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
(7540, 3040, 12414, 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 13:53:17', '2021-02-08 13:53:17'),
(7541, 3040, 12414, 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 16:39:52', '2021-02-09 16:39:52'),
(7542, 3040, 12414, 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 16:43:11', '2021-02-09 16:43:11'),
(7543, 3040, 12414, 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 16:44:04', '2021-02-09 16:44:04'),
(7544, 3040, 12414, 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 16:47:17', '2021-02-09 16:47:17'),
(7545, 3040, 12414, 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 13:33:18', '2021-02-16 13:33:18'),
(7546, 3040, 12414, 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 14:02:28', '2021-02-23 14:02:28'),
(7547, 3040, 12414, 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 10:41:05', '2021-02-25 10:41:05'),
(7548, 3040, 12414, 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 10:42:31', '2021-02-25 10:42:31'),
(7549, 3040, 12414, 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 17:21:06', '2021-03-04 17:21:06'),
(7550, 3040, 12414, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 17:03:21', '2021-03-12 17:03:21'),
(7551, 3040, 12414, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 15:50:21', '2021-03-19 15:50:21'),
(7552, 3040, 12414, 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 08:07:24', '2021-04-15 08:07:24'),
(7553, 3040, 12414, 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 12:20:39', '2021-04-15 12:20:39'),
(7554, 3040, 12414, 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 10:59:27', '2021-05-05 10:59:27'),
(7555, 3040, 12414, 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 08:29:47', '2021-06-01 08:29:47'),
(7556, 3040, 12414, 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 10:03:44', '2021-06-21 10:03:44'),
(7557, 3040, 12414, 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 10:05:45', '2021-06-21 10:05:45'),
(7558, 3040, 12414, 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 11:27:52', '2021-07-09 11:27:52'),
(7559, 3040, 12414, 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'),
(7560, 10057, 12414, 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 15:27:59', '2021-10-21 15:27:59'),
(7561, 10057, 12414, NULL, '2021-11-18 00:00:00.000', 'Not Eligible', 'Left Practice.  Please see attachment:', NULL, NULL, '2021-11-11 17:49:56', '2021-11-11 17:49:56'),
(7562, 2027, 12415, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 16:51:07', '2020-12-04 16:51:07'),
(7563, 2027, 12415, 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 16:51:27', '2020-12-04 16:51:27'),
(7564, 2027, 12415, 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 13:39:17', '2020-12-11 13:39:17'),
(7565, 3040, 12415, 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 13:06:25', '2020-12-18 13:06:25'),
(7566, 3040, 12415, 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 13:38:38', '2020-12-28 13:38:38'),
(7567, 3040, 12415, 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 17:56:12', '2021-01-04 17:56:12'),
(7568, 3040, 12415, 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 17:09:17', '2021-01-06 17:09:17'),
(7569, 3040, 12415, 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 14:58:09', '2021-01-13 14:58:09'),
(7570, 3040, 12415, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-20 14:10:52', '2021-01-20 14:10:52'),
(7571, 3040, 12415, 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 14:06:23', '2021-01-27 14:06:23'),
(7572, 3040, 12415, 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 14:36:19', '2021-01-28 14:36:19'),
(7573, 3040, 12415, 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 12:08:00', '2021-02-04 12:08:00'),
(7574, 3040, 12415, 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 12:49:02', '2021-02-11 12:49:02'),
(7575, 3040, 12415, 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 13:36:03', '2021-02-18 13:36:03'),
(7576, 3040, 12415, 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 14:42:27', '2021-02-25 14:42:27'),
(7577, 3040, 12415, 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 15:36:43', '2021-03-04 15:36:43'),
(7578, 3040, 12415, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 16:50:56', '2021-03-12 16:50:56'),
(7579, 3040, 12415, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 15:54:26', '2021-03-19 15:54:26'),
(7580, 3040, 12415, 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 15:37:29', '2021-04-13 15:37:29'),
(7581, 2027, 12416, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-04 16:52:39', '2020-12-04 16:52:39'),
(7582, 2027, 12416, 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 16:56:34', '2020-12-04 16:56:34'),
(7583, 2027, 12416, 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 13:40:17', '2020-12-11 13:40:17'),
(7584, 3040, 12416, 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 13:06:40', '2020-12-18 13:06:40'),
(7585, 3040, 12416, 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 13:38:47', '2020-12-28 13:38:47'),
(7586, 3040, 12416, 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 17:56:35', '2021-01-04 17:56:35'),
(7587, 3040, 12416, 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 17:09:28', '2021-01-06 17:09:28'),
(7588, 3040, 12416, 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 14:58:21', '2021-01-13 14:58:21'),
(7589, 3040, 12416, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-20 14:11:14', '2021-01-20 14:11:14'),
(7590, 3040, 12416, 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 14:06:29', '2021-01-27 14:06:29'),
(7591, 3040, 12416, 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 14:36:25', '2021-01-28 14:36:25'),
(7592, 3040, 12416, 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 12:08:08', '2021-02-04 12:08:08'),
(7593, 3040, 12416, 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 12:49:09', '2021-02-11 12:49:09'),
(7594, 3040, 12416, 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 13:36:15', '2021-02-18 13:36:15'),
(7595, 3040, 12416, 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 14:42:37', '2021-02-25 14:42:37'),
(7596, 3040, 12416, 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 15:36:52', '2021-03-04 15:36:52'),
(7597, 3040, 12416, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 16:51:01', '2021-03-12 16:51:01'),
(7598, 3040, 12416, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 15:54:36', '2021-03-19 15:54:36'),
(7599, 3040, 12416, 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 15:37:35', '2021-04-13 15:37:35'),
(7600, 1006, 12420, NULL, NULL, 'New/Not Initiated', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020 ', NULL, NULL, '2020-12-09 10:11:16', '2020-12-09 10:11:16'),
(7601, 1006, 12420, NULL, '2020-12-16 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020 ', NULL, NULL, '2020-12-09 10:11:30', '2020-12-09 10:11:30'),
(7602, 1006, 12421, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-09 17:11:22', '2020-12-09 17:11:22'),
(7603, 1006, 12421, NULL, '2020-12-16 00:00:00.000', 'Initiated', 'Request submitted @ PNM Department PNMDepartment@commonwealthcare.org on 07/08/2020: \"Hello,   Please find the following HCAS\'s for our providers, let me know if anything else is required to process this request and please expedite it as soon as possible.  Thank you!\"', NULL, NULL, '2020-12-09 17:15:14', '2020-12-09 17:15:14'),
(7604, 1006, 12421, NULL, '2020-12-16 00:00:00.000', 'Approved', 'Received following approval email today: \"Hello,  Provider Fauzia Wali Khan, MD is effective from 07/08/2020.  Thank you.\"', NULL, NULL, '2020-12-09 17:23:17', '2020-12-09 17:23:17'),
(7605, 1006, 12422, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-09 17:11:24', '2020-12-09 17:11:24'),
(7606, 1006, 12422, NULL, '2020-12-16 00:00:00.000', 'Initiated', 'Request submitted @ PNM Department PNMDepartment@commonwealthcare.org on 07/08/2020: \"Hello,   Please find the following HCAS\'s for our providers, let me know if anything else is required to process this request and please expedite it as soon as possible.  Thank you!\"', NULL, NULL, '2020-12-09 17:15:22', '2020-12-09 17:15:22'),
(7607, 1006, 12422, NULL, '2020-12-16 00:00:00.000', 'Approved', 'Received following approval email today: \"Hello,  Provider Mahreen Rashid, RN is effective from 07/08/2020.  Thank you.\" ', NULL, NULL, '2020-12-09 17:25:26', '2020-12-09 17:25:26'),
(7608, 2037, 12423, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-11 17:16:48', '2020-12-11 17:16:48'),
(7609, 2037, 12423, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Medicare Enrollment Application Receipt Notification (Tracking ID: T121120200002712 ) Inbox  customerservice-donotreply via Coastal Bend Urgent Care 4:25 PM (0 minutes ago) to CREDENTIALINGTX, KATHERINE.D.PATERSON, CBUC, SGRAPPE    To: CREDENTIALINGTX@NEXTCARE.COM,KATHERINE.D.PATERSON@GMAIL.COM,CBUC@CLAIMSMEDINC.COM,SGRAPPE@TWINFOUNTAINSCLINICS.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T121120200002712)   Sent: 12/11/2020 17:25 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T121120200002712        NPI: 1164776548        Medicare ID: 322099YLS1, 322099YLST, 322099YLSY        Name: KATHERINE DIERDRE PATERSON          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-12-11 17:27:54', '2020-12-11 17:27:54'),
(7610, 2037, 12423, NULL, '2020-12-23 00:00:00.000', 'Approved', 'Approval letter received effective 12/01/2020 Both Locations. Letter uploaded and approval sent to the billing', NULL, NULL, '2020-12-16 10:20:25', '2020-12-16 10:20:25'),
(7611, 2037, 12424, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-11 17:17:03', '2020-12-11 17:17:03'),
(7612, 2037, 12424, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Medicare Enrollment Application Receipt Notification (Tracking ID: T121120200002712 ) Inbox  customerservice-donotreply via Coastal Bend Urgent Care 4:25 PM (0 minutes ago) to CREDENTIALINGTX, KATHERINE.D.PATERSON, CBUC, SGRAPPE    To: CREDENTIALINGTX@NEXTCARE.COM,KATHERINE.D.PATERSON@GMAIL.COM,CBUC@CLAIMSMEDINC.COM,SGRAPPE@TWINFOUNTAINSCLINICS.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T121120200002712)   Sent: 12/11/2020 17:25 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T121120200002712        NPI: 1164776548        Medicare ID: 322099YLS1, 322099YLST, 322099YLSY        Name: KATHERINE DIERDRE PATERSON          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2020-12-11 17:28:01', '2020-12-11 17:28:01'),
(7613, 2037, 12424, NULL, '2020-12-23 00:00:00.000', 'Approved', 'Approval letter received effective 12/01/2020 Both Locations. Letter uploaded and approval sent to the billing', NULL, NULL, '2020-12-16 10:20:29', '2020-12-16 10:20:29'),
(7614, 1006, 12425, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-11 17:28:46', '2020-12-11 17:28:46'),
(7615, 1006, 12425, NULL, '2021-01-01 00:00:00.000', 'Initiated', 'Additional research is required to complete your request  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 :	20338000892 NPI :	1225645393 ', NULL, NULL, '2020-12-11 17:29:01', '2020-12-11 17:29:01'),
(7616, 1006, 12425, NULL, '2021-01-04 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 17:30:03', '2020-12-22 17:30:03'),
(7617, 1006, 12425, NULL, '2021-01-08 00:00:00.000', 'In Process', '\"Railroad Medicare does not have an enrollment record on file based on the information you submitted.\"', NULL, NULL, '2021-01-04 18:37:54', '2021-01-04 18:37:54'),
(7618, 1006, 12425, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Request still not found. ', NULL, NULL, '2021-01-11 18:22:04', '2021-01-11 18:22:04'),
(7619, 1006, 12425, NULL, '2021-01-20 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	CARLEE ROZELL NP PROVIDER PTAN	P02586446 PROVIDER NPI	1225645393 EFFECTIVE DATE	11/23/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-01-13 12:05:30', '2021-01-13 12:05:30'),
(7620, 2037, 12426, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-14 14:52:02', '2020-12-14 14:52:02'),
(7621, 2037, 12426, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Submitted LOI with W9 form to request the group/urgent care contract.Request submitted to psscenteral@cigna.com Subject: Provider Services and Contracting ---------- Greetings!  Kindly find the attached letter of intent and the W-9 form to get the below mentioned group In-network with Cigna. Please do feel free to get in touch with me in case additional information is required.  Longpoint Medical Center Tax ID: 76-0612416 NPI #: 1770763815 Address: 9504 LONG POINT RD STE E                Houston , TX 77055-4226. Services:Urgent Care.  Contact: Sherry Deen. Position: Credentialing Manager. Contact: 713-893-6214 Ext:405', NULL, NULL, '2020-12-14 14:54:39', '2020-12-14 14:54:39'),
(7622, 3040, 12426, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Location Added. ', NULL, NULL, '2021-03-05 15:24:00', '2021-03-05 15:24:00'),
(7623, 3040, 12427, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-15 13:51:31', '2020-12-15 13:51:31'),
(7624, 3040, 12427, NULL, '2020-12-22 00:00:00.000', 'Initiated', 'Request Initiated for Aetna for further queries please call 800-353-1232 ', NULL, NULL, '2020-12-15 13:53:22', '2020-12-15 13:53:22'),
(7625, 3040, 12427, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Called the Aetna and the representative provide the application tracking no: PVB1224964 ', NULL, NULL, '2020-12-23 15:20:41', '2020-12-23 15:20:41'),
(7626, 3040, 12427, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,  I had a word with Daniel (Aetna representative) who advised me that the application is under a refer report.    For your reference I mentioning the application no: PVB11224964  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-30 10:54:46', '2020-12-30 10:54:46'),
(7627, 3040, 12427, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,   Hope you are doing well. I wanted to know the update regarding my previous email in which I sent you the application no for Atinuke Dada. Did you find the application for her?  Also please advise me about the status of application for Oladipo Dada.  If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-06 09:38:32', '2021-01-06 09:38:32'),
(7628, 3040, 12427, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,  I had a word with an Aetna representative and they said that provider application is under special reports and the provider ID no is 5812804.   If you need anything else please call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-13 12:02:34', '2021-01-13 12:02:34'),
(7629, 3040, 12427, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Machado-PetryS@aetna.com  Subject: Aetna General Business  I am not sure as I do not pull any records under PVB11224964.  I have not received an application for Atinuke Dada as previously mentioned.  Dr. Oladipo Dada has been linked to tin 852432283 eff 1/15/21, once I get the countersigned copy of the agreement, you will also be receiving the copy of the contract, thank you.  ', NULL, NULL, '2021-01-13 12:03:09', '2021-01-13 12:03:09'),
(7630, 3040, 12427, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings, Hope you are doing well. This is a follow up email regarding the below mentioned provider as I sent you the provider ID after having speaking with Aetna representative.    Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283  Provider Name:  Dada, Atinuke Provider NPI# 1154782720  If you need anything else from my side please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-20 10:56:32', '2021-01-20 10:56:32'),
(7631, 3040, 12427, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,  Hope you are doing well. I just had a word with Aetna representative (Kristine) and she said the application for Atinuke Dada was received on 12/16/2020 and currently under review.   Thanks ', NULL, NULL, '2021-01-21 14:52:43', '2021-01-21 14:52:43'),
(7632, 3040, 12427, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: Machado-PetryS@aetna.com  Subject: Aetna General Business  Adil,  The request for Dr. Dada was sent thru the proper channels, the request for the Atinuke was not received, given the new tin is now effective for Dr. Dada, I can go ahead and issue a group agreement under the tin since both providers will work under it, in the future, please continue to use the online portal to submit all your requests, thank you.  ', NULL, NULL, '2021-01-21 14:53:24', '2021-01-21 14:53:24'),
(7633, 3040, 12427, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: [EXTERNAL] Re: Aetna General Business  Greetings,  Please find the information that you requested in your previous email.  Medical License Number: AP130032 Date of Birth: 1/9/1972  If you need any additional information please let me know. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-01-26 15:47:56', '2021-01-26 15:47:56'),
(7634, 3040, 12427, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: Machado-PetryS@aetna.com  Subject: [EXTERNAL] Re: Aetna General Business  Please provide the missing info for  Atinuke Dada.  Medical License Number  Date of Birth   ', NULL, NULL, '2021-01-26 15:48:39', '2021-01-26 15:48:39'),
(7635, 3040, 12427, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address:  2577 Madison Avenue League City , TX 77573  Provider Name:  Atinuke  Dada Provider NPI# 1154782720  Please get back to me once you get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-02 09:59:16', '2021-02-02 09:59:16'),
(7636, 3040, 12427, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email rcvd from: Machado-PetryS@aetna.com  Subject: Aetna General Business   The group agreement is in the loading process, it is effective 2/15/21 including your mid-level.  Once the contract has been loaded and contract executed, you will receive that copy via adobesign, thank you. ', NULL, NULL, '2021-02-02 14:11:44', '2021-02-02 14:11:44'),
(7637, 3040, 12427, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Follow up email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,  I wanted to know the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address:  2577 Madison Avenue League City , TX 77573  Provider Name:  Atinuke  Dada Provider NPI# 1154782720  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 09:51:21', '2021-02-09 09:51:21'),
(7638, 3040, 12427, NULL, '2021-02-17 00:00:00.000', 'Approved', 'The group is effective 02/15/2021,   Both providers have been loaded Oladipo and Atinuke Dada,   Once the contract is countersigned you will get the copy of the agreement,   Please begin to see/bill as of 2/15/21, thank you.  ', NULL, NULL, '2021-02-10 16:50:24', '2021-02-10 16:50:24'),
(7639, 3040, 12428, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-15 14:07:56', '2020-12-15 14:07:56'),
(7640, 3040, 12428, NULL, '2020-12-22 00:00:00.000', 'Initiated', 'Aetna Request Initiated for further please call 800-353-1232.', NULL, NULL, '2020-12-15 14:09:14', '2020-12-15 14:09:14'),
(7641, 3040, 12428, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Atena enrollment request in process', NULL, NULL, '2020-12-23 13:36:46', '2020-12-23 13:36:46'),
(7642, 3040, 12428, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,  Please find the attached W9 form as per your request. No, the provider will not be working as a hospital based provider under this TIN.    Also let me know the status for the below mentioned provider:  Provider Name: Atinuke  Dada Provider NPI# 1154782720  If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-23 14:02:57', '2020-12-23 14:02:57'),
(7643, 3040, 12428, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email rcvd from: Machado-PetryS@aetna.com  Subject: Aetna General Business  The contract has been received signed, loading will take 15-30 days, you will be notified once the provider has been loaded and contract once it is countersigned, thank you.', NULL, NULL, '2020-12-30 10:29:10', '2020-12-30 10:29:10'),
(7644, 3040, 12428, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject: Aetna General Business  Greetings,   Hope you are doing well. I wanted to know the update regarding my previous email in which I sent you the application no for Atinuke Dada. Did you find the application for her?  Also please advise me about the status of application for Oladipo Dada.  If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-06 09:40:39', '2021-01-06 09:40:39'),
(7645, 3040, 12428, NULL, '2021-01-15 00:00:00.000', 'Approved', 'Hi Oladipo Dada,  Welcome to the provider network effective 1/15/2021. Your Provider Identification Number (PIN) is: 5325910', NULL, NULL, '2021-01-08 14:08:06', '2021-01-08 14:08:06'),
(7646, 3040, 12429, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-15 16:58:42', '2020-12-15 16:58:42'),
(7647, 3040, 12429, NULL, '2020-12-22 00:00:00.000', 'Initiated', 'Blue Cross Blue Shield online group application submitted.   ', NULL, NULL, '2020-12-15 16:59:56', '2020-12-15 16:59:56'),
(7648, 3040, 12429, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Blue cross blue shield in process. ', NULL, NULL, '2020-12-17 09:41:52', '2020-12-17 09:41:52'),
(7649, 3040, 12429, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Hope you are doing well. I wanted to follow up on my request that I sent you regarding the group enrollment.   Kindly reply to me once you get a chance, Feel free to call or email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2020-12-18 10:50:48', '2020-12-18 10:50:48'),
(7650, 3040, 12429, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Contract Signed. For further info please see attachments. ', NULL, NULL, '2020-12-23 11:04:43', '2020-12-23 11:04:43'),
(7651, 3040, 12429, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to : provider_relations_houston@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552  Greetings,  I hope you are doing well. Please advise me what is required to get the providers enrolled as in-network under our group? .   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2020-12-23 13:43:48', '2020-12-23 13:43:48'),
(7652, 3040, 12429, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment of providers in the BCBS network under our group.  Please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-30 15:04:52', '2020-12-30 15:04:52'),
(7653, 3040, 12429, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_houston@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552 : Case Number - 02104447   On 12/21/2020 you were sent an email from the contracting team that they need the hospital coverage letter signed and returned due to the fact that HCA Houston Healthcare SE does not cover Medicaid.    Please sign and return that as quickly as possible to continue your credentialing.  The contracting case is 2074699.', NULL, NULL, '2021-01-06 09:44:02', '2021-01-06 09:44:02'),
(7654, 3040, 12429, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552 : Case Number - 02104447  Greetings,  Hope you are doing well. Please note that the facility is only a telemedicine hub. This is not an outpatient clinic.  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-07 16:44:33', '2021-01-07 16:44:33'),
(7655, 3040, 12429, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX- Out of Network Participation - OLADIPO A DADA, MD - Case 2074699  Good morning,  Credentialing will be initiated with the Council for Affordable Quality Healthcare (CAQH)* for the Universal Provider Datasource (UPD) and may take 30 to 90 days.  Please make sure Dr. Dada is registered with CAQH, that his CAQH profile is current, and authorization has either been assigned globally or BCBSTX has been added.  ', NULL, NULL, '2021-01-26 13:08:15', '2021-01-26 13:08:15'),
(7656, 3040, 12429, NULL, '2021-02-09 00:00:00.000', 'In Process', 'As per last email the application will take 30-90 day.   Still in process.', NULL, NULL, '2021-02-02 13:27:13', '2021-02-02 13:27:13'),
(7657, 3040, 12429, NULL, '2021-02-16 00:00:00.000', 'Approved', 'Executed contract received.  Please see attachment.', NULL, NULL, '2021-02-09 09:58:34', '2021-02-09 09:58:34');
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
(7658, 3040, 12430, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-16 11:13:53', '2020-12-16 11:13:53'),
(7659, 3040, 12430, NULL, '2020-12-23 00:00:00.000', 'Initiated', 'Request Initiate in Atena For Lira, Arturo Alejandro.', NULL, NULL, '2020-12-16 11:15:06', '2020-12-16 11:15:06'),
(7660, 3040, 12430, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Enroll in Atena ', NULL, NULL, '2020-12-16 17:20:40', '2020-12-16 17:20:40'),
(7661, 3040, 12430, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Enroll in Atena ', NULL, NULL, '2020-12-16 17:22:30', '2020-12-16 17:22:30'),
(7662, 3040, 12430, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Application under review.    Ref: 5783523673', NULL, NULL, '2020-12-23 14:49:28', '2020-12-23 14:49:28'),
(7663, 3040, 12430, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Spoke with the representative Mina and she said the application is still in process.   Processing time will take 30-60 Business days.', NULL, NULL, '2021-01-04 09:57:17', '2021-01-04 09:57:17'),
(7664, 3040, 12430, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-11 12:51:51', '2021-01-11 12:51:51'),
(7665, 3040, 12430, NULL, '2021-01-25 00:00:00.000', 'In Process', 'I had a word with (NATHAN) Aetna representative and he advised me that the provider application is still in credentialing and under review.  For review it will take 45-60 Business days ', NULL, NULL, '2021-01-18 11:04:39', '2021-01-18 11:04:39'),
(7666, 3040, 12430, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Still in process. Allow us 30-45 days', NULL, NULL, '2021-01-25 14:35:59', '2021-01-25 14:35:59'),
(7667, 3040, 12430, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments', NULL, NULL, '2021-01-28 12:34:32', '2021-01-28 12:34:32'),
(7668, 3040, 12431, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-16 12:15:16', '2020-12-16 12:15:16'),
(7669, 3040, 12431, NULL, '2020-12-23 00:00:00.000', 'Initiated', 'Atena Initiated ', NULL, NULL, '2020-12-16 12:16:06', '2020-12-16 12:16:06'),
(7670, 3040, 12431, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Called the Aetna and the representative advise that its in review .  Ref: 5783618943', NULL, NULL, '2020-12-23 15:23:55', '2020-12-23 15:23:55'),
(7671, 3040, 12431, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Spoke with the representative Mina and she said the application is still in process.   Processing time will take 30-60 Business days.', NULL, NULL, '2021-01-04 09:57:30', '2021-01-04 09:57:30'),
(7672, 3040, 12431, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-11 12:51:59', '2021-01-11 12:51:59'),
(7673, 3040, 12431, NULL, '2021-01-25 00:00:00.000', 'In Process', 'I had a word with (NATHAN) Aetna representative and he advised me that the provider application is still in credentialing and under review.  For review it will take 45-60 Business days ', NULL, NULL, '2021-01-18 11:04:46', '2021-01-18 11:04:46'),
(7674, 3040, 12431, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Still in process. Allow us 30-45 days', NULL, NULL, '2021-01-25 14:37:47', '2021-01-25 14:37:47'),
(7675, 3040, 12431, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 12:10:55', '2021-01-28 12:10:55'),
(7676, 3040, 12432, NULL, NULL, 'New/Not Initiated', 'Initiated ', NULL, NULL, '2020-12-16 17:15:29', '2020-12-16 17:15:29'),
(7677, 3040, 12432, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Enroll in Atena. ', NULL, NULL, '2020-12-16 17:19:48', '2020-12-16 17:19:48'),
(7678, 3040, 12432, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Application under review.    Ref: 5783523673', NULL, NULL, '2020-12-23 14:49:35', '2020-12-23 14:49:35'),
(7679, 3040, 12432, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Spoke with the representative Mina and she said the application is still in process.   Processing time will take 30-60 Business days.', NULL, NULL, '2021-01-04 09:57:41', '2021-01-04 09:57:41'),
(7680, 3040, 12432, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-11 12:52:07', '2021-01-11 12:52:07'),
(7681, 3040, 12432, NULL, '2021-01-25 00:00:00.000', 'In Process', 'I had a word with (NATHAN) Aetna representative and he advised me that the provider application is still in credentialing and under review.  For review it will take 45-60 Business days ', NULL, NULL, '2021-01-18 11:04:52', '2021-01-18 11:04:52'),
(7682, 3040, 12432, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Still in process. Allow us 30-45 days', NULL, NULL, '2021-01-25 14:38:54', '2021-01-25 14:38:54'),
(7683, 3040, 12432, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 12:28:52', '2021-01-28 12:28:52'),
(7684, 3040, 12433, NULL, NULL, 'New/Not Initiated', 'Initiated ', NULL, NULL, '2020-12-16 17:25:48', '2020-12-16 17:25:48'),
(7685, 3040, 12433, NULL, '2020-12-23 00:00:00.000', 'Initiated', 'Enroll in BCBS and form submitted through their website.  ', NULL, NULL, '2020-12-16 17:39:12', '2020-12-16 17:39:12'),
(7686, 3040, 12433, NULL, '2020-12-24 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02076377, for VALLEY MED URGENT CARE PLLC', NULL, NULL, '2020-12-17 09:52:32', '2020-12-17 09:52:32'),
(7687, 3040, 12433, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Enrollment request showing in process. ', NULL, NULL, '2020-12-24 13:05:47', '2020-12-24 13:05:47'),
(7688, 3040, 12433, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Enrollment showing in process ', NULL, NULL, '2020-12-31 12:17:27', '2020-12-31 12:17:27'),
(7689, 3040, 12433, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Enrollment showing still in process. ', NULL, NULL, '2021-01-07 17:57:21', '2021-01-07 17:57:21'),
(7690, 3040, 12433, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers.   Practice Name: Valley Med Urgent Care PLLC  Tax ID# 81-5123542 NPI# 1518404631  Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider Name: Moses Campos Provider NPI# 1558680009  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-14 16:03:45', '2021-01-14 16:03:45'),
(7691, 3040, 12433, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Good afternoon,  A provider record ID number has been assigned to each provider. Their onboarding case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be completed.  Below are the record ID numbers for each provider.  Larry Donald Wright - Provider Record ID #8NU758  All the Best,', NULL, NULL, '2021-01-15 16:40:42', '2021-01-15 16:40:42'),
(7692, 3040, 12433, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com,   Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira  Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 13:19:30', '2021-01-22 13:19:30'),
(7693, 3040, 12433, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good evening,  The onboariding case for the 3 providers is still in process.  Their case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be processed. ', NULL, NULL, '2021-01-28 09:14:35', '2021-01-28 09:14:35'),
(7694, 3040, 12433, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-04 13:30:58', '2021-02-04 13:30:58'),
(7695, 3040, 12433, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Hello,  Per your request, the status for case number 02137524 is still processing, for all providers on the request. We are not currently showing a request for additional information.  If additional information is needed from our Credentialing team, they will reach out to the credentialing contact information listed on the provider\'s CAQH.  In the meantime please do, allow more time for completion.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas ', NULL, NULL, '2021-02-05 09:06:35', '2021-02-05 09:06:35'),
