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
(6622, 1019, 11341, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:18:50', '2021-06-05 11:18:50'),
(6623, 1019, 11341, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:03:07', '2021-06-24 08:03:07'),
(6624, 1019, 11341, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Cannot be enrolled due to her specialty see attached', NULL, NULL, '2021-08-24 11:20:10', '2021-08-24 11:20:10'),
(6625, 2027, 11342, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:24:55', '2020-10-29 10:24:55'),
(6626, 2027, 11342, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: 	AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Superior Health)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care). Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:25:31', '2020-10-29 10:25:31'),
(6627, 2027, 11342, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good evening,     To add a provider to an existing contract, please submit to https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html        Megan Brooks Regional Manager, Provider Relations  Harris/Jefferson SDA', NULL, NULL, '2020-11-05 13:14:03', '2020-11-05 13:14:03'),
(6628, 2037, 11342, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 17:02:06', '2020-11-12 17:02:06'),
(6629, 2027, 11342, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Provider application has been submitted and attached in the attachments.', NULL, NULL, '2020-11-13 16:02:24', '2020-11-13 16:02:24'),
(6630, 2027, 11342, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of my application which I submitted a few days ago?  Thanks.', NULL, NULL, '2020-11-20 09:45:09', '2020-11-20 09:45:09'),
(6631, 2027, 11342, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,         After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/12/20. Credentialing process can take between 60 -120 days.     Please allow more time for application to process.        Lopez, Mayra Alejandra  NPI# 1265945125   Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542               Thank you,     Yesenia Prado', NULL, NULL, '2020-11-20 13:27:31', '2020-11-20 13:27:31'),
(6632, 2027, 11342, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process.', NULL, NULL, '2020-11-30 14:42:06', '2020-11-30 14:42:06'),
(6633, 2037, 11342, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:48:12', '2020-12-08 14:48:12'),
(6634, 1006, 11342, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a followup email @ AM Houston AM.Houston@superiorhealthplan.com regarding updated status. ', NULL, NULL, '2020-12-15 17:01:23', '2020-12-15 17:01:23'),
(6635, 3040, 11342, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Email received from : SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks ', NULL, NULL, '2020-12-21 17:24:48', '2020-12-21 17:24:48'),
(6636, 3040, 11342, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health || ||  Greetings,  Hope you are doing well.  Please update me regarding the enrollment status for the below provider.     Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks ', NULL, NULL, '2020-12-22 15:56:22', '2020-12-22 15:56:22'),
(6637, 3040, 11342, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health ||  Greetings,  Hope you are doing well. Please update me regarding the enrollment status for the below provider.  Also I am trying to reach out to Daniel but I wasn\'t able to get in touch with him.   Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks ', NULL, NULL, '2020-12-23 09:17:20', '2020-12-23 09:17:20'),
(6638, 3040, 11342, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email received From: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health ||   Good morning Adil,     Per review the provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 is under credentialing status. Application was received on 11/13/2020 with a TAT of 36  business days. Credentialing process can take between 60-120 days.  Thanks ', NULL, NULL, '2020-12-23 09:49:06', '2020-12-23 09:49:06'),
(6639, 3040, 11342, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per the last email the application received on 11/13/2020 and it will take 36 business days. So need to allow more time. ', NULL, NULL, '2020-12-30 10:17:54', '2020-12-30 10:17:54'),
(6640, 3040, 11342, NULL, '2021-01-13 00:00:00.000', 'In Process', 'I had a word with Veronica in Superior Health plan and she advised the application is still in process. Will take 90-120 Days.   For next follow up send an email to AM.CorpusChristi@superiorhealthplan.com with the reference no.  Ref No: 20913', NULL, NULL, '2021-01-06 10:45:27', '2021-01-06 10:45:27'),
(6641, 3040, 11342, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email sent to: outreachsupport@aperturecvo.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. Please find the attached the professional liability insurance certificate as per the request from Superior Health for credentialing process.  Please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-08 10:16:58', '2021-01-08 10:16:58'),
(6642, 3040, 11342, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health || ||  Good Afternoon Adil,  Mayra Alejandra Lopez NPI: 1265945125 TIN: 815123542 identifies (WAITING ON CVO).   Please reach out to CVO (Aperture) to determined what is pending.  Credentialing cannot work the application until it is forward back to Credentialing from the CVO.   If you require any further information, feel free to contact me.', NULL, NULL, '2021-01-08 10:19:41', '2021-01-08 10:19:41'),
(6643, 3040, 11342, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Email rcvd from: outreachsupport@aperturecvo.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Thank you for your response.   Certificate of Insurance has been received and routed to file for processing.  Regards,  Ann', NULL, NULL, '2021-01-11 09:12:07', '2021-01-11 09:12:07'),
(6644, 3040, 11342, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. Please update me regarding the enrollment status for the below provider. As I sent the requested documents to CVO and they sent the file for processing.      Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Group NPI # 1518404631  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-18 13:11:17', '2021-01-18 13:11:17'),
(6645, 3040, 11342, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:45:03', '2021-01-25 13:45:03'),
(6646, 3040, 11342, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from:  Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-01-27 10:41:31', '2021-01-27 10:41:31'),
(6647, 3040, 11342, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from:  Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-01-27 10:41:37', '2021-01-27 10:41:37'),
(6648, 3040, 11342, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-03 10:27:05', '2021-02-03 10:27:05'),
(6649, 3040, 11342, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.', NULL, NULL, '2021-02-10 12:42:45', '2021-02-10 12:42:45'),
(6650, 3040, 11342, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:42:58', '2021-02-10 12:42:58'),
(6651, 3040, 11342, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.  ', NULL, NULL, '2021-02-17 17:25:29', '2021-02-17 17:25:29'),
(6652, 3040, 11342, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Hello Daniel,  Please advise me the enrollment status for the below mentioned provider. Is there any good news for me?  Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-24 10:58:23', '2021-02-24 10:58:23'),
(6653, 3040, 11342, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings, Please note that I checked the superior health provider directory and provider is showing in-network. Can you please send me the plan details. If you need any additional information please feel free to call or email me. Waiting for your reply.  Thank you', NULL, NULL, '2021-03-03 13:46:57', '2021-03-03 13:46:57'),
(6654, 3040, 11342, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 displays Completed Provider Record with an effective date 3/1/2021.', NULL, NULL, '2021-03-03 13:47:51', '2021-03-03 13:47:51'),
(6655, 3040, 11342, NULL, '2021-03-18 00:00:00.000', 'Approved', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 displays Completed Provider Record with an effective date 3/1/2021.', NULL, NULL, '2021-03-11 15:39:45', '2021-03-11 15:39:45'),
(6656, 2027, 11343, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:27:29', '2020-10-29 10:27:29'),
(6657, 2027, 11343, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: 	AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Superior Health)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care). Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:27:41', '2020-10-29 10:27:41'),
(6658, 2027, 11343, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good evening,     To add a provider to an existing contract, please submit to https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html        Megan Brooks Regional Manager, Provider Relations  Harris/Jefferson SDA', NULL, NULL, '2020-11-05 13:25:46', '2020-11-05 13:25:46'),
(6659, 2037, 11343, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 17:06:09', '2020-11-12 17:06:09'),
(6660, 2027, 11343, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: shp.networkdevelopment@superiorhealthplan.com  Please find the provider application attached in this email.   Thanks. ', NULL, NULL, '2020-11-13 12:33:41', '2020-11-13 12:33:41'),
(6661, 2027, 11343, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of my application which I submitted a few days ago?  Thanks.', NULL, NULL, '2020-11-20 09:45:57', '2020-11-20 09:45:57'),
(6662, 2027, 11343, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,         After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/12/20. Credentialing process can take between 60 -120 days.     Please allow more time for application to process.        Lopez, Mayra Alejandra  NPI# 1265945125   Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542               Thank you,     Yesenia Prado', NULL, NULL, '2020-11-20 13:28:03', '2020-11-20 13:28:03'),
(6663, 2027, 11343, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process.', NULL, NULL, '2020-11-30 14:42:36', '2020-11-30 14:42:36'),
(6664, 2037, 11343, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:48:17', '2020-12-08 14:48:17'),
(6665, 1006, 11343, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a followup email @ AM Houston AM.Houston@superiorhealthplan.com regarding updated status. ', NULL, NULL, '2020-12-15 17:01:16', '2020-12-15 17:01:16'),
(6666, 3040, 11343, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health || ||  Greetings,  Hope you are doing well.  Please update me regarding the enrollment status for the below provider.     Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks ', NULL, NULL, '2020-12-22 15:56:34', '2020-12-22 15:56:34'),
(6667, 3040, 11343, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health ||  Greetings,  Hope you are doing well. Please update me regarding the enrollment status for the below provider.  Also I am trying to reach out to Daniel but I wasn\'t able to get in touch with him.   Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks ', NULL, NULL, '2020-12-23 09:17:28', '2020-12-23 09:17:28'),
(6668, 3040, 11343, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email received From: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health ||   Good morning Adil,     Per review the provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 is under credentialing status. Application was received on 11/13/2020 with a TAT of 36  business days. Credentialing process can take between 60-120 days.  Thanks ', NULL, NULL, '2020-12-23 09:49:13', '2020-12-23 09:49:13'),
(6669, 3040, 11343, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per the last email the application received on 11/13/2020 and it will take 36 business days. So need to allow more time. ', NULL, NULL, '2020-12-30 10:17:48', '2020-12-30 10:17:48'),
(6670, 3040, 11343, NULL, '2021-01-13 00:00:00.000', 'In Process', 'I had a word with Veronica in Superior Health plan and she advised the application is still in process. Will take 90-120 Days.   For next follow up send an email to AM.CorpusChristi@superiorhealthplan.com with the reference no.  Ref No: 20913', NULL, NULL, '2021-01-06 10:45:17', '2021-01-06 10:45:17'),
(6671, 3040, 11343, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email sent to: outreachsupport@aperturecvo.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. Please find the attached the professional liability insurance certificate as per the request from Superior Health for credentialing process.  Please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-08 10:16:44', '2021-01-08 10:16:44'),
(6672, 3040, 11343, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health || ||  Good Afternoon Adil,  Mayra Alejandra Lopez NPI: 1265945125 TIN: 815123542 identifies (WAITING ON CVO).   Please reach out to CVO (Aperture) to determined what is pending.  Credentialing cannot work the application until it is forward back to Credentialing from the CVO.   If you require any further information, feel free to contact me.', NULL, NULL, '2021-01-08 10:19:26', '2021-01-08 10:19:26'),
(6673, 3040, 11343, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Email rcvd from: outreachsupport@aperturecvo.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Thank you for your response.   Certificate of Insurance has been received and routed to file for processing.  Regards,  Ann', NULL, NULL, '2021-01-11 09:12:16', '2021-01-11 09:12:16'),
(6674, 3040, 11343, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. Please update me regarding the enrollment status for the below provider. As I sent the requested documents to CVO and they sent the file for processing.      Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Group NPI # 1518404631  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-18 13:11:11', '2021-01-18 13:11:11'),
(6675, 3040, 11343, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:44:58', '2021-01-25 13:44:58'),
(6676, 3040, 11343, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from:  Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-01-27 10:41:46', '2021-01-27 10:41:46'),
(6677, 3040, 11343, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-03 10:26:56', '2021-02-03 10:26:56'),
(6678, 3040, 11343, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.', NULL, NULL, '2021-02-10 12:41:14', '2021-02-10 12:41:14'),
(6679, 3040, 11343, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:42:03', '2021-02-10 12:42:03'),
(6680, 3040, 11343, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:42:03', '2021-02-10 12:42:03'),
(6681, 3040, 11343, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.  ', NULL, NULL, '2021-02-17 17:25:23', '2021-02-17 17:25:23'),
(6682, 3040, 11343, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Hello Daniel,  Please advise me the enrollment status for the below mentioned provider. Is there any good news for me?  Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-24 10:58:17', '2021-02-24 10:58:17'),
(6683, 3040, 11343, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings, Please note that I checked the superior health provider directory and provider is showing in-network. Can you please send me the plan details. If you need any additional information please feel free to call or email me. Waiting for your reply.  Thank you', NULL, NULL, '2021-03-03 13:46:52', '2021-03-03 13:46:52'),
(6684, 3040, 11343, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 displays Completed Provider Record with an effective date 3/1/2021.', NULL, NULL, '2021-03-03 13:47:46', '2021-03-03 13:47:46'),
(6685, 3040, 11343, NULL, '2021-03-18 00:00:00.000', 'Approved', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 displays Completed Provider Record with an effective date 3/1/2021.', NULL, NULL, '2021-03-11 15:39:13', '2021-03-11 15:39:13'),
(6686, 2027, 11344, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:29:39', '2020-10-29 10:29:39'),
(6687, 2027, 11344, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com, 9PSSCENT@cigna.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:32:58', '2020-10-29 10:32:58'),
(6688, 2027, 11344, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com, 9PSSCENT@cigna.com  This is a followup email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-05 14:42:01', '2020-11-05 14:42:01'),
(6689, 2037, 11344, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm ------- Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)', NULL, NULL, '2020-11-12 16:57:27', '2020-11-12 16:57:27'),
(6690, 2027, 11344, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-20 10:46:00', '2020-11-20 10:46:00'),
(6691, 2027, 11344, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-30 12:51:31', '2020-11-30 12:51:31'),
(6692, 2037, 11344, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm@cigna.com', NULL, NULL, '2020-12-08 12:37:40', '2020-12-08 12:37:40'),
(6693, 3040, 11344, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to : intake_pdm@cigna.com  Subject: Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 13:36:08', '2020-12-17 13:36:08'),
(6694, 3040, 11344, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to : intake_pdm@cigna.com  Subject: Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 13:36:44', '2020-12-17 13:36:44'),
(6695, 3040, 11344, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the above mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-24 13:27:24', '2020-12-24 13:27:24'),
(6696, 3040, 11344, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. Please find the attached the practitioner enrollment form for Mayra A Lopez for Cigna Healthspring.   Please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-06 10:51:36', '2021-01-06 10:51:36'),
(6697, 3040, 11344, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Follow up email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. I wanted to follow up the status regarding my previous email. Is there any update?  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-01-14 09:46:17', '2021-01-14 09:46:17'),
(6698, 3040, 11344, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: TXMAContracting@cigna.com, intake_pdm@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC NPI# 1518404631 Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-20 14:29:57', '2021-01-20 14:29:57'),
(6699, 3040, 11344, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent to: 	intake_pdm@cigna.com, TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for you response.  Thanks ', NULL, NULL, '2021-01-27 14:36:03', '2021-01-27 14:36:03'),
(6700, 3040, 11344, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: MedicaidProviderOperations@healthspring.com, intake_pdm@cigna.com, TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring   Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for you response.  Thanks', NULL, NULL, '2021-02-03 17:50:31', '2021-02-03 17:50:31'),
(6701, 3040, 11344, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Ci...  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include  Cigna Internal Reference # (W202101201473534).  Provider Name / Group Name         NPI                   TIN                        Effective / Termination Date               Status  Mayra A Lopez                             1265945125     815123542                            1/28/2020                             Contracted  As per the source document the request has been completed.  Sincerely,  Data Management   ', NULL, NULL, '2021-02-22 15:21:19', '2021-02-22 15:21:19'),
(6702, 3040, 11344, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@Cigna.com  Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandr  Dear Health Care Professional,  Reference WID# – W202102031507754  Please find the below provider status.  Provider Name: Lopez, Mayra Alejandra               CPF Provider ID: 1642926                   NPI: 1265945125     TIN: 815123542  Group: Valley Med Urgent Care PLLC  Effevtive Date: 01/28/2020  Status: Loaded  \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"  Regards, PDM         ', NULL, NULL, '2021-03-01 09:24:37', '2021-03-01 09:24:37'),
(6703, 3040, 11344, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Hello,   Please advise me the enrollment status for the below mentioned provider. As I already submitted the form.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Waiting for your reply.   Thank you', NULL, NULL, '2021-03-08 14:08:33', '2021-03-08 14:08:33'),
(6704, 3040, 11344, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:25:08', '2021-06-01 14:25:08'),
(6705, 3040, 11344, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:09', '2021-07-20 14:04:09'),
(6706, 3040, 11344, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:48', '2021-07-28 14:32:48'),
(6707, 3040, 11344, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:14', '2021-08-17 09:37:14'),
(6708, 10057, 11344, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:14:03', '2021-10-14 11:14:03'),
(6709, 10057, 11344, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:56:35', '2021-11-15 17:56:35'),
(6710, 10057, 11344, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:08:30', '2021-11-30 13:08:30'),
(6711, 10057, 11344, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:37:17', '2021-12-06 17:37:17'),
(6712, 10057, 11344, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:44:09', '2021-12-13 12:44:09');
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
(6713, 10057, 11344, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:46:29', '2021-12-20 11:46:29'),
(6714, 10057, 11344, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:11:18', '2021-12-27 11:11:18'),
(6715, 20067, 11344, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:58:36', '2022-01-05 12:58:36'),
(6716, 20067, 11344, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 14:00:21', '2022-01-11 14:00:21'),
(6717, 20067, 11344, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:06:30', '2022-01-11 14:06:30'),
(6718, 20067, 11344, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:51:04', '2022-01-11 17:51:04'),
(6719, 20067, 11344, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 11:03:33', '2022-01-18 11:03:33'),
(6720, 20067, 11344, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:57:17', '2022-01-28 17:57:17'),
(6721, 20067, 11344, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:52:54', '2022-02-04 10:52:54'),
(6722, 2027, 11345, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:33:41', '2020-10-29 10:33:41'),
(6723, 2027, 11345, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com, 9PSSCENT@cigna.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:33:59', '2020-10-29 10:33:59'),
(6724, 2027, 11345, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com, 9PSSCENT@cigna.com  This is a followup email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-05 14:42:59', '2020-11-05 14:42:59'),
(6725, 2037, 11345, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm ------- Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)', NULL, NULL, '2020-11-12 16:59:20', '2020-11-12 16:59:20'),
(6726, 2027, 11345, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-20 10:47:11', '2020-11-20 10:47:11'),
(6727, 2027, 11345, NULL, '2020-12-07 00:00:00.000', 'In Process', ' To: 	intake_pdm@cigna.com   This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-30 12:52:43', '2020-11-30 12:52:43'),
(6728, 2037, 11345, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm@cigna.com', NULL, NULL, '2020-12-08 12:37:43', '2020-12-08 12:37:43'),
(6729, 3040, 11345, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm@cigna.com  Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please feel free to email me. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2020-12-17 13:20:32', '2020-12-17 13:20:32'),
(6730, 3040, 11345, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the above mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-24 13:27:31', '2020-12-24 13:27:31'),
(6731, 3040, 11345, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. Please find the attached the practitioner enrollment form for Mayra A Lopez for Cigna Healthspring.   Please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-06 10:51:21', '2021-01-06 10:51:21'),
(6732, 3040, 11345, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Health spring  Greetings,  Hope you are doing well. I wanted to follow up the status regarding my previous email. Is there any update?  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-13 13:06:52', '2021-01-13 13:06:52'),
(6733, 3040, 11345, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: TXMAContracting@cigna.com, intake_pdm@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC NPI# 1518404631 Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-20 14:30:29', '2021-01-20 14:30:29'),
(6734, 3040, 11345, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent to: 	intake_pdm@cigna.com, TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for you response.  Thanks ', NULL, NULL, '2021-01-27 14:36:11', '2021-01-27 14:36:11'),
(6735, 3040, 11345, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: MedicaidProviderOperations@healthspring.com, intake_pdm@cigna.com, TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring   Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for you response.  Thanks', NULL, NULL, '2021-02-03 17:50:19', '2021-02-03 17:50:19'),
(6736, 3040, 11345, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Ci...  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include  Cigna Internal Reference # (W202101201473534).  Provider Name / Group Name         NPI                   TIN                        Effective / Termination Date               Status  Mayra A Lopez                             1265945125     815123542                            1/28/2020                             Contracted  As per the source document the request has been completed.  Sincerely,  Data Management', NULL, NULL, '2021-02-22 15:21:24', '2021-02-22 15:21:24'),
(6737, 3040, 11345, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@Cigna.com  Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandr  Dear Health Care Professional,  Reference WID# – W202102031507754  Please find the below provider status.  Provider Name: Lopez, Mayra Alejandra               CPF Provider ID: 1642926                   NPI: 1265945125     TIN: 815123542  Group: Valley Med Urgent Care PLLC  Effevtive Date: 01/28/2020  Status: Loaded  \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"  Regards, PDM         ', NULL, NULL, '2021-03-01 09:24:35', '2021-03-01 09:24:35'),
(6738, 3040, 11345, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Hello,   Please advise me the enrollment status for the below mentioned provider. As I already submitted the form.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Waiting for your reply.   Thank you', NULL, NULL, '2021-03-08 14:08:28', '2021-03-08 14:08:28'),
(6739, 3040, 11345, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:32:09', '2021-06-01 14:32:09'),
(6740, 3040, 11345, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:09', '2021-07-20 14:04:09'),
(6741, 3040, 11345, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:47', '2021-07-28 14:32:47'),
(6742, 3040, 11345, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:14', '2021-08-17 09:37:14'),
(6743, 10057, 11345, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:13:57', '2021-10-14 11:13:57'),
(6744, 10057, 11345, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:56:29', '2021-11-15 17:56:29'),
(6745, 10057, 11345, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:08:23', '2021-11-30 13:08:23'),
(6746, 10057, 11345, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:42:06', '2021-12-06 17:42:06'),
(6747, 10057, 11345, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:47:06', '2021-12-13 12:47:06'),
(6748, 10057, 11345, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:49:08', '2021-12-20 11:49:08'),
(6749, 10057, 11345, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:11:11', '2021-12-27 11:11:11'),
(6750, 20067, 11345, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:58:20', '2022-01-05 12:58:20'),
(6751, 20067, 11345, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 14:00:11', '2022-01-11 14:00:11'),
(6752, 20067, 11345, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:06:24', '2022-01-11 14:06:24'),
(6753, 20067, 11345, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:50:58', '2022-01-11 17:50:58'),
