-- Table structure for table `cm_credentialing_task_logs`
--

CREATE TABLE `cm_credentialing_task_logs` (
  `id` bigint(20) NOT NULL,
  `user_id` bigint(20) NOT NULL DEFAULT 0,
  `credentialing_task_id` bigint(20) NOT NULL DEFAULT 0,
  `last_follow_up` varchar(50) DEFAULT NULL,
  `next_follow_up` varchar(50) DEFAULT NULL,
  `status` varchar(50) NOT NULL DEFAULT 'Not initiated',
  `details` text DEFAULT NULL,
  `image` varchar(100) DEFAULT NULL,
  `pdf` varchar(100) DEFAULT NULL,
  `created_at` timestamp NOT NULL DEFAULT current_timestamp() ON UPDATE current_timestamp(),
  `updated_at` timestamp NOT NULL DEFAULT current_timestamp()
) ENGINE=InnoDB DEFAULT CHARSET=utf8;

--
-- Dumping data for table `cm_credentialing_task_logs`
--

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
(1, 4, 2, NULL, NULL, 'New/Not Initiated', 'Approved. Only updating the record', NULL, NULL, '2020-04-30 08:18:16', '2020-04-30 08:18:16'),
(2, 4, 2, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-04-30 08:18:45', '2020-04-30 08:18:45'),
(3, 4, 2, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-04-30 08:19:02', '2020-04-30 08:19:02'),
(4, 2028, 2, NULL, NULL, 'In Process', 'Rep: Nick Go to cms 855i for a change of information and mark the address that you have to change. Ref: 4020206244110', NULL, NULL, '2020-07-24 14:36:06', '2020-07-24 14:36:06'),
(5, 2028, 2, NULL, NULL, 'In Process', 'Rep: sara We can only mail the cms 855i to there www.cms.gov/MedicareProviderSupEnroll. no any other fax number or email address provided ref: 4020209243090', NULL, NULL, '2020-07-27 14:36:28', '2020-07-27 14:36:28'),
(6, 2028, 2, NULL, NULL, 'In Process', 'Submitted Date: THU - JULY 30 2020 01:42:35 PM EST  Submitted By: Stephane Cyriaque  Contact Email(s): FANFAN0503@HOTMAIL.COM BHUCC@CLAIMSMEDINC.COM', NULL, NULL, '2020-07-30 12:40:18', '2020-07-30 12:40:18'),
(7, 1006, 2, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Address has been updated on PECOS for both group and individual provider. Attached approval with updated address. ', NULL, NULL, '2020-08-10 14:56:56', '2020-08-10 14:56:56'),
(8, 1006, 2, NULL, '2020-08-17 00:00:00.000', 'Approved', NULL, NULL, NULL, '2020-08-10 14:59:20', '2020-08-10 14:59:20'),
(9, 1005, 2, NULL, NULL, 'Revalidation', 'test', NULL, NULL, '2020-10-21 09:06:37', '2020-10-21 09:06:37'),
(10, 1006, 2, NULL, NULL, 'Revalidated', 'Finishing test as this is causing it to show up in tasks without a next follow-up date.', NULL, NULL, '2020-10-22 14:03:18', '2020-10-22 14:03:18'),
(11, 4, 3, NULL, NULL, 'New/Not Initiated', 'Already Approved... Updating the Record', NULL, NULL, '2020-04-30 08:21:44', '2020-04-30 08:21:44'),
(12, 4, 3, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-04-30 08:22:13', '2020-04-30 08:22:13'),
(13, 4, 3, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-04-30 08:22:32', '2020-04-30 08:22:32'),
(14, 2028, 3, NULL, NULL, 'In Process', 'Fax: 6082217535 Tricare form sent and also attached. ', NULL, NULL, '2020-07-08 17:25:54', '2020-07-08 17:25:54'),
(15, 2028, 3, NULL, NULL, 'In Process', 'humana is only for address update rest the process is completed', NULL, NULL, '2020-07-13 16:38:45', '2020-07-13 16:38:45'),
(16, 2028, 3, NULL, NULL, 'In Process', 'TO: MEscobar2@humana.com Sub: Cyriaque, Stephane - Humana - BHUCC  Hello,  Hope you are doing great, we would like to update an address for this provider as the previous address was 3033 Texas Parkway, Unit# B, Missouri City, TX 77489 we want to change it to: 3003 Texas Parkway, Unit# B, Missouri City, TX 77489.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-14 17:49:32', '2020-07-14 17:49:32'),
(17, 2028, 3, NULL, NULL, 'In Process', 'TO: ywyatt@humana.com Sub: Cyriaque, Stephane - Humana - BHUCC  Hello,  Hope you are doing great, we would like to update an address for this provider as the previous address was 3033 Texas Parkway, Unit# B, Missouri City, TX 77489 we want to change it to: 3003 Texas Parkway, Unit# B, Missouri City, TX 77489.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633 ', NULL, NULL, '2020-07-16 17:21:27', '2020-07-16 17:21:27'),
(18, 2028, 3, NULL, NULL, 'New/Not Initiated', 'Rep: Danila Provided a number and an email address to update the address, no. is (8006262741), Email Address is  ksmonm@humana.com Ref: 138355694 ', NULL, NULL, '2020-07-17 11:32:39', '2020-07-17 11:32:39'),
(19, 2028, 3, NULL, NULL, 'In Process', 'To: ksmonm@humana.com Sub: Cyriaque, Stephane - Humana - BHUCC Hello,  Hope you are doing great, we would like to update an address for this provider as the previous address was 3033 Texas Parkway, Unit# B, Missouri City, TX 77489 we want to change it to: 3003 Texas Parkway, Unit# B, Missouri City, TX 77489.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able. Thank you. ', NULL, NULL, '2020-07-17 11:34:55', '2020-07-17 11:34:55'),
(20, 2028, 3, NULL, NULL, 'In Process', 'From: ywyatt@humana.com Sub: Cyriaque, Stephane - Humana - BHUCC  Hello Samuel,     We do not show this group tax id in our system as Tricare certified.     To become Tricare certified you need to complete a certification application found on the humanamiitary.com website click on provider> forms. Fax the completed application to WPS 608-221-7535. The fax # is listed on the application. The certification process can take up to 120 days to process. WPS will send you a letter once the application is approved.           Thanks,  Yvonne W. Wyatt,  Humana -Government Business  TRICARE Community Liaison II  Houston/Galveston/Austin  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2020-07-20 14:11:20', '2020-07-20 14:11:20'),
(21, 1006, 3, NULL, NULL, 'In Process', 'Received following email from HumanaHoustonPD@humana.com:   Sub: Secured: FW: Cyriaque, Stephane - Humana - BHUCC  \"I am showing this is also the billing/pay to address.  Humana Corporate will require a W-9 with the corrected address to make this update.  Please provide W-9.  Thank you, HumanaHoustonPD\"', NULL, NULL, '2020-07-20 14:21:33', '2020-07-20 14:21:33'),
(22, 1006, 3, NULL, NULL, 'In Process', 'Sent reply to Humana: \"Hello,   I\'ve attached the W9 that has the correct address for the provider/group. This should be listed as practice & pay-to/billing address.   Please let me know how long this address update request shall take.   Thanks. \"', NULL, NULL, '2020-07-20 14:25:25', '2020-07-20 14:25:25'),
(23, 2028, 3, NULL, NULL, 'In Process', 'Miriam ~ Received the W9, it has been sent out. Allow 10~15  business days,', NULL, NULL, '2020-07-20 16:15:03', '2020-07-20 16:15:03'),
(24, 2028, 3, NULL, NULL, 'In Process', 'TO: HumanaHoustonPD@humana.com Sub: Re: Secured: FW: Cyriaque, Stephane - Humana - BHUCC  Hello,  Hope you\'re doing great, we would like to confirm as we have sent the W9 for the Address correction for the provider and was just checking that it has been done or not.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able. Thank you.', NULL, NULL, '2020-07-28 09:58:54', '2020-07-28 09:58:54'),
(25, 2028, 3, NULL, NULL, 'In Process', 'From: HumanaHoustonPD@humana.com Sub: RE: Secured: FW: Cyriaque, Stephane - Humana - BHUCC  Your original request was just submitted one week ago. Please allow additional time for updating.', NULL, NULL, '2020-07-28 14:59:04', '2020-07-28 14:59:04'),
(26, 1006, 3, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Requested followup from Humana regarding address update. ', NULL, NULL, '2020-08-10 16:49:39', '2020-08-10 16:49:39'),
(27, 1006, 3, NULL, '2020-08-21 00:00:00.000', 'In Process', 'Received following update from HumanaHoustonPD HumanaHoustonPD@humana.com>:  The loading team is backlogged.  It could be anywhere from 5 to 20 days.  ', NULL, NULL, '2020-08-14 16:54:02', '2020-08-14 16:54:02'),
(28, 1006, 3, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Received the following update from Humana:   \"Confirming the billing/service address have all been updated.\"  Also attached approval received via email. ', NULL, NULL, '2020-09-09 09:08:46', '2020-09-09 09:08:46'),
(29, 11056, 3, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email received from : mnario@humana.com  Sub : Humana Partipation_Best Health Urgent Care and Clinic  Hello Ahmed,     Good afternoon!     As requested, sending the items discussed over the phone earlier under Interaction# 2000198840082.     ·         The practice is participating with Humana HMO, Medicare PPO, Medicare PFFS, Humana PPO and ChoiceCare PPO effective 6/1/2021.  ·         Shametria Tann FNP eff 4/1/2021  ·         Stephane Cyriaque MSN eff 6/1/2020     Thank you,       Marjorie Mae Nario  Frontline Leader | Provider Relations     Humana  HGS Manila     T 800 626 2741  F 888 274 1963  mnario@humana.com     Humana.com', NULL, NULL, '2021-08-31 14:52:13', '2021-08-31 14:52:13'),
(30, 4, 4, NULL, NULL, 'New/Not Initiated', 'Already Approved... Updating Record', NULL, NULL, '2020-04-30 08:24:00', '2020-04-30 08:24:00'),
(31, 4, 4, NULL, NULL, 'Approved', 'As per Asana... It has been Approved', NULL, NULL, '2020-05-01 09:49:22', '2020-05-01 09:49:22'),
(32, 4, 4, NULL, NULL, 'In Process', 'Address Change Request has been sent', NULL, NULL, '2020-05-01 09:50:21', '2020-05-01 09:50:21'),
(33, 4, 4, NULL, NULL, 'In Process', 'Approved - Address up-gradation is in process.', NULL, NULL, '2020-05-01 10:46:16', '2020-05-01 10:46:16'),
(34, 1006, 5, NULL, NULL, 'In Process', 'Sent following email to Tanillya Gass  Tanillya_Gass@bcbstx.com cc Bel Villarreal Bel_Villarreal@bcbstx.com:  Sub: Credentialing request for Teresa Saavedra-Case Number - 01439319   \"Hello,  I hope you are doing well, I wanted to know the current status of Teresa Saavedra\' enrollment, for Case# 01439319 & NPI# 1255676151. Kindly update me as soon as you\'re able.  Thanks.\"', NULL, NULL, '2020-06-10 17:11:53', '2020-06-10 17:11:53'),
(35, 2027, 5, NULL, NULL, 'Approved', 'Tanillya_Gass@bcbstx.com  Credentialing request for Teresa Saavedra-Case Number - 01439319  \"Good Afternoon Brad,   Teresa G Saavedra has an effective date of 06-08-2020 with Blue Choice PPO, Blue Essentials, Blue Advantage HMO, Medicare Advantage PPO, CHIP, STAR, and STAR Kids under Tax ID 815123542\" ', NULL, NULL, '2020-06-15 10:29:38', '2020-06-15 10:29:38'),
(36, 1006, 6, NULL, NULL, 'Initiated', 'As per my conversation with Aetna regarding the status update of provider Teresa Saavedra they asked me to send them a letter of intent to start the process which will take 30 business days. So i have sent the letter of intent to Aetna @ fax# (888) 850-7604 and am now waiting for their response.', NULL, NULL, '2020-06-11 15:43:39', '2020-06-11 15:43:39'),
(37, 2027, 6, NULL, NULL, 'Approved', 'From: sotexasancillary@aetna.com  To: vmuc@claimsmedinc.com  Sub: Dr. Teresa Saavedra // Valley Med Urgent Care PLLC  Good morning,    Valley Med Urgent Care PLLC holds an urgent care facility contract under TIN 815123542.  With a facility agreement, it is a global agreement under the facility. You do not need to perform roster loads or add individual providers.  All claims should be submitted under the UC.   A request was received asking to link Dr. Teresa Saavedra to the UC TIN.  However, no maintenance needs to be performed since this is a facility agreement.   Thank you,     Elizabeth Davis', NULL, NULL, '2020-06-17 13:31:46', '2020-06-17 13:31:46'),
(38, 1006, 7, NULL, NULL, 'In Process', 'Teresa Saavedra - Provider has still not been linked to the TIN, need to check back in a few weeks. Processing time is 30 business days.  Rep: Rhonda 06/11/2020 ', NULL, NULL, '2020-06-11 16:43:21', '2020-06-11 16:43:21'),
(39, 2027, 7, NULL, NULL, 'In Process', 'Talk to the insurance representative  she said the provider is already credentialed but they need link letter to complete the process.', NULL, NULL, '2020-06-23 09:51:52', '2020-06-23 09:51:52'),
(40, 2027, 7, NULL, NULL, 'In Process', 'To: 	hpdemo@uhc.com  Sub: Sending LOI For provider Teresa saavedra  Hello, Hope you are doing well, Please find attached LOI for the provider Teresa Saavedra. NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542  Thanks.', NULL, NULL, '2020-06-23 10:44:03', '2020-06-23 10:44:03'),
(41, 2027, 7, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com  To: mk@claimsmedinc.com  Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5350754  Received On: Jun 23, 2020 10:50:04 AM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2020-06-23 12:09:30', '2020-06-23 12:09:30'),
(42, 2027, 7, NULL, NULL, 'In Process', 'To; hpdemo@uhc.com  Sub: Need status update for the provider Teresa saavedra  Hello, Hope you are doing well, May i know the status update for the provider Teresa Saavedra. NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542  Last week I received a reference number:PR-5350754 by your email in which you have confirmed that now you are working on it and we have sent the LOI also which you have asked for. Kindly reply as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-29 13:24:52', '2020-06-29 13:24:52'),
(43, 2027, 7, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com, unitedhealthcare_request_addlinfo@uhc.com, twanda.taylor@uhc.com, brandi_n_mccarthy@uhc.com  Sub: (Teresa Saavedra)-(Valley Med Urgent Care PLLC) -(United HealthCare - UHC)  Hello, Hope you are doing well, May i know the status update for the provider Teresa Saavedra. NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542  Last week I received a reference number:PR-5350754 by your email in which you have confirmed that now you are working on it and we have sent the LOI also which you have asked for. Kindly reply as soon as you get this email.  Thanks.', NULL, NULL, '2020-07-06 17:50:28', '2020-07-06 17:50:28'),
(44, 2027, 7, NULL, NULL, 'In Process', '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-5370845  Received On: Jul 6, 2020 5:52:17 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,', NULL, NULL, '2020-07-06 17:55:21', '2020-07-06 17:55:21'),
(45, 2027, 7, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com   UnitedHealthcare Insurance Company   We’ve reviewed the provider/group updates you requested on Jul 6, 2020 5:52:17 PM and determined that your updates could not be completed. The subject of your original email submission was: (Teresa Saavedra)-(Valley Med Urgent Care PLLC) -(United HealthCare - UHC).  The request was assigned this reference number: PR-5370845. Why couldn\'t we complete your request? Please contact your Network Account Manager for updates on previously submitted requests. .  Your original submission is attached for your reference.   Thank you.', NULL, NULL, '2020-07-07 09:28:40', '2020-07-07 09:28:40'),
(46, 2027, 7, NULL, NULL, 'In Process', 'Talk to the representative her name is katherine ref# 01718332 she said this provider is already credentialed but not in the network, so she said on 06/26/2020 she had already received the signed contract from our side. Now hopefully it will take 30 days to complete the whole process and the PR# 5250421 is the reference for this request. ', NULL, NULL, '2020-07-07 10:12:56', '2020-07-07 10:12:56'),
(47, 2027, 7, NULL, NULL, 'In Process', 'Call to insurance: Talk to the representative his name is Gary and he gave me a new PR#5350754  so that next time we can track our application status through this number and the application is still in process need more time to be completed', NULL, NULL, '2020-07-17 13:29:54', '2020-07-17 13:29:54'),
(48, 2027, 7, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: United_Healthcare_Provider_Operations@uhc.com  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Saavedra, Teresa  Provider NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC      Tax ID:  81-5123542    Thanks.', NULL, NULL, '2020-10-11 17:36:44', '2020-10-11 17:36:44'),
(49, 2027, 7, NULL, '2020-10-27 00:00:00.000', 'Approved', 'This provider is now showing linked with the insurance and effective date is 08/22/2020. Plans are mentioned in the welcome letter and attached in the attachments.', NULL, NULL, '2020-10-20 10:57:17', '2020-10-20 10:57:17'),
(50, 1006, 8, NULL, NULL, 'In Process', 'Provider Relations - South pr.south@healthsmart.com Teresa Saavedra - Provider Credentialing Status Hello, Hope you\'re doing good, can you update me about the current status of this provider, details are as follows:Name - Teresa SaavedraNPI# 1518404631 Thanks ', NULL, NULL, '2020-06-11 12:27:09', '2020-06-11 12:27:09'),
(51, 2027, 8, NULL, NULL, 'In Process', 'To: pr.south@healthsmart.com  Sub: Need Provider Credentialing Status  Hello,   Hope you are doing great, I want to know the credentialing status of the provider. Following are the details:  Provider Name: Teresa Saavedra NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-06-22 13:29:19', '2020-06-22 13:29:19'),
(52, 2027, 8, NULL, NULL, 'Approved', 'From: mdiprsupport@healthsmart.com  To: mk@claimsmedinc.com  Hi,  \" Saavedra, Teresa G DO \" is effective date \" 08/01/2020 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 56639)  Thanks HealthSmart Provider Relations', NULL, NULL, '2020-06-23 12:21:30', '2020-06-23 12:21:30'),
(53, 1006, 9, NULL, NULL, 'In Process', 'Sent email to: dmarley@ghn-mci.com  Sub: Provider Status - Teresa Saavedra  \"Hello, Hope you are doing well, I wanted to know the current enrollment status of the provider, details are as follows:  Name - Teresa saavedra NPI# 1518404631  Thanks\"', NULL, NULL, '2020-06-11 14:27:04', '2020-06-11 14:27:04'),
(54, 2027, 9, NULL, NULL, 'In Process', 'talk to the insurance representative she said effective date has already issued which is 12/03/2020 waiting for the welcome letter', NULL, NULL, '2020-06-22 16:39:16', '2020-06-22 16:39:16'),
(55, 2027, 9, NULL, NULL, 'In Process', 'Talk to the representative she said welcome letter is with the group so we have to wait until they send us.', NULL, NULL, '2020-06-29 12:59:07', '2020-06-29 12:59:07'),
(56, 2027, 9, NULL, NULL, 'In Process', 'To: dmarley@ghn-mci.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care PLLC (Brownsville)-(Galaxy Health)  Please send us the welcome letter for the below mentioned provider as she is already in network and the effective date is 12/03/2020. Provider Name: Saavedra, Teresa  Provider NPI# 1255676151 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542   Thanks.', NULL, NULL, '2020-07-09 17:14:38', '2020-07-09 17:14:38'),
(57, 2027, 9, NULL, NULL, 'Approved', 'Call to insurance: Talk to the representative she said this provider is already linked with the insurance under the group contract so provider don\'t need a welcome letter ', NULL, NULL, '2020-07-15 12:35:57', '2020-07-15 12:35:57'),
(58, 1006, 10, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-04-30 14:17:03', '2020-04-30 14:17:03'),
(59, 1006, 10, NULL, NULL, 'Approved', 'Hi Brad  She is effective 4.8.2020.  Thanks!  ------------------------------------------------------------------- Kody Dunnett Provider Operations Associate Tufts Health Plan Phone:  617-972-9400 ext 59436 Fax:  617-972-9044', NULL, NULL, '2020-04-30 14:17:23', '2020-04-30 14:17:23'),
(60, 2027, 11, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  Sub: Need Status Update Of Provider Stephane Cyriaque  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Stephane Cyriaque NPI# 1780192633 Group Name: Best Health Urgent Care & Clinic Tax-ID: 84-4737737  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-19 14:58:45', '2020-06-19 14:58:45'),
(61, 2028, 11, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com SUB:  Reminder (Need Status Update Of Provider Stephane Cyriaque)  Hello,  I want to know about the current status of the provider  Following are the details:  Provider Name: Stephane Cyriaque NPI# 1780192633 Group Name: Best Health Urgent Care & Clinic Tax-ID: 84-4737737  Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-06-30 13:34:28', '2020-06-30 13:34:28'),
(62, 2028, 11, NULL, NULL, 'Approved', 'Effective Date: 05/13/2020 Medicare Program Rate: $75.00 (Per visit) Global Fee Urgent Care | Applicable CPT/HCPS Code Medicaid Program Rate: $65.00 (Per visit) Global Fee Urgent Care | Applicable CPT/HCPS Code', NULL, NULL, '2020-06-30 15:21:31', '2020-06-30 15:21:31'),
(63, 2028, 11, NULL, NULL, 'Approved', 'Effective Date: 05/13/2020 Medicare Program Rate: $75.00 (Per visit) Global Fee Urgent Care | Applicable CPT/HCPS Code Medicaid Program Rate: $65.00 (Per visit) Global Fee Urgent Care | Applicable CPT/HCPS Code', NULL, NULL, '2020-06-30 15:21:52', '2020-06-30 15:21:52'),
(64, 2028, 13, NULL, NULL, 'Initiated', 'online form submitted', NULL, NULL, '2020-07-14 13:53:58', '2020-07-14 13:53:58'),
(65, 2028, 13, NULL, NULL, 'In Process', 'Rep: Paula  As per rep, it will take 3 to 4 months for Aetna\'s credentialing, as we will receive the approval letter from them it will take a month for us to load the contract for you but there is no guarantee.  Ref: 5605567', NULL, NULL, '2020-07-24 15:26:49', '2020-07-24 15:26:49'),
(66, 2037, 13, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Follow up email sent to pdsdallas@aetna.com: ----------------  Greetings, Kindly provider the status of credentialing application for the below mentioned providers submitted to first health online. Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                  : 1780192633 ', NULL, NULL, '2020-10-06 14:05:38', '2020-10-06 14:05:38'),
(67, 2037, 13, NULL, '2020-11-05 00:00:00.000', 'In Process', 'As per live call to First Health the application is received and in process but there is no timeline for it to be completed it can take up-to 3 years maximum based upon the network needs , locations provider specialty  etc. Reference# 5605567. Representative : Robin.', NULL, NULL, '2020-10-15 09:49:46', '2020-10-15 09:49:46'),
(68, 2037, 13, NULL, '2020-11-12 00:00:00.000', 'In Process', 'As per live call to First Health the application is received and in process but there is no timeline for it to be completed it can take up-to 3 years maximum based upon the network needs , locations provider specialty  etc. Reference# 5605567. Representative : Robin.', NULL, NULL, '2020-11-05 17:56:40', '2020-11-05 17:56:40'),
(69, 2037, 13, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to pdsdallas ', NULL, NULL, '2020-11-12 10:39:49', '2020-11-12 10:39:49'),
(70, 2037, 13, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to pdsdallas for the updated status. ---------------- First Health-Cyriaque, Stephane-BHUCC', NULL, NULL, '2020-11-20 10:57:01', '2020-11-20 10:57:01'),
(71, 2037, 13, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:04:27', '2020-12-01 10:04:27'),
(72, 2037, 13, NULL, '2020-12-10 00:00:00.000', 'In Process', '	 Follow up email sent', NULL, NULL, '2020-12-08 13:43:34', '2020-12-08 13:43:34'),
(73, 2037, 13, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-11 12:20:22', '2020-12-11 12:20:22'),
(74, 2037, 13, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Another followup email sent', NULL, NULL, '2020-12-18 12:55:52', '2020-12-18 12:55:52'),
(75, 2037, 13, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 10:44:06', '2020-12-29 10:44:06'),
(76, 1006, 13, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent regarding credentialing status to bharathb@aetna.com ', NULL, NULL, '2021-01-26 15:49:51', '2021-01-26 15:49:51'),
(77, 1006, 13, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Cannot initiate First Health until Aetna has been enrolled, had to initiate a new request for First Health enrollment. Attached for reference. Ref# 5786413 Rep: Leandra ', NULL, NULL, '2021-02-02 17:34:31', '2021-02-02 17:34:31'),
(78, 1006, 13, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Need to allow more time for processing, will check in next week. ', NULL, NULL, '2021-02-12 15:55:52', '2021-02-12 15:55:52'),
(79, 3046, 13, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com Subject: Request For Status Update on Locations ||  Best Health Urgent Care & Clinic || First Health. Greetings,  Kindly provide me the status of the credentialing application for the below mentioned providers.  Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                 : 1780192633', NULL, NULL, '2021-02-25 13:24:17', '2021-02-25 13:24:17'),
(80, 3046, 13, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com Subject: Request For Status Update on Locations ||  Best Health Urgent Care & Clinic || First Health.  Greetings,  I hope you are doing well.  I would like to kindly send you a soft reminder regarding the status for the update on Location for the below mentioned provider: Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                 : 1780192633  Thank you.', NULL, NULL, '2021-03-04 09:46:08', '2021-03-04 09:46:08'),
(81, 3046, 13, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com Subject: Request For Status Update on Locations || Best Health Urgent Care & Clinic || First Health.  Hello,  I would like to kindly know the credentialing application status for the below mentioned provider:  Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                 : 1780192633 ', NULL, NULL, '2021-03-18 13:29:49', '2021-03-18 13:29:49'),
(82, 3040, 13, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic ||| Cyriaque, Stephane || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-09 14:18:16', '2021-06-09 14:18:16'),
(83, 11056, 13, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic ||| Cyriaque, Stephane || First Health ||   Hey Bharath,  Hope you are doing well. What do you require to link the Tax I.D? Kindly guide us the procedure to link the Tax I.D   We\'ll be waiting to hear from you soon. Thank you!', NULL, NULL, '2021-06-28 12:39:50', '2021-06-28 12:39:50'),
(84, 11056, 13, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic ||| Cyriaque, Stephane || First Health ||  Greetings,  Hope you are doing well. You haven\'t responded to our last email yet, in which we have asked you to guide us the procedure for linking the provider under the tax I.D of the practice. Kindly guide us as soon as possible.  Practice Details:  Practice Name: Best Health Urgent Care & Clinic  Practice Tax ID # : 84-4737737  Practice NPI # : 1013540962  Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242     Provider Details:  Provider Name: Cyriaque, Stephane  Provider NPI# 1780192633    If you need any information or documents feel free to contact us. Waiting to hear from you soon.    Thank you!', NULL, NULL, '2021-07-12 13:26:13', '2021-07-12 13:26:13'),
(85, 11056, 13, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to :     pdsdallas@aetna.com,        BharathB@aetna.com  Sub : Linking the provider - BHUCC - First Health  Greetings,  Hope you are doing well. You haven\'t responded to our last email yet, in which we have asked you to guide us the procedure for linking the provider under the tax I.D of the practice. Kindly guide us as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  If you need any information or documents feel free to contact us. Waiting to hear from you soon.  Thank you! Have a nice day!', NULL, NULL, '2021-07-16 12:22:47', '2021-07-16 12:22:47'),
(86, 11056, 13, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to :   MadirajuP@aetna.com   ,    BharathB@aetna.com  &       PDS Dallas pdsdallas@aetna.com  Sub : Enrollment Status Query - BHUCC - First Health  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers in our group Best Health Urgent Care & Clinic in First Health. Kindly inform me about the enrollment status as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  If you need any details please let me know. Waiting for your response.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-04 09:13:37', '2021-08-04 09:13:37'),
(87, 11056, 13, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Your request to join the network has been received.  Ref code is : NASB  Please see the attachment.', NULL, NULL, '2021-08-10 14:56:55', '2021-08-10 14:56:55'),
(88, 11056, 13, NULL, '2021-08-23 00:00:00.000', 'In Process', 'I had words with the Representative. He informed me that the application hasn\'t been received by credentialing department yet. It will take 30 - 90 days in credentialing.', NULL, NULL, '2021-08-16 13:33:41', '2021-08-16 13:33:41'),
(89, 11056, 13, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'Email received from : BharathB@aetna.com  Sub : Enrollment Status Query - BHUCC - First Health  Hi Ahmed,     The TIN does not have active contract under FH network hence provider has not loaded in system. Please reach out to Aetna Provider Services mentioned below who can in turn submit a NAF to the Aetna Local Market contact  Aetna Provider Services 800-624-0756 / 888-632-3862      Regards,  Bharath   Talked to a representative Paula. She informed me that it will be on hold until the group contract of the Practice with Aetna.', NULL, NULL, '2021-08-23 14:03:02', '2021-08-23 14:03:02'),
(90, 1005, 14, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-06-16 13:55:51', '2020-06-16 13:55:51'),
(91, 1006, 14, NULL, NULL, 'In Process', 'Called @ (800) 950-7040 As per the representative (Sam), they are gonna escalate the request. we should try back by the end of the week if we don\'t hear anything. Case# 7228197', NULL, NULL, '2020-06-23 17:02:23', '2020-06-23 17:02:23'),
(92, 1006, 14, NULL, NULL, 'New/Not Initiated', 'TO: Mariana.Juarez@multiplan.com  SUB: RE: Best Health Urgent Care and Clinic  Hi,I would like to know what\'s the current status of  Best Health Urgent Care & Clinic. Is it still in process? The details are as follows: Group Name: Best Health Urgent Care & Clinic Tax ID: 84-4737737 NPI: 1013540962  Please reply back to me as soon as you get this email.Thank you. ', NULL, NULL, '2020-06-23 17:30:46', '2020-06-23 17:30:46'),
(93, 1006, 14, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-06-24 10:53:17', '2020-06-24 10:53:17'),
(94, 2028, 14, NULL, NULL, 'In Process', 'From: Mariana.Juarez@multiplan.com SUB: Best Health Urgent Care and Clinic  Good morning,  Thank you for following up. Yes, still in process. Waiting for the medical director to approve. If approved, I should have a contract out to you next  week for signature.     Mariana Juarez  Provider Contracting Representative  mariana.juarez@multiplan.com     MultiPlan  25550 Commercentre Drive, Suite 200 Lake Forest, CA 92630  ph: 949-672-1561  fx: 630-245-2462', NULL, NULL, '2020-06-30 10:08:45', '2020-06-30 10:08:45'),
(95, 2028, 14, NULL, NULL, 'In Process', 'TO: Mariana.Juarez@multiplan.com SUB: RE: Best Health Urgent Care and Clinic Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-08 16:42:27', '2020-07-08 16:42:27'),
(96, 2028, 14, NULL, NULL, 'In Process', 'From: Mariana.Juarez@multiplan.com Sub: RE: Best Health Urgent Care and Clinic  Hello Samuel,  The medical director requested a different RFI to be completed. Please complete and return to me via email. I had previously requested this RFI on 6/30 via email from Brad.', NULL, NULL, '2020-07-10 09:56:49', '2020-07-10 09:56:49'),
(97, 2028, 14, NULL, NULL, 'In Process', 'TO: Mariana.Juarez@multiplan.com Sub: RE: Best Health Urgent Care and Clinic  Hello   Hope you\'re doing great, attached is the RFI Form which you sent.  Regards, Samuel Sharon', NULL, NULL, '2020-07-10 12:10:46', '2020-07-10 12:10:46'),
(98, 2028, 14, NULL, NULL, 'In Process', 'To: Mariana.Juarez@multiplan.com Sub: RE: Best Health Urgent Care and Clinic  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-17 12:56:50', '2020-07-17 12:56:50'),