(7696, 3040, 12433, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Follow up email sent. ', NULL, NULL, '2021-02-12 13:46:52', '2021-02-12 13:46:52'),
(7697, 3040, 12433, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: provider_relations_south_texas@bcbstx.com   Subject: RE: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-19 17:11:39', '2021-02-19 17:11:39'),
(7698, 3040, 12433, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-26 12:31:40', '2021-02-26 12:31:40'),
(7699, 3040, 12433, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 13:58:32', '2021-03-08 13:58:32'),
(7700, 3040, 12433, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:56:17', '2021-03-15 17:56:17'),
(7701, 3040, 12433, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:56:20', '2021-03-15 17:56:20'),
(7702, 3040, 12433, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,   Hope you are doing well. Please note the providers are not showing up in the BCBS provider directory in all three locations except (2534 Boca Chica Blvd, Brownsville TX, 78521). Can you please advise how much time will it take to show up in the directory?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    Please get back to me as soon as possible. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:34:23', '2021-04-14 10:34:23'),
(7703, 3040, 12433, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email rcvd From: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good afternoon,  My apologies that the locations still aren’t showing up for the providers.  Let me see what I can find out for you.  Thank you,  ', NULL, NULL, '2021-04-16 14:37:01', '2021-04-16 14:37:01'),
(7704, 3040, 12433, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Hello Noemi,  I checked the BCBS online provider directory and the providers are still not showing in other 02 locations. Can you please check and update.   Thank you ', NULL, NULL, '2021-05-03 13:35:33', '2021-05-03 13:35:33'),
(7705, 3040, 12433, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Good afternoon,  The satellite locations have now been added to the providers.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    All the Best,', NULL, NULL, '2021-05-04 08:12:39', '2021-05-04 08:12:39'),
(7706, 3040, 12434, NULL, NULL, 'New/Not Initiated', 'Initiated ', NULL, NULL, '2020-12-16 17:33:44', '2020-12-16 17:33:44'),
(7707, 3040, 12434, NULL, '2020-12-23 00:00:00.000', 'Initiated', 'Enroll in BCBS and form submitted through their website.  ', NULL, NULL, '2020-12-16 17:38:45', '2020-12-16 17:38:45'),
(7708, 3040, 12434, NULL, '2020-12-24 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02076377, for VALLEY MED URGENT CARE PLLC', NULL, NULL, '2020-12-17 10:01:58', '2020-12-17 10:01:58'),
(7709, 3040, 12434, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Enrollment request showing in process. ', NULL, NULL, '2020-12-24 13:05:53', '2020-12-24 13:05:53'),
(7710, 3040, 12434, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Enrollment showing in process ', NULL, NULL, '2020-12-31 12:17:32', '2020-12-31 12:17:32'),
(7711, 3040, 12434, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Enrollment showing still in process. ', NULL, NULL, '2021-01-07 17:57:32', '2021-01-07 17:57:32'),
(7712, 3040, 12434, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers.   Practice Name: Valley Med Urgent Care PLLC  Tax ID# 81-5123542 NPI# 1518404631  Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider Name: Moses Campos Provider NPI# 1558680009  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-14 16:03:51', '2021-01-14 16:03:51'),
(7713, 3040, 12434, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Good afternoon,  A provider record ID number has been assigned to each provider. Their onboarding case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be completed.  Below are the record ID numbers for each provider.  Moses Campos - Provider Record ID #8NU756', NULL, NULL, '2021-01-15 16:39:31', '2021-01-15 16:39:31'),
(7714, 3040, 12434, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com,   Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira  Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 13:19:37', '2021-01-22 13:19:37'),
(7715, 3040, 12434, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good evening,  The onboariding case for the 3 providers is still in process.  Their case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be processed. ', NULL, NULL, '2021-01-28 09:14:15', '2021-01-28 09:14:15'),
(7716, 3040, 12434, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-04 13:31:16', '2021-02-04 13:31:16'),
(7717, 3040, 12434, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Hello,  Per your request, the status for case number 02137524 is still processing, for all providers on the request. We are not currently showing a request for additional information.  If additional information is needed from our Credentialing team, they will reach out to the credentialing contact information listed on the provider\'s CAQH.  In the meantime please do, allow more time for completion.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas ', NULL, NULL, '2021-02-05 09:06:17', '2021-02-05 09:06:17'),
(7718, 3040, 12434, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Follow up email sent. ', NULL, NULL, '2021-02-12 13:46:57', '2021-02-12 13:46:57'),
(7719, 3040, 12434, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: provider_relations_south_texas@bcbstx.com   Subject: RE: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-19 17:11:51', '2021-02-19 17:11:51'),
(7720, 3040, 12434, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-26 12:31:45', '2021-02-26 12:31:45'),
(7721, 3040, 12434, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 13:58:40', '2021-03-08 13:58:40'),
(7722, 3040, 12434, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:56:46', '2021-03-15 17:56:46'),
(7723, 3040, 12434, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : VALLEY MED URGENT CARE PLLC Group Record Id : H000Q9Z701  Provider Name : MOSES CAMPOS Provider Record Number : H08NU75601 Specialty : Physician Assistant Effective Date: 03/15/2021', NULL, NULL, '2021-04-12 13:57:35', '2021-04-12 13:57:35'),
(7724, 3040, 12435, NULL, NULL, 'New/Not Initiated', 'Initiated ', NULL, NULL, '2020-12-16 17:39:52', '2020-12-16 17:39:52'),
(7725, 3040, 12435, NULL, '2020-12-23 00:00:00.000', 'Initiated', 'Enroll in BCBS and form submitted through their website.  ', NULL, NULL, '2020-12-16 17:49:57', '2020-12-16 17:49:57'),
(7726, 3040, 12435, NULL, '2020-12-24 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02076377, for VALLEY MED URGENT CARE PLLC', NULL, NULL, '2020-12-17 09:57:12', '2020-12-17 09:57:12'),
(7727, 3040, 12435, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Enrollment request showing in process. ', NULL, NULL, '2020-12-24 13:05:59', '2020-12-24 13:05:59'),
(7728, 3040, 12435, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Enrollment showing in process ', NULL, NULL, '2020-12-31 12:17:38', '2020-12-31 12:17:38'),
(7729, 3040, 12435, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Enrollment showing still in process. ', NULL, NULL, '2021-01-07 17:57:48', '2021-01-07 17:57:48'),
(7730, 3040, 12435, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers.   Practice Name: Valley Med Urgent Care PLLC  Tax ID# 81-5123542 NPI# 1518404631  Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider Name: Moses Campos Provider NPI# 1558680009  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-14 16:03:56', '2021-01-14 16:03:56'),
(7731, 3040, 12435, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Good afternoon,  A provider record ID number has been assigned to each provider. Their onboarding case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be completed.  Below are the record ID numbers for each provider.  Arturo Alejandro Lira - Provider Record ID #8NU757', NULL, NULL, '2021-01-15 16:38:00', '2021-01-15 16:38:00'),
(7732, 3040, 12435, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com,   Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira  Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 13:19:43', '2021-01-22 13:19:43'),
(7733, 3040, 12435, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good evening,  The onboariding case for the 3 providers is still in process.  Their case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be processed. ', NULL, NULL, '2021-01-28 09:14:23', '2021-01-28 09:14:23'),
(7734, 3040, 12435, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-02-04 13:31:32', '2021-02-04 13:31:32'),
(7735, 3040, 12435, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Hello,  Per your request, the status for case number 02137524 is still processing, for all providers on the request. We are not currently showing a request for additional information.  If additional information is needed from our Credentialing team, they will reach out to the credentialing contact information listed on the provider\'s CAQH.  In the meantime please do, allow more time for completion.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas ', NULL, NULL, '2021-02-05 09:06:27', '2021-02-05 09:06:27'),
(7736, 3040, 12435, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Follow up email sent. ', NULL, NULL, '2021-02-12 13:47:04', '2021-02-12 13:47:04'),
(7737, 3040, 12435, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: provider_relations_south_texas@bcbstx.com   Subject: RE: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-19 17:11:53', '2021-02-19 17:11:53'),
(7738, 3040, 12435, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-26 12:31:50', '2021-02-26 12:31:50'),
(7739, 3040, 12435, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 13:58:47', '2021-03-08 13:58:47'),
(7740, 3040, 12435, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:57:10', '2021-03-15 17:57:10'),
(7741, 3040, 12435, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,   Hope you are doing well. Please note the providers are not showing up in the BCBS provider directory in all three locations except (2534 Boca Chica Blvd, Brownsville TX, 78521). Can you please advise how much time will it take to show up in the directory?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 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: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    Please get back to me as soon as possible. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:34:06', '2021-04-14 10:34:06'),
(7742, 3040, 12435, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email rcvd From: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good afternoon,  My apologies that the locations still aren’t showing up for the providers.  Let me see what I can find out for you.  Thank you,  ', NULL, NULL, '2021-04-16 14:36:24', '2021-04-16 14:36:24'),
(7743, 3040, 12435, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Hello Noemi,  I checked the BCBS online provider directory and the providers are still not showing in other 02 locations. Can you please check and update.   Thank you ', NULL, NULL, '2021-05-03 13:35:17', '2021-05-03 13:35:17'),
(7744, 3040, 12435, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Good afternoon,  The satellite locations have now been added to the providers.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    All the Best,', NULL, NULL, '2021-05-04 08:12:20', '2021-05-04 08:12:20'),
(7745, 3040, 12436, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-18 10:53:59', '2020-12-18 10:53:59'),
(7746, 3040, 12436, NULL, '2020-12-25 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Hope all is well with you. I wanted to know if I needed to proceed with enrollment for the below mentioned providers separately, as we have already submitted an enrollment request for the group with the roster that mentions both providers.  Provider Info is as follows:   Provider 1: Practice Name: Ladot Healthcare LLC Provider Name: Dada, Atinuke Provider NPI# 1912502626 TIN# 85-2432283  Provider 2: Practice Name: Ladot Healthcare LLC Provider Name: Dada, Oladipo Provider NPI# 1760700223 TIN# 85-2432283  Please let me know regarding my query as soon as you\'re able to.   Thanks', NULL, NULL, '2020-12-18 10:55:43', '2020-12-18 10:55:43'),
(7747, 3040, 12436, NULL, '2020-12-25 00:00:00.000', 'Initiated', ' Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Hope you are doing well. I wanted to follow up on my request that I sent you regarding the group enrollment.   Kindly reply to me once you get a chance, Feel free to call or email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2020-12-18 10:56:35', '2020-12-18 10:56:35'),
(7748, 3040, 12436, NULL, '2020-12-25 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02082552.', NULL, NULL, '2020-12-18 13:54:26', '2020-12-18 13:54:26'),
(7749, 3040, 12436, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552  Greetings,  I hope you are doing well. Please advise me what is required to get the providers enrolled as in-network under our group? .   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2020-12-23 13:47:14', '2020-12-23 13:47:14'),
(7750, 3040, 12436, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment of providers in the BCBS network under our group.  Please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-30 15:09:15', '2020-12-30 15:09:15'),
(7751, 3040, 12436, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from: Angie_Cardenas@bcbstx.com  Subject: PHI Provider Enrollment Query  Hello,  I was routed the inquiry below for review. Under case # 02073481 both providers listed below are being processed under the group agreement returned. Please let us know if you have any additional questions.', NULL, NULL, '2021-01-05 09:41:55', '2021-01-05 09:41:55'),
(7752, 3040, 12436, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: Angie Cardenas  Subject: PHI Provider Enrollment Query  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please note that the facility is providing only telehealth service. I wanted to know that we can enroll the Atinuke Dada under the Ladot Group LLC without the hospital coverage letter.  If you have any questions please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-12 13:29:34', '2021-01-12 13:29:34'),
(7753, 3040, 12436, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Angie_Cardenas@bcbstx.com  Subject: PHI  Provider Enrollment Query  Greetings,  Hope you are doing well. Since Atinuke Dada is an NP, I was informed that she doesn\'t need a hospital coverage letter.   Kindly note that we don\'t have any office setting where patient can go to see provider, it will only be a telehealth service center for the foreseeable future.   If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-14 14:03:36', '2021-01-14 14:03:36'),
(7754, 3040, 12436, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: Angie_Cardenas@bcbstx.com  Subject: PHI Provider Enrollment Query   Good Afternoon  The provider specialty will require the provider to complete a hospital coverage letter otherwise our credentialing team will deny the request.  On your email below you mention the office will only provide telemedicine services does this mean you will not have an office setting where patients can go in to see the provider?  Thanks.', NULL, NULL, '2021-01-14 14:04:31', '2021-01-14 14:04:31'),
(7755, 3040, 12436, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email sent to: Angie_Cardenas@bcbstx.com  Subject: PHI  Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Please advise me that what we can do for the group enrollment under Atinuke Dada?. Oladipo Dada, MD we will be billing out of network.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks    ', NULL, NULL, '2021-01-14 16:57:14', '2021-01-14 16:57:14'),
(7756, 3040, 12436, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: Angie_Cardenas@bcbstx.com  Subject: PHI  Provider Enrollment Query - Ladot Healthcare LLC  Good Afternoon,  You are correct, the provider Atinuke Dada, APN is not required to have a hospital referral letter or hospital privileges based on the specialty. The only provider who will need to have hospital privileges or complete the hospital referral letter is Oladipo Dada, MD.  Please let me know if you have any additional questions.  Thanks   ', NULL, NULL, '2021-01-14 16:57:58', '2021-01-14 16:57:58'),
(7757, 3040, 12436, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: Angie_Cardenas@bcbstx.com  Subject: PHI  Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Hope all is well with you. This is a follow up email regarding the enrollment status of below mentioned provider.   Practice 1: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573   ​​​​​​Provider Detail: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please let me know regarding my query as soon as you\'re able to.   Thanks', NULL, NULL, '2021-01-25 15:26:30', '2021-01-25 15:26:30'),
(7758, 3040, 12436, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: Angie_Cardenas@bcbstx.com  Subject: PHI Provider Enrollment Query - Ladot Healthcare LLC  Good Afternoon,  The application continues to be in process. As of 1/22/2021 the case was routed to our credentialing team to begin the credentialing process. Please be sure that all information in CAQH is up to date as this will help expedite the process.  Thanks.   ', NULL, NULL, '2021-01-26 09:10:45', '2021-01-26 09:10:45'),
(7759, 3040, 12436, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: TX_Standard_Contracting_team@bcbstx.com  Subject: BCBSTX – Onboarding Process – Credentialing Application  Dear:   ATINUKE O DADA Thank you for your interest in participating in the Blue Cross and Blue Shield of Texas (BCBSTX) networks. To begin our credentialing process, providers applying for participation with BCBSTX must complete an online credentialing application and meet the BCBSTX credentialing criteria before being appointed to the network.  ', NULL, NULL, '2021-02-01 13:50:20', '2021-02-01 13:50:20'),
(7760, 3040, 12436, NULL, '2021-02-12 00:00:00.000', 'Approved', 'Effective date: 02/08/2021  Plans attached.', NULL, NULL, '2021-02-05 10:04:35', '2021-02-05 10:04:35');
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
(7761, 3040, 12437, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-18 10:56:49', '2020-12-18 10:56:49'),
(7762, 3040, 12437, NULL, '2020-12-25 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Hope all is well with you. I wanted to know if I needed to proceed with enrollment for the below mentioned providers separately, as we have already submitted an enrollment request for the group with the roster that mentions both providers.  Provider Info is as follows:   Provider 1: Practice Name: Ladot Healthcare LLC Provider Name: Dada, Atinuke Provider NPI# 1912502626 TIN# 85-2432283  Provider 2: Practice Name: Ladot Healthcare LLC Provider Name: Dada, Oladipo Provider NPI# 1760700223 TIN# 85-2432283  Please let me know regarding my query as soon as you\'re able to.   Thanks', NULL, NULL, '2020-12-18 10:56:56', '2020-12-18 10:56:56'),
(7763, 3040, 12437, NULL, '2020-12-25 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: Provider Enrollment Query - Ladot Healthcare LLC  Greetings,  Hope you are doing well. I wanted to follow up on my request that I sent you regarding the group enrollment.   Kindly reply to me once you get a chance, Feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-18 10:57:08', '2020-12-18 10:57:08'),
(7764, 3040, 12437, NULL, '2020-12-25 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02082552.', NULL, NULL, '2020-12-18 13:54:10', '2020-12-18 13:54:10'),
(7765, 3040, 12437, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - Expect DocuSign for Medical Group - LADOT HEALTHCARE LLC-02074699  Greetings,  Hope you are doing well. Please find below the information that is requested in above email for the BCBS enrollment.  Provider Name: Oladipo Dada Provider NPI # 1760700223 Primary Speciality: Internal Medicine Primary Sub-Speciality: Internal Medicine Hospital Privileges-1 (Hospital Name): Pearland Medical Center Hospital Privileges-1 (Type 2 NPI): 1891988861    If you need further information kindly feel free to call or email me. Looking forward to hearing from you soon.   Thanks ', NULL, NULL, '2020-12-23 10:55:15', '2020-12-23 10:55:15'),
(7766, 3040, 12437, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject:  Provider Enrollment Query - Ladot Healthcare LLC : Case Number - 02082552  Greetings,  I hope you are doing well. Please advise me what is required to get the providers enrolled as in-network under our group? .   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-23 13:45:47', '2020-12-23 13:45:47'),
(7767, 3040, 12437, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - Additional CRED Document Needed - Oladipo Dada, MD - Case 2074699  Greetings,  Please review the below hospital as our provider also has privileges there. Kindly advise if the hospital below covers all BCBSTX networks?  Provider Name: Oladipo Dada Provider NPI # 1760700223 Hospital Privileges (Hospital Name): Bayshore Medical Center Hospital Privileges (Type 2 NPI): 1174576698    If you need further information kindly feel free to call or email me. Looking forward to hearing from you soon.    Thanks ', NULL, NULL, '2020-12-23 17:49:57', '2020-12-23 17:49:57'),
(7768, 3040, 12437, NULL, '2021-01-06 00:00:00.000', 'In Process', 'We sent the hospital coverage letter to Oladipo Dada for signature.   Waiting for that letter.   Thanks ', NULL, NULL, '2020-12-30 10:03:59', '2020-12-30 10:03:59'),
(7769, 3040, 12437, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from: Angie_Cardenas@bcbstx.com  Subject: PHI Provider Enrollment Query  Hello,  I was routed the inquiry below for review. Under case # 02073481 both providers listed below are being processed under the group agreement returned. Please let us know if you have any additional questions.', NULL, NULL, '2021-01-05 09:42:14', '2021-01-05 09:42:14'),
(7770, 3040, 12437, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX- Out of Network Participation - OLADIPO A DADA, MD - Case 2074699  Good morning,  Credentialing will be initiated with the Council for Affordable Quality Healthcare (CAQH)* for the Universal Provider Datasource (UPD) and may take 30 to 90 days.  Please make sure Dr. Dada is registered with CAQH, that his CAQH profile is current, and authorization has either been assigned globally or BCBSTX has been added.  ', NULL, NULL, '2021-01-26 13:08:17', '2021-01-26 13:08:17'),
(7771, 3040, 12437, NULL, '2021-02-09 00:00:00.000', 'In Process', 'As per last email the application will take 30-90 day.  Still in process.', NULL, NULL, '2021-02-02 13:27:16', '2021-02-02 13:27:16'),
(7772, 3040, 12437, NULL, '2021-02-15 00:00:00.000', 'Approved', 'Effective date: 02/09/2021  Plans attached.', NULL, NULL, '2021-02-08 10:55:28', '2021-02-08 10:55:28'),
(7773, 3040, 12438, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-21 15:44:44', '2020-12-21 15:44:44'),
(7774, 3040, 12438, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Email sent to: psscentral@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  Hope you are doing well. Please find attached the LOI including W9 form for enrollment in Cigna for our group Ladot Healthcare LLC .  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks.', NULL, NULL, '2020-12-21 15:45:35', '2020-12-21 15:45:35'),
(7775, 3040, 12438, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Called the Cigna and had a conversation with the representative and they advise the application is received and in process.   Will take 60-90 days.  Ref: Vladimir 12/30/2020 ', NULL, NULL, '2020-12-30 17:29:08', '2020-12-30 17:29:08'),
(7776, 3040, 12438, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Cigna contract signed and submitted on 01/04/2021.', NULL, NULL, '2021-01-04 14:25:08', '2021-01-04 14:25:08'),
(7777, 3040, 12438, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from: ONBEloquaNotice@cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12418621  Application to participate in the Cigna medical network  Dear DADA ATINUKE,  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, '2021-01-05 14:33:06', '2021-01-05 14:33:06'),
(7778, 3040, 12438, NULL, '2021-01-19 00:00:00.000', 'In Process', 'I had a word with (Marcues A) Cigna representative and application is open and it will take 90-120 days.  Cigna Provider ID No: 4492983 Application No: 12418621 ', NULL, NULL, '2021-01-12 13:03:12', '2021-01-12 13:03:12'),
(7779, 3040, 12438, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Application still in process.   Ref: Shayla 01/19/2021', NULL, NULL, '2021-01-19 11:03:54', '2021-01-19 11:03:54'),
(7780, 3040, 12438, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had a word with (Sofia) Cigna representative and she said the application is still in process. ', NULL, NULL, '2021-01-26 10:16:13', '2021-01-26 10:16:13'),
(7781, 3040, 12438, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Application is still in process. ', NULL, NULL, '2021-02-01 11:19:47', '2021-02-01 11:19:47'),
(7782, 3040, 12438, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (Joaya) Cigna representative and she said the application is still in process.  Processing time  90-120 Business days.', NULL, NULL, '2021-02-08 12:27:36', '2021-02-08 12:27:36'),
(7783, 3040, 12438, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: 9psscent@cigna.com  Subject: Cigna Credentialing Status Update: Credentialing Verification  Re:	Reference number 12418621 Application complete: Credentialing process to begin Dear ATINUKE DADA,  We have confirmed that your application is complete, and have forwarded it for credentialing review', NULL, NULL, '2021-02-12 12:04:47', '2021-02-12 12:04:47'),
(7784, 3040, 12438, NULL, '2021-02-26 00:00:00.000', 'In Process', 'I had a word with (JOE C) Cigna representative and he said the application is still in process.   Application no: 12418621 Application rcvd: 12-03-2020 Contract rcvd: 01/04/2021 Ref: JOE 02/19/2021 ', NULL, NULL, '2021-02-19 17:53:45', '2021-02-19 17:53:45'),
(7785, 3040, 12438, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, psscentral@cigna.com  Subject: Enrollment Status || Ladot Healthcare LLC || Dada, Atinuke || Cigna ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Atinuke Provider NPI# 1154782720  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 12:38:28', '2021-02-26 12:38:28'),
(7786, 3040, 12438, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Dear ATINUKE DADA MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter Vice President Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 02/24/2021. Your provider identification number is‍ ‌4492983. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-03-05 14:58:31', '2021-03-05 14:58:31'),
(7787, 3040, 12439, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-21 15:44:48', '2020-12-21 15:44:48'),
(7788, 3040, 12439, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Greetings,  Hope you are doing well. Please find attached the LOI including W9 form for enrollment in Cigna for our group Ladot Healthcare LLC .  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks.', NULL, NULL, '2020-12-21 15:45:47', '2020-12-21 15:45:47'),
(7789, 3040, 12439, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Called the Cigna and had a conversation with the representative and they advise the application is received and in process.   Will take 60-90 days.  Ref: Vladimir 12/30/2020 ', NULL, NULL, '2020-12-30 17:29:15', '2020-12-30 17:29:15'),
(7790, 3040, 12439, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-01-06 10:14:09', '2021-01-06 10:14:09'),
(7791, 3040, 12439, NULL, '2021-01-22 00:00:00.000', 'In Process', 'I had a word with Cigna representative and application is still in process.', NULL, NULL, '2021-01-15 10:01:19', '2021-01-15 10:01:19'),
(7792, 3040, 12439, NULL, '2021-02-01 00:00:00.000', 'In Process', 'New email sent to: 	intake_pdm@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  Hope you are doing well. Please find attached the Link letter including W9 form for enrollment in Cigna for our provider for the group Ladot Healthcare LLC .  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks. ', NULL, NULL, '2021-01-25 17:11:28', '2021-01-25 17:11:28'),
(7793, 3040, 12439, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Application is still in process and will take 30 days. ', NULL, NULL, '2021-02-01 11:19:28', '2021-02-01 11:19:28'),
(7794, 3040, 12439, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: psscentral@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna ||  Greetings,  I hope you are doing well. I wanted to follow up regarding the enrollment status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC  Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-15 12:26:13', '2021-02-15 12:26:13'),
(7795, 3040, 12439, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: psscentral@cigna.com, intake_pdm@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  I hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC  Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-23 12:55:51', '2021-02-23 12:55:51'),
(7796, 3040, 12439, NULL, '2021-03-09 00:00:00.000', 'In Process', 'I had a word with (Essence) Cigna representative and she generate the escalation request to their department.    Ref: Essence 03/02/2021', NULL, NULL, '2021-03-02 15:05:01', '2021-03-02 15:05:01'),
(7797, 3040, 12439, NULL, '2021-03-17 00:00:00.000', 'Approved', 'Email rcvd from: 9PSSCENT@cigna.com.  Subject: Completion Notification - W202103021562722  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. This request has been completed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  ·       Cigna Internal Reference # (W202103021562722).  Provider Name / Group Name: OLADIPO DADA  CPF Provider ID: 9916985  Completed: Yes / No: YES  Transaction Type: ADD  Effective / Termination Date: 12/01/2020  As per the source document the request has been completed. Notification  Sincerely,  PDM ', NULL, NULL, '2021-03-10 15:32:37', '2021-03-10 15:32:37'),
(7798, 3040, 12440, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-21 15:47:42', '2020-12-21 15:47:42'),
(7799, 3040, 12440, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Email sent to: psscentral@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  Hope you are doing well. Please find attached the LOI including W9 form for enrollment in Cigna for our group Ladot Healthcare LLC .  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks.', NULL, NULL, '2020-12-21 15:48:00', '2020-12-21 15:48:00'),
(7800, 3040, 12440, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Called the Cigna and had a conversation with the representative and they advise the application is received and in process.   Will take 60-90 days.  Ref: Vladimir 12/30/2020 ', NULL, NULL, '2020-12-30 17:29:21', '2020-12-30 17:29:21'),
(7801, 3040, 12440, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-06 10:13:37', '2021-01-06 10:13:37'),
(7802, 3040, 12440, NULL, '2021-01-22 00:00:00.000', 'In Process', 'I had a word with Cigna representative and application is still in process.', NULL, NULL, '2021-01-15 10:01:10', '2021-01-15 10:01:10'),
(7803, 3040, 12440, NULL, '2021-02-01 00:00:00.000', 'In Process', 'New email sent to: 	intake_pdm@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  Hope you are doing well. Please find attached the Link letter including W9 form for enrollment in Cigna for our provider for the group Ladot Healthcare LLC .  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks.  After completing the providers process In-network with Cigna then we can request for the group facility contract. ', NULL, NULL, '2021-01-25 17:13:31', '2021-01-25 17:13:31'),
