54851, 11056, 50751, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:53', '2021-12-22 15:41:53'),
(54852, 11056, 50751, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:43:09', '2021-12-22 15:43:09'),
(54853, 11056, 50751, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:44:13', '2021-12-22 15:44:13'),
(54854, 11056, 50751, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:51:01', '2021-12-22 15:51:01'),
(54855, 11056, 50752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54856, 11056, 50752, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:39:21', '2021-12-22 15:39:21'),
(54857, 11056, 50752, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:36', '2021-12-22 15:40:36'),
(54858, 11056, 50752, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:47', '2021-12-22 15:41:47'),
(54859, 11056, 50752, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:43:04', '2021-12-22 15:43:04'),
(54860, 11056, 50752, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:44:08', '2021-12-22 15:44:08'),
(54861, 11056, 50752, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:56', '2021-12-22 15:50:56'),
(54862, 11056, 50753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54863, 11056, 50753, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:39:16', '2021-12-22 15:39:16'),
(54864, 11056, 50753, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:31', '2021-12-22 15:40:31'),
(54865, 11056, 50753, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:42', '2021-12-22 15:41:42'),
(54866, 11056, 50753, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:59', '2021-12-22 15:42:59'),
(54867, 11056, 50753, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:44:03', '2021-12-22 15:44:03'),
(54868, 11056, 50753, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:50', '2021-12-22 15:50:50'),
(54869, 11056, 50754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54870, 11056, 50754, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:39:11', '2021-12-22 15:39:11'),
(54871, 11056, 50754, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:27', '2021-12-22 15:40:27'),
(54872, 11056, 50754, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:35', '2021-12-22 15:41:35'),
(54873, 11056, 50754, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:53', '2021-12-22 15:42:53'),
(54874, 11056, 50754, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:58', '2021-12-22 15:43:58');
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
(54875, 11056, 50754, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:44', '2021-12-22 15:50:44'),
(54876, 11056, 50755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54877, 11056, 50755, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:39:05', '2021-12-22 15:39:05'),
(54878, 11056, 50755, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:22', '2021-12-22 15:40:22'),
(54879, 11056, 50755, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:30', '2021-12-22 15:41:30'),
(54880, 11056, 50755, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:48', '2021-12-22 15:42:48'),
(54881, 11056, 50755, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:54', '2021-12-22 15:43:54'),
(54882, 11056, 50755, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:37', '2021-12-22 15:50:37'),
(54883, 11056, 50756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54884, 11056, 50756, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:38:59', '2021-12-22 15:38:59'),
(54885, 11056, 50756, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:16', '2021-12-22 15:40:16'),
(54886, 11056, 50756, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:25', '2021-12-22 15:41:25'),
(54887, 11056, 50756, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:43', '2021-12-22 15:42:43'),
(54888, 11056, 50756, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:49', '2021-12-22 15:43:49'),
(54889, 11056, 50756, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:32', '2021-12-22 15:50:32'),
(54890, 11056, 50757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54891, 11056, 50757, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:38:53', '2021-12-22 15:38:53'),
(54892, 11056, 50757, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:12', '2021-12-22 15:40:12'),
(54893, 11056, 50757, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:20', '2021-12-22 15:41:20'),
(54894, 11056, 50757, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:39', '2021-12-22 15:42:39'),
(54895, 11056, 50757, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:44', '2021-12-22 15:43:44'),
(54896, 11056, 50757, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:25', '2021-12-22 15:50:25'),
(54897, 11056, 50758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:46', '2021-12-22 15:37:46'),
(54898, 11056, 50758, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:38:48', '2021-12-22 15:38:48'),
(54899, 11056, 50758, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:04', '2021-12-22 15:40:04'),
(54900, 11056, 50758, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:16', '2021-12-22 15:41:16'),
(54901, 11056, 50758, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:33', '2021-12-22 15:42:33'),
(54902, 11056, 50758, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:39', '2021-12-22 15:43:39'),
(54903, 11056, 50758, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:19', '2021-12-22 15:50:19'),
(54904, 11056, 50759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:47', '2021-12-22 15:37:47'),
(54905, 11056, 50759, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:38:43', '2021-12-22 15:38:43'),
(54906, 11056, 50759, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:39:59', '2021-12-22 15:39:59'),
(54907, 11056, 50759, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:10', '2021-12-22 15:41:10'),
(54908, 11056, 50759, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:28', '2021-12-22 15:42:28'),
(54909, 11056, 50759, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:35', '2021-12-22 15:43:35'),
(54910, 11056, 50759, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:12', '2021-12-22 15:50:12'),
(54911, 11056, 50760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:47', '2021-12-22 15:37:47'),
(54912, 11056, 50760, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:38:38', '2021-12-22 15:38:38'),
(54913, 11056, 50760, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:39:52', '2021-12-22 15:39:52'),
(54914, 11056, 50760, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:41:05', '2021-12-22 15:41:05'),
(54915, 11056, 50760, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:23', '2021-12-22 15:42:23'),
(54916, 11056, 50760, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:30', '2021-12-22 15:43:30'),