(99, 2028, 14, NULL, NULL, 'In Process', 'To: Mariana.Juarez@multiplan.com Sub: Automatic reply: Best Health Urgent Care and Clinic  I am out of the office and will return Monday, July 20th. I will reply to your message when I return.  Mariana Juarez', NULL, NULL, '2020-07-17 13:00:58', '2020-07-17 13:00:58'),
(100, 2028, 14, NULL, NULL, 'In Process', 'Mariana.Juarez@multiplan.com: RFI Received', NULL, NULL, '2020-07-21 15:02:47', '2020-07-21 15:02:47'),
(101, 2028, 14, NULL, NULL, 'In Process', 'TO: Mariana.Juarez@multiplan.com Sub: RE: Best Health Urgent Care and Clinic  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-24 09:45:52', '2020-07-24 09:45:52'),
(102, 2028, 14, NULL, NULL, 'In Process', 'From: Mariana.Juarez@multiplan.com Sub: RE: Best Health Urgent Care and Clinic  Good morning,  I am waiting for the medical director to approve. I should have a response sometime next week. Thank you for your patience.     Mariana ', NULL, NULL, '2020-07-24 10:05:25', '2020-07-24 10:05:25'),
(103, 2028, 14, NULL, NULL, 'In Process', 'From: Mariana.Juarez@multiplan.com Sub: RE: Best Health Urgent Care and Clinic  Good morning,  I have received a response from the medical director and Multiplan will respectfully decline to contract with Best Health Urgent Care and Clinic.     I am concerned that although they are stating they are a walk-in clinic and not an Urgent Care Center, their name is Best Health Urgent Care and Clinic.  Frankly this is misleading to anyone who goes there expecting a level of service and care consistent with that of an UCC but functioning at the level of a Walk-in clinic. Hours of operation are an issue in that they are open only M-F, 9-5.     Thank you for your time and interest.', NULL, NULL, '2020-07-30 12:09:06', '2020-07-30 12:09:06'),
(104, 1006, 14, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Asked Mariana if we could try going to individual enrollment for now, if they aren\'t allowing us urgentcare/group enrollment. ', NULL, NULL, '2020-08-10 10:11:17', '2020-08-10 10:11:17'),
(105, 1006, 14, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Sent another followup email to \"Juarez, Mariana\" Mariana.Juarez@multiplan.com> ', NULL, NULL, '2020-08-19 18:01:38', '2020-08-19 18:01:38'),
(106, 1006, 14, NULL, '2020-08-28 00:00:00.000', 'In Process', 'As per the rep, need to submit another provider nomination but for individual provider this time. Sent request:  \"Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page. Nomination Tracking Number: 0821201I2\"', NULL, NULL, '2020-08-21 11:39:05', '2020-08-21 11:39:05'),
(107, 2037, 14, NULL, '2020-09-10 00:00:00.000', 'In Process', 'Received Multiplan Individual Agreement for Signature for Stephane .Agreement Signed and sent back electronically.Below is the email for reference: --------------------------------------------- nominations@multiplan.com Attachments Aug 27, 2020, 2:05 PM (4 days ago) to bhucc  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks.  An agreement for signature is enclosed and available to sign electronically by clicking the following link:  Individual Agreement We have included a sample fee schedule for your review.  Please note, the applicability of the SLCP State Law Coordinating Provisions is determined by your service location(s). Please refer to your State Law Provisions.  Once we have received the signed agreement, we will begin the credentialing process. You will be notified of your effective date upon acceptance into the network(s) and a fully executed copy of the agreement will be sent to you via DocuSign email  If you need to nominate additional providers then please submit your provider nomination request by clicking the following link: ', NULL, NULL, '2020-08-31 13:24:31', '2020-08-31 13:24:31'),
(108, 1005, 14, NULL, '2020-10-03 00:00:00.000', 'In Process', 'Nomination Details Tracking Number:	0821201I2 Provider:	Stephane Cyriaque Status : Application Received', NULL, NULL, '2020-09-24 14:43:30', '2020-09-24 14:43:30'),
(109, 2037, 14, NULL, '2020-10-27 00:00:00.000', 'In Process', 'The application is currently in process with no deficiencies as of now. ', NULL, NULL, '2020-10-06 14:09:09', '2020-10-06 14:09:09'),
(110, 2037, 14, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Email Notification From MultiPlans:  ------------------------- Dear Provider Contact:  We have received your request to join MultiPlan\'s provider network. Your request has been processed by MultiPlan\'s Contracts and Development Team. We have released the necessary documents to our Registrar Department for review and processing. You will be contacted if additional information is needed. Once credentialing is approved; you will be notified of the provider\'s effective date.', NULL, NULL, '2020-10-12 10:54:58', '2020-10-12 10:54:58'),
(111, 2037, 14, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Notification Received. Multi has picked up Stephan\'s information from CAQH.', NULL, NULL, '2020-10-20 09:26:39', '2020-10-20 09:26:39'),
(112, 2037, 14, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Request received for TIN Designation form : ---------------------- Submitted @ appmissinginfo@multiplan.com  ------------------  Sherry Deen Attachments 1:21 PM (0 minutes ago) to appmissinginfo, bhucc@claimsmedinc.com  Greetings,  Kindly find the requested information attached for the subjected application. Please feel free to contact me for any further information.  Regards:  Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 | sd@claimsmedinc.com', NULL, NULL, '2020-10-26 13:25:12', '2020-10-26 13:25:12'),
(113, 2037, 14, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Per live call to Multiplan they have received the sent documents and the application has been resumed and is currently being processed with no further requirements as of yet.', NULL, NULL, '2020-10-29 09:59:11', '2020-10-29 09:59:11'),
(114, 2037, 14, NULL, '2020-12-03 00:00:00.000', 'In Process', 'Currently being processed.Need to allow more time', NULL, NULL, '2020-11-24 15:03:32', '2020-11-24 15:03:32'),
(115, 1006, 14, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Provider is participating with PHCS & Multiplan with Eff: 10/26/2020 We should be getting the welcome letter in 5 business days . Multiplan Medicaid - www.multiplan.us/providers/medicaid/ Medicare Advantage - https://www.multiplan.us/providers/medicare-advantage/  Case# 7440371', NULL, NULL, '2020-12-03 11:01:27', '2020-12-03 11:01:27'),
(116, 2037, 14, NULL, '2020-12-11 00:00:00.000', 'Approved', 'Welcome letter received from Multiplan . Uploaded on EMRBS.', NULL, NULL, '2020-12-04 15:59:32', '2020-12-04 15:59:32'),
(117, 2028, 15, NULL, NULL, 'New/Not Initiated', 'To: PENAT@usamco.com Sub: Request for the Welcome letter Hello, Hope you are doing great. Tina, we are waiting for the approval letter of  Stephane Cyriaque. Do you know when we can expect it?  Following are the details: Group Name: Best Health Urgent Care & Clinic Provider NPI: 1780192633 Group Tax ID: 84-4737737  Please get back to me as soon as you\'re able.  Thank you.', NULL, NULL, '2020-07-01 13:54:24', '2020-07-01 13:54:24'),
(118, 2028, 15, NULL, NULL, 'In Process', 'Rep Asked for the status of the provider she said that he is already enrolled then asked for the welcome letter she took the fax number and on the call faxed the welcome letter as i was asking the name and Reference ID the line got disconnected.', NULL, NULL, '2020-07-10 09:45:41', '2020-07-10 09:45:41'),
(119, 2028, 15, NULL, NULL, 'In Process', 'Rep : Nicholas  Agent said to wait for 1 more hour for the fax to receive.   ref : 39305876000', NULL, NULL, '2020-07-10 12:50:47', '2020-07-10 12:50:47'),
(120, 2028, 15, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-10 13:10:46', '2020-07-10 13:10:46'),
(121, 2028, 15, NULL, NULL, 'Approved', 'TO: PENAT@usamco.com Sub: Cyriaque, Stephane - Managed Care Organization - MCO - BHUCC  Hope you are doing great, We are waiting for the approval letter of Stephane Cyriaque. Do you know when we can expect it?  Following are the details: Group Name: Best Health Urgent Care & Clinic Provider NPI: 1780192633 Group Tax ID: 84-4737737  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-10 13:20:32', '2020-07-10 13:20:32'),
(122, 2037, 15, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Email sent @ providerinfo@usamco.com Hello, This is a formal request to obtain the copy of the executed contract for the below mentioned group. Group Name: Best Health Urgent Care & Clinic Provider NPI: 1780192633Group Tax ID: 84-4737737Effective Date: 06/08/2020', NULL, NULL, '2020-08-19 15:49:35', '2020-08-19 15:49:35'),
(123, 2037, 15, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Spoke to Donna about the status of Stephane and his linkage to the group. Verified twice but they don\'t have any records of the request.How ever the rep will double check and get back to me by tomorrow. Ref#4174-08/31/2020', NULL, NULL, '2020-08-31 16:25:29', '2020-08-31 16:25:29'),
(124, 2037, 15, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Received confirmation Email from MCO:  Erin Turner turnere@usamco.com Sep 1, 2020, 8:53 AM (1 day ago) to me     Good Morning    Following our conversation yesterday I wanted to provide you with an update. Stephane Cyriaque is part of Best Health Urgent Care, which is an ancillary agreement and therefore individual providers are not credentialed, only the facility. All providers billing under this TIN are considered in network. Please let me know if there is anything else I can assist you with. Thank you and have a great week!', NULL, NULL, '2020-09-02 12:37:38', '2020-09-02 12:37:38'),
(125, 2028, 16, NULL, NULL, 'In Process', 'Name: Raina G As per rep, Contact us this coming Wednesday for address update Ticket no. 39404058001 ', NULL, NULL, '2020-07-24 13:45:37', '2020-07-24 13:45:37'),
(126, 2028, 16, NULL, NULL, 'In Process', 'Rep: marina As per rep, we have to fill the form TMHP she explained the form and said to send it with a W9 to the given fax number which is on the form. I have downloaded the form but according to Army we can change the address online on TMHP website but before that, we have to mail the medicare 855i  REF: 39435992000', NULL, NULL, '2020-07-29 16:55:28', '2020-07-29 16:55:28'),
(127, 1006, 16, NULL, '2020-08-17 00:00:00.000', 'Approved', 'Address has been updated. Proof is attached. ', NULL, NULL, '2020-08-10 15:20:59', '2020-08-10 15:20:59'),
(128, 1006, 16, NULL, '2020-08-17 00:00:00.000', 'Approved', 'Received email from Lluvia regarding Billing Address update:   \"From: Lluvia Munguia Lluvia_Munguia@bcbstx.com> Date: Mon, Aug 3, 2020 at 2:26 PM Subject: RE: W9 - Form To: Alex Garrett mu@claimsmedinc.com>  Hello. Good morning, I was just looking that up.  It has been updated.   Thank you, Lluvia Munguia\"', NULL, NULL, '2020-08-10 15:58:01', '2020-08-10 15:58:01'),
(129, 4, 17, NULL, NULL, 'On Hold', NULL, NULL, NULL, '2020-05-01 10:12:51', '2020-05-01 10:12:51'),
(130, 4, 17, NULL, NULL, 'On Hold', 'Awaiting TPI', NULL, NULL, '2020-05-01 10:13:08', '2020-05-01 10:13:08'),
(131, 2028, 17, NULL, NULL, 'In Process', 'To: Evelin.Suazo@MolinaHealthCare.Com Sub: Status of the provider Hello,  Hope you are doing great,  I want to know about the current status of the provider  Following are the details:  Group Name: Best Health Urgent Care & Clinic   Provider NPI: 1780192633  Group Tax ID: 84-4737737   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-06-29 18:10:53', '2020-06-29 18:10:53'),
(132, 2028, 17, NULL, NULL, 'In Process', 'From: Evelin.Suazo@molinahealthcare.com Sub: Status of the provider  Good Morning Samuel,     The CRF was received and right now provider is on the first step of contracting with our credentialing department, please check status with me again within 30 days. Thank you   Evelin Suazo  Associate Specialist,Provider Contracts  Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com  5605 N. MacArthur Blvd, Suite 400 | Irving, Texas 75038  1888-562-5442 Ext. 207438  www.MolinaHealthcare.com  Your Extended Family        ', NULL, NULL, '2020-06-30 13:17:10', '2020-06-30 13:17:10'),
(133, 2028, 17, NULL, NULL, 'In Process', 'Contacted CSR : 18557436161 Agent explained the aperture and advise to click the link www.availitv.com for further  process and also provided number for any query (18557436161)', NULL, NULL, '2020-07-01 13:29:03', '2020-07-01 13:29:03'),
(134, 2028, 17, NULL, NULL, 'In Process', 'TO: (Cyriaque, Stephane) - (Molina Health) - (BHUCC) Sub: evelin.suazo@molinahealthcare.com Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-08 13:08:49', '2020-07-08 13:08:49'),
(135, 1005, 17, NULL, NULL, 'In Process', 'Application on Availity has been updated as well. Current status: In Process', NULL, NULL, '2020-07-08 14:55:35', '2020-07-08 14:55:35'),
(136, 2028, 17, NULL, NULL, 'In Process', 'From: outreachsupport@aperturecvo.com Sub: Fw: Best Health Urgent Care Clinic // Molina Healthcare of Texas (TAHP  Good Afternoon Mr. Peterson,     Thank you for your response.      The request that Aperture received for Best Health Urgent Care Clinic is for:  Best Health Urgent Care Clinic  3003 Texas Pkwy, Unit B  Missouri City, TX  77489  NPI 1013540960     If the NPI is incorrect on the TAHP Facility application that you sent, if you can update and re-send, that will be helpful.  We can then process.      The Availity application is showing an NPI number of 178019633 and our system is unable to download because the NPI doesn’t match Molina Healthcare of Texas request.     We also received your application for Stephanie Cyriaque but Aperture is not showing an open request for the provider for Molina Healthcare.      Regards,  Ann Bostock  Customer Service Representative', NULL, NULL, '2020-07-15 13:12:44', '2020-07-15 13:12:44');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(137, 2028, 17, NULL, NULL, 'In Process', 'To: outreachsupport@aperturecvo.com Sub: Fw: Best Health Urgent Care Clinic // Molina Healthcare of Texas (TAHP) Hello,   The NPI that you\'ve listed is incorrect, this is the correct NPI# 1013540962. I have also updated the group NPI on the TAHP form and the Availity application now has the group NPI listed on it as well. Please let me know if there\'s anything else that needs to be done. Otherwise, what\'s the expected time-frame for the request?  Thanks. ', NULL, NULL, '2020-07-15 13:15:09', '2020-07-15 13:15:09'),
(138, 2028, 17, NULL, NULL, 'In Process', 'From: outreachsupport@aperturecvo.com Sub: Fw: Best Health Urgent Care Clinic // Molina Healthcare of Texas (TAHP)  Good Afternoon,     Thank you for your response.      Application has been received and routed to file for processing.     Note made for correction in NPI.       Regards,  Ann Bostock  Customer Service Representative', NULL, NULL, '2020-07-20 10:02:58', '2020-07-20 10:02:58'),
(139, 2028, 17, NULL, NULL, 'In Process', 'TO: outreachsupport@aperturecvo.com Sub: Re: FW: Fw: Best Health Urgent Care Clinic // Molina Healthcare of Texas (TAHP)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-28 10:52:54', '2020-07-28 10:52:54'),
(140, 2028, 17, NULL, NULL, 'In Process', 'Name: Christina (Molina health) As per rep, she could not pull out the information of the provider through both NPI\'s  Ref: c00015412598', NULL, NULL, '2020-07-30 13:47:24', '2020-07-30 13:47:24'),
(141, 1006, 17, NULL, NULL, 'In Process', 'Aperture is still requesting the Malpractice for group, the one that we currently have does list the group itself on the 4th page but not on the declaration page itself. After speaking to CM&F Group they suggested that we should send an email over to info@cmfgroup.com and get this corrected. ', NULL, NULL, '2020-07-30 15:13:12', '2020-07-30 15:13:12'),
(142, 1006, 17, NULL, '2020-08-10 00:00:00.000', 'In Process', 'Submitted group malpractice which was received from CM&F group to Aperture via their online portal.', NULL, NULL, '2020-08-03 13:03:21', '2020-08-03 13:03:21'),
(143, 1006, 17, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Aperture update as they requested information AGAIN: \"FYI Received a call from Aperture - Molina. Rep requested General Liability sheet. Sent it over and she confirmed that she received it (on call) also said will complete your file by today. Regards, Ben\"', NULL, NULL, '2020-08-05 12:44:29', '2020-08-05 12:44:29'),
(144, 1006, 17, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Sent followup email to evelin.suazo@molinahealthcare.com ', NULL, NULL, '2020-08-13 13:00:20', '2020-08-13 13:00:20'),
(145, 1006, 17, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Sent a VM to ', NULL, NULL, '2020-08-17 14:37:50', '2020-08-17 14:37:50'),
(146, 2037, 17, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Credentialing Approval Letter received from Margaret.White@molinahealthcare.com ----------------------- August 18, 2020   Best Health Urgent Care & Clinic  3003 Texas Pkwy Unit B  Missouri City, TX 77489    Dear Best Health Urgent Care & Clinic:   Your credentialing file was reviewed by the Molina Healthcare of Texas Credentialing Committee on 8/14/2020.  After careful consideration of the information in your file, I am pleased to inform you that the Committee has approved your credentialing application in the primary specialty of Ambulatory Care, Urgent Care.   Upon execution of your contract with Molina, you will receive under separate cover, a letter informing you of your effective date as a contracted, participating network provider.  Until that time, Molina will reimburse you for services provided to Molina members at the out-of-network rate subject to Title I, Part 15, Chapter 353, Subchapter A, Rule  §353.4 of the Texas Administrative Code  (c) Reasonable reimbursement methodology.      For questions regarding the contracting process please contact Contract Coordination at: 855-322-4080 or email: TexasExpansionContracting@MolinaHealthCare.Com     For Molina’s authorization requirements please refer to the forms at the link below: https://www.molinahealthcare.com/providers/tx/medicaid/forms/pages/fuf.aspx     Thank you for your commitment to joining with Molina Healthcare in providing our members with the best quality health care possible.  We look forward to our continuing successful partnership.  Sincerely, Lawrence O’Brien, MD Medical Director Molina Healthcare of Texas ', NULL, NULL, '2020-08-19 13:30:39', '2020-08-19 13:30:39'),
(147, 1006, 17, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Sent follow-up email to TexasExpansionContracting TexasExpansionContracting@molinahealthcare.com> regarding contracting status.  ', NULL, NULL, '2020-08-25 17:32:34', '2020-08-25 17:32:34'),
(148, 1006, 17, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Received following update from TexasExpansionContracting TexasExpansionContracting@molinahealthcare.com>:  Sub: RE: Best Health Urgent Care & Clinic (TIN# 84-4737737) (163081)  \"Hello Brad,  Thank you for checking the status of contract.  Please see below comments.  Group Name: Best Health Urgent Care & Clinic - TIN# 84-4737737 - As of 08/26/2020, Molina\'s Loading Department queue; up to 30 days; in process.  Provider Name: Stephane Cyriaque NPI# 1780192633 - Please reach out to designated coordinator Suazo, Evelin Evelin.Suazo@MolinaHealthCare.Com for current status.\"', NULL, NULL, '2020-08-31 14:23:21', '2020-08-31 14:23:21'),
(149, 1006, 17, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Sent another followup email to Evelin.Suazo@MolinaHealthCare.Com ', NULL, NULL, '2020-08-31 14:25:11', '2020-08-31 14:25:11'),
(150, 2037, 17, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received the update from the Elivin Suazo that they are On the last step of contracting and the loading  department is processing it.', NULL, NULL, '2020-09-23 10:08:50', '2020-09-23 10:08:50'),
(151, 2037, 17, NULL, '2020-10-02 00:00:00.000', 'Approved', 'Received Urgent Care Contract for the practice effective 10/01/2020. Placed on the server and uploaded on EMRBS. As the facility is now contracted as and Urgent Care with molina so all the practicing providers will be considered in-network.', NULL, NULL, '2020-09-25 15:39:17', '2020-09-25 15:39:17'),
(152, 2037, 18, NULL, '2020-08-31 00:00:00.000', 'In Process', 'Requested to add all the other Lines of business as the group is enrolled in Ambetter only as of now. -------------- Hi Sherry,  You can use the link below to add additional products.  Add a Product to an Existing Contract  https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Product.html  Regards,        Barbara McDonald', NULL, NULL, '2020-08-20 12:16:23', '2020-08-20 12:16:23'),
(153, 2037, 18, NULL, '2020-10-20 00:00:00.000', 'In Process', 'As per live call the Request to add products has been received.Waiting for an email from them for the confirmation.', NULL, NULL, '2020-09-29 14:01:18', '2020-09-29 14:01:18'),
(154, 2037, 18, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Follow up email sent on AM.Houston@superiorhealthplan.com -------------- Hello Barbra,  If I may get an update on the plan addition process as the request was initiated on 08/29/2020 using the provided link but haven\'t received any confirmation or notification yet.  Waiting for your kind response.  Thank you! ', NULL, NULL, '2020-10-06 14:28:40', '2020-10-06 14:28:40'),
(155, 2037, 18, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Response received: -------------- Good Afternoon Sherry     I hope you are doing well. I received an email from them and they advised that the request was sent to leadership because they are capped for adding Medicare and Medicaid products. Once I receive a response back I will follow-up with you or they will notify you.     Have a great weekend! ', NULL, NULL, '2020-10-12 10:47:05', '2020-10-12 10:47:05'),
(156, 2037, 18, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Got another email: ------------------------------------------ Good Afternoon Sherry  I hope you are doing well. I received an email from them and they advised that the request was sent to leadership because they are capped for adding Medicare and Medicaid products. Once I receive a response back I will follow-up with you or they will notify you.   Have a great weekend!  ---------------------------------------- Hi Brittney,  Thank you so much for the update.  I\'ll be looking forward to hearing from you once you get any updated information on it.  Thank you!', NULL, NULL, '2020-10-13 09:24:41', '2020-10-13 09:24:41'),
(157, 2037, 18, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Follow up email sent to Brittney: ----------------------- Sherry Deen  10:34 AM (0 minutes ago) to SHPNetwork.DevelopmentNPRContracting, AM, PLLC  Hi Brittney,   I still haven\'t heard back from the leadership on my request. Just wanted to check if you did get any update.  Thank you!', NULL, NULL, '2020-10-28 10:38:49', '2020-10-28 10:38:49'),
(158, 2037, 18, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Got the following response from Brittney. --------------  AM Houston 11:35 AM (7 minutes ago) to me  Good Morning Sherry     I hope you are doing well. I was advised this morning that the contract for Medicare and Medicaid has been approved by leadership and someone from contracting should be in contact with you all soon. Please follow-up with SHP.NetworkDevelopment-Medicaid@superiorhealthplan.com if you do not here anything back by next week.  ', NULL, NULL, '2020-11-02 12:46:48', '2020-11-02 12:46:48'),
(159, 2037, 18, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Agreement received. Signed electronically and submitted back.', NULL, NULL, '2020-11-02 15:10:47', '2020-11-02 15:10:47'),
(160, 2037, 18, NULL, '2020-11-25 00:00:00.000', 'Approved', 'Executed contract received with Par Plan Details and effective date 12/01/2020. Contract uploaded in EMRBS', NULL, NULL, '2020-11-18 17:28:05', '2020-11-18 17:28:05'),
(161, 1006, 18, NULL, NULL, 'Revalidation', 'We received a contract amendment from Superior to add Wellcare - Medicare Advantage to our contract. The contract was signed and sent back to Semetra Brazle Semetra.Brazle@superiorhealthplan.com, attached for reference.  ', NULL, NULL, '2021-04-30 07:57:59', '2021-04-30 07:57:59'),
(162, 1005, 18, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria & Cyriaque, Stephane || Superior Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Tann, Shametria Provider NPI# 1124615612  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-09 16:46:56', '2021-06-09 16:46:56'),
(163, 11056, 18, NULL, '2021-07-05 00:00:00.000', 'Revalidated', 'Email sent to :  AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-06-28 12:50:12', '2021-06-28 12:50:12'),
(164, 11056, 18, NULL, '2021-07-20 00:00:00.000', 'Revalidated', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good afternoon Ahmed  Hope you had a restful weekend  Here is the information you requested for the following Providers under Best Health Urgent Care and Clinic  NPI#1013540962  TID#844737737 Provider Name : Cyriaque, Stephane---- Application completed with effective date of 6/1/2020 Provider NPI# : 1780192633  Veronica Botello Rocha  Provider Relations Coordinator II  Provider Relations Department  Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-07-12 15:52:44', '2021-07-12 15:52:44'),
(165, 11056, 18, NULL, '2021-08-02 00:00:00.000', 'Revalidated', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good afternoon  My apologies for the delay in response  Here is the information you requested for the following Provider Veronica Botello Rocha  Provider Relations Coordinator II  Provider Relations Department  Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-07-26 10:10:45', '2021-07-26 10:10:45'),
(166, 2028, 20, NULL, NULL, 'In Process', 'TO: lluvia_munguia@bcbstx.com SUB: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hello,  Hope you are doing great, I want to know about the Effective date of this Provider  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you  Hello,  Hope you are doing great, I want to know about the Effective date of this Provider  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-06 14:54:16', '2020-07-06 14:54:16'),
(167, 2028, 20, NULL, NULL, 'In Process', 'From: Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Good afternoon,     The effective date for the provider shows to be 06.19.2020.     Thank you,  Lluvia Munguia', NULL, NULL, '2020-07-07 17:41:14', '2020-07-07 17:41:14'),
(168, 2028, 20, NULL, NULL, 'In Process', 'voicemail left for call back', NULL, NULL, '2020-07-10 13:28:21', '2020-07-10 13:28:21'),
(169, 2028, 20, NULL, NULL, 'Approved', 'TO:Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hello, I would also like to know in which plans Stephane Cyriaque is enrolled. The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-13 10:11:26', '2020-07-13 10:11:26'),
(170, 1006, 20, NULL, NULL, 'In Process', 'Task re-opened to update address:   \"Hello Lluvia,   I hope you\'re doing well, I wanted to check in with you regarding the providers plans and also to update the current address for him.  Provider Name: Stephane Cyriaque NPI# 1780192633 TIN# 84-4737737 Correct Address: 3003 Texas Parkway, Unit# B, Missouri City, TX 77489  Please get back to me as soon as you\'re able.   Thanks. \"', NULL, NULL, '2020-07-14 13:12:07', '2020-07-14 13:12:07'),
(171, 1006, 20, NULL, NULL, 'In Process', 'Submitted online demographics update request as well:  \"Thank you for submitting the form.  Your case number:01610262  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.  Please close the tab using X (Close) Button.\"', NULL, NULL, '2020-07-14 14:03:22', '2020-07-14 14:03:22'),
(172, 2028, 20, NULL, NULL, 'In Process', 'From: Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Good afternoon,     I show an effective date of 06.19.2020.  Plans include HMO, PPO, Medicare HMO, and PPO.  We have address 3033 Texas Pkwy Unit B.  The below address is 3003 Texas Pkwy Unit B.  Please advise which is correct and I will change it.     Thank you,  Lluvia Munguia', NULL, NULL, '2020-07-15 10:26:38', '2020-07-15 10:26:38'),
(173, 2028, 20, NULL, NULL, 'In Process', 'To: RE Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hey Lluvia,   Thank you for the update, the correct address is 3003 Texas Pkwy Unit B.   Please let me know how long this request will take?  Thank you. ', NULL, NULL, '2020-07-15 10:28:58', '2020-07-15 10:28:58'),
(174, 2028, 20, NULL, NULL, 'In Process', 'TO: RE Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hello,  Hope you are doing well, I wanted to ask if this 3003 Texas Pkwy Unit B address is been updated for Cyriaque, Stephane   The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633    Please get back to me as soon as you\'re able.  Thank you  ', NULL, NULL, '2020-07-15 10:30:07', '2020-07-15 10:30:07'),
(175, 2028, 20, NULL, NULL, 'In Process', 'From: Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Good afternoon,     The request to update address has been sent.  Please allow time for the request to be completed. Time frame is unclear, but I would say maybe two weeks.', NULL, NULL, '2020-07-15 17:42:05', '2020-07-15 17:42:05'),
(176, 2028, 20, NULL, NULL, 'In Process', 'TO: Lluvia_Munguia@bcbstx.com Sub: Cyriaque, Stephane - Blue Cross Blue Shield - BHCC   Hello, Hope you\'re doing great, I would like to confirm that the address which has been updated for this provider is 3003 Texas Parkway, Unit# BMissouri City , TX 77489. We have received an email regarding confirmation of the address that it has been processed. The case number is 01610262, please confirm it has been updated for Billing, Practice and Financial?  Please get back to me as soon as you\'re able Thank you.', NULL, NULL, '2020-07-20 10:53:18', '2020-07-20 10:53:18'),
(177, 2028, 20, NULL, NULL, 'In Process', 'TO: Lluvia_Munguia@bcbstx.com Sub: (Reminder) Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hello, Hope you\'re doing great, I would like to confirm that the address which has been updated for this provider is 3003 Texas Parkway, Unit# B Missouri City, TX 77489. We have received an email regarding the confirmation of the address that it has been processed. The case number is 01610262, please confirm it has been updated for Billing, Practice, and Financial?  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able. Thank you.', NULL, NULL, '2020-07-22 10:56:35', '2020-07-22 10:56:35'),
(178, 2028, 20, NULL, NULL, 'In Process', 'From: Lluvia_Munguia@bcbstx.com Sub: RE: (Reminder) Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Good morning,     Yes the address looks like it has been update in our system.     Thank you, Lluvia Munguia', NULL, NULL, '2020-07-22 12:00:34', '2020-07-22 12:00:34'),
(179, 2028, 20, NULL, NULL, 'In Process', 'Rep: Sharon The address has been updated and we can contact for the roster and 50+ claims which are sent to wrong address to: Lluvia Munguia Email: Lluvia_Munguia@bcbstx.com Contact no. 7136237238  (Details are provided to billing head farhan bhai) Ref: Sharon', NULL, NULL, '2020-07-23 14:02:17', '2020-07-23 14:02:17'),
(180, 2028, 20, NULL, NULL, 'In Process', 'TO: Lluvia_Munguia@bcbstx.com Sub: (Reminder) Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hello,  Could you please send us a roster or a welcome letter for this provider and also respond to the calls from billing department as there trying to reach you.  Please get back to me as soon as you\'re able. Thank you.', NULL, NULL, '2020-07-24 10:27:13', '2020-07-24 10:27:13'),