(7804, 3040, 12440, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Once the providers get In-Network with Cigna after that we can request for the facility group contract. ', NULL, NULL, '2021-02-01 11:23:22', '2021-02-01 11:23:22'),
(7805, 3040, 12440, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: psscentral@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  I hope you are doing well. I wanted to follow up regarding the enrollment status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC  Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-15 12:27:29', '2021-02-15 12:27:29'),
(7806, 3040, 12440, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: psscentral@cigna.com, intake_pdm@cigna.com  Subject: Provider Services and Contracting || Ladot Healthcare LLC || Cigna  Greetings,  I hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC  Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-23 12:55:57', '2021-02-23 12:55:57'),
(7807, 3040, 12440, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Once we enrolled at least 2 providers after that we can request for group contract. ', NULL, NULL, '2021-03-02 15:06:56', '2021-03-02 15:06:56'),
(7808, 1006, 12440, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Sent f/u email @ psscentral@cigna.com:  Sub: Group Contract Request - LHC - Cigna  \"Hello,  We wish to enroll the following group with Cigna, the details are as follows: Group name: Ladot Healthcare LLCTIN# 85-2432283Billing, Mailing & Service Address: 2577 Madison Avenue, League City, TX 77573 Provider Name: Oladipo DadaNPI# 1760700223 Provider Name: Atinuke DadaNPI# 1154782720 Please reach out to me if you have any questions, I have also attached the W9 for your reference. Thank you. \"', NULL, NULL, '2021-05-27 10:02:16', '2021-05-27 10:02:16'),
(7809, 1006, 12440, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent another f/u email @ psscentral@cigna.com:  Sub: Group Contract Request - LHC - Cigna  \"Hello,  I am still waiting on an update regarding this query, please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-16 09:50:14', '2021-06-16 09:50:14'),
(7810, 1006, 12440, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent new f/u email @ psscentral@cigna.com/intake_pdm@cigna.com/PDMCOGZ@cigna.com:  Sub: Group Contract Request - LHC - Cigna  \"Hello,   I hope you\'re doing well, I am still waiting on an update regarding the status of this request. Please get back to me as soon as possible.   Thank you. \"', NULL, NULL, '2021-07-05 10:25:36', '2021-07-05 10:25:36'),
(7811, 1006, 12440, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Received the following approval confirmation from :  Sub: Completion Notification - 12694232  \"Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. As per the source document the request has been completed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include:   Cigna Internal Reference # (12694232)                                                                                      PID                Provider  Name                      Effective date   5850800   LADOT HEALTHCARE LLC            07/23/2021  Sincerely, PDM\"', NULL, NULL, '2021-07-30 13:29:51', '2021-07-30 13:29:51'),
(7812, 3040, 12441, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-21 17:02:16', '2020-12-21 17:02:16'),
(7813, 3040, 12441, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Email sent to: 	networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Ladot Healthcare LLC .   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks. ', NULL, NULL, '2020-12-21 17:03:53', '2020-12-21 17:03:53'),
(7814, 3040, 12441, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Based on the nature of your inquiry, your request will need to be handled by the demographic team.   Please submit the request for group contract  to the demographic department (hpdemo@uhc.com) for assistance.   ', NULL, NULL, '2020-12-29 18:09:43', '2020-12-29 18:09:43'),
(7815, 3040, 12441, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Ladot Healthcare LLC .   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks.', NULL, NULL, '2021-01-05 12:49:21', '2021-01-05 12:49:21'),
(7816, 3040, 12441, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. I just wanted to follow up regarding my previous email. Is there any update?  If you need anything from my side please let me know. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-12 13:33:50', '2021-01-12 13:33:50'),
(7817, 3040, 12441, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. I received an email from your side in which it\'s showing that you reviewed the provider/group updates and determined that our updates couldn\'t be completed. Please advise me what information you need from my side? Reference Number: PR-5680549.  Below are the provider details:  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  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 18:00:47', '2021-01-20 18:00:47'),
(7818, 3040, 12441, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com  Subject:  Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find the attached the W9 form as per the requested email. Below is the information which was requested in the previous email. Case reference PR-5662565.  1: Please provide the following information (W9 from) so we can link this group to the Tax ID. Attached  2: Please provide the billing/remittance address and phone number. Billing/Remittance Address: 2577 Madison Avenue  League City , TX 77573 Phone Number: 832-340-7101   3: The phone number is missing or invalid for (2577 MADISON AVE). Please respond with a valid Phone Number. Phone Number: 832-340-7101     4: Please provide the primary specialty for provider (Oladipo Dada)   Internal Medicine  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 16:46:20', '2021-01-21 16:46:20'),
(7819, 3040, 12441, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from corin_lett@uhc.com  Good afternoon Adil,  Thank you for  contacting Network Management Resource Team.  The request for contract is in process with case reference PR-5662565. I show that the following informatin is requested, please submit to hpdemo@uhc.com.  Please provide the following information (W9 from) so we can link this group to the Tax ID. 2: Please provide the billing/remittance address and phone number. 3: The phone number is missing or invalid for (2577 MADISON AVE). Please respond with a valid Phone Number. 4: Please provide the primary specialty for provider (Oladipo Dada)​  Thank You.', NULL, NULL, '2021-01-21 16:47:21', '2021-01-21 16:47:21'),
(7820, 3040, 12441, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Follow up Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider 2:   Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-28 17:54:21', '2021-01-28 17:54:21'),
(7821, 3040, 12441, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from subreana_keeler@uhc.com  With regards to Atinuke Dada, it shows credentialing will be required. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    Onboard Pro is not yet available to all participating medical groups. To find out if your TIN is eligible, go to the Request for Participation (RFP) After entering your TIN, you’ll either be rerouted to Onboard Pro or you’ll complete your request in RFP. Please see the attached FAQ.   Request For Participation Form submitted online.  See attachment.   ', NULL, NULL, '2021-02-01 10:45:25', '2021-02-01 10:45:25'),
(7822, 3040, 12441, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Credentialing Application  2/4/2021  ATINUKE DADA lhc@claimsmedinc.com  MPIN#: 7587679 Re: We’re Ready to Review Your Credentialing Application  Dear ATINUKE DADA:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your completed application and will now begin verifying your credentials. Here’s what you need to know about the next steps:', NULL, NULL, '2021-02-04 09:29:02', '2021-02-04 09:29:02'),
(7823, 3040, 12441, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Good Morning,  This is a follow up email regarding the enrollment status of the below mentioned providers.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider 2:   Provider Name: Atinuke Dada Provider NPI# 1154782720  Waiting for your response.   Thanks ', NULL, NULL, '2021-02-11 10:35:28', '2021-02-11 10:35:28'),
(7824, 3040, 12441, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The group’s contract does not require the providers to be credentialed or to have contract lines loaded to their individual records. The provider only has to be demographically linked to the TIN.    I show that the provider Oladipo Dada is linked to the TIN effective  1/12/21.  I show that the provider Oladipo Dada is linked to the TIN effective   2/10/21.  It is still recommended you check benefits and eligibility before seeing patients.  Please let us know if we can assist further via email. ', NULL, NULL, '2021-02-11 14:11:57', '2021-02-11 14:11:57'),
(7825, 3040, 12441, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Kindly find the attached email that I received from your side and its mentioned the providers are non-participating in-network with UHC. Can you please advise the onward process?  Waiting for your response.  Thanks', NULL, NULL, '2021-02-18 10:37:20', '2021-02-18 10:37:20'),
(7826, 3040, 12441, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from andrew_vinson@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry  LADOT HEALTHCARE is linked to the tin, non-participating  Provider: Oladipo  Dada -  NPI# 1760700223 -  Linked to the tin, delegated credentialing, non-participating Provider: Atinuke Dada - NPI# 1154782720 – Linked to the tin, credentialed 2/10/2021, non-participating.  No contract on file. No Product Roster available.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Please let us know if we can assist further.   Sincerely,  Andrew Vinson UnitedHealth Care Network Management Resource Team   ', NULL, NULL, '2021-02-18 10:39:12', '2021-02-18 10:39:12'),
(7827, 3040, 12441, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Thank you so much for your prompt response. I received an email from your side and it mentioned that provider linked under the Tax ID 85-2432283. Can you please send me the executed contract/provider roster and effective date for the group.  For your reference I attached the email screenshot. Also please confirm the effective date for Atinuke Dada.   Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-18 10:41:28', '2021-02-18 10:41:28'),
(7828, 3040, 12441, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Can you please resend the sign contract for Atinuke Dada again because I didn\'t receive it.   Yes, the Ladot Health care LLC interested in a Medical group.   For your reference I attached the email that I received from your side. 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 13:36:33', '2021-02-25 13:36:33'),
(7829, 3040, 12441, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from brittany_epps@uhc.com (02/18/2021 10:23:27 PM GMT)  Hello,  Thank you for contacting the Network Management Resource Team.  Upon checking, as previously noted the following providers are  listed as out-of-network. However, for provider Atinuke Dada, we have sent her contract electronically via DocuSign to (lhc@claimsmedinc.com). We are currently waiting for her to sign and, return it. Once, we receive the agreement back, we will forward her contract, to the execution process. We will not be able to provide an effective date until contracts are loaded.  In regards to, Oladipo Dada it appears there may be some confusion with his participation. So, I would like to clarify. Is Ladot Healthcare interested in a contract for their clinic NPI? I ask, because, we are only able to author a contract based upon the specialty of their clinic NPI. It appears, our contracting fulfillment team forward your contractual request for Ladot Healthcare to our facility team for processing, due to the specialty listed on NPI registry; Ladot Healthcare is a clinic not a medical group. I would like to, clear-up this confusion, so we can process your contractual request appropriately. Is Ladot Healthcare interested in medical group agreement? or a Facility agreement?  I apologize, I’m not sure why, they would send a separate agreement for Atinuke Dada, but, once we receive your response back, we can address her contractual agreement accordingly. Thank you we look forward to your reply!  Brittany Epps UNITED HEALTHCARE GROUP Network Management Resource Team', NULL, NULL, '2021-02-25 13:37:41', '2021-02-25 13:37:41'),
(7830, 3040, 12441, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from j_mize@uhc.com  Good Morning-  I have submitted a request to have the contract for ATINUKE DADA  sent to you via DocuSign.  You should receive it within 24-48 hours.   Please resubmit your letter of interest to our demographic team at hpdemo@uhc.com and request a medical group contract.  Include the providers’ name, npi, demographic information for place of service and billing, W9 and specially request a MEDICAL GROUP contract.  Please let us know if we may further assist.', NULL, NULL, '2021-02-26 10:11:03', '2021-02-26 10:11:03'),
(7831, 3040, 12441, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from japarker@uhc.com  Greetings Adil,  The request for provider ARTURO A LIRA under (PR-5692160) is showing in processing, pending completion. If you do not hear anything within the next 2 weeks, please feel free to check back with PR number.  Please let us know if we can assist further via email.  Please direct all replies, questions, or concerns to Network Managemnet to Networkhelp@uhc.com  Thank you,  Janice P Associate Network Contractor UnitedHealthcare Network Management Resorce Team (NMR   ', NULL, NULL, '2021-03-01 09:16:50', '2021-03-01 09:16:50'),
(7832, 3040, 12441, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: UHC_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Subject: UHC Contract || Ladot Health Care LLC || Dada, Atinuke || LHC ||  Greetings,  We received a UHC contract for the below mentioned provider from your side but we are facing difficulties signing the contract. I attached the error that we are getting after filling out the information before signing the contract.   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 08:43:02', '2021-05-26 08:43:02'),
(7833, 3040, 12441, NULL, '2021-06-02 00:00:00.000', 'In Process', 'UHC call center in not functional that why we can\'t call them regarding the Contract issue. ', NULL, NULL, '2021-05-26 08:59:29', '2021-05-26 08:59:29'),
(7834, 1006, 12441, NULL, '2021-06-22 00:00:00.000', 'In Process', 'As per my discussion with Dr. Dada this request is pending as he has received the contract last week but wants to discuss it in the next meeting to verify if there will be no issues. ', NULL, NULL, '2021-06-15 15:32:08', '2021-06-15 15:32:08'),
(7835, 1006, 12441, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received a copy of the physical contract from Dada, signed and sent to NMRT networkhelp@uhc.com:  Sub: Group Signed Contract - LHC - UHC  \"Hello,   Please find the attached signed contract for our group, do let me know if anything else is required to proceed with our contracting process.  Thank you. \"  Attached in main group task for reference. ', NULL, NULL, '2021-06-25 16:48:03', '2021-06-25 16:48:03'),
(7836, 1006, 12441, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following reply from NMRT networkhelp@uhc.com:  Sub: Group Signed Contract - LHC - UHC  \"Hello Brad,  Thank you for contacting the Network Management Resource Team with the signed group contract, which our team has submitted to the contract team in order for it to be reviewed before it is counter-signed and executed. Please allow some time for this process to be completed in order for the group to be contracted under the TIN.  Please let us know if we can assist further via email.   Thank you!   Gabriel Olvera UnitedHealthcare Network Management Resource Team (NMRT)\"', NULL, NULL, '2021-06-28 16:49:30', '2021-06-28 16:49:30'),
(7837, 11056, 12441, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Query - LHC - United HealthCare  Greetings,  Hope you are doing well. This is just a follow-up email. I want to inquire about the contract which we have sent to you for countersigning for the enrollment of the group and providers. Kindly update me about the contract as soon as possible .  Practice Details: Practice Name : Ladot Healthcare LLC Practice NP I# : 1912502626 Practice Tax ID # : 85-2432283 Practice   Address : 2577 Madison Avenue, League City , TX 77573  Providers: Provider Name : Atinuke Dada Provider NPI # : 1154782720  Provider Name : Oladipo  Dada Provider NPI # : 1760700223  If you have any queries feel free to reach out to me.  Thank you!', NULL, NULL, '2021-07-12 12:38:15', '2021-07-12 12:38:15'),
(7838, 11056, 12441, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Enrollment Query - LHC - United HealthCare  Hello,     Atinuke Dada MPIN 7587679 is linked to TIN 852432283 and credentialed and will have active Commercial contracts effective 07/15/21     Oladipo Dada MPIN 4864632 is linked to TIN 852432283 and credentialed as delegated with Cardiovascular Care Providers Inc (CVCP) and will have active Commercial contracts effective 07/15/21           LaShonda Lymon  UnitedHealthcare  Network Management Resource Team (NMRT)   We have emailed them back and demanded the plan roster of UHC ', NULL, NULL, '2021-07-15 15:51:52', '2021-07-15 15:51:52'),
(7839, 1006, 12441, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Received the following approval confirmation from networkhelp@uhc.com:  Sub: Secure Message from lashonda_lymon@uhc.com  \"Hello,   Atinuke Dada MPIN 7587679 is linked to TIN 852432283 and credentialed and will have active Commercial contracts effective 07/15/21   Oladipo Dada MPIN 4864632 is linked to TIN 852432283 and credentialed as delegated with Cardiovascular Care Providers Inc (CVCP) and will have active Commercial contracts effective 07/15/21   LaShonda Lymon UnitedHealthcare Network Management Resource Team (NMRT)\"  ', NULL, NULL, '2021-07-16 16:15:50', '2021-07-16 16:15:50'),
(7840, 3040, 12442, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-21 17:03:55', '2020-12-21 17:03:55'),
(7841, 3040, 12442, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Email sent to: 	networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Ladot Healthcare LLC .   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks. ', NULL, NULL, '2020-12-21 17:04:07', '2020-12-21 17:04:07'),
(7842, 3040, 12442, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Based on the nature of your inquiry, your request will need to be handled by the demographic team.   Please submit the request for group contract  to the demographic department (hpdemo@uhc.com) for assistance.   ', NULL, NULL, '2020-12-29 18:09:38', '2020-12-29 18:09:38'),
(7843, 3040, 12442, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Ladot Healthcare LLC .   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks.', NULL, NULL, '2021-01-05 12:49:37', '2021-01-05 12:49:37'),
(7844, 3040, 12442, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. I just wanted to follow up regarding my previous email. Is there any update?  If you need anything from my side please let me know. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-12 13:33:58', '2021-01-12 13:33:58'),
(7845, 3040, 12442, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. I received an email from your side in which it\'s showing that you reviewed the provider/group updates and determined that our updates couldn\'t be completed. Please advise me what information you need from my side? Reference Number: PR-5680549.  Below are the provider details:  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  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 18:00:58', '2021-01-20 18:00:58'),
(7846, 3040, 12442, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com  Subject:  Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find the attached the W9 form as per the requested email. Below is the information which was requested in the previous email. Case reference PR-5662565.  1: Please provide the following information (W9 from) so we can link this group to the Tax ID. Attached  2: Please provide the billing/remittance address and phone number. Billing/Remittance Address: 2577 Madison Avenue  League City , TX 77573 Phone Number: 832-340-7101   3: The phone number is missing or invalid for (2577 MADISON AVE). Please respond with a valid Phone Number. Phone Number: 832-340-7101     4: Please provide the primary specialty for provider (Oladipo Dada)   Internal Medicine  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 16:46:29', '2021-01-21 16:46:29'),
(7847, 3040, 12442, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from corin_lett@uhc.com  Good afternoon Adil,  Thank you for  contacting Network Management Resource Team.  The request for contract is in process with case reference PR-5662565. I show that the following informatin is requested, please submit to hpdemo@uhc.com.  Please provide the following information (W9 from) so we can link this group to the Tax ID. 2: Please provide the billing/remittance address and phone number. 3: The phone number is missing or invalid for (2577 MADISON AVE). Please respond with a valid Phone Number. 4: Please provide the primary specialty for provider (Oladipo Dada)​  Thank You.', NULL, NULL, '2021-01-21 16:47:27', '2021-01-21 16:47:27'),
(7848, 3040, 12442, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Follow up Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider 2:   Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-28 17:54:26', '2021-01-28 17:54:26'),
(7849, 3040, 12442, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from subreana_keeler@uhc.com  Hello,  Based on my review, it shows PR-5662565 to add Oladipo Dada was received on 01/11/2021. Currently it’s in process of completion. If you have access to LINK, using the My Practice Profile app, you will be able to confirm it’s completion with in a week or so.   ', NULL, NULL, '2021-02-01 09:58:04', '2021-02-01 09:58:04'),
(7850, 3040, 12442, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned facility/providers.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider 2:   Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to as soon as you get a chance. Waiting for your response.  Thanks  ', NULL, NULL, '2021-02-08 12:54:34', '2021-02-08 12:54:34'),
(7851, 3040, 12442, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The group’s contract does not require the providers to be credentialed or to have contract lines loaded to their individual records. The provider only has to be demographically linked to the TIN.    I show that the provider Oladipo Dada is linked to the TIN effective  1/12/21.  I show that the provider Oladipo Dada is linked to the TIN effective   2/10/21.  It is still recommended you check benefits and eligibility before seeing patients.  Please let us know if we can assist further via email. ', NULL, NULL, '2021-02-11 14:11:51', '2021-02-11 14:11:51'),
(7852, 3040, 12442, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Kindly find the attached email that I received from your side and its mentioned the providers are non-participating in-network with UHC. Can you please advise the onward process?  Waiting for your response.  Thanks', NULL, NULL, '2021-02-18 10:37:28', '2021-02-18 10:37:28'),
(7853, 3040, 12442, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from andrew_vinson@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry  LADOT HEALTHCARE is linked to the tin, non-participating  Provider: Oladipo  Dada -  NPI# 1760700223 -  Linked to the tin, delegated credentialing, non-participating Provider: Atinuke Dada - NPI# 1154782720 – Linked to the tin, credentialed 2/10/2021, non-participating.  No contract on file. No Product Roster available.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Please let us know if we can assist further.   Sincerely,  Andrew Vinson UnitedHealth Care Network Management Resource Team   ', NULL, NULL, '2021-02-18 10:39:21', '2021-02-18 10:39:21'),
(7854, 3040, 12442, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Thank you so much for your prompt response. I received an email from your side and it mentioned that provider linked under the Tax ID 85-2432283. Can you please send me the executed contract/provider roster and effective date for the group.  For your reference I attached the email screenshot. Also please confirm the effective date for Atinuke Dada.   Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-18 10:41:56', '2021-02-18 10:41:56');
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
(7855, 3040, 12442, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Can you please resend the sign contract for Atinuke Dada again because I didn\'t receive it.   Yes, the Ladot Health care LLC interested in a Medical group.   For your reference I attached the email that I received from your side. 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 13:36:07', '2021-02-25 13:36:07'),
(7856, 3040, 12442, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from brittany_epps@uhc.com (02/18/2021 10:23:27 PM GMT)  Hello,  Thank you for contacting the Network Management Resource Team.  Upon checking, as previously noted the following providers are  listed as out-of-network. However, for provider Atinuke Dada, we have sent her contract electronically via DocuSign to (lhc@claimsmedinc.com). We are currently waiting for her to sign and, return it. Once, we receive the agreement back, we will forward her contract, to the execution process. We will not be able to provide an effective date until contracts are loaded.  In regards to, Oladipo Dada it appears there may be some confusion with his participation. So, I would like to clarify. Is Ladot Healthcare interested in a contract for their clinic NPI? I ask, because, we are only able to author a contract based upon the specialty of their clinic NPI. It appears, our contracting fulfillment team forward your contractual request for Ladot Healthcare to our facility team for processing, due to the specialty listed on NPI registry; Ladot Healthcare is a clinic not a medical group. I would like to, clear-up this confusion, so we can process your contractual request appropriately. Is Ladot Healthcare interested in medical group agreement? or a Facility agreement?  I apologize, I’m not sure why, they would send a separate agreement for Atinuke Dada, but, once we receive your response back, we can address her contractual agreement accordingly. Thank you we look forward to your reply!  Brittany Epps UNITED HEALTHCARE GROUP Network Management Resource Team', NULL, NULL, '2021-02-25 13:37:46', '2021-02-25 13:37:46'),
(7857, 3040, 12442, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Link Letter || Ladot Healthcare LLC || Dada, Oladipo || UHC ||  Greetings,  Hope you are doing well. I received an email from your side and it mentioned to send the Letter of interest. Please find the attached Letter of interest to enroll the provider.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider: Provider Name: Oladipo  Dada Provider NPI# 1760700223  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-05 17:01:26', '2021-03-05 17:01:26'),
(7858, 3040, 12442, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from j_mize@uhc.com  Good Morning-  I have submitted a request to have the contract for ATINUKE DADA  sent to you via DocuSign.  You should receive it within 24-48 hours.   Please resubmit your letter of interest to our demographic team at hpdemo@uhc.com and request a medical group contract.  Include the providers’ name, npi, demographic information for place of service and billing, W9 and specially request a MEDICAL GROUP contract.  Please let us know if we may further assist.', NULL, NULL, '2021-03-05 17:02:19', '2021-03-05 17:02:19'),
(7859, 3040, 12442, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Letter of interest resend again ', NULL, NULL, '2021-03-15 17:34:15', '2021-03-15 17:34:15'),
(7860, 3040, 12442, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com, hpdemo@uhc.com,  Subject: Enrollment Status || Ladot Healthcare LLC || Dada, Oladipo || UHC ||  Greetings,  Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider for our group Ladot Healthcare LLC under below location. I already sent the Link Letter on Mar, 15.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-05-26 08:33:10', '2021-05-26 08:33:10'),
(7861, 1006, 12442, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub: Enrollment Status - LHC - UHC  \"Hello,  I want to get an update regarding the enrollment status for the following group and provider, their information is as follows: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-15 15:36:32', '2021-06-15 15:36:32'),
(7862, 1006, 12442, NULL, '2021-06-23 00:00:00.000', 'In Process', 'We received the following reply from NMRT networkhelp@uhc.com:  Sub: Secure Message from katherine_k_floyd@uhc.com  \"Good morning Brad,      DADA, OLADIPO AYOWOLE is linked to TX tin and there are no contracts.     LADOT HEALTHCARE -  (GRP) is linked to TX tin and there are no contracts.  Submit to Demographics for contracts via email (hpdemo@uhc.com.  Please let us know if we can assist further via email.  Katherine Floyd UnitedHealthcare Network Management Resource Team (NMRT)\"  Sent email @ hpdemo@uhc.com \"Hello,  Can you please let me know what is the status of the contracting for the group and provider, their information is as follows:  Practice Name: Ladot Healthcare LLCPractice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-16 08:58:35', '2021-06-16 08:58:35'),
(7863, 1006, 12442, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received a copy of the physical contract from Dada, signed and sent to NMRT networkhelp@uhc.com:  Sub: Group Signed Contract - LHC - UHC  \"Hello,   Please find the attached signed contract for our group, do let me know if anything else is required to proceed with our contracting process.  Thank you. \"  Attached in main group task for reference. ', NULL, NULL, '2021-06-25 16:48:00', '2021-06-25 16:48:00'),
(7864, 1006, 12442, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following reply from NMRT networkhelp@uhc.com:  Sub: Group Signed Contract - LHC - UHC  \"Hello Brad,  Thank you for contacting the Network Management Resource Team with the signed group contract, which our team has submitted to the contract team in order for it to be reviewed before it is counter-signed and executed. Please allow some time for this process to be completed in order for the group to be contracted under the TIN.  Please let us know if we can assist further via email.   Thank you!   Gabriel Olvera UnitedHealthcare Network Management Resource Team (NMRT)\"', NULL, NULL, '2021-06-28 16:49:27', '2021-06-28 16:49:27'),
(7865, 11056, 12442, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Query - LHC - United HealthCare  Greetings,  Hope you are doing well. This is just a follow-up email. I want to inquire about the contract which we have sent to you for countersigning for the enrollment of the group and providers. Kindly update me about the contract as soon as possible .  Practice Details: Practice Name : Ladot Healthcare LLC Practice NP I# : 1912502626 Practice Tax ID # : 85-2432283 Practice   Address : 2577 Madison Avenue, League City , TX 77573  Providers: Provider Name : Atinuke Dada Provider NPI # : 1154782720  Provider Name : Oladipo  Dada Provider NPI # : 1760700223  If you have any queries feel free to reach out to me.  Thank you!', NULL, NULL, '2021-07-12 12:38:03', '2021-07-12 12:38:03'),