(54917, 11056, 50760, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:07', '2021-12-22 15:50:07'),
(54918, 11056, 50761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-22 15:37:47', '2021-12-22 15:37:47'),
(54919, 11056, 50761, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good morning!  Hope all is well with you. Please let us know with the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:38:33', '2021-12-22 15:38:33'),
(54920, 11056, 50761, NULL, '2021-12-29 00:00:00.000', 'Initiated', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:39:48', '2021-12-22 15:39:48'),
(54921, 11056, 50761, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com & mmonroe@ghn-mci.com &  cguerue@ghn-mci.com  Sub : Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health  Good evening!  Hope all of you are fine. Please assist me in adding the additional location with Galaxy Health under the facility and the providers. Kindly reply with the procedure, Our Facility, and the providers are already enrolled with Galaxy Health.  Please get back to me as soon as possible.  Thank you! Have a wonderfully blessed week ahead!', NULL, NULL, '2021-12-22 15:40:58', '2021-12-22 15:40:58'),
(54922, 11056, 50761, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to:  rpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - TRPN  Good afternoon!  Hope all is well with you. Please let us know the procedure to add the below highlighted location with the already enrolled group and providers under the facility TIN and NPI. Kindly respond to our query at your earliest convenience.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary& Billing Location	500 E CAESAR KINGSVILLE, TX 78363 Additional Location	2102 FM 2165, Rockport, TX 78382 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220   If you require documents or information feel free to reach out to me without any hesitation. Also, see the attached W-9 for the billing and additional location in the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 15:42:18', '2021-12-22 15:42:18'),
(54923, 11056, 50761, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Kavalos@ghn-mci.com  Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health   Good afternoon!  It was nice talking to you.  Tones of thanks to you. Kindly do provide me with the facility agreement as well for the facility.  Your efforts and assistance are highly appreciated.   Take Care!', NULL, NULL, '2021-12-22 15:43:25', '2021-12-22 15:43:25'),
(54924, 11056, 50761, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: kavalos@ghn-mci.com   Sub: Demographic Updates Needed - StatCare Minor Emergency Clinic - Galaxy Health    Hello Ahmed;  For this new practice location, the effective date is  11/11/2021     Sincerely:  Karen Avalos Provider Relations Galaxy Health Network  (P) 800-975-3322 X 1601 (F) 1-817-394-2497    Another Email:   Hi Ahmed,  The location has been added, but will only be listed as a clinic   Thank you,  Michelle        Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425  mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497    Please see the attachments for the agreement and proof. Group has a facility contract.', NULL, NULL, '2021-12-22 15:50:01', '2021-12-22 15:50:01'),
(54925, 1019, 51745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-27 09:56:17', '2021-12-27 09:56:17'),
(54926, 1019, 51745, NULL, '2022-01-03 00:00:00.000', 'Initiated', 'Application Submitted Thru Website. \"Your submission has been received by our provider services department. Someone will be in contact in regards to your request to join our network of providers within 3-5 business days..\"', NULL, NULL, '2021-12-27 09:57:34', '2021-12-27 09:57:34'),
(54927, 1019, 51745, NULL, '2022-01-11 00:00:00.000', 'Initiated', 'Sent the following email to elina.navarro@clearspringhealthcare.com  Hello Elina,  Hope you\'re doing well, we submitted an application to join the network through the website, and we were told that someone will get back to us in 3 to 5 business days, But no one has reached us yet. Can I get that status of my application?.  Group Information:  MK Healthcare PLLC NPI: 1275290587 Address: 3501 S Corona St Ste 1, Englewood , CO 80113-3907', NULL, NULL, '2022-01-04 10:11:52', '2022-01-04 10:11:52'),
(54928, 1019, 51745, NULL, '2022-02-22 00:00:00.000', 'In Process', 'REceived the following email from Elina Sub: Enrollment Query || Group || Clear Spring Health Care || MK Heakth   Could you please send me a list of codes you will render? I will need to review to see if they are covered benefits.      Elina Navarro     Provider Relations Contracting Consultant  CLEAR SPRING HEALTH  Colorado Market  T: 720-762-1184|Fax 312-284-1862  E:Elina.navarro@clearspringhealthcare.com  www.clearspringhealthcare.com   Waiting for the billing dept. to respond', NULL, NULL, '2022-02-15 14:41:19', '2022-02-15 14:41:19'),
(54929, 1019, 51746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-27 09:56:17', '2021-12-27 09:56:17'),
(54930, 1019, 51746, NULL, '2022-01-03 00:00:00.000', 'Initiated', 'Enrollment Application emailed to COA attached is the application for reference. Hello,  Attached is the complete enrollment application attached with the required documents.  Let me know if you have any questions,', NULL, NULL, '2021-12-27 09:59:38', '2021-12-27 09:59:38'),
(54931, 1019, 51746, NULL, '2022-01-03 00:00:00.000', 'Initiated', 'Enrollment Application emailed to COA attached is the application for reference. Hello,  Attached is the complete enrollment application attached with the required documents.  Let me know if you have any questions,', NULL, NULL, '2021-12-27 09:59:41', '2021-12-27 09:59:41'),
(54932, 1019, 51746, NULL, '2022-01-11 00:00:00.000', 'On Hold', 'Need to wait for Medicaid to get enrolled first.  Hello,     We have discovered that you are not validated by Colorado Department of Health Care Financing (HCPF).  This is required for us to complete your Colorado Access contract.  I have attached the link below to initiate the validation process, or you can call Provider Services Call Center at 1-844-235-2387.     Once you are validated, please contact me and I will resume the contracting process. if you already have an approval letter for NPI 1275290587, please forward.  https://www.colorado.gov/hcpf/provider-enrollment        Thank You,  Provider Contracting ', NULL, NULL, '2022-01-04 10:23:16', '2022-01-04 10:23:16'),
(54933, 1019, 51747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-12-27 09:56:17', '2021-12-27 09:56:17'),
(54934, 1019, 51747, NULL, '2022-01-03 00:00:00.000', 'Initiated', 'Enrollment application was emailed to DHManagedCare_BecomeaProvider@dhha.org  \"Hello,  Attached is the complete enrollment application attached with the required documents. Let me know if you have any questions,   Regards, Alex', NULL, NULL, '2021-12-27 10:01:34', '2021-12-27 10:01:34'),