(181, 2028, 20, NULL, NULL, 'In Process', 'TO: 	Lluvia_Munguia@bcbstx.com Sub: W9 - Form  Hello Lluvia.   As we discussed attached is the W-9 form for Best Health Urgent Care and Clinic, Tax ID- 84737737. Please expedite our request to update our Billing address.', NULL, NULL, '2020-07-27 16:18:44', '2020-07-27 16:18:44'),
(182, 1006, 20, NULL, NULL, 'In Process', 'The request is still pending, waiting on Lluvia to update billing address via the submitted W9.   Rep: Jana 07/30/2020', NULL, NULL, '2020-07-30 14:08:29', '2020-07-30 14:08:29'),
(183, 1006, 20, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Received email from Lluvia regarding Billing Address update:   \"From: Lluvia Munguia Lluvia_Munguia@bcbstx.com> Date: Mon, Aug 3, 2020 at 2:26 PM Subject: RE: W9 - Form To: Alex Garrett mu@claimsmedinc.com>  Hello. Good morning, I was just looking that up.  It has been updated.   Thank you, Lluvia Munguia\"', NULL, NULL, '2020-08-10 15:58:20', '2020-08-10 15:58:20'),
(184, 1006, 20, NULL, '2020-08-17 00:00:00.000', 'Approved', NULL, NULL, NULL, '2020-08-10 15:58:41', '2020-08-10 15:58:41'),
(185, 1006, 21, NULL, NULL, 'In Process', 'Contract was received (Shuntell Widow Has Sent You HOU_NP-Spec_Ind_Agmt_Stephane Cyriaque, NP to Sign), signed and sent back to Shuntell Widow. ', NULL, NULL, '2020-06-17 17:09:57', '2020-06-17 17:09:57'),
(186, 2028, 21, NULL, NULL, 'In Process', 'Outgoing call REP: Mark Contract was sent to us on  June-17-2020 for signature purpose and was also sent back on the same date will take 30 days from the date 06-17-2020 can contact us after that through Monday to Friday  Expected date is  06-29-2020 Reference ID:  5385744596', NULL, NULL, '2020-07-07 17:19:37', '2020-07-07 17:19:37'),
(187, 2028, 21, NULL, NULL, 'In Process', 'To: Machado-PetryS@aetna.com Sub: Cyriaque, Stephane - Aetna - Bhucc  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-14 17:28:11', '2020-07-14 17:28:11'),
(188, 2028, 21, NULL, NULL, 'In Process', 'From: Machado-PetryS@aetna.com Sub: SEND SECURE AETNA GENERAL BUSINESS Samuel,  Elizabeth Davis manages all Urgent care contracts, has she not reached out to you?  I have emailed her again to get status, thank you.', NULL, NULL, '2020-07-15 15:22:23', '2020-07-15 15:22:23'),
(189, 2028, 21, NULL, NULL, 'In Process', 'Rep: Joan will take 45 days from the date 06-17-2020 for effective date can contact Monday to Friday ref: 5408250793', NULL, NULL, '2020-07-17 11:53:25', '2020-07-17 11:53:25'),
(190, 2028, 21, NULL, NULL, 'In Process', 'Rep: art  Asp per rep the enrollment need sometime, provided the ticket number which is naf35144 Ref: 2541591', NULL, NULL, '2020-07-20 10:25:39', '2020-07-20 10:25:39'),
(191, 2028, 21, NULL, NULL, 'In Process', 'sheldon will take some time ticket no. naf353523 ref:5431889086', NULL, NULL, '2020-07-28 10:33:34', '2020-07-28 10:33:34'),
(192, 1006, 21, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent followup email to davise11@aetna.com', NULL, NULL, '2020-08-06 17:59:47', '2020-08-06 17:59:47'),
(193, 1006, 21, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Provider is in-network and linked to the group.  Eff: 04/24/2020 Requested rep to send us a welcome letter or copy of executed contract. Ref# 5463161292', NULL, NULL, '2020-08-10 14:37:18', '2020-08-10 14:37:18'),
(194, 1006, 21, NULL, '2020-08-21 00:00:00.000', 'In Process', 'We should be receiving a welcome letter soon, August 25 as per the rep. I\'ve notified the demographic department regarding the incorrect address and it\'s being worked on currently, sent fax to (859) 455-8650 with LOI to correct the address. ', NULL, NULL, '2020-08-14 15:20:12', '2020-08-14 15:20:12'),
(195, 2037, 21, NULL, '2020-09-16 00:00:00.000', 'Approved', 'As per live call to Aetna , Stephane is successfully linked to BHUCC TIN. Ref# 5531862513. Snapshot from provider directory attached and placed on the server.', NULL, NULL, '2020-09-09 13:04:21', '2020-09-09 13:04:21'),
(196, 2028, 22, NULL, NULL, 'Approved', 'From: bhucc@claimsmedinc.com Sub: Secure Message from KERRY.HOWARD@uhc.com  Hello,     This email is to notify you that the contract for BEST HEALTH URGENT CARE & CLINIC TIN 844737737  has been executed with an effective date of 7-10-2020 .  Please allow time for a copy of the executed contract to be mailed or you may retrieve a copy by visiting docusign.com.      Thank You,     It was a pleasure helping you today.  If you have feedback on my services today, please contact my Manager, Cynthia Curtner  via email at cynthia_curtner@uhc.com.  Please include on the subject line:  Feedback Re: Kerry Howard     Kerry D. Howard      Kerry D. Howard  Network Contractor  Network Management Resource Team (NMRT)  Email: KERRY.HOWARD@UHC.COM', NULL, NULL, '2020-07-01 10:39:15', '2020-07-01 10:39:15'),
(197, 2028, 22, NULL, NULL, 'Approved', 'To: KERRY.HOWARD@uhc.com Sub: Secure Message from KERRY.HOWARD@uhc.com   Hello,  Hope you\'re doing well. I would like you to send me a Plan roster for this provider.  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-01 10:52:14', '2020-07-01 10:52:14'),
(198, 2028, 22, NULL, NULL, 'In Process', 'Rep: Brittney Told her to back date the effective date she said that we cannot do anything but she can provide a number through which you can discuss your matter  (Patricia voles 7632833194) Left a voicemail for call back ', NULL, NULL, '2020-07-14 10:47:47', '2020-07-14 10:47:47'),
(199, 2028, 22, NULL, NULL, 'In Process', 'Rep: Latresha Coles (7632833194) Cannot back date the Effective date. Ref: Latresha Coles', NULL, NULL, '2020-07-15 09:34:38', '2020-07-15 09:34:38'),
(200, 2028, 22, NULL, NULL, 'In Process', 'rep: janice Asked for plan rooster email provided. ref: 1732728', NULL, NULL, '2020-07-15 10:04:31', '2020-07-15 10:04:31'),
(201, 2028, 22, NULL, NULL, 'In Process', 'Rep: Andrew Asked for plan rooster Rep emailed it on call. Email Provided (bhucc@claimsmedinc.com) Ref: 01738209', NULL, NULL, '2020-07-17 12:53:37', '2020-07-17 12:53:37'),
(202, 2028, 22, NULL, NULL, 'Approved', 'Plan rooster received also attached', NULL, NULL, '2020-07-17 13:18:47', '2020-07-17 13:18:47'),
(203, 2028, 22, NULL, NULL, 'Approved', 'correct address is been updated', NULL, NULL, '2020-07-17 13:23:46', '2020-07-17 13:23:46'),
(204, 4, 23, NULL, NULL, 'On Hold', 'Panels are Currently Closed', NULL, NULL, '2020-05-01 09:42:03', '2020-05-01 09:42:03'),
(205, 1006, 23, NULL, NULL, 'In Process', 'Received contract from Cigna, signed and sent back to them. Attached. ', NULL, NULL, '2020-06-29 14:59:22', '2020-06-29 14:59:22'),
(206, 2028, 23, NULL, NULL, 'In Process', 'From: PSU Inquiry (Non-Claim) <9PSSCENT@Cigna.com> TO: sharon@claimsmedinc.com  Thank you for contacting Cigna.    We apologize for our delayed response. Our email volumes are higher than normal impacting our response times. We appreciate your patience.   Your application is currently in process and was started on 05262020. The credentialing/contracting process takes up to 90 business days. If you have any additional questions, please contact the Provider Services Unit at 800.882.4462.      Provider Name: STEPHANIE CYRIAQUE  Tax ID: 844737737  Application Number: 12109895', NULL, NULL, '2020-07-08 12:37:35', '2020-07-08 12:37:35'),
(207, 2028, 23, NULL, NULL, 'In Process', 'Rep: Brendan Request is still in process for Stephane, nothing is required. Contract was received on 06/29/2020, the turnaround time is 90 days. Ref# Brendan 07/15/2020', NULL, NULL, '2020-07-15 14:31:14', '2020-07-15 14:31:14'),
(208, 2028, 23, NULL, NULL, 'On Hold', 'From: Dotson-Trice, Felicia 790 Sub: BID 12109895 STEPHANE CYRIAQUE   We have received the Cigna credentialing application for the above referenced provider.  At this time we are not adding midlevel providers to our network in your area without approval from the local Cigna contracting team.     The request submitted has been forwarded to contracting for review and you should receive notification once a decision has been made.     If you have any questions, please call Cigna Customer Service at 1.800.88Cigna (882-4462).        Thank you for your interest in Cigna. ', NULL, NULL, '2020-07-16 09:31:50', '2020-07-16 09:31:50'),
(209, 1006, 23, NULL, '2020-08-24 00:00:00.000', 'In Process', 'As per my discussion with Cigna, we should try and bill under the supervising physician (Segun Adeoye). Sent the following email to intake_pdm@cigna.com:   \"Hello,   We wish to link the following provider to the below mentioned group as an in-network/PAR provider, I\'ve also attached a W-9. Information is as follows:   Provider Name: Segun Adeoye NPI# 1629418025 Group Name: Best Health Urgent Care & Clinic TIN# 84-4737737 Servicing/Billing Address: 3003 Texas Parkway, Unit# B, Missouri City , TX 77489  Please get this request completed as soon as you can. Do let me know if there\'s anything else required to get this expedited.  Thank you. \"', NULL, NULL, '2020-08-17 17:29:14', '2020-08-17 17:29:14'),
(210, 1006, 23, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Received an email from Cigna asking what the effective date should be for Dr. Segun Adeoye @ BHUCC. Informed them that the effective date will be 05/01/2020 so that we don\'t miss any claims. ', NULL, NULL, '2020-08-25 17:47:12', '2020-08-25 17:47:12'),
(211, 1006, 23, NULL, '2020-09-07 00:00:00.000', 'Approved', 'Received following email from Cigna, notifying us that Segun has been added to BHUCC:  \"Dear Health Care Professional,  \"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  Name: Segun Adeoye PID: 5883559 Effective date: 05/01/2020  Sincerely, Data Management\"', NULL, NULL, '2020-08-31 13:47:55', '2020-08-31 13:47:55'),
(212, 3040, 23, NULL, NULL, 'Revalidation', 'Called Cigna and enrollment requested initiated through representative.   Application: 12549064 Provider ID: 9511500 ', NULL, NULL, '2021-04-05 13:32:01', '2021-04-05 13:32:01'),
(213, 1005, 23, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'intake_pdm@cigna.com Credentialing Status Request (Application# 12109895)  Good afternoon,   Can you Please let me know the current status of Credentialing. I have mentioned below the details. Practice Name :  Best Health Urgent Care & Clinic Tax ID : 84-4737737 Provider Name : Stephane Cyriaque Provider NPI: 1780192633   Do let me know if you need any information.   Thank You! ', NULL, NULL, '2021-06-09 16:46:35', '2021-06-09 16:46:35'),
(214, 11056, 23, NULL, '2021-07-05 00:00:00.000', 'Revalidation', 'Email sent to :  intake_pdm@cigna.com   Sub : Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Good morning!  Hope you are doing well. Could you Please let me know the current status of Credentialing.I have mentioned the details below.  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Provider : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information.   Thank You!', NULL, NULL, '2021-06-28 12:12:51', '2021-06-28 12:12:51'),
(215, 11056, 23, NULL, '2021-07-05 00:00:00.000', 'Revalidated', 'Email sent to :  intake_pdm@cigna.com   Sub : Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Good morning!  Hope you are doing well. Could you Please let me know the current status of Credentialing.I have mentioned the details below.  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Provider : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information.   Thank You!', NULL, NULL, '2021-06-28 12:13:36', '2021-06-28 12:13:36'),
(216, 11056, 23, NULL, '2021-07-26 00:00:00.000', 'Revalidated', 'Email sent to  : intake_pdm@cigna.com  Sub :  Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Good evening!  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Providers : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information. Waiting to hear from you soon.   Thank You!', NULL, NULL, '2021-07-19 12:56:27', '2021-07-19 12:56:27'),
(217, 11056, 23, NULL, '2021-08-04 00:00:00.000', 'Revalidated', 'Email received from : 	PDMCOGZ@cigna.com  Sub  : FW: [External] Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Hi Team,     Kindly handle this request.  Work id - W202107121793247  NPI-1780192633  NPI-1124615612     \"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.\"', NULL, NULL, '2021-07-28 11:42:29', '2021-07-28 11:42:29'),
(218, 2028, 24, NULL, NULL, 'In Process', 'Rep: Marty M  Was trying to pull out the provider information through type 1, type 2 NPIs and also through the Tin but could not find any details of the provider.  agent requested to wait so that she could forward the information and will get back to us as soon as there able. Call back number provided Ref: 07-08-2020', NULL, NULL, '2020-07-08 17:08:47', '2020-07-08 17:08:47'),
(219, 2028, 24, NULL, NULL, 'In Process', 'Rep: Marty M spoke with her once again she is saying you will receive a call shortly Ref 7-10-2020', NULL, NULL, '2020-07-10 13:58:38', '2020-07-10 13:58:38'),
(220, 2028, 24, NULL, NULL, 'In Process', 'TO: ljramir1@texaschildrens.org SUB: Cyriaque, Stephane - Texas Children Health Plan - TCHP - BHUCC  Hello,  Hope you\'re doing great, attached are the W-9, Provider Information and LOI for  Cyriaque, Stephane.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-10 14:55:36', '2020-07-10 14:55:36'),
(221, 2028, 24, NULL, NULL, 'In Process', 'From: ljramir1@texaschildrens.org TO: Cyriaque, Stephane - Texas Children Health Plan - TCHP - BHUCC  I am confused, why did you send both PIF and LOI? If the provider’s group affiliation is in network with Texas Children’s Health Plan, it’s a PIF. If the provider’s group affiliation is not in our network it’s an LOI. Which would you like to submit?  - Cyriaque, Stephane', NULL, NULL, '2020-07-13 11:11:37', '2020-07-13 11:11:37'),
(222, 2028, 24, NULL, NULL, 'In Process', 'To: ljramir1@texaschildrens.org Sub: Cyriaque, Stephane - Texas Children Health Plan - TCHP - BHUCC Hello,  We are unaware of the affiliation for this provider because our application has been in process since April 2020, if the group is affiliated then please accept the PIF, if not then the LOI should suffice and as previously stated the request has been in-process as of April with no updates we need to get this expedited ASAP.   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-13 11:18:22', '2020-07-13 11:18:22'),
(223, 2028, 24, NULL, NULL, 'In Process', 'From: ljramir1@texaschildrens.org Sub: Cyriaque, Stephane - Texas Children Health Plan - TCHP - BHUCC  I will submit your LOI, communication will be sent out to you once the review is complete. Thank you', NULL, NULL, '2020-07-13 13:08:58', '2020-07-13 13:08:58'),
(224, 2028, 24, NULL, NULL, 'In Process', 'TO: ljramir1@texaschildrens.org Sub: Cyriaque, Stephane - Texas Children Health Plan - TCHP - BHUCC  Hello,  Hope you are doing great, I want to know about the current status of the Provider. The details are as follows:  Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-21 15:14:08', '2020-07-21 15:14:08'),
(225, 2028, 24, NULL, NULL, 'In Process', 'TO: ljramir1@texaschildrens.org Sub: (Reminder) - Cyriaque, Stephane - Texas Children Health Plan TCHP - BHUCC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able. Thank you  ', NULL, NULL, '2020-07-22 10:45:15', '2020-07-22 10:45:15'),
(226, 2028, 24, NULL, NULL, 'In Process', 'From: ljramir1@texaschildrens.org Sub: (Reminder) - Cyriaque, Stephane - Texas Children Health Plan TCHP - BHUCC  Provider is pending,   thank you', NULL, NULL, '2020-07-22 11:55:26', '2020-07-22 11:55:26'),
(227, 2028, 24, NULL, NULL, 'In Process', 'TO: ljramir1@texaschildrens.org Sub: Re: (Reminder) - Cyriaque, Stephane - Texas Children Health Plan TCHP - BHUCC  Hello,  Is there any time frame?  Please get back to me as soon as you\'re able. Thank you.', NULL, NULL, '2020-07-22 11:56:54', '2020-07-22 11:56:54'),
(228, 2028, 24, NULL, NULL, 'In Process', 'From: ljramir1@texaschildrens.org Sub: RE: (Reminder) - Cyriaque, Stephane - Texas Children  No time frame  ', NULL, NULL, '2020-07-22 11:58:02', '2020-07-22 11:58:02'),
(229, 2028, 24, NULL, NULL, 'In Process', 'TO: ljramir1@texaschildrens.org Sub: (Reminder) - Cyriaque, Stephane - Texas Children Health Plan TCHP - BHUCC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please get back to me as soon as you\'re able. Thank you ', NULL, NULL, '2020-07-30 13:13:44', '2020-07-30 13:13:44'),
(230, 1006, 24, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Sent followup email to ljramir1@texaschildrens.org', NULL, NULL, '2020-08-10 14:46:00', '2020-08-10 14:46:00'),
(231, 1006, 24, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Sent followup email to ljramir1@texaschildrens.org ', NULL, NULL, '2020-08-19 18:05:56', '2020-08-19 18:05:56'),
(232, 1006, 24, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Received following update from Liz:   \"This letter of Interest is pending. Thank you for your patience.\"  Asked TCHP is there is any way to see patients currently that we are getting due to the COVID pandemic @ \"Ramirez, Liz J.\" ljramir1@texaschildrens.org> ', NULL, NULL, '2020-08-20 15:27:27', '2020-08-20 15:27:27'),
(233, 1006, 24, NULL, '2020-09-04 00:00:00.000', 'In Process', 'Sent a followup email to \"Ramirez, Liz J.\" ljramir1@texaschildrens.org> ', NULL, NULL, '2020-08-28 12:40:47', '2020-08-28 12:40:47'),
(234, 2037, 24, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received rejection for missing supervising provider.Updated LOI resent with W9 Form @ ljramir1@texaschildrens.org.Below is the reference email: ------------------- Good Morning Liz, Thank you so much for your kind response. I have listed the supervising physician MD in TCHP network in the attached LOI as instructed. It is a humble request if you could kindly consider it as a missing information and re-continue the process as the application for enrollment was submitted back in June and we are having a large number of patients with Texas Children Health Plan as their primary payer and we regrettably are unable to accept them up until now.It would be so kind of you to help us with this regard or if you could probably advise on how to proceed with the intention to resume the application process. Assumingly resubmitting the LOI @ TCHPNetworkManagemen@texaschildrens.org will take the process to the initial stages. Your kind response will be of great help.', NULL, NULL, '2020-09-29 10:19:45', '2020-09-29 10:19:45'),
(235, 2037, 24, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Follow up email sent .', NULL, NULL, '2020-10-06 14:29:21', '2020-10-06 14:29:21'),
(236, 2037, 24, NULL, '2020-10-28 00:00:00.000', 'In Process', 'As per Marty she will send in a request to Liz.Ramirez to get in touch with me and possibly see if she would be able to resume the application as we  have provided her with Segun\'s information as the In-Network supervising doctor for Stephane. Reference#Marty.M10/20/2020.Waiting on the call back from Liz', NULL, NULL, '2020-10-20 10:54:16', '2020-10-20 10:54:16'),
(237, 2037, 24, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Follow up email sent to LIZ: ------------------ Sherry Deen 10:39 AM (0 minutes ago) to Liz, PLLC  Good Morning Liz,  I did request Marty to get in touch with you regarding the above application for Stephane Cyriaque. If you could help me get it resumed. May I please get the current status of it?  Thank you!', NULL, NULL, '2020-10-28 10:43:41', '2020-10-28 10:43:41'),
(238, 2037, 24, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Follow up email sent to tchpnetworkmanagement@texaschildrens.org ---------------------------------', NULL, NULL, '2020-11-10 10:45:47', '2020-11-10 10:45:47'),
(239, 2037, 24, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follow up email sent to liz ', NULL, NULL, '2020-11-18 15:51:34', '2020-11-18 15:51:34'),
(240, 2037, 24, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Response received from Liz ------------------------------- Ramirez, Liz J. Thu, Nov 19, 10:23 AM (1 day ago) to me  Thank you for your interest in our health plan’s network. Your LOI resubmission  has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-11-20 15:00:28', '2020-11-20 15:00:28'),
(241, 1006, 24, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Follow-up sent @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2020-12-02 17:56:28', '2020-12-02 17:56:28'),
(242, 2037, 24, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Response received. Need to allow more time. ------------------  TCHP CA Contract Admin Thu, Dec 3, 9:19 AM (8 days ago) to Brad, me, PLLC  We are unable to provide a timeframe at this time, communication will be sent out once the review is complete. Thank you for your patience.', NULL, NULL, '2020-12-11 12:25:09', '2020-12-11 12:25:09'),
(243, 1006, 24, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Received following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Thank you for your interest in our health plan’s network. Your resubmission of the LOI has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan\"  ', NULL, NULL, '2021-01-04 17:56:39', '2021-01-04 17:56:39'),
(244, 1006, 24, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2021-01-19 11:29:20', '2021-01-19 11:29:20'),
(245, 1006, 24, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Received following response:  \"The LOI for Stephane Cyriaque is in process. Thank you for your patience\"', NULL, NULL, '2021-01-19 13:50:40', '2021-01-19 13:50:40'),
(246, 1006, 24, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2021-02-02 17:03:41', '2021-02-02 17:03:41'),
(247, 1006, 24, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Received the following response from TCHP: \"We appreciate your patience. The LOI for this provider is in process.\"', NULL, NULL, '2021-02-03 10:08:14', '2021-02-03 10:08:14'),
(248, 1006, 24, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent another f/u @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2021-02-12 15:12:41', '2021-02-12 15:12:41'),
(249, 1006, 24, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received following update from TCHP: \"The LOI for this provider is in process. Thank you\"  Requested them to expedite the process.', NULL, NULL, '2021-02-15 10:57:00', '2021-02-15 10:57:00'),
(250, 3046, 24, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org Subject: LOi Status || Best Health Urgent Care & Clinic  ||  Texas Children Health Plan || Greetings Kindly update me what is the LOi status of the below mentioned provider. Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633 Thank you', NULL, NULL, '2021-02-25 13:31:45', '2021-02-25 13:31:45'),
(251, 1006, 24, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following response from Fouts, Melissa (Melissa) mdfouts@texaschildrens.org:  \"Thank you.  I’ve uploaded the Confidentiality Agreement to Docusign. It will first go to TCHP mgmt. for their review and signature, then come to Stephane for review/signature.   Melissa\"', NULL, NULL, '2021-02-25 17:24:34', '2021-02-25 17:24:34'),
(252, 3046, 24, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Contract has been signed and updated for Stephane Cyriaque sent and sent back.', NULL, NULL, '2021-02-26 16:53:04', '2021-02-26 16:53:04'),
(253, 3046, 24, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Contract signed has been received and attached.', NULL, NULL, '2021-03-02 09:37:07', '2021-03-02 09:37:07'),
(254, 3046, 24, NULL, '2021-03-16 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org Subject: LOI Status || Best Health Urgent Care & Clinic || Texas Children Health Plan ||  Greetings I would like to inform you that we have received the executed contract. Please advise the status of LOI for the below mentioned provider. Group Name: Best Health Urgent Care & Clinic  Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633 Thank you. ', NULL, NULL, '2021-03-09 12:52:48', '2021-03-09 12:52:48'),
(255, 3046, 24, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org Subject: LOI Status || Best Health Urgent Care & Clinic || Texas Children Health Plan ||  Hello, Hope you are doing well. I would kindly like to ask the status of LOI for below mentioned provider Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Thank you. ', NULL, NULL, '2021-03-18 13:35:20', '2021-03-18 13:35:20'),
(256, 3040, 24, NULL, '2021-04-12 00:00:00.000', 'In Process', 'I had a word with (Marty M) TCHP representative and she said the provider is non-participating. Provider is loaded in the system because claim is receiving.   Contracting department will call regarding the enrollment status.   Ref: Marty M 04/05/2021 ', NULL, NULL, '2021-04-05 11:03:15', '2021-04-05 11:03:15'),
(257, 1006, 24, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Received the following email from Ruiz, Natalia E. neruiz@texaschildrens.org:  Sub: TCHP-Best Health Urgent Care & Clinic Contract  \"Good Morning Stephane,  I am reaching out regarding the next steps on the contract for Best Health Urgent Care & Clinic. I have received a Provider Information Form (PIF) to add a provider to the TCHP network.  In order to add this provider to the network, we will also need to do a contract amendment.  Can you please provide me with the following information.   •       A list of all the providers that need to be included in the contract (including physician extenders). Please include their name and NPI number. Please keep in mind we can only add providers who are attested to the group and the service address with TMPH. I have provided a screen shot of the current list of providers from the original contract agreement.  Thank you, Natalia Ruiz  cid:image001.png@01D5D884.722F68D0  Natalia Ruiz, MHA Contracting Administrator 6330 West Loop South Bellaire, Texas 77401 neruiz@texaschildrens.org\"  Informed her that we didn\'t receive a screenshot and that she should re-send the email. ', NULL, NULL, '2021-04-16 11:50:43', '2021-04-16 11:50:43'),
(258, 1006, 24, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Currently, TCHP enrollment is on hold because we need to have a supervising physician enrolled to proceed, sent f/u email to Stephane regarding this:  \"Hello Stephane,  I hope you\'re doing well, I just wanted to check in with you if you had any luck getting in touch with Dr. Segun regarding what we discussed in regards to enrollment with TCHP? As he will also need to be enrolled with TCHP under BHUCC.   Thank you. \"', NULL, NULL, '2021-06-07 15:05:36', '2021-06-07 15:05:36'),
(259, 11056, 24, NULL, '2021-07-22 00:00:00.000', 'On Hold', 'Confirmation received from the Provider. Now initiating his Medicare and after the Medicare we will work soon on this too!', NULL, NULL, '2021-07-14 16:07:19', '2021-07-14 16:07:19');
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
(260, 11056, 24, NULL, '2021-09-17 00:00:00.000', 'On Hold', 'Email received from : neruiz@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Thank you for the clarification Brad.     Looking into the physicians credentials more in-depth, we show she is no longer attested with the group through TCHP and is showing as excluded. We need both the Supervising Physician and NP attested to the group (Best Health Urgent Care & Clinic )under TCHP.     Please follow up with the health plan to get this information updated. Once updated, please submit a new Letter of Interest for both physicians. We are unable to move the process forward under the current request as is.     To update: call TMHP 800-925-9126 opt 3 or go online https://www.tmhp.com/  Waiting for the response of Mr. Segun. To be the Supervising physician for the group in this plan.', NULL, NULL, '2021-09-10 12:00:28', '2021-09-10 12:00:28'),
(261, 11056, 24, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Email sent to : TCHPnetworkmanagement@texaschildren.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning!  Hope all is well. We want to enroll the providers and practice with the Texas Children Health Plan. We do have the Supervising Physician now for the group. Please assist us as soon as possible   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Adeoye, Segun          Supervising Physician Provider NPI# : 1629418025  Provider Name : Tann, Shametria         FNP Provider NPI# : 1124615612  Provider Name : Cyriaque, Stephane    FNP Provider NPI# : 1780192633   If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a Blessed Day!', NULL, NULL, '2021-09-14 10:05:27', '2021-09-14 10:05:27'),
(262, 11056, 24, NULL, '2021-10-04 00:00:00.000', 'Approved', 'Email sent to : 	TCHPnetworkmanagement@texaschildren.org Join TCHP jointchp@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract   Good morning!  Hope you had a great and safe weekend. I am still waiting to get assistance on enrolling the below mentioned providers and practice with TCHP. But no one haven\'t responded to my query yet.   Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242 Provider Name	NPI Stephane Cyriaque (FNP)	1780192633 Shametria Tann  (FNP)	1124615612 Segun Adeoye (Supervising Physician)	1629418025  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 10:02:13', '2021-09-27 10:02:13'),
(263, 11056, 24, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Hello Ahmed,  The contract has been executed with an effective date of 12/01/2021. However, only Stephane Cyriaque has completed credentialing. Dr. Tann and Adeoye are still in credentialing and do not have an effective date yet.  The only provider who is effective with the 12/1/21 date is Stephanie Cyriaque.   The contract agreement is effective 12/1/21 for the group  See attached, but you will also receive a welcome packet with more information.  ', NULL, NULL, '2021-11-16 15:33:51', '2021-11-16 15:33:51'),
(264, 4, 26, NULL, NULL, 'On Hold', 'Waiting for Aetna to be Enrolled', NULL, NULL, '2020-05-01 09:43:30', '2020-05-01 09:43:30'),
(265, 2028, 26, NULL, NULL, 'Initiated', 'To: enterprise.credentialing@memorialhermann.org Sub: Cyriaque, Stephane - Memorial Hermann - Bhucc  Hello,  I would like to enroll Stephane Cyriaque with Memorial Hermann, attached is the Participation Form.  Regards, Samuel Sharon', NULL, NULL, '2020-07-14 16:17:00', '2020-07-14 16:17:00'),
(266, 2028, 26, NULL, NULL, 'In Process', 'From: Enterprise.Credentialing@memorialhermann.org Sub: Cyriaque, Stephane - Memorial Hermann - Bhucc  Hello,     Please provide Stephanie Cyriaque’s personal email address and name of sponsoring physician. We noticed that you also filled out the portion “FOR ALL ANCILLARY SERVICES AND FACILITIES (HEALTH PLAN ONLY)”. Kindly confirm if you also wish to be credentialed as a facility aside from an individual practitioner.  Thank you!', NULL, NULL, '2020-07-14 16:19:17', '2020-07-14 16:19:17'),
(267, 2028, 26, NULL, NULL, 'In Process', 'To: RE Enterprise.Credentialing@memorialhermann.org Sub: Cyriaque, Stephane - Memorial Hermann - Bhucc  Hello,  Hope you\'re doing well, Stephane Cyriaque\'s personal email address is fanfan0503@hotmail.com and the sponsoring physician will be Segun Adeoye and yes we want to be credentialed as a facility aside from an individual practitioner.  Regards, Samuel Sharon', NULL, NULL, '2020-07-14 16:21:49', '2020-07-14 16:21:49'),