(7866, 11056, 12442, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Enrollment Query - LHC - United HealthCare  Hello,     Atinuke Dada MPIN 7587679 is linked to TIN 852432283 and credentialed and will have active Commercial contracts effective 07/15/21     Oladipo Dada MPIN 4864632 is linked to TIN 852432283 and credentialed as delegated with Cardiovascular Care Providers Inc (CVCP) and will have active Commercial contracts effective 07/15/21           LaShonda Lymon  UnitedHealthcare  Network Management Resource Team (NMRT)   We have emailed them back and demanded the plan roster of UHC ', NULL, NULL, '2021-07-15 15:51:35', '2021-07-15 15:51:35'),
(7867, 1006, 12442, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Received the following approval confirmation from networkhelp@uhc.com:  Sub: Secure Message from lashonda_lymon@uhc.com  \"Hello,   Atinuke Dada MPIN 7587679 is linked to TIN 852432283 and credentialed and will have active Commercial contracts effective 07/15/21   Oladipo Dada MPIN 4864632 is linked to TIN 852432283 and credentialed as delegated with Cardiovascular Care Providers Inc (CVCP) and will have active Commercial contracts effective 07/15/21   LaShonda Lymon UnitedHealthcare Network Management Resource Team (NMRT)\"  ', NULL, NULL, '2021-07-16 16:15:28', '2021-07-16 16:15:28'),
(7868, 3040, 12443, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-21 17:04:17', '2020-12-21 17:04:17'),
(7869, 3040, 12443, NULL, '2020-12-28 00:00:00.000', 'Initiated', 'Email sent to: 	networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Ladot Healthcare LLC .  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue, League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need further information please feel free to call or email me. Waiting to hear from you soon.  Thanks. ', NULL, NULL, '2020-12-21 17:05:01', '2020-12-21 17:05:01'),
(7870, 3040, 12443, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Based on the nature of your inquiry, your request will need to be handled by the demographic team.   Please submit the request for group contract  to the demographic department (hpdemo@uhc.com) for assistance.   ', NULL, NULL, '2020-12-29 18:09:29', '2020-12-29 18:09:29'),
(7871, 3040, 12443, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email rcvd from: United_Healthcare_Provider_Operations@uhc.com  Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com  UnitedHealthcare Insurance Company   Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5662565  Received On: Dec 29, 2020 5:10:58 PM   If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,', NULL, NULL, '2020-12-30 09:21:01', '2020-12-30 09:21:01'),
(7872, 3040, 12443, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: unitedhealthcare_request_addlinfo@uhc.com  Subject: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-5662565  Greetings, Hope you are doing well. I really appreciate your prompt response. As per your above email please find below the information that you requested for enrollment at Ladot Healthcare LLC.   Requested Documents to add the above group:  1- W 9 Form:  Please find the attached W9 form.  2- Billing Address/remittance address: 2577 Madison Avenue League City , TX 77573 Phone: 832-340-7101  3- Valid Phone Number:  832-340-7101  4- Primary Specialty Oladipo Dada:  Internal Medicine.  If you need further information please call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-05 09:32:11', '2021-01-05 09:32:11'),
(7873, 3040, 12443, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: unitedhealthcare_request_addlinfo@uhc.com, submission_inquiry@uhc.com  Subject: Clarification on Previous UnitedHealthcare Data Request - Reference: PR-5662565   Greetings,  Hope you are doing well. I just wanted to follow up 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, '2021-01-12 13:38:23', '2021-01-12 13:38:23'),
(7874, 3040, 12443, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: submission_inquiry@uhc.com  Subject: Secure Message from katrina_hodge@uhc.com  Good Morning Adil,  We received request your and want to let you know this PR-5662565  is being worked on and is pending completion. Once this PR is completed you will receive an email confirmation showing this completion.  Thank You,', NULL, NULL, '2021-01-14 12:46:30', '2021-01-14 12:46:30'),
(7875, 3040, 12443, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email sent to: 	hpdemo@uhc.com  Subject:  Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please find the attached the W9 form as per the requested email. Below is the information which was requested in the previous email. Case reference PR-5662565.  1: Please provide the following information (W9 from) so we can link this group to the Tax ID. Attached  2: Please provide the billing/remittance address and phone number. Billing/Remittance Address: 2577 Madison Avenue  League City , TX 77573 Phone Number: 832-340-7101   3: The phone number is missing or invalid for (2577 MADISON AVE). Please respond with a valid Phone Number. Phone Number: 832-340-7101     4: Please provide the primary specialty for provider (Oladipo Dada)   Internal Medicine  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 16:46:05', '2021-01-21 16:46:05'),
(7876, 3040, 12443, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from corin_lett@uhc.com  Good afternoon Adil,  Thank you for  contacting Network Management Resource Team.  The request for contract is in process with case reference PR-5662565. I show that the following informatin is requested, please submit to hpdemo@uhc.com.  Please provide the following information (W9 from) so we can link this group to the Tax ID. 2: Please provide the billing/remittance address and phone number. 3: The phone number is missing or invalid for (2577 MADISON AVE). Please respond with a valid Phone Number. 4: Please provide the primary specialty for provider (Oladipo Dada)​  Thank You.', NULL, NULL, '2021-01-21 16:47:16', '2021-01-21 16:47:16'),
(7877, 3040, 12443, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Follow up Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider 2:   Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-28 17:54:13', '2021-01-28 17:54:13'),
(7878, 3040, 12443, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from subreana_keeler@uhc.com  Hello,  Based on my review, it shows PR-5662565 to add Oladipo Dada was received on 01/11/2021. Currently it’s in process of completion. If you have access to LINK, using the My Practice Profile app, you will be able to confirm it’s completion with in a week or so. ', NULL, NULL, '2021-02-04 13:37:00', '2021-02-04 13:37:00'),
(7879, 3040, 12443, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned facility/providers.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider 2:   Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to as soon as you get a chance. Waiting for your response.  Thanks  ', NULL, NULL, '2021-02-08 12:54:41', '2021-02-08 12:54:41'),
(7880, 3040, 12443, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email sent to: natlcred_components@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned facility.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-08 17:04:23', '2021-02-08 17:04:23'),
(7881, 3040, 12443, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The group’s contract does not require the providers to be credentialed or to have contract lines loaded to their individual records. The provider only has to be demographically linked to the TIN.    I show that the provider Oladipo Dada is linked to the TIN effective  1/12/21.  I show that the provider Oladipo Dada is linked to the TIN effective   2/10/21.  It is still recommended you check benefits and eligibility before seeing patients.  Please let us know if we can assist further via email. ', NULL, NULL, '2021-02-11 14:11:45', '2021-02-11 14:11:45'),
(7882, 3040, 12443, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Kindly find the attached email that I received from your side and its mentioned the providers are non-participating in-network with UHC. Can you please advise the onward process?  Waiting for your response.  Thanks', NULL, NULL, '2021-02-18 10:37:34', '2021-02-18 10:37:34'),
(7883, 3040, 12443, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from andrew_vinson@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry  LADOT HEALTHCARE is linked to the tin, non-participating  Provider: Oladipo  Dada -  NPI# 1760700223 -  Linked to the tin, delegated credentialing, non-participating Provider: Atinuke Dada - NPI# 1154782720 – Linked to the tin, credentialed 2/10/2021, non-participating.  No contract on file. No Product Roster available.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Please let us know if we can assist further.   Sincerely,  Andrew Vinson UnitedHealth Care Network Management Resource Team   ', NULL, NULL, '2021-02-18 10:39:27', '2021-02-18 10:39:27'),
(7884, 3040, 12443, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Thank you so much for your prompt response. I received an email from your side and it mentioned that provider linked under the Tax ID 85-2432283. Can you please send me the executed contract/provider roster and effective date for the group.  For your reference I attached the email screenshot. Also please confirm the effective date for Atinuke Dada.   Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-18 10:45:13', '2021-02-18 10:45:13'),
(7885, 3040, 12443, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Ladot Healthcare LLC || UHC  Greetings,  Hope you are doing well. Can you please resend the sign contract for Atinuke Dada again because I didn\'t receive it.   Yes, the Ladot Health care LLC interested in a Medical group.   For your reference I attached the email that I received from your side. 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 13:36:12', '2021-02-25 13:36:12'),
(7886, 3040, 12443, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from brittany_epps@uhc.com (02/18/2021 10:23:27 PM GMT)  Hello,  Thank you for contacting the Network Management Resource Team.  Upon checking, as previously noted the following providers are  listed as out-of-network. However, for provider Atinuke Dada, we have sent her contract electronically via DocuSign to (lhc@claimsmedinc.com). We are currently waiting for her to sign and, return it. Once, we receive the agreement back, we will forward her contract, to the execution process. We will not be able to provide an effective date until contracts are loaded.  In regards to, Oladipo Dada it appears there may be some confusion with his participation. So, I would like to clarify. Is Ladot Healthcare interested in a contract for their clinic NPI? I ask, because, we are only able to author a contract based upon the specialty of their clinic NPI. It appears, our contracting fulfillment team forward your contractual request for Ladot Healthcare to our facility team for processing, due to the specialty listed on NPI registry; Ladot Healthcare is a clinic not a medical group. I would like to, clear-up this confusion, so we can process your contractual request appropriately. Is Ladot Healthcare interested in medical group agreement? or a Facility agreement?  I apologize, I’m not sure why, they would send a separate agreement for Atinuke Dada, but, once we receive your response back, we can address her contractual agreement accordingly. Thank you we look forward to your reply!  Brittany Epps UNITED HEALTHCARE GROUP Network Management Resource Team', NULL, NULL, '2021-02-25 13:37:52', '2021-02-25 13:37:52'),
(7887, 3040, 12443, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com, networkhelp@uhc.com  Subject: Link Letter || Ladot Healthcare LLC || Dada, Oladipo || UHC ||  Greetings,  Hope you are doing well. I received an email from your side and it mentioned to send the Letter of interest. Please find the attached Letter of interest to enroll the provider.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider: Provider Name: Oladipo  Dada Provider NPI# 1760700223  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-05 17:03:01', '2021-03-05 17:03:01'),
(7888, 3040, 12443, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from j_mize@uhc.com  Good Morning-  I have submitted a request to have the contract for ATINUKE DADA  sent to you via DocuSign.  You should receive it within 24-48 hours.   Please resubmit your letter of interest to our demographic team at hpdemo@uhc.com and request a medical group contract.  Include the providers’ name, npi, demographic information for place of service and billing, W9 and specially request a MEDICAL GROUP contract.  Please let us know if we may further assist.', NULL, NULL, '2021-03-05 17:03:23', '2021-03-05 17:03:23'),
(7889, 3040, 12443, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Letter of interest resend again ', NULL, NULL, '2021-03-15 17:34:10', '2021-03-15 17:34:10'),
(7890, 3040, 12443, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com, hpdemo@uhc.com,  Subject: Enrollment Status || Ladot Healthcare LLC || Dada, Oladipo || UHC ||  Greetings,  Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider for our group Ladot Healthcare LLC under below location. I already sent the Link Letter on Mar, 15.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider: Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-05-26 08:33:23', '2021-05-26 08:33:23'),
(7891, 1006, 12443, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub: Enrollment Status - LHC - UHC  \"Hello,  I want to get an update regarding the enrollment status for the following group and provider, their information is as follows: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-15 15:36:24', '2021-06-15 15:36:24'),
(7892, 1006, 12443, NULL, '2021-06-23 00:00:00.000', 'In Process', 'We received the following reply from NMRT networkhelp@uhc.com:  Sub: Secure Message from katherine_k_floyd@uhc.com  \"Good morning Brad,      DADA, OLADIPO AYOWOLE is linked to TX tin and there are no contracts.     LADOT HEALTHCARE -  (GRP) is linked to TX tin and there are no contracts.  Submit to Demographics for contracts via email (hpdemo@uhc.com.  Please let us know if we can assist further via email.  Katherine Floyd UnitedHealthcare Network Management Resource Team (NMRT)\"  Sent email @ hpdemo@uhc.com \"Hello,  Can you please let me know what is the status of the contracting for the group and provider, their information is as follows:  Practice Name: Ladot Healthcare LLCPractice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-16 08:58:25', '2021-06-16 08:58:25'),
(7893, 1006, 12443, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received a copy of the physical contract from Dada, signed and sent to NMRT networkhelp@uhc.com:  Sub: Group Signed Contract - LHC - UHC  \"Hello,   Please find the attached signed contract for our group, do let me know if anything else is required to proceed with our contracting process.  Thank you. \"  Attached in main group task for reference. ', NULL, NULL, '2021-06-25 16:47:42', '2021-06-25 16:47:42'),
(7894, 1006, 12443, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following reply from NMRT networkhelp@uhc.com:  Sub: Group Signed Contract - LHC - UHC  \"Hello Brad,  Thank you for contacting the Network Management Resource Team with the signed group contract, which our team has submitted to the contract team in order for it to be reviewed before it is counter-signed and executed. Please allow some time for this process to be completed in order for the group to be contracted under the TIN.  Please let us know if we can assist further via email.   Thank you!   Gabriel Olvera UnitedHealthcare Network Management Resource Team (NMRT)\"', NULL, NULL, '2021-06-28 16:49:16', '2021-06-28 16:49:16'),
(7895, 11056, 12443, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Query - LHC - United HealthCare  Greetings,  Hope you are doing well. This is just a follow-up email. I want to inquire about the contract which we have sent to you for countersigning for the enrollment of the group and providers. Kindly update me about the contract as soon as possible .  Practice Details: Practice Name : Ladot Healthcare LLC Practice NP I# : 1912502626 Practice Tax ID # : 85-2432283 Practice   Address : 2577 Madison Avenue, League City , TX 77573  Providers: Provider Name : Atinuke Dada Provider NPI # : 1154782720  Provider Name : Oladipo  Dada Provider NPI # : 1760700223  If you have any queries feel free to reach out to me.  Thank you!', NULL, NULL, '2021-07-12 12:37:38', '2021-07-12 12:37:38'),
(7896, 11056, 12443, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Enrollment Query - LHC - United HealthCare  Hello,     Atinuke Dada MPIN 7587679 is linked to TIN 852432283 and credentialed and will have active Commercial contracts effective 07/15/21     Oladipo Dada MPIN 4864632 is linked to TIN 852432283 and credentialed as delegated with Cardiovascular Care Providers Inc (CVCP) and will have active Commercial contracts effective 07/15/21           LaShonda Lymon  UnitedHealthcare  Network Management Resource Team (NMRT)  We have emailed them back and demanded the plan roster of UHC ', NULL, NULL, '2021-07-15 15:51:04', '2021-07-15 15:51:04'),
(7897, 11056, 12443, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status - LHC - Wellcare  Good Afternoon,   The providers are being loaded eff 6.01.2021, We will let you know as soon as they become par.  Thanks. Network Development', NULL, NULL, '2021-07-22 15:47:52', '2021-07-22 15:47:52'),
(7898, 11056, 12443, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Sub : Secure Message from kathleen_m_mcnulty@uhc.com  Thank you for contacting UnitedHealthcare network.     Attached please find a copy of the executed contract and signature page.  This is a group contract and the provider are loaded to the group.     Please let us know if we can help with anything else.        If you have any questions or concerns about the content of this email, please do not reply to this email as they will be deleted, but rather email directly to: networkhelp@uhc.com  for further assistance; thank you.     For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.   For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation     Thank you,     Kathleen McNulty  Network Management Resource Team', NULL, NULL, '2021-07-26 10:48:26', '2021-07-26 10:48:26'),
(7899, 3040, 12444, NULL, NULL, 'New/Not Initiated', 'Initiated  The request for enrollment initiated through their call center because we facing an error while submitting the application online. So they will contact us through email.  Ref: 2000160997101  Thanks ', NULL, NULL, '2020-12-22 12:31:20', '2020-12-22 12:31:20'),
(7900, 3040, 12444, NULL, '2020-12-29 00:00:00.000', 'Initiated', 'Initiated  The request for enrollment initiated through their call center because we facing an error while submitting the application online. So they will contact us through email.  Ref: 2000160997101 ', NULL, NULL, '2020-12-22 15:29:13', '2020-12-22 15:29:13'),
(7901, 3040, 12444, NULL, '2021-01-11 00:00:00.000', 'Initiated', 'Ref: 2000162457255 Spoke with Humana representative. She said sending request to market contractor. Some will contact you or will send email.  We submitting the request through online but we facing an error.  We cannot identify the NPI entered. Please enter a different NPI. Reference code: NPI0004 ', NULL, NULL, '2021-01-04 10:46:30', '2021-01-04 10:46:30'),
(7902, 3040, 12444, NULL, '2021-01-18 00:00:00.000', 'In Process', 'I had a word with Humama representative and they advised that the contract market department will contact u through email or call.   Interaction no: 2000163867748', NULL, NULL, '2021-01-11 10:50:07', '2021-01-11 10:50:07'),
(7903, 3040, 12444, NULL, '2021-01-19 00:00:00.000', 'In Process', 'I had a word with (SHANE) Humana representative and she said that some will contact us from market contractor  will contact today.   Interaction no: 2000165230057 ', NULL, NULL, '2021-01-18 14:52:43', '2021-01-18 14:52:43'),
(7904, 3040, 12444, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. Please find the attached the group roaster and contract coversheet along with the documents that you requested in your previous email.  If I add the provider in the contract so that provider will be In-network or out of network?  If you need any additional information please feel free to call or email me. Waiting to hear from you.  Thanks', NULL, NULL, '2021-01-19 16:40:50', '2021-01-19 16:40:50'),
(7905, 3040, 12444, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon Adil, Please complete the group roster, contract coversheet ( indicate the group NPI number) and return both documents with a W9. As always, please insure CAQH is up to date and complete, and all information including CAQH and NPI information is correct. I see you have a NP within the group, do you want the provider added to the contract or do you wish the NP go through a credentialing process with panel. Please let me know when you return the documents. If you have any question, please let me know. Thank you.', NULL, NULL, '2021-01-19 16:41:37', '2021-01-19 16:41:37'),
(7906, 3040, 12444, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment of below mentioned providers. As per your previous email I sent all the requested documents.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 12:58:01', '2021-01-26 12:58:01'),
(7907, 3040, 12444, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon, Yes I have received your email and information, I will get to it as soon as possible. Thank you. ', NULL, NULL, '2021-01-26 14:51:38', '2021-01-26 14:51:38'),
(7908, 3040, 12444, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the group and providers mentioned below.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If its possible for you to advise me the time frame of processing. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-02 10:06:12', '2021-02-02 10:06:12'),
(7909, 3040, 12444, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  I will review by Friday, I currently have other requests that are head of yours.  Thank you.', NULL, NULL, '2021-02-09 13:08:00', '2021-02-09 13:08:00'),
(7910, 3040, 12444, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Do you wish your NP go through credentialing process with panel assignment or do you simply want them added to the contract ?', NULL, NULL, '2021-02-09 13:08:24', '2021-02-09 13:08:24'),
(7911, 3040, 12444, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  I really appreciate your prompt response. The NP needs to be added to the agreement.  Let me know if you have any other questions.  Thanks', NULL, NULL, '2021-02-09 13:08:59', '2021-02-09 13:08:59'),
(7912, 3040, 12444, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Contracts were signed and they are effective 4/1/21.', NULL, NULL, '2021-02-10 16:41:42', '2021-02-10 16:41:42'),
(7913, 3040, 12444, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. Please advise me the effective date you gave me is for the both providers.  Thanks', NULL, NULL, '2021-02-17 17:50:55', '2021-02-17 17:50:55'),
(7914, 3040, 12444, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Waiting for the welcome letter.  Effective date: 04/01/2021', NULL, NULL, '2021-02-18 16:43:58', '2021-02-18 16:43:58'),
(7915, 3040, 12444, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Hello Micheal,  Hope you are doing well. Can you please advise me when I will received the welcome letter as I received the executed contract and effective date 04/01/2021.   Thank you  ', NULL, NULL, '2021-03-05 16:42:48', '2021-03-05 16:42:48'),
(7916, 3040, 12444, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Please refer the effective date of your contract which 4/1/21 for the TAX ID. Any services billed prior to your effective date will be out of network. Thank you. ', NULL, NULL, '2021-03-05 16:43:59', '2021-03-05 16:43:59'),
(7917, 3040, 12444, NULL, '2021-03-15 00:00:00.000', 'Approved', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD Good afternoon, The contract did not require credentialing so there is no welcome letter issued.', NULL, NULL, '2021-03-08 16:52:25', '2021-03-08 16:52:25'),
(7918, 2037, 12445, NULL, NULL, 'New/Not Initiated', 'Reappointment Application for Beeville Medical Clinic Initiated', NULL, NULL, '2020-12-22 14:54:32', '2020-12-22 14:54:32'),
(7919, 2037, 12445, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Response received. ----------------------------- Sullivan, Tyesha Tue, Dec 22, 3:56 PM (22 hours ago) to me  Hi Sherry,  Thank you for completing the applications. After careful review it appears we are still pending the application for the following facility. You may email the completed copy and I will gladly add it to our database. It appears we have received the application for the location: 301 South Hillside Drive. If you have any questions, please contact the email above or call  469-282-2949. Thank you!   CHRISTUS Health Plan Beeville Medical Clinic 1427509264  Active  600 South Hillside Drive TX --------------- Replied her back: --------------- Hello Tyesha,  Thank you for the response.  Kindly note that 600 South Hillside Drive location is no longer active so you can remove it from your records. More over I have added a secondary location to the same application which is currently active please add that in your records so  that it does reflect in the directory.  image.png  Do let me know if you need any further documentation.  Thank you! Regards:', NULL, NULL, '2020-12-23 16:00:07', '2020-12-23 16:00:07'),
(7920, 1006, 12445, NULL, '2021-01-18 00:00:00.000', 'Approved', 'Received following reply from Sullivan, Tyesha tyesha.sullivan@christushealth.org:  \"Hi Brad,     Yes, at this time both location have been credentialed. If any additional information is needed, we will contact you directly. The effective date for George West is 11/19/2020.\"', NULL, NULL, '2021-01-11 16:35:57', '2021-01-11 16:35:57'),
(7921, 2037, 12446, NULL, NULL, 'New/Not Initiated', 'Reappointment Application for George West Medical Clinic Initiated', NULL, NULL, '2020-12-22 14:54:58', '2020-12-22 14:54:58'),
(7922, 2037, 12446, NULL, '2021-01-08 00:00:00.000', 'Initiated', 'Response received. ----------------------------- Sullivan, Tyesha Tue, Dec 22, 3:56 PM (22 hours ago) to me  Hi Sherry,  Thank you for completing the applications. After careful review it appears we are still pending the application for the following facility. You may email the completed copy and I will gladly add it to our database. It appears we have received the application for the location: 301 South Hillside Drive. If you have any questions, please contact the email above or call  469-282-2949. Thank you!   CHRISTUS Health Plan Beeville Medical Clinic 1427509264  Active  600 South Hillside Drive TX --------------- Replied her back: --------------- Hello Tyesha,  Thank you for the response.  Kindly note that 600 South Hillside Drive location is no longer active so you can remove it from your records. More over I have added a secondary location to the same application which is currently active please add that in your records so  that it does reflect in the directory.  image.png  Do let me know if you need any further documentation.  Thank you! Regards:', NULL, NULL, '2020-12-23 16:00:17', '2020-12-23 16:00:17'),
(7923, 1006, 12446, NULL, '2021-01-18 00:00:00.000', 'Approved', 'Received the following reply from Tyesha: \"Hi Brad,  Thank you for your patience. It appears the new location (504A Houston Street) has been added and has been credentialed effective 11/2020. Thank you!  Tyesha Sullivan  Credentialing Coordinator Christus System CVO 919 Hidden Ridge Irving, TX 75038 (O) 469-282-2949\"', NULL, NULL, '2021-01-11 15:10:09', '2021-01-11 15:10:09'),
(7924, 3040, 12447, NULL, NULL, 'New/Not Initiated', 'Initiated   Clinic or group practice certification application form filled and send through fax.    See attachments.', NULL, NULL, '2020-12-22 15:11:10', '2020-12-22 15:11:10'),
(7925, 3040, 12447, NULL, '2020-12-29 00:00:00.000', 'Initiated', 'Enrollment form send to Tricare through fax.', NULL, NULL, '2020-12-22 15:22:19', '2020-12-22 15:22:19'),
(7926, 3040, 12447, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Email sent to: 	ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  A very happy new year to you. Hope you are doing well. I wanted to know the status of application for our group and providers. I sent the practice certification application form for the facility & provider certification application through fax. I hope they have been received.   Below are the information for the group and provider:   Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 NPI # 1912502626  Provider Name: Atinuke Dada NPI# 1154782720  One of the providers is already in the Tricare network. We sent the letter of intent. Below is the information of that provider.   Provider Name: Oladipo Dada NPI# 1760700223   If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-31 09:46:46', '2020-12-31 09:46:46'),
(7927, 3040, 12447, NULL, '2021-01-14 00:00:00.000', 'In Process', 'I had a word with (Becky) Tricare representative and she said they received the application and its in process.   Interaction no: 11320126', NULL, NULL, '2021-01-07 10:13:09', '2021-01-07 10:13:09'),
(7928, 3040, 12447, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Well I had a word with (Becky) Tricare representative and she advised me that the application was received and still in process.   Please feel free to call or email me if you need any additional information from my side. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-13 17:11:05', '2021-01-13 17:11:05'),
(7929, 3040, 12447, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Good Afternoon Adil,  Certification application are faxed to WPS the company who process the claims. I do not have visual access to their system to give the status. I can only see it once it’s complete and has been updated to our system.  You can contact WPS at 800 444 5445 option 2,2,5 and 1. WPS will send you a letter once the certification is complete.      ', NULL, NULL, '2021-01-13 17:12:18', '2021-01-13 17:12:18'),
(7930, 3040, 12447, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned practice and providers. Has there been any update?  Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 NPI # 1912502626  Provider Name: Atinuke Dada NPI# 1154782720  One of the providers is already in the Tricare network. We sent the letter of intent. Below is the information of that provider.   Provider Name: Oladipo Dada NPI# 1760700223   If you need additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-20 12:40:38', '2021-01-20 12:40:38'),
(7931, 3040, 12447, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please advise me how we can start the credentialing/contracting process.   Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 12:12:16', '2021-01-27 12:12:16'),
(7932, 3040, 12447, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject:  RE: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Good Morning  Adil,  We show this tax id as TRICARE certified and non-network.  As a certified non network provider, you are authorized to provide care to TRICARE beneficiaries with the following Plans listed below. The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary  •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult  Joining the Network:', NULL, NULL, '2021-01-27 12:13:35', '2021-01-27 12:13:35'),