(54935, 1019, 52745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-06 14:11:51', '2022-01-06 14:11:51'),
(54936, 19067, 52745, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-01-13 09:20:58', '2022-01-13 09:20:58'),
(54937, 19067, 52745, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans    Hi Alex,  Please give me a call.  Thanks    Jquonda Brown  Consultant       Phone: 281-520-0997     fridayhealthplans.com  ', NULL, NULL, '2022-01-13 09:22:56', '2022-01-13 09:22:56'),
(54938, 19067, 52745, NULL, '2022-01-20 00:00:00.000', 'Initiated', '	 Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-01-13 10:48:30', '2022-01-13 10:48:30'),
(54939, 20067, 52745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Attached are the W9 for the Urgent Care Centers. Let me know if you have any questions.   Regards, Alex', NULL, NULL, '2022-03-17 09:37:17', '2022-03-17 09:37:17'),
(54940, 20067, 52745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  Attached please find the contracts.  Please let me know if you have any questions.  Thanks', NULL, NULL, '2022-03-17 09:37:39', '2022-03-17 09:37:39'),
(54941, 20067, 52745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  As per our previous discussions the Urgent care contract has to be for $150.00, but you have sent me the contracts for $125.00.    Regards, Alex', NULL, NULL, '2022-03-17 09:38:05', '2022-03-17 09:38:05'),
(54942, 20067, 52745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from:  Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  My apologies.  Here you go.  I\'ll correct the other contracts and get them back to you.  Thanks', NULL, NULL, '2022-03-17 09:38:31', '2022-03-17 09:38:31'),
(54943, 20067, 52745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Re: Fw: TIME SENSITIVE - Friday Health Plans  Hi Alex,  Any updates on the remaining agreements?  Thanks, Jquonda', NULL, NULL, '2022-03-17 09:38:49', '2022-03-17 09:38:49'),
(54944, 20067, 52745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub:Re: Fw: TIME SENSITIVE - Friday Health Plans  Hello Jquonda,  Hope you\'re doing as I was not well so I was out of the office attached are the remaining agreements, I\'ll share the others as well by today. ', NULL, NULL, '2022-03-17 09:39:15', '2022-03-17 09:39:15'),
(54945, 1019, 52746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-06 14:12:06', '2022-01-06 14:12:06'),
(54946, 19067, 52746, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-01-13 09:20:53', '2022-01-13 09:20:53'),
(54947, 19067, 52746, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans    Hi Alex,  Please give me a call.  Thanks    Jquonda Brown  Consultant       Phone: 281-520-0997     fridayhealthplans.com  ', NULL, NULL, '2022-01-13 09:22:51', '2022-01-13 09:22:51'),
(54948, 19067, 52746, NULL, '2022-01-20 00:00:00.000', 'Initiated', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-01-13 10:48:40', '2022-01-13 10:48:40'),
(54949, 20067, 52746, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Sub:  Signed Agreement || Group and Providers || Friday Health || VMUC  Hello Jquonda,  Attached is the updated agreement and Roster.   Regards, Alex', NULL, NULL, '2022-01-24 10:16:26', '2022-01-24 10:16:26'),
(54950, 20067, 52746, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Sub: Signed Agreement || Group and Providers || Friday Health || VMUC  Hi Alex,  Everything looks good.  Can you confirm the address that your payments should be sent to?  I have 3 W-9s for Valley Med each with a different address.  Please confirm and I can get this submitted. ', NULL, NULL, '2022-02-04 15:16:11', '2022-02-04 15:16:11'),
(54951, 20067, 52746, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: Jquonda.Brown@fridayhealthplans.com  Sub: Signed Agreement || Group and Providers || Friday Health || VMUC   The primary and mailing address will be,  2534 Boca Chica Blvd, Brownsville , TX 78521-3496    Regards, Alex', NULL, NULL, '2022-02-17 13:45:50', '2022-02-17 13:45:50'),
(54952, 20067, 52746, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to:  jquonda.brown@fridayhealthplans.com  Sub: Signed Agreement || Group and Providers || Friday Health || VMUC    Hello Jquonda!  Hope you are doing great. Any updates on the request?  Thank you,', NULL, NULL, '2022-03-04 14:22:23', '2022-03-04 14:22:23'),
(54953, 20067, 52746, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: jquonda.brown@fridayhealthplans.com  Sub: Signed Agreement || Group and Providers || Friday Health || VMUC   I\'m awaiting feedback from the credentialing department regarding status.  As soon as I\'m updated I will let you know.  Thanks', NULL, NULL, '2022-03-17 17:14:53', '2022-03-17 17:14:53'),
(54954, 22077, 52746, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: Signed Agreement || Group and Providers || Friday Health || VMUC  Hi Jquonda,  Hope this email finds you well.  Syed Ahad no longer works here. Kindly update me about the agreement of VMUC.  Thanks, Alex Fernandes ', NULL, NULL, '2022-04-07 15:07:53', '2022-04-07 15:07:53'),
(54955, 22077, 52746, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Subject: Re: Signed Agreement || Group and Providers || Friday Health || VMUC   Hi Alex,  I show that the centers have been loaded in our systems.  I\'m just awaiting the receipt of the fully executed agreement.  Upon receipt I will forward it over to you.  Thanks, Jquonda    Jquonda Brown  Consultant       Phone: 281-520-0997     fridayhealthplans.com   ', NULL, NULL, '2022-04-07 15:27:09', '2022-04-07 15:27:09'),
(54956, 1019, 52747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-06 14:14:36', '2022-01-06 14:14:36'),
(54957, 19067, 52747, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-01-13 09:20:48', '2022-01-13 09:20:48'),
(54958, 19067, 52747, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans    Hi Alex,  Please give me a call.  Thanks    Jquonda Brown  Consultant       Phone: 281-520-0997     fridayhealthplans.com  ', NULL, NULL, '2022-01-13 09:22:43', '2022-01-13 09:22:43');
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
(54959, 19067, 52747, NULL, '2022-01-20 00:00:00.000', 'Initiated', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans   Hello Jquonda,  We have patients of Friday Health in our clinics so is there a way we bill those and they get processed?   Regards, Alex', NULL, NULL, '2022-01-13 10:48:46', '2022-01-13 10:48:46'),
(54960, 19067, 52747, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: Jquonda.Brown@fridayhealthplans.com  Subject: Fwd: Fw: TIME SENSITIVE - Friday Health Plans   Hi Alex,  Please give me a call when you return.    Thanks    Jquonda Brown  Consultant       Phone: 281-520-0997     fridayhealthplans.com  ', NULL, NULL, '2022-02-11 14:26:14', '2022-02-11 14:26:14'),