(268, 2028, 26, NULL, NULL, 'In Process', 'From: MHHPContracting@memorialhermann.org Sub: Memorial Hermann Health Plan Request to Participate  We are in receipt of Best Health Urgent Care & Clinic’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.     Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee    Your participation request will be presented at the next NAAC meeting following receipt of the additional information.     Best Regards,  MHHP Network Contracting', NULL, NULL, '2020-07-22 16:41:55', '2020-07-22 16:41:55'),
(269, 2028, 26, NULL, NULL, 'In Process', 'TO: MHHPContracting@memorialhermann.org From: Re: Memorial Hermann Health Plan Request to Participate  Hello,  Following are the additional information which is required:  List of services provided. (Walk-in Urgent Care Clinic) Do you provide Virtual Health Services?  (Yes)  Current service area and/or list of locations. (3003 Texas Parkway, Unit# B, Missouri City, TX 77489)  List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) (Cyriaque, Stephane, NPI no. 1780192633) What age-population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years. (0-18+) Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. (Through supervising physician at Kingwood Medical Center) Link to website (N/A) Current W-9  (Attached is the W9) Current quality and outcomes data. (Could you please elaborate on this?)  Any additional information you would like presented to the Network Access and Adequacy Committee. (N/A) ', NULL, NULL, '2020-07-22 16:47:07', '2020-07-22 16:47:07'),
(270, 2028, 26, NULL, NULL, 'In Process', 'TO: MHHPContracting@memorialhermann.org Sub: Memorial Hermann Health Plan Request to Participate  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Stephane  Cyriaque  TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-30 13:09:28', '2020-07-30 13:09:28'),
(271, 1006, 26, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Received reply from MHHP Contracting MHHPContracting@memorialhermann.org>:   \"Good afternoon. The Urgent Care will be presented to our committee this month. Will the Provider, Stephane Cyriaque, be providing other services outside of the Urgent Care? Please advise.  Thank you.  Camilla\"  Informed that BHUCC will only be doing Urgencare services. ', NULL, NULL, '2020-08-06 17:19:41', '2020-08-06 17:19:41'),
(272, 1006, 26, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Sent followup email to MHHP Contracting MHHPContracting@memorialhermann.org>', NULL, NULL, '2020-08-19 18:07:42', '2020-08-19 18:07:42'),
(273, 1006, 26, NULL, '2020-09-01 00:00:00.000', 'Initiated', 'Sent another followup email to MHHP Contracting MHHPContracting@memorialhermann.org> as committee meeting was supposed to be held on 08/21/2020. ', NULL, NULL, '2020-08-25 17:50:35', '2020-08-25 17:50:35'),
(274, 1006, 26, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Received following response from MHHP Contracting MHHPContracting@memorialhermann.org>:  \"Good afternoon. You were approved by our committee on Friday. I should have an agreement out to you by the end of next week.\"', NULL, NULL, '2020-08-31 14:42:14', '2020-08-31 14:42:14'),
(275, 2037, 26, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Contract Received!!!! Signed and submitted back via email @ MHHPContracting@memorialhermann.org .Below is the reference: ------------------------ Greetings,  Kindly find the attached Signed Provider Agreement for further processing.Please do not hesitate to contact me for any additional information.  Regards:Sherry Deen | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 | sd@claimsmedinc.com  ', NULL, NULL, '2020-09-14 17:12:28', '2020-09-14 17:12:28'),
(276, 2037, 26, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Follow up email sent : ------------- Greetings,  If we may get an update on the current status of the provider with details mentioned below: Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                  : 1780192633', NULL, NULL, '2020-10-06 14:38:15', '2020-10-06 14:38:15'),
(277, 2037, 26, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-20 17:21:46', '2020-10-20 17:21:46'),
(278, 2037, 26, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Application completed over E-Credentialing provider portal MHHP', NULL, NULL, '2020-10-27 14:04:49', '2020-10-27 14:04:49'),
(279, 2037, 26, NULL, '2020-11-29 00:00:00.000', 'In Process', 'Application is currently being reviewed', NULL, NULL, '2020-11-03 11:11:51', '2020-11-03 11:11:51'),
(280, 2037, 26, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent to MHHSICredentialing.Department@memorialhermann.org  Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Greetings,  If we may get an update on the current status of the provider with details mentioned below:  Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                  : 1780192633  Thank You!', NULL, NULL, '2020-11-30 15:22:04', '2020-11-30 15:22:04'),
(281, 1006, 26, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ MHHSI Credentialing Department MHHSICredentialing.Department@memorialhermann.org', NULL, NULL, '2020-12-15 17:10:16', '2020-12-15 17:10:16'),
(282, 2037, 26, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Response received -------------------- On Wed, Dec 16, 2020 at 2:37 PM MHHSI Credentialing Department MHHSICredentialing.Department@memorialhermann.org wrote: Good afternoon,     The credentialing application is in processing.     Thanks.', NULL, NULL, '2020-12-17 10:35:38', '2020-12-17 10:35:38'),
(283, 2037, 26, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being processed', NULL, NULL, '2020-12-29 10:51:31', '2020-12-29 10:51:31'),
(284, 1006, 26, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent a follow-up email to MHHSICredentialing.Department@memorialhermann.org', NULL, NULL, '2021-01-11 17:25:48', '2021-01-11 17:25:48'),
(285, 1006, 26, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent follow-up email @ credentialing.helpdesk@memorialhermann.org:  \"Hello,   I am trying to work on our groups\' application on the eCredentialing portal and I had a few questions relating to it:   1. In the license & insurance tab, it\'s requesting a HealthSol State License even though the provider\'s state license is already mentioned.  2. In the documents section it is requesting accreditation or a site visit, but we do not have any accreditation and haven\'t had a site visit conducted at our location, would something else suffice?  Looking forward to your reply.  Thanks.\" ', NULL, NULL, '2021-01-19 10:26:57', '2021-01-19 10:26:57'),
(286, 1006, 26, NULL, '2021-02-02 00:00:00.000', 'In Process', 'As we discussed on the phone call, verification is still in process and needs to allow more time. This email is just for a status update on the process. Nothing to do more on this.', NULL, NULL, '2021-01-26 16:41:32', '2021-01-26 16:41:32'),
(287, 1006, 26, NULL, '2021-02-09 00:00:00.000', 'In Process', 'The request is still pending on Stephane\'s end as he is coordinating with the provider rep. ', NULL, NULL, '2021-02-02 17:04:48', '2021-02-02 17:04:48'),
(288, 1006, 26, NULL, '2021-02-28 00:00:00.000', 'In Process', 'Request is still pending on Stephane. ', NULL, NULL, '2021-02-12 15:13:04', '2021-02-12 15:13:04'),
(289, 3046, 26, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Request is still pending on Stephane', NULL, NULL, '2021-03-02 09:51:59', '2021-03-02 09:51:59'),
(290, 3046, 26, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Had a word with Stephane over the phone and he advised that he is waiting for aetna to send them some templates over the email.  Sent and email to aetna regarding the status for adding a location.  Email sent to: pdsdallas@aetna.com Subject: [EXTERNAL] Request For Status Update on Locations || Best Health Urgent Care & Clinic || First Health. Log #92667621056251526  Greetings, Kindly provide me the status of the credentialing application for the below mentioned providers.  Group Name  : Best Health Urgent Care & Clinic.  Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                 : 1780192633   Thank you. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------   Dear Bharath, Greetings Hope my email finds you well. As per your request, please find below details.  Group Details:Group Name  : Best Health Urgent Care & Clinic.Group Tax ID : 84-4737737.Group NPI:      1013540962Address:          3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242    Provider Details: Provider         : Cyriaque, Stephane NPI                 : 1780192633 Thank you.', NULL, NULL, '2021-03-11 14:28:52', '2021-03-11 14:28:52'),
(291, 3046, 26, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: MHHSICredentialing.Department@memorialhermann.org Subject: [EXTERNAL] Memorial Hermann Health Plan Request to Participate  Hello,  I would like to get an update on the current participation status of the provider mentioned below:  Group Name  : Best Health Urgent Care & Clinic. Group Tax ID : 84-4737737. Provider         : Cyriaque, Stephane NPI                  : 1780192633  Thank You!  Kindly ignore previous comment from     Kindly ignore the comments updated on 3/11/2021 7:28:52 PM', NULL, NULL, '2021-03-19 13:04:30', '2021-03-19 13:04:30'),
(292, 1006, 26, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request has been put on hold as per my discussion with Stephane, he is unable to provide Memorial Hermann with what they are requesting at the moment. We will have to submit a new request at a later time. ', NULL, NULL, '2021-06-07 11:02:01', '2021-06-07 11:02:01'),
(293, 2027, 28, NULL, NULL, 'In Process', 'To: ywyatt@humana.com  Sub: Need Status Update Of Provider Stephane Cyriaque  Hello,   Hope you are doing great, I want to know about the current status of the provider Certification.  Following are the details:  Provider Name: Stephane Cyriaque NPI# 1780192633 Group Name: Best Health Urgent Care & Clinic Tax-ID: 84-4737737  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-19 14:42:48', '2020-06-19 14:42:48'),
(294, 2028, 28, NULL, NULL, 'In Process', 'TO: KMoten4@humana.com SUB: Cyriaque, Stephane - Tricare - (BHUCC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name:Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.', NULL, NULL, '2020-07-09 16:41:35', '2020-07-09 16:41:35'),
(295, 2028, 28, NULL, NULL, 'In Process', 'From: KMoten4@humana.com Sub:  RE: Cyriaque, Stephane - Tricare - (BHUCC)  Good Afternoon,     This provider is not showing certified in the system. It can take up to 120 days from when application was submitted to WPS.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com   ', NULL, NULL, '2020-07-10 09:23:04', '2020-07-10 09:23:04'),
(296, 2028, 28, NULL, NULL, 'In Process', 'TO: KMoten4@humana.com Sub: Cyriaque, Stephane - Tricare - (BHUCC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name:Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.', NULL, NULL, '2020-07-23 10:35:31', '2020-07-23 10:35:31'),
(297, 2028, 28, NULL, NULL, 'In Process', 'From: KMoten4@humana.com Sub: RE: Cyriaque, Stephane - Tricare - (BHUCC)   Good Afternoon,     This provider is not showing in the system yet. Please allow for 120 days for certifications to be completed by WPS.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com', NULL, NULL, '2020-07-24 09:19:04', '2020-07-24 09:19:04'),
(298, 1006, 28, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Followup email sent to Kmoten. ', NULL, NULL, '2020-08-10 16:53:36', '2020-08-10 16:53:36'),
(299, 1006, 28, NULL, '2020-08-18 00:00:00.000', 'In Process', 'Received following update from Tricare KMoten4@humana.com:    \"Good Morning,  This provider was certified by WPS on 8-1-2020. Please submit a credentialing application to me with the following documents: CV, DEA, License verification,  Malpractice Insurance Verification.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2020-08-11 10:42:53', '2020-08-11 10:42:53'),
(300, 1006, 28, NULL, '2020-08-18 00:00:00.000', 'In Process', 'Asked Katherine to send over the application we needed to fill out for credentialing. ', NULL, NULL, '2020-08-11 14:47:26', '2020-08-11 14:47:26'),
(301, 1006, 28, NULL, '2020-08-18 00:00:00.000', 'In Process', 'Received credentialing application, filled out and sent to Katherine. Attached. ', NULL, NULL, '2020-08-11 17:22:10', '2020-08-11 17:22:10'),
(302, 2037, 28, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Follow up email sent to Katherine requesting the confirmation of receiving of the application.  ------------ Greetings Katherine,  Hope this email finds you well. If I may get the confirmation of receiving of the credentialing application submitted on behalf of the below mentioned provider submitted on 08/11/2020.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name:Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633', NULL, NULL, '2020-09-16 12:40:03', '2020-09-16 12:40:03'),
(303, 2037, 28, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Application Received and currently being processed.Got the confirmation from Katherine : -------------------- The application was submitted on 8/12/20; please allow 90 days for processing.     Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2020-09-16 12:56:42', '2020-09-16 12:56:42'),
(304, 2037, 28, NULL, '2020-10-08 00:00:00.000', 'Approved', 'Approval letter received with effective date obtained over the phone call (07/31/2020) Reference # 10432331. Approval email sent to the billing.Letter uploaded on EMRBS.', NULL, NULL, '2020-10-01 10:41:15', '2020-10-01 10:41:15'),
(305, 3040, 28, NULL, NULL, 'Revalidation', 'Email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.  Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-06 14:31:30', '2021-04-06 14:31:30'),
(306, 1005, 28, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email sent to:  ywyatt@humana.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Hello Yvonne,   Hope you are doing well. As I mentioned in my previous email, we received a welcome letter from Tricare and it stated that the provider enrolled with Tricare on 09/22/2020. Can you please check and let me know the status.   Thank you. ', NULL, NULL, '2021-06-09 16:47:28', '2021-06-09 16:47:28'),
(307, 1006, 28, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Please disregard the previous post.   We received the following email from Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  \"Good Afternoon Adil,  It looks like this provider was credential in error.  We do not show we have a contract on file to network this Group tax id. We are only networking Providers based on the need for the area for certain specialties.  This special  As a non-network TRICARE certified provider you can see TRCARE Benes with the following TRICARE plans.\"  Replied with:   \"Hello Yvonne,  I hope you\'re doing well, how does Tricare credential a provider in error, and what is required to get them correctly credentialed in the system? Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-22 12:49:59', '2021-06-22 12:49:59'),
(308, 1006, 28, NULL, '2021-07-15 00:00:00.000', 'Revalidation', 'We received the following updates from Yvonne @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  \"Good Morning Brad,  The person who worked this application is new and she failed to check to see if the Group  tax id was network before approving a credentialing application.  When a provider is credential this does not make them network we must have a sign contract agreement on file to activate them as network.  Humana Military do not have a Contract agreement for Best Health Urgent Care and Clinic on file.  We do show the Group and Stephane Cyiraques as non-network and TRICARE certified who can see TRICARE Beneficiaries.  I will check with Contracting to see if they will agree to send a contract agreement for this group tax id to become network and will let you know once I receive a respond back.\"  \"Good Morning Brad,  I am sorry, contracting did not approve to network this provider’s group tax id.  As a non-network TRICARE certified provider the provider can see the following TRICARE Beneficiaries.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult  Thanks, Yvonne\"  Replied with:  \"Hello Yvonne,   I appreciate the update, can you please let me know when we can request for group and provider contracting? As we would appreciate it if we can our providers and group enrolled ASAP. Thank you.\" ', NULL, NULL, '2021-07-08 14:54:28', '2021-07-08 14:54:28'),
(309, 11056, 28, NULL, '2021-07-29 00:00:00.000', 'Revalidation', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Good Morning Brad,  I am sorry, contracting did not approve to network this provider’s group tax id.  As a non-network TRICARE certified provider the provider can see the following TRICARE Beneficiaries.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult  Thanks, Yvonne', NULL, NULL, '2021-07-22 11:02:39', '2021-07-22 11:02:39'),
(310, 11056, 28, NULL, '2021-08-03 00:00:00.000', 'Revalidation', 'On Hold   Email received from : ywyatt@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Good Morning Brad,  You can check with us in 6 months to see if the Panel is open to new providers.       As a non-network TRICARE certified  provider you can see TRICARE Beneficiaries who has the following plans     •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult               Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-27 10:45:51', '2021-07-27 10:45:51'),
(311, 22077, 28, NULL, '2022-04-21 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: 	Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Hi,  I would like to enroll the following provider  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary & Billing Address	3003 TEXAS PKWY UNIT B MISSOURI CITY, TX 77489-5242 Provider Name	NPI Stephane Cyriaque	1780192633 Shametria Tann	1124615612  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:18:01', '2022-04-14 13:18:01'),
(312, 22077, 28, NULL, '2022-05-02 00:00:00.000', 'Revalidation', 'Email received from: ywyatt@humana.com  Subject: RE: Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Good Afternoon Alex,     We show both Providers are affiliated to this group tax id. You can check status by using the online Self Service Provider Portal. Highlighted below is the link to create a log in.              In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military     502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     HumanaMilitary.com  Additional Resources:  ** Provider claims, certification and other forms  ** Rates and reimbursements', NULL, NULL, '2022-04-25 13:20:30', '2022-04-25 13:20:30'),
(313, 22077, 28, NULL, '2022-05-02 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: 	Re: Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Hi,  I want to know the effective date for both providers,  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary & Billing Address	3003 TEXAS PKWY UNIT B MISSOURI CITY, TX 77489-5242 Provider Name	NPI Stephane Cyriaque	1780192633 Shametria Tann	1124615612  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 13:21:58', '2022-04-25 13:21:58'),
(314, 2028, 29, NULL, NULL, 'In Process', 'REP: Kris Status shows its on pending will take 90 days from the time your request submitted. Reference ID: Kris', NULL, NULL, '2020-07-06 16:04:08', '2020-07-06 16:04:08'),
(315, 2028, 29, NULL, NULL, 'In Process', 'Rep: Ryan as per the agent the address is still same for financial, billing and practice which is 3033 Texas Parkway, Unit# B Missouri City , TX 77489 we have to send in written with W-9 on there fax number for the request of the address change the fax no. is (8772317695) Ref: Ryan 7-16-2020', NULL, NULL, '2020-07-16 12:31:22', '2020-07-16 12:31:22'),
(316, 2028, 29, NULL, NULL, 'In Process', 'Rep: Jadi  The W9 was submitted on 5 May and  April 27,  As per rep, on the July 16 brad was advise that they are not contracting to Avmed because we are not credentialing outside FL and we also spoke to wally regarding address change will take some time and will reach out to you as it\'s done. Ref: Jadi 7-23-2020', NULL, NULL, '2020-07-23 10:05:32', '2020-07-23 10:05:32'),
(317, 2028, 29, NULL, NULL, 'In Process', 'Name: jen As per rep, the address has been updated ref:jen 7/30/2020', NULL, NULL, '2020-07-30 09:46:49', '2020-07-30 09:46:49'),
(318, 2028, 29, NULL, NULL, 'In Process', 'rep: imo As per rep, We can get the cheques reissued as we provide the member Id and claim number   Ref: imo7/30/2020', NULL, NULL, '2020-07-30 10:04:55', '2020-07-30 10:04:55'),
(319, 2028, 29, NULL, NULL, 'In Process', 'Rep: David As per rep, he took all the information regarding the cheque as one cheque shows for Florida as he could not assist me for the Florida patient transferred me to Khristine david7-30-2020 Khristine: As per Christine the check for OJUKWU, OTEGA the Florida base patient is not been paid by the insurance it is been declined so cannot reissue the cheque. ', NULL, NULL, '2020-07-30 11:17:29', '2020-07-30 11:17:29'),
(320, 2028, 29, NULL, NULL, 'In Process', 'REP: Sara 0 As per rep, it will probably take 2 weeks for the cheque to be reissued the day start from yesterday Sara 7-31-2020', NULL, NULL, '2020-07-31 08:32:20', '2020-07-31 08:32:20'),
(321, 1006, 29, NULL, '2020-08-17 00:00:00.000', 'In Process', 'They are migrating into a different tool and is the reason that re-issuing checks are being delayed. The request is on file on their system but they cannot work on it yet.   The group address was updated on 07/28/2020', NULL, NULL, '2020-08-10 13:46:58', '2020-08-10 13:46:58'),
(322, 1005, 29, NULL, '2020-10-01 00:00:00.000', 'Rejected', 'Unable to enroll. They only accept providers located in Florida.', NULL, NULL, '2020-09-24 13:37:41', '2020-09-24 13:37:41'),
(323, 2027, 34, NULL, NULL, 'In Process', 'To:	JCRidley@texaschildrens.org  Subject: Re-credentialing of Group-Imperial Valley Urgent Care  Hello,   Hope you are doing great, I want to know is there any document required for re-credentialing of group Imperial Valley Urgent Care. If yes then please let me know. Following are the group Details: Group Name:Imperial Valley Urgent Care NPI# 1598128787 Tax ID: 27-0796429.  Thanks.', NULL, NULL, '2020-06-17 13:16:30', '2020-06-17 13:16:30'),
(324, 2027, 34, NULL, NULL, 'In Process', 'To: JCRidley@texaschildrens.org  Sub; Re-credentialing of Group-Imperial Valley Urgent Care  Hello,  Hope you are doing great, I want to know is there any document required for re-credentialing of group Imperial Valley Urgent Care. If yes then please let me know. Following are the group Details: Group Name:Imperial Valley Urgent Care NPI# 1598128787 Tax ID: 27-0796429.  Thanks.', NULL, NULL, '2020-06-23 15:01:41', '2020-06-23 15:01:41'),
(325, 2027, 34, NULL, NULL, 'In Process', 'From: JCRidley@texaschildrens.org  To: mk@claimsmedinc.com  Hello,     There is not a facility or other provider appearing in my credentialing database with that NPI number.     “Imperial Urgent Care” listed in my credentialing database has NPI 1407171077 associated with it.     This facility was re-credentialed 05-13-2020.     Longpoint Medical Center was also re-credentialed 05-13-2020', NULL, NULL, '2020-06-23 16:48:25', '2020-06-23 16:48:25'),
(326, 2027, 34, NULL, NULL, 'In Process', 'Call to insurance: talk to the representative she said she do not have the access to check the details, So she took our call back number and sent it to the concerned department, We may get a call shortly. ', NULL, NULL, '2020-06-25 14:28:03', '2020-06-25 14:28:03'),
(327, 1006, 34, NULL, NULL, 'In Process', 'Sent the requested information to Staggs, Rosemary rxstaggs@texaschildrens.org>:   Sub: Re: Re-credentialing for Normandy Urgent Care Center   \"Good morning Brad,   Thanks so much for your help in getting the documentation over; I think we have everything we need.  Have a great weekend, Rosemary\"', NULL, NULL, '2020-07-10 09:56:09', '2020-07-10 09:56:09'),
(328, 1005, 34, NULL, NULL, 'In Process', 'Test', NULL, NULL, '2020-07-22 09:54:22', '2020-07-22 09:54:22'),
(329, 1005, 34, NULL, NULL, 'In Process', 'Test 2', NULL, NULL, '2020-07-22 10:45:27', '2020-07-22 10:45:27'),
(330, 1011, 34, NULL, NULL, 'In Process', 'test', NULL, NULL, '2020-07-23 13:18:21', '2020-07-23 13:18:21'),
(331, 2027, 34, NULL, '2020-08-17 00:00:00.000', 'In Process', 'To: rxstaggs@texaschildrens.org  Sub: (For Group)-(Normandy Urgent Care Center)-(Texas Children Health Plan - TCHP)  Hello, Hope you are doing well, May i know the current status Of the group. Following are the details: Group Name: Normandy Urgent Care Center Group NPI: 1407171077 Group Tax ID: 27-0796429.  Thanks.  ', NULL, NULL, '2020-08-10 15:02:34', '2020-08-10 15:02:34'),
(332, 2027, 34, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: JCRidley@texaschildrens.org  Sub; (For Group)-(Normandy Urgent Care Center)-(Texas Children Health Plan - TCHP)  Hello, Hope you are doing well, May i know the current status of the group. Following are the details: Group Name: Normandy Urgent Care Center Group NPI: 1407171077 Group Tax ID: 27-0796429.  Thanks.', NULL, NULL, '2020-09-21 10:40:10', '2020-09-21 10:40:10'),
(333, 2027, 34, NULL, '2020-09-29 00:00:00.000', 'In Process', 'To: 	tchpnetworkmanagemen@texaschildrens.org  May I know the contract type of these below mentioned groups either they have group contract with TCHP or ancillary contract:  Group Name	Group Tax-ID	Group NPI Normandy Urgent Care Center	27-0796429	1407171077 Longpoint Medical Center	76-0612416	1770763815 Imperial Valley Urgent Care Center	270796429	1598128787  Thanks.', NULL, NULL, '2020-09-22 14:18:49', '2020-09-22 14:18:49'),
(334, 2027, 34, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (For Group)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  Hello Juanita,  Can I have executed signed contract with (TCHP) and the effective date of the below mentioned practice: Practice Name: Normandy Urgent Care Center  Practice Tax-ID: 27-0796429  Practice NPI# 1407171077  Thanks. ', NULL, NULL, '2020-10-21 15:44:27', '2020-10-21 15:44:27'),
(335, 1006, 34, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Alanis, Juanita\" jxalanis@texaschildrens.org> regarding executed contract copy. ', NULL, NULL, '2020-10-28 18:07:37', '2020-10-28 18:07:37'),
(336, 2027, 34, NULL, '2020-11-12 00:00:00.000', 'In Process', 'sent follow up ', NULL, NULL, '2020-11-05 14:19:09', '2020-11-05 14:19:09'),
(337, 2037, 34, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent to jxalanis@texaschildrens.org for the copy of the exwcuted contract', NULL, NULL, '2020-11-12 10:44:46', '2020-11-12 10:44:46'),
(338, 2037, 34, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Response received:   Alanis, Juanita Fri, Nov 13, 9:27 AM (10 days ago) to me  Good morning Sherry,     I have forward your request to contracting department; will let you know once I receive a response.  Thank you     Juanita Alanis  Provider Relations   Texas Children\'s Health Plan  6330 West Loop South Bellaire, TX 77401  Office: 832.828.1255  Fax : 832 825 8715   ', NULL, NULL, '2020-11-23 14:35:08', '2020-11-23 14:35:08'),
(339, 2037, 34, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Currently being processed need to allow more time', NULL, NULL, '2020-11-30 17:47:52', '2020-11-30 17:47:52'),
(340, 2037, 34, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being processed need to allow more time', NULL, NULL, '2020-12-11 12:25:43', '2020-12-11 12:25:43'),
(341, 1006, 34, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Left a VM for a call back regarding the executed contract. ', NULL, NULL, '2021-01-19 11:43:01', '2021-01-19 11:43:01'),
(342, 3040, 34, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:47:21', '2021-05-31 15:47:21'),
(343, 3040, 34, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:43', '2021-06-17 12:21:43'),
(344, 3040, 34, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:26', '2021-07-06 13:39:26'),
(345, 3040, 34, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:43', '2021-07-06 13:42:43'),
(346, 3040, 34, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:15', '2021-07-26 16:39:15'),
(347, 11056, 34, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:23:02', '2021-08-13 15:23:02'),
(348, 3040, 34, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:49', '2021-08-26 08:45:49'),
(349, 10057, 34, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:56:58', '2021-10-08 13:56:58'),
(350, 10057, 34, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:08:59', '2021-10-21 11:08:59'),
(351, 10057, 34, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:45:12', '2021-10-29 09:45:12'),
(352, 10057, 34, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 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  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 John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:31:25', '2021-11-22 13:31:25'),
(353, 10057, 34, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:22:15', '2021-12-02 14:22:15'),
(354, 10057, 34, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:50:53', '2021-12-09 11:50:53');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(355, 10057, 34, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:50:24', '2021-12-16 14:50:24'),
(356, 10057, 34, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:47:24', '2021-12-22 13:47:24'),
(357, 10057, 34, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:02:16', '2021-12-29 12:02:16'),
(358, 20067, 34, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 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 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 Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:58', '2022-01-12 15:01:58'),
(359, 20067, 34, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:57:39', '2022-01-19 09:57:39'),
(360, 20067, 34, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:23:27', '2022-01-28 10:23:27'),
(361, 20067, 34, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 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 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 Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:27:40', '2022-03-01 15:27:40'),
(362, 20067, 34, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Email received from: bxgupta@texaschildrens.org  Sub: Welcome letter - Group - Normandy Urgent Care Center,   Greetings,         Welcome to TCHP James M Piccione, Jr, MD, Limy Fernandus, FNP & Sigi Paul, FNP are now participating with Texas Children’s Health Plan under Normandy Urgent Care Center, group. Attached you will find a welcome letter with effective dates for all contracted products as well as the contact information for your Provider Relations Representative. Please reach out to your PR Rep or the Contracting Department phone line at (832) 828-1004 with any questions.         Thank you and have a great day!   ​  Respectfully,', NULL, NULL, '2022-03-22 13:42:09', '2022-03-22 13:42:09'),
(363, 2028, 40, NULL, NULL, 'In Process', 'TO: CHC.Contracting@communityhealthchoice.org SUB: (Cyriaque, Stephane) - (Community Health Choice) - (BHUCC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Community Health Choice Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-06 13:40:38', '2020-07-06 13:40:38'),