(7933, 3040, 12447, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Follow up Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me how we can start the credentialing/Contracting process?   Waiting for your response.   Thanks', NULL, NULL, '2021-02-03 17:32:16', '2021-02-03 17:32:16'),
(7934, 3040, 12447, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Could you please advise me regarding the plans that you mentioned in the above email for certification, are the providers in-network in all these plans after they have been certified? Or are we only able to bill patients that have OoN (Out of network) benefits for those plans?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-04 11:01:47', '2021-02-04 11:01:47'),
(7935, 3040, 12447, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Has there been any update regarding the previous email.   Thanks', NULL, NULL, '2021-02-11 10:20:24', '2021-02-11 10:20:24'),
(7936, 3040, 12447, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me regarding my previous email.   Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:08:06', '2021-02-18 12:08:06');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(7937, 3040, 12447, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached signed contract for Humana and Choice care. Please adviss?  Thanks ', NULL, NULL, '2021-02-25 13:41:43', '2021-02-25 13:41:43'),
(7938, 3040, 12447, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Hello Adil,  If the provider did not sign a contract agreement with Humana Military they are not in network but TRICARE certified.  Joining the network:  At this time, we are not currently expanding our network based on your specialty and location within the East Region for Humana Military. We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future.  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult', NULL, NULL, '2021-02-25 13:43:44', '2021-02-25 13:43:44'),
(7939, 3040, 12447, NULL, '2021-05-31 00:00:00.000', 'On Hold', NULL, NULL, NULL, '2021-03-05 14:03:50', '2021-03-05 14:03:50'),
(7940, 1006, 12447, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Received the following email from Yvonne and why the task is currently on hold:  At this time, we are not currently expanding our network based on your specialty and location within the East Region for Humana Military. We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future.', NULL, NULL, '2021-04-02 15:49:40', '2021-04-02 15:49:40'),
(7941, 1006, 12447, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Sent an email to Yvonne @ Yvonne Wyatt ywyatt@humana.com as per my discussion with Tricare provider relations:  Sub: Enrollment Query - Ladot Healthcare  \"Hello Yvonne, I hope you\'re doing well, we wanted to enroll our group and providers with Tricare, the information is as follows: Group Name: Ladot Healthcare LLC NPI# 1912502626 Provider Name: OladipoDada  NPI# 1760700223 Provider Name: Atinuke Dada NPI# 1154782720  Please let me know if you have any questions. Thank you. \"', NULL, NULL, '2021-05-27 11:33:35', '2021-05-27 11:33:35'),
(7942, 1006, 12447, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following rejection email from Tricare @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Query - Ladot Healthcare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194\"', NULL, NULL, '2021-05-31 09:46:41', '2021-05-31 09:46:41'),
(7943, 3040, 12448, NULL, NULL, 'New/Not Initiated', 'Initiated   Provider enrollment form filled and send it through fax.  See attachment. ', NULL, NULL, '2020-12-22 15:17:23', '2020-12-22 15:17:23'),
(7944, 3040, 12448, NULL, '2020-12-29 00:00:00.000', 'Initiated', 'Requirement send to Tricare for enrollment. ', NULL, NULL, '2020-12-22 15:19:23', '2020-12-22 15:19:23'),
(7945, 3040, 12448, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Email sent to: 	ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  A very happy new year to you. Hope you are doing well. I wanted to know the status of application for our group and providers. I sent the practice certification application form for the facility & provider certification application through fax. I hope they have been received.   Below are the information for the group and provider:   Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 NPI # 1912502626  Provider Name: Atinuke Dada NPI# 1154782720  One of the providers is already in the Tricare network. We sent the letter of intent. Below is the information of that provider.   Provider Name: Oladipo Dada NPI# 1760700223   If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-31 09:47:02', '2020-12-31 09:47:02'),
(7946, 3040, 12448, NULL, '2021-01-11 00:00:00.000', 'In Process', 'I had a word with (Becky) and she said they didn\'t the application for Atinuke Dada and we need to send it again.   Interaction no: 11320126  Next Follow up on 01/11/2021', NULL, NULL, '2021-01-07 09:56:23', '2021-01-07 09:56:23'),
(7947, 3040, 12448, NULL, '2021-01-14 00:00:00.000', 'In Process', 'I called again and had a word with (Greg) Tricare representative and he said they received the application and its in process.   Interaction no: 11320126', NULL, NULL, '2021-01-07 10:19:01', '2021-01-07 10:19:01'),
(7948, 3040, 12448, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Well I had a word with (Becky) Tricare representative and she advised me that the application was received and still in process.   Please feel free to call or email me if you need any additional information from my side. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-13 17:11:13', '2021-01-13 17:11:13'),
(7949, 3040, 12448, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Good Afternoon Adil,  Certification application are faxed to WPS the company who process the claims. I do not have visual access to their system to give the status. I can only see it once it’s complete and has been updated to our system.  You can contact WPS at 800 444 5445 option 2,2,5 and 1. WPS will send you a letter once the certification is complete.      ', NULL, NULL, '2021-01-13 17:12:24', '2021-01-13 17:12:24'),
(7950, 3040, 12448, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned practice and providers. Has there been any update?  Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 NPI # 1912502626  Provider Name: Atinuke Dada NPI# 1154782720  One of the providers is already in the Tricare network. We sent the letter of intent. Below is the information of that provider.   Provider Name: Oladipo Dada NPI# 1760700223   If you need additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-20 12:40:43', '2021-01-20 12:40:43'),
(7951, 3040, 12448, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please advise me how we can start the credentialing/contracting process.   Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 12:12:24', '2021-01-27 12:12:24'),
(7952, 3040, 12448, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject:  RE: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Good Morning  Adil,  We show this tax id as TRICARE certified and non-network.  As a certified non network provider, you are authorized to provide care to TRICARE beneficiaries with the following Plans listed below. The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary  •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult  Joining the Network:', NULL, NULL, '2021-01-27 12:13:40', '2021-01-27 12:13:40'),
(7953, 3040, 12448, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Follow up Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me how we can start the credentialing/Contracting process?   Waiting for your response.   Thanks', NULL, NULL, '2021-02-03 17:32:21', '2021-02-03 17:32:21'),
(7954, 3040, 12448, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Could you please advise me regarding the plans that you mentioned in the above email for certification, are the providers in-network in all these plans after they have been certified? Or are we only able to bill patients that have OoN (Out of network) benefits for those plans?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-04 11:01:53', '2021-02-04 11:01:53'),
(7955, 3040, 12448, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Has there been any update regarding the previous email.   Thanks', NULL, NULL, '2021-02-11 10:20:35', '2021-02-11 10:20:35'),
(7956, 3040, 12448, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me regarding my previous email.   Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:08:11', '2021-02-18 12:08:11'),
(7957, 3040, 12448, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached signed contract for Humana and Choice care. Please adviss?  Thanks ', NULL, NULL, '2021-02-25 13:41:50', '2021-02-25 13:41:50'),
(7958, 3040, 12448, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Hello Adil,  If the provider did not sign a contract agreement with Humana Military they are not in network but TRICARE certified.  Joining the network:  At this time, we are not currently expanding our network based on your specialty and location within the East Region for Humana Military. We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future.  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult', NULL, NULL, '2021-02-25 13:43:48', '2021-02-25 13:43:48'),
(7959, 3040, 12448, NULL, '2021-05-31 00:00:00.000', 'On Hold', NULL, NULL, NULL, '2021-03-05 14:04:04', '2021-03-05 14:04:04'),
(7960, 1006, 12448, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Received the following email from Yvonne and why the task is currently on hold:  At this time, we are not currently expanding our network based on your specialty and location within the East Region for Humana Military. We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future.', NULL, NULL, '2021-04-02 15:49:45', '2021-04-02 15:49:45'),
(7961, 1006, 12448, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following rejection email from Tricare @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Query - Ladot Healthcare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194\"', NULL, NULL, '2021-05-31 09:46:50', '2021-05-31 09:46:50'),
(7962, 3040, 12449, NULL, NULL, 'New/Not Initiated', 'Initated ', NULL, NULL, '2020-12-22 15:20:05', '2020-12-22 15:20:05'),
(7963, 3040, 12449, NULL, '2020-12-29 00:00:00.000', 'Initiated', 'LOI send it to Tricare for linkage the provider.', NULL, NULL, '2020-12-22 15:21:02', '2020-12-22 15:21:02'),
(7964, 3040, 12449, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Email sent to: 	ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  A very happy new year to you. Hope you are doing well. I wanted to know the status of application for our group and providers. I sent the practice certification application form for the facility & provider certification application through fax. I hope they have been received.   Below are the information for the group and provider:   Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 NPI # 1912502626  Provider Name: Atinuke Dada NPI# 1154782720  One of the providers is already in the Tricare network. We sent the letter of intent. Below is the information of that provider.   Provider Name: Oladipo Dada NPI# 1760700223   If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-31 09:47:10', '2020-12-31 09:47:10'),
(7965, 3040, 12449, NULL, '2021-01-14 00:00:00.000', 'In Process', 'I had a word with (Becky) Tricare representative and she advised that they received the LOI and it will take time.  Interaction no: 11320126', NULL, NULL, '2021-01-07 09:54:31', '2021-01-07 09:54:31'),
(7966, 3040, 12449, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Well I had a word with (Becky) Tricare representative and she advised me that the application was received and still in process.   Please feel free to call or email me if you need any additional information from my side. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-13 17:11:20', '2021-01-13 17:11:20'),
(7967, 3040, 12449, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Good Afternoon Adil,  Certification application are faxed to WPS the company who process the claims. I do not have visual access to their system to give the status. I can only see it once it’s complete and has been updated to our system.  You can contact WPS at 800 444 5445 option 2,2,5 and 1. WPS will send you a letter once the certification is complete.      ', NULL, NULL, '2021-01-13 17:12:29', '2021-01-13 17:12:29'),
(7968, 3040, 12449, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned practice and providers. Has there been any update?  Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 NPI # 1912502626  Provider Name: Atinuke Dada NPI# 1154782720  One of the providers is already in the Tricare network. We sent the letter of intent. Below is the information of that provider.   Provider Name: Oladipo Dada NPI# 1760700223   If you need additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-20 12:40:50', '2021-01-20 12:40:50'),
(7969, 3040, 12449, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please advise me how we can start the credentialing/contracting process.   Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 12:12:29', '2021-01-27 12:12:29'),
(7970, 3040, 12449, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject:  RE: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Good Morning  Adil,  We show this tax id as TRICARE certified and non-network.  As a certified non network provider, you are authorized to provide care to TRICARE beneficiaries with the following Plans listed below. The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary  •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult  Joining the Network:', NULL, NULL, '2021-01-27 12:13:46', '2021-01-27 12:13:46'),
(7971, 3040, 12449, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Follow up Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me how we can start the credentialing/Contracting process?   Waiting for your response.   Thanks', NULL, NULL, '2021-02-03 17:32:27', '2021-02-03 17:32:27'),
(7972, 3040, 12449, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Could you please advise me regarding the plans that you mentioned in the above email for certification, are the providers in-network in all these plans after they have been certified? Or are we only able to bill patients that have OoN (Out of network) benefits for those plans?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-04 11:01:58', '2021-02-04 11:01:58'),
(7973, 3040, 12449, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Has there been any update regarding the previous email.   Thanks', NULL, NULL, '2021-02-11 10:20:52', '2021-02-11 10:20:52'),
(7974, 3040, 12449, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please advise me regarding my previous email.   Waiting for your response.   Thanks', NULL, NULL, '2021-02-18 12:08:17', '2021-02-18 12:08:17'),
(7975, 3040, 12449, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached signed contract for Humana and Choice care. Please adviss?  Thanks ', NULL, NULL, '2021-02-25 13:41:55', '2021-02-25 13:41:55'),
(7976, 3040, 12449, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status ||Ladot Healthcare LLC || Tricare ||  Hello Adil,  If the provider did not sign a contract agreement with Humana Military they are not in network but TRICARE certified.  Joining the network:  At this time, we are not currently expanding our network based on your specialty and location within the East Region for Humana Military. We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future.  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary.  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult', NULL, NULL, '2021-02-25 13:43:53', '2021-02-25 13:43:53'),
(7977, 3040, 12449, NULL, '2021-05-31 00:00:00.000', 'On Hold', NULL, NULL, NULL, '2021-03-05 14:04:17', '2021-03-05 14:04:17'),
(7978, 1006, 12449, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Received the following email from Yvonne and why the task is currently on hold:  At this time, we are not currently expanding our network based on your specialty and location within the East Region for Humana Military. We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future.', NULL, NULL, '2021-04-02 15:49:50', '2021-04-02 15:49:50'),
(7979, 1006, 12449, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'We received the following rejection email from Tricare @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Query - Ladot Healthcare  \"Good Morning Brad,  Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry  We show this tax id as non-network TRICARE certified  As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary  •            Tricare Select •            Tricare for Life •            Tricare Reserve Select •            Tricare Retired Reserve •            Tricare Retired Reserved •            Tricare Young Adult   Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider  https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194\"', NULL, NULL, '2021-05-31 09:46:57', '2021-05-31 09:46:57'),
(7980, 2037, 12450, NULL, NULL, 'New/Not Initiated', 'Location addition Initiated', NULL, NULL, '2020-12-23 10:37:14', '2020-12-23 10:37:14'),
(7981, 2037, 12450, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Location addition initiated: ----------------- Thomas-Martin, Michele 9:19 AM (11 minutes ago) to me  Record # 171061  Provider: Jeemol George  Good Morning,   Thank you for your inquiry.  We have all the locations in the billing system but the above provider was only loaded under 779 Normandy St Suite 114.  The request only listed one location, please advise on the contract request forms going forward which locations the provider should be listed under.  I’ve created a new record # 173450 to add the provider under the 2nd and 3rd locations listed below.  Please allow 30 days for processing.', NULL, NULL, '2020-12-23 10:37:42', '2020-12-23 10:37:42'),
(7982, 1006, 12450, NULL, '2021-02-01 00:00:00.000', 'In Process', 'W9 was requested for group, sent @ Provider contract coordination Fax ProvcontractCoordFax@molinahealthcare.com', NULL, NULL, '2021-01-19 17:46:36', '2021-01-19 17:46:36'),
(7983, 3040, 12450, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	MHTContractrequest@molinahealthcare.com  Subject:  Molina Provider Contracting - Missing W-9  Greetings,  Hope you are doing well. Please advise me the enrollment status of the provider in the below location.   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-01 13:09:28', '2021-03-01 13:09:28'),
(7984, 3040, 12450, NULL, '2021-03-08 00:00:00.000', 'Approved', 'Jeemol George  - The provider has been loaded in the billing system effective 12/1/2020 ( 779 Normandy St.)  and 1/15/2021 under additional 2 service locations ( 9504 long Point Rd & 16272 IMPERIAL VALLEY DR ).  Please see the  attached welcome letters for the provider.', NULL, NULL, '2021-03-01 17:20:54', '2021-03-01 17:20:54'),
(7985, 1006, 12451, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:40', '2020-12-23 14:15:40'),
(7986, 1006, 12451, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:40:54', '2020-12-23 14:40:54'),
(7987, 1006, 12451, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \" ', NULL, NULL, '2021-01-05 10:11:20', '2021-01-05 10:11:20'),
(7988, 1006, 12451, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:37:20', '2021-01-19 10:37:20'),
(7989, 1006, 12451, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further processing.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:52:58', '2021-01-28 15:52:58'),
(7990, 1006, 12451, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:56:31', '2021-02-03 16:56:31'),
(7991, 1006, 12452, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:42', '2020-12-23 14:15:42'),
(7992, 1006, 12452, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:41:06', '2020-12-23 14:41:06'),
(7993, 1006, 12452, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \" ', NULL, NULL, '2021-01-05 10:11:14', '2021-01-05 10:11:14'),
(7994, 1006, 12452, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:37:40', '2021-01-19 10:37:40'),
(7995, 1006, 12452, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:13', '2021-01-28 15:53:13'),
(7996, 1006, 12452, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:56:37', '2021-02-03 16:56:37'),
(7997, 1006, 12453, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:43', '2020-12-23 14:15:43'),
(7998, 1006, 12453, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:41:24', '2020-12-23 14:41:24'),
(7999, 1006, 12453, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \" ', NULL, NULL, '2021-01-05 10:11:05', '2021-01-05 10:11:05'),
(8000, 1006, 12453, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:37:45', '2021-01-19 10:37:45'),
(8001, 1006, 12453, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:20', '2021-01-28 15:53:20'),
(8002, 1006, 12453, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:56:47', '2021-02-03 16:56:47'),
(8003, 1006, 12454, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:44', '2020-12-23 14:15:44'),
(8004, 1006, 12454, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:41:33', '2020-12-23 14:41:33'),
(8005, 1006, 12454, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \" ', NULL, NULL, '2021-01-05 10:10:59', '2021-01-05 10:10:59'),
(8006, 1006, 12454, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:37:50', '2021-01-19 10:37:50'),
(8007, 1006, 12454, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:25', '2021-01-28 15:53:25'),
(8008, 1006, 12454, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:56:53', '2021-02-03 16:56:53'),
(8009, 1006, 12455, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:45', '2020-12-23 14:15:45'),
(8010, 1006, 12455, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:41:42', '2020-12-23 14:41:42'),
(8011, 1006, 12455, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \" ', NULL, NULL, '2021-01-05 10:10:51', '2021-01-05 10:10:51'),
(8012, 1006, 12455, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:38:58', '2021-01-19 10:38:58'),
(8013, 1006, 12455, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:31', '2021-01-28 15:53:31'),
(8014, 1006, 12455, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:56:59', '2021-02-03 16:56:59'),
(8015, 1006, 12456, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:45', '2020-12-23 14:15:45'),
(8016, 1006, 12456, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:41:54', '2020-12-23 14:41:54'),
(8017, 1006, 12456, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \" ', NULL, NULL, '2021-01-05 10:10:45', '2021-01-05 10:10:45'),
(8018, 1006, 12456, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:39:10', '2021-01-19 10:39:10'),
(8019, 1006, 12456, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:36', '2021-01-28 15:53:36'),
(8020, 1006, 12456, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:57:05', '2021-02-03 16:57:05'),
(8021, 1006, 12457, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:46', '2020-12-23 14:15:46'),
(8022, 1006, 12457, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:42:00', '2020-12-23 14:42:00'),
(8023, 1006, 12457, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \"', NULL, NULL, '2021-01-05 10:09:37', '2021-01-05 10:09:37'),
(8024, 1006, 12457, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:39:16', '2021-01-19 10:39:16'),
(8025, 1006, 12457, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:42', '2021-01-28 15:53:42'),
(8026, 1006, 12457, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:57:11', '2021-02-03 16:57:11'),
(8027, 1006, 12458, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:47', '2020-12-23 14:15:47'),
(8028, 1006, 12458, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:42:08', '2020-12-23 14:42:08'),
(8029, 1006, 12458, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \"', NULL, NULL, '2021-01-05 10:09:24', '2021-01-05 10:09:24'),
(8030, 1006, 12458, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:39:21', '2021-01-19 10:39:21'),
(8031, 1006, 12458, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:47', '2021-01-28 15:53:47');
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
(8032, 1006, 12458, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:57:19', '2021-02-03 16:57:19'),
(8033, 1006, 12459, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:48', '2020-12-23 14:15:48'),
(8034, 1006, 12459, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:42:19', '2020-12-23 14:42:19'),
(8035, 1006, 12459, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \"', NULL, NULL, '2021-01-05 10:09:18', '2021-01-05 10:09:18'),
(8036, 1006, 12459, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:39:26', '2021-01-19 10:39:26'),
(8037, 1006, 12459, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:53', '2021-01-28 15:53:53'),
(8038, 1006, 12459, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:57:24', '2021-02-03 16:57:24'),
(8039, 1006, 12460, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:48', '2020-12-23 14:15:48'),
(8040, 1006, 12460, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:42:25', '2020-12-23 14:42:25'),
(8041, 1006, 12460, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \"', NULL, NULL, '2021-01-05 10:09:11', '2021-01-05 10:09:11'),
(8042, 1006, 12460, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:39:32', '2021-01-19 10:39:32'),
(8043, 1006, 12460, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:53:59', '2021-01-28 15:53:59'),
(8044, 1006, 12460, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:57:30', '2021-02-03 16:57:30'),
(8045, 1006, 12461, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 14:15:49', '2020-12-23 14:15:49'),
(8046, 1006, 12461, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Request initiated via submitting LOI to pcontracting@hne.com: \"Hello,   Please find the attached LOI for our group and providers, as well as all of their CV\'s. Please let me know if anything else is required and also please let me know what the expected time-frame is for enrollment?  Thanks. \" ', NULL, NULL, '2020-12-23 14:42:30', '2020-12-23 14:42:30'),
(8047, 1006, 12461, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Sent following email @ providerrelations@hne.com: \"Good morning,   I hope you\'re doing well, I wanted to check up on the status of an LOI that I submitted last month for our group/providers, the group info is as follows: Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Please let me know if the LOI has been received and if so, what the expected turnaround time is for enrollment of the group and providers?  Thanks. \"', NULL, NULL, '2021-01-05 10:09:02', '2021-01-05 10:09:02'),
(8048, 1006, 12461, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Sent another follow-up email @ providerrelations@hne.com for status of LOI. ', NULL, NULL, '2021-01-19 10:39:38', '2021-01-19 10:39:38'),
(8049, 1006, 12461, NULL, '2021-02-04 00:00:00.000', 'In Process', 'The LOI has been received and is currently waiting on the behavioral health department to get back to them for further processing.   Should email @ pcontracting@hne.com for further queries.  Mary Santiago 413-233-3463 Ref# 3004241811', NULL, NULL, '2021-01-28 15:54:04', '2021-01-28 15:54:04'),
(8050, 1006, 12461, NULL, '2021-02-10 00:00:00.000', 'Rejected', 'Rejection received as we do not meet the geographical guidelines: \"February 1, 2021  Brad Peterson SNB Care-Spectrum Neuro Behavioral Health  Dear Mr. Peterson:  Thank you for your interest in becoming a Health New England Provider.  We have carefully evaluated our need for new providers with your specialty.  At this time, we have found that your physical address is outside of our geographical service area of Western Mass and Worcester counties.    We appreciate the time and effort you have extended to contact us and we will keep your letter and information on file.  If we find a need in the future for new providers in your geographic area, we will contact you.  Sincerely, The Provider Contracting Team bl pcontracting@hne.com Phone/Fax 413.233.3175\"', NULL, NULL, '2021-02-03 16:57:35', '2021-02-03 16:57:35'),
(8051, 3040, 12462, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 16:43:40', '2020-12-23 16:43:40'),
(8052, 3040, 12462, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Contract Request || Ladot Healthcare LLC Group || Superior Healthplan ||  Greetings,  Hope you are doing well. Please find the attached the W9 form for our group contract request.  Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Contract request form submitted online. Please see attachments.  Thanks ', NULL, NULL, '2020-12-23 16:45:26', '2020-12-23 16:45:26'),
(8053, 3040, 12462, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: [SECURE] Important request from Superior Healthplan  Greetings,  Hope you are doing well. I really appreciate your prompt reply. Please find the attached the W9 form that you requested in the above email. Kindly find below the information that you requested:  Practice Name: Ladot Healthcare LLC The group will participate with all products but currently Medicare & Medicaid enrollment is still in-process. The group is a General Clinic and the following providers are working in it:  Provider 1: Provider Name: Oladipo Dada, MD Specialty: Internal Medicine  Provider 2: Provider Name: Atinuke Dada Specialty: Family Nurse Practitioner  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-29 17:20:38', '2020-12-29 17:20:38'),
(8054, 3040, 12462, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health Greetings,  Hope you are doing well. Please find the attached the credential facility form with the documents that are requested for enrollment.  Please feel free to contact me if you have any questions. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2020-12-30 14:11:18', '2020-12-30 14:11:18'),
(8055, 3040, 12462, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Greetings,  Hope you are doing well. I sent the credential facility form with the requested documents. I just wanted to take an update if you need anything else from my side?  Please let me know as soon as possible. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-06 09:59:43', '2021-01-06 09:59:43'),
(8056, 3040, 12462, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Hello  We received your completed application on 12/30/2020.  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 16:06:28', '2021-01-07 16:06:28'),
(8057, 3040, 12462, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Greetings,  Hope you are doing well. I just wanted to follow up regarding the below mentioned facility. Has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-21 11:56:36', '2021-01-21 11:56:36'),
(8058, 3040, 12462, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Hello  We received your completed application on 12/30/2020. Your projected effective date is 02/01/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-01-22 12:06:48', '2021-01-22 12:06:48'),
(8059, 3040, 12462, NULL, '2021-02-05 00:00:00.000', 'In Process', 'As per conversation with (CAMARA) Superior Health representative she said application is still in process. ', NULL, NULL, '2021-01-29 13:20:41', '2021-01-29 13:20:41'),
(8060, 3040, 12462, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned facility. Has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-05 12:35:20', '2021-02-05 12:35:20'),
(8061, 3040, 12462, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Hello,  This record is in processing, we are a little behind but will let you know when welcome packet will be sent out.  Thanks  Felicia Napier', NULL, NULL, '2021-02-12 10:17:09', '2021-02-12 10:17:09'),
(8062, 3040, 12462, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned facility. Has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283  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 10:17:59', '2021-02-12 10:17:59'),