(54961, 19067, 52747, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Jquonda Brown she said that allow them some time.', NULL, NULL, '2022-03-15 14:59:05', '2022-03-15 14:59:05'),
(54962, 22077, 52747, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: jquonda.brown@fridayhealthplans.com  Subject: TIME SENSITIVE - Friday Health Plans  Hey Jquonda,  Any updates on the contract we sent you?  I am looking forward to your kind response.  Thanks & Regards, Alex.', NULL, NULL, '2022-04-22 10:31:06', '2022-04-22 10:31:06'),
(54963, 19067, 52748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-12 17:51:15', '2022-01-12 17:51:15'),
(54964, 19067, 52748, NULL, '2022-01-19 00:00:00.000', 'New/Not Initiated', 'Application initiated through Portal.', NULL, NULL, '2022-01-12 17:52:50', '2022-01-12 17:52:50'),
(54965, 19067, 52748, NULL, '2022-01-19 00:00:00.000', 'Initiated', 'Application initiated through Portal. See attachment.', NULL, NULL, '2022-01-12 17:53:37', '2022-01-12 17:53:37'),
(54966, 19067, 52748, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || Aetna ||   Greetings!  I would like to know the enrollment status of the following provider with Aetna.   I submitted an application through the portal. The application number is: 87225949  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 Barbara Arnold	1922432053 Barbara Arnold	1922432053  Regards,   ', NULL, NULL, '2022-01-30 12:39:01', '2022-01-30 12:39:01'),
(54967, 1019, 52748, 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 12:19:07', '2022-02-01 12:19:07'),
(54968, 19067, 52748, 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 15:13:25', '2022-02-10 15:13:25'),
(54969, 19067, 52748, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: RE: [EXTERNAL] Enrollment Query || SNBCARE || Barbara Arnold || Aetna ||   Good morning,  Our Credentialing Dept. is in the process of verifying the information on her CAQH application.  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2022-02-16 10:06:30', '2022-02-16 10:06:30'),
(54970, 19067, 52748, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Spoke with Anne B. She gave me the effective date as of 02/04/2022. The application will take 15 business days to get completed. Application Ticket# NAF506402 Ref# 62078350613', NULL, NULL, '2022-03-07 11:54:21', '2022-03-07 11:54:21'),
(54971, 19067, 52748, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: reply-febf13727d610574-92_HTML-214289560-515007887-549@provider.aetna.com  Subject: Welcome to our network. Let’s get started.     Hi Barbara Arnold,  Welcome to the provider network effective Apr 1 2022 12:00AM.  Your Provider Identification Number (PIN) is: 6962906.  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, '2022-03-10 11:11:05', '2022-03-10 11:11:05'),
(54972, 19067, 52748, NULL, '2022-03-23 00:00:00.000', 'Approved', 'Email received from: reply-febf13727d610574-92_HTML-214289560-515007887-549@provider.aetna.com  Subject: Welcome to our network. Let’s get started.     Hi Barbara Arnold,  Welcome to the provider network effective Apr 1 2022 12:00AM.  Your Provider Identification Number (PIN) is: 6962906.  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, '2022-03-16 12:04:16', '2022-03-16 12:04:16'),
(54973, 19067, 52749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-12 17:55:45', '2022-01-12 17:55:45'),
(54974, 19067, 52749, NULL, '2022-01-19 00:00:00.000', 'Initiated', 'Application initiated through Portal. See Attachment.', NULL, NULL, '2022-01-12 17:57:29', '2022-01-12 17:57:29'),
(54975, 19067, 52749, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com, Behavioralcontracting@evernorth.com, behPWS@cigna.com  Subject: Enrollment Query || Barbara Arnold || SNBCARE || Cigna ||   Hello!  Hope this email finds you well.  I would like to know the enrollment status of the following provider with Cigna.   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 Barbara Arnold	1922432053 Barbara Arnold	1922432053   Kindly respond promptly.  Regards,', NULL, NULL, '2022-02-04 12:01:57', '2022-02-04 12:01:57'),
(54976, 19067, 52749, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: Julia.Perkins@evernorth.com  Subject: Enrollment Query || Barbara Arnold || SNBCARE || Cigna ||    Your application is being processed    Thank you for reaching out to Evernorth Behavioral Health about the status of your application. My records show the following regarding your status:     c  Packet received – provider 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.     Your assigned Evernorth Recruiter is:     Amanda Williams amanda.williams2@evernorth.com    You will need to follow up with the above recruiter for further details about regarding your credentialing status. I have copied your recruiter on this email for your convenience.', NULL, NULL, '2022-02-08 14:11:34', '2022-02-08 14:11:34'),
(54977, 19067, 52749, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: amanda.williams2@evernorth.com  Subject: Re: [External] Enrollment Query || Barbara Arnold || SNBCARE || Cigna ||   Good Morning Amanda!  Hope you are doing well. Can I get the welcome letter for the provider, Barbara Arnold.  Thanks!', NULL, NULL, '2022-03-17 10:47:22', '2022-03-17 10:47:22'),
(54978, 22077, 52749, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: Julia.Perkins@evernorth.com  Subject: Fwd: [External] Enrollment Query || Barbara Arnold || SNBCARE || Cigna |  Hello!  Hope you are doing well. Can I get the welcome letter for the provider, Barbara Arnold.  Thanks!', NULL, NULL, '2022-04-04 13:11:09', '2022-04-04 13:11:09'),
(54979, 19067, 52750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(54980, 19067, 52750, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'CAQH Application faxed at 866-612-7790. See attachment for reference.', NULL, NULL, '2022-01-24 15:04:26', '2022-01-24 15:04:26'),
(54981, 19067, 52750, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||     Greetings!  I would like to know the enrollment status of the following provider with Beacon Health Options & Beacon Health Strategies. I faxed the CAQH Application form for both locations.   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 Barbara Arnold	1922432053 Barbara Arnold	1922432053  Kindly respond promptly.  Regards,', NULL, NULL, '2022-01-30 12:52:50', '2022-01-30 12:52:50'),
(54982, 19067, 52750, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-04 07:20:14', '2022-02-04 07:20:14'),
(54983, 19067, 52750, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  You haven\'t responded yet. Looking forward to hearing from you soon.  Regards.', NULL, NULL, '2022-02-11 09:46:48', '2022-02-11 09:46:48'),