(364, 2028, 40, NULL, NULL, 'In Process', 'from: CHC.Contracting@communityhealthchoice.org Sub: (Cyriaque, Stephane) - (Community Health Choice) - (BHUCC)   Good Morning Samuel,     We’re glad to inform you that the request is transitioning smoothly. Stephane Cyriaque is in the credentialing process as of 6/25/2020. Kindly allow a minimum of ninety days for credentialing to be completed. Should you have questions or need further assistance, please do not hesitate to contact us.     Have a great day and stay safe! J', NULL, NULL, '2020-07-07 10:45:52', '2020-07-07 10:45:52'),
(365, 2028, 40, NULL, NULL, 'In Process', 'TO: CHC.Contracting@communityhealthchoice.org Sub: (Cyriaque, Stephane) - (Community Health Choice) - (BHUCC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-16 17:14:16', '2020-07-16 17:14:16'),
(366, 2028, 40, NULL, NULL, 'In Process', 'From: CHC.Contracting@communityhealthchoice.org Sub: (Cyriaque, Stephane) - (Community Health Choice) - (BHUCC)  Good Morning,  It is our pleasure to inform you that the provider is in the credentialing process. Please see attached letter and allow a minimum of ninety days for credentialing to be completed. Should you have questions or need further assistance, feel free to advise.     Best Regards,  Contracting team', NULL, NULL, '2020-07-17 11:07:38', '2020-07-17 11:07:38'),
(367, 2028, 40, NULL, NULL, 'In Process', 'TO: CHC.Contracting@communityhealthchoice.org Sub: (Cyriaque, Stephane) - (Community Health Choice) - (BHUCC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-27 12:05:49', '2020-07-27 12:05:49'),
(368, 2028, 40, NULL, NULL, 'In Process', 'From: CHC.Contracting@communityhealthchoice.org Sub: (Cyriaque, Stephane) - (Community Health Choice) - (BHUCC)  Good Afternoon Samuel,     Stephanie Cyriaque is in the credentialing process as of 6/25/2020. Please keep in mind the credentialing process takes a minimum of ninety days to complete. Kindly allow additional time for the process to be completed. Should you need further assistance, feel free to advise.     Best Regards, Contracting Team', NULL, NULL, '2020-07-27 14:43:19', '2020-07-27 14:43:19'),
(369, 2028, 40, NULL, NULL, 'In Process', 'From: ljramir1@texaschildrens.org Sub: (Reminder) - Cyriaque, Stephane - Texas Children Health Plan TCHP - BHUCC  Provider is pending. Communication will be sent out once review is complete.  Thankyou', NULL, NULL, '2020-07-30 16:48:32', '2020-07-30 16:48:32'),
(370, 2028, 40, NULL, NULL, 'In Process', 'TO: ljramir1@texaschildrens.org Sub: (Reminder) - Cyriaque, Stephane - Texas Children Health Plan TCHP - BHUCC  Hello, Please expedite it as soon as possible. Thank you', NULL, NULL, '2020-07-30 16:57:30', '2020-07-30 16:57:30'),
(371, 1006, 40, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Sent followup email to CHC Contracting CHC.Contracting@communityhealthchoice.org> ', NULL, NULL, '2020-08-19 18:10:47', '2020-08-19 18:10:47'),
(372, 1006, 40, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Received following response from CHC Contracting CHC.Contracting@communityhealthchoice.org>:   \"Good Morning,  This provider is still in the credentialing process. At this time we do not show additional information needed from credentialing. Please allow a minimum of ninety days from submission (6/25/2020) for the request to be processed. If further inquiries, please feel free to advise.  Thank you\"', NULL, NULL, '2020-08-20 13:42:51', '2020-08-20 13:42:51'),
(373, 1006, 40, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Asked CHC is there is any way to see patients currently that we are getting due to the COVID pandemic @ CHC Contracting CHC.Contracting@communityhealthchoice.org> ', NULL, NULL, '2020-08-20 15:06:54', '2020-08-20 15:06:54'),
(374, 2037, 40, NULL, '2020-09-23 00:00:00.000', 'In Process', 'As per live call to Community Health Choice @ 7132952295 . Information is still not reflecting into their system . Catina.J has sent in a request for the update to the contracting department. We will be receiving a an update shortly. Ticket number : 319439. ', NULL, NULL, '2020-09-16 10:28:48', '2020-09-16 10:28:48'),
(375, 2037, 40, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Rep Nubia still finds Stephan to be out of network.She followed up with Cynthia to see if she had an update on her created ticket but still there is none from the credentialing department. Nubia has added her notes and submitted a re-query to the credentialing department.Reference#4280093. Representative: Nubia. R', NULL, NULL, '2020-10-06 13:12:23', '2020-10-06 13:12:23'),
(376, 2037, 40, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Sent a follow up email to lisa.clay@communityhealthchoice.org  : ---------------------- Hi Lisa,  Happy Thursday!!  Hope your day is off to a good start.  As per the conversation we had over the phone kindly find the details of the provider for your reference :  Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  Please do feel free to contact me for any additional information.', NULL, NULL, '2020-10-15 10:31:27', '2020-10-15 10:31:27'),
(377, 2037, 40, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Sent a follow up email to chc.contracting@communityhealthchoice.org Received a response from Kris.Olier@communityhealthchoice.org -------------------- Provider is still in the credentialing process, no further documents needed. -------- ', NULL, NULL, '2020-10-23 13:15:08', '2020-10-23 13:15:08'),
(378, 2037, 40, NULL, '2020-11-11 00:00:00.000', 'In Process', ' Sherry Deen 1:15 PM (34 minutes ago) to Kris, CHC, PLLC  Hello Kris,  Thank you for your email. Just wanted to check if there is an estimated time of completion of the request as it was initiated back in the month of May.  Regards:  ---------------------------------  Olier, Kris 1:21 PM (29 minutes ago) to me, CHC, PLLC  Credentialing currently has a back log of providers, and working to complete them by November.', NULL, NULL, '2020-10-23 13:55:51', '2020-10-23 13:55:51'),
(379, 2037, 40, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Currently in process will be finalized by November', NULL, NULL, '2020-11-11 14:53:17', '2020-11-11 14:53:17'),
(380, 2037, 40, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Follow up email sent to kris', NULL, NULL, '2020-11-19 17:40:42', '2020-11-19 17:40:42'),
(381, 2037, 40, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Follow up email sent to Kris ----- Following up on the contracting process for the below mentioned provider.  Group Name: Best Health Urgent Care & Clinic Provider Name: Cyriaque, Stephane TIN# 84-4737737 NPI# 1780192633  A prompt response would be appreciated.', NULL, NULL, '2020-11-30 10:06:19', '2020-11-30 10:06:19'),
(382, 2037, 40, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Another follow up email sent to Kris. --------------  Hello Kris,  Hope you had a great weekend. Following up on the credentialing application for the below mentioned provider. You did mention that it will be finalized by november 2020. May I know the current status please.', NULL, NULL, '2020-12-07 12:39:14', '2020-12-07 12:39:14'),
(383, 2037, 40, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Response received. -------------------------------- Olier, Kris Mon, Dec 7, 2:03 PM (2 days ago) to me  Best Health Urgent Care is still in process.', NULL, NULL, '2020-12-09 15:28:28', '2020-12-09 15:28:28'),
(384, 2037, 40, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-22 16:39:16', '2020-12-22 16:39:16'),
(385, 1006, 40, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent a follow-up email @ CHC Contracting chc.contracting@communityhealthchoice.org  Waiting on status. ', NULL, NULL, '2021-01-11 17:09:45', '2021-01-11 17:09:45'),
(386, 1006, 40, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Received following reply: \"Hi,  I’m currently am processing the application for Best Health Urgent Care & Clinic.  I’m needing an updated attestation as the one on file is over 180 days.  I have attached a copy and if you could sign and date.  Also,  does the site have a CMS Survey if so please send a copy.  Thank you,  Melissa Aguilar Credentialing Quality Specialist Melissa.Aguilar@CommunityHealthChoice.org Phone: 713-295-4711\"  Gave her the signed form and asked for update on the status of request and expected date.', NULL, NULL, '2021-01-12 16:46:14', '2021-01-12 16:46:14'),
(387, 1006, 40, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Sent another follow-up email @ \"Aguilar, Melissa\" Melissa.Aguilar@communityhealthchoice.org', NULL, NULL, '2021-01-18 14:04:25', '2021-01-18 14:04:25'),
(388, 1006, 40, NULL, '2021-02-02 00:00:00.000', 'In Process', 'follow up email sent to Melissa.Aguilar@communityhealthchoice.org', NULL, NULL, '2021-01-26 16:58:50', '2021-01-26 16:58:50'),
(389, 1006, 40, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Olier, Kris\" Kris.Olier@communityhealthchoice.org & CHC Contracting CHC.Contracting@communityhealthchoice.org:  \"Hello,   We\'re still waiting on an update regarding the status of our providers enrollment, please get back to us as soon as possible.  Thanks.\"', NULL, NULL, '2021-01-29 14:30:31', '2021-01-29 14:30:31'),
(390, 1006, 40, NULL, '2021-02-09 00:00:00.000', 'In Process', 'The request is nearing completion:  \"The provider was presented at the meeting on January 28, we are currently awaiting the complete approval list. The approval letter and contract will be sent out in the next 5 days.   Kris Olier Provider Contract Coordinator Kris.Olier@CommunityHealthChoice.org Phone: 713-314-5629 Fax: 713-295-7058\"', NULL, NULL, '2021-02-02 17:36:07', '2021-02-02 17:36:07'),
(391, 1006, 40, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Best Health Urgent Care is approved with an effective date 1/28/2021, please allow 10 days for loading.  ', NULL, NULL, '2021-02-12 15:41:03', '2021-02-12 15:41:03'),
(392, 2037, 41, NULL, '2020-09-25 00:00:00.000', 'Initiated', 'Online application has been resubmitted submitted & attached as the previous submitted application got rejected due to closed business.', NULL, NULL, '2020-09-18 11:04:52', '2020-09-18 11:04:52'),
(393, 2037, 41, NULL, '2020-09-25 00:00:00.000', 'In Process', 'Application Identifier .1a679507-b2f6-48c9-ae0d-ebd91861171c ', NULL, NULL, '2020-09-18 11:06:48', '2020-09-18 11:06:48'),
(394, 2037, 41, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Received Email from them: Vanessa.Samuels@bswhealth.org ------------------ Good afternoon,  I do not show that you have an existing contract with SWHP/FCHP. Please visit the website and submit your request to begin the contracting process. A member of our Contracting team will reach out for required documents.  https://swhp.org/forms/html/provider-account-request.html  Thank you,  Vanessa  Bellow is our Response to them: --------------------- Hello Vanessa, An application was submitted on 09/18/2020 through the website with Application Identifier# 1a679507-b2f6-48c9-ae0d-ebd91861171c.Is it possible to get the confirmation of the receiving?Attached is the copy for your reference.  Thank you!', NULL, NULL, '2020-09-25 18:01:27', '2020-09-25 18:01:27'),
(395, 2037, 41, NULL, '2020-10-05 00:00:00.000', 'On Hold', 'Need to get the group enrolled first.', NULL, NULL, '2020-09-28 09:47:47', '2020-09-28 09:47:47'),
(396, 2037, 41, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Group enrollment got rejected by Scott and White due to network requirement . Submitted individual enrollment application for Stephane . Got a response from them requesting supervising physician\'s information. Responded back with Segun\'s Details . Reference emails as follows: ----------- Dear Provider,     On 10/08/2020, we received a request for a new contract from Nurse Practitioner Stephane Cyriaque.  Please provide the supervising physician information, that is contracted with Scott & White Health Plan.     Please respond within 7 days.     Thank you ----------- Greetings,  Kindly find the supervising physician\'s information for Nurse Practitioner Stephane Cyriaque as follows:  Provider: Segun Adeoye Specialty: 207Q00000X: Family Medicine NPI: 1629418025  Do contact me for any additional information if needed.', NULL, NULL, '2020-10-13 17:25:35', '2020-10-13 17:25:35'),
(397, 2037, 41, NULL, '2021-02-27 00:00:00.000', 'On Hold', 'Application Got rejected !!! --------------------------------------------------- Dear Provider,  Unfortunately, Dr Adeoye is not contracted and neither is the NASA Health Clinic.   The New Application Request from Nurse Practitioner Stephane Cyriaque will be closed.', NULL, NULL, '2020-10-20 14:21:02', '2020-10-20 14:21:02'),
(398, 1006, 43, NULL, '2020-08-11 00:00:00.000', 'In Process', 'Address update still pending. Need to update. ', NULL, NULL, '2020-08-04 15:24:25', '2020-08-04 15:24:25'),
(399, 1005, 43, NULL, '2020-10-01 00:00:00.000', 'Approved', 'Address has been updated/corrected in Provider Directory', NULL, NULL, '2020-09-24 13:22:44', '2020-09-24 13:22:44'),
(400, 2027, 46, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com,         PDMCOGZ@cigna.com  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Cigna)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-25 12:47:29', '2020-08-25 12:47:29'),
(401, 2027, 46, NULL, '2020-09-04 00:00:00.000', 'Approved', 'From: PDM COGZ  Hi,     Thank you for your submission.     The attached request has been reviewed.     See below the current status of the requested provider with Name, PID #, TIN # and Eff. Date.     • Provider Name : Joseph, Vibitha     • Provider ID : 0308160     • Tax ID : 47-1914151     • Status : Provider Is  participating with effective 7.2.2020     Cigna Internal Ref. ID : W202008251207038     Enclosure: A copy of your original request        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, '2020-08-28 09:46:37', '2020-08-28 09:46:37'),
(402, 2027, 47, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:59:17', '2020-10-12 17:59:17'),
(403, 1006, 47, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:50:22', '2020-10-26 13:50:22'),
(404, 2027, 47, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:16:51', '2020-11-06 10:16:51'),
(405, 2027, 47, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:48:56', '2020-11-13 16:48:56'),
(406, 2027, 47, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:24:27', '2020-11-20 12:24:27'),
(407, 2027, 47, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:25:27', '2020-11-20 12:25:27'),
(408, 2027, 47, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:48:48', '2020-11-30 15:48:48'),
(409, 2037, 47, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:08', '2020-12-08 17:17:08'),
(410, 1006, 47, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:38:17', '2020-12-15 17:38:17'),
(411, 2037, 47, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:49:23', '2020-12-22 17:49:23'),
(412, 1006, 47, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:11:13', '2021-01-05 18:11:13'),
(413, 1006, 47, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:54:11', '2021-02-02 17:54:11'),
(414, 1006, 47, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:23:51', '2021-02-11 10:23:51'),
(415, 3040, 47, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:43:31', '2021-05-20 14:43:31'),
(416, 2027, 49, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Scott & White)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-24 17:47:42', '2020-08-24 17:47:42'),
(417, 2027, 49, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Scott & White)  Dear Provider,     You will need to work directly with your Contracting Manager, Rick Hinkley, for assistance with status inquiries.  He can be reached at Richard.Hinkley@BSWHealth.org .     Thank you,', NULL, NULL, '2020-08-25 11:15:49', '2020-08-25 11:15:49'),
(418, 2027, 49, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Scott & White)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-25 11:18:40', '2020-08-25 11:18:40'),
(419, 2027, 49, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: Richard.Hinkley@bswhealth.org  Good afternoon Martin,   Please be aware that the facility NPI is still in credentialing as part of a new contracting request. Please be aware that we only credential Urgent Care providers for Medicaid. This provider did not have a TPI associated with this group’s TIN at the time that the group PIF was submitted to credentialing and still does not as of today therefore this provider is not in credentialing with this group and will only be able to bill for commercial services through the urgent care when this contract is activated. You will need to submit a new provider add through the website once this contract is activated after she has secured TPI attestation with this group. There were also two other providers listed on the updated group PIF I received at the end of June from you that did not and as of today still do not have current attestation with this group through TMHP which are not being credentialed at this time:  Joseph NPI 1952931560  Brown NPI 1275163537   Thank you,   Rick Hinkley  Provider Relations Representative  Provider Network Management', NULL, NULL, '2020-08-25 17:10:15', '2020-08-25 17:10:15'),
(420, 1006, 49, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-16 14:32:05', '2020-10-16 14:32:05'),
(421, 1006, 49, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Received following update from SWHP REGION 2 SWHPREGION2@bswhealth.org>:  \"Hello,  Please see notes in blue/red.   Provider Name: Vibitha Joseph – shows active under TIN 270796429 NPI# 1952931560  Provider Name: Cini Thomas – Pending CVO review. NPI# 1134777238  Provider Name: Julie Jose – Applicant in review. NPI# 1447883061  Provider Name: Odette Tiranke Kourouma – No records found, when did you submit the request? NPI# 1134525868  Provider Name: Jeemol George - Applicant in review. NPI# 1497219067  Group Name: Columbus Urgent Care PA- Applicant in review. TIN# 47-1914151  Thanks,  Jennifer C. Provider Relations Representative cid:image001.png@01D42404.EBBCB8F0 1206 West Campus Dr | MS-A4-126 | Temple, TX  76502 254-298-3064 Office | 254-298-3044 Fax\"', NULL, NULL, '2020-10-23 19:01:33', '2020-10-23 19:01:33'),
(422, 2027, 49, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Scott & White)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-10-30 10:05:09', '2020-10-30 10:05:09'),
(423, 2027, 49, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  This is a follow up email. Please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-06 14:37:28', '2020-11-06 14:37:28'),
(424, 2027, 49, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-13 15:16:33', '2020-11-13 15:16:33'),
(425, 2027, 49, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  Could you please reply to me for the request I have sent you earlier regarding the provider (Joseph Vibitha).  Thanks. ', NULL, NULL, '2020-11-20 09:28:13', '2020-11-20 09:28:13'),
(426, 2027, 49, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  This is a follow up email. Please reply to me as soon as possible', NULL, NULL, '2020-11-30 13:29:59', '2020-11-30 13:29:59'),
(427, 2027, 49, NULL, '2020-12-09 00:00:00.000', 'In Process', 'From: Richard.Hinkley@bswhealth.org  Good afternoon Martin,     As previously stated the individual providers are no longer credentialed only the facility. The Facility Credentialing has been completed and I submitted SR and SAM tickets to have them setup with configuration before I went on vacation. I believe you got a few different automatic replies from me so sorry for the delay. Those tickets are still in process but I will submit a copy of the contract which goes into effect today in just a few moments.     Thank you,     Rick Hinkley  Provider Relations Representative  Provider Network Management', NULL, NULL, '2020-12-02 09:16:10', '2020-12-02 09:16:10'),
(428, 2027, 49, NULL, '2020-12-09 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good morning,     Please see the attached contract for Columbus Urgent Care PA TIN: 471914751  This contract contains: HMO, PPO, EPO  You contract also includes Medicare Advantage & RightCare (Medicaid)     Congratulations on joining the health plan. I have attached your contract, portal activation materials, and the current Commercial Provider Manual. You can also visit our website at the following link to access the current quick reference guide as well as the most current versions of all provider materials you may need including claims and billing information, reimbursement policies, and authorization information: https://swhp.org/en-us/prov/provider-training-manual. Please also see this link for the most current quick reference guide for the health plan: https://swhp.org/Portals/0/Files/Forms/Prov_FormsGuides/SWHP-Provider-Reference-Guide.pdf. This is updated fairly regularly and contains quick links and guidelines for web resources, claims/appeals addresses and guidelines, prior auths, how to read ID cards, and other necessary information. This final link is the most current Medicare specific orientation information: https://swhp.org/Portals/0/Files/Forms/Providers/Provider_Orientation_Medicare_Advantage.pdf. Please let me know if you have any questions or concerns and I will do my best to assist you. As part of your introduction, let me know if you would like to schedule a new provider orientation where we can discuss these materials and I can try and answer any questions you may have about joining the health plan. I will also send along information on the RightCare Medicaid line of business in just a few minutes.     Thank you,', NULL, NULL, '2020-12-02 09:40:14', '2020-12-02 09:40:14'),
(429, 2027, 50, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: Jamie.Llefi@molinahealthcare.com  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Molina Health)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-24 17:09:47', '2020-08-24 17:09:47'),
(430, 2027, 50, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: Jamie.Llefi@molinahealthcare.com  Good Afternoon Martin,     I have reached out to your assigned Contract Coordinator-Michele Thomas Martin so she can provide you with a status update on this request. Record #165931.     Thank you,', NULL, NULL, '2020-08-25 15:46:01', '2020-08-25 15:46:01'),
(431, 2027, 50, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Molina Health)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-25 15:50:16', '2020-08-25 15:50:16'),
(432, 2027, 50, NULL, '2020-09-01 00:00:00.000', 'Approved', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 165931     Provider:  Vibitha Joseph     Good Afternoon,     Thank you for your inquiry.  The above provider has been loaded under all plans effective 9/1/2020.  The provider may start seeing members under the group 9/1/2020.  Please see the attached welcome letter and copy of executed agreement.     Thank You,', NULL, NULL, '2020-08-25 17:14:09', '2020-08-25 17:14:09'),
(433, 2027, 50, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: Jamie.Llefi@molinahealthcare.com  Good Afternoon Martin,     I have reached out to your assigned Contract Coordinator-Michele Thomas Martin so she can provide you with a status update on this request. Record #165931.     Thank you,', NULL, NULL, '2020-08-25 17:27:05', '2020-08-25 17:27:05'),
(434, 1005, 50, NULL, '2020-10-03 00:00:00.000', 'In Process', 'Sent a reminder. Awaiting response.', NULL, NULL, '2020-09-24 14:36:47', '2020-09-24 14:36:47'),
(435, 2027, 50, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Molina Health)  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Columbus Urgent Care PA Group Tax-ID- 471914151  Thanks.', NULL, NULL, '2020-10-22 12:28:22', '2020-10-22 12:28:22'),
(436, 2027, 50, NULL, '2020-10-29 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Good Afternoon,     Thank you for your inquiry.  At this time we do not add individual providers under Urgent Care Facilities.  Urgent Care facilities bill under a flat rate plan for the group.  If we received a request for the below provider, it may have been discontinued.  I’ve included the contract coordinator that assist with the Columbus Urgent Care in the email and listed his information below.  Please follow up directly with the assigned contract coordinator for further assistance.     CHIP,  Mauricio Chavez  Mauricio.Chavez@molinahealthcare.com  888-562-5442 x202008     Thank You,', NULL, NULL, '2020-10-22 14:35:29', '2020-10-22 14:35:29'),
(437, 2027, 50, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Molina Health)  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Columbus Urgent Care PA Group Tax-ID- 471914151  Thanks.', NULL, NULL, '2020-10-22 14:37:12', '2020-10-22 14:37:12'),
(438, 2027, 50, NULL, '2020-11-06 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Good Afternoon,     Thank you for your inquiry.  At this time we do not add individual providers under Urgent Care Facilities.  Urgent Care facilities bill under a flat rate plan for the group.  If we received a request for the below provider, it may have been discontinued.  I’ve included the contract coordinator that assist with the Columbus Urgent Care in the email and listed his information below.  Please follow up directly with the assigned contract coordinator for further assistance.     CHIP,  Mauricio Chavez  Mauricio.Chavez@molinahealthcare.com  888-562-5442 x202008     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-10-30 10:12:34', '2020-10-30 10:12:34'),
(439, 2027, 50, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Columbus Urgent Care PA Group Tax-ID- 471914151  Thanks.  ', NULL, NULL, '2020-11-06 14:45:31', '2020-11-06 14:45:31'),
(440, 2027, 50, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-13 15:11:27', '2020-11-13 15:11:27'),
(441, 2027, 50, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  Please confirm do we need to add the provider in this contract or it is an urgent care contract?  Thanks.', NULL, NULL, '2020-11-20 09:23:02', '2020-11-20 09:23:02'),
(442, 2027, 50, NULL, '2020-11-30 00:00:00.000', 'Approved', 'This is an urgent care contract so provider don\'t need to be enrolled individually. Executed signed contract is attached.', NULL, NULL, '2020-11-23 10:04:28', '2020-11-23 10:04:28'),
(443, 2027, 53, NULL, '2020-08-21 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  May I know the current status of the below mentioned provider. Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-14 16:41:17', '2020-08-14 16:41:17'),
(444, 2027, 53, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Sub: (Joseph, Vibitha)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  Application is pending, Thank you for you patience', NULL, NULL, '2020-08-17 09:11:41', '2020-08-17 09:11:41'),
(445, 2027, 53, NULL, '2020-10-27 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  May I know the current status of the below mentioned provider: Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks. ', NULL, NULL, '2020-10-20 17:14:21', '2020-10-20 17:14:21'),
(446, 2027, 53, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Sent email to followup the task about the current status', NULL, NULL, '2020-10-30 18:02:19', '2020-10-30 18:02:19'),
(447, 2027, 53, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 14:48:05', '2020-11-06 14:48:05'),
(448, 2027, 53, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  This is a follow up email. Please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-13 16:37:31', '2020-11-13 16:37:31'),
(449, 2027, 53, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Please reply to me as this is my 3rd follow up.  Thanks.', NULL, NULL, '2020-11-20 09:50:25', '2020-11-20 09:50:25'),
(450, 2027, 53, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  May I know the current status of the below mentioned provider: Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-11-30 14:45:28', '2020-11-30 14:45:28'),
(451, 2037, 53, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:50:21', '2020-12-08 14:50:21'),
(452, 1006, 53, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for updated status. ', NULL, NULL, '2020-12-15 17:47:55', '2020-12-15 17:47:55'),
(453, 1006, 53, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for updated status. ', NULL, NULL, '2020-12-15 17:53:07', '2020-12-15 17:53:07'),
(454, 2037, 53, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-23 10:21:01', '2020-12-23 10:21:01'),
(455, 1006, 53, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Received following reply from : \"Thank you for your interest in our health plan’s network. Your PIF has been received and communication will be sent out to you once the review has been completed.   Liz J. Ramirez Texas Children’s Health Plan\"', NULL, NULL, '2021-01-04 18:23:49', '2021-01-04 18:23:49'),
(456, 1006, 53, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2021-02-02 18:21:45', '2021-02-02 18:21:45'),
(457, 1006, 53, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Received the following response from TCHP: \"Provider Name: Vibitha Joseph-in process\"', NULL, NULL, '2021-02-03 10:04:40', '2021-02-03 10:04:40');
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
(458, 3040, 53, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Enrollment Status || Joseph, Vibitha || Columbus Urgent Care PA || TCHP ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501 Group Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  If you need any additional information please feel free to email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-02-15 14:11:16', '2021-02-15 14:11:16'),
(459, 3040, 53, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Joseph, Vibitha || Columbus Urgent Care PA || TCHP ||  Greetings,  We already sent the PIF with W9 on 10/14/2020 to Liz J. Ramirez @ tchpnetworkmanagement@texaschildrens.org and she replied that all the documents received.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-08 10:45:24', '2021-03-08 10:45:24'),
(460, 3040, 53, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Enrollment Status || Joseph, Vibitha || Columbus Urgent Care PA || TCHP ||  Hello,  Please advise me the enrollment status for the below mentioned provider.   Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501 Group Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-16 16:11:03', '2021-03-16 16:11:03'),
(461, 3040, 53, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:27', '2021-05-19 13:58:27'),
(462, 2027, 54, NULL, NULL, 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2020-07-09 09:57:21', '2020-07-09 09:57:21'),
(463, 2027, 58, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:57:35', '2020-10-12 17:57:35'),
(464, 1006, 58, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:48:50', '2020-10-26 13:48:50'),
(465, 2027, 58, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:14:01', '2020-11-06 10:14:01'),
(466, 2027, 58, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:49:24', '2020-11-13 16:49:24'),
(467, 2027, 58, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:26:18', '2020-11-20 12:26:18'),
(468, 2027, 58, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:26:33', '2020-11-20 12:26:33'),
(469, 2027, 58, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:49:17', '2020-11-30 15:49:17'),
(470, 2037, 58, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:14', '2020-12-08 17:17:14'),
(471, 1006, 58, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:38:38', '2020-12-15 17:38:38'),
(472, 2037, 58, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:49:41', '2020-12-22 17:49:41'),