(8063, 3040, 12462, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Greetings,  Can you please let me know the updated status and expected time frame?   Thanks', NULL, NULL, '2021-02-19 15:36:27', '2021-02-19 15:36:27'),
(8064, 3040, 12462, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-02-26 12:54:50', '2021-02-26 12:54:50'),
(8065, 3040, 12462, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: RE: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  We received your completed application  for Atinuke Dad on 2/2/21 & your signed contract on 2/26/2021  We are currently reviewing your file.  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, '2021-03-05 16:33:50', '2021-03-05 16:33:50'),
(8066, 3040, 12462, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Hello,  Hope you are doing well. I just wanted to follow up regarding the enrollment for the below mentioned facility. Has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-12 15:41:55', '2021-03-12 15:41:55'),
(8067, 3040, 12462, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-19 12:46:14', '2021-03-19 12:46:14'),
(8068, 3040, 12462, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned group and providers.   Practice Details: Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-06 15:21:56', '2021-05-06 15:21:56'),
(8069, 3040, 12462, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Hello Veronica,   Thank you so much for your response. Can you please send me the welcome letter for both the providers.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 12:51:34', '2021-05-24 12:51:34'),
(8070, 3040, 12462, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good morning Adil  My apologies for the delay in response  Per review I do see both providers application has been completed with the effective date of 6/1/2021  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223   Veronica Botello Rocha', NULL, NULL, '2021-05-24 12:52:26', '2021-05-24 12:52:26'),
(8071, 3040, 12462, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good afternoon,  Welcome letters are provided by our ECM team. Please allow some time for them to send. If not received by effective date you can reach out to them directly at ECMExecutionTeam@superiorhealthplan.com .  Thank you,      ', NULL, NULL, '2021-05-26 10:35:09', '2021-05-26 10:35:09'),
(8072, 1006, 12462, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Sent f/u email @ ECMExecutionTeam@superiorhealthplan.com:  Sub: Welcome Letters Request - LHC - Superior Health  \"Hello,  I am still waiting for the welcome letters for the following providers, their information is as follows:  Group Name: Ladot Healthcare LLC NPI# 1912502626TIN# 85-2432283 Provider Name: Oladipo Dada NPI# 1760700223 Provider Name: Atinuke Dada NPI# 1154782720 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-14 15:33:21', '2021-06-14 15:33:21'),
(8073, 1006, 12462, NULL, '2021-07-09 00:00:00.000', 'Approved', 'We received the following approval confirmation from AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Good morning Ahmed  Happy Friday  Here is the information you requested for the following Providers:  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3\"  Approval confirmation is attached for reference.', NULL, NULL, '2021-07-02 14:15:25', '2021-07-02 14:15:25'),
(8074, 3040, 12463, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 17:07:20', '2020-12-23 17:07:20'),
(8075, 3040, 12463, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Contract Request For Provider || Ladot Healthcare LLC || Dada, Oladipo, Dada, Atinuke || Superior Health plan ||  Greetings,  Hope you are doing well. Please find the attached the W9 form for our providers contract request.  Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626  Provider 1: Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider 2: Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Contract request form attached.   Thanks ', NULL, NULL, '2020-12-23 17:09:24', '2020-12-23 17:09:24'),
(8076, 3040, 12463, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Group contract signed and waiting for the reply. ', NULL, NULL, '2020-12-30 17:48:48', '2020-12-30 17:48:48'),
(8077, 3040, 12463, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-06 10:12:36', '2021-01-06 10:12:36'),
(8078, 3040, 12463, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers. I submitted the contract request form on 12/23/2020.   Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626  Provider 1: Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider 2: Provider Name: Atinuke Dada Provider NPI# 1154782720  Thanks', NULL, NULL, '2021-01-15 12:04:44', '2021-01-15 12:04:44'),
(8079, 3040, 12463, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Hello  We received your completed application on 12/30/2020. Your projected effective date is 02/01/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-01-22 14:37:23', '2021-01-22 14:37:23'),
(8080, 3040, 12463, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. Please find the attached provider contract request form for Atinuke Dada NPI # 1154782720 submitted on 12/23/2020.  The receiving application date that you mentioned in your previous email for Oladipo Dada might be wrong. Kindly double check in your system.  If you need any additional information please let me know. Waiting for your response.   Thanks  ', NULL, NULL, '2021-01-29 16:50:22', '2021-01-29 16:50:22'),
(8081, 3040, 12463, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: LADOT HEALTHCARE LLC  Greetings,  Hope you are doing well. Please find the attached provider contracting form as per the email received from Superior Health plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-02 17:30:54', '2021-02-02 17:30:54'),
(8082, 3040, 12463, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: LADOT HEALTHCARE LLC  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status of the below mentioned provider.   Practice Details: Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  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 12:37:10', '2021-02-09 12:37:10'),
(8083, 3040, 12463, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: LADOT HEALTHCARE LLC - REF # 26227  Good afternoon,  After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 2/2/2021 .  Credentialing process can take between 60 -120 days. Please allow more time for application to process.  Thank you,  Yesenia Prado Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-02-16 12:06:47', '2021-02-16 12:06:47'),
(8084, 3040, 12463, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Follow up email sent to: AM.Houston@superiorhealthplan.com  Subject: LADOT HEALTHCARE LLC - REF # 26227  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.    Practice Details: Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-23 10:51:44', '2021-02-23 10:51:44'),
(8085, 3040, 12463, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Follow up email sent to: AM.Houston@superiorhealthplan.com  Subject: LADOT HEALTHCARE LLC - REF # 26227  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-02 14:28:07', '2021-03-02 14:28:07'),
(8086, 3040, 12463, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good morning Adil,  Hope all is well. Here is the information you requested  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720---- pending/credentialing status received application on 2/2/2021  ', NULL, NULL, '2021-03-10 14:52:07', '2021-03-10 14:52:07'),
(8087, 3040, 12463, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-18 13:06:55', '2021-03-18 13:06:55'),
(8088, 1006, 12463, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Received the following response from Stephanie Edwards - External Stephanie.Edwards@superiorhealthplan.com:  Sub: FIRST CREDENTIALIG REQUEST ATINUKE DADA 1154782720  \"Good morning,  We received your (re)credentialing application for Atinuke Dada; however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below:   Completed Conflict of Interest Disclosure forms ( YES or NO must be checked and all forms must be signed and dated by provider even if not applicable) PAGE 12  You may fax or email the requested information to the contact information listed below.  Fax: 866-702-4831 Phone: 1-800-820-5686  Thank you, Stephanie Edwards Credentialing Specialist | Superior Health Plan 5900 Ben White Blvd Austin, TX 78741 Phone: 800-218-7453 Fax: 866-702-4831 Stephanie.Edwards@superiorhealthplan.com\"  Sent a reply to them with the corrected form. ', NULL, NULL, '2021-04-15 07:39:44', '2021-04-15 07:39:44'),
(8089, 3040, 12463, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned group and providers.   Practice Details: Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-06 15:22:02', '2021-05-06 15:22:02'),
(8090, 3040, 12463, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Hello Veronica,   Thank you so much for your response. Can you please send me the welcome letter for both the providers.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 12:51:38', '2021-05-24 12:51:38'),
(8091, 3040, 12463, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good morning Adil  My apologies for the delay in response  Per review I do see both providers application has been completed with the effective date of 6/1/2021  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223   Veronica Botello Rocha', NULL, NULL, '2021-05-24 12:52:30', '2021-05-24 12:52:30'),
(8092, 3040, 12463, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good afternoon,  Welcome letters are provided by our ECM team. Please allow some time for them to send. If not received by effective date you can reach out to them directly at ECMExecutionTeam@superiorhealthplan.com .  Thank you,      ', NULL, NULL, '2021-05-26 10:35:15', '2021-05-26 10:35:15'),
(8093, 1006, 12463, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Sent f/u email @ ECMExecutionTeam@superiorhealthplan.com:  Sub: Welcome Letters Request - LHC - Superior Health  \"Hello,  I am still waiting for the welcome letters for the following providers, their information is as follows:  Group Name: Ladot Healthcare LLC NPI# 1912502626TIN# 85-2432283 Provider Name: Oladipo Dada NPI# 1760700223 Provider Name: Atinuke Dada NPI# 1154782720 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-14 15:33:18', '2021-06-14 15:33:18'),
(8094, 1006, 12463, NULL, '2021-07-09 00:00:00.000', 'Approved', 'We received the following approval confirmation from AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Good morning Ahmed  Happy Friday  Here is the information you requested for the following Providers:  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3\"  Approval confirmation is attached for reference.', NULL, NULL, '2021-07-02 14:18:38', '2021-07-02 14:18:38'),
(8095, 3040, 12464, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-23 17:09:27', '2020-12-23 17:09:27'),
(8096, 3040, 12464, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Contract Request For Provider || Ladot Healthcare LLC || Dada, Oladipo, Dada, Atinuke || Superior Health plan ||  Greetings,  Hope you are doing well. Please find the attached the W9 form for our providers contract request.  Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626  Provider 1: Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider 2: Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Contract request form attached.   Thanks ', NULL, NULL, '2020-12-23 17:09:35', '2020-12-23 17:09:35'),
(8097, 3040, 12464, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Group contract signed and waiting for the reply.', NULL, NULL, '2020-12-30 17:48:54', '2020-12-30 17:48:54'),
(8098, 3040, 12464, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-01-06 10:12:51', '2021-01-06 10:12:51'),
(8099, 3040, 12464, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers. I submitted the contract request form on 12/23/2020.   Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626  Provider 1: Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider 2: Provider Name: Atinuke Dada Provider NPI# 1154782720  Thanks', NULL, NULL, '2021-01-15 12:04:55', '2021-01-15 12:04:55'),
(8100, 3040, 12464, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Credential Form For Facility || Ladot Healthcare LLC || Superior Health  Hello  We received your completed application on 12/30/2020. Your projected effective date is 02/01/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-01-22 14:37:29', '2021-01-22 14:37:29'),
(8101, 3040, 12464, NULL, '2021-02-05 00:00:00.000', 'In Process', 'As per conversation with (CAMARA) she said the application is still in process. ', NULL, NULL, '2021-01-29 13:21:15', '2021-01-29 13:21:15'),
(8102, 3040, 12464, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to; SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of below mentioned providers.   Practice Details: Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider: Provider Name: Atinuke Dada Provider NPI# 1154782720  Could you please send me the welcome letter for Oladipo Dada. Below are the provider details:  Provider 1: Provider Name: Oladipo Dada Provider NPI# 1760700223  Thanks', NULL, NULL, '2021-02-05 12:40:19', '2021-02-05 12:40:19'),
(8103, 3040, 12464, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. Please find the attached provider contracting form for Oladipo Dada. The provider is In-network.   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 10:26:17', '2021-02-12 10:26:17'),
(8104, 3040, 12464, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Hello,  Provider: Provider Name: Atinuke Dada Provider NPI# 1154782720  - We just received this provider 2.2.21 it is still in que to be processed  Provider 1: Provider Name: Oladipo Dada Provider NPI# 1760700223-  We do not have this provider under this Tax-ID and Group NPI  ', NULL, NULL, '2021-02-12 10:27:19', '2021-02-12 10:27:19'),
(8105, 3040, 12464, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.co  Subject: Re: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||   Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223  If you need any additional information please feel free to email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-19 15:43:12', '2021-02-19 15:43:12'),
(8106, 3040, 12464, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to:SHP.NetworkDevelopment@superiorhealthplan.com,  AM.Houston@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Re: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223  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 12:49:33', '2021-02-26 12:49:33'),
(8107, 3040, 12464, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good morning Adil,  Hope all is well. Here is the information you requested  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720---- pending/credentialing status received application on 2/2/2021  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223---- We do not have this provider under this Tax-ID and Group NPI   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-03-05 16:35:38', '2021-03-05 16:35:38'),
(8108, 3040, 12464, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject:  Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good afternoon Adil,  Yes the Credentialing/Network and Development have received the application for the provider Oladipo Dada NPI# 1760700223 on 3/4/2021.  ', NULL, NULL, '2021-03-12 15:43:08', '2021-03-12 15:43:08'),
(8109, 3040, 12464, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  I just wanted a follow up that you received the credentialing application form for Oladipo Dada.   Thank you  ', NULL, NULL, '2021-03-12 15:43:56', '2021-03-12 15:43:56'),
(8110, 3040, 12464, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  Hope you are doing well. Please find the attached provider contracting form that was sent out on Feb-10. Can you please check and advise.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-12 15:44:31', '2021-03-12 15:44:31'),
(8111, 3040, 12464, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-19 12:46:18', '2021-03-19 12:46:18'),
(8112, 3040, 12464, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned group and providers.   Practice Details: Practice Name: Ladot Healthcare LLC Tax ID # 85-2432283 Group NPI# 1912502626 Address: 2577 Madison Avenue  League City , TX 77573  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-06 15:22:06', '2021-05-06 15:22:06'),
(8113, 3040, 12464, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Hello Veronica,   Thank you so much for your response. Can you please send me the welcome letter for both the providers.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 12:51:43', '2021-05-24 12:51:43'),
(8114, 3040, 12464, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good morning Adil  My apologies for the delay in response  Per review I do see both providers application has been completed with the effective date of 6/1/2021  Provider 1: Provider Name: Atinuke Dada Provider NPI# 1154782720  Provider 2: Provider Name: Oladipo Dada Provider NPI# 1760700223   Veronica Botello Rocha', NULL, NULL, '2021-05-24 12:52:34', '2021-05-24 12:52:34'),
(8115, 3040, 12464, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Dada, Atinuke, Dada, Oladipo || Ladot Healthcare LLC || Superior Health ||  Good afternoon,  Welcome letters are provided by our ECM team. Please allow some time for them to send. If not received by effective date you can reach out to them directly at ECMExecutionTeam@superiorhealthplan.com .  Thank you,      ', NULL, NULL, '2021-05-26 10:35:19', '2021-05-26 10:35:19'),
(8116, 1006, 12464, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Sent f/u email @ ECMExecutionTeam@superiorhealthplan.com:  Sub: Welcome Letters Request - LHC - Superior Health  \"Hello,  I am still waiting for the welcome letters for the following providers, their information is as follows:  Group Name: Ladot Healthcare LLC NPI# 1912502626TIN# 85-2432283 Provider Name: Oladipo Dada NPI# 1760700223 Provider Name: Atinuke Dada NPI# 1154782720 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-14 15:33:12', '2021-06-14 15:33:12'),
(8117, 1006, 12464, NULL, '2021-07-09 00:00:00.000', 'Approved', 'We received the following approval confirmation from AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Good morning Ahmed  Happy Friday  Here is the information you requested for the following Providers:  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3\"  Approval confirmation is attached for reference.', NULL, NULL, '2021-07-02 14:18:25', '2021-07-02 14:18:25'),
(8118, 3040, 12465, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-24 14:17:47', '2020-12-24 14:17:47'),
(8119, 3040, 12465, NULL, '2020-12-31 00:00:00.000', 'Initiated', 'Enrollment request submitted  ', NULL, NULL, '2020-12-24 14:18:45', '2020-12-24 14:18:45'),
(8120, 3040, 12465, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  I hope you are doing well. I wanted to know the status of the application request for the below mentioned provider.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2020-12-31 10:07:46', '2020-12-31 10:07:46'),
(8121, 3040, 12465, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart  Greetings,  I hope you are doing well. I just followed up to know the status of the application request for the below mentioned provider.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-07 10:33:16', '2021-01-07 10:33:16'),
(8122, 3040, 12465, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Hope you are doing well. Please find the attached CAQH access form that you requested in the above email.  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-08 09:21:58', '2021-01-08 09:21:58'),
(8123, 3040, 12465, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject : Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Hi,  Please fill out the attached CAQH Access form and send W9 so that we can process your request.  *Dada, Oladipo  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :70273)', NULL, NULL, '2021-01-08 09:23:34', '2021-01-08 09:23:34'),
(8124, 3040, 12465, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Follow up email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greeting,  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 10:24:18', '2021-01-15 10:24:18'),
(8125, 3040, 12465, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject:  Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart   Hi,  We are returning your application due to missing information listed below.  *W9  Please review the attached Application Review Form and forward the missing information within the next 5 days.  Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  (Inventory Log ID : 70273 )', NULL, NULL, '2021-01-15 13:33:29', '2021-01-15 13:33:29'),
(8126, 3040, 12465, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthSmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Hope you are doing well. Please find the attached the W9 form that you 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.   Thanks', NULL, NULL, '2021-01-15 13:35:29', '2021-01-15 13:35:29');
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
(8127, 3040, 12465, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Dada, Oladipo MD. ', NULL, NULL, '2021-01-18 13:50:08', '2021-01-18 13:50:08'),
(8128, 3040, 12465, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Hope you are doing well. This is a follow up email regarding the status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need anything else from my side please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-25 16:36:53', '2021-01-25 16:36:53'),
(8129, 3040, 12465, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Please follow up in 30 days for a status.', NULL, NULL, '2021-02-01 13:41:59', '2021-02-01 13:41:59'),
(8130, 3040, 12465, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: 	pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Please get back to me as soon as you get a chance. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-08 10:20:34', '2021-02-08 10:20:34'),
(8131, 3040, 12465, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email rcvd from: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  You should be getting it by the end of the month. ', NULL, NULL, '2021-02-15 12:16:01', '2021-02-15 12:16:01'),
(8132, 3040, 12465, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email rcvd from: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Hope you are doing well. Can you please advise me when I will receive the welcome letter for Oladipo Dada.   Thanks ', NULL, NULL, '2021-02-15 12:16:25', '2021-02-15 12:16:25'),
(8133, 3040, 12465, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email rcvd from: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Dada, Oladipo- effective date is 2/18/21.', NULL, NULL, '2021-02-15 12:16:55', '2021-02-15 12:16:55'),
(8134, 3040, 12465, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the welcome letter. ', NULL, NULL, '2021-02-22 10:40:34', '2021-02-22 10:40:34'),
(8135, 3040, 12465, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Hope you are doing well. Can you please advise me when I will receive the welcome letter for Oladipo Dada.  Thanks ', NULL, NULL, '2021-03-01 13:15:16', '2021-03-01 13:15:16'),
(8136, 3040, 12465, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Greetings,  Has there been any update?  Thank you ', NULL, NULL, '2021-03-08 12:10:17', '2021-03-08 12:10:17'),
(8137, 3040, 12465, NULL, '2021-03-22 00:00:00.000', 'Approved', 'Email rcvd from: pr.south@healthsmart.com  Subject: Enrollment Application Status || Ladot Healthcare LLC || Dada, Oladipo || Health Smart ||  Hello,  This provider is effective 3/1/2021.   Please allow 30 days from the effective date for the letters to be mailed.  Thank you,  Michelle Adams | Provider Relations HealthSmart | Network Solutions www.HealthSmart.com ', NULL, NULL, '2021-03-15 15:52:17', '2021-03-15 15:52:17'),
(8138, 3040, 12466, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 13:45:25', '2020-12-28 13:45:25'),
(8139, 3040, 12466, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Enrollment request submitted  ', NULL, NULL, '2020-12-28 13:46:01', '2020-12-28 13:46:01'),
(8140, 3040, 12466, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email sent to: 	pr.south@healthsmart.com  Subject: Enroll Request || Ladot Heathcare LLC || Atinuke Dada || Healthsmart  Greetings,  Hope you are doing well. Please find the attached agreement & CAQH access form with W9 as requested for enrollment.   If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-29 16:36:52', '2020-12-29 16:36:52'),
(8141, 3040, 12466, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Request || Ladot Heathcare LLC || Atinuke Dada || Healthsmart  Greetings,  I hope you are doing well. I wanted to know the status of the application request for the below mentioned provider.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-05 13:41:44', '2021-01-05 13:41:44'),
(8142, 3040, 12466, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Enroll Request || Ladot Heathcare LLC || Atinuke Dada || Healthsmart   Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  *Dada, Atinuke NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :69056)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-01-07 16:03:05', '2021-01-07 16:03:05'),
(8143, 3040, 12466, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: Leslie.Perez@healthsmart.com  Subject: Atinuke Dada NPI 1154782720  Greetings,  Hope you are doing well. Please find the attached the American Academy of Nurse Practitioner certificate that you 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.  Thanks  ', NULL, NULL, '2021-01-20 09:24:05', '2021-01-20 09:24:05'),
(8144, 3040, 12466, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email rcvd from: Leslie.Perez@healthsmart.com  Subject: Atinuke Dada NPI 1154782720  Hello,  I need the following information on Atinuke Dada NPI 1154782720.  Once, I\'ve obtained this information I will continue to credential this provider.    Copy of current board of specialty --   American Academy of Nurse Practitioners          Thank you,', NULL, NULL, '2021-01-20 09:24:52', '2021-01-20 09:24:52'),
(8145, 3040, 12466, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email sent to: Leslie.Perez@healthsmart.com  Subject: Atinuke Dada NPI 1154782720  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address; 2577 Madison Avenue League City , TX 77573   Provider Name: Atinuke Dada Provider NPI# 1154782720  Please let me know if you need any additional information. Waiting for your response.   Thanks ', NULL, NULL, '2021-01-27 12:18:38', '2021-01-27 12:18:38'),
(8146, 3040, 12466, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from: Leslie.Perez@healthsmart.com  Subject:  Atinuke Dada NPI 1154782720  Hello,  Provider Atinuke Dada NPI# 1154782720, will go to mac committee on 2/18/2021.  If approve, provider will have an effective of 3/1/2021.  Leslie', NULL, NULL, '2021-01-27 13:10:57', '2021-01-27 13:10:57'),
(8147, 3040, 12466, NULL, '2021-02-18 00:00:00.000', 'In Process', 'As per last email the application is still in process. ', NULL, NULL, '2021-02-03 10:08:30', '2021-02-03 10:08:30'),
(8148, 3040, 12466, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Follow up email sent to: Leslie.Perez@healthsmart.com  Subject: Atinuke Dada NPI 1154782720  Good Afternoon,  Hope you are doing well. I just wanted to follow up regarding the enrollment status of the below mentioned provider. Has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address; 2577 Madison Avenue League City , TX 77573   Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-18 12:12:43', '2021-02-18 12:12:43'),
(8149, 3040, 12466, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: Leslie.Perez@healthsmart.com  Subject: Atinuke Dada NPI 1154782720  Good Afternoon,  Hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider. In the previous email you said the committee will meeting this evening has there been any update?  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address; 2577 Madison Avenue League City , TX 77573   Provider Name: Atinuke Dada Provider NPI# 1154782720  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-25 13:50:24', '2021-02-25 13:50:24'),
(8150, 3040, 12466, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: Leslie.Perez@healthsmart.com  Subject:  Atinuke Dada NPI 1154782720  Hello, The committee will meet this evening.  Once they update this provider status I will let you know.  ', NULL, NULL, '2021-02-25 13:50:59', '2021-02-25 13:50:59'),
(8151, 3040, 12466, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Email rcvd from: Leslie.Perez@healthsmart.com  Subject: Atinuke Dada NPI 1154782720  Hello,  Atinuke Dada was approved by the mac, effective date 3/1/2021.', NULL, NULL, '2021-03-03 16:51:45', '2021-03-03 16:51:45'),
(8152, 3040, 12467, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 15:32:30', '2020-12-28 15:32:30'),
(8153, 3040, 12467, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Enrollment Tracking Information  Applicant Name: LIMY FERNANDUS  Tracking ID: T122820200001888  Submitted Date: MON - DECEMBER 28 2020 03:23:15 PM EST  Submitted By: Limy Fernandus  Contact Email(s): NUCC@CLAIMSMEDINC.COM', NULL, NULL, '2020-12-28 15:33:33', '2020-12-28 15:33:33'),
(8154, 3040, 12467, NULL, '2020-12-30 00:00:00.000', 'Approved', 'Dear LIMY FERNANDUS:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information  Individual Name: LIMY FERNANDUS Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1972005189 Individual Provider Transaction Access Number (PTAN): 1K5888 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: November 1, 2020 Changed Information: N/A  ', NULL, NULL, '2020-12-30 16:08:30', '2020-12-30 16:08:30'),
(8155, 3040, 12468, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 15:34:46', '2020-12-28 15:34:46'),
(8156, 3040, 12468, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Enrollment Tracking Information  Applicant Name: LIMY FERNANDUS  Tracking ID: T122820200001888  Submitted Date: MON - DECEMBER 28 2020 03:23:15 PM EST  Submitted By: Limy Fernandus ', NULL, NULL, '2020-12-28 15:35:25', '2020-12-28 15:35:25'),
(8157, 3040, 12468, NULL, '2020-12-30 00:00:00.000', 'Approved', 'Dear LIMY FERNANDUS:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information  Individual Name: LIMY FERNANDUS Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1972005189 Individual Provider Transaction Access Number (PTAN): 1K5888 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: November 1, 2020 Changed Information: N/A  ', NULL, NULL, '2020-12-30 16:08:16', '2020-12-30 16:08:16'),
(8158, 3040, 12469, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 15:35:58', '2020-12-28 15:35:58'),
(8159, 3040, 12469, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Enrollment Tracking Information  Applicant Name: LIMY FERNANDUS  Tracking ID: T122820200001888  Submitted Date: MON - DECEMBER 28 2020 03:23:15 PM EST  Submitted By: Limy Fernandus', NULL, NULL, '2020-12-28 15:36:14', '2020-12-28 15:36:14'),
(8160, 3040, 12469, NULL, '2020-12-30 00:00:00.000', 'Approved', 'Dear LIMY FERNANDUS:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: LIMY FERNANDUS Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1972005189 Individual Provider Transaction Access Number (PTAN): 1K5895 Group Legal Business Name (LBN): COLUMBUS URGENT CARE PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: November 1, 2020 Changed Information: N/A', NULL, NULL, '2020-12-30 16:07:14', '2020-12-30 16:07:14'),
(8161, 3040, 12470, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 15:36:49', '2020-12-28 15:36:49'),