(54984, 19067, 52750, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||    Good Afternoon Amhed,     I have received your email and I’m looking into this. I’ll get back to you later today.     Thank you!  Elody Ramirez Jr.  Network Management Rep II, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630', NULL, NULL, '2022-02-14 10:02:20', '2022-02-14 10:02:20'),
(54985, 19067, 52750, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: praccredspec@beaconhealthoptions.com  Subject: Beacon Health Options Alert for ARNOLD, BARBARA L-CS19 - CRED INITIAL FINAL PEND - BH - TEST{C1876181} 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 {C1876181}  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, '2022-02-17 15:32:37', '2022-02-17 15:32:37'),
(54986, 19067, 52750, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: praccredspec@beaconhealthoptions.com  Subject: Re: Beacon Health Options Alert for ARNOLD, BARBARA L-CS19 - CRED INITIAL FINAL PEND - BH - TEST{C1876181} zx   Hi,  Kindly see the attached file as per requested.  Regards, Hammad.', NULL, NULL, '2022-02-24 15:18:29', '2022-02-24 15:18:29'),
(54987, 19067, 52750, NULL, '2022-03-07 00:00:00.000', 'In Process', 'Email sent to: yolanda.ramos@beaconhealthoptions.com  Subject: Requested Document - SNBC - Barbara Arnold - BHO    Hi Yolanda!  Kindly see the attached as per your request.   Regards,', NULL, NULL, '2022-02-28 17:16:49', '2022-02-28 17:16:49'),
(54988, 19067, 52750, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Any updates on the enrollment process?  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-07 13:53:18', '2022-03-07 13:53:18'),
(54989, 22077, 52750, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||  Hello  Any updates on the request below?  Thanks', NULL, NULL, '2022-04-04 12:53:56', '2022-04-04 12:53:56'),
(54990, 19067, 52751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(54991, 19067, 52751, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'CAQH Application faxed at 866-612-7790. See attachment for reference.', NULL, NULL, '2022-01-24 15:04:45', '2022-01-24 15:04:45'),
(54992, 19067, 52751, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||     Greetings!  I would like to know the enrollment status of the following provider with Beacon Health Options & Beacon Health Strategies. I faxed the CAQH Application form for both locations.   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 Barbara Arnold	1922432053 Barbara Arnold	1922432053  Kindly respond promptly.  Regards,', NULL, NULL, '2022-01-30 12:52:46', '2022-01-30 12:52:46'),
(54993, 19067, 52751, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-04 07:20:32', '2022-02-04 07:20:32'),
(54994, 19067, 52751, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  You haven\'t responded yet. Looking forward to hearing from you soon.  Regards.', NULL, NULL, '2022-02-11 09:46:56', '2022-02-11 09:46:56'),
(54995, 19067, 52751, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||    Good Afternoon Amhed,     I have received your email and I’m looking into this. I’ll get back to you later today.     Thank you!  Elody Ramirez Jr.  Network Management Rep II, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630', NULL, NULL, '2022-02-14 10:02:31', '2022-02-14 10:02:31'),
(54996, 19067, 52751, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: praccredspec@beaconhealthoptions.com  Subject: Re: Beacon Health Options Alert for ARNOLD, BARBARA L-CS19 - CRED INITIAL FINAL PEND - BH - TEST{C1876181} zx   Hi,  Kindly see the attached file as per requested.  Regards, Hammad.', NULL, NULL, '2022-02-24 15:18:33', '2022-02-24 15:18:33'),
(54997, 19067, 52751, NULL, '2022-03-07 00:00:00.000', 'In Process', 'Email sent to: yolanda.ramos@beaconhealthoptions.com  Subject: Requested Document - SNBC - Barbara Arnold - BHO    Hi Yolanda!  Kindly see the attached as per your request.   Regards,', NULL, NULL, '2022-02-28 17:17:19', '2022-02-28 17:17:19'),
(54998, 19067, 52751, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||   Hello!  Any updates on the enrollment process?  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-07 13:53:08', '2022-03-07 13:53:08'),
(54999, 22077, 52751, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Secure email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || SNBCARE || Barbara Arnold || BHO/BHS ||  Hello  Any updates on the request below?  Thanks', NULL, NULL, '2022-04-04 12:54:43', '2022-04-04 12:54:43'),
(55000, 19067, 52752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55001, 19067, 52752, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: Provider-Enrollment@bcbsma.com  Subject: Provider Enrollment Query || SNBCARE || Barbara Arnold || BCBS ||    Greetings!  We need to enroll the following provider with BCBS MA, Barbara Arnold NPI: 1922432053 under our group Spectrum Neuro Behavioral Care LLC. Let me know the next steps.  Regards. ', NULL, NULL, '2022-01-24 09:48:08', '2022-01-24 09:48:08'),
(55002, 19067, 52752, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider-Enrollment@bcbsma.com  Subject: Re: Provider Enrollment Query || SNBCARE || Barbara Arnold || BCBS ||    Hello!  Any update on this?  Kindly respond promptly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:30:56', '2022-02-04 09:30:56'),
(55003, 19067, 52752, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: ProviderApplicationStatus@bcbsma.com  Subject: 	RE: Provider Enrollment Query || SNBCARE || Barbara Arnold || BCBS ||  Hello:     You would need to send in an application for the provider.     Please see the link below for information in regard to participating with Blue Cross Blue Shield of Massachusetts and guidance through the application process.     https://provider.bluecrossma.com/ProviderHome/portal/home/office-resources/enrollment/become-a-blue-cross-provider     Please make sure you select the correct application based on the providers specialty.     Best,     Network Management Services  Blue Cross and Blue Shield of Massachusetts', NULL, NULL, '2022-02-10 16:17:09', '2022-02-10 16:17:09'),
(55004, 19067, 52752, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Sent a fax at 617-246-5053. ', NULL, NULL, '2022-03-09 13:24:16', '2022-03-09 13:24:16'),
(55005, 19067, 52752, NULL, '2022-04-08 00:00:00.000', 'In Process', 'Email received from: ellen.dyer@bcbsma.com  Subject: Signature requested on \"Spectrum Neuro Behav_BHG__Barbara Arnold_0422_Attachment A.pdf\"    Hello,  Please review and sign the attached documents.  C074167 Barbara Arnold', NULL, NULL, '2022-04-01 11:21:26', '2022-04-01 11:21:26'),
(55006, 19067, 52753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55007, 19067, 52753, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || Commonwealth Care Alliance ||    Greetings!   We want to enroll the following provider. Please see the attached application.  Let me know if anything is required.  Thanks, Hammad Ahmed', NULL, NULL, '2022-01-24 09:56:04', '2022-01-24 09:56:04'),