(6754, 20067, 11345, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 11:03:27', '2022-01-18 11:03:27'),
(6755, 20067, 11345, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:57:09', '2022-01-28 17:57:09'),
(6756, 20067, 11345, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:52:42', '2022-02-04 10:52:42'),
(6757, 2027, 11346, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:35:03', '2020-10-29 10:35:03'),
(6758, 2027, 11346, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com, 9PSSCENT@cigna.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:35:15', '2020-10-29 10:35:15'),
(6759, 2027, 11346, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com, 9PSSCENT@cigna.com  This is a followup email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-05 14:44:12', '2020-11-05 14:44:12'),
(6760, 2037, 11346, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm ------- Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)', NULL, NULL, '2020-11-12 16:59:33', '2020-11-12 16:59:33'),
(6761, 2027, 11346, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-20 10:47:30', '2020-11-20 10:47:30'),
(6762, 2027, 11346, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com   This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-30 12:53:05', '2020-11-30 12:53:05'),
(6763, 2037, 11346, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm@cigna.com', NULL, NULL, '2020-12-08 12:37:50', '2020-12-08 12:37:50'),
(6764, 3040, 11346, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to intake_pdm@cigna.com  Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please feel free to email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2020-12-17 13:20:47', '2020-12-17 13:20:47'),
(6765, 3040, 11346, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Enrollment Status Update (Lopez, Mayra Alejandra)-(Valley Med Urgent Care )-(Cigna Healthspring)  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the above mentioned provider in all three locations of (Valley Med Urgent Care) with (Cigna Healthspring),   Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-24 13:26:23', '2020-12-24 13:26:23'),
(6766, 3040, 11346, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. Please find the attached the practitioner enrollment form for Mayra A Lopez for Cigna Healthspring.   Please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-06 10:51:46', '2021-01-06 10:51:46'),
(6767, 3040, 11346, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Follow up email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. I wanted to follow up the status regarding my previous email. Is there any update?  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-01-14 09:46:23', '2021-01-14 09:46:23'),
(6768, 3040, 11346, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: TXMAContracting@cigna.com, intake_pdm@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC NPI# 1518404631 Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-20 14:30:04', '2021-01-20 14:30:04'),
(6769, 3040, 11346, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent to: 	intake_pdm@cigna.com, TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for you response.  Thanks ', NULL, NULL, '2021-01-27 14:36:17', '2021-01-27 14:36:17'),
(6770, 3040, 11346, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: MedicaidProviderOperations@healthspring.com, intake_pdm@cigna.com, TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring   Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for you response.  Thanks', NULL, NULL, '2021-02-03 17:50:36', '2021-02-03 17:50:36'),
(6771, 3040, 11346, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Ci...  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include  Cigna Internal Reference # (W202101201473534).  Provider Name / Group Name         NPI                   TIN                        Effective / Termination Date               Status  Mayra A Lopez                             1265945125     815123542                            1/28/2020                             Contracted  As per the source document the request has been completed.  Sincerely,  Data Management', NULL, NULL, '2021-02-22 15:21:29', '2021-02-22 15:21:29'),
(6772, 3040, 11346, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@Cigna.com  Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandr  Dear Health Care Professional,  Reference WID# – W202102031507754  Please find the below provider status.  Provider Name: Lopez, Mayra Alejandra               CPF Provider ID: 1642926                   NPI: 1265945125     TIN: 815123542  Group: Valley Med Urgent Care PLLC  Effevtive Date: 01/28/2020  Status: Loaded  \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"  Regards, PDM         ', NULL, NULL, '2021-03-01 09:24:34', '2021-03-01 09:24:34'),
(6773, 3040, 11346, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Enrollment Form || Valley Med Urgent Care PLLC || Lopez, Mayra Alejandra || Cigna Healthspring  Hello,   Please advise me the enrollment status for the below mentioned provider. As I already submitted the form.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Lopez, Mayra Alejandra NPI# 1265945125  Waiting for your reply.   Thank you', NULL, NULL, '2021-03-08 14:08:37', '2021-03-08 14:08:37'),
(6774, 3040, 11346, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:26:03', '2021-06-01 14:26:03'),
(6775, 3040, 11346, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:10', '2021-07-20 14:04:10'),
(6776, 3040, 11346, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:47', '2021-07-28 14:32:47'),
(6777, 3040, 11346, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:14', '2021-08-17 09:37:14'),
(6778, 10057, 11346, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:13:44', '2021-10-14 11:13:44'),
(6779, 10057, 11346, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:56:23', '2021-11-15 17:56:23'),
(6780, 10057, 11346, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:08:18', '2021-11-30 13:08:18'),
(6781, 10057, 11346, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:40:31', '2021-12-06 17:40:31'),
(6782, 10057, 11346, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:45:50', '2021-12-13 12:45:50'),
(6783, 10057, 11346, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:48:00', '2021-12-20 11:48:00'),
(6784, 10057, 11346, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:11:03', '2021-12-27 11:11:03'),
(6785, 20067, 11346, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:58:04', '2022-01-05 12:58:04'),
(6786, 20067, 11346, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 14:00:04', '2022-01-11 14:00:04'),
(6787, 20067, 11346, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:06:17', '2022-01-11 14:06:17'),
(6788, 20067, 11346, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:50:52', '2022-01-11 17:50:52'),
(6789, 20067, 11346, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 11:03:00', '2022-01-18 11:03:00'),
(6790, 20067, 11346, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:57:02', '2022-01-28 17:57:02'),
(6791, 20067, 11346, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:52:25', '2022-02-04 10:52:25'),
(6792, 2027, 11347, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:38:25', '2020-10-29 10:38:25'),
(6793, 2027, 11347, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Ambetter)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Ambetter), Please assist me with how I can start the process. Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:57:39', '2020-10-29 10:57:39');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(6794, 2027, 11347, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Ambetter)  Good Afternoon Martin     I hope you are doing well. I believe I have already sent you this information yesterday or the day before. However the links below is how you request to add a provider to an existing contract. Please keep in mind that after the packet is received it could take up to 90-120 days to complete process. Please keep these links on hand for future practitioners you may wish to add. Additional information can also be found on our website for future reference.     https://www.superiorhealthplan.com/providers/resources/forms.html (Credentialing Section is where to find packet to print out and email directly to our Network Development Team)     https://www.superiorhealthplan.com/providers/become-a-provider.html (Online Application submission form Medicare/Medicaid)  https://ambetter.superiorhealthplan.com/provider-resources/join-our-network.html (Ambetter Online Application Submission)        Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks', NULL, NULL, '2020-11-05 14:29:31', '2020-11-05 14:29:31'),
(6795, 2037, 11347, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 16:52:27', '2020-11-12 16:52:27'),
(6796, 2027, 11347, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Online form has been submitted and screenshot is attached.', NULL, NULL, '2020-11-13 12:55:24', '2020-11-13 12:55:24'),
(6797, 2027, 11347, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of this request? as I have already submitted the online application.  Thanks.', NULL, NULL, '2020-11-20 10:09:45', '2020-11-20 10:09:45'),
(6798, 2027, 11347, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,         After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/18/20. Credentialing process can take between 60 -120 days.     Please allow more time for application to process.        CYNTHIA RODRIGUEZ NPI# 1124282553  Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542           Thank you,     Yesenia Prado', NULL, NULL, '2020-11-20 13:30:53', '2020-11-20 13:30:53'),
(6799, 2027, 11347, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of the below mention provider: Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-30 12:40:33', '2020-11-30 12:40:33'),
(6800, 2037, 11347, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Follow up email sent to AM.Houston@superiorhealthplan.com', NULL, NULL, '2020-12-08 12:28:46', '2020-12-08 12:28:46'),
(6801, 3040, 11347, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Follow up email sent to AM.Houston@superiorhealthplan.com  Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia  Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-16 10:23:35', '2020-12-16 10:23:35'),
(6802, 3040, 11347, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia  Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-23 14:23:23', '2020-12-23 14:23:23'),
(6803, 3040, 11347, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Need to allow more time. Application in process.', NULL, NULL, '2020-12-30 10:32:47', '2020-12-30 10:32:47'),
(6804, 3040, 11347, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good morning,  Provider is still in the credentialing phase, per Credentialing Team.  They advised provider has only 29 days in process.  Credentialing phase can take up to 90 days.  Please allow more time for processing.', NULL, NULL, '2021-01-06 11:12:46', '2021-01-06 11:12:46'),
(6805, 3040, 11347, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: 	Veronica.Trevino@superiorhealthplan.com,  Credentialing@superiorhealthplan.com  Subject:  Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542    Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider Name: Rodriguez Cynthia Provider NPI# 1124282553  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-20 13:28:42', '2021-01-20 13:28:42'),
(6806, 3040, 11347, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good morning,  Credentialing for provider can take up to 90 days.  I believe provider has around 34 days.  Please allow more time for processing.  If credentialing needs anything, they will advise you.  Respectfully,', NULL, NULL, '2021-01-21 10:48:23', '2021-01-21 10:48:23'),
(6807, 3040, 11347, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter |  Hi,  I show Cynthia to be in the credentialing cycle, please allow more time to complete the cycle.  Thank you,   ', NULL, NULL, '2021-01-21 10:49:12', '2021-01-21 10:49:12'),
(6808, 3040, 11347, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Rodriguez Cynthia ||Valley Med Urgent Care PLLC || Ambetter ||  Hi,  I show Cynthia to be in the credentialing cycle, please allow more time to complete the cycle.  Thank you,', NULL, NULL, '2021-01-28 16:59:44', '2021-01-28 16:59:44'),
(6809, 3040, 11347, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-04 10:33:35', '2021-02-04 10:33:35'),
(6810, 3040, 11347, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Re: Enroll Status Update || Cynthia, Rodriguez  ||Valley Med Urgent Care PLLC || Ambetter ||  Good Afternoon,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542   Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Rodriguez Cynthia Provider NPI# 1124282553  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:36:29', '2021-02-18 12:36:29'),
(6811, 3040, 11347, NULL, '2021-03-02 00:00:00.000', 'Approved', 'Approval confirmation received in email.   See Attachment', NULL, NULL, '2021-02-23 13:40:56', '2021-02-23 13:40:56'),
(6812, 2027, 11348, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:58:47', '2020-10-29 10:58:47'),
(6813, 2027, 11348, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Ambetter)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Ambetter), Please assist me with how I can start the process. Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 10:58:57', '2020-10-29 10:58:57'),
(6814, 2027, 11348, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Ambetter)  Good Afternoon Martin     I hope you are doing well. I believe I have already sent you this information yesterday or the day before. However the links below is how you request to add a provider to an existing contract. Please keep in mind that after the packet is received it could take up to 90-120 days to complete process. Please keep these links on hand for future practitioners you may wish to add. Additional information can also be found on our website for future reference.     https://www.superiorhealthplan.com/providers/resources/forms.html (Credentialing Section is where to find packet to print out and email directly to our Network Development Team)     https://www.superiorhealthplan.com/providers/become-a-provider.html (Online Application submission form Medicare/Medicaid)  https://ambetter.superiorhealthplan.com/provider-resources/join-our-network.html (Ambetter Online Application Submission)        Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks', NULL, NULL, '2020-11-05 14:30:23', '2020-11-05 14:30:23'),
(6815, 2037, 11348, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 16:54:41', '2020-11-12 16:54:41'),
(6816, 2027, 11348, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Online form has been submitted and screenshot is attached.', NULL, NULL, '2020-11-13 12:56:33', '2020-11-13 12:56:33'),
(6817, 2027, 11348, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of this request? as I have already submitted the online application.  Thanks', NULL, NULL, '2020-11-20 10:11:28', '2020-11-20 10:11:28'),
(6818, 2027, 11348, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,         After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/18/20. Credentialing process can take between 60 -120 days.     Please allow more time for application to process.        CYNTHIA RODRIGUEZ NPI# 1124282553  Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542           Thank you,     Yesenia Prado', NULL, NULL, '2020-11-20 13:31:20', '2020-11-20 13:31:20'),
(6819, 2027, 11348, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of the below mention provider: Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-30 12:41:28', '2020-11-30 12:41:28'),
(6820, 2037, 11348, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Follow up email sent to AM.Houston@superiorhealthplan.com', NULL, NULL, '2020-12-08 12:29:40', '2020-12-08 12:29:40'),
(6821, 3040, 11348, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Follow up email sent to AM.Houston@superiorhealthplan.com  Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia  Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-16 10:34:25', '2020-12-16 10:34:25'),
(6822, 3040, 11348, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia  Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-23 14:23:16', '2020-12-23 14:23:16'),
(6823, 3040, 11348, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Need to allow more time. Application in process.', NULL, NULL, '2020-12-30 10:32:39', '2020-12-30 10:32:39'),
(6824, 3040, 11348, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good morning,  Provider is still in the credentialing phase, per Credentialing Team.  They advised provider has only 29 days in process.  Credentialing phase can take up to 90 days.  Please allow more time for processing.', NULL, NULL, '2021-01-06 11:12:40', '2021-01-06 11:12:40'),
(6825, 3040, 11348, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: 	Veronica.Trevino@superiorhealthplan.com,  Credentialing@superiorhealthplan.com  Subject:  Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542    Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider Name: Rodriguez Cynthia Provider NPI# 1124282553  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-20 13:28:24', '2021-01-20 13:28:24'),
(6826, 3040, 11348, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good morning,  Credentialing for provider can take up to 90 days.  I believe provider has around 34 days.  Please allow more time for processing.  If credentialing needs anything, they will advise you.  Respectfully,', NULL, NULL, '2021-01-21 10:48:20', '2021-01-21 10:48:20'),
(6827, 3040, 11348, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter |  Hi,  I show Cynthia to be in the credentialing cycle, please allow more time to complete the cycle.  Thank you, ', NULL, NULL, '2021-01-21 10:49:18', '2021-01-21 10:49:18'),
(6828, 3040, 11348, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Rodriguez Cynthia ||Valley Med Urgent Care PLLC || Ambetter ||  Hi,  I show Cynthia to be in the credentialing cycle, please allow more time to complete the cycle.  Thank you,', NULL, NULL, '2021-01-28 16:59:37', '2021-01-28 16:59:37'),
(6829, 3040, 11348, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-04 10:33:13', '2021-02-04 10:33:13'),
(6830, 3040, 11348, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Re: Enroll Status Update || Cynthia, Rodriguez  ||Valley Med Urgent Care PLLC || Ambetter ||  Good Afternoon,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542   Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Rodriguez Cynthia Provider NPI# 1124282553  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:36:23', '2021-02-18 12:36:23'),
(6831, 3040, 11348, NULL, '2021-03-02 00:00:00.000', 'Approved', 'Approval confirmation received in email.   See Attachment', NULL, NULL, '2021-02-23 13:41:01', '2021-02-23 13:41:01'),
(6832, 2027, 11349, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 10:59:54', '2020-10-29 10:59:54'),
(6833, 2027, 11349, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Ambetter)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Ambetter), Please assist me with how I can start the process. Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 11:00:03', '2020-10-29 11:00:03'),
(6834, 2027, 11349, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Ambetter)  Good Afternoon Martin     I hope you are doing well. I believe I have already sent you this information yesterday or the day before. However the links below is how you request to add a provider to an existing contract. Please keep in mind that after the packet is received it could take up to 90-120 days to complete process. Please keep these links on hand for future practitioners you may wish to add. Additional information can also be found on our website for future reference.     https://www.superiorhealthplan.com/providers/resources/forms.html (Credentialing Section is where to find packet to print out and email directly to our Network Development Team)     https://www.superiorhealthplan.com/providers/become-a-provider.html (Online Application submission form Medicare/Medicaid)  https://ambetter.superiorhealthplan.com/provider-resources/join-our-network.html (Ambetter Online Application Submission)        Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks', NULL, NULL, '2020-11-05 14:31:22', '2020-11-05 14:31:22'),
(6835, 2037, 11349, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 16:54:58', '2020-11-12 16:54:58'),
(6836, 2027, 11349, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Online form has been submitted and screenshot is attached. ', NULL, NULL, '2020-11-13 12:57:15', '2020-11-13 12:57:15'),
(6837, 2027, 11349, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of this request? as I have already submitted the online application.  Thanks', NULL, NULL, '2020-11-20 10:11:51', '2020-11-20 10:11:51'),
(6838, 2027, 11349, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,         After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/18/20. Credentialing process can take between 60 -120 days.     Please allow more time for application to process.        CYNTHIA RODRIGUEZ NPI# 1124282553  Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542           Thank you,     Yesenia Prado', NULL, NULL, '2020-11-20 13:31:52', '2020-11-20 13:31:52'),
(6839, 2027, 11349, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of the below mention provider: Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-30 12:41:49', '2020-11-30 12:41:49'),
(6840, 2037, 11349, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Follow up email sent to AM.Houston@superiorhealthplan.com', NULL, NULL, '2020-12-08 12:32:55', '2020-12-08 12:32:55'),
(6841, 3040, 11349, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Follow up email sent to AM.Houston@superiorhealthplan.com  Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia  Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-16 10:34:58', '2020-12-16 10:34:58'),
(6842, 3040, 11349, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia  Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-23 14:23:04', '2020-12-23 14:23:04'),
(6843, 3040, 11349, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Need to allow more time. Application in process.', NULL, NULL, '2020-12-30 10:32:29', '2020-12-30 10:32:29'),
(6844, 3040, 11349, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good morning,  Provider is still in the credentialing phase, per Credentialing Team.  They advised provider has only 29 days in process.  Credentialing phase can take up to 90 days.  Please allow more time for processing.', NULL, NULL, '2021-01-06 11:12:33', '2021-01-06 11:12:33'),
(6845, 3040, 11349, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: 	Veronica.Trevino@superiorhealthplan.com,  Credentialing@superiorhealthplan.com  Subject:  Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542    Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider Name: Rodriguez Cynthia Provider NPI# 1124282553  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-20 13:28:19', '2021-01-20 13:28:19'),
(6846, 3040, 11349, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good morning,  Credentialing for provider can take up to 90 days.  I believe provider has around 34 days.  Please allow more time for processing.  If credentialing needs anything, they will advise you.  Respectfully,', NULL, NULL, '2021-01-21 10:48:19', '2021-01-21 10:48:19'),
(6847, 3040, 11349, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter |  Hi,  I show Cynthia to be in the credentialing cycle, please allow more time to complete the cycle.  Thank you, ', NULL, NULL, '2021-01-21 10:49:23', '2021-01-21 10:49:23'),
(6848, 3040, 11349, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Rodriguez Cynthia ||Valley Med Urgent Care PLLC || Ambetter ||  Hi,  I show Cynthia to be in the credentialing cycle, please allow more time to complete the cycle.  Thank you,', NULL, NULL, '2021-01-28 16:59:22', '2021-01-28 16:59:22'),
(6849, 3040, 11349, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-04 10:33:26', '2021-02-04 10:33:26'),
(6850, 3040, 11349, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Re: Enroll Status Update || Cynthia, Rodriguez  ||Valley Med Urgent Care PLLC || Ambetter ||  Good Afternoon,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542   Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Rodriguez Cynthia Provider NPI# 1124282553  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:36:16', '2021-02-18 12:36:16'),
(6851, 3040, 11349, NULL, '2021-03-02 00:00:00.000', 'Approved', 'Approval confirmation received in email.   See Attachment', NULL, NULL, '2021-02-23 13:41:06', '2021-02-23 13:41:06'),
(6852, 2027, 11350, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 11:03:42', '2020-10-29 11:03:42'),
(6853, 2027, 11350, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Driscoll)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Driscoll), Please assist me with how I can start the process. Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 11:05:14', '2020-10-29 11:05:14'),
(6854, 2027, 11350, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: Martha.Butler@dchstx.org  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Driscoll)  Good afternoon Martin,     In regards to enrolling Provider: Rodriguez, Cynthia, you will need to complete the attached Request to Credential for Existing Group Form to initiate the verification process and return to email box: DHPContracting@dchstx.org     I have included contact points for your reference and/or credentialing inquires in the future.     ·         Anna Bartholomew Credentialing Supervisor 615 N. Upper Broadway, Suite 1621 Corpus Christi, TX 78401 Office:  (361) 694-6929 Fax: (361) 808-2182 Email: Anna.Bartholomew@dchstx.org  ·         Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  615 N Upper Broadway Ste 1621  Corpus Christi TX 78401-0764  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org     Please let me know if I may be of further assistance.        Thank You,  Martha Butler  Provider Relations Representative  5001 N McColl Rd  McAllen, TX 78504  Office: (956) 632-8311  Fax: (956) 992-0392  Email: martha.butler@dchstx.org  Website: www.driscollhealthplan.com', NULL, NULL, '2020-11-05 14:33:20', '2020-11-05 14:33:20'),
(6855, 2037, 11350, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 17:00:54', '2020-11-12 17:00:54'),
(6856, 2027, 11350, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  Please find the requested document attached in this email.  Thanks.', NULL, NULL, '2020-11-13 15:04:40', '2020-11-13 15:04:40'),
(6857, 2027, 11350, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  May I know the current status of my request as I have already submitted the application through my last email?  Thanks.', NULL, NULL, '2020-11-20 10:55:28', '2020-11-20 10:55:28'),
(6858, 2027, 11350, NULL, '2020-12-07 00:00:00.000', 'In Process', 'From: Karla.Claunch@dchstx.org  Good afternoon martin,  I responded 11/16/2020 to the original email, that we are unable to process Cynthia Rodriguez due to her not having a valid TPI on the state file.  If you think this may be an error in her TPI records, please contact TMHP.  Karla Claunch    ', NULL, NULL, '2020-11-30 12:59:21', '2020-11-30 12:59:21'),
(6859, 2037, 11350, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Medicaid in process', NULL, NULL, '2020-12-08 13:40:40', '2020-12-08 13:40:40'),
(6860, 2037, 11350, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Medicaid in process', NULL, NULL, '2020-12-08 13:41:31', '2020-12-08 13:41:31'),
(6861, 1006, 11350, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Medicaid still showing up as in-process, need to allow more time. ', NULL, NULL, '2020-12-15 15:49:35', '2020-12-15 15:49:35'),
(6862, 3040, 11350, NULL, '2020-12-29 00:00:00.000', 'In Process', '	 Medicaid still showing up as in-process, need to allow more time. ', NULL, NULL, '2020-12-22 15:48:48', '2020-12-22 15:48:48'),
(6863, 3040, 11350, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per Medicaid call center representative Sarah.   The application process will be completed till Jan-06-2021.   Need to follow up.', NULL, NULL, '2020-12-30 16:54:18', '2020-12-30 16:54:18'),
(6864, 3040, 11350, NULL, '2021-01-07 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:30:40', '2021-01-06 12:30:40'),
(6865, 3040, 11350, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Medicaid is still in process.', NULL, NULL, '2021-01-07 10:51:28', '2021-01-07 10:51:28'),