(8162, 3040, 12470, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Enrollment Tracking Information  Applicant Name: LIMY FERNANDUS  Tracking ID: T122820200001888  Submitted Date: MON - DECEMBER 28 2020 03:23:15 PM EST  Submitted By: Limy Fernandus', NULL, NULL, '2020-12-28 15:36:59', '2020-12-28 15:36:59'),
(8163, 3040, 12470, NULL, '2020-12-30 00:00:00.000', 'Approved', 'Dear LIMY FERNANDUS:  Novitas Solutions, Inc. has approved your Change of Information (COI) application.  Medicare Enrollment Information Individual Name: LIMY FERNANDUS Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1972005189 Individual Provider Transaction Access Number (PTAN): 1K5906 Group Legal Business Name (LBN): LONGPOINT MEDICAL PA Group NPI: 1770763815 Group PTAN: 622527 Reassignment Effective Date: November 1, 2020 Changed Information: N/A', NULL, NULL, '2020-12-30 16:06:32', '2020-12-30 16:06:32'),
(8164, 3040, 12471, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 17:01:41', '2020-12-28 17:01:41'),
(8165, 3040, 12471, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Provider is already in Aetna network. We submitted the letter of intent.   Follow up for receiving the application with in 24 to 48 hours   Processing time will take 30 business days.', NULL, NULL, '2020-12-28 17:05:15', '2020-12-28 17:05:15'),
(8166, 3040, 12471, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Longpoint Medical Center  Ref: NAF391560 Document Control no: 201228121867 Still in process 30-45 Business days ', NULL, NULL, '2021-01-04 09:59:50', '2021-01-04 09:59:50'),
(8167, 3040, 12471, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Its already escalated to the department of the provider for demographic changes.  Ticket escalation no: NAF391560', NULL, NULL, '2021-01-11 12:07:38', '2021-01-11 12:07:38'),
(8168, 3040, 12471, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Had a word with (KIM) Aetna representative and he advised the request has been submitted and in the review status. Ticket no: NAF391560', NULL, NULL, '2021-01-18 10:15:10', '2021-01-18 10:15:10'),
(8169, 3040, 12471, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Had a word with Aetna representative and application is still in process.', NULL, NULL, '2021-01-25 11:14:04', '2021-01-25 11:14:04'),
(8170, 3040, 12471, NULL, '2021-02-08 00:00:00.000', 'In Process', 'I had a word with (Julie B) Aetna representative and she said the application is still in process.', NULL, NULL, '2021-02-01 10:35:38', '2021-02-01 10:35:38'),
(8171, 3040, 12471, NULL, '2021-02-15 00:00:00.000', 'Initiated', 'I had a word with (ELA Y) Aetna representative and she said the provider is in-network and welcome letter will be received in 7 to 10 business days.   Effective date: 11/0/2020 Record # for welcome letter request: 14115 ', NULL, NULL, '2021-02-08 10:40:55', '2021-02-08 10:40:55'),
(8172, 3040, 12471, NULL, '2021-02-18 00:00:00.000', 'In Process', 'I had a word with (Mark) Aetna representative and he said follow up after 3 days for Welcome Letter.', NULL, NULL, '2021-02-15 10:09:12', '2021-02-15 10:09:12'),
(8173, 3040, 12471, NULL, '2021-02-22 00:00:00.000', 'Initiated', 'I had a word with Aetna representative and he said request for welcome letter initiated on Feb-09 and it will take 7 to 10 business days.  ', NULL, NULL, '2021-02-18 17:49:23', '2021-02-18 17:49:23'),
(8174, 3040, 12471, NULL, '2021-03-04 00:00:00.000', 'Approved', 'Limy Fernandus is In-network with Aetna. Effective Date: 11/01/2020  Please see attachments. ', NULL, NULL, '2021-02-25 12:39:26', '2021-02-25 12:39:26'),
(8175, 3040, 12472, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 17:06:04', '2020-12-28 17:06:04'),
(8176, 3040, 12472, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Provider is already in Aetna network. We submitted the letter of intent.   Follow up for receiving the application with in 24 to 48 hours   Processing time will take 30 business days.', NULL, NULL, '2020-12-28 17:06:17', '2020-12-28 17:06:17'),
(8177, 3040, 12472, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Imperial Valley Urgent Care Center Ref: NAF391560 Document Control no: 201228121675 Still in process 30-45 Business days ', NULL, NULL, '2021-01-04 10:01:35', '2021-01-04 10:01:35'),
(8178, 3040, 12472, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Had a word with Aetna representative and they said the application is still in process. ', NULL, NULL, '2021-01-11 12:06:05', '2021-01-11 12:06:05'),
(8179, 3040, 12472, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Had a word with (KIM) Aetna representative and he advised the application forward to network management office. Ticket no: NAF396552', NULL, NULL, '2021-01-18 10:13:08', '2021-01-18 10:13:08'),
(8180, 3040, 12472, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Had a word with Aetna representative and application is still in process.', NULL, NULL, '2021-01-25 11:13:58', '2021-01-25 11:13:58'),
(8181, 3040, 12472, NULL, '2021-02-08 00:00:00.000', 'In Process', 'I had a word with (Julie B) Aetna representative and she said the application is still in process.', NULL, NULL, '2021-02-01 10:35:20', '2021-02-01 10:35:20'),
(8182, 3040, 12472, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (ELA Y) Aetna representative and she said need allow more time the application is still in process.   Request completed by march and call back to u by the next week.  Interaction no: 5903459968', NULL, NULL, '2021-02-08 10:42:13', '2021-02-08 10:42:13'),
(8183, 3040, 12472, NULL, '2021-02-22 00:00:00.000', 'In Process', 'I had a word (AVI) Aetna representative and she said the application is still in process.  Application will be completed by 03/01/2021 or before that.  Ticket no: NAF396552', NULL, NULL, '2021-02-15 10:34:15', '2021-02-15 10:34:15'),
(8184, 3040, 12472, NULL, '2021-03-03 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-24 10:31:44', '2021-02-24 10:31:44'),
(8185, 3040, 12473, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 17:11:01', '2020-12-28 17:11:01'),
(8186, 3040, 12473, NULL, '2020-12-30 00:00:00.000', 'Initiated', 'Provider is already in Aetna network. We submitted the letter of intent.   Follow up for receiving the application with in 24 to 48 hours   Processing time will take 30 business days.', NULL, NULL, '2020-12-28 17:12:35', '2020-12-28 17:12:35'),
(8187, 3040, 12473, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Normandy Urgent Care Center Ref: NAF391560 Document Control no: 201228121675 Still in process 30-45 Business days ', NULL, NULL, '2021-01-04 10:00:13', '2021-01-04 10:00:13'),
(8188, 3040, 12473, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Had a word with Aetna representative and they said the application is still in process.   ', NULL, NULL, '2021-01-11 12:05:53', '2021-01-11 12:05:53'),
(8189, 3040, 12473, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Had a word with (KIM) Aetna representative and he advised the application forward to network management office. Ticket no: NAF396552', NULL, NULL, '2021-01-18 10:12:59', '2021-01-18 10:12:59'),
(8190, 3040, 12473, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Had a word with Aetna representative and application is still in process.', NULL, NULL, '2021-01-25 11:13:52', '2021-01-25 11:13:52'),
(8191, 3040, 12473, NULL, '2021-02-08 00:00:00.000', 'In Process', 'I had a word with (Julie B) Aetna representative and she said the application is still in process.', NULL, NULL, '2021-02-01 10:35:32', '2021-02-01 10:35:32'),
(8192, 3040, 12473, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (ELA Y) Aetna representative and she said need allow more time the application is still in process.   Request completed by march and call back to u by the next week.  Interaction no: 5903459968', NULL, NULL, '2021-02-08 10:42:07', '2021-02-08 10:42:07'),
(8193, 3040, 12473, NULL, '2021-02-22 00:00:00.000', 'In Process', 'I had a word (AVI) Aetna representative and she said the application is still in process.  Application will be completed by 03/01/2021 or before that.  Ticket no: NAF396552', NULL, NULL, '2021-02-15 10:34:01', '2021-02-15 10:34:01'),
(8194, 3040, 12473, NULL, '2021-03-03 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-24 10:31:46', '2021-02-24 10:31:46'),
(8195, 3040, 12474, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-28 17:51:46', '2020-12-28 17:51:46'),
(8196, 3040, 12474, NULL, '2021-01-04 00:00:00.000', 'Initiated', 'Provider is already in Aetna network. We submitted the letter of intent.   Follow up for receiving the application with in 24 to 48 hours   Processing time will take 30 business days.', NULL, NULL, '2020-12-28 17:53:07', '2020-12-28 17:53:07'),
(8197, 3040, 12474, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Columbus Urgent Care PA Ref: NAF391560 Document Control no: 201228121957 Still in process 30-45 Business days ', NULL, NULL, '2021-01-04 10:00:35', '2021-01-04 10:00:35'),
(8198, 3040, 12474, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Had a word with Aetna representative and they said the application is still in process. ', NULL, NULL, '2021-01-11 12:06:13', '2021-01-11 12:06:13'),
(8199, 3040, 12474, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Had a word with (KIM) Aetna representative and he advised the request has been submitted. Ticket no: NAF396555 Will take 15-30 Business day', NULL, NULL, '2021-01-18 10:33:56', '2021-01-18 10:33:56'),
(8200, 3040, 12474, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Had a word with Aetna representative and application is still in process.', NULL, NULL, '2021-01-25 11:14:10', '2021-01-25 11:14:10'),
(8201, 3040, 12474, NULL, '2021-02-08 00:00:00.000', 'In Process', 'I had a word with (Josh) Aetna representative and he said that the application is still in process.  ', NULL, NULL, '2021-02-01 16:42:39', '2021-02-01 16:42:39'),
(8202, 3040, 12474, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (ELA Y) Aetna representative and she said need allow more time the application is still in process.   Request completed by march and call back to u by the next week.  Interaction no: 5903459968', NULL, NULL, '2021-02-08 10:42:19', '2021-02-08 10:42:19'),
(8203, 3040, 12474, NULL, '2021-02-22 00:00:00.000', 'In Process', 'I had a word with (Mark) Aetna representative and she said the application is still in process. ', NULL, NULL, '2021-02-15 09:58:41', '2021-02-15 09:58:41'),
(8204, 3040, 12474, NULL, '2021-03-03 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-24 10:31:42', '2021-02-24 10:31:42'),
(8205, 3040, 12475, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 12:51:01', '2020-12-29 12:51:01'),
(8206, 3040, 12475, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS  Greetings,  Hope you are doing well. Please find the attached letter of intent for linking the provider with BCBS with an existing In-Network Tax ID.  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 27-0796429 Practice NPI# 1407171077  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-29 12:54:05', '2020-12-29 12:54:05'),
(8207, 3040, 12475, NULL, '2021-01-05 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02101010.', NULL, NULL, '2020-12-29 15:07:12', '2020-12-29 15:07:12'),
(8208, 3040, 12475, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-01-05 13:35:08', '2021-01-05 13:35:08'),
(8209, 3040, 12475, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkeage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS  Greetings,  Hope you are doing well. I just wanted to follow up 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, '2021-01-12 13:45:52', '2021-01-12 13:45:52'),
(8210, 3040, 12475, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkeage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Any update?  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 27-0796429 Practice NPI# 1407171077  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-19 10:38:15', '2021-01-19 10:38:15'),
(8211, 3040, 12475, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Re: LOI For Linkeage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS : Case Number - 02143702  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 02143702.', NULL, NULL, '2021-01-20 10:18:48', '2021-01-20 10:18:48'),
(8212, 3040, 12475, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Application submitted online.  Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 277104 Case Number - 02154330 ', NULL, NULL, '2021-01-20 16:35:32', '2021-01-20 16:35:32'),
(8213, 3040, 12475, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Check status online. Application received and in progress', NULL, NULL, '2021-01-27 10:56:40', '2021-01-27 10:56:40'),
(8214, 3040, 12475, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID 277104.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Thanks ', NULL, NULL, '2021-02-03 10:02:24', '2021-02-03 10:02:24'),
(8215, 3040, 12475, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - NORMANDY URGENT CARE CENTER PA : Case Number - 02189395  Good Morning,   We have reviewed your application ID, and it appears that the application has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you', NULL, NULL, '2021-02-03 12:28:48', '2021-02-03 12:28:48'),
(8216, 3040, 12475, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_houston@bcbstx.com  Subject: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394  Limy Fernandus APN is still in process to be assigned a provider record under this UCC. CASE 2154331. Please allow 15-20 days for the provider to be assigned a record #.  You can use the case status checker located on the BCBSTX provider portal.  http://https://hcscproviderintake.secure.force.com/CaseStatusRedirectPage  Heather Swearingen Network Management Consultant  Blue Cross and Blue Shield of Texas Southeast Region', NULL, NULL, '2021-02-10 12:14:33', '2021-02-10 12:14:33'),
(8217, 3040, 12475, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394  Greetings,  This is a follow up email regarding the enrollment for the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-17 09:37:31', '2021-02-17 09:37:31'),
(8218, 3040, 12475, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS || : Case Number - 02189470  Greetings,  Please advise me the enrollment status for the below mentioned provider. Can you please send me the record number.   Practice: Practice Name: Longpoint Medical Center Practice Tax-ID: 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Thanks', NULL, NULL, '2021-02-24 10:40:17', '2021-02-24 10:40:17'),
(8219, 3040, 12475, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394  Greetings,  Please advise me the enrollment status for the below mentioned provider. Can you please send me the provider record ID#.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-24 10:44:07', '2021-02-24 10:44:07'),
(8220, 3040, 12475, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394   Hello,  This is a follow up email regarding the enrollment status for the below mentioned provider. Can you please send me the provider record ID#.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-03 13:29:45', '2021-03-03 13:29:45'),
(8221, 3040, 12475, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com, provider_relations_south_texas@bcbstx.com,noemi_martinez@bcbstx.com, sue_chang@bcbstx.com, taylor_graham@bcbstx.com, Valerie_Martinez@bcbstx.com, va_triwest@bcbstx.com, Heather_Swearingen@bcbstx.com, txproviderupdatesubmission@bcbstx.com  Subject: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Hello,  Please advise me the enrollment status for the below mentioned provider. I am trying to email you but I am not getting any response.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-10 14:47:03', '2021-03-10 14:47:03'),
(8222, 3040, 12475, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Latrice_Thomas@bcbstx.com  Subject:  Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Hello Latrice,  This is a follow up email regarding the enrollment status for the below mentioned provider. Application ID 277104.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-18 09:53:25', '2021-03-18 09:53:25'),
(8223, 3040, 12475, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : NORMANDY URGENT CARE CENTER PA Group Record Id : H00032WN01  Provider Name : LIMY FERNANDUS Provider Record Number : h08nx17301 Specialty : ANP/CERT/CLNP  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	05/05/2021 BCA - BlueChoice PPO	05/05/2021 SNP - Dual Eligible Special Needs Plan	05/05/2021 HME - Health Select	05/05/2021 MCH - Medicare Advantage HMO	05/05/2021 PMC - Medicare Advantage PPO	05/05/2021 WEL - WellMed MA HMO	05/05/2021 ', NULL, NULL, '2021-05-04 08:50:50', '2021-05-04 08:50:50'),
(8224, 3040, 12476, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 12:53:01', '2020-12-29 12:53:01'),
(8225, 3040, 12476, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS  Greetings,  Hope you are doing well. Please find the attached letter of intent for linking the provider with BCBS with an existing In-Network Tax ID.  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 27-0796429 Practice NPI# 1407171077  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-29 12:54:01', '2020-12-29 12:54:01'),
(8226, 3040, 12476, NULL, '2021-01-05 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02101010.', NULL, NULL, '2020-12-29 15:07:05', '2020-12-29 15:07:05'),
(8227, 3040, 12476, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-01-05 13:35:16', '2021-01-05 13:35:16'),
(8228, 3040, 12476, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com,  Provider_Relations_Houston@bcbstx.com,  ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkage || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || UHC ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding my previous email. Is there any update?  If you need anything from my side please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-12 12:13:49', '2021-01-12 12:13:49'),
(8229, 3040, 12476, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkeage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Any update?  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 27-0796429 Practice NPI# 1407171077  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-19 10:23:42', '2021-01-19 10:23:42'),
(8230, 3040, 12476, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Re: LOI For Linkeage || Fernandus, Limy || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || BCBS : Case Number - 02143702  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 02143702.', NULL, NULL, '2021-01-20 10:19:02', '2021-01-20 10:19:02'),
(8231, 3040, 12476, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Application submitted online.  Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 277104 Case Number - 02154330 ', NULL, NULL, '2021-01-20 16:35:47', '2021-01-20 16:35:47'),
(8232, 3040, 12476, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Check status online. Application received and in progress ', NULL, NULL, '2021-01-27 10:57:09', '2021-01-27 10:57:09'),
(8233, 3040, 12476, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID 277104.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Thanks ', NULL, NULL, '2021-02-03 10:02:36', '2021-02-03 10:02:36'),
(8234, 3040, 12476, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - NORMANDY URGENT CARE CENTER PA : Case Number - 02189395  Good Morning,   We have reviewed your application ID, and it appears that the application has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you', NULL, NULL, '2021-02-03 12:28:54', '2021-02-03 12:28:54'),
(8235, 3040, 12476, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_houston@bcbstx.com  Subject: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394  Limy Fernandus APN is still in process to be assigned a provider record under this UCC. CASE 2154331. Please allow 15-20 days for the provider to be assigned a record #.  You can use the case status checker located on the BCBSTX provider portal.  http://https://hcscproviderintake.secure.force.com/CaseStatusRedirectPage  Heather Swearingen Network Management Consultant  Blue Cross and Blue Shield of Texas Southeast Region', NULL, NULL, '2021-02-10 12:14:38', '2021-02-10 12:14:38'),
(8236, 3040, 12476, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394  Greetings,  This is a follow up email regarding the enrollment for the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-17 09:37:59', '2021-02-17 09:37:59'),
(8237, 3040, 12476, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394  Greetings,  Please advise me the enrollment status for the below mentioned provider. Can you please send me the provider record ID#.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-24 10:44:11', '2021-02-24 10:44:11'),
(8238, 3040, 12476, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS || : Case Number - 02189394   Hello,  This is a follow up email regarding the enrollment status for the below mentioned provider. Can you please send me the provider record ID#.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-03 13:29:47', '2021-03-03 13:29:47'),
(8239, 3040, 12476, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com, provider_relations_south_texas@bcbstx.com,noemi_martinez@bcbstx.com, sue_chang@bcbstx.com, taylor_graham@bcbstx.com, Valerie_Martinez@bcbstx.com, va_triwest@bcbstx.com, Heather_Swearingen@bcbstx.com, txproviderupdatesubmission@bcbstx.com  Subject: Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Hello,  Please advise me the enrollment status for the below mentioned provider. I am trying to email you but I am not getting any response.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-10 14:47:09', '2021-03-10 14:47:09'),
(8240, 3040, 12476, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Latrice_Thomas@bcbstx.com  Subject:  Application ID 277104 || Fernandus, Limy || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Hello Latrice,  This is a follow up email regarding the enrollment status for the below mentioned provider. Application ID 277104.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-18 09:53:29', '2021-03-18 09:53:29'),
(8241, 3040, 12476, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : NORMANDY URGENT CARE CENTER PA Group Record Id : H00032WN01  Provider Name : LIMY FERNANDUS Provider Record Number : h08nx17301 Specialty : ANP/CERT/CLNP  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	05/05/2021 BCA - BlueChoice PPO	05/05/2021 SNP - Dual Eligible Special Needs Plan	05/05/2021 HME - Health Select	05/05/2021 MCH - Medicare Advantage HMO	05/05/2021 PMC - Medicare Advantage PPO	05/05/2021 WEL - WellMed MA HMO	05/05/2021 ', NULL, NULL, '2021-05-04 08:50:55', '2021-05-04 08:50:55'),
(8242, 3040, 12477, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 12:55:41', '2020-12-29 12:55:41'),
(8243, 3040, 12477, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com,  ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkage || Fernandus, Limy || Longpoint Medical Center || BCBS  Greetings,  Hope you are doing well. Please find the attached letter of intent for linking the provider with BCBS with an existing In-Network Tax ID.  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 76-0612416 Practice NPI# 1770763815  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-29 12:56:44', '2020-12-29 12:56:44'),
(8244, 3040, 12477, NULL, '2021-01-05 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02101006.', NULL, NULL, '2020-12-29 15:06:37', '2020-12-29 15:06:37'),
(8245, 3040, 12477, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-01-05 13:35:29', '2021-01-05 13:35:29');
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
(8246, 3040, 12477, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkeage || Fernandus, Limy || Longpoint Medical Center || BCBS  Greetings,  Hope you are doing well. I just wanted to follow up 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, '2021-01-12 13:42:13', '2021-01-12 13:42:13'),
(8247, 3040, 12477, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Follow up email sent to: hpdemo@uhc.com, provider_relations_houston@bcbstx.com  Subject: LOI For Linkage || Fernandus, Limy || Longpoint Medical Center || UHC ||  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Any update?  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 27-0796429 Practice NPI# 1407171077  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-19 10:33:41', '2021-01-19 10:33:41'),
(8248, 3040, 12477, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Re: LOI For Linkage || Fernandus, Limy || Longpoint Medical Center || UHC || : Case Number - 02143754  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 02143754. ', NULL, NULL, '2021-01-20 10:23:38', '2021-01-20 10:23:38'),
(8249, 3040, 12477, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Application submitted online.   Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 277033 Case Number - 02154105', NULL, NULL, '2021-01-20 15:38:39', '2021-01-20 15:38:39'),
(8250, 3040, 12477, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email rcvd from: marina_machuca@bcbstx.com  Subject: Limy Fernanduz  Adil,  On 12/30/20 I spoke to you and explained that in order to add a provider to a TAX ID#, you will need to submit a Provider Onboarding Form.  Please visit our website - www.bcbstx.com/Provider than look at the section Network Participation - How to Join our Networks.   Thank you  Marina Machuca', NULL, NULL, '2021-01-20 15:39:46', '2021-01-20 15:39:46'),
(8251, 3040, 12477, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Check status online. Application received and still in progress.', NULL, NULL, '2021-01-27 10:58:27', '2021-01-27 10:58:27'),
(8252, 3040, 12477, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID 277033.  Practice: Practice Name: Longpoint Medical Center Practice Tax-ID: 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-03 10:20:11', '2021-02-03 10:20:11'),
(8253, 3040, 12477, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID 277033.  Practice: Practice Name: Longpoint Medical Center Practice Tax-ID: 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-03 10:20:12', '2021-02-03 10:20:12'),
(8254, 3040, 12477, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - LONG POINT MEDICAL PA : Case Number - 02189471  Good Morning Adil,   We have reviewed your application ID, and it appears that the application for the provider has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you,', NULL, NULL, '2021-02-03 12:24:44', '2021-02-03 12:24:44'),
(8255, 3040, 12477, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_houston@bcbstx.com  Subject: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS || : Case Number - 02189470  Still in process, Please allow 15-20 days for a provider record to be assigned  Heather Swearingen Network Management Consultant  Blue Cross and Blue Shield of Texas Southeast Region ', NULL, NULL, '2021-02-10 12:16:40', '2021-02-10 12:16:40'),
(8256, 3040, 12477, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS || : Case Number - 02189470  Greetings,  I just wanted to follow up regarding the enrollment status of the below mentioned provider. Has there been any update?  Practice: Practice Name: Longpoint Medical Center Practice Tax-ID: 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-17 17:16:34', '2021-02-17 17:16:34'),
(8257, 3040, 12477, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS || : Case Number - 02189470  Greetings,  Please advise me the enrollment status for the below mentioned provider. Can you please send me the record number.   Practice: Practice Name: Longpoint Medical Center Practice Tax-ID: 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Thanks', NULL, NULL, '2021-02-24 10:40:45', '2021-02-24 10:40:45'),
(8258, 3040, 12477, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com, marina_machuca@bcbstx.com  Subject: Application ID 277033 || Fernandus, Limy || Longpoint Medical Center || BCBS || : Case Number - 02189470  Hello,  I just wanted to follow up regarding the enrollment status for the below mentioned provider. Can you please send me the record number.   Practice: Practice Name: Longpoint Medical Center Practice Tax-ID: 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Waiting for your reply.   Thank you', NULL, NULL, '2021-03-05 17:08:44', '2021-03-05 17:08:44'),
(8259, 3040, 12477, NULL, '2021-03-19 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Provider Name : LIMY FERNANDUS Provider Record Number : H08NX17201 Specialty : ANP/CERT/CLNP', NULL, NULL, '2021-03-12 11:05:59', '2021-03-12 11:05:59'),
(8260, 3040, 12478, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 12:57:29', '2020-12-29 12:57:29'),
(8261, 3040, 12478, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Email sent to: Provider_Relations_Houston@bcbstx.com, ProfessionalProviderNetworkDept@bcbstx.com  Subject: LOI For Linkage || Fernandus, Limy || Columbus Urgent Care PA || BCBS  Greetings,  Hope you are doing well. Please find the attached letter of intent for linking the provider with BCBS with an existing In-Network Tax ID.    Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 47-1914151 Practice NPI# 1215330501  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-29 12:58:42', '2020-12-29 12:58:42'),
(8262, 3040, 12478, NULL, '2021-01-05 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02101007.', NULL, NULL, '2020-12-29 15:05:45', '2020-12-29 15:05:45'),
(8263, 3040, 12478, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Linkage Status || Fernandus, Limy || Columbus Urgent Care PA || BCBS : Case Number - 02101007  Greetings,  Hope you are doing well. I wanted to know the status of the application for the below mentioned provider. I checked the case number 02101007 on the status checker and it shows the case status (Closed Process. Notification has been sent to the submitter) but we haven\'t received anything yet.  Practice Name: Columbus Urgent Care PA Tax ID# 47-1914151 NPI# 1215330501 Provider Name: Limy Fernandus Provider NPI# 1972005189  If you need any information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-05 14:03:51', '2021-01-05 14:03:51'),
(8264, 3040, 12478, NULL, '2021-01-12 00:00:00.000', 'In Process', 'This email is confirmation we have received your inquiry, case number is 02113256.', NULL, NULL, '2021-01-05 14:39:34', '2021-01-05 14:39:34'),
(8265, 3040, 12478, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Linkage Status || Fernandus, Limy || Columbus Urgent Care PA || BCBS : Case Number - 02101007  Greetings,  Hope you are doing well. I just wanted to follow up regarding my previous email. Is there any update?  If you need anything from my side please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-12 12:06:56', '2021-01-12 12:06:56'),
(8266, 3040, 12478, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Follow up email sent to: provider_relations_houston@bcbstx.com  Subject: Linkage Status || Fernandus, Limy || Columbus Urgent Care PA || BCBS : Case Number - 02101007  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Any update?  Provider Name: Limy Fernandus  Provider NPI# 1972005189 Practice Tax ID# 27-0796429 Practice NPI# 1407171077  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-19 10:26:14', '2021-01-19 10:26:14'),
(8267, 3040, 12478, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed.  If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date.  Application ID: 276838', NULL, NULL, '2021-01-19 18:19:33', '2021-01-19 18:19:33'),
(8268, 3040, 12478, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Application submitted online. ', NULL, NULL, '2021-01-19 18:20:50', '2021-01-19 18:20:50'),