(55008, 19067, 52753, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: PNMDepartment@commonwealthcare.org  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Commonwealth Care Alliance ||    Hello,     Provider Barbara L Arnold, LCSW Is effective 01/24/2022 at Spectrum Neuro Behavioral Care LLC.     Thanks,', NULL, NULL, '2022-02-10 16:33:21', '2022-02-10 16:33:21'),
(55009, 19067, 52753, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: PNMDepartment@commonwealthcare.org  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Commonwealth Care Alliance ||    Hi,  Can you please confirm the affected location?  Regards. ', NULL, NULL, '2022-02-17 13:51:51', '2022-02-17 13:51:51'),
(55010, 19067, 52753, NULL, '2022-02-24 00:00:00.000', 'Approved', 'Received the following email from: PNMDepartment@commonwealthcare.org  Hello,     Provider Barbara L Arnold, LCSW is active at 2 primary locations below:  61 Lincoln St Suite 203  100 New State Hwy under tin - 834482753     Thank You,', NULL, NULL, '2022-02-17 13:52:38', '2022-02-17 13:52:38'),
(55011, 19067, 52754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55012, 19067, 52754, NULL, '2022-01-21 00:00:00.000', 'On Hold', 'Waiting for Aetna enrollment.', NULL, NULL, '2022-01-14 14:04:57', '2022-01-14 14:04:57'),
(55013, 19067, 52755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55014, 19067, 52755, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Greetings!  I would like to enroll the following provider, Barbara Arnold NPI: 1922432053. Please see the attached roster.  Let me know if anything is required.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-24 14:06:50', '2022-01-24 14:06:50'),
(55015, 19067, 52755, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Greetings!  I would like to enroll the following provider, Barbara Arnold NPI: 1922432053. Please see the attached roster.  Let me know if anything is required.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-24 14:07:44', '2022-01-24 14:07:44'),
(55016, 19067, 52755, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Greetings!  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:03:32', '2022-01-30 13:03:32'),
(55017, 19067, 52755, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: BehavioralHealthProviderServices@humana.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||   Hello!  Hope you are doing well.  I haven\'t heard from you in a while. Kindly look into my request.  Regards, Hammad.', NULL, NULL, '2022-02-08 14:16:35', '2022-02-08 14:16:35'),
(55018, 19067, 52755, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: BehavioralHealthProviderServices@humana.com, mtasby2@humana.com  Subject: Re: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||  Hello!  I would like to enroll a provider with Humana as in-network. Kindly see attached roster  Kindly look into my request as soon as possible as it is time sensitive.  Regards,', NULL, NULL, '2022-03-09 14:06:10', '2022-03-09 14:06:10'),
(55019, 19067, 52755, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: RE: Provider Enrollment || SNBCARE || Barbara Arnold || Humana ||    Ahmed,     Spectrum Neuro Behavioral Care LLC, market roster submitted. Please allow up to 30 business days for complete processing (unless otherwise specified by state law). If you wish to see Humana members prior to your confirmed effective date, you will be considered out-of-network under this requested tax ID. You will receive confirmation once the provider(s) have been added to the group.        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 13:20:40', '2022-03-10 13:20:40'),
(55020, 19067, 52755, NULL, '2022-04-07 00:00:00.000', 'Approved', 'Email received from: behavioralhealthproviderservices@humana.com  Subject: MA - Spectrum Neuro Behavioral Care LLC/ Barbara Arnold - Provider Status    Good afternoon,     Provider Barbara Arnold NPI 1922432053 has been added/linked to the groups contract with Humana Behavioral Health Network  effective 1/1/2022.     To check provider status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory.     If you have additional questions or concerns feel free to email behavioralhealthproviderservices@humana.com.     Emails are worked in the order they are received; please be advised that response times can take 30 Days.     Thank you,     Wanda M.     Behavioral Health Provider Services  Humana Behavioral Health Network  2001 W. John Carpenter Freeway Irving, TX 75063  T 800-890-8288  F 833-931-0662  behavioralhealthproviderservices@humana.com', NULL, NULL, '2022-03-31 13:06:00', '2022-03-31 13:06:00'),
(55021, 19067, 52756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55022, 19067, 52756, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Application initiated through Portal.', NULL, NULL, '2022-01-14 15:12:12', '2022-01-14 15:12:12'),
(55023, 19067, 52756, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Hello Judith!  I would like to know the enrollment status of the following provider. I initiated the application through the portal.  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 Barbara Arnold	1922432053 Barbara Arnold	1922432053  Regards.', NULL, NULL, '2022-02-11 10:20:20', '2022-02-11 10:20:20'),
(55024, 19067, 52756, 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 morning,  The provider was added to the roster 1/14/2022 and the provider is in the credentialing process.   Judy', NULL, NULL, '2022-02-11 10:38:13', '2022-02-11 10:38:13'),
(55025, 19067, 52756, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello Judy!  Hope this email finds you well.  Any updates on the enrollment process of the providers, Barbara Arnold, Eliza Rodrigues & Lauren Powell.  Kindly make an update on it.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 11:42:51', '2022-03-17 11:42:51'),
(55026, 22077, 52756, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: FW: Enrollment Status || Providers || SNBCARE || || Magellan |  Hello,  Any updates on the credentialing process of the provider,  Barbara Arnold NPI: 1922432053  Eliza Rodrigues NPI: 1821751405  Fauzia Khan NPI: 1699761965  Thanks', NULL, NULL, '2022-04-04 14:27:55', '2022-04-04 14:27:55'),
(55027, 22077, 52756, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||  Good afternoon,  Barbara Arnold NPI: 1922432053: The provider is at the end of the credentialing process and should be active by next week. Please check next week, towards the end of the week.  Eliza Rodrigues NPI: 1821751405: Provider has been linked to your group effective date 1/18/2022  Fauzia Khan NPI: 1699761965: This provider has been linked to your group since 4/3/2020  Judy', NULL, NULL, '2022-04-05 14:23:12', '2022-04-05 14:23:12'),