(6866, 3040, 11350, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll ||  Greetings,  Hope you are doing well. Please find the attached the request for credentialing a new provider to the existing group. Below are details of the practice and provider.  Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-12 11:02:45', '2021-01-12 11:02:45'),
(6867, 3040, 11350, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Greetings,  Hope you are doing well. I searched the providers TPI and they should be showing up on the state master now. Can you please double check at your end?  If you need any additional information please let me know. Waiting for your response.  Thanks  ', NULL, NULL, '2021-01-14 18:05:51', '2021-01-14 18:05:51'),
(6868, 3040, 11350, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Good afternoon,  Thank you for your request however, this provider does not currently appear on the state master with a valid TPI and the request is being withdrawn.  If you recently requested the TPI, it may take a few weeks for it to appear on the master.  If you have not requested the TPI or feel there is an issue, please contact TMHP for the TPI updates.  You are welcome to contact me back and I will be glad to check it again.  I will already have her loaded and ready to start processing.    I am looking forward to hearing back from you soon.  Karla Claunch      ', NULL, NULL, '2021-01-14 18:06:55', '2021-01-14 18:06:55'),
(6869, 3040, 11350, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll ||  Greetings,  Hope you are doing well. Please find the attached form as per your previous email requested.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-15 13:21:14', '2021-01-15 13:21:14'),
(6870, 3040, 11350, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Thank you for these.  We also need her current PAA or Collaborative Agreement.  I apologize for duplication or for forgetting to mention it.', NULL, NULL, '2021-01-22 12:56:46', '2021-01-22 12:56:46'),
(6871, 3040, 11350, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Waiting for PAA or Collaborative Agreement', NULL, NULL, '2021-01-29 14:28:24', '2021-01-29 14:28:24'),
(6872, 3040, 11350, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Waiting for PAA or Collaborative Agreement.', NULL, NULL, '2021-02-05 10:19:13', '2021-02-05 10:19:13'),
(6873, 3040, 11350, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Greetings,  First and foremost I really apologize for the delay response. Please find the attached PAA or Collaborative agreement for Cynthia Rodriguez.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-12 12:41:08', '2021-02-12 12:41:08'),
(6874, 3040, 11350, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the references. ', NULL, NULL, '2021-02-22 15:14:54', '2021-02-22 15:14:54'),
(6875, 3040, 11350, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: ibarra.vmuc@outlook.com  Subject:Need References From Cynthia Rodriguez, PA  Greetings,  This is a follow up email regarding the references from Cynthia Rodriguez. Can you please send me the requested information?  Thanks ', NULL, NULL, '2021-03-01 15:56:59', '2021-03-01 15:56:59'),
(6876, 3040, 11350, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Waiting for the references. ', NULL, NULL, '2021-03-08 14:16:35', '2021-03-08 14:16:35'),
(6877, 3040, 11350, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: Cynthia Rodriguez, PA  Hello,   Hope you are doing well. Please find the attached information that was requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-15 17:47:27', '2021-03-15 17:47:27'),
(6878, 3040, 11350, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:33:53', '2021-04-13 13:33:53'),
(6879, 3040, 11350, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,  Thank you so much for your prompt response. Can you please advise me the time frame?   Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-04-15 15:39:39', '2021-04-15 15:39:39'),
(6880, 3040, 11350, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello again Adil,  Wanted to let you know that only 2 of these providers needed the locations added  Cynthia Rodriguez PA andTeresa Saavedra DO', NULL, NULL, '2021-04-15 15:42:12', '2021-04-15 15:42:12'),
(6881, 3040, 11350, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   I checked the below providers on the Driscoll Health Plan provider directory and the providers are not showing in below locations which I requested in my previous email. Can you please check and let me know when they will be updated in the directory.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-04 13:15:50', '2021-05-04 13:15:50'),
(6882, 3040, 11350, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   Has there been any update regarding the additional locations.   Thanks  ', NULL, NULL, '2021-05-28 08:59:31', '2021-05-28 08:59:31'),
(6883, 3040, 11350, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject:Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  These were added on the date of the request 4/13/2021', NULL, NULL, '2021-06-03 15:40:53', '2021-06-03 15:40:53'),
(6884, 2027, 11351, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 11:05:55', '2020-10-29 11:05:55'),
(6885, 2027, 11351, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Driscoll)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Driscoll), Please assist me with how I can start the process. Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 11:06:17', '2020-10-29 11:06:17'),
(6886, 2027, 11351, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: Martha.Butler@dchstx.org  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Driscoll)  Good afternoon Martin,     In regards to enrolling Provider: Rodriguez, Cynthia, you will need to complete the attached Request to Credential for Existing Group Form to initiate the verification process and return to email box: DHPContracting@dchstx.org     I have included contact points for your reference and/or credentialing inquires in the future.     ·         Anna Bartholomew Credentialing Supervisor 615 N. Upper Broadway, Suite 1621 Corpus Christi, TX 78401 Office:  (361) 694-6929 Fax: (361) 808-2182 Email: Anna.Bartholomew@dchstx.org  ·         Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  615 N Upper Broadway Ste 1621  Corpus Christi TX 78401-0764  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org     Please let me know if I may be of further assistance.        Thank You,  Martha Butler  Provider Relations Representative  5001 N McColl Rd  McAllen, TX 78504  Office: (956) 632-8311  Fax: (956) 992-0392  Email: martha.butler@dchstx.org  Website: www.driscollhealthplan.com     Driscoll Health System Logo_email_sig', NULL, NULL, '2020-11-05 14:34:26', '2020-11-05 14:34:26'),
(6887, 2037, 11351, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 17:01:28', '2020-11-12 17:01:28'),
(6888, 2027, 11351, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  Please find the requested document attached in this email.  Thanks.', NULL, NULL, '2020-11-13 15:06:27', '2020-11-13 15:06:27'),
(6889, 2027, 11351, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  May I know the current status of my request as I have already submitted the application through my last email?  Thanks.', NULL, NULL, '2020-11-20 10:57:00', '2020-11-20 10:57:00'),
(6890, 2027, 11351, NULL, '2020-12-07 00:00:00.000', 'In Process', 'From: Karla.Claunch@dchstx.org  Good afternoon martin,  I responded 11/16/2020 to the original email, that we are unable to process Cynthia Rodriguez due to her not having a valid TPI on the state file.  If you think this may be an error in her TPI records, please contact TMHP.  Karla Claunch   ', NULL, NULL, '2020-11-30 13:01:28', '2020-11-30 13:01:28'),
(6891, 2037, 11351, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Medicaid in process', NULL, NULL, '2020-12-08 13:41:38', '2020-12-08 13:41:38'),
(6892, 1006, 11351, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Medicaid still showing up as in-process, need to allow more time. ', NULL, NULL, '2020-12-15 15:49:27', '2020-12-15 15:49:27'),
(6893, 3040, 11351, NULL, '2020-12-29 00:00:00.000', 'In Process', '	 Medicaid still showing up as in-process, need to allow more time. ', NULL, NULL, '2020-12-22 15:48:56', '2020-12-22 15:48:56'),
(6894, 3040, 11351, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per Medicaid call center representative Sarah.   The application process will be completed till Jan-06-2021.   Need to follow up.', NULL, NULL, '2020-12-30 16:54:05', '2020-12-30 16:54:05'),
(6895, 3040, 11351, NULL, '2021-01-07 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:31:20', '2021-01-06 12:31:20'),
(6896, 3040, 11351, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Had a word with (Anilisia) Medicaid representative.   The application is under the decision review.  Waiting for the state release. Next Follow up 01/12/2021(Tuesday) Application no: 7306982    Ref: 40584687000 ', NULL, NULL, '2021-01-07 10:49:15', '2021-01-07 10:49:15'),
(6897, 3040, 11351, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll ||  Greetings,  Hope you are doing well. Please find the attached the request for credentialing a new provider to the existing group. Below are details of the practice and provider.  Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-12 11:02:51', '2021-01-12 11:02:51'),
(6898, 3040, 11351, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Greetings,  Hope you are doing well. I searched the providers TPI and they should be showing up on the state master now. Can you please double check at your end?  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-14 18:05:57', '2021-01-14 18:05:57'),
(6899, 3040, 11351, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Good afternoon,  Thank you for your request however, this provider does not currently appear on the state master with a valid TPI and the request is being withdrawn.  If you recently requested the TPI, it may take a few weeks for it to appear on the master.  If you have not requested the TPI or feel there is an issue, please contact TMHP for the TPI updates.  You are welcome to contact me back and I will be glad to check it again.  I will already have her loaded and ready to start processing.    I am looking forward to hearing back from you soon.  Karla Claunch      ', NULL, NULL, '2021-01-14 18:07:00', '2021-01-14 18:07:00'),
(6900, 3040, 11351, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll ||  Greetings,  Hope you are doing well. Please find the attached form as per your previous email requested.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-15 13:21:16', '2021-01-15 13:21:16'),
(6901, 3040, 11351, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Thank you for these.  We also need her current PAA or Collaborative Agreement.  I apologize for duplication or for forgetting to mention it.', NULL, NULL, '2021-01-22 12:56:34', '2021-01-22 12:56:34'),
(6902, 3040, 11351, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Waiting for PAA or Collaborative Agreement', NULL, NULL, '2021-01-29 14:28:30', '2021-01-29 14:28:30'),
(6903, 3040, 11351, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Waiting for PAA or Collaborative Agreement.', NULL, NULL, '2021-02-05 10:19:11', '2021-02-05 10:19:11'),
(6904, 3040, 11351, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Greetings,  First and foremost I really apologize for the delay response. Please find the attached PAA or Collaborative agreement for Cynthia Rodriguez.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-12 12:41:16', '2021-02-12 12:41:16'),
(6905, 3040, 11351, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the references. ', NULL, NULL, '2021-02-22 15:14:44', '2021-02-22 15:14:44'),
(6906, 3040, 11351, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: ibarra.vmuc@outlook.com  Subject:Need References From Cynthia Rodriguez, PA  Greetings,  This is a follow up email regarding the references from Cynthia Rodriguez. Can you please send me the requested information?  Thanks ', NULL, NULL, '2021-03-01 15:57:03', '2021-03-01 15:57:03'),
(6907, 3040, 11351, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Waiting for the references. ', NULL, NULL, '2021-03-08 14:16:26', '2021-03-08 14:16:26'),
(6908, 3040, 11351, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: Cynthia Rodriguez, PA  Hello,   Hope you are doing well. Please find the attached information that was requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-15 17:47:18', '2021-03-15 17:47:18');
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
(6909, 3040, 11351, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:33:58', '2021-04-13 13:33:58'),
(6910, 3040, 11351, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,  Thank you so much for your prompt response. Can you please advise me the time frame?   Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-04-15 15:39:46', '2021-04-15 15:39:46'),
(6911, 3040, 11351, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello again Adil,  Wanted to let you know that only 2 of these providers needed the locations added  Cynthia Rodriguez PA andTeresa Saavedra DO', NULL, NULL, '2021-04-15 15:42:16', '2021-04-15 15:42:16'),
(6912, 3040, 11351, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   I checked the below providers on the Driscoll Health Plan provider directory and the providers are not showing in below locations which I requested in my previous email. Can you please check and let me know when they will be updated in the directory.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-04 13:15:54', '2021-05-04 13:15:54'),
(6913, 3040, 11351, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   Has there been any update regarding the additional locations.   Thanks  ', NULL, NULL, '2021-05-28 08:59:52', '2021-05-28 08:59:52'),
(6914, 3040, 11351, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject:Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  These were added on the date of the request 4/13/2021', NULL, NULL, '2021-06-03 15:40:59', '2021-06-03 15:40:59'),
(6915, 2027, 11352, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-29 11:07:00', '2020-10-29 11:07:00'),
(6916, 2027, 11352, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Driscoll)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with (Driscoll), Please assist me with how I can start the process. Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 11:07:09', '2020-10-29 11:07:09'),
(6917, 2027, 11352, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: Martha.Butler@dchstx.org  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Driscoll)  Good afternoon Martin,     In regards to enrolling Provider: Rodriguez, Cynthia, you will need to complete the attached Request to Credential for Existing Group Form to initiate the verification process and return to email box: DHPContracting@dchstx.org     I have included contact points for your reference and/or credentialing inquires in the future.     ·         Anna Bartholomew Credentialing Supervisor 615 N. Upper Broadway, Suite 1621 Corpus Christi, TX 78401 Office:  (361) 694-6929 Fax: (361) 808-2182 Email: Anna.Bartholomew@dchstx.org  ·         Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  615 N Upper Broadway Ste 1621  Corpus Christi TX 78401-0764  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org     Please let me know if I may be of further assistance.        Thank You,  Martha Butler  Provider Relations Representative  5001 N McColl Rd  McAllen, TX 78504  Office: (956) 632-8311  Fax: (956) 992-0392  Email: martha.butler@dchstx.org  Website: www.driscollhealthplan.com     Driscoll Health System Logo_email_sig', NULL, NULL, '2020-11-05 14:35:38', '2020-11-05 14:35:38'),
(6918, 2037, 11352, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Forms needs to be filled out  following the links provided in the email.', NULL, NULL, '2020-11-12 17:01:42', '2020-11-12 17:01:42'),
(6919, 2027, 11352, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  Please find the requested document attached in this email.  Thanks.', NULL, NULL, '2020-11-13 15:07:13', '2020-11-13 15:07:13'),
(6920, 2027, 11352, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  May I know the current status of my request as I have already submitted the application through my last email?  Thanks.', NULL, NULL, '2020-11-20 10:57:42', '2020-11-20 10:57:42'),
(6921, 2027, 11352, NULL, '2020-12-07 00:00:00.000', 'In Process', 'From: Karla.Claunch@dchstx.org  Good afternoon martin,  I responded 11/16/2020 to the original email, that we are unable to process Cynthia Rodriguez due to her not having a valid TPI on the state file.  If you think this may be an error in her TPI records, please contact TMHP.  Karla Claunch   ', NULL, NULL, '2020-11-30 13:01:55', '2020-11-30 13:01:55'),
(6922, 2037, 11352, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Medicaid in process', NULL, NULL, '2020-12-08 13:41:54', '2020-12-08 13:41:54'),
(6923, 1006, 11352, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Medicaid still showing up as in-process, need to allow more time. ', NULL, NULL, '2020-12-15 15:49:40', '2020-12-15 15:49:40'),
(6924, 3040, 11352, NULL, '2020-12-29 00:00:00.000', 'In Process', '	 Medicaid still showing up as in-process, need to allow more time. ', NULL, NULL, '2020-12-22 15:49:03', '2020-12-22 15:49:03'),
(6925, 3040, 11352, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per Medicaid call center representative Sarah.   The application process will be completed till Jan-06-2021.   Need to follow up.', NULL, NULL, '2020-12-30 16:54:11', '2020-12-30 16:54:11'),
(6926, 3040, 11352, NULL, '2021-01-07 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:30:28', '2021-01-06 12:30:28'),
(6927, 3040, 11352, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Medicaid is still in process.', NULL, NULL, '2021-01-07 10:51:43', '2021-01-07 10:51:43'),
(6928, 3040, 11352, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll ||  Greetings,  Hope you are doing well. Please find the attached the request for credentialing a new provider to the existing group. Below are details of the practice and provider.  Provider Name: Rodriguez Cynthia   Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-12 11:02:47', '2021-01-12 11:02:47'),
(6929, 3040, 11352, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Greetings,  Hope you are doing well. I searched the providers TPI and they should be showing up on the state master now. Can you please double check at your end?  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-14 18:06:02', '2021-01-14 18:06:02'),
(6930, 3040, 11352, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Good afternoon,  Thank you for your request however, this provider does not currently appear on the state master with a valid TPI and the request is being withdrawn.  If you recently requested the TPI, it may take a few weeks for it to appear on the master.  If you have not requested the TPI or feel there is an issue, please contact TMHP for the TPI updates.  You are welcome to contact me back and I will be glad to check it again.  I will already have her loaded and ready to start processing.    I am looking forward to hearing back from you soon.  Karla Claunch      ', NULL, NULL, '2021-01-14 18:07:06', '2021-01-14 18:07:06'),
(6931, 3040, 11352, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll ||  Greetings,  Hope you are doing well. Please find the attached form as per your previous email requested.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-15 13:21:19', '2021-01-15 13:21:19'),
(6932, 3040, 11352, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Thank you for these.  We also need her current PAA or Collaborative Agreement.  I apologize for duplication or for forgetting to mention it.', NULL, NULL, '2021-01-22 12:56:40', '2021-01-22 12:56:40'),
(6933, 3040, 11352, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Waiting for PAA or Collaborative Agreement', NULL, NULL, '2021-01-29 14:28:18', '2021-01-29 14:28:18'),
(6934, 3040, 11352, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Waiting for PAA or Collaborative Agreement.', NULL, NULL, '2021-02-05 10:19:10', '2021-02-05 10:19:10'),
(6935, 3040, 11352, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enrollment || Rodriguez, Cynthia || Valley Med Urgent Care || Driscoll||  Greetings,  First and foremost I really apologize for the delay response. Please find the attached PAA or Collaborative agreement for Cynthia Rodriguez.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-12 12:41:00', '2021-02-12 12:41:00'),
(6936, 3040, 11352, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the references. ', NULL, NULL, '2021-02-22 15:14:48', '2021-02-22 15:14:48'),
(6937, 3040, 11352, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: ibarra.vmuc@outlook.com  Subject:Need References From Cynthia Rodriguez, PA  Greetings,  This is a follow up email regarding the references from Cynthia Rodriguez. Can you please send me the requested information?  Thanks ', NULL, NULL, '2021-03-01 15:57:08', '2021-03-01 15:57:08'),
(6938, 3040, 11352, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Waiting for the references. ', NULL, NULL, '2021-03-08 14:16:31', '2021-03-08 14:16:31'),
(6939, 3040, 11352, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: Cynthia Rodriguez, PA  Hello,   Hope you are doing well. Please find the attached information that was requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-15 17:47:22', '2021-03-15 17:47:22'),
(6940, 3040, 11352, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,  Thank you so much for your prompt response. Can you please advise me the time frame?   Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-04-15 15:39:56', '2021-04-15 15:39:56'),
(6941, 3040, 11352, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello again Adil,  Wanted to let you know that only 2 of these providers needed the locations added  Cynthia Rodriguez PA andTeresa Saavedra DO', NULL, NULL, '2021-04-15 15:42:20', '2021-04-15 15:42:20'),
(6942, 3040, 11352, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Rodriguez, Cynthia, PA Valley Med Urgent Care PLLC  Good afternoon,  Please find attached the Welcome letter for this provider effective 04.01.2021.  Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  4525 Ayers St  Corpus Christi TX 78415-1401  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org   ', NULL, NULL, '2021-05-04 13:06:01', '2021-05-04 13:06:01'),
(6943, 2027, 11353, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-30 15:05:39', '2020-10-30 15:05:39'),
(6944, 2027, 11353, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Kourouma , Odette Tiranke)-(Longpoint Medical Center)-(Texas Children Health Plan)  Hello Juanita,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with (TCHP) ( Normandy Urgent Care Center 9504 LONG POINT RD STE E Houston , TX 77055-4226) so I want to enroll this below mentioned provider in this location with (TCHP) kindly assist me how can I start the process. Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-30 15:26:43', '2020-10-30 15:26:43'),
(6945, 2027, 11353, NULL, '2020-11-13 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Hi Mr. Rodriguez,  Provider Kourouma , Odette Tiranke is not attested to 9504 Long Point Rd. STE E, Houston , TX 77055-4226 there for I cannot add her to the location.  Please attest provider to the service location.  Thank you     Juanita Alanis  Provider Relations   Texas Children\'s Health Plan  6330 West Loop South Bellaire, TX 77401  Office: 832.828.1255', NULL, NULL, '2020-11-06 15:50:05', '2020-11-06 15:50:05'),
(6946, 2027, 11353, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  This provider is now attested on (9504 Long Point Rd. STE E, Houston , TX 77055-4226) in (TMHP), I am attaching a screenshot for your reference. ', NULL, NULL, '2020-11-06 15:50:58', '2020-11-06 15:50:58'),
(6947, 2037, 11353, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to jxalanis@texaschildrens.org ------------- (Kourouma , Odette Tiranke)-(Longpoint Medical Center)-(Texas Children Health Plan)  Greetings, Provider Kourouma , Odette Tiranke was attested to 9504 Long Point Rd. STE E, Houston , TX 77055-4226 over Texas Medicaid. Kindly check if the change is now reflecting at your end to proceed further with the location addition. Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429  ', NULL, NULL, '2020-11-13 17:21:06', '2020-11-13 17:21:06'),
(6948, 2037, 11353, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Response received from Juanita : ------------ Alanis, Juanita Nov 16, 2020, 10:11 AM (3 days ago) to me  Good morning Sherry,  I requested the Provider Kourouma Odette to be added to the 9504 Long Point Rd. STE E, Houston location, I will let you know once the location has been added.  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, '2020-11-19 10:19:36', '2020-11-19 10:19:36'),
(6949, 2037, 11353, NULL, '2020-12-29 00:00:00.000', 'In Process', 'In process need to allow more time', NULL, NULL, '2020-12-11 14:05:18', '2020-12-11 14:05:18'),
(6950, 2037, 11353, NULL, '2021-01-07 00:00:00.000', 'In Process', 'In process need to allow more time', NULL, NULL, '2020-12-29 16:49:44', '2020-12-29 16:49:44'),
(6951, 1006, 11353, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Received an email from Juanita stating that the provider isn\'t attested and cannot be added to the address, sent following reply: \"Hello Juanita,  Appreciate the update, as per my discussion with TMHP the provider is already enrolled and attested on their end. Could you please explain what you mean regarding them not being attested and what we can do to get them attested and added to the address ASAP?  Thank you.  \"', NULL, NULL, '2021-01-18 14:28:40', '2021-01-18 14:28:40'),
(6952, 1006, 11353, NULL, '2021-02-03 00:00:00.000', 'Approved', 'Received the following reply from Juanita: \"Good morning Brad,  Effective date for KOUROUMA, ODETTE T is 10/30/20.  Thank you  Juanita Alanis Provider Relations  Texas Children\'s Health Plan  6330 West Loop South Bellaire, TX 77401 Office: 832.828.1255\"', NULL, NULL, '2021-01-27 14:56:09', '2021-01-27 14:56:09'),
(6953, 1006, 11354, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-03 10:23:05', '2020-11-03 10:23:05'),
(6954, 1006, 11354, NULL, '2020-11-10 00:00:00.000', 'Initiated', 'Sent following email to Chuck McGrew @ Tricare for certification status:  \"Good morning, Chuck!  Appreciate the update, on that note would you be able to check the certification/credentialing status of another provider?   Her info is as follows:  Provider Name: Barbara Hignite  NPI# 1982617262  Let me know what you need to get her added to our group.   Thanks!\"', NULL, NULL, '2020-11-03 10:23:41', '2020-11-03 10:23:41'),
(6955, 1006, 11354, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent following email to Chuck:  \"Hey Chuck,   Here\'s a provider add form, this should suffice in getting her added to our group, correct?  Thanks.\"', NULL, NULL, '2020-11-03 18:08:45', '2020-11-03 18:08:45'),
(6956, 1006, 11354, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Received following reply from Chuck:  \"That should do it.  Thanks!  Chuck McGrew Tricare Community Liaison II Servicing provider relations matters in the following areas: RI / CT / Western MA Humana Military T 502-313-9524 F 806-517-2809 jmcgrew3@humana.com  www.humanamilitary.com\"', NULL, NULL, '2020-11-04 09:57:23', '2020-11-04 09:57:23'),
(6957, 1006, 11354, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Sent a follow-up email to Chuck: \"Hey Chuck,   I also wanted to check in on the status of Barbara Hignite, has she been added to the group? If so, what\'s her effective date?  Thanks again for all the help! \"', NULL, NULL, '2020-11-13 18:17:37', '2020-11-13 18:17:37'),
(6958, 1006, 11354, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Sent another follow-up email to Chuck: \"Good morning,   I wanted to check in on this request again, has Barbara Hignite been added to our group?   Group Name: Spectrum Neuro Behavioral Care LLC Provider Name: Barbara Hignite NPI# 1982617262  Thanks. \" ', NULL, NULL, '2020-11-20 10:40:41', '2020-11-20 10:40:41'),
(6959, 1006, 11354, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Received following update from John McGrew jmcgrew3@humana.com:  \"Morning, Brad!  I show her attached as of 10/1/20, but we’re still waiting on an internal number we use to populate before she’ll show in the Directory or as available for direct referrals.  That’ll probably be another couple weeks.  Thanks!\"', NULL, NULL, '2020-11-20 11:13:49', '2020-11-20 11:13:49'),
(6960, 1006, 11355, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-03 10:36:31', '2020-11-03 10:36:31'),