(473, 1006, 58, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:11:25', '2021-01-05 18:11:25'),
(474, 1006, 58, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:54:19', '2021-02-02 17:54:19'),
(475, 1006, 58, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:23:57', '2021-02-11 10:23:57'),
(476, 3040, 58, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:43:38', '2021-05-20 14:43:38'),
(477, 2027, 65, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com  Sub: Stephen, Ani-United HealthCare-Columbus Urgent Care PA  Hello, May i know the Current status of the provider Stephen, Ani. On May 05/06/2020 I talked to a representative for the status. She said it will take 30-45 days to complete this request. She also gave me a reference# 01582965.  Following are the provider details: Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name:Columbus Urgent Care PA  Thanks. ', NULL, NULL, '2020-07-01 16:41:25', '2020-07-01 16:41:25'),
(478, 2027, 65, NULL, NULL, 'In Process', '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-5365677  Received On: Jul 1, 2020 4:44:18 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations  *--SecureDelivery--*', NULL, NULL, '2020-07-01 16:45:52', '2020-07-01 16:45:52'),
(479, 2027, 65, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:59:49', '2020-10-12 17:59:49'),
(480, 1006, 65, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:50:51', '2020-10-26 13:50:51'),
(481, 2027, 65, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:18:17', '2020-11-06 10:18:17'),
(482, 2027, 65, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:49:41', '2020-11-13 16:49:41'),
(483, 2027, 65, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.', NULL, NULL, '2020-11-20 12:27:02', '2020-11-20 12:27:02'),
(484, 2027, 65, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:27:12', '2020-11-20 12:27:12'),
(485, 2027, 65, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:50:24', '2020-11-30 15:50:24'),
(486, 2037, 65, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:20', '2020-12-08 17:17:20'),
(487, 1006, 65, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:38:53', '2020-12-15 17:38:53'),
(488, 2037, 65, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:50:00', '2020-12-22 17:50:00'),
(489, 2037, 65, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:50:36', '2020-12-22 17:50:36'),
(490, 1006, 65, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:11:35', '2021-01-05 18:11:35'),
(491, 1006, 65, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:54:27', '2021-02-02 17:54:27'),
(492, 1006, 65, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:24:03', '2021-02-11 10:24:03'),
(493, 3040, 65, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:43:43', '2021-05-20 14:43:43'),
(494, 2027, 66, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  May i know the current status of the provider mentioned below: Provider Name-Jose, Julie Provider NPI#1447883061 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-24 17:38:16', '2020-08-24 17:38:16'),
(495, 1005, 66, NULL, '2020-10-01 00:00:00.000', 'In Process', 'No response. Sent a reminder.', NULL, NULL, '2020-09-24 13:56:25', '2020-09-24 13:56:25'),
(496, 2027, 66, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Community Health Choice)  May I know the current status of the provider mentioned below: Provider Name- Jose, Julie Provider NPI# 1447883061 Group Name- Columbus Urgent Care PA Group Tax-ID- 471914151  Thanks. ', NULL, NULL, '2020-10-22 09:47:50', '2020-10-22 09:47:50'),
(497, 2027, 66, NULL, '2020-11-06 00:00:00.000', 'Rejected', 'From: CHC.Contracting@communityhealthchoice.org  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Community Health Choice)  Good Morning Martin,     Please see attached letter for your records. Columbus is out of our service area and we are unable to process the request. You may refer to the service area map to indicate the areas where we provide network. Should you have questions or need further assistance, feel free to advise.   Have a great weekend,  Contracting Dept.', NULL, NULL, '2020-10-30 09:53:06', '2020-10-30 09:53:06'),
(498, 2027, 76, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Cigna)  May i know the current status of the provider mentioned below: Provider Name-Jose, Julie Provider NPI#1447883061 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-25 12:54:40', '2020-08-25 12:54:40'),
(499, 2027, 76, NULL, '2020-09-04 00:00:00.000', 'Approved', 'From: PDM COGZ  Dear Healthcare Professional,     \"Thank you for your submission.     Cigna Internal Reference WID #.  W202008251207048     PID  NAME  TAX ID  EFFECTIVE DATE  TERM DATE  COMMENTS  5883413  JULIE JOSE  471914151  07/28/2020  Provider Participating        **Please do not reply to this Email”** . All future request should be sent to Intake_PDM@cigna.com\"     Regards,  PDM', NULL, NULL, '2020-08-28 12:37:16', '2020-08-28 12:37:16'),
(500, 2027, 77, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub; (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks.', NULL, NULL, '2020-08-17 14:03:27', '2020-08-17 14:03:27'),
(501, 1005, 77, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:12:59', '2020-09-24 14:12:59'),
(502, 2037, 77, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email Sent: --------------  Greetings, I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status.  Please find the list below:  Columbus Urgent Care   TIN # 471914151  Brown, Brittany	NPI:1275163537   George, JeemolNPI:1497219067  Piccione JR, James M	NPI:1356321509   Thomas, Cini	NPI:1134777238  Stephen, Ani	NPI:1588959118  Joseph, Vibitha	NPI:1952931560   Jose, Julie	NPI:1447883061  Thanks.', NULL, NULL, '2020-10-23 17:22:33', '2020-10-23 17:22:33'),
(503, 2027, 77, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  This is a follow up to my last email. Kindly reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:40:30', '2020-11-18 09:40:30'),
(504, 2027, 77, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  Please find the requested information below:   Providers	NPI	Tax-ID	Practice Location	Phone & Fax #	License Information Brown, Brittany	1275163537	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP141955) (Eff Date-6/20/2019) (Exp Date-5/10/2024) Chennemkara, Mini Philip	1841755956	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140439) (Eff Date-1/31/2019) (Exp Date-5/31/2022) George, Jeemol	1497219067	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140325) (Eff Date-1/25/2019) (Exp Date-4/30/2021) Jose, Julie	1447883061	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142708) (Eff Date-8/14/2019) (Exp Date-8/31/2021) Joseph, Vibitha	1952931560	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142857) (Eff Date-8/22/2019) (Exp Date-1/31/2022) Kourouma , Odette Tiranke	1134525868	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126172) (Eff Date-8/6/2014) (Exp Date-4/30/2021) Piccione JR, James M	1356321509	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#J2973) (Eff Date-2/27/1993) (Exp Date-10/31/2021) Stephen, Ani	1588959118	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126450) (Eff Date-9/16/2014) (Exp Date-1/31/2022) Thomas, Cini	1134777238	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142314) (Eff Date-7/18/2019) (Exp Date-5/31/2022)    Thanks.', NULL, NULL, '2020-11-18 12:53:39', '2020-11-18 12:53:39'),
(505, 2027, 77, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     Please share the below information for providers. So that we can initiate to load the providers.  Practice location along with phone and fax number Date of birth and License information    Regards,  Bharath', NULL, NULL, '2020-11-18 12:54:42', '2020-11-18 12:54:42'),
(506, 2027, 77, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  May I know the current status of my request? as I have already provided you the requested information regarding the providers in my last email.  Thanks. ', NULL, NULL, '2020-11-25 10:26:40', '2020-11-25 10:26:40'),
(507, 2027, 77, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  I have already provided you the requested information in my last two emails. May I know the current status of this request? ', NULL, NULL, '2020-12-02 12:23:24', '2020-12-02 12:23:24'),
(508, 2027, 77, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     If the contract is done I will receive a provider agreement forms along with rates information which needs to be signed by providers.', NULL, NULL, '2020-12-10 12:43:47', '2020-12-10 12:43:47'),
(509, 2037, 77, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Need to allow more time for the contract', NULL, NULL, '2020-12-17 17:00:47', '2020-12-17 17:00:47'),
(510, 1006, 77, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent a follow-up email @ BharathB@aetna.com & \"Lakkakula, Shruthi\" LakkakulaS@aetna.com', NULL, NULL, '2021-01-04 18:31:37', '2021-01-04 18:31:37'),
(511, 1006, 77, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent enrollment request @ pdsdallas@aetna.com for providers. ', NULL, NULL, '2021-01-22 18:00:23', '2021-01-22 18:00:23'),
(512, 1006, 77, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent another enrollment request @ pdsdallas@aetna.com, LakkakulaS@aetna.com, BharathB@aetna.com ', NULL, NULL, '2021-02-02 18:07:58', '2021-02-02 18:07:58'),
(513, 1006, 77, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Received the following reply from thandapanim@aetna.com:  \"Hello,  We have received a request to add multiple providers under FTIN# 47-1914151, However there is no Location information. Kindly provide location information to proceed further.  Thanks, Meena.\"  Sent her the group information and address. ', NULL, NULL, '2021-02-05 13:55:23', '2021-02-05 13:55:23'),
(514, 1006, 77, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com, \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  \"Hi Brad,  Please share practice location information of below providers so that we can initiate the further process.  Regards, Bharath\"  Sent group address to them. ', NULL, NULL, '2021-02-15 10:42:41', '2021-02-15 10:42:41'),
(515, 1006, 77, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com:  \"Hi,  The below provider are loaded as per requested.\"  Asked them to send me proof of enrollment via a roster or welcome letter.', NULL, NULL, '2021-02-23 13:29:54', '2021-02-23 13:29:54'),
(516, 3040, 77, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, TalasilaB@aetna.com, MuchakurthiS@aetna.com  Subject: First Health Network - Enrollment Request Log #9266762103322409  Greetings,  Please advise me the enrollment status for the below mentioned providers. Find the attached reply that we get from your side in which you mentioned that all providers are loaded as per requested. Can you please send me the provider roster or welcome letter in which the provider is showing in the system.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 12:01:43', '2021-03-08 12:01:43'),
(517, 3040, 77, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers. ', NULL, NULL, '2021-03-16 16:30:30', '2021-03-16 16:30:30'),
(518, 3040, 77, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:43:39', '2021-06-15 10:43:39'),
(519, 3040, 77, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Online application submitted. Please see attachment.', NULL, NULL, '2021-06-29 16:57:44', '2021-06-29 16:57:44'),
(520, 3040, 77, NULL, '2021-07-26 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:58', '2021-07-19 11:31:58'),
(521, 11056, 77, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:24:06', '2021-08-04 16:24:06'),
(522, 3040, 77, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:26', '2021-08-30 12:01:26'),
(523, 10057, 77, NULL, '2021-11-12 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:07:18', '2021-11-02 14:07:18'),
(524, 10057, 77, NULL, '2021-11-24 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:09:49', '2021-11-17 17:09:49'),
(525, 10057, 77, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:36:02', '2021-11-22 17:36:02'),
(526, 10057, 77, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:42:12', '2021-11-22 17:42:12'),
(527, 10057, 77, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:05:46', '2021-12-09 11:05:46'),
(528, 10057, 77, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:34:06', '2021-12-16 14:34:06');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(529, 10057, 77, NULL, '2021-12-30 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:55:26', '2021-12-22 10:55:26'),
(530, 10057, 77, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:52:46', '2021-12-29 15:52:46'),
(531, 20067, 77, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:20:27', '2022-01-19 12:20:27'),
(532, 20067, 77, NULL, '2022-02-03 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:35:08', '2022-01-27 12:35:08'),
(533, 20067, 77, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:24:35', '2022-02-02 11:24:35'),
(534, 20067, 77, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:11:57', '2022-02-17 17:11:57'),
(535, 2027, 82, NULL, NULL, 'In Process', 'To: 	Mauricio.Chavez@molinahealthcare.com  Sub: Need Status update of the provider  Good afternoon,  We are requesting to add an individual provider (Julie Jose) in the existing group.  Following are the details:  Provider Name:  Julie Jose  Provider NPI# 1447883061   Group Name: Columbus Urgent Care PA  Group Tax ID: 471914151   We have already sent a W9 form on the company\'s letterhead which you have asked in the last email. May i know the current status of this provider and Please let us know if you need anything else from our end.      Thanks.', NULL, NULL, '2020-06-30 13:10:13', '2020-06-30 13:10:13'),
(536, 2027, 82, NULL, NULL, 'In Process', 'From: Mauricio.Chavez@molinahealthcare.com  Good morning,     I received a contract request for Julie Jose, NPI 1447883061 to under Columbus Urgent Care PA. I verified the Group NPI 1215330501 with TMHP under TPI @ 347139301 and the specialty is reflecting a physician group. When I verify the group NPI with NPPES the specialty is reflecting an urgent care. Please advise if you are wanting to contract the physician group or facility.     Thank you,', NULL, NULL, '2020-07-07 17:35:57', '2020-07-07 17:35:57'),
(537, 2027, 82, NULL, NULL, 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  Hello, Actually we want this contract with the physician group.  Thanks.', NULL, NULL, '2020-07-07 17:47:35', '2020-07-07 17:47:35'),
(538, 2027, 82, NULL, NULL, 'In Process', 'from: Mauricio.Chavez@molinahealthcare.com  Good morning,     I doubled check the Group NPI 1215330501 and we have the facility contracted as an urgent care. Please see attached.     Thank you,', NULL, NULL, '2020-07-14 11:01:49', '2020-07-14 11:01:49'),
(539, 2027, 82, NULL, NULL, 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  May I know if we need to link this provider with this urgent care or we can bill with this urgent care directly  Thanks.', NULL, NULL, '2020-07-14 11:03:32', '2020-07-14 11:03:32'),
(540, 2027, 82, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  May I know the current enrollment status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-08 10:27:52', '2020-10-08 10:27:52'),
(541, 2037, 82, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Request for Urgent Care Contract:CUC-Molina Health  Sherry Deen Attachments 5:46 PM (0 minutes ago) to Mauricio.Chavez, Abdur  Hello Mauricio,  If I may request the copy of the executed Urgent Care contract for Columbus Urgent Care PA with the Group NPI 1215330501. Also wanted to re-verify as the facility is holding an urgent care agreement so linkage of any individual provider to the TIN is not a requirement.  Attached is the W-9 Form with the letter of Intent.  Thank you!', NULL, NULL, '2020-10-23 17:51:06', '2020-10-23 17:51:06'),
(542, 2027, 82, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-16 10:20:46', '2020-11-16 10:20:46'),
(543, 2027, 82, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To:Mauricio.Chavez@molinahealthcare.com  This is a follow up email. Please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-23 09:37:57', '2020-11-23 09:37:57'),
(544, 2027, 82, NULL, '2020-11-30 00:00:00.000', 'Approved', 'This is an urgent care contract so provider don\'t need to be enrolled individually. Executed signed contract is attached. ', NULL, NULL, '2020-11-23 10:06:23', '2020-11-23 10:06:23'),
(545, 3040, 84, NULL, NULL, 'Revalidation', 'Email sent to: offlinedataintegrity@multiplan.com  Subject: MultiPlan Provider Demographic Request  Greetings,  Hope you are doing well. I am really sorry for my previous email. Please find the attached information that was requested in the previous email.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-19 17:35:03', '2021-01-19 17:35:03'),
(546, 3040, 84, NULL, '2021-06-16 00:00:00.000', 'Revalidation', 'Subject: MultiPlan Provider Demographic Request  Greetings,   This is a follow up email regarding the participating status for the below mentioned provider in our group Columbus Urgent Care PA.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-09 17:05:47', '2021-06-09 17:05:47'),
(547, 3040, 84, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Hello,   Hope you are doing well. This is a follow up email regarding the participating status for the below mentioned provider in our group Columbus Urgent Care PA.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-06-29 16:43:25', '2021-06-29 16:43:25'),
(548, 3040, 84, NULL, '2021-07-22 00:00:00.000', 'Revalidation', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan in our group under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:05', '2021-07-15 14:30:05'),
(549, 11056, 84, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-05 10:07:45', '2021-08-05 10:07:45'),
(550, 3040, 84, NULL, '2021-08-27 00:00:00.000', 'Revalidated', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:45:41', '2021-08-20 16:45:41'),
(551, 2027, 85, NULL, NULL, 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org  To; cucc@claimsmedinc.com    To:     Last Name  First Name  NPI  TIN  ORG name  George  Jeemol  1497219067  47-1914151  Columbus Urgent Care PA  Jose  Julie  1447883061  47-1914151  Columbus Urgent Care PA        Need information in the next 10 days (July 20, 2020).  No follow up email will be sent.     Here at Scott & White Health Plan (SWHP) and First Care Health Plan (FCHP) we take pride in working expeditiously to provide you with quality service in a timely and accurate manner. We have recently received a request to add a provider(s) to your existing SWHP or FCHP group agreement. In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept. and our Credentialing Verification Organization (CVO), Aperture Credentialing.     Please forward, via email to HPCREDENTIALINGEXPEDITE@BSWHealth.org, with the subject line EXPEDITED and the attached documents before the above date so we can initiate the process to start your credentialing process.     Required:  1.      Provider Information Spreadsheet – This is not your credentialing application.  This provides us information to send to Aperture to get you started with their request.  If you use CAQH please ensure your information and attestations are up to date and that you have designated SWHP and/or FCHP as an authorized provider.  If you do not use CAQH please send us your Texas Standardized Credentialing Application (TSCA) and attachments.   2.       Copy of the W-9  If applicable:  3.       Privilege Exception/Mid-Level Form - If applicable  4.       CME Acknowledgement:  For any non-boarded PHYSICIANs, who are no longer in the eligibility period for certification, SWHP and FCHP requires additional CMEs annually.  To acknowledge this requirement please sign, date, and return the attached CME form.     This will be the only request sent from SWHP and FCHP requesting these items above to initiate the credentialing process. If the information above has not been received within 10 days, you will be required to re-apply through www.swhp.org     Once we have processed the initial information the Credentialing process will begin. Once credentialing is complete, we will contact you with your effective date. If you have any questions or concerns please contact your provider relations representatives.     Thank you,', NULL, NULL, '2020-07-06 17:30:13', '2020-07-06 17:30:13'),
(552, 2027, 85, NULL, NULL, 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Please find the attached documents you have requested for jeemol george and julie jose.  Thanks. ', NULL, NULL, '2020-07-06 17:31:10', '2020-07-06 17:31:10'),
(553, 2027, 85, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  May I know the current enrollment status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-08 10:32:30', '2020-10-08 10:32:30'),
(554, 1006, 85, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-16 14:32:20', '2020-10-16 14:32:20'),
(555, 2037, 85, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-23 17:57:45', '2020-10-23 17:57:45'),
(556, 1006, 85, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Received following update from SWHP REGION 2 SWHPREGION2@bswhealth.org>:  \"Hello,  Please see notes in blue/red.   Provider Name: Vibitha Joseph – shows active under TIN 270796429 NPI# 1952931560  Provider Name: Cini Thomas – Pending CVO review. NPI# 1134777238  Provider Name: Julie Jose – Applicant in review. NPI# 1447883061  Provider Name: Odette Tiranke Kourouma – No records found, when did you submit the request? NPI# 1134525868  Provider Name: Jeemol George - Applicant in review. NPI# 1497219067  Group Name: Columbus Urgent Care PA- Applicant in review. TIN# 47-1914151  Thanks,  Jennifer C. Provider Relations Representative cid:image001.png@01D42404.EBBCB8F0 1206 West Campus Dr | MS-A4-126 | Temple, TX  76502 254-298-3064 Office | 254-298-3044 Fax\"', NULL, NULL, '2020-10-23 19:01:25', '2020-10-23 19:01:25'),
(557, 2027, 85, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: SWHPREGION2@bswhealth.org  Good morning,     The provider shows to be in applicant status. You will need to allow more time for the review to be complete.     Thank you,     Jennifer C.  Provider Relations Representative', NULL, NULL, '2020-10-26 09:44:08', '2020-10-26 09:44:08'),
(558, 2027, 85, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: SWHPREGION2@bswhealth.org  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Scott & White)  May I know the current status of the below mentioned provider: Provider Name: Jose, Julie  Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-11-02 13:52:04', '2020-11-02 13:52:04'),
(559, 2027, 85, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: SWHPREGION2@bswhealth.org  Hello,     TIN shows to be in review at this time. Please allow more time.     Thanks,     Jennifer C.  Provider Relations Representative', NULL, NULL, '2020-11-03 17:07:30', '2020-11-03 17:07:30'),
(560, 2027, 85, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: SWHPREGION2@bswhealth.org  May I know the current status of this request?', NULL, NULL, '2020-11-10 13:33:42', '2020-11-10 13:33:42'),
(561, 2027, 85, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: SWHPREGION2@bswhealth.org  May I know the current status of my request?  Thanks.', NULL, NULL, '2020-11-18 09:57:59', '2020-11-18 09:57:59'),
(562, 2027, 85, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-25 10:37:28', '2020-11-25 10:37:28'),
(563, 2027, 85, NULL, '2020-12-09 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good morning,     Please see the attached contract for Columbus Urgent Care PA TIN: 471914751  This contract contains: HMO, PPO, EPO  You contract also includes Medicare Advantage & RightCare (Medicaid)     Congratulations on joining the health plan. I have attached your contract, portal activation materials, and the current Commercial Provider Manual. You can also visit our website at the following link to access the current quick reference guide as well as the most current versions of all provider materials you may need including claims and billing information, reimbursement policies, and authorization information: https://swhp.org/en-us/prov/provider-training-manual. Please also see this link for the most current quick reference guide for the health plan: https://swhp.org/Portals/0/Files/Forms/Prov_FormsGuides/SWHP-Provider-Reference-Guide.pdf. This is updated fairly regularly and contains quick links and guidelines for web resources, claims/appeals addresses and guidelines, prior auths, how to read ID cards, and other necessary information. This final link is the most current Medicare specific orientation information: https://swhp.org/Portals/0/Files/Forms/Providers/Provider_Orientation_Medicare_Advantage.pdf. Please let me know if you have any questions or concerns and I will do my best to assist you. As part of your introduction, let me know if you would like to schedule a new provider orientation where we can discuss these materials and I can try and answer any questions you may have about joining the health plan. I will also send along information on the RightCare Medicaid line of business in just a few minutes.     Thank you,', NULL, NULL, '2020-12-02 09:42:07', '2020-12-02 09:42:07'),
(564, 2027, 86, NULL, '2020-08-21 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Superior Health)  May I know the current status of the below mentioned provider. Provider Name: Jose, Julie  Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-14 17:24:59', '2020-08-14 17:24:59'),
(565, 2027, 86, NULL, '2020-08-22 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Superior Health)  Hi Martin,  At this time all of the requested information for credentialing has been received and Julie Jose is being processed.     Sincerely,', NULL, NULL, '2020-08-15 09:39:57', '2020-08-15 09:39:57'),
(566, 2027, 86, NULL, '2020-10-15 00:00:00.000', 'Approved', 'Provider is now linked with insurance and effective date is 11/01/2020', NULL, NULL, '2020-10-08 13:07:34', '2020-10-08 13:07:34'),
(567, 2027, 87, NULL, '2020-08-21 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  May I know the current status of the below mentioned provider. Provider Name: Jose, Julie  Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-14 16:34:54', '2020-08-14 16:34:54'),
(568, 2027, 87, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Provider’s LOI is pending, Thank you for your patience', NULL, NULL, '2020-08-17 09:16:52', '2020-08-17 09:16:52'),
(569, 2027, 87, NULL, '2020-10-27 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  Please find the LOI and W9 attached in this email.  Thanks.', NULL, NULL, '2020-10-20 16:56:21', '2020-10-20 16:56:21'),
(570, 2027, 87, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (Jose, Julie)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  May I know the current status of the below mentioned provider. Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-10-30 17:36:46', '2020-10-30 17:36:46'),
(571, 2027, 87, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	TCHPNetworkManagemen@texaschildrens.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 14:30:57', '2020-11-06 14:30:57'),
(572, 2027, 87, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-13 16:39:30', '2020-11-13 16:39:30'),
(573, 2027, 87, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Please reply to me as this is my 3rd follow up.  Thanks.', NULL, NULL, '2020-11-20 09:52:53', '2020-11-20 09:52:53'),
(574, 2027, 87, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  May I know the current status of the below mentioned provider. Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-11-30 14:46:54', '2020-11-30 14:46:54'),
(575, 2037, 87, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:50:34', '2020-12-08 14:50:34'),
(576, 1006, 87, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Received following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.  Liz J. Ramirez  Texas Children’s Health Plan\" ', NULL, NULL, '2020-12-15 17:44:20', '2020-12-15 17:44:20'),
(577, 2037, 87, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-29 15:49:18', '2020-12-29 15:49:18'),
(578, 1006, 87, NULL, '2021-02-08 00:00:00.000', 'Rejected', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-02-01 11:40:51', '2021-02-01 11:40:51'),
(579, 2027, 88, NULL, NULL, 'In Process', 'To: ywyatt@humana.com, KMoten4@humana.com  Sub: Need Status Update Of Provider  Hello, We have submitted the certification file on 05/19/2020 to you to start the application process for this provider. Following are the details: Provider Name: Jose, Julie   Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Group TaxID: 471914151 May i know the current status of this provider.  Thanks.', NULL, NULL, '2020-07-01 14:34:58', '2020-07-01 14:34:58'),
(580, 2027, 88, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  To: mk@claimsmedinc.com  Hi Martin,     When certifications are submitted, they go to WPS. This provider is not yet showing certified in our system as it can take up to 120 days. If you need to check the status, you will need to call WPS.     WPS processes Certifications, once certification is completed – we (Tricare Community Liaison’s)  assist with the Credentialing application.     Please let me know if you have any questions.        Respectfully,', NULL, NULL, '2020-07-01 16:57:24', '2020-07-01 16:57:24'),
(581, 2027, 88, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  May I know the current enrollment status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-08 10:36:15', '2020-10-08 10:36:15'),
(582, 2037, 88, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Sherry Deen  5:58 PM (0 minutes ago) to ywyatt, Abdur  May I know the current enrollment status of the below mentioned provider if she is showing certified as of now?  Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-23 18:02:48', '2020-10-23 18:02:48'),
(583, 2037, 88, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent to Ywone- ------------------- Columbus Urgent Care-Jose, Julie-Tricare East  May I know the current enrollment status of the below mentioned provider if she is showing certified as of now?  Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-11-12 17:11:23', '2020-11-12 17:11:23'),
(584, 2027, 88, NULL, '2020-11-20 00:00:00.000', 'In Process', 'From: ywyatt@humana.com  Good morning Sherry,     We show this provider is in process with  credentialing. Credentialing has up to 90 days to approve a provider. Her application was submitted to credentialing on 11/4/2020 by another group. I have submit a request to get her added to this group tax id once she is approve by credentialing.', NULL, NULL, '2020-11-13 09:48:21', '2020-11-13 09:48:21'),
(585, 2027, 88, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: ywyatt@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-20 10:03:29', '2020-11-20 10:03:29'),
(586, 2027, 88, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process need more time to be completed', NULL, NULL, '2020-11-30 15:12:31', '2020-11-30 15:12:31'),