(55028, 19067, 52757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55029, 19067, 52757, NULL, '2022-01-31 00:00:00.000', 'Not Eligible', 'Not Eligible due to LCSW', NULL, NULL, '2022-01-24 15:10:20', '2022-01-24 15:10:20'),
(55030, 19067, 52758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55031, 19067, 52759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55032, 19067, 52759, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Greeting!  We would like to enroll the following provider, Barbara Arnold NPI: 1922432053. Please see the attached application.  Let me know if anything is required.  Regards, Hammad Ahmed', NULL, NULL, '2022-01-24 13:19:54', '2022-01-24 13:19:54'),
(55033, 19067, 52759, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Hi, Hammad!     Barbara’s actually not yet Tricare-certified, so if she’s not done so, she’ll need to fill out this app     http://apps.humana.com/marketing/documents.asp?file=4199936     and fax it with her license to WPS at 608-221-7535. Oh, and FYI, Anne has moved to a different part of the company, so she no longer handles this kind of stuff.     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', NULL, NULL, '2022-01-24 15:23:09', '2022-01-24 15:23:09'),
(55034, 19067, 52759, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Sent a fax at 608-221-7535. See attachment for reference.', NULL, NULL, '2022-01-24 15:54:49', '2022-01-24 15:54:49'),
(55035, 19067, 52759, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Hello!  I faxed the application on 01/24/2022. Any updates on the request so far?  Regards, Hammad. ', NULL, NULL, '2022-02-11 11:26:22', '2022-02-11 11:26:22'),
(55036, 19067, 52759, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Oh, no; new certs are taking about four months to process. I can escalate at three if it’s not complete, but even that is more than two months away.      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', NULL, NULL, '2022-02-15 17:11:23', '2022-02-15 17:11:23'),
(55037, 19067, 52759, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Hi Chuck,  Thanks for the update. Has the process started yet?  Regards, Hammad.', NULL, NULL, '2022-02-15 17:13:01', '2022-02-15 17:13:01'),
(55038, 19067, 52759, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Oh, no; new certs are taking about four months to process. I can escalate at three if it’s not complete, but even that is more than two months away.  ', NULL, NULL, '2022-02-16 09:42:22', '2022-02-16 09:42:22'),
(55039, 19067, 52759, NULL, '2022-02-23 00:00:00.000', 'In Process', '	 Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare    Hi Chuck,  Thanks for the update. Has the process started yet?  Regards, Hammad.', NULL, NULL, '2022-02-16 09:43:17', '2022-02-16 09:43:17'),
(55040, 19067, 52759, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare    Morning, Hammad!     I can only presume so. Since those apps go to WPS, and I have no access to their systems, I’m blind as to an app’s progress. I can tell when it’s done, because then it appears on my screens, but nothing before that.', NULL, NULL, '2022-02-16 09:44:02', '2022-02-16 09:44:02'),
(55041, 19067, 52759, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: RE: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Morning, Hammad!     I can only presume so. Since those apps go to WPS, and I have no access to their systems, I’m blind as to an app’s progress. I can tell when it’s done, because then it appears on my screens, but nothing before that.', NULL, NULL, '2022-03-17 09:40:56', '2022-03-17 09:40:56'),
(55042, 19067, 52759, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || Barbara Arnold || Tricare   Good Morning Chuck!  Hope you are doing well. Any updates on the process as of yet?  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 09:42:39', '2022-03-17 09:42:39'),
(55043, 22077, 52759, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare  Hello,  What are the updates for the enrollment process of Barbara Arnold  Thanks', NULL, NULL, '2022-04-06 13:54:58', '2022-04-06 13:54:58'),
(55044, 22077, 52759, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Enrollment Request || SNBCARE || Barbara Arnold || Tricare  Hi, Alex!   Nothing yet, which is what I’d expect. If we get to the 24th with no action, then I can escalate it.     Thanks!', NULL, NULL, '2022-04-07 10:36:54', '2022-04-07 10:36:54'),
(55045, 19067, 52760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55046, 19067, 52760, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    Greetings!  Hope this email finds you well.  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-14 16:22:54', '2022-01-14 16:22:54'),
(55047, 19067, 52760, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: Provider_Data_Request@tufts-health.com  Subject: PRO0161963 - Request Received   Hello ,  We are in receipt of your request regarding Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS that was submitted on 2022-01-14 16:32:46 EST.  Please reference ticket number PRO0161963 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG8218378 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). SMR1.Point32Health.org made the following annotations', NULL, NULL, '2022-01-24 16:21:34', '2022-01-24 16:21:34'),
(55048, 19067, 52760, 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: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS   Hello!  Any updates on the previously mentioned request?   Reference Ticket Number: PRO0161963   Regards, Hammad.', NULL, NULL, '2022-02-11 12:01:50', '2022-02-11 12:01:50'),
(55049, 19067, 52760, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: servicenow@point32health.org  Subject: Number: PPO0142872 - Request Completed    Hello,  We are in receipt of your request regarding Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS originally sent to tufts_health_plan_credentialing_department@tufts-health.com,Provider_Data_Request@tufts-health.com regarding your Status Inquiry submitted on 2022-01-14 16:32:47 EST.  Please reference ticket number PPO0142872 for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG8551326 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907).', NULL, NULL, '2022-03-18 13:19:30', '2022-03-18 13:19:30'),
(55050, 19067, 52760, NULL, '2022-03-25 00:00:00.000', 'Not Eligible', 'Email received from: Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Subject: PPO0142872 - Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    incident number - PPO0142872   Hi Hammad:   Sorry for the delay in answering your email.   Our Allied Health Contracting Department reviewed her application and decided she was not eligible for a contract.  They sited \"Eligibility not met\".    For further information, please reach out to them at AHCBehavioralHealth@Tufts-Health.com.   Regards,   Provider Operations Team Tufts Health Plan   Ref:MSG8551323', NULL, NULL, '2022-03-18 13:23:35', '2022-03-18 13:23:35'),