(6961, 1006, 11355, NULL, '2020-11-14 00:00:00.000', 'Initiated', 'Sent following email to PNM Department PNMDepartment@commonwealthcare.org> #Credentialing Credentialing@commonwealthcare.org>: \"Hello,   Please find the attached enrollment record for our provider, do let me know how long it will take to get the provider linked and PAR with our group?  Thanks. \"', NULL, NULL, '2020-11-03 10:37:10', '2020-11-03 10:37:10'),
(6962, 1006, 11355, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Sent a follow-up email to  PNMDepartment@commonwealthcare.org: \"Hello,   I wanted to get an update regarding the enrollment status for the following providers, was the request received, and is it in-process?  Provider information is as follows: Provider Name: Barbara Hignite NPI# 1982617262 Provider Name: Carlee Rozell NPI# 1225645393  Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-11-19 14:53:04', '2020-11-19 14:53:04'),
(6963, 1006, 11355, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent another follow-up email to PNM Department PNMDepartment@commonwealthcare.org. ', NULL, NULL, '2020-11-30 13:54:07', '2020-11-30 13:54:07'),
(6964, 1006, 11355, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Sent another follow-up email @ PNM Department PNMDepartment@commonwealthcare.org. ', NULL, NULL, '2020-12-07 14:57:44', '2020-12-07 14:57:44'),
(6965, 1006, 11355, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Called CCA, as per them we can only email them for the status of enrollment.   Sent another follow-up email @ PNM Department PNMDepartment@commonwealthcare.org>, #Credentialing Credentialing@commonwealthcare.org>, credentialingdepartment@commonwealthcare.org, CCAcredentialing@commonwealthcare.org ', NULL, NULL, '2020-12-10 17:12:09', '2020-12-10 17:12:09'),
(6966, 1006, 11355, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Sent another follow-up email.', NULL, NULL, '2020-12-21 18:09:46', '2020-12-21 18:09:46'),
(6967, 1006, 11355, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow-up email sent, waiting on reply. ', NULL, NULL, '2020-12-29 14:16:24', '2020-12-29 14:16:24'),
(6968, 1006, 11355, NULL, '2021-01-22 00:00:00.000', 'Approved', 'Hello,     Provider Barbara Hignite, PMHNP  is effective from 11/03/2020.     Thank you.  ', NULL, NULL, '2021-01-15 11:41:29', '2021-01-15 11:41:29'),
(6969, 2027, 11356, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-09 13:48:16', '2020-11-09 13:48:16'),
(6970, 2027, 11356, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 08/01/2020. Welcome letter is attached', NULL, NULL, '2020-11-09 13:48:28', '2020-11-09 13:48:28'),
(6971, 2027, 11357, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-09 13:51:58', '2020-11-09 13:51:58'),
(6972, 2027, 11357, NULL, '2020-11-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 08/01/2020. Welcome letter is attached', NULL, NULL, '2020-11-09 13:52:16', '2020-11-09 13:52:16'),
(6973, 1006, 11358, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-09 15:26:46', '2020-11-09 15:26:46'),
(6974, 1006, 11358, NULL, '2020-11-16 00:00:00.000', 'Initiated', 'Request initiated online:  \"Thank you for your enrollment request.  Within four business days of the submission of this form, you should receive an email that will serve to confirm receipt of your request. The email will also include an attachment that contains a packet of important forms such as a provider agreement, W9, EFT instructions, etc., as well as information that will help guide you through the initial credentialing process. Those forms should be completed and returned to Database.Credentialing@bcbsri.org as soon as possible. It is important to note that your application will not be considered complete until all of the required documents have been returned.  Additionally, BCBSRI utilizes the CAQH application to credential providers. It is very important to ensure that you have made your CAQH accessible to BCBSRI and updated and attested to the information in CAQH within the last 120 days.  If you do not receive an email response within two days after submitting this form please email Database.Credentialing@bcbsri.org to confirm the status of your submission and request that the packet be resent to you.  We appreciate your interest in joining the BCBSRI network and will work to begin prompt processing of your request. However, please note the credentialing process may be discontinued if we are unable to access your CAQH application or if your CAQH application is not updated and attested to in the required timeframe, or if you do not return the provider agreement and required forms.\"', NULL, NULL, '2020-11-09 15:27:51', '2020-11-09 15:27:51'),
(6975, 1006, 11358, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following email from BCBSRI: \"Good Morning,   Request you to return back the signed contracts & W9 form ASAP to database.Credentialing@bcbsri.org or you can fax it to 401-459-1369. Thank You   Regards  Mukesh M\"  Contract signed and sent back to database.Credentialing@bcbsri.org', NULL, NULL, '2020-11-12 11:20:25', '2020-11-12 11:20:25'),
(6976, 1006, 11358, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Sent followup email to Database Credentialing Database.Credentialing@bcbsri.org, waiting on status. ', NULL, NULL, '2020-11-23 18:04:50', '2020-11-23 18:04:50'),
(6977, 1006, 11358, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Received following update from BCBS @ Database Credentialing:  \"Dear Provider,  Thank you for your recent request to become a participating Provider in the Blue Cross & Blue Shield of Rhode Island (BCBSRI) provider network.    Your application for participation is currently in process and is pending with our vendor (Aperture). If needed Aperture will outreach to you directly for any information required to complete the verification process.  If you have any questions please feel free to email us at Database.Credentialing@BCBSRI.org.Thank you for your cooperation.  Sincerely,  BCBSRI Credentialing Department\"', NULL, NULL, '2020-11-24 17:18:14', '2020-11-24 17:18:14'),
(6978, 1006, 11358, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Followup @ Database Credentialing Database.Credentialing@bcbsri.org ', NULL, NULL, '2020-12-01 18:10:23', '2020-12-01 18:10:23'),
(6979, 1006, 11358, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received following reply from Database BCBSRI: \"Good Morning,  Provider file is correctly in process, we require provider updated PLI copy effective through 12/8/2020. Kindly Provide the updated PLI Document ASAP.   Regards,  Mukesh M\"  Sent them the updated Malpractice. ', NULL, NULL, '2020-12-02 10:56:36', '2020-12-02 10:56:36'),
(6980, 1006, 11358, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Received the following update from Database Credentialing: \"Dear Provider,  Thank you for your recent request to become a participating Provider in the Blue Cross & Blue Shield of Rhode Island (BCBSRI) provider network.    Your application for participation is currently pending with the BCBSRI Credentialing Committee. Our next committee is scheduled for 12/22/2020 and we will advise you on the status once a decision has been made.  If you have any questions please feel free to email us at Database.Credentialing@BCBSRI.org.Thank you for your cooperation.  Sincerely, BCBSRI Credentialing Department\" ', NULL, NULL, '2020-12-10 09:35:40', '2020-12-10 09:35:40'),
(6981, 1006, 11358, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ Database Credentialing Database.Credentialing@BCBSRI.org', NULL, NULL, '2020-12-22 11:01:25', '2020-12-22 11:01:25'),
(6982, 1006, 11358, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Received following reply from Database: \"Good Evening,  The BCBSRI Credentialing Committee has approved your request for Participation and we are currently in the process of adding your information to our systems. You can expect to receive a welcome letter with additional information by 01/06/2021  If you have, any questions please feel free to email us at Provdb@BCBSRI.org. Thank you for your cooperation.  Regards, Mukesh M\"', NULL, NULL, '2020-12-22 17:08:03', '2020-12-22 17:08:03'),
(6983, 1006, 11358, NULL, '2021-01-04 00:00:00.000', 'Approved', 'Good Morning..     Provider set up done in our system and Please find the attached Welcome Letter for Provider Melody C. L’Etoile, LICSW with signed agreements, instructions to generate Web PIN and contact sheet.     Please send email to ProvDB@BCBSRI.org of any questions or clarifications.     Thank you,  Sridhar K', NULL, NULL, '2020-12-28 10:53:34', '2020-12-28 10:53:34'),
(6984, 1006, 11359, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-09 17:13:41', '2020-11-09 17:13:41'),
(6985, 1006, 11359, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Initiated request online, attached. ', NULL, NULL, '2020-11-09 17:14:04', '2020-11-09 17:14:04'),
(6986, 1006, 11359, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura Bevin. ', NULL, NULL, '2020-11-23 16:56:15', '2020-11-23 16:56:15'),
(6987, 1006, 11359, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Hi,  Melody L\'Etoile, 6466643 – our Credentialing Dept. should be accessing her CAQH application shortly  Thank you  Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health  ', NULL, NULL, '2020-11-23 17:35:54', '2020-11-23 17:35:54'),
(6988, 1006, 11359, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Sent another follow-up email to \"Bevin, Laura J\" Laura.Bevin@aetna.com regarding status of enrollment.  ', NULL, NULL, '2020-12-07 14:42:12', '2020-12-07 14:42:12'),
(6989, 1006, 11359, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Receieved following update from Laura: \"Hello,  I have contacted our Credentialing Dept. for an update. I will let you know when I have more information.  Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-07 15:16:36', '2020-12-07 15:16:36'),
(6990, 1006, 11359, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent a follow-up email to Bevin Laura @ \"Bevin, Laura J\" Laura.Bevin@aetna.com', NULL, NULL, '2020-12-14 18:00:19', '2020-12-14 18:00:19'),
(6991, 1006, 11359, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Received following reply from Laura: \"Good morning,  Melody L\'Etoile, 6466643 – requested a credentialing update  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-15 10:51:31', '2020-12-15 10:51:31'),
(6992, 1006, 11359, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura Bevin', NULL, NULL, '2020-12-22 11:31:53', '2020-12-22 11:31:53'),
(6993, 1006, 11359, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Received the following update from Laura: \"Hello,  Our Credentialing Dept. is verifying the CAQH application for Melody L\'Etoile, 6466643.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-28 11:58:20', '2020-12-28 11:58:20'),
(6994, 1006, 11359, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura', NULL, NULL, '2021-01-15 18:19:19', '2021-01-15 18:19:19'),
(6995, 1006, 11359, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Received the following response from Bevin Laura: \"Hello,  Melody L\'Etoile, 6466643 completed the credentialing process on 01/15/2021 so she is waiting to be added to the group contract.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-01-18 17:51:51', '2021-01-18 17:51:51'),
(6996, 1006, 11359, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Received reply: \"Hello,  I would allow 2-3 weeks for her to be added to the group contract.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-01-19 09:19:10', '2021-01-19 09:19:10'),
(6997, 1006, 11359, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura', NULL, NULL, '2021-01-29 16:00:12', '2021-01-29 16:00:12'),
(6998, 1006, 11359, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura regarding status. ', NULL, NULL, '2021-02-03 15:12:26', '2021-02-03 15:12:26'),
(6999, 1006, 11359, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Received the following reply from Laura: \"Hello,  Melody L\'Etoile, 6466643 has not been assigned an effective date yet.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-02-04 13:42:29', '2021-02-04 13:42:29'),
(7000, 1006, 11359, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Bevin, Laura J\" Laura.Bevin@aetna.com', NULL, NULL, '2021-02-12 16:45:43', '2021-02-12 16:45:43'),
(7001, 1006, 11359, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Received the following reply from Laura Bevin: \"Good morning,  Melody L\'Etoile, 6466643 – waiting to be linked to the contract  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"  Requested Laura to expedite request as her request for contract addition has been on-going for a month. ', NULL, NULL, '2021-02-15 10:49:48', '2021-02-15 10:49:48'),
(7002, 1006, 11359, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Received reply: \"Hello,  I have sent a request to the Network Relations Specialist to link Melody L\'Etoile, 6466643.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-02-15 11:51:38', '2021-02-15 11:51:38'),
(7003, 1006, 11359, NULL, '2021-03-09 00:00:00.000', 'Approved', 'Hi Melody L\'Etoile,  Welcome to the provider network effective Jan 15 2021 12:00AM.  Your Provider Identification Number (PIN) is: 6466643.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.  ', NULL, NULL, '2021-03-02 09:56:21', '2021-03-02 09:56:21'),
(7004, 2037, 11360, NULL, NULL, 'New/Not Initiated', 'Re-validation Initiated', NULL, NULL, '2020-11-10 14:13:49', '2020-11-10 14:13:49'),
(7005, 2037, 11360, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Revalidation has been successfully completed and application is on submitted status for South Texas Institute of Pain Management (Group). Transaction In Process.', NULL, NULL, '2020-11-10 14:14:27', '2020-11-10 14:14:27'),
(7006, 2037, 11360, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Re-validation in process', NULL, NULL, '2020-11-18 14:22:47', '2020-11-18 14:22:47'),
(7007, 2037, 11360, NULL, '2021-02-28 00:00:00.000', 'On Hold', 'License Sanctioned', NULL, NULL, '2020-11-25 17:08:58', '2020-11-25 17:08:58'),
(7008, 1006, 11360, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Deficiency received for revalidation, information updated and sanction reason was given.: \"Application Status        PEP Ticket Number      In Progress		        17359795\"', NULL, NULL, '2021-01-13 15:46:39', '2021-01-13 15:46:39'),
(7009, 1006, 11360, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Received another deficiency based on the group name, called Medicaid, and informed them that I already submitted a provider change of information form to update the group name to reflect the one that is listed on PECOS.  Ticket# 40820518000', NULL, NULL, '2021-02-09 15:10:32', '2021-02-09 15:10:32'),
(7010, 1006, 11360, NULL, '2021-02-24 00:00:00.000', 'On Hold', 'The request is on hold as per Shazana\'s request to not work on Medicaid/Medicare enrollment due to attorneys suggestion.', NULL, NULL, '2021-02-12 13:48:00', '2021-02-12 13:48:00'),
(7011, 1006, 11361, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-10 17:41:52', '2020-11-10 17:41:52'),
(7012, 1006, 11361, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Certification request sent to Chuck. Attached. ', NULL, NULL, '2020-11-10 17:42:14', '2020-11-10 17:42:14'),
(7013, 1006, 11361, NULL, '2020-11-25 00:00:00.000', 'In Process', '\"Hi again!  Great! I\'ve got it sent over to WPS.  Chuck McGrew Tricare Community Liaison II Servicing provider relations matters in the following areas: RI / CT / Western MA\"', NULL, NULL, '2020-11-12 14:09:17', '2020-11-12 14:09:17'),
(7014, 1006, 11361, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Sent a follow-up email to \"John McGrew JMcGrew3@humana.com\": \"Good afternoon, Chuck,  Hope you\'re doing good, I wanted to check in on the status of the following provider:  Provider Name: Melody L\'Etoile NPI# 1942687108  Thanks and happy holidays!\"', NULL, NULL, '2020-11-25 14:21:56', '2020-11-25 14:21:56'),
(7015, 1006, 11361, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received following update from Chuck: \"Morning, Brad!  Nothing yet. New certs can take up to ninety days to process, and we’re still less than a month since submission.  Thanks!\"', NULL, NULL, '2020-11-30 10:56:16', '2020-11-30 10:56:16'),
(7016, 1006, 11361, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent a follow-up email @ Chuck: \"Hello Chuck,   Hope you\'re doing well, I wanted to check in to see if there were any updates regarding Melody\'s enrollment?  Thanks. \"', NULL, NULL, '2020-12-14 18:14:28', '2020-12-14 18:14:28'),
(7017, 1006, 11361, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Sent another followup to Chuck ', NULL, NULL, '2020-12-21 18:14:15', '2020-12-21 18:14:15'),
(7018, 1006, 11361, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Sent a follow-up email to Chuck @ John McGrew JMcGrew3@humana.com ', NULL, NULL, '2020-12-29 11:46:55', '2020-12-29 11:46:55'),
(7019, 1006, 11361, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Received following reply from Chuck: \"Hi, Brad!  Yes, I did. Hope yours was good as well. But now we’re both back at work. :-p Oh well.  Provider Name: Melody L\'Etoile---cert 12/10/20 NPI# 1942687108  So, we’ve got ‘em both, but not credentialed yet. For Melody, I can get by with her CAQH number.   Thanks!\"', NULL, NULL, '2020-12-29 16:46:59', '2020-12-29 16:46:59'),
(7020, 1006, 11361, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a f/u email @ John McGrew jmcgrew3@humana.com', NULL, NULL, '2021-02-12 18:09:14', '2021-02-12 18:09:14'),
(7021, 1006, 11361, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Received the following update from Chuck:  \"Morning, Brad!  I show Melody’s cred app as submitted 1/8/21, still awaiting processing. I’ve likewise submitted Carlee’s app to lock in the date, but we are going to need an updated malpractice cert, as hers here expired 12/31.  Thanks!\"', NULL, NULL, '2021-02-15 10:06:22', '2021-02-15 10:06:22'),
(7022, 1006, 11361, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ JMcGrew3@humana.com:  \"Hello Chuck,   Hope you\'re doing well, I just wanted to check in on the enrollment status for Melody L\'Etoile (1942687108) & Carlee Rozell (1225645393).   Appreciate the help!\"', NULL, NULL, '2021-03-02 11:59:04', '2021-03-02 11:59:04'),
(7023, 1006, 11361, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent another f/u email @ John McGrew JMcGrew3@humana.com as his previous email was not clear.  ', NULL, NULL, '2021-03-23 16:31:17', '2021-03-23 16:31:17'),
(7024, 1006, 11361, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Received the following approval confirmation from Chuck: \"Hi, Brad!  Cred status; affil date  Melody L\'Etoile (1942687108---App rcvd; 12/10/20 Carlee Rozell (1225645393).---App rcvd; 2/11/20  Oh, sorry about that. The dates are just the dates my system shows the providers attached to the tax ID. It doesn’t really mean anything much to us; has nothing to do with claims, but I find that providers set great store by it. :-)  As soon as we have them hooked up, they can see patients, or even before, really. Our timely filing guideline is a year after the date of service, even if the provider wasn’t Tricare-certified ON that DOS. We’re still waiting on these cred apps to process; those usually take about three months.  Chuck McGrew Tricare Community Liaison II Servicing provider relations matters in the following areas: RI / CT / Western MA Humana Military T 502-313-9524 F 806-517-2809 jmcgrew3@humana.com www.humanamilitary.com\"', NULL, NULL, '2021-03-24 09:50:04', '2021-03-24 09:50:04'),
(7025, 1006, 11362, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 10:02:01', '2020-11-11 10:02:01'),
(7026, 1006, 11362, NULL, '2020-12-04 00:00:00.000', 'Initiated', 'Request initiated online via PalmettoGBA. Attached. ', NULL, NULL, '2020-11-11 10:06:56', '2020-11-11 10:06:56'),
(7027, 1006, 11362, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Request still does not show up on PalmettoGBA as of yet, need to allow more time. ', NULL, NULL, '2020-12-02 14:07:35', '2020-12-02 14:07:35'),
(7028, 1006, 11362, NULL, '2020-12-15 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	P RAVEENDRAN MD PROVIDER PTAN	P02568053 PROVIDER NPI	1124247267 EFFECTIVE DATE	09/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	 ', NULL, NULL, '2020-12-08 14:35:38', '2020-12-08 14:35:38'),
(7029, 2027, 11363, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 10:04:54', '2020-11-11 10:04:54'),
(7030, 2027, 11363, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: MHTXProviderServices@molinahealthcare.com  Please find the provider change of information form attached in this email with the w9 as per communication.  Thanks.', NULL, NULL, '2020-11-11 10:36:07', '2020-11-11 10:36:07'),
(7031, 2027, 11363, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Clarissa.Robles@molinahealthcare.com  Hi,  May I know the current status of my request regarding location addition as I have already submitted the change of information form.   Thanks.', NULL, NULL, '2020-11-18 09:55:58', '2020-11-18 09:55:58'),
(7032, 2027, 11363, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: Clarissa.Robles@molinahealthcare.com  Hi Martin,     It’s already been submitted but does take a few days for it to reflect. I will keep you apprised on when it’s reflecting.', NULL, NULL, '2020-11-18 10:31:54', '2020-11-18 10:31:54'),
(7033, 2027, 11363, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: Clarissa.Robles@molinahealthcare.com  May I know the current status of this request? it has been 7 days passed now.  Thanks.', NULL, NULL, '2020-11-25 10:35:39', '2020-11-25 10:35:39'),
(7034, 2027, 11363, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-02 12:46:53', '2020-12-02 12:46:53'),
(7035, 2027, 11363, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:13:16', '2020-12-10 13:13:16'),
(7036, 3040, 11363, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to: 	Clarissa.Robles@molinahealthcare.com  Subject: Location Update ||Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. We already filled the request form for change of location and it\'s already submitted. I wanted to know what is the updated status.   Please reply to me back as soon as possible. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-17 14:36:29', '2020-12-17 14:36:29'),
(7037, 3040, 11363, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to: david.balli@molinahealthcare.com  Subject: Location Update || Valley Med Urgent Care PLLC || Molina Health ||  Hello David,   Hope you are doing well. Please find the attached provider change of information form and W9 as per your request. Kindly update the McAllen address in Valley Med Urgent Care.  If you need anything else please feel to contact me or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 16:55:46', '2020-12-17 16:55:46'),
(7038, 3040, 11363, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Reply received From: David.Balli@molinahealthcare.com  Subject: Location Update || Valley Med Urgent Care PLLC || Molina Health ||  Good Morning Adil     I have submitted your request to add the new Mcallen location, please allow 14 days.  Please let me know if you need further information or assistances.     This is your reference number: RITM1900526      Thank you', NULL, NULL, '2020-12-18 09:14:37', '2020-12-18 09:14:37'),
(7039, 3040, 11363, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Location Update || Valley Med Urgent Care PLLC || Molina Health ||  Greetings,  I hope you had a great weekend. I wanted to know the status of the location update against the reference no RITM1900526.  Please feel free to call or email if you need further assistance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-28 17:59:31', '2020-12-28 17:59:31'),
(7040, 3040, 11363, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Location Update || Valley Med Urgent Care PLLC || Molina Health ||  Greetings,  Happy new year to you too. First and foremost I really appreciate your prompt response.  Please advise me that the McAllen address that you added is it for the group? Also, I wanted to know if the provider is added under that address as well.  The address that you listed (1040 W JEFFERSON ST BROWNSVILLE, TX) who is that for? As none of our groups should be listed with that address.  Please feel free to call or email me. Waiting to hear from you soon.    Thanks ', NULL, NULL, '2021-01-04 18:10:25', '2021-01-04 18:10:25'),
(7041, 3040, 11363, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Location Update || Valley Med Urgent Care PLLC || Molina Health ||  Greetings,  Hope you are doing well. As I mentioned in my previous email that we have quite a lot of providers in this practice and we need to add them in all three locations.  The address that you listed (1040 W JEFFERSON ST BROWNSVILLE, TX) who is that for? As none of our groups should be listed with that address.     Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-14 15:50:01', '2021-01-14 15:50:01'),
(7042, 3040, 11363, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Location added in ancillary contract. Please see attachment. ', NULL, NULL, '2021-03-03 16:37:36', '2021-03-03 16:37:36'),
(7043, 1006, 11364, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 10:34:11', '2020-11-11 10:34:11'),
(7044, 1006, 11364, NULL, '2020-12-04 00:00:00.000', 'Initiated', 'Request initiated online via palmetto GBA portal. Attached. ', NULL, NULL, '2020-11-11 10:34:38', '2020-11-11 10:34:38'),
(7045, 1006, 11364, NULL, '2020-12-17 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MELODY C LETOILE LCS PROVIDER PTAN	P02568200 PROVIDER NPI	1942687108 EFFECTIVE DATE	09/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0360 BUSINESS STATE	RI EFFECTIVE DATE	07/29/2019 END DATE	 ', NULL, NULL, '2020-12-10 15:18:31', '2020-12-10 15:18:31'),
(7046, 1006, 11365, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 10:37:28', '2020-11-11 10:37:28'),
(7047, 1006, 11365, NULL, '2020-11-18 00:00:00.000', 'Initiated', 'Initiation request submitted via PalmettoGBA portal. Attached. ', NULL, NULL, '2020-11-11 10:37:45', '2020-11-11 10:37:45'),
(7048, 1006, 11365, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Request is still in-process as there\'s no update on PalmettoGBA portal. ', NULL, NULL, '2020-11-19 17:31:23', '2020-11-19 17:31:23');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(7049, 1006, 11365, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Request still shows up as in-process on PalmettoGBA, need to allow more time. ', NULL, NULL, '2020-12-02 13:48:04', '2020-12-02 13:48:04'),
(7050, 1006, 11365, NULL, '2020-12-15 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	ERIN E OLIVA MSW PROVIDER PTAN	P02568190 PROVIDER NPI	1407349632 EFFECTIVE DATE	09/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0360 BUSINESS STATE	RI EFFECTIVE DATE	07/29/2019 END DATE	 ', NULL, NULL, '2020-12-08 14:28:21', '2020-12-08 14:28:21'),
(7051, 1006, 11366, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 13:15:47', '2020-11-11 13:15:47'),
(7052, 1006, 11366, NULL, '2020-11-18 00:00:00.000', 'Initiated', 'Request submitted via PECOS for enrollment. ', NULL, NULL, '2020-11-11 13:17:50', '2020-11-11 13:17:50'),
(7053, 1006, 11366, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Received following status via the NGS Status Tool: \" PE0000134790	 CMS855I Web	 11/11/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-11-19 17:36:49', '2020-11-19 17:36:49'),
(7054, 1006, 11366, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Received the following update from NGS Medicare Application Status tool: CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000134790	 CMS855I Web	 11/11/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks. ', NULL, NULL, '2020-11-30 14:43:38', '2020-11-30 14:43:38'),
(7055, 1006, 11366, NULL, '2020-12-09 00:00:00.000', 'Approved', 'Application Tracking ID: T111120200000937   NPI ID: 1225645393   Medicare ID: S400704092   Name: CARLEE ROZELL  State: MA   Form Type: 855I  Date: 12/02/2020  Status: APPROVED', NULL, NULL, '2020-12-02 09:40:41', '2020-12-02 09:40:41'),
(7056, 1006, 11367, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 13:32:33', '2020-11-11 13:32:33'),
(7057, 1006, 11367, NULL, '2020-11-18 00:00:00.000', 'Initiated', 'Initiated enrollment request by sending form. Attached. ', NULL, NULL, '2020-11-11 13:32:50', '2020-11-11 13:32:50'),