(8269, 3040, 12478, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Hello,  You will need to fill out the onboarding form online at bcbstx.com on the provider tab, under Network Participation and then how to join to get your provider added to your group.  thank you', NULL, NULL, '2021-01-19 18:21:16', '2021-01-19 18:21:16'),
(8270, 3040, 12478, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: provider_relations_houston@bcbstx.com  Subject: Linkage Status || Fernandus, Limy || Columbus Urgent Care PA || BCBS : Case Number - 02101007 : Case Number - 02143723  Greetings,  Hope you are doing well. I just wanted to follow up regarding your previous email. I submitted the online boarding form for the provider. Application no 276838.  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-26 12:40:41', '2021-01-26 12:40:41'),
(8271, 3040, 12478, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: provider_relations_houston@bcbstx.com  Subject: Linkage Status || Fernandus, Limy || Columbus Urgent Care PA || BCBS : Case Number - 02101007 : Case Number - 02143723  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Online application was submitted on 01/19/2021 and application no: 276838.  Practice Name: Columbus Urgent Care PA Tax ID# 47-1914151 NPI# 1215330501 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Limy  Fernandus Provider NPI# 1972005189  Please let me know if you need any additional information from my side. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-02 12:58:57', '2021-02-02 12:58:57'),
(8272, 3040, 12478, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject:  Linkage Status || Fernandus, Limy || Columbus Urgent Care PA || BCBS : Case Number - 02101007   Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned provider.   Practice Name: Columbus Urgent Care PA Tax ID# 47-1914151 NPI# 1215330501 Address:926 Walnut St, Columbus , TX 78934-2215  Provider Name: Limy  Fernandus Provider NPI# 1972005189  Please get back to me as soon as possible. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 17:40:17', '2021-02-09 17:40:17'),
(8273, 3040, 12478, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Application ID 276838 || Fernandus, Limy || Columbus Urgent Care PA || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID 276838.  Practice: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Address: 926 Walnut St, Columbus, TX 78934-2215  Provider: Provider Name: Fernandus, Limy Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-16 10:32:35', '2021-02-16 10:32:35'),
(8274, 3040, 12478, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Application ID 276838 || Fernandus, Limy || Columbus Urgent Care PA || BCBS || : Case Number - 02219476   Greetings,  Hope you are doing well. Please note that I didn\'t receive an email from your side regarding the W9 because the email address that you mentioned in the above email is incorrect. It\'s cucc@claimsmedinc.com. Kindly find the attached updated W 9 form.   If you need any additional information please let me know. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-23 10:40:04', '2021-02-23 10:40:04'),
(8275, 3040, 12478, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Application ID 276838 || Fernandus, Limy || Columbus Urgent Care PA || BCBS || : Case Number - 02219476  Greetings,  Hope you are doing well. Has there been any update?  Thanks', NULL, NULL, '2021-03-02 14:05:35', '2021-03-02 14:05:35'),
(8276, 3040, 12478, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Provider on boarding submitted again   View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date.  Application ID: 288543', NULL, NULL, '2021-03-09 14:07:45', '2021-03-09 14:07:45'),
(8277, 3040, 12478, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || BCBS || : Case Number - 02453834  Good morning,  I have attached a roster of the listed providers in the group.  Thank you,  If you have any questions or concerns please us the contact information below.  Thank you,', NULL, NULL, '2021-05-12 11:25:31', '2021-05-12 11:25:31'),
(8278, 3040, 12479, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 14:50:10', '2020-12-29 14:50:10'),
(8279, 3040, 12479, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Enrollment application initiated through Cigna call center.  Contract decision department will take 30 Days for review.   Application Ref: 12437488  ', NULL, NULL, '2020-12-29 14:53:48', '2020-12-29 14:53:48'),
(8280, 3040, 12479, NULL, '2021-01-12 00:00:00.000', 'In Process', 'I had a word with Cigna representative and they advised me it will take At least 10 to 15 business days for the contract sign.', NULL, NULL, '2021-01-05 13:42:19', '2021-01-05 13:42:19'),
(8281, 3040, 12479, NULL, '2021-01-19 00:00:00.000', 'In Process', 'I had a word with (Marcuos A) Cigna representative and he advised me that the application is still in review.  Application no: 12437488', NULL, NULL, '2021-01-12 12:34:24', '2021-01-12 12:34:24'),
(8282, 3040, 12479, NULL, '2021-01-26 00:00:00.000', 'In Process', 'I had a word with (SHAYLA) and she said the application is still in review. Wait for the contract.  Ref: Shayla 01/19/2021', NULL, NULL, '2021-01-19 11:05:54', '2021-01-19 11:05:54'),
(8283, 3040, 12479, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had a word with (Sofia) Cigna representative and she said the application on Medical on boarding process.   New Application no: 12465212', NULL, NULL, '2021-01-26 10:14:20', '2021-01-26 10:14:20'),
(8284, 3040, 12479, NULL, '2021-02-04 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference. ', NULL, NULL, '2021-01-28 15:59:40', '2021-01-28 15:59:40'),
(8285, 3040, 12480, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 14:54:16', '2020-12-29 14:54:16'),
(8286, 3040, 12480, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Enrollment application initiated through Cigna call center.  Contract decision department will take 30 Days for review.   Application Ref: 12437488', NULL, NULL, '2020-12-29 14:54:23', '2020-12-29 14:54:23'),
(8287, 3040, 12480, NULL, '2021-01-12 00:00:00.000', 'In Process', 'I had a word with Cigna representative and they advised me it will take At least 10 to 15 business days for the contract sign.', NULL, NULL, '2021-01-05 13:42:28', '2021-01-05 13:42:28'),
(8288, 3040, 12480, NULL, '2021-01-19 00:00:00.000', 'In Process', 'I had a word with (Marcuos A) Cigna representative and he advised me that the application is still in review.  Application no: 12437488', NULL, NULL, '2021-01-12 12:34:08', '2021-01-12 12:34:08'),
(8289, 3040, 12480, NULL, '2021-01-26 00:00:00.000', 'In Process', 'I had a word with (SHAYLA) and she said the application is still in review. Wait for the contract.  Ref: Shayla 01/19/2021', NULL, NULL, '2021-01-19 11:06:02', '2021-01-19 11:06:02'),
(8290, 3040, 12480, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had a word with (Sofia) Cigna representative and she said the application on Medical on boarding process.   New Application no: 12465212', NULL, NULL, '2021-01-26 10:14:22', '2021-01-26 10:14:22'),
(8291, 3040, 12480, NULL, '2021-02-04 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference. ', NULL, NULL, '2021-01-28 15:59:38', '2021-01-28 15:59:38'),
(8292, 3040, 12481, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 14:54:43', '2020-12-29 14:54:43'),
(8293, 3040, 12481, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Enrollment application initiated through Cigna call center.  Contract decision department will take 30 Days for review.   Application Ref: 12437488', NULL, NULL, '2020-12-29 14:54:49', '2020-12-29 14:54:49'),
(8294, 3040, 12481, NULL, '2021-01-12 00:00:00.000', 'In Process', 'I had a word with Cigna representative and they advised me it will take At least 10 to 15 business days for the contract sign.', NULL, NULL, '2021-01-05 13:42:35', '2021-01-05 13:42:35'),
(8295, 3040, 12481, NULL, '2021-01-19 00:00:00.000', 'In Process', 'I had a word with (Marcues A) Cigna representative and he initiate the request again.   Application no: 12450155 Cigna provider ID no: 4594739', NULL, NULL, '2021-01-12 12:59:23', '2021-01-12 12:59:23'),
(8296, 3040, 12481, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Application is still in process.  ', NULL, NULL, '2021-01-19 11:01:56', '2021-01-19 11:01:56'),
(8297, 3040, 12481, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had a word with (Sofia) Cigna representative and she said the application under contract decision department. ', NULL, NULL, '2021-01-26 10:15:18', '2021-01-26 10:15:18'),
(8298, 3040, 12481, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Contract signed and submitted on 01/28/2021.  See attachment', NULL, NULL, '2021-01-29 14:44:55', '2021-01-29 14:44:55'),
(8299, 3040, 12481, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: ONBEloquaNotice@cigna.com  Subject : Cigna Credentialing Status Update: Application Received  Re:	Reference number 12450155 Application to participate in the Cigna medical network Dear LIMY FERNANDUS,  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, '2021-02-01 09:50:32', '2021-02-01 09:50:32'),
(8300, 3040, 12481, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (Joaya) Cigna representative and she said the application is still in process.  Credentialing started: 01/29/21  Process 90-120 Business days ', NULL, NULL, '2021-02-08 12:45:47', '2021-02-08 12:45:47'),
(8301, 3040, 12481, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-15 10:48:55', '2021-02-15 10:48:55'),
(8302, 3040, 12481, NULL, '2021-03-15 00:00:00.000', 'In Process', 'I had a word with (Lynetce) Cigna representative and she said the application is still in process.', NULL, NULL, '2021-03-08 12:27:04', '2021-03-08 12:27:04'),
(8303, 3040, 12481, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-18 10:51:23', '2021-03-18 10:51:23'),
(8304, 3040, 12481, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Cigna in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 2:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 6:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2021-05-31 16:21:50', '2021-05-31 16:21:50'),
(8305, 3040, 12481, NULL, '2021-06-09 00:00:00.000', 'Approved', 'Email rcvd from:  PDM COGZ  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Dear Health Care Professional,  Thank you for your submission. This is to confirm that your request has been completed. Please find the below status. The return address is not monitored. All future request should be sent to Intake_PDM@Cigna.com  Cigna Internal Reference # W202105311722949.     PID             PROVIDER NAME              NPI                   4594739       Fernandus, Limy       1972005189    4/2/2021   Contracted  Regards,  Cigna PDM.', NULL, NULL, '2021-06-02 17:08:13', '2021-06-02 17:08:13'),
(8306, 3040, 12482, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-29 14:55:16', '2020-12-29 14:55:16'),
(8307, 3040, 12482, NULL, '2021-01-05 00:00:00.000', 'Initiated', 'Enrollment application initiated through Cigna call center.  Contract decision department will take 30 Days for review.   Application Ref: 12437488', NULL, NULL, '2020-12-29 14:55:22', '2020-12-29 14:55:22'),
(8308, 3040, 12482, NULL, '2021-01-12 00:00:00.000', 'In Process', 'I had a word with Cigna representative and they advised me it will take At least 10 to 15 business days for the contract sign.', NULL, NULL, '2021-01-05 13:42:41', '2021-01-05 13:42:41'),
(8309, 3040, 12482, NULL, '2021-01-19 00:00:00.000', 'In Process', 'I had a word with (Marcues A) representative and he initiate the request again.   Application no: 12450070 Cigna provider ID no: 4594739 ', NULL, NULL, '2021-01-12 12:51:08', '2021-01-12 12:51:08'),
(8310, 3040, 12482, NULL, '2021-01-26 00:00:00.000', 'In Process', 'I had a word with (SHAYLA) and she said the application is still in review. Wait for the contract.  Ref: Shayla 01/19/2021', NULL, NULL, '2021-01-19 11:06:11', '2021-01-19 11:06:11'),
(8311, 3040, 12482, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had a word with (Sofia) Cigna representative and she said the application is under the contract decision department. ', NULL, NULL, '2021-01-26 10:10:41', '2021-01-26 10:10:41'),
(8312, 3040, 12482, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Cigna contract signed and submitted on 01/29/2021  See attachment.', NULL, NULL, '2021-01-29 14:59:19', '2021-01-29 14:59:19'),
(8313, 3040, 12482, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: ONBEloquaNotice@cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12450070 Application to participate in the Cigna medical network Dear LIMY FERNANDUS,  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, '2021-02-01 09:49:41', '2021-02-01 09:49:41'),
(8314, 3040, 12482, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (Joaya) Cigna representative and she said the application is still in process.  Credentialing started: 01/29/21  Process 90-120 Business days ', NULL, NULL, '2021-02-08 12:45:54', '2021-02-08 12:45:54'),
(8315, 3040, 12482, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-15 10:49:11', '2021-02-15 10:49:11'),
(8316, 3040, 12482, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-08 15:47:20', '2021-03-08 15:47:20'),
(8317, 3040, 12482, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-15 10:04:25', '2021-03-15 10:04:25'),
(8318, 3040, 12482, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email rcvd from: 9psscent@cigna.com  Subject: Cigna Credentialing Status Update: Credentialing Verification   Re:	Reference number 12450070 Application complete: Credentialing process to begin Dear LIMY FERNANDUS,  We have confirmed that your application is complete, and have forwarded it for credentialing review', NULL, NULL, '2021-03-16 08:50:18', '2021-03-16 08:50:18'),
(8319, 3040, 12482, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with Cigna.   Executed contract attached. ', NULL, NULL, '2021-04-12 17:15:11', '2021-04-12 17:15:11'),
(8320, 2037, 12483, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-30 10:46:12', '2020-12-30 10:46:12'),
(8321, 2037, 12483, NULL, '2021-01-06 00:00:00.000', 'In Process', 'LOI for Linkage with W-9 Sent via fax @608-221-7535. Note: Process will be initiated once the provider will be certified first for BAQC. Application in process.Ref#10210905 Turn Around Time 30 to 60 business days after certification.', NULL, NULL, '2020-12-30 10:47:00', '2020-12-30 10:47:00'),
(8322, 2037, 12483, NULL, '2021-01-06 00:00:00.000', 'Approved', 'As per live call to Tricare East provider is showing certified and completely loaded into the system effective 10/07/2020 and we can start to bill out claims for All three locations.Directory Confirmation & Location addition confirmation uploaded in EMRBS welcome letter will be received shortly.', NULL, NULL, '2020-12-30 10:47:21', '2020-12-30 10:47:21'),
(8323, 2037, 12484, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-30 10:46:17', '2020-12-30 10:46:17'),
(8324, 2037, 12484, NULL, '2021-01-06 00:00:00.000', 'In Process', 'LOI for Linkage with W-9 Sent via fax @608-221-7535. Note: Process will be initiated once the provider will be certified first for BAQC. Application in process.Ref#10210905 Turn Around Time 30 to 60 business days after certification.', NULL, NULL, '2020-12-30 10:47:05', '2020-12-30 10:47:05'),
(8325, 2037, 12484, NULL, '2021-01-06 00:00:00.000', 'Approved', 'As per live call to Tricare East provider is showing certified and completely loaded into the system effective 10/07/2020 and we can start to bill out claims for All three locations.Directory Confirmation & Location addition confirmation uploaded in EMRBS welcome letter will be received shortly.', NULL, NULL, '2020-12-30 10:47:25', '2020-12-30 10:47:25'),
(8326, 2037, 12485, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-30 12:18:02', '2020-12-30 12:18:02'),
(8327, 2037, 12485, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per the live call to Cigna William Francis got on board with cigna (BAQC) effective 12/07/2020 and also RHC Tax ID is also included in the BAQC contract with the same effective date. For RHC he is in the process of being fully loaded . Need to allow one more week to get the confirmation for RHC before we can start to bill.', NULL, NULL, '2020-12-30 12:24:04', '2020-12-30 12:24:04'),
(8328, 2037, 12485, NULL, '2021-01-06 00:00:00.000', 'Approved', 'William\'s Profile has been fully loaded with CIGNA-RHC effective date 12/07/2020. Provider is appearing in the directory with all three locations added. Snapshots uploaded in EMRBS.and par plans detail updated in the notes.', NULL, NULL, '2020-12-30 12:24:54', '2020-12-30 12:24:54'),
(8329, 2037, 12486, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-12-30 12:18:07', '2020-12-30 12:18:07'),
(8330, 2037, 12486, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per the live call to Cigna William Francis got on board with cigna (BAQC) effective 12/07/2020 and also RHC Tax ID is also included in the BAQC contract with the same effective date. For RHC he is in the process of being fully loaded . Need to allow one more week to get the confirmation for RHC before we can start to bill.', NULL, NULL, '2020-12-30 12:24:08', '2020-12-30 12:24:08'),
(8331, 2037, 12486, NULL, '2021-01-06 00:00:00.000', 'Approved', 'William\'s Profile has been fully loaded with CIGNA-RHC effective date 12/07/2020. Provider is appearing in the directory with all three locations added. Snapshots uploaded in EMRBS.and par plans detail updated in the notes.', NULL, NULL, '2020-12-30 12:25:00', '2020-12-30 12:25:00'),
(8332, 1006, 12487, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-31 12:59:04', '2020-12-31 12:59:04'),
(8333, 1006, 12487, NULL, '2021-01-07 00:00:00.000', 'Initiated', 'Submitted LOI with W9 @ (859) 455-8650. Attached for reference.  ', NULL, NULL, '2020-12-31 12:59:29', '2020-12-31 12:59:29'),
(8334, 1006, 12487, NULL, '2021-01-20 00:00:00.000', 'In Process', 'The letter has been received and the request is being worked on, request should be completed on/around 02/11/2020.  Document Control# 201231068092', NULL, NULL, '2021-01-11 15:47:11', '2021-01-11 15:47:11'),
(8335, 1006, 12487, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Physician group contract received. It has been signed and sent back. Attached for reference. ', NULL, NULL, '2021-02-09 09:48:44', '2021-02-09 09:48:44'),
(8336, 1006, 12487, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Request currently in process by the network team, need to check back in next week after 30 business days have elapsed.  Ticket# NAF392508 - Already closed, as the network has already sent us the contract as it should only take 30 business days from 02/09/2021.  Rep: Mark', NULL, NULL, '2021-03-18 13:15:25', '2021-03-18 13:15:25'),
(8337, 1006, 12487, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following update from Aetna on the physician group contract:  \"Good afternoon, can you please complete the roster for this group?\"', NULL, NULL, '2021-03-22 09:33:30', '2021-03-22 09:33:30'),
(8338, 1006, 12487, NULL, '2021-03-29 00:00:00.000', 'In Process', 'The roster has been filled out and sent to So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com. Attached for reference.  ', NULL, NULL, '2021-03-22 09:50:43', '2021-03-22 09:50:43'),
(8339, 1006, 12487, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: FW: [EXTERNAL] Your signature is required on TX_PhysicianGroup_100%AMFS-AMMFSwithMids85%_Right Step Medical Center LLC  \"Hello,   I hope that you\'re doing well, I wanted to get an update on the status of enrollment for our group & providers.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-04-05 16:29:00', '2021-04-05 16:29:00'),
(8340, 1006, 12487, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Called Aetna, was informed to reach out to the email that we sent a roster to for better updates.   Ref# 6015065079  Sent email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:   Sub: Provider Enrollment Query - RSM - Aetna  \"Hello,  I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  I was informed that the group is showing up with the provider\'s NPI instead, could you please verify how we can correct this?  Thank you. \"', NULL, NULL, '2021-04-23 14:24:08', '2021-04-23 14:24:08'),
(8341, 1006, 12487, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent another f/u email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \"Good morning,  I want to follow-up on the status of my enrollment for the following group and providers:Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as possible as this request has been ongoing for more than 2 months without any updates from Aetna.  Thank you. \"', NULL, NULL, '2021-05-03 07:46:15', '2021-05-03 07:46:15'),
(8342, 1006, 12487, NULL, '2021-06-02 00:00:00.000', 'In Process', 'As per my discussion with Aetna representative (Roy), we need to send W9 for Ramegowda @ ATTN: Provider Relations and fax# 859-455-8650. W9 was faxed over. ', NULL, NULL, '2021-05-26 09:29:14', '2021-05-26 09:29:14'),
(8343, 1006, 12487, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \'Hello,  I appreciate the update, could you please let me know what the effective dates are for the providers that are linked to the group TIN?  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Thank you. \"', NULL, NULL, '2021-06-11 09:28:52', '2021-06-11 09:28:52'),
(8344, 1006, 12487, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I have words with Ms. Julie about the enrollment process. She said us to fill out the online application form again but when we fill-up the form again the site responded to us that we are already an existing member of it.', NULL, NULL, '2021-06-30 16:51:41', '2021-06-30 16:51:41'),
(8345, 1006, 12487, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \"Hello,   As per my discussion with the Aetna representative on the given number they still do not see the group or providers listed, please get back to me on the status of this request as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-27 16:49:56', '2021-07-27 16:49:56'),
(8346, 1006, 12487, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \"Hello,   We are still waiting on the status of this request as soon as possible, we still have not received any response on this for quite some time.  Thank you. \"', NULL, NULL, '2021-08-10 16:40:37', '2021-08-10 16:40:37'),
(8347, 1006, 12487, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Requested Aetna rep to get our enrollment request forwarded to management.  Ref# NAF454645 Rep: Jelo ', NULL, NULL, '2021-08-31 14:06:11', '2021-08-31 14:06:11'),
(8348, 11056, 12487, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.  Call rep. : MARS R REF CODE. : Hang up the call deliberately  The participation is out of network but still working to bring in network.  Application ticket no. : NAF454645', NULL, NULL, '2021-09-08 10:21:56', '2021-09-08 10:21:56'),
(8349, 11056, 12487, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep. Name : Theresa  R. & Mae D  Status : Reviewed by network team & Uploading the participation status .  Ref code no. : 92424  Phone no. : 800-353-1232  Application ticket no. : NAF454645', NULL, NULL, '2021-09-17 09:14:09', '2021-09-17 09:14:09'),
(8350, 11056, 12487, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Rep : Amby J  Ramegowda = under process for loading and linking Shybi = In network and linked to the TIN Glory = getting loaded under process Group = will be loaded after the providers contracting immediately.  Also in network.  Eff date will be : 05/15/2021  May be completed in the 1st week or 2nd week of october  Contract has been provided to credentialing for uploading the system.  Ref code : 6044414296  Contact no. : 800-353-1232', NULL, NULL, '2021-09-23 17:02:42', '2021-09-23 17:02:42'),
(8351, 11056, 12487, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Rep. : Jesse R  Status :   Showing out of network. Request Stiil in process network statrted loading provider 09/09/2021  Case no. : 1679009  Ref code : 6046707646  Contact no. : 800-353-1232', NULL, NULL, '2021-10-04 12:34:29', '2021-10-04 12:34:29'),
(8352, 11056, 12487, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Rep :  Rick N  Status : Ramegowda & Glory request is in received to link and load. Still in processing   created on : 10/10/2021 30 business days.  Case no. : 17559543  Ref code : 6049980343  contact no : 800-353-1232', NULL, NULL, '2021-10-13 13:05:58', '2021-10-13 13:05:58'),
(8353, 11056, 12487, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Jam P  Status :  Process is completed. Loaded on the system and linked with the tax ID Future effective date is 11/01/2021   Ref code. : 6051507347  contact no : 800-353-1232', NULL, NULL, '2021-10-21 10:59:19', '2021-10-21 10:59:19'),
(8354, 11056, 12487, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep:  Mark L  Status:  The group is in-network. Going to provide welcome letters in 10 business days for the providers.  Ref code: 6054022733  contact no : 800-353-1232', NULL, NULL, '2021-11-01 10:27:10', '2021-11-01 10:27:10'),
(8355, 11056, 12487, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: In-network case properly started in 9/15/21 ticket# NAF454645 Welcome letters are expected in the next week. The future effective date is 11/01/2021  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:18:51', '2021-11-11 15:18:51'),
(8356, 11056, 12487, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:00:50', '2021-11-18 12:00:50'),
(8357, 11056, 12487, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:00:51', '2021-11-18 12:00:51'),
(8358, 11056, 12487, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Dori M  Status: Case has been escalated. Ramegowda is in credentialing process. Glory Abraham case is missing by their side. LOI had to be sent to add this provider.  Case no.: 13547054  Ref code: 6059846680', NULL, NULL, '2021-11-24 18:07:00', '2021-11-24 18:07:00'),
(8359, 11056, 12487, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Arianne E   Status: Applications are still in process. Welcome letters can be expected soon.   Refcode: 11302021Ariannee', NULL, NULL, '2021-11-30 17:32:47', '2021-11-30 17:32:47'),
(8360, 11056, 12487, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status:Fully loaded in the system.Gonna receive soon a welcome letter  Ref code: 6065804152', NULL, NULL, '2021-12-22 13:48:51', '2021-12-22 13:48:51'),
(8361, 19067, 12487, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||  Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Aetna.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12, Stafford, TX 77477   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 15:07:03', '2021-12-28 15:07:03'),
(8362, 20067, 12487, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject:  Enrollment Status || RSM || Group & Provider || Aetna ||   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned Group and providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 Ramegowda Belakere	1235166687 Glory Abraham	1194206490  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:22:56', '2022-01-06 17:22:56'),
(8363, 19067, 12487, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: RE: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hammad,  I only received the request for Ancy Kurian under this tin, I did not receive the request for these 3 providers, can you please confirm the role of these providers, will they be practicing in a PCP role or Specialist role?', NULL, NULL, '2022-01-09 21:30:45', '2022-01-09 21:30:45'),
(8364, 20067, 12487, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Sub: Enrollment Status || RSM || Group & Provider || Aetna ||   Until the missing information is confirmed, this request will remain to be incomplete, please answer the missing information so I can complete this request for you.     can you please confirm the role of these providers, will they be practicing in a PCP role or Specialist role? ', NULL, NULL, '2022-01-11 09:53:18', '2022-01-11 09:53:18'),
(8365, 20067, 12487, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||  Good Morning, Hope this email finds you well.   Ancy Vinoy Kurian is a Family Nurse Practitioner (363LF0000X) CAQH: 15187581  Ramegowda Belakere is a Family Medicine (207Q00000X) CAQH: 11817469  Glory Abraham is a Family Nurse Practitioner (363LF0000X) CAQH: 14381983  Kindly complete my request and update me ASAP.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 09:54:57', '2022-01-11 09:54:57'),
(8366, 19067, 12487, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: RE: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Syed,  We do not have a group agreement to add these providers currently, we do not complete group agreements with only mid-level providers staffed.  I see however, in this request you have submitted includes a physician that was not submitted previously, I will need to send you a group agreement before any providers can be added, please make sure the group owner signs the agreement.     In the future, any request you submit to add providers will need to be submitted as our process is to submit online through the provider portal here.  ', NULL, NULL, '2022-01-12 11:17:11', '2022-01-12 11:17:11'),
(8367, 19067, 12487, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||    Syed,  We do not have a group agreement to add these providers currently, we do not complete group agreements with only mid-level providers staffed.  I see however, in this request you have submitted includes a physician that was not submitted previously, I will need to send you a group agreement before any providers can be added, please make sure the group owner signs the agreement.     In the future, any request you submit to add providers will need to be submitted as our process is to submit online through the provider portal here.', NULL, NULL, '2022-01-25 13:15:10', '2022-01-25 13:15:10'),
(8368, 19067, 12487, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Hello!  Still waiting to get the group agreement from your side.   Kindly respond as per your convenience.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-08 11:53:15', '2022-02-08 11:53:15'),
(8369, 19067, 12487, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Hello!  I have updated the agreement, Kindly look into it.  Regards.', NULL, NULL, '2022-02-18 11:42:10', '2022-02-18 11:42:10'),
(8370, 19067, 12487, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hi Sylvia,  Did you receive the signed agreement? Kindly respond timely.  Regards, Hammad.', NULL, NULL, '2022-03-11 09:53:09', '2022-03-11 09:53:09'),
(8371, 22077, 12487, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Fwd: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hi,  Hope this email finds you well,  Did you receive the signed agreement? kindly respond timely.  Thanks,  Alex ', NULL, NULL, '2022-04-04 09:59:33', '2022-04-04 09:59:33'),
(8372, 19067, 12487, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:04:45', '2022-04-05 13:04:45'),
(8373, 1006, 12488, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-12-31 12:59:04', '2020-12-31 12:59:04'),
(8374, 1006, 12488, NULL, '2021-01-07 00:00:00.000', 'Initiated', 'Submitted LOI with W9 @ (859) 455-8650. Attached for reference.  ', NULL, NULL, '2020-12-31 12:59:34', '2020-12-31 12:59:34'),
(8375, 1006, 12488, NULL, '2021-01-20 00:00:00.000', 'In Process', 'The letter has been received and the request is being worked on, request should be completed on/around 02/11/2020.  Document Control# 201231068092', NULL, NULL, '2021-01-11 15:46:52', '2021-01-11 15:46:52'),
(8376, 1006, 12488, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Physician group contract received. It has been signed and sent back. Attached for reference. ', NULL, NULL, '2021-02-09 09:48:49', '2021-02-09 09:48:49');