(55051, 19067, 52761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:49', '2022-01-14 11:04:49'),
(55052, 19067, 52761, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    Greetings!  Hope this email finds you well.  Attached is the application for our provider, please expedite this application as we were waiting on it for several months now.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-14 16:23:00', '2022-01-14 16:23:00'),
(55053, 19067, 52761, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: Provider_Data_Request@tufts-health.com  Subject: PRO0161963 - Request Received   Hello ,  We are in receipt of your request regarding Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS that was submitted on 2022-01-14 16:32:46 EST.  Please reference ticket number PRO0161963 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG8218378 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). SMR1.Point32Health.org made the following annotations', NULL, NULL, '2022-01-24 16:21:49', '2022-01-24 16:21:49'),
(55054, 19067, 52761, 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: Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS   Hello!  Any updates on the previously mentioned request?   Reference Ticket Number: PRO0161963   Regards, Hammad.', NULL, NULL, '2022-02-11 12:02:00', '2022-02-11 12:02:00'),
(55055, 19067, 52761, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: servicenow@point32health.org  Subject: Number: PPO0142872 - Request Completed    Hello,  We are in receipt of your request regarding Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS originally sent to tufts_health_plan_credentialing_department@tufts-health.com,Provider_Data_Request@tufts-health.com regarding your Status Inquiry submitted on 2022-01-14 16:32:47 EST.  Please reference ticket number PPO0142872 for further communications about this request.  Thank you,  Tufts Health Plan Provider Operations Team    Ref:MSG8551326 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907).', NULL, NULL, '2022-03-18 13:19:43', '2022-03-18 13:19:43'),
(55056, 19067, 52761, NULL, '2022-03-25 00:00:00.000', 'Not Eligible', 'Email received from: Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Subject: PPO0142872 - Provider Enrollment || SNBCARE || Barbara Arnold || TUFTS    incident number - PPO0142872   Hi Hammad:   Sorry for the delay in answering your email.   Our Allied Health Contracting Department reviewed her application and decided she was not eligible for a contract.  They sited \"Eligibility not met\".    For further information, please reach out to them at AHCBehavioralHealth@Tufts-Health.com.   Regards,   Provider Operations Team Tufts Health Plan   Ref:MSG8551323', NULL, NULL, '2022-03-18 13:23:21', '2022-03-18 13:23:21'),
(55057, 19067, 52762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:04:50', '2022-01-14 11:04:50'),
(55058, 19067, 52762, NULL, '2022-01-31 00:00:00.000', 'Initiated', 'Application initiated through Portal. See attachment for reference.', NULL, NULL, '2022-01-24 11:06:27', '2022-01-24 11:06:27'),
(55059, 19067, 52762, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || UBH ||   Greetings!  Hope you\'re doing well.  I would like to know the enrollment status of the following provider. I initiated an application via portal.  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 Barbara Arnold	1922432053 Barbara Arnold	1922432053  Regards,', NULL, NULL, '2022-02-11 11:31:46', '2022-02-11 11:31:46'),
(55060, 1019, 52762, NULL, '2022-02-21 00:00:00.000', 'Not Eligible', 'Received the following email from Optum, as she is a LCSW.  2/10/2022   Attn:  Alex Garrett, Credentialing Contact  barbaralynnearnold@gmail.com  snbc@claimsmedinc.com    RE:  Network Participation - Barbara Arnold    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      a0b2T000008EaLO|AMTLetter|Letters    United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum  U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California    © 2021 Optum, Inc. All Rights Reserved  BH3315b_04/2021', NULL, NULL, '2022-02-14 12:54:25', '2022-02-14 12:54:25'),
(55061, 19067, 52763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58'),
(55062, 19067, 52763, NULL, '2022-01-21 00:00:00.000', 'Initiated', 'Application initiated through Portal. See attachment.', NULL, NULL, '2022-01-14 11:10:34', '2022-01-14 11:10:34'),
(55063, 19067, 52763, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Query || SNBCARE || Barbara Arnold || Aetna ||   Greetings!  I would like to know the enrollment status of the following provider with Aetna.   I submitted an application through the portal. The application number is: 87225949  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 Barbara Arnold	1922432053 Barbara Arnold	1922432053  Regards,   ', NULL, NULL, '2022-01-30 12:38:44', '2022-01-30 12:38:44'),
(55064, 1019, 52763, 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 12:19:01', '2022-02-01 12:19:01'),
(55065, 19067, 52763, 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 15:13:33', '2022-02-10 15:13:33'),
(55066, 19067, 52763, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: RE: [EXTERNAL] Enrollment Query || SNBCARE || Barbara Arnold || Aetna ||   Good morning,  Our Credentialing Dept. is in the process of verifying the information on her CAQH application.  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2022-02-16 10:06:35', '2022-02-16 10:06:35'),
(55067, 19067, 52763, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Spoke with Anne B. She gave me the effective date as of 02/04/2022. The application will take 15 business days to get completed. Application Ticket# NAF506402 Ref# 62078350613', NULL, NULL, '2022-03-07 11:54:27', '2022-03-07 11:54:27'),
(55068, 19067, 52763, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: reply-febf13727d610574-92_HTML-214289560-515007887-549@provider.aetna.com  Subject: Welcome to our network. Let’s get started.     Hi Barbara Arnold,  Welcome to the provider network effective Apr 1 2022 12:00AM.  Your Provider Identification Number (PIN) is: 6962906.  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, '2022-03-10 11:11:00', '2022-03-10 11:11:00'),
(55069, 19067, 52763, NULL, '2022-04-11 00:00:00.000', 'Approved', 'Eff date: 04/01/2022. See the attachment for the provider directory.', NULL, NULL, '2022-04-04 13:33:17', '2022-04-04 13:33:17'),
(55070, 19067, 52764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2022-01-14 11:05:58', '2022-01-14 11:05:58');