(7058, 1006, 11367, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Sent follow-up email to providerapplicationstatus@bcbsma.com: \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for the following provider: Provider Name: Carlee RozellNPI# 1225645393TIN# 83-4482753  Please get back to me as soon as you\'re able to. Thanks. \"', NULL, NULL, '2020-11-19 14:47:17', '2020-11-19 14:47:17'),
(7059, 1006, 11367, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Received following rejection from providerapplicationstatus@bcbsma.com:  \"Hello,  Please review rejection letter below and resubmit accordingly.  BCBSMA is in receipt of the NP application for your Carlee Rozell, however we are unable to process your request. This provider is an Adult-Gerontology Primary Care NP and cannot join a group with a Psychiatrist as a collaborating MD.  She needs to have a non Behavioral Health participating collab.   Please update collab and re-submit your request.  If you have any questions, please call Network Management Services at 1-800-316-BLUE (2583).   Thank you, Healthcare Contracting and Management\"', NULL, NULL, '2020-11-23 10:32:16', '2020-11-23 10:32:16'),
(7060, 1006, 11367, NULL, '2021-02-01 00:00:00.000', 'On Hold', 'Furquan suggested waiting on this until Carlee has done her PMHNP so we can re-initiate. ', NULL, NULL, '2020-12-08 17:47:58', '2020-12-08 17:47:58'),
(7061, 1019, 11367, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-11-09 10:31:57', '2021-11-09 10:31:57'),
(7062, 1006, 11368, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 13:54:27', '2020-11-11 13:54:27'),
(7063, 1006, 11368, NULL, '2020-11-19 00:00:00.000', 'Initiated', 'Initiation enrollment request online via \"Join Beacon Health\". Form attached. ', NULL, NULL, '2020-11-11 13:54:53', '2020-11-11 13:54:53'),
(7064, 1006, 11368, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com regarding updated status. ', NULL, NULL, '2020-11-19 17:42:03', '2020-11-19 17:42:03'),
(7065, 1006, 11368, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received following reply from Kayla: \"Good morning,  Both applications for the below providers are currently still in process. This typically takes 90-120 business days.  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632 www.beaconhealthoptions.com\"', NULL, NULL, '2020-11-25 11:34:18', '2020-11-25 11:34:18'),
(7066, 1006, 11368, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com.  Sub: Provider Enrollment Status - SNBCare', NULL, NULL, '2020-12-18 15:51:54', '2020-12-18 15:51:54'),
(7067, 1006, 11368, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Request is still processing, need to allow more time. Expected time-frame 90 business days. Event# 8975263 Ref# 12292020-0058739', NULL, NULL, '2020-12-29 18:02:25', '2020-12-29 18:02:25'),
(7068, 1006, 11368, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Called Beacon but wasn\'t able to reach anyone, requested a call back from them. ', NULL, NULL, '2021-01-15 17:05:09', '2021-01-15 17:05:09'),
(7069, 1006, 11368, NULL, '2021-02-01 00:00:00.000', 'In Process', 'The request still on day 50, need to allow more time.   Ref# 01202021-0292859', NULL, NULL, '2021-01-20 13:08:26', '2021-01-20 13:08:26'),
(7070, 1006, 11368, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:20:16', '2021-02-11 15:20:16'),
(7071, 1006, 11368, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:08:30', '2021-03-03 18:08:30'),
(7072, 1019, 11368, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:43:10', '2021-03-23 10:43:10'),
(7073, 1019, 11368, NULL, '2021-04-14 00:00:00.000', 'In Process', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-07 08:22:31', '2021-04-07 08:22:31'),
(7074, 1019, 11368, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:07:26', '2021-04-14 07:07:26'),
(7075, 1019, 11368, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-04-14 08:10:45', '2021-04-14 08:10:45'),
(7076, 1019, 11368, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:52:44', '2021-04-22 15:52:44'),
(7077, 1019, 11368, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:34:47', '2021-05-03 12:34:47'),
(7078, 1019, 11368, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:34:15', '2021-05-20 08:34:15'),
(7079, 1019, 11368, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:18:41', '2021-06-05 11:18:41'),
(7080, 1019, 11368, NULL, '2021-06-30 00:00:00.000', 'Not Eligible', 'Received the following Denial Letter from Beacon as her ANCC certification is for AGNP. ', NULL, NULL, '2021-06-23 08:38:42', '2021-06-23 08:38:42'),
(7081, 1006, 11369, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 14:38:45', '2020-11-11 14:38:45'),
(7082, 1006, 11369, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Submitted online application via Tufts_Health_Plan_Credentialing_Department@tufts-health.com. Attached form. ', NULL, NULL, '2020-11-11 14:39:25', '2020-11-11 14:39:25'),
(7083, 1006, 11369, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent a follow-up email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com regarding the status of our request. ', NULL, NULL, '2020-11-23 15:02:46', '2020-11-23 15:02:46'),
(7084, 1006, 11369, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent another follow-up email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com. ', NULL, NULL, '2020-11-30 17:30:25', '2020-11-30 17:30:25'),
(7085, 1006, 11369, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Received following response from Tufts: \"incident number - PPO0073923       Hi   A contract will be sent next week for Carlee Rozell.  Once signed, returned and processed, she will be put into cred.  Once cred is complete, she will be all set.   Thank you   Provider Operations   Ref:MSG6191554 thpwatsmr2.tufts-health.com made the following annotations\"', NULL, NULL, '2020-12-01 18:00:40', '2020-12-01 18:00:40'),
(7086, 1006, 11369, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received following reply from Tufts:  \"incident number - PPO0073923   Hi Brad   Looks like BH Contracting missed this app.  I just reached out to them to select a contract.  Once they do so, we will send it out.  Once signed and returned, she will be put into credentialing.  Once cred is complete, she will be all set.  Thank you  Provider Operations\"', NULL, NULL, '2020-12-07 11:21:05', '2020-12-07 11:21:05'),
(7087, 1006, 11369, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com regarding status.  ', NULL, NULL, '2020-12-14 18:06:27', '2020-12-14 18:06:27'),
(7088, 1006, 11369, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Signed agreement & sent to Tufts @ tufts_health_plan_credentialing_department@tufts-health.com  \"Hello,   Please find the signed agreement as well as the W-9, please let me know if anything else is required and what the expected time-frame is for enrollment for our provider?  Thanks. \"', NULL, NULL, '2020-12-22 12:07:22', '2020-12-22 12:07:22'),
(7089, 1006, 11369, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts Health Plan Credentialing Department tufts_health_plan_credentialing_department@tufts-health.com', NULL, NULL, '2020-12-29 15:46:09', '2020-12-29 15:46:09'),
(7090, 1006, 11369, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Received following update from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"incident number - PPO0080776   Hello   Carlee Rozell, NP is in credentialing right now.  Once that is complete, she will be all set.   Thank you Provider Operations   Ref:MSG6349418\"', NULL, NULL, '2021-01-07 17:54:03', '2021-01-07 17:54:03'),
(7091, 1006, 11369, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com. ', NULL, NULL, '2021-01-15 18:13:09', '2021-01-15 18:13:09'),
(7092, 1006, 11369, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Received the following response from : \"Good Morning Brad,  Tufts Health Plan needs the attached DEA waiver signed , dated and returned.  This would be in Lieu of actual certification.  Once we have this on file will be able to finish up initial credentialing.  Your Response is Appreciated,  Michael S. Kerble Provider Network Management Services Credentialing Department Tufts Health Plan 705 Mount Auburn St Watertown MA 02472,  MS-81 Tel: (617)-972-9495, X59812      : (888)-306-6307, X59812 Personal THP Fax: 617-673-0912\"', NULL, NULL, '2021-01-20 10:36:39', '2021-01-20 10:36:39'),
(7093, 1006, 11369, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Received the following reply from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hi Brad   Barbara Hignite, APRN - all set eff 1.7.2021, ID 370708   Carlee Rozell, NP - all set eff 1.22.2021, ID 228943   Jessica Hartman, APRN - all set eff 12.31.2021, ID 869409   Thank you Provider Operations\" ', NULL, NULL, '2021-01-26 17:16:59', '2021-01-26 17:16:59'),
(7094, 1006, 11369, NULL, '2021-02-02 00:00:00.000', 'Approved', NULL, NULL, NULL, '2021-01-26 17:17:09', '2021-01-26 17:17:09'),
(7095, 1006, 11370, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 18:09:57', '2020-11-11 18:09:57'),
(7096, 1006, 11370, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Sent email to Furquan to send mail to RI Medicaid with the enrollment application. Attached. ', NULL, NULL, '2020-11-11 18:10:43', '2020-11-11 18:10:43'),
(7097, 1006, 11370, NULL, '2020-11-30 00:00:00.000', 'In Process', 'The provider does not show up as attached to the group yet. Allow more time as per the representative.  Ref# 465548', NULL, NULL, '2020-11-23 14:03:03', '2020-11-23 14:03:03'),
(7098, 1006, 11370, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Jessica - Provider still does not show up as enrolled under the group, need to allow more time.   Ref# 466259', NULL, NULL, '2020-11-30 15:54:38', '2020-11-30 15:54:38'),
(7099, 1006, 11370, NULL, '2020-12-15 00:00:00.000', 'Approved', 'As per the rep, the provider is effective as of 11/01/2020. We probably will not be receiving a welcome letter any time soon as they are backlogged.  Ref# 467349 Rep: Shericka ', NULL, NULL, '2020-12-08 09:49:26', '2020-12-08 09:49:26'),
(7100, 1006, 11371, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 18:09:57', '2020-11-11 18:09:57'),
(7101, 1006, 11371, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Sent email to Furquan to send mail to RI Medicaid with the enrollment application. Attached. ', NULL, NULL, '2020-11-11 18:10:51', '2020-11-11 18:10:51'),
(7102, 1006, 11371, NULL, '2020-11-30 00:00:00.000', 'In Process', 'The provider does not show up as attached to the group yet. Allow more time as per the representative.  Ref# 465548', NULL, NULL, '2020-11-23 14:03:12', '2020-11-23 14:03:12'),
(7103, 1006, 11371, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Melody - Provider still does not show up as enrolled under the group, need to allow more time. Ref# 466259', NULL, NULL, '2020-11-30 15:54:56', '2020-11-30 15:54:56'),
(7104, 1006, 11371, NULL, '2020-12-15 00:00:00.000', 'Approved', 'As per the rep, the provider is effective as of 11/01/2020. We probably will not be receiving a welcome letter any time soon as they are backlogged.  Ref# 467349 Rep: Shericka ', NULL, NULL, '2020-12-08 09:49:31', '2020-12-08 09:49:31'),
(7105, 1006, 11372, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-11 18:09:59', '2020-11-11 18:09:59'),
(7106, 1006, 11372, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Sent email to Furquan to send mail to RI Medicaid with the enrollment application. Attached. ', NULL, NULL, '2020-11-11 18:10:59', '2020-11-11 18:10:59'),
(7107, 1006, 11372, NULL, '2020-11-30 00:00:00.000', 'In Process', 'The provider does not show up as attached to the group yet. Allow more time as per the representative.  Ref# 465548', NULL, NULL, '2020-11-23 14:03:20', '2020-11-23 14:03:20'),
(7108, 1006, 11372, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Erin - Provider does not come up at all yet, need to allow more time.  Ref# 466259', NULL, NULL, '2020-11-30 15:55:17', '2020-11-30 15:55:17'),
(7109, 1006, 11372, NULL, '2020-12-15 00:00:00.000', 'Approved', 'As per the rep, the provider is effective as of 11/01/2020. We probably will not be receiving a welcome letter any time soon as they are backlogged.  Ref# 467349 Rep: Shericka ', NULL, NULL, '2020-12-08 09:49:49', '2020-12-08 09:49:49'),
(7110, 1006, 11373, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-12 17:11:15', '2020-11-12 17:11:15'),
(7111, 1006, 11373, NULL, '2020-11-24 00:00:00.000', 'Initiated', 'Sent email to Miguel with the application:  \"Hey Miguel,   Here are the filled applications for the LCSW\'s, I\'ll reply to your email regarding Mahreen, Pandeeswari & Fauzia as soon as I\'m able to.   Thanks. \"', NULL, NULL, '2020-11-12 17:11:43', '2020-11-12 17:11:43'),
(7112, 1006, 11373, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Sent following email to Miguel: \"Hey Miguel,   I\'m sorry for the delay, would we be able to set up a meeting tomorrow so I can go over a few questions I had regarding all of the providers missing information? Please let me know what number I should reach out to you at and when you will be available.  Thanks.  \"', NULL, NULL, '2020-11-24 15:29:50', '2020-11-24 15:29:50'),
(7113, 1006, 11373, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request. ', NULL, NULL, '2020-12-11 17:40:26', '2020-12-11 17:40:26'),
(7114, 3040, 11373, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:07', '2021-04-21 08:18:07'),
(7115, 1006, 11374, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-12 17:11:46', '2020-11-12 17:11:46'),
(7116, 1006, 11374, NULL, '2020-11-24 00:00:00.000', 'Initiated', 'Sent email to Miguel with the application:  \"Hey Miguel,   Here are the filled applications for the LCSW\'s, I\'ll reply to your email regarding Mahreen, Pandeeswari & Fauzia as soon as I\'m able to.   Thanks. \"', NULL, NULL, '2020-11-12 17:11:57', '2020-11-12 17:11:57'),
(7117, 1006, 11374, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Sent following email to Miguel: \"Hey Miguel,   I\'m sorry for the delay, would we be able to set up a meeting tomorrow so I can go over a few questions I had regarding all of the providers missing information? Please let me know what number I should reach out to you at and when you will be available.  Thanks.  \"', NULL, NULL, '2020-11-24 15:29:54', '2020-11-24 15:29:54'),
(7118, 1006, 11374, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request. ', NULL, NULL, '2020-12-11 17:40:33', '2020-12-11 17:40:33'),
(7119, 3040, 11374, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: MNHPnetworkoperations@beaconhealthoption.com  Subject: Enroll Providers || Spectrum Neuro Behavioral Care LLC || Rashid, Mahreen & Ullrich, Jennifer Lee || MBHP ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers for our group   Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-21 08:16:16', '2021-04-21 08:16:16'),
(7120, 1019, 11374, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:33:41', '2021-06-04 15:33:41'),
(7121, 1019, 11374, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:49:20', '2021-06-23 10:49:20'),
(7122, 19067, 11374, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:02:40', '2021-12-13 15:02:40'),
(7123, 19067, 11374, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:45:00', '2021-12-29 13:45:00'),
(7124, 19067, 11374, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:04:47', '2022-01-10 14:04:47'),
(7125, 19067, 11374, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:03', '2022-02-11 10:45:03'),
(7126, 19067, 11374, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: 	RE: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Ahmed,     The below providers that will need to complete the form, please indicate in the service section they want to add MBHP line of insurance.     Peggy Pionke – Complete the attached form  Katie Tawakolv – Already in network  Mahreen Rashid – Complete the attached form  Prisca Hefti – Already in network  Jennifer Ullrich – Complete the attached form     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-15 09:48:30', '2022-02-15 09:48:30'),
(7127, 19067, 11374, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Randy,  Please provide an effective date and approval letter for the providers who are now in-network with MBHP.   Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 17:12:12', '2022-03-16 17:12:12'),
(7128, 22077, 11374, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:12:50', '2022-04-05 08:12:50'),
(7129, 22077, 11374, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:20:33', '2022-04-05 10:20:33'),
(7130, 1006, 11375, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-12 17:11:47', '2020-11-12 17:11:47'),
(7131, 1006, 11375, NULL, '2020-11-24 00:00:00.000', 'Initiated', 'Sent email to Miguel with the application:  \"Hey Miguel,   Here are the filled applications for the LCSW\'s, I\'ll reply to your email regarding Mahreen, Pandeeswari & Fauzia as soon as I\'m able to.   Thanks. \"', NULL, NULL, '2020-11-12 17:12:03', '2020-11-12 17:12:03'),
(7132, 1006, 11375, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Sent following email to Miguel: \"Hey Miguel,   I\'m sorry for the delay, would we be able to set up a meeting tomorrow so I can go over a few questions I had regarding all of the providers missing information? Please let me know what number I should reach out to you at and when you will be available.  Thanks.  \"', NULL, NULL, '2020-11-24 15:29:58', '2020-11-24 15:29:58'),
(7133, 1006, 11375, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request. ', NULL, NULL, '2020-12-11 17:40:43', '2020-12-11 17:40:43'),
(7134, 1019, 11375, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:33:23', '2021-06-04 15:33:23'),
(7135, 1019, 11375, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:49:12', '2021-06-23 10:49:12'),
(7136, 19067, 11375, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:02:32', '2021-12-13 15:02:32'),
(7137, 19067, 11375, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:44:26', '2021-12-29 13:44:26'),
(7138, 19067, 11375, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:05:15', '2022-01-10 14:05:15'),
(7139, 19067, 11375, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:36', '2022-02-11 10:45:36'),
(7140, 1006, 11376, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-13 10:17:51', '2020-11-13 10:17:51'),
(7141, 1006, 11376, NULL, '2020-11-23 00:00:00.000', 'Initiated', 'Submitted request online via UBH portal. Attached application. ', NULL, NULL, '2020-11-13 10:19:37', '2020-11-13 10:19:37'),
(7142, 1006, 11376, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Application has been received and is currently under initial review. Should take 30~45 days.  Ref# ANN D 11/23/2020', NULL, NULL, '2020-11-23 15:50:17', '2020-11-23 15:50:17'),
(7143, 1006, 11376, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Request still shows up as pending review, need to allow more time. ', NULL, NULL, '2020-12-07 17:21:13', '2020-12-07 17:21:13'),
(7144, 1006, 11376, NULL, '2020-12-15 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-12-14 18:02:21', '2020-12-14 18:02:21'),
(7145, 1006, 11376, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Request shows as up incorrectly in the system, the request shows submission date as 12/03/2020, rep told me that she will get it forwarded to a network account manager to call us back. ', NULL, NULL, '2020-12-17 17:22:04', '2020-12-17 17:22:04'),
(7146, 1006, 11376, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Request shows as up incorrectly in the system, the request shows submission date as 12/03/2020, rep told me that she will get it forwarded to a network account manager to call us back.  Ref# Karl P', NULL, NULL, '2020-12-17 17:22:42', '2020-12-17 17:22:42'),
(7147, 1006, 11376, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Following status on NRPF: \"Your application has been submitted and is currently waiting to be reviewed by our Network Management Team.\" Submission Date is 11/13/2020', NULL, NULL, '2020-12-24 14:17:20', '2020-12-24 14:17:20'),
(7148, 1006, 11376, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Received following update from @ \"Gentile, Richard C\" richard_c_gentile_@optum.com: \"Good morning!  I’ve just submitted this request.   Once the application reaches the Credentialing Department, it will take approximately 60 days to process.  As a new fuction, if your application was submitted online,  you may check the status of your application during this time on our Provider Express site here, and you should receive a confirmation packet with an effective date once the process is complete.  Please note that we cannot review for Telehealth at this point. ZOOM requires a Business Associate Agreement (BAA) be submitted to us for review.  You may return directly that form directly to me vial email. Once I receive, I will update the request, asking them to review for Telehealth. (Going forward, you may also attach the form directly in Salesforce to any submitted application requests.)  Thanks, Rich  Richard Gentile Network Associate, Behavioral Network Services Richard_C_Gentile_@optum.com 950 Winter Street Suite 2200/3800 Waltham, Ma.  02451 Phone: 781-472-8537 Fax:     844-481-2861 Optum l United Behavioral Health My behavioral style is PROMOTING.\"', NULL, NULL, '2020-12-28 14:00:31', '2020-12-28 14:00:31'),
(7149, 1006, 11376, NULL, '2021-01-22 00:00:00.000', 'In Process', 'The request seems to be halfway done: \"Your application is currently with our Credentialing Department\'s Processing Team.\"', NULL, NULL, '2021-01-15 18:04:58', '2021-01-15 18:04:58'),
(7150, 1006, 11376, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Received an email from Rodney Wiley rodney.wiley@optum.com asking for DEA, sent reply:  \"Hello Rodney,   Sure thing, the provider\'s DEA is currently pending and should be issued in a few week\'s time. Would her MCSR number (MCS003221B) suffice?   Thanks.\"', NULL, NULL, '2021-01-18 17:47:48', '2021-01-18 17:47:48');
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
(7151, 1006, 11376, NULL, '2021-02-02 00:00:00.000', 'Approved', 'Received following approval confirmation from Optum Behavioral Health: \"1/22/2021 001029586 Carlee Rozell snbc@claimsmedinc.com snbc@claimsmedinc.com  Dear Carlee Rozell:  I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 1/22/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  \"', NULL, NULL, '2021-01-26 15:39:46', '2021-01-26 15:39:46'),
(7152, 1006, 11377, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-13 14:27:17', '2020-11-13 14:27:17'),
(7153, 1006, 11377, NULL, '2020-11-25 00:00:00.000', 'Initiated', 'Your application has been received, your CBP ID is CBP-0000184208. A recruiter will process your application and provide onboarding instructions within 20 business days. The process to join the Cigna Network can take up to 90 days. To check the status of your application, please email behavioralcontracting@cigna.com. ', NULL, NULL, '2020-11-13 14:27:36', '2020-11-13 14:27:36'),
(7154, 1006, 11377, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Spoke to rep, as per her we should have received a contract on Nov-19 but haven\'t. Told her to get it re-issued. Rep: Johanna 11-25-2020 ', NULL, NULL, '2020-11-25 10:09:46', '2020-11-25 10:09:46'),
(7155, 1006, 11377, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Called into Cigna since we still haven\'t received the contract, spoke to Rayne R, she notified me to contact the following representative Vanessa Puentesaenz.   Sent an email @ vanessa.puentesaenz@cigna.com requesting the contract to be sent to us so we can move forward with the request. ', NULL, NULL, '2020-12-02 14:02:40', '2020-12-02 14:02:40'),
(7156, 1006, 11377, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Sent another follow-up email @ \"Puente Saenz, Vanessa (Vanessa Puente Saenz) HHHH\" vanessa.puentesaenz@cigna.com', NULL, NULL, '2020-12-07 14:52:32', '2020-12-07 14:52:32'),
(7157, 1006, 11377, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent one more follow up email to \"Puente Saenz, Vanessa (Vanessa Puente Saenz) HHHH\" vanessa.puentesaenz@cigna.com ', NULL, NULL, '2020-12-17 16:58:30', '2020-12-17 16:58:30'),
(7158, 1006, 11377, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Received contract, signed and sent back. Attached a copy.  ', NULL, NULL, '2020-12-23 09:59:30', '2020-12-23 09:59:30'),
(7159, 1006, 11377, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ vanessa.puentesaenz@cigna.com', NULL, NULL, '2021-01-15 18:15:06', '2021-01-15 18:15:06'),
(7160, 1006, 11377, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Signed new contract as previous one was voided stating: Provider needs clinician agreement  ', NULL, NULL, '2021-01-27 11:51:10', '2021-01-27 11:51:10'),
(7161, 1006, 11377, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Sent another follow-up email @ \"Puente Saenz, Vanessa (Vanessa Puente Saenz) HHHH\" vanessa.puentesaenz@cigna.com for status.  ', NULL, NULL, '2021-02-01 15:27:20', '2021-02-01 15:27:20'),
(7162, 1006, 11377, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a f/u email @ Behavioral Contracting BehavioralContracting@Cigna.com', NULL, NULL, '2021-02-12 16:43:27', '2021-02-12 16:43:27'),
(7163, 1006, 11377, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Received the following response from Behavioral Contracting:  \"Provider Name: Carlee Rozell – Onboarding packet has been submitted to the Behavioral Credentialing Team for processing\"', NULL, NULL, '2021-02-25 13:18:12', '2021-02-25 13:18:12'),
(7164, 1019, 11377, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com Sub: Enrollment Status || Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards, Alex', NULL, NULL, '2021-04-08 11:16:46', '2021-04-08 11:16:46'),
(7165, 1019, 11377, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from: BehavioralContracting@cigna.com SUB: Enrollment Status || Providers || SNBCARE || CIGNA   Hi, Please see below for the provider status update.  Justin Souliere- Received application will process shortly. Kerry Smith- Received application will process shortly. Rodesia Edmundson- Received application will process shortly. Carlee Rozell- Credentialing status  Kiara   Cigna Behavioral NCU   E: BehavioralContracting@cigna.com', NULL, NULL, '2021-04-14 07:22:58', '2021-04-14 07:22:58'),
(7166, 1019, 11377, NULL, '2021-04-21 00:00:00.000', 'Approved', 'Signed Contact received effective date is 04/13/2021. See Attachment for ref', NULL, NULL, '2021-04-14 09:47:02', '2021-04-14 09:47:02'),
(7167, 1006, 11378, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-13 16:03:10', '2020-11-13 16:03:10'),
(7168, 1006, 11378, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Sent following email to PNM Department PNMDepartment@commonwealthcare.org> & #Credentialing Credentialing@commonwealthcare.org>:  \"Hello,   Please find the attached enrollment form for our provider and expedite the enrollment process as much as possible. Do let me know how long it will take to get her added to our group.   Thanks. \"  Form attached for reference. ', NULL, NULL, '2020-11-13 16:03:52', '2020-11-13 16:03:52'),
(7169, 1006, 11378, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Sent a follow-up email to  PNMDepartment@commonwealthcare.org: \"Hello,   I wanted to get an update regarding the enrollment status for the following providers, was the request received, and is it in-process?  Provider information is as follows: Provider Name: Barbara Hignite NPI# 1982617262 Provider Name: Carlee Rozell NPI# 1225645393  Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-11-19 14:53:14', '2020-11-19 14:53:14'),
(7170, 1006, 11378, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent another follow-up email to PNM Department PNMDepartment@commonwealthcare.org. ', NULL, NULL, '2020-11-30 13:54:17', '2020-11-30 13:54:17'),
(7171, 1006, 11378, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Sent another follow-up email @ PNM Department PNMDepartment@commonwealthcare.org. ', NULL, NULL, '2020-12-07 14:57:57', '2020-12-07 14:57:57'),
(7172, 1006, 11378, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Called CCA, as per them we can only email them for the status of enrollment.   Sent another follow-up email @ PNM Department PNMDepartment@commonwealthcare.org>, #Credentialing Credentialing@commonwealthcare.org>, credentialingdepartment@commonwealthcare.org, CCAcredentialing@commonwealthcare.org ', NULL, NULL, '2020-12-10 17:12:18', '2020-12-10 17:12:18'),
(7173, 1006, 11378, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Sent another follow-up email.', NULL, NULL, '2020-12-21 18:09:51', '2020-12-21 18:09:51'),
(7174, 1006, 11378, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Received following reply from: \"Hello,  Provider is in process, please allow time for credentialing period.  Credentialing period can take 30-60 days and you will receive confirmation once completed.  Thank You,\"', NULL, NULL, '2020-12-22 15:56:00', '2020-12-22 15:56:00'),