(587, 2037, 88, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Follow up email sent for status to ywyatt@humana.com ----------------- May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1) Group Name: Columbus Urgent Care PA     Group Tax-ID: 471914151       Provider Name: Jose, Julie                Provider NPI# 1447883061     --------------------------------------- 2)  Group Name: Valley Med Urgent Care (All three locations)      Group Tax-ID: 81-5123542     Provider Name: Rodriguez, Cynthia     Provider NPI# 1124282553      Provider Name: Campos, Moses                Provider NPI# 1558680009      Provider Name: Wright, Larry Donald                Provider NPI# 1033769765', NULL, NULL, '2020-12-08 15:08:47', '2020-12-08 15:08:47'),
(588, 2037, 88, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Response received from the Yvonne Wyatt --------------  Provider Name: Jose, Julie- is in process with credentialing once approve she will be activated as network.                Provider NPI# 1447883061', NULL, NULL, '2020-12-18 14:13:27', '2020-12-18 14:13:27'),
(589, 2037, 88, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-29 15:56:52', '2020-12-29 15:56:52'),
(590, 1006, 88, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ Yvonne Wyatt ywyatt@humana.com ', NULL, NULL, '2021-02-02 18:18:34', '2021-02-02 18:18:34'),
(591, 3040, 88, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status - Julie Jose  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.   Practice Name: Columbus Urgent Care PA Practice NPI# 1215330501 Practice Tax ID# 47-1914151 Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-02-15 13:53:59', '2021-02-15 13:53:59'),
(592, 3040, 88, NULL, '2021-02-23 00:00:00.000', 'Approved', 'I had a word with (Erin) Tricare representative and she said the provider Get Credentialed: 01/26/2021.   See attachment.', NULL, NULL, '2021-02-16 14:50:00', '2021-02-16 14:50:00'),
(593, 2027, 89, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: trpndataentry@trpnppo.com  May I know the current enrollment status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-08 10:39:27', '2020-10-08 10:39:27'),
(594, 2037, 89, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Follow up email sent: trpndataentry@trpnppo.com ---------------- ', NULL, NULL, '2020-10-28 17:03:59', '2020-10-28 17:03:59'),
(595, 2027, 89, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: trpndataentry@trpnppo.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.  ', NULL, NULL, '2020-11-18 10:15:58', '2020-11-18 10:15:58'),
(596, 2027, 89, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: trpndataentry@trpnppo.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-25 10:47:33', '2020-11-25 10:47:33'),
(597, 2027, 89, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: trpndataentry@trpnppo.com   May I know the current enrollment status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-12-02 12:51:57', '2020-12-02 12:51:57'),
(598, 2027, 89, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: trpndataentry@trpnppo.com   May I know the current enrollment status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061  Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-12-10 12:46:13', '2020-12-10 12:46:13'),
(599, 2037, 89, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-12-18 13:42:36', '2020-12-18 13:42:36'),
(600, 2037, 89, NULL, '2021-01-08 00:00:00.000', 'In Process', '	 Another follow up email sent', NULL, NULL, '2020-12-29 16:31:59', '2020-12-29 16:31:59'),
(601, 1006, 89, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ trpndataentry@trpnppo.com', NULL, NULL, '2021-02-02 18:10:17', '2021-02-02 18:10:17'),
(602, 3040, 89, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject:  Julie Jose - CUCC  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned provider.   Provider Name: Julie Jose NPI# 1447883061 TIN# 47-1914151  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-18 17:58:36', '2021-02-18 17:58:36'),
(603, 3040, 89, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: 	trpndataentry@trpnppo.com  Subject: Julie Jose - CUCC  Greetings,  I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Columbus Urgent Care PA Practice NPI# 1215330501 Practice Tax ID#  47-1914151 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Name: Julie Jose NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-25 12:49:20', '2021-02-25 12:49:20'),
(604, 3040, 89, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 14:35:57', '2021-05-19 14:35:57'),
(605, 3040, 89, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:47', '2021-06-08 12:09:47'),
(606, 3040, 89, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:19', '2021-06-08 12:32:19'),
(607, 3040, 89, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:43:33', '2021-06-20 16:43:33'),
(608, 2027, 90, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:59:01', '2020-10-12 17:59:01'),
(609, 1006, 90, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:49:47', '2020-10-26 13:49:47'),
(610, 2027, 90, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:16:28', '2020-11-06 10:16:28'),
(611, 2027, 90, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:50:08', '2020-11-13 16:50:08'),
(612, 2027, 90, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:27:52', '2020-11-20 12:27:52'),
(613, 2027, 90, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:28:31', '2020-11-20 12:28:31'),
(614, 2027, 90, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:51:20', '2020-11-30 15:51:20'),
(615, 2037, 90, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:33', '2020-12-08 17:17:33'),
(616, 1006, 90, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:39:03', '2020-12-15 17:39:03'),
(617, 2037, 90, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:50:46', '2020-12-22 17:50:46'),
(618, 1006, 90, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:11:49', '2021-01-05 18:11:49'),
(619, 1006, 90, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:54:35', '2021-02-02 17:54:35'),
(620, 1006, 90, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:24:08', '2021-02-11 10:24:08'),
(621, 3040, 90, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:43:48', '2021-05-20 14:43:48'),
(622, 2027, 92, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  May i know the current application status of this provider, her details are mentioned below: Provider Name: Stephen, Ani   Provider NPI# 1588959118   Thanks.   ', NULL, NULL, '2020-10-11 16:10:49', '2020-10-11 16:10:49'),
(623, 2037, 92, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-26 17:17:56', '2020-10-26 17:17:56'),
(624, 2037, 92, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Follow up email sent to Corey', NULL, NULL, '2020-11-19 17:36:19', '2020-11-19 17:36:19'),
(625, 2037, 92, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Response received.  Subject: Stephen, Ani-Longpoint Medical Center-UHC', NULL, NULL, '2020-11-23 15:13:51', '2020-11-23 15:13:51'),
(626, 2037, 92, NULL, '2020-12-08 00:00:00.000', 'Approved', 'Roaster received with Par plan Details and effective dates. Linked to LPMC individual TIN. Effective 05/04/2020.Roaster uploaded in EMRBS', NULL, NULL, '2020-12-01 09:52:39', '2020-12-01 09:52:39'),
(627, 2027, 94, NULL, NULL, 'In Process', 'From: txcredentialing@amerigroup.com  To: ma@claimsmedinc.com  Amerigroup contracted Columbus Urgent Care as a facility and will be globally, which means that the rendering NPI will be that of the Urgent Care, not the individual.   ', NULL, NULL, '2020-07-06 12:36:15', '2020-07-06 12:36:15'),
(628, 2027, 94, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  The Columbus urgent care NPI#1215330501 is this. ', NULL, NULL, '2020-07-06 12:37:04', '2020-07-06 12:37:04'),
(629, 2027, 94, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Jason.Hughes@amerigroup.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Amerigroup)  May I know the current status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501  Thanks.  ', NULL, NULL, '2020-10-08 10:11:53', '2020-10-08 10:11:53'),
(630, 2037, 94, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent for Jeemol George @ Jason.Hughes@amerigroup.com & txcredentialing@amerigroup.com  May I know the current status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501  Thanks.  ', NULL, NULL, '2020-10-22 17:49:26', '2020-10-22 17:49:26'),
(631, 2027, 94, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-13 13:00:09', '2020-11-13 13:00:09'),
(632, 2027, 94, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com Jason.Hughes@amerigroup.com  Please reply to me as this is my 3rd follow up.  Thanks.', NULL, NULL, '2020-11-20 10:16:18', '2020-11-20 10:16:18'),
(633, 2027, 94, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com Jason.Hughes@amerigroup.com  May I know the current status of the below mentioned provider: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501  Thanks.    ', NULL, NULL, '2020-11-30 12:45:25', '2020-11-30 12:45:25'),
(634, 2037, 94, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Another follow up email sent to txcredentialing@amerigroup.com', NULL, NULL, '2020-12-08 12:35:32', '2020-12-08 12:35:32'),
(635, 1006, 94, NULL, '2020-12-16 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020 ', NULL, NULL, '2020-12-09 09:53:53', '2020-12-09 09:53:53'),
(636, 2027, 95, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Community Health Choice)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-24 17:20:49', '2020-08-24 17:20:49');
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
(637, 2027, 95, NULL, '2020-09-04 00:00:00.000', 'Rejected', 'From: CHC.Contracting@communityhealthchoice.org  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Community Health Choice)  Good Afternoon Martin,     Please see attached letter for your records and refer to the service area map to indicate the areas where we provide service. Should you have questions or concerns, feel free to advise.   Best regards,  Contracting team', NULL, NULL, '2020-08-28 15:23:33', '2020-08-28 15:23:33'),
(638, 2027, 96, NULL, NULL, 'In Process', 'Talk to the representative her name is nita and ref# 12130587 she said she did not find any record under the tax id of CUCC so now i have requested her to start the process for this provider under this tax id so the application is in process.', NULL, NULL, '2020-07-09 14:43:02', '2020-07-09 14:43:02'),
(639, 2027, 96, NULL, '2020-10-15 00:00:00.000', 'Approved', 'The provider is now showing linked with the insurance and the effective date is 07/13/2020. Screenshot from provider directory is already attached as a confirmation', NULL, NULL, '2020-10-08 09:51:04', '2020-10-08 09:51:04'),
(640, 2027, 97, NULL, NULL, 'In Process', 'To: 	SidleyJ1@firsthealth.com, \"Lakkakula, Shruthi\" LakkakulaS@aetna.com, AbhishekV@aetna.com, MuchakurthiS@aetna.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(First Health)  May i know the current status of provider as we have already submitted the application online and sent the W9 and LOI also. Provider details are mentioned below: Provider Name:  George, Jeemol  Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-07-09 14:52:58', '2020-07-09 14:52:58'),
(641, 2027, 97, NULL, NULL, 'In Process', 'From; LakkakulaS@aetna.com  Hello Martin,     The below provider “George, Jeemol” is not contracted with Coventry National.     Kindly, let us know if you need any additional information.   ', NULL, NULL, '2020-07-13 10:14:37', '2020-07-13 10:14:37'),
(642, 2027, 97, NULL, NULL, 'In Process', 'To: LakkakulaS@aetna.com  We have already submitted the application online and sent the W9 and LOI also and I am attaching these documents as a proof in this email for you. Kindly check this application again in your system.  Thanks ', NULL, NULL, '2020-07-13 10:15:35', '2020-07-13 10:15:35'),
(643, 2027, 97, NULL, '2020-08-24 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  Sub: (Providers)-(Columbus Urgent Care PA)-(First Health)  I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status. Please find the list below  Providers	Provider-NPI#	Group Tax-ID	Group Name	First Health Status Brown, Brittany	1275163537	471914151	Columbus Urgent Care PA	Application Submitted George, Jeemol	1497219067	471914151	Columbus Urgent Care PA	Application Submitted Piccione JR, James M	1356321509	471914151	Columbus Urgent Care PA	Application Submitted Thomas, Cini	1134777238	471914151	Columbus Urgent Care PA	Application Submitted Stephen, Ani	1588959118	471914151	Columbus Urgent Care PA	Application Submitted Joseph, Vibitha	1952931560	471914151	Columbus Urgent Care PA	Application Submitted Jose, Julie	1447883061	471914151	Columbus Urgent Care PA	Application Submitted   Thanks.', NULL, NULL, '2020-08-17 13:53:25', '2020-08-17 13:53:25'),
(644, 1005, 97, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:12:40', '2020-09-24 14:12:40'),
(645, 2037, 97, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email Sent: --------------  Greetings, I am sending you a list of providers who are already in an enrollment process with first health. I just want to know their current status.  Please find the list below:  Columbus Urgent Care   TIN # 471914151  Brown, Brittany	NPI:1275163537   George, JeemolNPI:1497219067  Piccione JR, James M	NPI:1356321509   Thomas, Cini	NPI:1134777238  Stephen, Ani	NPI:1588959118  Joseph, Vibitha	NPI:1952931560   Jose, Julie	NPI:1447883061  Thanks.', NULL, NULL, '2020-10-23 17:22:19', '2020-10-23 17:22:19'),
(646, 2027, 97, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: LakkakulaS@aetna.com  This is a follow up to my last email. Kindly reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:43:35', '2020-11-18 09:43:35'),
(647, 2027, 97, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     Please share the below information for providers. So that we can initiate to load the providers.  Practice location along with phone and fax number Date of birth and License information    Regards,  Bharath', NULL, NULL, '2020-11-18 12:55:32', '2020-11-18 12:55:32'),
(648, 2027, 97, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  Please find the requested information below:   Providers	NPI	Tax-ID	Practice Location	Phone & Fax #	License Information Brown, Brittany	1275163537	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP141955) (Eff Date-6/20/2019) (Exp Date-5/10/2024) Chennemkara, Mini Philip	1841755956	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140439) (Eff Date-1/31/2019) (Exp Date-5/31/2022) George, Jeemol	1497219067	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP140325) (Eff Date-1/25/2019) (Exp Date-4/30/2021) Jose, Julie	1447883061	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142708) (Eff Date-8/14/2019) (Exp Date-8/31/2021) Joseph, Vibitha	1952931560	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142857) (Eff Date-8/22/2019) (Exp Date-1/31/2022) Kourouma , Odette Tiranke	1134525868	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126172) (Eff Date-8/6/2014) (Exp Date-4/30/2021) Piccione JR, James M	1356321509	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#J2973) (Eff Date-2/27/1993) (Exp Date-10/31/2021) Stephen, Ani	1588959118	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP126450) (Eff Date-9/16/2014) (Exp Date-1/31/2022) Thomas, Cini	1134777238	27-0796429	(Columbus Urgent Care PA-926 Walnut St,Columbus , TX 78934-2215)	(T) (979) 942-9084   (F) (979) 942-9085	(State Lic#AP142314) (Eff Date-7/18/2019) (Exp Date-5/31/2022)    Thanks.', NULL, NULL, '2020-11-18 12:56:01', '2020-11-18 12:56:01'),
(649, 2027, 97, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  May I know the current status of my request? as I have already provided you the requested information regarding the providers in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:27:05', '2020-11-25 10:27:05'),
(650, 2027, 97, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  I have already provided you the requested information in my last two emails. May I know the current status of this request?', NULL, NULL, '2020-12-02 12:24:18', '2020-12-02 12:24:18'),
(651, 2027, 97, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: BharathB@aetna.com  Hi Martin,     If the contract is done I will receive a provider agreement forms along with rates information which needs to be signed by providers.', NULL, NULL, '2020-12-10 12:48:02', '2020-12-10 12:48:02'),
(652, 2037, 97, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Need to allow more time for the contract', NULL, NULL, '2020-12-17 16:59:52', '2020-12-17 16:59:52'),
(653, 1006, 97, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent enrollment request @ pdsdallas@aetna.com for providers. ', NULL, NULL, '2021-01-22 18:00:45', '2021-01-22 18:00:45'),
(654, 1006, 97, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent another enrollment request @ pdsdallas@aetna.com, LakkakulaS@aetna.com, BharathB@aetna.com ', NULL, NULL, '2021-02-02 18:08:11', '2021-02-02 18:08:11'),
(655, 1006, 97, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Received the following reply from thandapanim@aetna.com:  \"Hello,  We have received a request to add multiple providers under FTIN# 47-1914151, However there is no Location information. Kindly provide location information to proceed further.  Thanks, Meena.\"  Sent her the group information and address. ', NULL, NULL, '2021-02-05 13:55:31', '2021-02-05 13:55:31'),
(656, 3040, 97, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: thandapanim@aetna.com  Subject: Send Secure [EXTERNAL] First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Morning,  We wish to enroll the following providers to the given group, the information is as follows. We already sent the address to you.   Group Name: Columbus Urgent Care PA TIN# 47-1914151 Ph# (979) 942-9084 Fax# (979) 942-9085 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Julie Jose NPI# 1447883061  Provider Name: Brittany Brown NPI# 1275163537  Provider Name: Cini Thomas NPI# 1134777238  Provider Name: Ani Stephen NPI# 1588959118  Provider Name: Vibitha Joseph NPI# 1952931560  Provider Name: Jeemol George NPI# 1497219067  Please let me know what is required to get these providers enrolled as in-network with Firsthealth ASAP.   Thanks.', NULL, NULL, '2021-02-12 11:05:27', '2021-02-12 11:05:27'),
(657, 1006, 97, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com cc \"Talasila, Bala M\" TalasilaB@aetna.com, \"Muchakurthi, Satish Kumar X\" MuchakurthiS@aetna.com:  \"Hi Brad,  Please share practice location information of below providers so that we can initiate the further process.  Regards, Bharath\"  Sent group address to them. ', NULL, NULL, '2021-02-15 10:43:23', '2021-02-15 10:43:23'),
(658, 1006, 97, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following reply from Bharath, Bollu BharathB@aetna.com:  \"Hi,  The below provider are loaded as per requested.\"  Asked them to send me proof of enrollment via a roster or welcome letter. ', NULL, NULL, '2021-02-23 13:30:14', '2021-02-23 13:30:14'),
(659, 3040, 97, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: BharathB@aetna.com, TalasilaB@aetna.com, MuchakurthiS@aetna.com  Subject: First Health Network - Enrollment Request Log #9266762103322409  Greetings,  Please advise me the enrollment status for the below mentioned providers. Find the attached reply that we get from your side in which you mentioned that all providers are loaded as per requested. Can you please send me the provider roster or welcome letter in which the provider is showing in the system.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 12:01:48', '2021-03-08 12:01:48'),
(660, 3040, 97, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers. ', NULL, NULL, '2021-03-16 16:30:36', '2021-03-16 16:30:36'),
(661, 3040, 97, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:43:21', '2021-06-15 10:43:21'),
(662, 3040, 97, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'Online application submitted. Please see attachment.', NULL, NULL, '2021-06-29 16:57:42', '2021-06-29 16:57:42'),
(663, 3040, 97, NULL, '2021-07-26 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:56', '2021-07-19 11:31:56'),
(664, 11056, 97, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:23:17', '2021-08-04 16:23:17'),
(665, 11056, 97, NULL, '2021-08-12 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:23:51', '2021-08-04 16:23:51'),
(666, 3040, 97, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:25', '2021-08-30 12:01:25'),
(667, 10057, 97, NULL, '2021-11-09 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:07:10', '2021-11-02 14:07:10'),
(668, 10057, 97, NULL, '2021-11-24 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:09:43', '2021-11-17 17:09:43'),
(669, 10057, 97, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:35:57', '2021-11-22 17:35:57'),
(670, 10057, 97, NULL, '2021-11-29 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:42:07', '2021-11-22 17:42:07'),
(671, 10057, 97, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:05:41', '2021-12-09 11:05:41'),
(672, 10057, 97, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:34:00', '2021-12-16 14:34:00'),
(673, 10057, 97, NULL, '2021-12-30 00:00:00.000', 'Revalidation', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:55:17', '2021-12-22 10:55:17'),
(674, 10057, 97, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:52:42', '2021-12-29 15:52:42'),
(675, 20067, 97, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:20:21', '2022-01-19 12:20:21'),
(676, 20067, 97, NULL, '2022-02-03 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:34:53', '2022-01-27 12:34:53'),
(677, 20067, 97, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:21:27', '2022-02-02 11:21:27'),
(678, 20067, 97, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:11:52', '2022-02-17 17:11:52'),
(679, 2027, 98, NULL, NULL, 'In Process', 'From: ywyatt@humana.com  Hello Martin,  The date on this application is still within the 120 days\' timeline for WPS to process. We can\'t forward the application to WPS without a fax confirmation as proof it was submitted and the date has to be over 90 days for WPS to assist.  WPS will send a letter once the application is complete.     Thanks,', NULL, NULL, '2020-07-17 11:25:02', '2020-07-17 11:25:02'),
(680, 2027, 98, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: ywyatt@humana.com KMoten4@humana.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Humana)  May I know the current enrollment status of the below mentioned provider with (Humana):  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.  ', NULL, NULL, '2020-10-08 10:10:31', '2020-10-08 10:10:31'),
(681, 2037, 98, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent to yawett', NULL, NULL, '2020-10-28 17:01:27', '2020-10-28 17:01:27'),
(682, 2027, 98, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: ywyatt@humana.com KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.   Thanks.', NULL, NULL, '2020-11-16 09:49:10', '2020-11-16 09:49:10'),
(683, 2027, 98, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  May I know the current enrollment status of the below mentioned provider with (Humana):  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.  ', NULL, NULL, '2020-11-23 09:30:29', '2020-11-23 09:30:29'),
(684, 2027, 98, NULL, '2020-11-30 00:00:00.000', 'In Process', 'From: HumanaHoustonPD@humana.com  There are no prior requests to add this provider to Columbus Urgent Care on file in this mailbox.      Follow the below instructions to add new practitioners to an existing group.     Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the professional network roster.     Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.     Look forward to receiving your documents.     HumanaHoustonPD', NULL, NULL, '2020-11-23 15:40:49', '2020-11-23 15:40:49'),
(685, 2027, 98, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  Please find the roster attached in this email along with the w9.  Thanks.', NULL, NULL, '2020-11-23 15:41:25', '2020-11-23 15:41:25'),
(686, 2027, 98, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  May I know the current status of this request?', NULL, NULL, '2020-11-30 13:04:37', '2020-11-30 13:04:37'),
(687, 2027, 98, NULL, '2020-12-09 00:00:00.000', 'In Process', 'From: HumanaHoustonPD@humana.com  Please see item highlighted in yellow.  Request was receive 11/23/2020.  Allow 60 days for update.  You may verify status yourself by checking the Humana on-line directory.   You may also follow up after 60 days with Provider Relations at 800-448-6262 or 800-626-2741.     Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  ', NULL, NULL, '2020-12-02 09:07:51', '2020-12-02 09:07:51'),
(688, 2027, 98, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 12:50:47', '2020-12-10 12:50:47'),
(689, 2037, 98, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-17 17:01:46', '2020-12-17 17:01:46'),
(690, 2037, 98, NULL, '2020-12-28 00:00:00.000', 'Approved', 'Email received! Columbus is contracted as an Ancillary facility. We do not load/link individual physicians to this TIN.  Yes.   However, we recommend that you list the Billing NPI in both the billing and rendering fields.  --------------------- Contract uploaded and Notification sent to the billing. Par Plans: ------------ Commercial PPO Plans. Commercial HMO Plans. Commercial POS Plans. Commercial EPO Plans. Commercial Open Access Plans. Medicare PPO Plans. Medicare Network PFFS Plans. Traditional Plans. Choice POS Plans.', NULL, NULL, '2020-12-21 17:45:41', '2020-12-21 17:45:41'),
(691, 2027, 99, NULL, NULL, 'In Process', 'talked to the representative her name is rina ref# 39156572001 she said  the provider application is in process but in order to complete this application we have fulfill the  requirements by today 06/18/2020 or we have to restart the process all over.  i gave our fax# to her to get the documents they want us to fill and send them back.  ', NULL, NULL, '2020-06-18 10:01:29', '2020-06-18 10:01:29'),
(692, 2027, 99, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Medicaid initiated again for this provider and ticket# is 17215477', NULL, NULL, '2020-09-16 17:08:43', '2020-09-16 17:08:43'),
(693, 2027, 99, NULL, '2020-10-28 00:00:00.000', 'Approved', 'Provider is now showing linked to the insurance and the effective date is 02/07/2020', NULL, NULL, '2020-10-21 10:13:58', '2020-10-21 10:13:58'),
(694, 1006, 103, NULL, NULL, 'In Process', 'Received following update from MHTX Provider Services MHTXProviderServices@molinahealthcare.com>:   \"Good Afternoon Luis,  If you can please assist with this request. Upon reaching out to the contract department for status update for provider below, they were unable to process this request as TIN is missing. If you could please fix and send over to them for processing. If you and your colleagues are in need of status update please reach out to TexasExpansionContracting TexasExpansionContracting@MolinaHealthCare.Com as they are a direct point of contact and they are the ones that process these request.  Thank you, Jamie Llefi | Provider Service Representative I | Houston/Jefferson/ SDA Molina Healthcare of Texas, Inc.\"', NULL, NULL, '2020-07-02 14:29:16', '2020-07-02 14:29:16'),
(695, 1006, 103, NULL, NULL, 'In Process', 'Sent following email with corrected CRF to TexasExpansionContracting TexasExpansionContracting@MolinaHealthCare.Com>:   \"Hello,   Please find the corrected CRF, also please expedite this request as it has been over a month since it was submitted and we were under the impression that it was in-process.   Thanks.\"', NULL, NULL, '2020-07-02 14:36:28', '2020-07-02 14:36:28'),
(696, 2027, 103, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: TexasExpansionContracting@molinahealthcare.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Molina Health)  May I know the current enrollment status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.  ', NULL, NULL, '2020-10-08 10:16:06', '2020-10-08 10:16:06'),
(697, 2037, 103, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Follow up email sent: -------------- Greetings, May I know the current enrollment status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.  ', NULL, NULL, '2020-10-23 17:29:30', '2020-10-23 17:29:30'),
(698, 2027, 103, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: TexasExpansionContracting@molinahealthcare.com  This is a follow up email. Please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-11 13:35:29', '2020-11-11 13:35:29'),
(699, 2027, 103, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: TexasExpansionContracting@molinahealthcare.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 09:47:09', '2020-11-18 09:47:09'),
(700, 2027, 103, NULL, '2020-11-30 00:00:00.000', 'Approved', 'This is an urgent care contract so provider don\'t need to be enrolled individually. Executed signed contract is attached.', NULL, NULL, '2020-11-23 09:57:58', '2020-11-23 09:57:58'),
(701, 2027, 105, NULL, NULL, 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org  To: cucc@claimsmedinc.com    To:     Last Name  First Name  NPI  TIN  ORG name  George  Jeemol  1497219067  47-1914151  Columbus Urgent Care PA  Jose  Julie  1447883061  47-1914151  Columbus Urgent Care PA        Need information in the next 10 days (July 20, 2020).  No follow up email will be sent.     Here at Scott & White Health Plan (SWHP) and First Care Health Plan (FCHP) we take pride in working expeditiously to provide you with quality service in a timely and accurate manner. We have recently received a request to add a provider(s) to your existing SWHP or FCHP group agreement. In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept. and our Credentialing Verification Organization (CVO), Aperture Credentialing.     Please forward, via email to HPCREDENTIALINGEXPEDITE@BSWHealth.org, with the subject line EXPEDITED and the attached documents before the above date so we can initiate the process to start your credentialing process.     Required:  1.      Provider Information Spreadsheet – This is not your credentialing application.  This provides us information to send to Aperture to get you started with their request.  If you use CAQH please ensure your information and attestations are up to date and that you have designated SWHP and/or FCHP as an authorized provider.  If you do not use CAQH please send us your Texas Standardized Credentialing Application (TSCA) and attachments.   2.       Copy of the W-9  If applicable:  3.       Privilege Exception/Mid-Level Form - If applicable  4.       CME Acknowledgement:  For any non-boarded PHYSICIANs, who are no longer in the eligibility period for certification, SWHP and FCHP requires additional CMEs annually.  To acknowledge this requirement please sign, date, and return the attached CME form.     This will be the only request sent from SWHP and FCHP requesting these items above to initiate the credentialing process. If the information above has not been received within 10 days, you will be required to re-apply through www.swhp.org     Once we have processed the initial information the Credentialing process will begin. Once credentialing is complete, we will contact you with your effective date. If you have any questions or concerns please contact your provider relations representatives.     Thank you,', NULL, NULL, '2020-07-06 17:24:51', '2020-07-06 17:24:51'),
(702, 2027, 105, NULL, NULL, 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Please find the attached documents you have requested for jeemol george and julie jose.  Thanks.  ', NULL, NULL, '2020-07-06 17:25:45', '2020-07-06 17:25:45'),