(7175, 1006, 11378, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow-up email sent, waiting on reply. ', NULL, NULL, '2020-12-29 14:16:33', '2020-12-29 14:16:33'),
(7176, 1006, 11378, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Sent another follow-up email. ', NULL, NULL, '2021-01-15 17:52:54', '2021-01-15 17:52:54'),
(7177, 1006, 11378, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Received a reply from #Credentialing Credentialing@commonwealthcare.org asking what address is her primary, replied: \"Good morning,   The primary location she should be listed under is 61 Lincoln St., Suite 203, Framingham, MA 01702.  Please let me know if she has been contracted/credentialed as in-network under that location.   Thanks. \"', NULL, NULL, '2021-01-19 09:22:21', '2021-01-19 09:22:21'),
(7178, 1006, 11378, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Received the following email from Yelena Bratslavskaya ybratslavskaya@commonwealthcare.org:  \"Carlee Rozell, NP NPI – 1225645393  Good Morning,  The above listed provider is in the process of Credentialing with CCA.  Please submit a current and active copy of the providers ANCC board certification.  Credentialing cannot be completed without this.  Thanks!\"', NULL, NULL, '2021-01-27 15:28:32', '2021-01-27 15:28:32'),
(7179, 1006, 11378, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Sent a follow-up email @ Yelena Bratslavskaya ybratslavskaya@commonwealthcare.org regarding status.  ', NULL, NULL, '2021-02-01 15:29:11', '2021-02-01 15:29:11'),
(7180, 1006, 11378, NULL, '2021-02-19 00:00:00.000', 'Approved', 'February 12, 2021     Carlee Ann Rozell, NP                           RE: Status of Credentialing & Enrollment Request     The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 2/12/2021.     Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.     Sincerely,     CCA Credentialing Department  2 Avenue De Lafayette 5th Floor  Boston, MA 02111  ', NULL, NULL, '2021-02-12 09:30:57', '2021-02-12 09:30:57'),
(7181, 1006, 11379, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-13 16:51:25', '2020-11-13 16:51:25'),
(7182, 1006, 11379, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Initiated request for enrollment via Magellan\'s website. Attached reference. ', NULL, NULL, '2020-11-13 16:51:52', '2020-11-13 16:51:52'),
(7183, 1006, 11379, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received following reply from Judith: \"Good Day,  CAQH ID: 14991424  If all of the information is showing correctly in the CAQH application including the service address(es), such as the work history and malpractice insurance, then send nothing more.  Judy   Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management O 410-953-3537 | F   1-888-656-1598 | E JJonesWright@magellanhealth.com\"', NULL, NULL, '2020-11-16 13:59:32', '2020-11-16 13:59:32'),
(7184, 1006, 11379, NULL, '2020-12-01 00:00:00.000', 'Rejected', 'Received the following email from Judith: \"Good Morning,   The credentialing department has indicated that this provider does not meet credentialing requirements. Please see letter attached.   Judy   Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management\"  Provider cannot be enrolled due to not being behavioral health provider.', NULL, NULL, '2020-11-24 14:32:23', '2020-11-24 14:32:23'),
(7185, 1006, 11380, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-13 17:27:19', '2020-11-13 17:27:19'),
(7186, 1006, 11380, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Initiated medical provider enrollment request under the group as the provider is an AGNP. Initiation form attached for reference. ', NULL, NULL, '2020-11-13 17:27:51', '2020-11-13 17:27:51'),
(7187, 1006, 11380, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent a follow-up email to Bevin Laura regarding status of our request. ', NULL, NULL, '2020-11-23 14:57:02', '2020-11-23 14:57:02'),
(7188, 1006, 11380, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Received following update: \"Hi,  Carlee Rozell is early in the credentialing process.  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health\"', NULL, NULL, '2020-11-23 16:57:44', '2020-11-23 16:57:44'),
(7189, 1006, 11380, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Sent another follow-up email to \"Bevin, Laura J\" Laura.Bevin@aetna.com regarding updated status. ', NULL, NULL, '2020-12-07 14:34:29', '2020-12-07 14:34:29'),
(7190, 1006, 11380, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Received following reply:  \"Hi,  The application for Carlee Rozell is in process.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-07 14:46:53', '2020-12-07 14:46:53'),
(7191, 1006, 11380, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Bevin, Laura J\" laura.bevin@aetna.com regarding updated status. ', NULL, NULL, '2020-12-17 10:27:18', '2020-12-17 10:27:18'),
(7192, 1006, 11380, NULL, '2020-12-25 00:00:00.000', 'Approved', 'Received following approval email from Laura Bevin: \"Good afternoon,  Carlee Rozell, 6712207 has a 01/01/2021 effective date.  Thank you Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-18 11:30:16', '2020-12-18 11:30:16'),
(7193, 1006, 11381, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-13 17:58:50', '2020-11-13 17:58:50'),
(7194, 1006, 11381, NULL, '2020-11-20 00:00:00.000', 'Initiated', 'Sent certification request to Chuck: \"Hey, Chuck.   I\'ve got another provider that needs to be certified, could you send this over to WPS as well?   Thanks.  \"', NULL, NULL, '2020-11-13 17:59:08', '2020-11-13 17:59:08'),
(7195, 1006, 11381, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following reply from John McGrew JMcGrew3@humana.com:  \"And hi again, again!  I can send this over, but they will need a copy of her license, as stated on the application.  Thanks!\"  Submitted temporary license to Chuck. ', NULL, NULL, '2020-11-16 11:11:26', '2020-11-16 11:11:26'),
(7196, 1006, 11381, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent follow-up email to Chuck regarding the status for the providers.', NULL, NULL, '2020-11-23 18:21:06', '2020-11-23 18:21:06'),
(7197, 1006, 11381, NULL, '2020-12-10 00:00:00.000', 'In Process', 'As per my discussion with Chuck, the request is still in-process. Need to allow more time as they are initial enrollments. ', NULL, NULL, '2020-11-30 17:25:36', '2020-11-30 17:25:36'),
(7198, 1006, 11381, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a followup email @ John McGrew JMcGrew3@humana.com:  Hello Chuck!  I hope you\'re doing well, I wanted to check in on the status of enrollment for the following provider: Provider Name: Carlee Rozell NPI# 1225645393  Thank you!', NULL, NULL, '2020-12-10 18:05:35', '2020-12-10 18:05:35'),
(7199, 1006, 11381, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Sent a follow-up email to Chuck @ John McGrew JMcGrew3@humana.com ', NULL, NULL, '2020-12-29 11:46:42', '2020-12-29 11:46:42'),
(7200, 1006, 11381, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Received following reply from Chuck: \"Hi, Brad!  Yes, I did. Hope yours was good as well. But now we’re both back at work. :-p Oh well.  Provider Name: Carlee Rozell---cert 12/11/20 NPI# 1225645393  So, we’ve got ‘em both, but not credentialed yet. Unless all the info I have for Carlee is incorrect, she is NOT a BH provider, so I’ll need a full “paper” cred packet for her.  Thanks!\"', NULL, NULL, '2020-12-29 16:55:03', '2020-12-29 16:55:03'),
(7201, 1006, 11381, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Sent filled credentialing application to Chuck, attached for reference.', NULL, NULL, '2021-02-12 18:09:40', '2021-02-12 18:09:40'),
(7202, 1006, 11381, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Received the following update from Chuck:  \"Morning, Brad!  I show Melody’s cred app as submitted 1/8/21, still awaiting processing. I’ve likewise submitted Carlee’s app to lock in the date, but we are going to need an updated malpractice cert, as hers here expired 12/31.  Thanks!\"  Sent the updated copy of Malpractice to Chuck.', NULL, NULL, '2021-02-15 10:06:39', '2021-02-15 10:06:39'),
(7203, 1006, 11381, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ Monica Tasby mtasby2@humana.com: \"Hello Monica,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the group and our providers, are we still set for a May 1st effective date?  Provider Information is as follows:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Carlee Rozell NPI# 1225645393  Please let me know if there have been any updates or if anything else is required.   Thank you!\"', NULL, NULL, '2021-03-02 11:52:40', '2021-03-02 11:52:40'),
(7204, 1006, 11381, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Disregard previous email.   Sent a follow-up email @ JMcGrew3@humana.com:  \"Hello Chuck,   Hope you\'re doing well, I just wanted to check in on the enrollment status for Melody L\'Etoile (1942687108) & Carlee Rozell (1225645393).   Appreciate the help!\"', NULL, NULL, '2021-03-02 11:58:58', '2021-03-02 11:58:58'),
(7205, 1006, 11381, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent another f/u email @ John McGrew JMcGrew3@humana.com as his previous email was not clear.  ', NULL, NULL, '2021-03-23 16:31:12', '2021-03-23 16:31:12'),
(7206, 1006, 11381, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Received the following replies from Chuck: \"Hi, Brad!  Cred status; affil date  Melody L\'Etoile (1942687108---App rcvd; 12/10/20 Carlee Rozell (1225645393).---App rcvd; 2/11/20  Oh, sorry about that. The dates are just the dates my system shows the providers attached to the tax ID. It doesn’t really mean anything much to us; has nothing to do with claims, but I find that providers set great store by it. :-)  As soon as we have them hooked up, they can see patients, or even before, really. Our timely filing guideline is a year after the date of service, even if the provider wasn’t Tricare-certified ON that DOS. We’re still waiting on these cred apps to process; those usually take about three months.  Chuck McGrew Tricare Community Liaison II Servicing provider relations matters in the following areas: RI / CT / Western MA Humana Military T 502-313-9524 F 806-517-2809 jmcgrew3@humana.com www.humanamilitary.com\"', NULL, NULL, '2021-03-24 09:50:12', '2021-03-24 09:50:12'),
(7207, 2027, 11382, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-16 13:40:13', '2020-11-16 13:40:13'),
(7208, 2027, 11382, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Provider is now in enrollment process with medicaid.', NULL, NULL, '2020-11-16 13:41:30', '2020-11-16 13:41:30'),
(7209, 2027, 11382, NULL, '2020-11-30 00:00:00.000', 'In Process', 'The request is still in process need more time to be completed.', NULL, NULL, '2020-11-23 09:33:41', '2020-11-23 09:33:41'),
(7210, 2027, 11382, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-30 13:16:38', '2020-11-30 13:16:38'),
(7211, 2037, 11382, NULL, '2020-12-15 00:00:00.000', 'In Process', '	 Request is still in process', NULL, NULL, '2020-12-08 13:49:03', '2020-12-08 13:49:03'),
(7212, 1006, 11382, NULL, '2020-12-18 00:00:00.000', 'In Process', 'As per the rep (Lisa) request is pending internally at Medicaid, she said to check back in on Friday.  Ref# 40457087000', NULL, NULL, '2020-12-15 15:22:53', '2020-12-15 15:22:53'),
(7213, 3040, 11382, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Speak to call center agent Anilisia and she said the enrollment is still in process.   Ticket no: 7306982 ', NULL, NULL, '2020-12-18 17:19:57', '2020-12-18 17:19:57'),
(7214, 3040, 11382, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Speak to Naija. She said next follow up on Dec 31.   Ref no: 40123183000', NULL, NULL, '2020-12-28 13:12:11', '2020-12-28 13:12:11'),
(7215, 3040, 11382, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per call center representative Sarah.   The application process will be completed till Jan-06-2021', NULL, NULL, '2020-12-30 16:53:13', '2020-12-30 16:53:13'),
(7216, 3040, 11382, NULL, '2021-01-13 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:28:09', '2021-01-06 12:28:09'),
(7217, 3040, 11382, NULL, '2021-01-14 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:29:04', '2021-01-06 12:29:04'),
(7218, 3040, 11382, NULL, '2021-01-07 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:29:31', '2021-01-06 12:29:31'),
(7219, 3040, 11382, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Had a word with (Anilisia) Medicaid representative.   The application is under the decision review.  Waiting for the state release. Next Follow up 01/12/2021(Tuesday) Application no: 7306982 (Medicaid)    Ref: 40584687000', NULL, NULL, '2021-01-07 10:50:42', '2021-01-07 10:50:42'),
(7220, 3040, 11382, NULL, '2021-01-19 00:00:00.000', 'Approved', 'Taxes Medicaid Provider ID: 198813103 Effective Date: 06/20/2020', NULL, NULL, '2021-01-12 10:26:03', '2021-01-12 10:26:03'),
(7221, 2027, 11383, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-16 13:45:36', '2020-11-16 13:45:36'),
(7222, 2027, 11383, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Provider is now in enrollment process with medicaid.', NULL, NULL, '2020-11-16 13:46:13', '2020-11-16 13:46:13'),
(7223, 2027, 11383, NULL, '2020-11-30 00:00:00.000', 'In Process', 'The request is still in process need more time to be completed. ', NULL, NULL, '2020-11-23 09:34:05', '2020-11-23 09:34:05'),
(7224, 2027, 11383, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-30 13:17:06', '2020-11-30 13:17:06'),
(7225, 2037, 11383, NULL, '2020-12-15 00:00:00.000', 'In Process', '	 Request is still in process', NULL, NULL, '2020-12-08 13:49:11', '2020-12-08 13:49:11'),
(7226, 1006, 11383, NULL, '2020-12-18 00:00:00.000', 'In Process', 'As per the rep (Lisa) request is pending internally at Medicaid, she said to check back in on Friday.  Ref# 40457087000 ', NULL, NULL, '2020-12-15 17:07:45', '2020-12-15 17:07:45'),
(7227, 3040, 11383, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Speak to call center agent Anilisia and she said the enrollment is still in process.   Ticket no: 7306982 ', NULL, NULL, '2020-12-18 17:18:00', '2020-12-18 17:18:00'),
(7228, 3040, 11383, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Speak to Naija. She said next follow up on Dec 31.   Ref no: 40123183000', NULL, NULL, '2020-12-28 13:12:31', '2020-12-28 13:12:31'),
(7229, 3040, 11383, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per call center representative Sarah.   The application process will be completed till Jan-06-2021.', NULL, NULL, '2020-12-30 16:52:58', '2020-12-30 16:52:58'),
(7230, 3040, 11383, NULL, '2021-01-14 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:27:55', '2021-01-06 12:27:55'),
(7231, 3040, 11383, NULL, '2021-01-07 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:30:52', '2021-01-06 12:30:52'),
(7232, 3040, 11383, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Had a word with (Anilisia) Medicaid representative.   The application is under the decision review.  Waiting for the state release. Next Follow up 01/12/2021(Tuesday) Application no: 7306982 (Medicaid)    Ref: 40584687000', NULL, NULL, '2021-01-07 10:50:15', '2021-01-07 10:50:15'),
(7233, 3040, 11383, NULL, '2021-01-21 00:00:00.000', 'Approved', 'Taxes Medicaid Provider ID: 198813103 Effective Date: 06/20/2020', NULL, NULL, '2021-01-14 09:39:29', '2021-01-14 09:39:29'),
(7234, 2027, 11384, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-16 13:48:17', '2020-11-16 13:48:17'),
(7235, 2027, 11384, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Provider is now in enrollment process with medicaid.', NULL, NULL, '2020-11-16 13:48:29', '2020-11-16 13:48:29'),
(7236, 2027, 11384, NULL, '2020-11-30 00:00:00.000', 'In Process', 'The request is still in process need more time to be completed. ', NULL, NULL, '2020-11-23 09:34:19', '2020-11-23 09:34:19'),
(7237, 2027, 11384, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-30 13:17:31', '2020-11-30 13:17:31'),
(7238, 2037, 11384, NULL, '2020-12-15 00:00:00.000', 'In Process', '	 Request is still in process', NULL, NULL, '2020-12-08 13:49:18', '2020-12-08 13:49:18'),
(7239, 1006, 11384, NULL, '2020-12-18 00:00:00.000', 'In Process', 'As per the rep (Lisa) request is pending internally at Medicaid, she said to check back in on Friday.  Ref# 40457087000', NULL, NULL, '2020-12-15 15:23:01', '2020-12-15 15:23:01'),
(7240, 3040, 11384, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Speak to call center agent and she said the enrollment is still in process.  Ticket no: 7306982', NULL, NULL, '2020-12-18 17:23:40', '2020-12-18 17:23:40'),
(7241, 3040, 11384, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Speak to Naija. She said next follow up on Dec 31.   Ref no: 40123183000', NULL, NULL, '2020-12-28 13:12:19', '2020-12-28 13:12:19'),
(7242, 3040, 11384, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per call center representative Sarah.   The application process will be completed till Jan-06-2021', NULL, NULL, '2020-12-30 16:53:06', '2020-12-30 16:53:06'),
(7243, 3040, 11384, NULL, '2021-01-14 00:00:00.000', 'In Process', 'End of the day will be updated.  The application in finalizing state review.  Ref: 40576577001', NULL, NULL, '2021-01-06 12:28:26', '2021-01-06 12:28:26'),
(7244, 3040, 11384, NULL, '2021-01-21 00:00:00.000', 'Approved', 'Taxes Medicaid Provider ID: 198813103 Effective Date: 06/20/2020', NULL, NULL, '2021-01-14 09:39:37', '2021-01-14 09:39:37'),
(7245, 2027, 11385, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-18 13:40:27', '2020-11-18 13:40:27'),
(7246, 2027, 11385, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: NETOPS-ADMIN@centene.com    Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.           Thank you,  Zujey Ashbaugh (Zuzy)  Contract Coordinator  Network Participation Request related info     Phone Number 866-615-9399', NULL, NULL, '2020-11-18 13:41:09', '2020-11-18 13:41:09'),
(7247, 2027, 11385, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com  Please find the application attached in this email.  Thanks.', NULL, NULL, '2020-11-18 14:11:14', '2020-11-18 14:11:14'),
(7248, 2027, 11385, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com NETOPS-ADMIN@centene.com  May I know the current status of my request? as I have already submitted the application in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:42:00', '2020-11-25 10:42:00'),
(7249, 2027, 11385, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-02 12:49:00', '2020-12-02 12:49:00'),
(7250, 2027, 11385, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:14:53', '2020-12-10 13:14:53'),
(7251, 3040, 11385, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.  Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542    Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 13:31:12', '2020-12-17 13:31:12'),
(7252, 3040, 11385, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Email received from : SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks ', NULL, NULL, '2020-12-21 17:24:38', '2020-12-21 17:24:38'),
(7253, 3040, 11385, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2020-12-28 13:42:38', '2020-12-28 13:42:38'),
(7254, 3040, 11385, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-01-04 15:43:22', '2021-01-04 15:43:22'),
(7255, 3040, 11385, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the provider. Has there been any update?  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-15 10:15:36', '2021-01-15 10:15:36'),
(7256, 3040, 11385, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  ', NULL, NULL, '2021-01-21 10:54:22', '2021-01-21 10:54:22'),
(7257, 3040, 11385, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-01-28 17:01:51', '2021-01-28 17:01:51'),
(7258, 3040, 11385, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.  Practice Information: Practice Name: Valley Med Urgent Care Practice Tax-ID# 81-5123542   Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-04 10:17:46', '2021-02-04 10:17:46'),
(7259, 3040, 11385, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-11 10:58:54', '2021-02-11 10:58:54'),
(7260, 3040, 11385, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care Practice Tax-ID# 81-5123542   Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:45:28', '2021-02-18 12:45:28'),
(7261, 3040, 11385, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 10/18/2020. Your effective date is 3/1/2021 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-02-25 14:02:48', '2021-02-25 14:02:48'),
(7262, 3040, 11385, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Please note that I didn\'t receive the welcome packet from your side. Would you be able to send me the welcome packet?  Thank you ', NULL, NULL, '2021-03-04 16:06:14', '2021-03-04 16:06:14'),
(7263, 3040, 11385, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: 	CYNTHIA RODRIGUEZ WELCOME LETTER  CYNTHIA RODRIGUEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM  Welcome to the Superior Health Plan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   03/01/2021                                                  C/ 46076', NULL, NULL, '2021-03-05 12:21:14', '2021-03-05 12:21:14'),
(7264, 1006, 11386, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-18 14:01:11', '2020-11-18 14:01:11'),
(7265, 1006, 11386, NULL, '2020-11-30 00:00:00.000', 'Initiated', 'Request initiated via PECOS. ', NULL, NULL, '2020-11-18 14:01:28', '2020-11-18 14:01:28'),
(7266, 1006, 11386, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Received following update via NGS Application Status Tool:  PE0000139395	 CMS855I Web	 11/18/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks. ', NULL, NULL, '2020-11-30 13:27:33', '2020-11-30 13:27:33'),
(7267, 1006, 11386, NULL, '2020-12-16 00:00:00.000', 'Approved', 'Application Tracking ID: T111820200002023   NPI ID: 1598163602   Medicare ID: S400706440   Name: LYNNETTA LOVELAND  State: MA   Form Type: 855I  Date: 12/09/2020  Status: APPROVED ', NULL, NULL, '2020-12-09 14:40:23', '2020-12-09 14:40:23'),
(7268, 2027, 11387, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-18 14:13:42', '2020-11-18 14:13:42'),
(7269, 2027, 11387, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: NETOPS-ADMIN@centene.com    Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.           Thank you,', NULL, NULL, '2020-11-18 14:14:00', '2020-11-18 14:14:00'),
(7270, 2027, 11387, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com  Please find the application attached in this email.  Thanks.', NULL, NULL, '2020-11-18 14:14:21', '2020-11-18 14:14:21'),
(7271, 2027, 11387, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com NETOPS-ADMIN@centene.com  May I know the current status of my request? as I have already submitted the application in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:45:18', '2020-11-25 10:45:18'),
(7272, 2027, 11387, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-02 12:49:30', '2020-12-02 12:49:30'),
(7273, 2027, 11387, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:15:44', '2020-12-10 13:15:44'),
(7274, 3040, 11387, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.  Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542    Please feel free to email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2020-12-17 13:30:17', '2020-12-17 13:30:17'),
(7275, 3040, 11387, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Email received from : SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks ', NULL, NULL, '2020-12-21 17:26:30', '2020-12-21 17:26:30'),
(7276, 3040, 11387, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2020-12-28 13:42:20', '2020-12-28 13:42:20'),
(7277, 3040, 11387, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-01-04 15:42:39', '2021-01-04 15:42:39'),
(7278, 3040, 11387, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject : Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the provider. Has there been any update?  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-15 10:16:51', '2021-01-15 10:16:51'),
(7279, 3040, 11387, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent. ', NULL, NULL, '2021-01-21 10:54:48', '2021-01-21 10:54:48'),
(7280, 3040, 11387, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-01-28 17:01:45', '2021-01-28 17:01:45'),
(7281, 3040, 11387, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.  Practice Information: Practice Name: Valley Med Urgent Care Practice Tax-ID# 81-5123542   Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-04 10:17:53', '2021-02-04 10:17:53'),
(7282, 3040, 11387, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-11 10:58:47', '2021-02-11 10:58:47'),
(7283, 3040, 11387, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care Practice Tax-ID# 81-5123542   Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:45:22', '2021-02-18 12:45:22'),
(7284, 3040, 11387, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 10/18/2020. Your effective date is 3/1/2021 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-02-25 14:02:43', '2021-02-25 14:02:43'),
(7285, 3040, 11387, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Please note that I didn\'t receive the welcome packet from your side. Would you be able to send me the welcome packet?  Thank you ', NULL, NULL, '2021-03-04 16:06:09', '2021-03-04 16:06:09'),
(7286, 3040, 11387, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: 	CYNTHIA RODRIGUEZ WELCOME LETTER  CYNTHIA RODRIGUEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM  Welcome to the Superior Health Plan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   03/01/2021                                                  C/ 46076', NULL, NULL, '2021-03-05 12:21:18', '2021-03-05 12:21:18'),
(7287, 2027, 11388, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-18 14:15:43', '2020-11-18 14:15:43'),
(7288, 2027, 11388, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: NETOPS-ADMIN@centene.com    Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.           Thank you,  Zujey Ashbaugh (Zuzy)  Contract Coordinator  Network Participation Request related info     Phone Number 866-615-9399', NULL, NULL, '2020-11-18 14:16:10', '2020-11-18 14:16:10'),
(7289, 2027, 11388, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com  Please find the application attached in this email.  Thanks.', NULL, NULL, '2020-11-18 14:16:21', '2020-11-18 14:16:21'),
(7290, 2027, 11388, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com NETOPS-ADMIN@centene.com  May I know the current status of my request? as I have already submitted the application in my last email.  Thanks.', NULL, NULL, '2020-11-25 10:45:37', '2020-11-25 10:45:37'),
(7291, 2027, 11388, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-02 12:49:51', '2020-12-02 12:49:51'),
(7292, 2027, 11388, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:16:33', '2020-12-10 13:16:33'),
(7293, 3040, 11388, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.  Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542    Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 13:31:48', '2020-12-17 13:31:48'),
(7294, 3040, 11388, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Email received from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2020-12-24 12:25:03', '2020-12-24 12:25:03');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(7295, 3040, 11388, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Email sent to:  SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the provider. Has there been any update?  Please feel free to email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2020-12-31 13:28:16', '2020-12-31 13:28:16'),
(7296, 3040, 11388, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-01-07 15:33:42', '2021-01-07 15:33:42'),
(7297, 3040, 11388, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject : Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the provider. Has there been any update?  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-15 10:17:57', '2021-01-15 10:17:57'),
(7298, 3040, 11388, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 11/18/2020.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent. ', NULL, NULL, '2021-01-21 10:54:53', '2021-01-21 10:54:53'),
(7299, 3040, 11388, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-01-28 17:01:56', '2021-01-28 17:01:56'),
(7300, 3040, 11388, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.  Practice Information: Practice Name: Valley Med Urgent Care Practice Tax-ID# 81-5123542   Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-04 10:17:59', '2021-02-04 10:17:59'),
(7301, 3040, 11388, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-11 10:58:59', '2021-02-11 10:58:59'),
(7302, 3040, 11388, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care Practice Tax-ID# 81-5123542   Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:45:37', '2021-02-18 12:45:37'),
(7303, 3040, 11388, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Hello  We received your completed application on 10/18/2020. Your effective date is 3/1/2021 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-02-25 14:02:55', '2021-02-25 14:02:55'),
(7304, 3040, 11388, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status Update || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Superior Health  Greetings,  Please note that I didn\'t receive the welcome packet from your side. Would you be able to send me the welcome packet?  Thank you ', NULL, NULL, '2021-03-04 16:06:19', '2021-03-04 16:06:19'),
(7305, 3040, 11388, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: 	CYNTHIA RODRIGUEZ WELCOME LETTER  CYNTHIA RODRIGUEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM  Welcome to the Superior Health Plan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   03/01/2021                                                  C/ 46076', NULL, NULL, '2021-03-05 12:21:20', '2021-03-05 12:21:20'),
(7306, 2037, 11389, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-11-19 10:39:29', '2020-11-19 10:39:29'),
(7307, 2037, 11389, NULL, '2020-12-14 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, '2020-11-19 10:39:55', '2020-11-19 10:39:55'),
(7308, 2037, 11389, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:10:15', '2020-11-20 13:10:15'),
(7309, 2037, 11389, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:18:25', '2020-12-23 17:18:25'),
(7310, 1006, 11389, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Received the following update from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Jeemol George –in process\" ', NULL, NULL, '2021-01-29 09:41:17', '2021-01-29 09:41:17'),
(7311, 1006, 11389, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:22:09', '2021-02-16 17:22:09'),
(7312, 3040, 11389, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: kjcarter@texaschildrens.org  Subject: Brittany Brown- TCHP Letter of Interest  Greetings,  Please advise me the enrollment status for the below mentioned providers.   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  Provider Name: George, Jeemol Provider NPI# 1497219067  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:57:47', '2021-02-26 13:57:47'),
(7313, 3040, 11389, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Jeemol George, FNP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Morning,  Welcome to TCHP. Jeemol George, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-16 14:48:15', '2021-03-16 14:48:15'),
(7314, 20067, 11389, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective Date: 11/13/2020 Provider ID: PR00002343737 ', NULL, NULL, '2022-02-24 12:40:39', '2022-02-24 12:40:39'),
(7315, 2027, 11390, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-19 15:52:02', '2020-11-19 15:52:02'),
(7316, 2027, 11390, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Provider is now in enrollment process with medicaid. Screenshot of ticket# is attached.', NULL, NULL, '2020-11-19 15:56:35', '2020-11-19 15:56:35'),
(7317, 2027, 11390, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-30 13:19:16', '2020-11-30 13:19:16'),
(7318, 2037, 11390, NULL, '2020-12-15 00:00:00.000', 'In Process', '	 Request is still in process', NULL, NULL, '2020-12-08 13:49:23', '2020-12-08 13:49:23'),
(7319, 2037, 11390, NULL, '2020-12-21 00:00:00.000', 'Approved', 'Welcome letter received with the effective date of 02/11/2020 with traditional medicaid . Letter uploaded in EMRBS. Notification sent to the billing.', NULL, NULL, '2020-12-14 17:04:00', '2020-12-14 17:04:00'),
(7320, 2037, 11391, NULL, NULL, 'New/Not Initiated', 'initiated', NULL, NULL, '2020-11-20 13:16:02', '2020-11-20 13:16:02'),
(7321, 2037, 11391, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:16:38', '2020-11-20 13:16:38'),
(7322, 2037, 11391, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:18:17', '2020-12-23 17:18:17'),
(7323, 1006, 11391, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following update from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Ani Stephen –in process\" ', NULL, NULL, '2021-01-29 09:44:34', '2021-01-29 09:44:34'),
(7324, 1006, 11391, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:23:27', '2021-02-16 17:23:27'),
(7325, 3040, 11391, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: kjcarter@texaschildrens.org  Subject: Stephen Ani & Brittany Brown- TCHP Letter of Interest  Greetings,  Please advise me the enrollment status for the below mentioned providers.   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  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  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.   Thanks ', NULL, NULL, '2021-02-26 13:54:27', '2021-02-26 13:54:27'),
(7326, 3040, 11391, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Ani Stephen, FNP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Evening,  Welcome to TCHP. Ani Stephen, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-18 12:27:58', '2021-03-18 12:27:58'),
(7327, 1006, 11392, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-24 14:44:16', '2020-11-24 14:44:16'),
(7328, 1006, 11392, NULL, '2020-12-18 00:00:00.000', 'Initiated', 'Request initated via Palmetto GBA portal. Attached copy. ', NULL, NULL, '2020-11-24 14:44:44', '2020-11-24 14:44:44'),
(7329, 1006, 11392, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Request still does not show up on PalmettoGBA need to allow more time.', NULL, NULL, '2020-12-18 10:48:01', '2020-12-18 10:48:01'),
(7330, 1006, 11392, NULL, '2021-01-04 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JESSICA HARTMAN PROVIDER PTAN	P02577228 PROVIDER NPI	1326665472 EFFECTIVE DATE	09/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0360 BUSINESS STATE	RI EFFECTIVE DATE	07/29/2019 END DATE	 ', NULL, NULL, '2020-12-28 17:58:42', '2020-12-28 17:58:42'),
(7331, 2037, 11393, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-11-25 12:23:34', '2020-11-25 12:23:34'),
(7332, 2037, 11393, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Received a confirmation email from Cigna that Normandy Urgent Care Center is in network with them having an urgent care contract with both Imperial Valley location added. Requested the copy of the executed signed contract as we do not have it in our records.Reference email as follows: ----------- To : psscentral@cigna.com Sub: Copy Contract Request.  Greetings,  It is kindly requested to forward us the copy of the executed urgent care contract for the below facility.  Group:Normandy Urgent Care Center TIN: 27-0796429 NPI: 1407171077 Billing/Mailing Address:779 Normandy St Ste 114                                           Houston , TX 77015-3441.  Point of Contact: Sherry Deen. Phone Number: 713-893-6214. ', NULL, NULL, '2020-11-25 12:29:36', '2020-11-25 12:29:36'),
(7333, 2037, 11393, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Follow up email sent for the copy of the executed contract.', NULL, NULL, '2020-12-16 14:44:37', '2020-12-16 14:44:37'),
(7334, 2037, 11393, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent for executed contract', NULL, NULL, '2020-12-29 10:39:05', '2020-12-29 10:39:05'),
(7335, 1006, 11393, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent following email @ \"Wasson, Michele J HHHH\" Michele.Wasson@cigna.com: \"Hello Michele,  Appreciate the update, can you please get us a copy of the executed ancillary contract? We\'ve been trying to get it for a while.  Thanks.\"', NULL, NULL, '2021-01-28 14:25:19', '2021-01-28 14:25:19'),
(7336, 1006, 11393, NULL, '2021-02-04 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference. ', NULL, NULL, '2021-01-28 14:32:08', '2021-01-28 14:32:08'),
(7337, 2027, 12392, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-30 12:26:26', '2020-11-30 12:26:26'),
(7338, 2027, 12392, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Provider is in enrollment process with medicare and the details are as follows: pplication Tracking ID: T113020200000724        NPI: 1245789502        Medicare ID: 581120YMKA, 930217, 930311        Name: ARTURO ALEJANDRO LIRA JR.                State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-11-30 12:27:33', '2020-11-30 12:27:33'),
(7339, 2027, 12392, NULL, '2020-12-09 00:00:00.000', 'Approved', 'This provider is enrolled in (Medicare) and effective date is 10/01/2020', NULL, NULL, '2020-12-02 10:35:30', '2020-12-02 10:35:30'),
(7340, 2027, 12393, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-30 12:31:24', '2020-11-30 12:31:24'),
(7341, 2027, 12393, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Provider is in enrollment process with medicare and the details are as follows: Application Tracking ID: T113020200000724        NPI: 1245789502        Medicare ID: 581120YMKA, 930217, 930311        Name: ARTURO ALEJANDRO LIRA JR.                State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-11-30 12:31:41', '2020-11-30 12:31:41'),
(7342, 2027, 12393, NULL, '2020-12-09 00:00:00.000', 'Approved', 'This provider is enrolled in (Medicare) and effective date is 10/01/2020 ', NULL, NULL, '2020-12-02 10:45:40', '2020-12-02 10:45:40'),
(7343, 2027, 12394, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-11-30 12:32:21', '2020-11-30 12:32:21'),
(7344, 2027, 12394, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Provider is in enrollment process with medicare and the details are as follows: Application Tracking ID: T113020200000724        NPI: 1245789502        Medicare ID: 581120YMKA, 930217, 930311        Name: ARTURO ALEJANDRO LIRA JR.                State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-11-30 12:32:36', '2020-11-30 12:32:36'),
(7345, 2027, 12394, NULL, '2020-12-09 00:00:00.000', 'New/Not Initiated', 'This provider is enrolled in (Medicare) and effective date is 10/01/2020 ', NULL, NULL, '2020-12-02 10:48:36', '2020-12-02 10:48:36'),
(7346, 2027, 12394, NULL, '2020-12-09 00:00:00.000', 'Approved', 'This provider is enrolled in (Medicare) and effective date is 10/01/2020 ', NULL, NULL, '2020-12-02 10:48:59', '2020-12-02 10:48:59'),
(7347, 1006, 12395, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-01 17:09:48', '2020-12-01 17:09:48'),
(7348, 1006, 12395, NULL, '2020-12-10 00:00:00.000', 'Initiated', 'Request submitted for individual enrollment.   \"   Application Tracking ID: T120120200002719        NPI: 1760700223        Medicare ID:         Name: OLADIPO  DADA          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813\"', NULL, NULL, '2020-12-01 17:11:05', '2020-12-01 17:11:05'),
(7349, 1006, 12395, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Sent an email to Dada regarding the group\'s deficiency. Waiting on a response. ', NULL, NULL, '2020-12-11 17:57:32', '2020-12-11 17:57:32'),
(7350, 3040, 12395, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent an email to Dada regarding the group\'s deficiency. Waiting on a response. ', NULL, NULL, '2020-12-18 10:03:53', '2020-12-18 10:03:53'),
(7351, 1005, 12395, NULL, '2020-12-31 00:00:00.000', 'In Process', 'DCN/CCN	303360637 NPI	1760700223 Tracking Id	T120120200002719 Application Type	855I Name	OLADIPO DADA Legal Business Name	 Received Date	2020-12-01 The status of this application is: In Development', NULL, NULL, '2020-12-24 12:11:11', '2020-12-24 12:11:11'),
(7352, 3040, 12395, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Waiting for CP575 from Oladipo Dada.', NULL, NULL, '2020-12-31 09:18:59', '2020-12-31 09:18:59'),
(7353, 3040, 12395, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Still waiting for CP575', NULL, NULL, '2021-01-07 10:24:28', '2021-01-07 10:24:28'),
(7354, 3040, 12395, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Still waiting for CP575', NULL, NULL, '2021-01-11 13:54:58', '2021-01-11 13:54:58'),
(7355, 3040, 12395, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Applicant Name: OLADIPO DADA Tracking ID: T022520210003482 Reassignment Tracking ID: T030320210002179 Submitted Date: WED - MARCH 03 2021 01:15:22 PM EST Submitted By: Oladipo Dada Contact Email(s): LHC@CLAIMSMEDINC.COM', NULL, NULL, '2021-03-03 13:16:23', '2021-03-03 13:16:23'),
(7356, 3040, 12395, NULL, '2021-03-16 00:00:00.000', 'Approved', 'Individual Name: Oladipo Dada MD Individual Specialty: INTERNAL MEDICINE Individual National Provider Identifier (NPI): 1760700223 Individual Provider Transaction Access Number (PTAN): 1M9247 Individual PTAN Effective Date: December 03, 2020 Changed Information: LICENSE/CERTIFICATION/REGISTRATION INFORMATION, CORRESPONDENCE MAILING ADDRESS, CONTACT PERSON INFORMATION', NULL, NULL, '2021-03-09 09:57:14', '2021-03-09 09:57:14'),
(7357, 1006, 12396, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-01 17:09:50', '2020-12-01 17:09:50'),
(7358, 1006, 12396, NULL, '2020-12-10 00:00:00.000', 'Initiated', 'Request submitted for group enrollment.   \"   Application Tracking ID: T120120200002719        NPI: 1760700223        Medicare ID:         Name: OLADIPO  DADA          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813\"', NULL, NULL, '2020-12-01 17:10:44', '2020-12-01 17:10:44'),
(7359, 1006, 12396, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Sent an email to Dada regarding the group\'s deficiency. Waiting on a response. ', NULL, NULL, '2020-12-11 17:57:38', '2020-12-11 17:57:38'),
(7360, 3040, 12396, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent an email to Dada regarding the group\'s deficiency. Waiting on a response. ', NULL, NULL, '2020-12-18 10:04:02', '2020-12-18 10:04:02'),
(7361, 1005, 12396, NULL, '2020-12-31 00:00:00.000', 'In Process', 'DCN/CCN	303360637 NPI	1912502626 Tracking Id	T120120200002719 Application Type	855I Name	OLADIPO DADA Legal Business Name	 Received Date	2020-12-01 The status of this application is: In Development', NULL, NULL, '2020-12-24 12:10:02', '2020-12-24 12:10:02'),
(7362, 3040, 12396, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Waiting for CP575 from Oladipo Dada.', NULL, NULL, '2020-12-31 09:19:12', '2020-12-31 09:19:12'),
(7363, 3040, 12396, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Still waiting for CP575', NULL, NULL, '2021-01-07 10:25:02', '2021-01-07 10:25:02'),
(7364, 3040, 12396, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Still waiting for CP575', NULL, NULL, '2021-01-11 13:54:49', '2021-01-11 13:54:49'),
(7365, 3040, 12396, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Applicant Name: OLADIPO DADA Tracking ID: T022520210003482 Reassignment Tracking ID: T030320210002179 Submitted Date: WED - MARCH 03 2021 01:15:22 PM EST Submitted By: Oladipo Dada Contact Email(s): LHC@CLAIMSMEDINC.COM', NULL, NULL, '2021-03-03 13:22:50', '2021-03-03 13:22:50'),
(7366, 3040, 12396, NULL, '2021-03-16 00:00:00.000', 'Approved', 'Legal Business Name (LBN): Ladot Healthcare LLC Doing Business As (DBA): N/A Provider/Supplier Type: CLINIC/GROUP PRACTICE National Provider Identifier (NPI): 1912502626 Provider Transaction Access Number (PTAN): 1M9248 Group PTAN Effective Date: December 03, 2020 Participation Status: PARTICIPATING PROVIDER Changed Information: N/A', NULL, NULL, '2021-03-09 10:00:45', '2021-03-09 10:00:45'),
(7367, 1006, 12397, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-01 17:40:34', '2020-12-01 17:40:34'),
(7368, 1006, 12397, NULL, '2020-12-10 00:00:00.000', 'Initiated', 'Initiated request via PECOS: \"Applicant Name: ATINUKE DADA  Tracking ID: T120120200003568  Reassignment Tracking ID: T120120200003569  Submitted Date: TUE - DECEMBER 01 2020 05:39:51 PM EST  Submitted By: Atinuke Dada  Contact Email(s): AA@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is reactivating a deactivated Medicare billing number.\"', NULL, NULL, '2020-12-01 17:40:52', '2020-12-01 17:40:52'),
(7369, 1006, 12397, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Sent an email to Dada regarding the group\'s deficiency. Waiting on a response. ', NULL, NULL, '2020-12-11 17:57:45', '2020-12-11 17:57:45'),
(7370, 3040, 12397, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent an email to Dada regarding the group\'s deficiency. Waiting on a response. ', NULL, NULL, '2020-12-18 10:04:13', '2020-12-18 10:04:13'),
(7371, 1005, 12397, NULL, '2020-12-31 00:00:00.000', 'In Process', 'DCN/CCN	303360536 NPI	1154782720 Tracking Id	T120120200003569 Application Type	855R Name	ATINUKE DADA Legal Business Name	 Received Date	2020-12-01 The status of this application is: In Development', NULL, NULL, '2020-12-24 12:08:43', '2020-12-24 12:08:43'),
(7372, 3040, 12397, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Waiting for CP575 from Oladipo Dada.', NULL, NULL, '2020-12-31 09:19:18', '2020-12-31 09:19:18'),
(7373, 3040, 12397, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Still waiting for CP575', NULL, NULL, '2021-01-07 10:25:11', '2021-01-07 10:25:11'),
(7374, 3040, 12397, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Still waiting for CP575', NULL, NULL, '2021-01-11 13:55:09', '2021-01-11 13:55:09'),
(7375, 3040, 12397, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Enrollment Tracking Information: Applicant Name: ATINUKE DADA Tracking ID: T040120210000792 Reassignment Tracking ID: T040120210000793 Submitted Date: THU - APRIL 01 2021 11:19:34 AM EST Submitted By: Atinuke Dada Contact Email(s): LHC@CLAIMSMEDINC.COM', NULL, NULL, '2021-04-01 10:20:29', '2021-04-01 10:20:29'),
(7376, 3040, 12397, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Received a deficiency letter. Leave the voice msg to Katrisha Leonard on 04/12/2021.    ', NULL, NULL, '2021-04-12 13:39:48', '2021-04-12 13:39:48'),
(7377, 3040, 12397, NULL, '2021-05-07 00:00:00.000', 'In Process', 'I had a word with (Sandra) Medicare representative and she advise me to send the copy of nurse practitioner certification through fax @ 877-439-5479.   Ref: 4021120210020 ', NULL, NULL, '2021-04-30 11:48:33', '2021-04-30 11:48:33'),
(7378, 3040, 12397, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Applicant Name: ATINUKE DADA  Tracking ID: T040120210000792  Submitted Date: THU - MAY 06 2021 11:25:36 AM EST  Submitted By: Atinuke Dada  Contact Email(s): LHC@CLAIMSMEDINC.COM', NULL, NULL, '2021-05-06 10:34:00', '2021-05-06 10:34:00'),
(7379, 3040, 12397, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Applicant Name: ATINUKE DADA  Tracking ID: T040120210000792  Reassignment Tracking ID: T051120210000297  Submitted Date: TUE - MAY 11 2021 08:29:39 AM EST  Submitted By: Atinuke Dada  Contact Email(s): LHC@CLAIMSMEDINC.COM', NULL, NULL, '2021-05-11 07:30:14', '2021-05-11 07:30:14'),
(7380, 3040, 12397, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: ATINUKE DADA NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1154782720 Individual Provider Transaction Access Number (PTAN): 1P2911 Group Legal Business Name (LBN): LADOT HEALTHCARE LLC Group NPI: 1912502626 Group PTAN: 1M9248 Reassignment Effective Date: FEBRUARY 05, 2021', NULL, NULL, '2021-05-18 08:20:33', '2021-05-18 08:20:33'),
(7381, 2027, 12398, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 09:26:23', '2020-12-02 09:26:23'),
(7382, 2027, 12398, 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 09:28:24', '2020-12-02 09:28:24'),
(7383, 2027, 12399, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 14:26:31', '2020-12-02 14:26:31'),
(7384, 2027, 12399, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Provider is now under enrollment process with medicaid and this is the PEP Ticket# 17416087', NULL, NULL, '2020-12-02 14:28:17', '2020-12-02 14:28:17'),
(7385, 2027, 12399, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:05:20', '2020-12-10 13:05:20'),
(7386, 2037, 12399, NULL, '2020-12-25 00:00:00.000', 'Approved', 'Welcome letter received with the effective date of 01/22/2020 with traditional medicaid . Confirmation uploaded in EMRBS. Notification sent to the billing.', NULL, NULL, '2020-12-18 13:19:53', '2020-12-18 13:19:53'),
(7387, 2027, 12400, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 14:33:14', '2020-12-02 14:33:14'),
(7388, 2027, 12400, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Provider is now under enrollment process with medicaid. PEP Ticket# is attached', NULL, NULL, '2020-12-02 15:13:16', '2020-12-02 15:13:16'),
(7389, 2027, 12400, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:08:49', '2020-12-10 13:08:49'),
(7390, 3040, 12400, NULL, '2020-12-23 00:00:00.000', 'Approved', 'Received approval letter and status updated in system & effective date 10/01/2020. ', NULL, NULL, '2020-12-16 16:53:52', '2020-12-16 16:53:52'),
(7391, 2027, 12401, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 15:17:06', '2020-12-02 15:17:06'),
(7392, 2027, 12401, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Provider is now under enrollment process with medicaid. PEP Ticket# is attached ', NULL, NULL, '2020-12-02 15:17:19', '2020-12-02 15:17:19'),
(7393, 2027, 12401, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:09:50', '2020-12-10 13:09:50'),
(7394, 3040, 12401, NULL, '2020-12-23 00:00:00.000', 'Approved', 'Received approval letter and status updated in system & effective date 10/01/2020. ', NULL, NULL, '2020-12-16 16:58:38', '2020-12-16 16:58:38'),
(7395, 2027, 12402, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 15:19:05', '2020-12-02 15:19:05'),
(7396, 2027, 12402, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Provider is now under enrollment process with medicaid. PEP Ticket# is attached ', NULL, NULL, '2020-12-02 15:21:09', '2020-12-02 15:21:09'),
(7397, 2027, 12402, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:10:54', '2020-12-10 13:10:54'),
(7398, 3040, 12402, NULL, '2020-12-23 00:00:00.000', 'Approved', 'Received approval letter and status updated in system & effective date 10/01/2020. ', NULL, NULL, '2020-12-16 16:55:35', '2020-12-16 16:55:35'),
(7399, 2027, 12403, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 15:29:05', '2020-12-02 15:29:05'),
(7400, 2027, 12403, NULL, '2020-12-09 00:00:00.000', 'Approved', 'Provider is now enrolled with medicare railroad and effective date is 06/20/2020 ', NULL, NULL, '2020-12-02 15:29:26', '2020-12-02 15:29:26'),
(7401, 2027, 12404, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-02 15:31:05', '2020-12-02 15:31:05'),
(7402, 2027, 12404, NULL, '2020-12-09 00:00:00.000', 'Approved', 'Provider is now enrolled with medicare railroad and effective date is 06/20/2020 ', NULL, NULL, '2020-12-02 15:31:21', '2020-12-02 15:31:21'),
(7403, 1006, 12405, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-03 14:39:00', '2020-12-03 14:39:00'),
(7404, 1006, 12405, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	20328000378 NPI :	1982617262 ', NULL, NULL, '2020-12-03 14:39:13', '2020-12-03 14:39:13'),
(7405, 1006, 12405, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Request still does not show up on Palmetto GBA. Need to allow more time. ', NULL, NULL, '2020-12-22 17:29:49', '2020-12-22 17:29:49'),
(7406, 1006, 12405, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Request still does not show up on Medicare RR portal, need to allow more time. ', NULL, NULL, '2020-12-29 12:04:36', '2020-12-29 12:04:36'),
(7407, 1006, 12405, NULL, '2021-01-11 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	BARBARA A HIGNITE PROVIDER PTAN	P02580825 PROVIDER NPI	1982617262 EFFECTIVE DATE	09/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-01-04 14:20:03', '2021-01-04 14:20:03'),
(7408, 1006, 12406, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-03 15:12:07', '2020-12-03 15:12:07'),
(7409, 1006, 12406, NULL, '2020-12-21 00:00:00.000', 'Initiated', 'Faxed contracting application @ (617) 246-5053. Attached. ', NULL, NULL, '2020-12-03 15:12:31', '2020-12-03 15:12:31'),
(7410, 1006, 12406, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Signature page received. Signed and sent back. Attached. ', NULL, NULL, '2020-12-03 17:02:27', '2020-12-03 17:02:27'),
(7411, 1006, 12406, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com ', NULL, NULL, '2020-12-17 18:05:51', '2020-12-17 18:05:51'),
(7412, 1006, 12406, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Received following reply from BCBSMA:  \"Provider’s contract was received on 12/3/20 and the provider’s enrollment is currently in process.  Standard processing time is approximately 50-60 days.  Once the provider’s enrollment has been completed, we will send out a welcome letter via email which will show the effective date of the provider’s participation with us and the products enrolled in .  Regards,  Network Management Services  Blue Cross Blue Shield of Massachusetts  TH\"', NULL, NULL, '2020-12-18 09:22:06', '2020-12-18 09:22:06'),
(7413, 1006, 12406, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com', NULL, NULL, '2020-12-28 17:51:12', '2020-12-28 17:51:12'),
(7414, 1006, 12406, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Need to allow more time for processing. ', NULL, NULL, '2021-01-04 18:39:04', '2021-01-04 18:39:04'),
(7415, 1006, 12406, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Received the following reply from providerapplicationstatus@bcbsma.com: \"In process.  Please allow approximately another 30 days for processing.  Regards,  Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2021-01-07 10:07:03', '2021-01-07 10:07:03'),
(7416, 1006, 12406, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent follow-up email @ providerapplicationstatus@bcbsma.com', NULL, NULL, '2021-01-19 14:46:56', '2021-01-19 14:46:56'),
(7417, 1006, 12406, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com', NULL, NULL, '2021-01-27 11:44:23', '2021-01-27 11:44:23'),
(7418, 1006, 12406, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Received the following response from BCBSMA: \"Hello,  Contracts were received for the provider on 12/3/20 .   Standard processing time for a new enrollment is approximately 60 days.   Once the provider’s enrollment has been completed, we will send out a welcome letter via email which will show the effective date of the provider’s participation with us and the products enrolled in.  Thank you,  Provider Application Status  /rr\"', NULL, NULL, '2021-01-27 11:56:41', '2021-01-27 11:56:41'),
(7419, 1006, 12406, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Received the following reply from providerapplicationstatus@bcbsma.com: \"Hello,  Contracts were received for the provider on 12/3/20 .   Standard processing time for a new enrollment is approximately 60 days.   Once the provider’s enrollment has been completed, we will send out a welcome letter via email which will show the effective date of the provider’s participation with us and the products enrolled in.  Thank you, Provider Application Status\"', NULL, NULL, '2021-02-02 15:53:23', '2021-02-02 15:53:23'),
(7420, 1006, 12406, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com ', NULL, NULL, '2021-02-12 16:40:27', '2021-02-12 16:40:27'),
(7421, 1006, 12406, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received following response from providerapplicationstatus@bcbsma.com:  \"Hello,  The providers contract was received on 12/3/20 and is still pending credentialing.  Please be sure providers CAQH is completed.  Thank you,  Provider Application Status\"', NULL, NULL, '2021-02-17 09:59:50', '2021-02-17 09:59:50'),
(7422, 1006, 12406, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Received a request from BCBSMA asking for MA DEA, Lynnetta provided it to them and received the following response: \"Hi Lynetta,  Thank you so much for sending me your MA FDEA and so quickly.  Your application should go to Committee on Monday.  Have a good weekend and be well,  Francine\"', NULL, NULL, '2021-02-19 15:12:00', '2021-02-19 15:12:00'),
(7423, 1006, 12406, NULL, '2021-03-09 00:00:00.000', 'Approved', 'I.PCNS.Loveland, Lynnetta  Spectrum Neuro Behavioral Care Llc  Reference#: 00013888  The application for the above provider has been completed.  If you have any further questions, please contact Network Management & Credentialing Services at 1-800-316-Blue (2583).  Thank you, Blue Cross Blue Shield of Massachusetts ', NULL, NULL, '2021-03-02 11:36:46', '2021-03-02 11:36:46'),
(7424, 1006, 12407, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-03 17:22:38', '2020-12-03 17:22:38'),
(7425, 1006, 12407, NULL, '2020-12-10 00:00:00.000', 'Initiated', 'Submitted RFA form to RFA@beaconhealthoptions.com. Attached for reference. ', NULL, NULL, '2020-12-03 17:22:51', '2020-12-03 17:22:51'),