(703, 2027, 105, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub; (George, Jeemol)-(Columbus Urgent Care PA)-(Scott & White)  May I know the current enrollment status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks. ', NULL, NULL, '2020-10-08 10:19:25', '2020-10-08 10:19:25'),
(704, 1006, 105, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-16 14:32:32', '2020-10-16 14:32:32'),
(705, 2037, 105, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-23 17:31:35', '2020-10-23 17:31:35'),
(706, 2027, 105, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: SWHPREGION2@bswhealth.org  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Scott & White)  Good morning,     The provider shows to be in applicant status. You will need to allow more time for the review to be complete.     Thank you,     Jennifer C.  Provider Relations Representative', NULL, NULL, '2020-10-26 09:42:42', '2020-10-26 09:42:42'),
(707, 2027, 105, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org SWHPREGION2@bswhealth.org  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Scott & White)  May I know the current enrollment status of the below mentioned provider: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks. ', NULL, NULL, '2020-11-02 12:20:26', '2020-11-02 12:20:26'),
(708, 2027, 105, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: SWHPREGION2@bswhealth.org  Hello,     TIN shows to be in review at this time. Please allow more time.     Thanks,     Jennifer C.  Provider Relations Representative', NULL, NULL, '2020-11-03 17:08:31', '2020-11-03 17:08:31'),
(709, 2027, 105, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: SWHPREGION2@bswhealth.org  May I know the current status of this request?  Thanks.', NULL, NULL, '2020-11-10 13:25:48', '2020-11-10 13:25:48'),
(710, 2027, 105, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  May I know the current status of my request?  Thanks.', NULL, NULL, '2020-11-18 10:05:59', '2020-11-18 10:05:59'),
(711, 2027, 105, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Request is still in process.', NULL, NULL, '2020-11-25 10:38:10', '2020-11-25 10:38:10'),
(712, 2027, 105, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Request is still in process.', NULL, NULL, '2020-11-25 10:38:11', '2020-11-25 10:38:11'),
(713, 2027, 105, NULL, '2020-12-09 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good morning,     Please see the attached contract for Columbus Urgent Care PA TIN: 471914751  This contract contains: HMO, PPO, EPO  You contract also includes Medicare Advantage & RightCare (Medicaid)     Congratulations on joining the health plan. I have attached your contract, portal activation materials, and the current Commercial Provider Manual. You can also visit our website at the following link to access the current quick reference guide as well as the most current versions of all provider materials you may need including claims and billing information, reimbursement policies, and authorization information: https://swhp.org/en-us/prov/provider-training-manual. Please also see this link for the most current quick reference guide for the health plan: https://swhp.org/Portals/0/Files/Forms/Prov_FormsGuides/SWHP-Provider-Reference-Guide.pdf. This is updated fairly regularly and contains quick links and guidelines for web resources, claims/appeals addresses and guidelines, prior auths, how to read ID cards, and other necessary information. This final link is the most current Medicare specific orientation information: https://swhp.org/Portals/0/Files/Forms/Providers/Provider_Orientation_Medicare_Advantage.pdf. Please let me know if you have any questions or concerns and I will do my best to assist you. As part of your introduction, let me know if you would like to schedule a new provider orientation where we can discuss these materials and I can try and answer any questions you may have about joining the health plan. I will also send along information on the RightCare Medicaid line of business in just a few minutes.     Thank you,', NULL, NULL, '2020-12-02 09:45:02', '2020-12-02 09:45:02'),
(714, 2027, 106, NULL, '2020-08-22 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Superior Health)  May I know the current status of the below mentioned provider. Provider Name:George, Jeemol  Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-15 09:56:48', '2020-08-15 09:56:48'),
(715, 2027, 106, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Superior Health)  Good Afternoon Martin     I hope you are doing well. The provider is still in credentialing and was ready for processing on 6/3/2020 and it could take up to 90-120 days to complete. The provider is still in the credentialing process and you can follow-up next month for an update.     Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks', NULL, NULL, '2020-08-17 17:19:45', '2020-08-17 17:19:45'),
(716, 2027, 106, NULL, '2020-09-25 00:00:00.000', 'In Process', 'From: Alberta.Randall@superiorhealthplan.com  Hello,     Thank you for your interest in Superior HealthPlan of Texas. We have received your credentialing application for Jeemol George ; however, we did not receive all of the documentation necessary to complete the credentialing process. Please submit the requested item(s) within the next 3 days marked below:     ·          Disclosure of Prior Contracts or Business with Superior HealthPlan pg. 12 – please check yes or no and provide signature, printed name, title and signature date     You may fax or email the requested information to the contact information listed below.     Thank You,', NULL, NULL, '2020-09-18 15:10:55', '2020-09-18 15:10:55'),
(717, 2027, 106, NULL, '2020-09-25 00:00:00.000', 'In Process', 'To: Alberta.Randall@superiorhealthplan.com  Please find the requested document attached in this email.  Thanks.', NULL, NULL, '2020-09-18 15:11:35', '2020-09-18 15:11:35'),
(718, 2027, 106, NULL, '2020-10-16 00:00:00.000', 'Approved', 'Provider is now showing linked with insurance and effective date is 11/01/2020. welcome letter is attached ', NULL, NULL, '2020-10-09 13:12:00', '2020-10-09 13:12:00'),
(719, 2027, 107, NULL, '2020-08-21 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  May I know the current status of the below mentioned provider. Provider Name:George, Jeemol   Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-14 15:35:24', '2020-08-14 15:35:24'),
(720, 2027, 107, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Provider’s LOI is pending, thank you for your patience.', NULL, NULL, '2020-08-17 09:21:43', '2020-08-17 09:21:43'),
(721, 2027, 107, NULL, '2020-10-27 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Please find the LOI attached in this email as per your request.   Thanks. ', NULL, NULL, '2020-10-20 16:46:10', '2020-10-20 16:46:10'),
(722, 2027, 107, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Texas Children Health Plan)  May I know the current status of the below mentioned provider. Provider Name:George, Jeemol   Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-10-30 17:22:32', '2020-10-30 17:22:32'),
(723, 2027, 107, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  This is a followup email. Please reply to me as soon as possible  Thanks.', NULL, NULL, '2020-11-06 13:46:59', '2020-11-06 13:46:59'),
(724, 2027, 107, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  This is a followup email. Please reply to me as soon as possible  Thanks.', NULL, NULL, '2020-11-13 16:41:05', '2020-11-13 16:41:05'),
(725, 2027, 107, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Please reply to me as this is my 3rd follow up.  Thanks.', NULL, NULL, '2020-11-20 09:58:26', '2020-11-20 09:58:26'),
(726, 2027, 107, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  May I know the current status of the below mentioned provider. Provider Name:George, Jeemol   Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-11-30 14:50:52', '2020-11-30 14:50:52'),
(727, 2037, 107, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:50:48', '2020-12-08 14:50:48'),
(728, 1006, 107, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for updated status. ', NULL, NULL, '2020-12-15 17:52:44', '2020-12-15 17:52:44'),
(729, 2037, 107, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-12-23 10:20:33', '2020-12-23 10:20:33'),
(730, 1006, 107, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2021-01-04 18:27:14', '2021-01-04 18:27:14');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(731, 1006, 107, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2021-02-02 18:21:53', '2021-02-02 18:21:53'),
(732, 1006, 107, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Received response that request is still in process:  \"Provider  Name: Jeemol George-PIF in process NPI# 1497219067\"', NULL, NULL, '2021-02-03 09:43:49', '2021-02-03 09:43:49'),
(733, 3040, 107, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Enrollment Status || George, Jeemol || Columbus Urgent Care PA || TCHP ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501 Group Address: 926 Walnut St,  Columbus , TX 78934-2215  Provider Name: George, Jeemol Provider NPI# 1497219067  If you need any additional information please feel free to email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-15 14:13:03', '2021-02-15 14:13:03'),
(734, 3040, 107, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:46', '2021-05-19 13:58:46'),
(735, 2027, 108, NULL, NULL, 'In Process', 'To: ywyatt@humana.com, KMoten4@humana.com  Sub: Need Status Update Of Provider  Hello, We have submitted the certification file on 05/19/2020 to you to start the application process for this provider. Following are the details: Provider Name:  George, Jeemol  Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group TaxID: 471914151 May i know the current status of this provider.  Thanks.', NULL, NULL, '2020-07-01 14:27:25', '2020-07-01 14:27:25'),
(736, 2027, 108, NULL, NULL, 'In Process', 'From: ywyatt@humana.com  Good morning Martin,     We do not have visual access  to WPS system to give status on the applications you sent to them. In order to assist, we need a copy of the application you sent to WPS along with the faxed confirmation.             Thanks,', NULL, NULL, '2020-07-14 09:31:22', '2020-07-14 09:31:22'),
(737, 2027, 108, NULL, NULL, 'In Process', 'To: ywyatt@humana.com  Please find the attached certification application which you have requested. I don\'t have the faxed confirmation record right now because i am having some problem in my system, kindly look into this matter and reply me back thanks.', NULL, NULL, '2020-07-14 09:32:41', '2020-07-14 09:32:41'),
(738, 2027, 108, NULL, NULL, 'Approved', 'Received confirmation from insurance provider is now in network with effective date 07/21/2020 welcome letter attached', NULL, NULL, '2020-07-29 17:31:44', '2020-07-29 17:31:44'),
(739, 2027, 108, NULL, NULL, 'Approved', 'To: billing@claimsmedinc.com credentialing@claimsmedinc.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Tricare)  Hello,  I want to inform the billing department regarding provider Jeemol George this provider is now in network with an effective date of 7/21/2020 with Tricare. Please start sending test claims.   Also I am attaching the welcome letter for the confirmation, this is not a plan specific approval.', NULL, NULL, '2020-07-29 17:55:07', '2020-07-29 17:55:07'),
(740, 2027, 109, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: providerrelations@trpnppo.com  Sub: (George, Jeemol)-(Columbus Urgent Care PA)-(Three Rivers Provider Network - TRPN)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Columbus Urgent Care PA Group Tax-ID-471914151  Thanks.', NULL, NULL, '2020-08-25 13:01:36', '2020-08-25 13:01:36'),
(741, 2027, 109, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: providerrelations@trpnppo.com   Hello Martin,     Below provider is not showing link to your tax id number. Is there any way you might be able to provided us your initial request or have attach link for fill out and sent back.', NULL, NULL, '2020-08-25 14:36:09', '2020-08-25 14:36:09'),
(742, 2027, 109, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To:providerrelations@trpnppo.com  I am attaching the W9 and LOI which i have sent earlier please find attached and do let me know if you need any other document.', NULL, NULL, '2020-08-25 14:39:32', '2020-08-25 14:39:32'),
(743, 2027, 109, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: providerrelations@trpnppo.com  Thank you for sending over the needed information. I have sent this update to our data entry supervisor to assist. Once I heard back with updates I will let you know.     Provider Relations 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (866) 393-0966  Fax: (619) 600-4818 providerrelations@trpnppo.com www.trpnppo.com     TRPNSecure', NULL, NULL, '2020-08-25 16:47:32', '2020-08-25 16:47:32'),
(744, 2027, 109, NULL, '2020-09-15 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance under an ancillary contract and effective date is 01/01/2019 contract copy and confirmation email is attached ', NULL, NULL, '2020-09-08 12:14:48', '2020-09-08 12:14:48'),
(745, 2027, 111, NULL, NULL, 'In Process', 'To: pr.south@healthsmart.com  Sub: (Julie Jose)-(Health Smart)-(Columbus Urgent Care PA)  Hello, May i know the current status for credentialing of the provider Julie Jose. Following are his details: Provider NPI: 1447883061   Group Tax ID: 471914151  Group Name: Columbus Urgent Care PA  Thanks.  ', NULL, NULL, '2020-07-09 10:12:31', '2020-07-09 10:12:31'),
(746, 2027, 111, NULL, NULL, 'In Process', 'From: mdiprsupport@healthsmart.com  Hi,  \"  Jose, Julie NP \" is effective date \" 06/08/2020 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 56489)  Thanks HealthSmart Provider Relations', NULL, NULL, '2020-07-13 10:33:54', '2020-07-13 10:33:54'),
(747, 2027, 111, NULL, NULL, 'In Process', 'To: 	pr.south@healthsmart.com  Hello, Thanks for the confirmation. Can i have the welcome letter for this provider as you have already issued the effective date which is 06/08/2020.  Provider details are mentioned below: Provider Name: Julie Jose Provider NPI: 1447883061   Group Tax ID: 471914151  Group Name: Columbus Urgent Care PA  Thanks.', NULL, NULL, '2020-07-13 10:34:42', '2020-07-13 10:34:42'),
(748, 2027, 111, NULL, '2020-10-15 00:00:00.000', 'Approved', 'Provider is  showing linked with the insurance and the effective date is 06/08/2020', NULL, NULL, '2020-10-08 10:45:51', '2020-10-08 10:45:51'),
(749, 2027, 112, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:58:13', '2020-10-12 17:58:13'),
(750, 1006, 112, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:49:07', '2020-10-26 13:49:07'),
(751, 2027, 112, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To Billing: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-11-05 14:05:09', '2020-11-05 14:05:09'),
(752, 2027, 112, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:19:29', '2020-11-06 10:19:29'),
(753, 2027, 112, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:50:51', '2020-11-13 16:50:51'),
(754, 2027, 112, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:29:07', '2020-11-20 12:29:07'),
(755, 2027, 112, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:29:21', '2020-11-20 12:29:21'),
(756, 2027, 112, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:51:38', '2020-11-30 15:51:38'),
(757, 2037, 112, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:39', '2020-12-08 17:17:39'),
(758, 1006, 112, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:39:11', '2020-12-15 17:39:11'),
(759, 2037, 112, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:51:42', '2020-12-22 17:51:42'),
(760, 1006, 112, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:12:00', '2021-01-05 18:12:00'),
(761, 1006, 112, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:54:43', '2021-02-02 17:54:43'),
(762, 1006, 112, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:24:13', '2021-02-11 10:24:13'),
(763, 3040, 112, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:43:53', '2021-05-20 14:43:53'),
(764, 2027, 113, NULL, NULL, 'In Process', 'Talk to the representative of cigna her name is joiya she said the the provider has already contracted and the effective date is 05/04/2020 but welcome letter is still in pending', NULL, NULL, '2020-06-17 14:23:41', '2020-06-17 14:23:41'),
(765, 2027, 113, NULL, NULL, 'In Process', 'Talk to the representative to get the welcome letter for this provider she said it will take 7 days ', NULL, NULL, '2020-06-23 15:38:16', '2020-06-23 15:38:16'),
(766, 2027, 113, NULL, NULL, 'In Process', 'To: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Sub: (Stephen, Ani)-(Normandy Urgent Care Center)-(Cigna)  Can i have the welcome letter for this provider as the effective date has already issued 5/4/2020 provider details are mentioned below: Provider Name: Stephen, Ani  Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-07-16 15:47:27', '2020-07-16 15:47:27'),
(767, 2027, 113, NULL, NULL, 'In Process', 'Online request to obtain a welcome letter has been submitted on cignaforhcp.cigna.com', NULL, NULL, '2020-07-22 15:02:28', '2020-07-22 15:02:28'),
(768, 2027, 113, NULL, NULL, 'In Process', 'from: providerwebsiteforms@cigna.com  Dear Provider: Your request for a copy of your Participating Provider Agreement has been logged as case # 4575624. We will respond to your request within 30 days. Thank you for using Cigna for Health Care Professionals. Important: This is an electronically generated E-mail. Please do not respond to this message.', NULL, NULL, '2020-07-22 15:12:19', '2020-07-22 15:12:19'),
(769, 2027, 113, NULL, NULL, 'Approved', 'Provider is now showing in network with effective date 5/4/2020 also screenshot is attached for confirmation with the plans participation.', NULL, NULL, '2020-07-28 10:34:33', '2020-07-28 10:34:33'),
(770, 2027, 114, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: registrar@multiplan.com, christos.ziogas@multiplan.com  Sub: (For Group)-(Longpoint Medical Center)-(Multiplan)  May I know the current status of the application. Below are the details mentioned: Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-08-24 15:39:45', '2020-08-24 15:39:45'),
(771, 2027, 114, NULL, '2020-08-31 00:00:00.000', 'In Process', 'From: registrar@multiplan.com  Thank you for contacting Registrar at MultiPlan.  On behalf of MultiPlan, please accept our gratitude for your efforts in the fight against Coronavirus.  Please do not respond to this email as this mailbox is set up for replies only. To ensure a timely resolution to your inquiry, please see the options below.  New Requests: This message serves as confirmation of receipt. Your submission will be handled in the order in which it was received, unless mandated by state regulation.  We will contact you if additional information is necessary. Inquiries: Please use MultiPlan\'s customer service portal https: custservice.multiplan.com https://custservice.multiplan.com to inquire about submission status, request a contract copy, or inquire about your fee schedule. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions.  If you need assistance navigating the portal please contact customer service at 800-950-7040. Submitting Missing Information: When submitting missing information, please email the information to registrarmissinginfo@multiplan.com mailto:registrarmissinginfo@multiplan.com or fax to 781-487-8278.   Are You Using Our Online Portal? Almost any claim or network-related request can be handled online with MultiPlan’s customer service tool https:custservice.multiplan.comhttps:custservice.multiplan.com no downloads required and no software to install. You can even create an account and log in anytime to review the latest notes on your open and closed cases. That’s right – we track your case history so you don’t have to.  Thank you,  Registrar Department  MultiPlan', NULL, NULL, '2020-08-24 15:53:07', '2020-08-24 15:53:07'),
(772, 2027, 114, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: christos.ziogas@multiplan.com  Sub: (For Group)-(Longpoint Medical Center)-(Multiplan)  May i know the current status of the group mentioned below: Group Name-Longpoint Medical Center Group Tax-ID-76-0612416 Group NPI#1770763815 Thanks.', NULL, NULL, '2020-09-01 16:54:27', '2020-09-01 16:54:27'),
(773, 2027, 114, NULL, '2020-09-09 00:00:00.000', 'In Process', 'From: christos.ziogas@multiplan.com  Sub: (For Group)-(Longpoint Medical Center)-(Multiplan)  Hello Martin,     I handle credentialing of providers so I would not be able to help you with your question. You may either send an email to registrar@multiplan.com, call our service line at 800-950-7040, or open up a portal case for the group.   Thank you,', NULL, NULL, '2020-09-02 14:57:09', '2020-09-02 14:57:09'),
(774, 1005, 114, NULL, '2020-10-03 00:00:00.000', 'In Process', 'Awaiting response.', NULL, NULL, '2020-09-24 14:54:21', '2020-09-24 14:54:21'),
(775, 2027, 114, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: registrar@multiplan.com  Sub: (For Group)-(Longpoint Medical Center)-(Multiplan)  May I know the current enrollment status of the below mentioned practice: Practice Name: Longpoint Medical Center   Practice Tax-ID:  76-0612416  Practice NPI# 1770763815  Thanks.  ', NULL, NULL, '2020-10-22 10:24:37', '2020-10-22 10:24:37'),
(776, 2027, 114, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: 	registrar@multiplan.com  Sub: (For Group)-(Longpoint Medical Center)-(Multiplan)  May I know the current enrollment status of the below mentioned practice: Practice Name: Longpoint Medical Center   Practice Tax-ID:  76-0612416 Practice NPI# 1770763815  Thanks. ', NULL, NULL, '2020-10-30 13:33:19', '2020-10-30 13:33:19'),
(777, 2027, 114, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	registrar@multiplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 14:18:47', '2020-11-06 14:18:47'),
(778, 2037, 114, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent to registrar............', NULL, NULL, '2020-11-13 16:56:01', '2020-11-13 16:56:01'),
(779, 2037, 114, NULL, '2020-12-01 00:00:00.000', 'In Process', 'As per Multiplans request for LPMC TIn got closed as Longpoint is already linked to Normandy.Waiting for the billing report for NUCC,LPMC from the billing department to act accordingly,', NULL, NULL, '2020-11-23 14:37:13', '2020-11-23 14:37:13'),
(780, 2037, 114, NULL, '2020-12-03 00:00:00.000', 'In Process', 'As per Multiplans request for LPMC TIn got closed as Longpoint is already linked to Normandy.Waiting for the billing report for NUCC,LPMC from the billing department to act accordingly,', NULL, NULL, '2020-12-01 16:35:25', '2020-12-01 16:35:25'),
(781, 1006, 114, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Waiting on report from billing team (MFA) so we can proceed with this request. ', NULL, NULL, '2020-12-03 09:59:18', '2020-12-03 09:59:18'),
(782, 2037, 114, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Waiting on report from billing team (MFA) so we can proceed with this request. ', NULL, NULL, '2020-12-08 14:00:33', '2020-12-08 14:00:33'),
(783, 2037, 114, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Waiting on report from billing team (MFA) so we can proceed with this request. ', NULL, NULL, '2020-12-11 12:26:34', '2020-12-11 12:26:34'),
(784, 2037, 114, NULL, '2021-01-01 00:00:00.000', 'In Process', 'Report not received.Following up', NULL, NULL, '2020-12-22 16:41:15', '2020-12-22 16:41:15'),
(785, 3040, 114, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:30', '2021-05-28 16:26:30'),
(786, 3040, 114, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:38', '2021-06-17 11:18:38'),
(787, 3040, 114, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:33', '2021-07-06 11:57:33'),
(788, 11056, 114, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:00:46', '2021-08-09 13:00:46'),
(789, 3040, 114, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a word with Multiplan representative and she said the group request is still pending. ', NULL, NULL, '2021-08-23 14:30:00', '2021-08-23 14:30:00'),
(790, 10057, 114, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : 	registrar@multiplan.com & appmissinginfo@multiplan.com  Sub : Nomination Tracking # 042920ZSW  Good Afternoon,  Hope you are doing well. Please let me know the updated status for Tracking # 042920ZSW. (Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||)  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 11:53:09', '2021-10-14 11:53:09'),
(791, 10057, 114, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 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  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 John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:34:15', '2021-11-22 09:34:15'),
(792, 10057, 114, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:48:02', '2021-12-02 13:48:02'),
(793, 10057, 114, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:18:55', '2021-12-09 11:18:55'),
(794, 10057, 114, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:44:08', '2021-12-16 14:44:08'),
(795, 10057, 114, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:28:12', '2021-12-22 11:28:12'),
(796, 10057, 114, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:57:23', '2021-12-29 11:57:23'),
(797, 20067, 114, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:26', '2022-01-12 17:42:26'),
(798, 20067, 114, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:50', '2022-01-18 17:00:50'),
(799, 20067, 114, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Check status through portal  Dear Steve Albert,  Thank you for contacting our Service Department for MultiPlan/PHCS. We would be happy to assist you with a demographic update. Please submit your requested changes on letterhead signed by the group administrator or duly authorized representative along with the group name, address and TIN affiliated with the group.  Please fax the information to our Registrar department at (781) 487-8273 or email registrar@multiplan.com.  If you have any questions regarding your current inquiry, please contact our Customer Service department at 800-950-7040 with reference to your Case # 7901374. You may re-open a closed case using the Portal if you have further inquiry on the same case.  Sent to: nucc@claimsmedinc.com', NULL, NULL, '2022-02-21 17:31:48', '2022-02-21 17:31:48'),
(800, 20067, 114, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Fax the letterhead to (781) 487-8273  See the attachment', NULL, NULL, '2022-03-16 14:52:22', '2022-03-16 14:52:22'),
(801, 2027, 116, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com,         PDMCOGZ@cigna.com  Sub: (Joseph, Vibitha)-(Longpoint Medical Center)-(Cigna)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-08-24 13:04:45', '2020-08-24 13:04:45'),
(802, 2027, 116, NULL, '2020-09-01 00:00:00.000', 'Approved', 'From: PDM COGZ  Dear Healthcare Professional,     The given provider is active under tin 760612416     NOTE: PLEASE REFER THE STATUS FOR BELOW PROVIDER.     NPI  PID  PROVIDER NAME  STATUS  EFFECTIVE DATE  1952931560  0308160  VIBITHA JOSEPH  ACTIVE  07/02/2020     Cigna Internal Reference WID # W202008241205060        \"Thank you for your submission. **Please do not reply to this Email”** . All future request should be sent to Intake_PDM@cigna.com\"        Regards,               PDM.', NULL, NULL, '2020-08-25 10:47:17', '2020-08-25 10:47:17'),
(803, 2027, 120, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  I want to enroll this provider with Tricare please assist me how I can start the process. Details of the provider are mentioned below:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Thanks.', NULL, NULL, '2020-10-11 15:52:38', '2020-10-11 15:52:38'),
(804, 2027, 120, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  (Joseph, Vibitha)-(Longpoint Medical Center)-(Tricare)  This provider is in the process of being credentialed. You provided a Credentialing Application to me on 9/22/2020. It takes about 90 days for the process to be completed.     Please allow more time.     Respectfully,  Katherine Moten', NULL, NULL, '2020-10-12 09:45:22', '2020-10-12 09:45:22'),
(805, 1006, 120, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Sent a f/u email to Katherine Moten regarding the status of enrollment for provider.', NULL, NULL, '2020-10-26 12:51:14', '2020-10-26 12:51:14'),
(806, 1006, 120, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Received following update from Katherine Moten KMoten4@humana.com>:   \"Good Afternoon,  The Cred Application was submitted for review on 9/22/2020. Please allow 90 days for all cred apps to be reviewed.  Thank you. Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2020-10-26 14:46:58', '2020-10-26 14:46:58'),
(807, 2027, 120, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 15:42:21', '2020-11-09 15:42:21'),
(808, 2037, 120, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-16 12:40:20', '2020-11-16 12:40:20'),
(809, 2037, 120, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Still under process need to allow more time.', NULL, NULL, '2020-11-16 12:41:29', '2020-11-16 12:41:29'),
(810, 2037, 120, NULL, '2020-12-10 00:00:00.000', 'In Process', 'As per live call need to allow more time.', NULL, NULL, '2020-11-30 14:27:46', '2020-11-30 14:27:46'),
(811, 2037, 120, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-11 14:07:20', '2020-12-11 14:07:20'),
(812, 1006, 120, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to KMoten4@humana.com  ', NULL, NULL, '2021-01-27 12:17:20', '2021-01-27 12:17:20'),
(813, 1006, 120, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email received:  They are all credentialed and affiliated with the TIN’s you provided for each provider.  Follow up email sent:  Can you please provide me their welcome letters or executed contracts? Are all the providers listed under the following location as in-network & certified under the following address? 9504 LONG POINT RD STE E, Houston , TX 77055-422', NULL, NULL, '2021-01-27 14:03:45', '2021-01-27 14:03:45'),
(814, 3040, 120, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K Houston , TX 77060  Practice 2: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice Tax ID# 76-0612416 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-25 16:03:28', '2021-02-25 16:03:28'),
(815, 3040, 120, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Please allow 3 business days for updates to show. Provider will be showing under all 3 locations.   ', NULL, NULL, '2021-02-25 17:18:35', '2021-02-25 17:18:35'),
(816, 3040, 120, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Hello Katherine,  Hope you are doing well. Please note that I checked the Tricare provider portal and over there provider is not showing at 01 location. I attached the screenshot for your reference.  Under below address provider is not showing in the portal  Practice Name: Longpoint Medical Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-03-16 16:52:20', '2021-03-16 16:52:20'),
(817, 3040, 120, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Please allow 3 business days for updates to show.  Provider will be showing under all 3 locations. ', NULL, NULL, '2021-03-16 16:53:37', '2021-03-16 16:53:37'),
(818, 3040, 120, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:10:40', '2021-06-02 16:10:40'),
(819, 3040, 120, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:45:59', '2021-06-22 09:45:59');