(7426, 1006, 12407, NULL, '2020-12-21 00:00:00.000', 'In Process', 'RFA does not show up on file, the representative sent an email to contracting to get checked out. Need to allow more time.  Ref# 12102020-9885757', NULL, NULL, '2020-12-10 17:39:57', '2020-12-10 17:39:57'),
(7427, 1006, 12407, NULL, '2020-01-08 00:00:00.000', 'In Process', 'Sent follow-up email @ provider.relations@beaconhealthoptions.com: \"Hello,   I need an update regarding the enrollment status of the following providers:   Provider Name: Lynneta Loveland NPI# 1598163602  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2020-12-24 14:07:34', '2020-12-24 14:07:34'),
(7428, 1006, 12407, NULL, '2021-01-27 00:00:00.000', 'Approved', 'Submitted online application for enrollment', NULL, NULL, '2021-01-20 11:17:54', '2021-01-20 11:17:54'),
(7429, 1019, 12407, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Attached is the Welcome letter, eff 08/06/2021.', NULL, NULL, '2021-09-13 08:54:16', '2021-09-13 08:54:16'),
(7430, 1006, 12408, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-03 18:03:02', '2020-12-03 18:03:02'),
(7431, 1006, 12408, NULL, '2020-12-10 00:00:00.000', 'Initiated', 'Provider enrollment request submitted online via Aetna website. ', NULL, NULL, '2020-12-03 18:03:23', '2020-12-03 18:03:23'),
(7432, 1006, 12408, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Bevin, Laura J\" Laura.Bevin@aetna.com', NULL, NULL, '2020-12-10 17:19:32', '2020-12-10 17:19:32'),
(7433, 1006, 12408, NULL, '2021-01-01 00:00:00.000', 'On Hold', 'Received the following update from Bevin: \"Good morning,  Lynnetta Loveland, 6154081 has a temporary license for MA and Aetna does not accept temporary licenses. Please advise when she has a full license and I will have her credentialing placed back in process.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-11 09:56:53', '2020-12-11 09:56:53'),
(7434, 1006, 12408, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Sent an email to Laura to re-initiate the enrollment process for Nita as her APRN license has been issued. ', NULL, NULL, '2021-02-03 15:14:01', '2021-02-03 15:14:01'),
(7435, 1006, 12408, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Received the following reply from Laura:  \"Hello,  I have notified our Credentialing Dept. regarding the license for Lynnetta Loveland.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-02-04 13:44:39', '2021-02-04 13:44:39'),
(7436, 1006, 12408, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Bevin, Laura J\" Laura.Bevin@aetna.com', NULL, NULL, '2021-02-12 16:45:49', '2021-02-12 16:45:49'),
(7437, 1006, 12408, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Received the following reply from Laura Bevin: \"Good morning,  Lynnetta Loveland, 6785859 – waiting to be linked to the contract  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-02-15 10:50:27', '2021-02-15 10:50:27'),
(7438, 1006, 12408, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Bevin, Laura J\" Laura.Bevin@aetna.com regarding updated status. ', NULL, NULL, '2021-03-02 10:17:18', '2021-03-02 10:17:18'),
(7439, 1006, 12408, NULL, '2021-03-09 00:00:00.000', 'Approved', 'Received the following email from Laura.Bevin@aetna.com: \"Lynnetta Loveland, 6785859 has a 03/01/2021 effective  date.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2021-03-02 17:34:22', '2021-03-02 17:34:22'),
(7440, 1006, 12409, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 10:58:23', '2020-12-04 10:58:23'),
(7441, 1006, 12409, NULL, '2020-12-15 00:00:00.000', 'Initiated', 'Enrollment request submitted online. Attached for reference. ', NULL, NULL, '2020-12-04 10:58:42', '2020-12-04 10:58:42'),
(7442, 1006, 12409, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Received following email from behPWS@cigna.com:  \"Dear Lynnetta Loveland,  Thank you for submitting an online screening form / application for network participation. However, our records indicate that you are already contracted / fully credentialed with the Cigna behavioral network. If you need to submit demographic changes, please do one of the following to make those changes.  . Call the Provider Service center at 800.926.2273 . Fax a written request to Network Operations at 860.687.7257 . Mail a written request to Network Operations at 11095 Viking Dr Ste 350, Eden Prairie, MN 55343 . Log in to CignaforHCP.com and submit changes through the web portal If you have other questions unrelated to updating your demographic information, our Provider Advocates can assist with this as well.  Sincerely, Cigna Behavioral Credentialing\"', NULL, NULL, '2020-12-14 09:26:20', '2020-12-14 09:26:20'),
(7443, 1006, 12409, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Called Cigna, as per them the request has been initiated to add group address to provider. Need to allow 5 business days for the request to process.  Rep requested me to fax over the temp license to 860-687-7257 with ATTN: Network Operations, sent.   Ref# Tessa M 12/22/2020', NULL, NULL, '2020-12-22 10:56:29', '2020-12-22 10:56:29'),
(7444, 1006, 12409, NULL, '2021-01-05 00:00:00.000', 'Approved', 'Provider is in-network and has been added under the address.  Effective: 12/23/2020  Ref# Izzy L 12/29/2020', NULL, NULL, '2020-12-29 14:42:49', '2020-12-29 14:42:49'),
(7445, 1006, 12410, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 11:44:54', '2020-12-04 11:44:54'),
(7446, 1006, 12410, NULL, '2020-12-15 00:00:00.000', 'Initiated', 'Request initiated via Magellan website. ', NULL, NULL, '2020-12-04 11:45:11', '2020-12-04 11:45:11'),
(7447, 1006, 12410, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Received following reply from Judith: \"Good Day,  CAQH ID: 13826718  If all of the information is showing correctly in the CAQH application including the service address(es), such as the work history and malpractice insurance, then send nothing more. The provider will be in the credentialing process.  Judy  Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management\"', NULL, NULL, '2020-12-09 15:47:35', '2020-12-09 15:47:35'),
(7448, 1006, 12410, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent follow-up email @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com ', NULL, NULL, '2020-12-17 12:03:34', '2020-12-17 12:03:34'),
(7449, 1006, 12410, NULL, '2021-01-06 00:00:00.000', 'On Hold', 'Received following reply from Judith: \"The credentialing department has indicated that she holds a temp license and they cannot cred on a temp license. If you have the permanent MA license you may send to my attention.  Judy\"', NULL, NULL, '2020-12-24 13:44:38', '2020-12-24 13:44:38'),
(7450, 1006, 12410, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Sent an email to Judith (\"Jones-Wright, Judith\" JJonesWright@magellanhealth.com) to reinitiate the enrollment. ', NULL, NULL, '2021-02-03 16:02:04', '2021-02-03 16:02:04'),
(7451, 1006, 12410, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent f/u @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com', NULL, NULL, '2021-02-12 17:00:54', '2021-02-12 17:00:54'),
(7452, 1006, 12410, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Received the following reply from Judith @ Jones-Wright, Judith JJonesWright@magellanhealth.com:  \"The provider is in process.  Judy\"', NULL, NULL, '2021-02-15 10:46:35', '2021-02-15 10:46:35'),
(7453, 1006, 12410, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Sent a follow-up @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com:  \"Hello Judith,  I wanted to check in on the enrollment status for the following provider:  Provider Name: Lynnetta Loveland NPI# 1598163602 TIN# 83-4482753  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-03-02 11:54:51', '2021-03-02 11:54:51'),
(7454, 1006, 12410, NULL, '2021-03-15 00:00:00.000', 'Approved', 'Received an email from Wright, Judith JWright@magellanhealth.com: \"Good Morning,  The provider has been linked to your group and is now able to see members.\"', NULL, NULL, '2021-03-08 12:00:26', '2021-03-08 12:00:26'),
(7455, 2027, 12411, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 12:41:18', '2020-12-04 12:41:18'),
(7456, 2027, 12411, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Provider is now in certification process with tricare. Documents have been sent by fax at (608)221-7535', NULL, NULL, '2020-12-04 13:29:25', '2020-12-04 13:29:25'),
(7457, 2027, 12411, NULL, '2020-12-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Katherine, May I know the current status of the below mentioned provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-12-11 13:24:05', '2020-12-11 13:24:05'),
(7458, 3040, 12411, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Greetings, Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please reply to me back as soon as possible. Waiting to hear from you soon.    Thanks ', NULL, NULL, '2020-12-18 12:11:48', '2020-12-18 12:11:48');
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
(7459, 3040, 12411, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Email received from: KMoten4@humana.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Good Afternoon,     This provider is not showing certified in our system yet.     Thank you.', NULL, NULL, '2020-12-18 16:51:09', '2020-12-18 16:51:09'),
(7460, 3040, 12411, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject:  Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please reply to me back as soon as possible. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-25 12:54:19', '2021-01-25 12:54:19'),
(7461, 3040, 12411, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:31:32', '2021-02-01 15:31:32'),
(7462, 3040, 12411, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:52:51', '2021-02-08 13:52:51'),
(7463, 3040, 12411, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Please find the attached the provider credentialing application form along with the documents that you requested in your previous email for Arturo Alejandro Lira.  If you need any additional information please let me know. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 16:39:33', '2021-02-09 16:39:33'),
(7464, 3040, 12411, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  The provider was certified, now we need a credentialing application. Please send to me with all documents.', NULL, NULL, '2021-02-09 16:42:55', '2021-02-09 16:42:55'),
(7465, 3040, 12411, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Please note the we already sent the credentialing application for Lira, Arturo Alejandro on 12/04/2020 through fax.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 16:43:47', '2021-02-09 16:43:47'),
(7466, 3040, 12411, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Please see my notes below.  Also, for the rest of the providers you need to add them to attached roster and email to: HGBProviderRosters@humana.com mailto:HGBProviderRosters@humana.com  Anytime you need to add providers to your locations you need to use the attached roster and email it in to our roster team.  Please begin to use the provider portal to check status of all providers and locations moving forward: https://infocenter.humana-military.com/provider/service/Account/Login ', NULL, NULL, '2021-02-09 16:47:03', '2021-02-09 16:47:03'),
(7467, 3040, 12411, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-16 13:33:11', '2021-02-16 13:33:11'),
(7468, 3040, 12411, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Detail: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  If you need any additional information please feel free to call or email me. Waiting to hear form you soon.  Thanks ', NULL, NULL, '2021-02-23 14:02:11', '2021-02-23 14:02:11'),
(7469, 3040, 12411, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Please find the attached provider credentialing application form along with the documents that you requested in your previous email for Arturo Alejandro Lira. I sent this out on Feb-09.  Thanks', NULL, NULL, '2021-02-25 10:40:51', '2021-02-25 10:40:51'),
(7470, 3040, 12411, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Good Morning,  Please provide a credentialing application for Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-02-25 10:42:18', '2021-02-25 10:42:18'),
(7471, 3040, 12411, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com (25 February 2021 15:23)  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  The Cred Application and all documents have been submitted for processing. Please allow 90 days for processing.', NULL, NULL, '2021-03-04 17:20:59', '2021-03-04 17:20:59'),
(7472, 3040, 12411, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 17:03:14', '2021-03-12 17:03:14'),
(7473, 3040, 12411, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 15:50:17', '2021-03-19 15:50:17'),
(7474, 3040, 12411, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-04-15 08:05:50', '2021-04-15 08:05:50'),
(7475, 3040, 12411, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 1: Provider Name: Lira, Arturo Alejandro - submitted cred app on 2/25/21; allow 90 days for processing. Provider NPI# 1245789502 ', NULL, NULL, '2021-04-15 12:20:23', '2021-04-15 12:20:23'),
(7476, 3040, 12411, NULL, '2021-05-12 00:00:00.000', 'New/Not Initiated', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,   Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-05 10:59:19', '2021-05-05 10:59:19'),
(7477, 3040, 12411, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,   Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-05 11:00:00', '2021-05-05 11:00:00'),
(7478, 3040, 12411, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-01 08:29:39', '2021-06-01 08:29:39'),
(7479, 3040, 12411, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Application is still pending to be processed. It was submitted for review on 2/25/21 – please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com   ', NULL, NULL, '2021-06-21 10:03:30', '2021-06-21 10:03:30'),
(7480, 3040, 12411, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,  Hope you had a great weekend. Please advise me the enrollment status for the below mentioned provider. We submitted the application on 02/25/2021.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-06-21 10:05:32', '2021-06-21 10:05:32'),
(7481, 3040, 12411, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,  Hope you had a great weekend. Please advise the enrollment status for the below mentioned provider. We submitted the application on 02/25/2021.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-07-09 11:27:47', '2021-07-09 11:27:47'),
(7482, 3040, 12411, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:17:01', '2021-09-09 16:17:01'),
(7483, 10057, 12411, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:28:12', '2021-10-21 15:28:12'),
(7484, 10057, 12411, NULL, '2021-11-18 00:00:00.000', 'Not Eligible', 'Left Practice.  Please see attachment:', NULL, NULL, '2021-11-11 17:50:20', '2021-11-11 17:50:20'),
(7485, 2027, 12412, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 14:44:01', '2020-12-04 14:44:01'),
(7486, 2027, 12412, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Provider is now under enrollment process and the details of  the application are as follows: Provider ID: 2483429 Application# 12419150 This application could take 90 to 120 days to be completed.', NULL, NULL, '2020-12-04 14:47:18', '2020-12-04 14:47:18'),
(7487, 2027, 12412, NULL, '2020-12-18 00:00:00.000', 'In Process', 'To: intake_pdm@cigna.com  May I know the current status of the below mentioned provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Cigna Provider-ID: 2483429 Cigna Application # 12419150  Thanks.', NULL, NULL, '2020-12-11 13:39:00', '2020-12-11 13:39:00'),
(7488, 3040, 12412, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email sent to: 	intake_pdm@cigna.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Cigna   Greetings,  Hope you are doing well.  I wanted to know the enrollment status of the below mentioned provider.  Group Name: Valley Med Urgent Care   Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Tax-ID: 81-5123542 Cigna Provider-ID: 2483429 Cigna Application # 12419150  Please reply to me back as soon as possible. Waiting to hear from you soon.    Thanks ', NULL, NULL, '2020-12-18 13:06:34', '2020-12-18 13:06:34'),
(7489, 3040, 12412, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Follow up email sent to: 	intake_pdm@cigna.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Cigna   Greetings,  This is a reminder email to know the enrollment status of the below mentioned provider.  Group Name: Valley Med Urgent Care   Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Tax-ID: 81-5123542 Cigna Provider-ID: 2483429 Cigna Application # 12419150  Please reply to me back as soon as possible. Waiting to hear from you soon.    Thanks ', NULL, NULL, '2020-12-28 13:38:22', '2020-12-28 13:38:22'),
(7490, 3040, 12412, NULL, '2021-01-11 00:00:00.000', 'In Process', 'I had a word with Cigna representative and he send the email to the contract department regarding to send the contract. ', NULL, NULL, '2021-01-04 17:56:27', '2021-01-04 17:56:27'),
(7491, 3040, 12412, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Reference number 12419150  Application to participate in the Cigna medical network  Dear ARTURO LIRA,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-01-06 17:09:06', '2021-01-06 17:09:06'),
(7492, 3040, 12412, NULL, '2021-01-20 00:00:00.000', 'In Process', 'The application sent out on 1/5/2021.   Once its back it will take 60 days', NULL, NULL, '2021-01-13 14:58:02', '2021-01-13 14:58:02'),
(7493, 3040, 12412, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-20 14:11:06', '2021-01-20 14:11:06'),
(7494, 3040, 12412, NULL, '2021-02-03 00:00:00.000', 'In Process', 'I had a word with (Brendan) Cigna representative and he said that the application is approved from contract decision and now the application is in credentialing process. ', NULL, NULL, '2021-01-27 14:06:12', '2021-01-27 14:06:12'),
(7495, 3040, 12412, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: ONBEloquaNotice@cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12447282 Application to participate in the Cigna medical network Dear ARTURO LIRA,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-01-28 14:36:12', '2021-01-28 14:36:12'),
(7496, 3040, 12412, NULL, '2021-02-11 00:00:00.000', 'In Process', 'I had a word with Cigna representative and he advised that application is still in process. ', NULL, NULL, '2021-02-04 12:07:52', '2021-02-04 12:07:52'),
(7497, 3040, 12412, NULL, '2021-02-18 00:00:00.000', 'In Process', 'I had a word with (Kris) Cigna representative and she said the application was open from 12/04/2020 and still in process. ', NULL, NULL, '2021-02-11 12:48:55', '2021-02-11 12:48:55'),
(7498, 3040, 12412, NULL, '2021-02-25 00:00:00.000', 'In Process', 'I had a word with (Marques) Cigna representative and he said the application is still in process. ', NULL, NULL, '2021-02-18 13:36:09', '2021-02-18 13:36:09'),
(7499, 3040, 12412, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: Dominique.Clermont@cigna.com, medicalonboarding@cigna.com  Subject: TX_Arturo Lira_MLP_Credentialing  Greetings,   Hope you are doing well. Please note that I had a word with (Santana) Cigna representative regarding the enrollment status for the below mentioned provider and she said that the Medical rep sent you an email and she didn\'t see any reply from our side. As you can see the above email conversation I had with Dominique and I replied to his email on the same day the day I received the email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-25 14:42:32', '2021-02-25 14:42:32'),
(7500, 3040, 12412, NULL, '2021-03-11 00:00:00.000', 'In Process', 'I had a word with (Ivan C) Cigna representative and he said the application is still in process.   Application no: 12419150', NULL, NULL, '2021-03-04 15:36:47', '2021-03-04 15:36:47'),
(7501, 3040, 12412, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 16:50:51', '2021-03-12 16:50:51'),
(7502, 3040, 12412, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 15:54:30', '2021-03-19 15:54:30'),
(7503, 3040, 12412, NULL, '2021-04-20 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Welcome to the Cigna network  Dear ARTURO LIRA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Your effective date is 03/12/2021. Your provider identification number is‍ ‌2483429.', NULL, NULL, '2021-04-13 15:37:25', '2021-04-13 15:37:25'),
(7504, 2027, 12413, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 15:17:10', '2020-12-04 15:17:10'),
(7505, 2027, 12413, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Provider is now in certification process with tricare. Documents have been sent by fax at (608)221-7535', NULL, NULL, '2020-12-04 15:17:25', '2020-12-04 15:17:25'),
(7506, 2027, 12413, NULL, '2020-12-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Katherine, May I know the current status of the below mentioned provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-12-11 13:36:41', '2020-12-11 13:36:41'),
(7507, 3040, 12413, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Greetings, Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please reply to me back as soon as possible. Waiting to hear from you soon.    Thanks ', NULL, NULL, '2020-12-18 12:11:30', '2020-12-18 12:11:30'),
(7508, 3040, 12413, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Email received from: KMoten4@humana.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Good Afternoon,     This provider is not showing certified in our system yet.     Thank you.', NULL, NULL, '2020-12-18 16:51:27', '2020-12-18 16:51:27'),
(7509, 3040, 12413, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject:  Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please reply to me back as soon as possible. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-25 12:53:51', '2021-01-25 12:53:51'),
(7510, 3040, 12413, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:32:02', '2021-02-01 15:32:02'),
(7511, 3040, 12413, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:53:07', '2021-02-08 13:53:07'),
(7512, 3040, 12413, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Please find the attached the provider credentialing application form along with the documents that you requested in your previous email for Arturo Alejandro Lira.  If you need any additional information please let me know. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 16:39:43', '2021-02-09 16:39:43'),
(7513, 3040, 12413, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  The provider was certified, now we need a credentialing application. Please send to me with all documents.', NULL, NULL, '2021-02-09 16:43:04', '2021-02-09 16:43:04'),
(7514, 3040, 12413, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Please note the we already sent the credentialing application for Lira, Arturo Alejandro on 12/04/2020 through fax.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 16:43:56', '2021-02-09 16:43:56'),
(7515, 3040, 12413, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Please see my notes below.  Also, for the rest of the providers you need to add them to attached roster and email to: HGBProviderRosters@humana.com mailto:HGBProviderRosters@humana.com  Anytime you need to add providers to your locations you need to use the attached roster and email it in to our roster team.  Please begin to use the provider portal to check status of all providers and locations moving forward: https://infocenter.humana-military.com/provider/service/Account/Login ', NULL, NULL, '2021-02-09 16:47:11', '2021-02-09 16:47:11'),
(7516, 3040, 12413, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-16 13:33:24', '2021-02-16 13:33:24'),
(7517, 3040, 12413, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Detail: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  If you need any additional information please feel free to call or email me. Waiting to hear form you soon.  Thanks ', NULL, NULL, '2021-02-23 14:02:18', '2021-02-23 14:02:18'),
(7518, 3040, 12413, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Please find the attached provider credentialing application form along with the documents that you requested in your previous email for Arturo Alejandro Lira. I sent this out on Feb-09.  Thanks', NULL, NULL, '2021-02-25 10:41:00', '2021-02-25 10:41:00'),
(7519, 3040, 12413, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Good Morning,  Please provide a credentialing application for Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-02-25 10:42:24', '2021-02-25 10:42:24'),
(7520, 3040, 12413, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com (25 February 2021 15:23)  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  The Cred Application and all documents have been submitted for processing. Please allow 90 days for processing.', NULL, NULL, '2021-03-04 17:20:51', '2021-03-04 17:20:51'),
(7521, 3040, 12413, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 17:03:06', '2021-03-12 17:03:06'),
(7522, 3040, 12413, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 15:50:12', '2021-03-19 15:50:12'),
(7523, 3040, 12413, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:21', '2021-04-15 08:07:21'),
(7524, 3040, 12413, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 1: Provider Name: Lira, Arturo Alejandro - submitted cred app on 2/25/21; allow 90 days for processing. Provider NPI# 1245789502 ', NULL, NULL, '2021-04-15 12:20:36', '2021-04-15 12:20:36'),
(7525, 3040, 12413, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,   Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-05 10:59:25', '2021-05-05 10:59:25'),
(7526, 3040, 12413, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-01 08:29:35', '2021-06-01 08:29:35'),
(7527, 3040, 12413, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Application is still pending to be processed. It was submitted for review on 2/25/21 – please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com   ', NULL, NULL, '2021-06-21 10:03:36', '2021-06-21 10:03:36'),
(7528, 3040, 12413, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,  Hope you had a great weekend. Please advise me the enrollment status for the below mentioned provider. We submitted the application on 02/25/2021.   Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-06-21 10:05:34', '2021-06-21 10:05:34'),
(7529, 3040, 12413, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Tricare ||  Hello Katherine,  Hope you had a great weekend. Please advise the enrollment status for the below mentioned provider. We submitted the application on 02/25/2021.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-07-09 11:27:50', '2021-07-09 11:27:50'),
(7530, 3040, 12413, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:17:01', '2021-09-09 16:17:01'),
(7531, 10057, 12413, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:28:06', '2021-10-21 15:28:06'),
(7532, 10057, 12413, NULL, '2021-11-18 00:00:00.000', 'Not Eligible', 'Left Practice.  Please see attachment:', NULL, NULL, '2021-11-11 17:50:07', '2021-11-11 17:50:07'),
(7533, 2027, 12414, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 15:20:55', '2020-12-04 15:20:55'),
(7534, 2027, 12414, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Provider is now in certification process with tricare. Documents have been sent by fax at (608)221-7535', NULL, NULL, '2020-12-04 15:21:08', '2020-12-04 15:21:08'),
(7535, 2027, 12414, NULL, '2020-12-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Katherine, May I know the current status of the below mentioned provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-12-11 13:37:25', '2020-12-11 13:37:25'),
(7536, 3040, 12414, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Greetings, Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please reply to me back as soon as possible. Waiting to hear from you soon.    Thanks ', NULL, NULL, '2020-12-18 12:11:55', '2020-12-18 12:11:55'),
(7537, 3040, 12414, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Email received from: KMoten4@humana.com  Subject: Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Good Afternoon,     This provider is not showing certified in our system yet.     Thank you.', NULL, NULL, '2020-12-18 16:51:38', '2020-12-18 16:51:38'),
(7538, 3040, 12414, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject:  Enrollment Status Update || Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || Tricare  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Please reply to me back as soon as possible. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-25 12:54:45', '2021-01-25 12:54:45'),
(7539, 3040, 12414, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:32:18', '2021-02-01 15:32:18');
