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
(2823, 3040, 3738, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:50:56', '2021-03-19 13:50:56'),
(2824, 3040, 3738, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:45', '2021-05-26 17:03:45'),
(2825, 2027, 3739, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796430	First Health George, Jeemol	1497219067	27-0796431	First Health Jose, Julie	1447883061	27-0796432	First Health Joseph, Vibitha	1447883061	27-0796433	First Health Kourouma , Odette Tiranke	1134525868	27-0796434	First Health Piccione JR, James M	1356321509	27-0796435	First Health Stephen, Ani	1588959118	27-0796436	First Health Thomas, Cini	1134777238	27-0796437	First Health ', NULL, NULL, '2020-07-20 12:29:18', '2020-07-20 12:29:18'),
(2826, 2027, 3739, NULL, '2020-09-21 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  Sub: (Chennemkara, Mini Philip)-(Normandy Urgent Care Center)-(First Health)  May I know the current enrollment status of the provider with first health. Details are mentioned below: Provider Name: Chennemkara, Mini Philip   Provider NPI#  1841755956   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks. ', NULL, NULL, '2020-09-14 12:27:08', '2020-09-14 12:27:08'),
(2827, 2027, 3739, NULL, '2020-09-28 00:00:00.000', 'In Process', 'Online application has been filled and submitted', NULL, NULL, '2020-09-21 16:57:25', '2020-09-21 16:57:25'),
(2828, 2027, 3739, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  Sub: (Chennemkara, Mini Philip)-(Normandy Urgent Care Center)-(First Health)  May I know the current enrollment status of the provider with first health. Details are mentioned below: Provider Name: Chennemkara, Mini Philip   Provider NPI#  1841755956   Group Name: Normandy Urgent Care Center   Tax ID: 27-0796429    Thanks. ', NULL, NULL, '2020-10-21 13:50:26', '2020-10-21 13:50:26'),
(2829, 2037, 3739, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:11:37', '2020-10-29 14:11:37'),
(2830, 2037, 3739, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:55', '2020-11-13 16:51:55'),
(2831, 2037, 3739, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:54', '2020-11-20 11:00:54'),
(2832, 2037, 3739, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:03:49', '2020-12-01 10:03:49'),
(2833, 2037, 3739, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:45:44', '2020-12-08 13:45:44'),
(2834, 2037, 3739, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:19:18', '2020-12-11 13:19:18'),
(2835, 3040, 3739, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to:  AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  Subject:   (Providers)-(Normandy Urgent Care Center)-(First Health)  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned providers.    If you need any additional information please feel free to email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-16 15:57:52', '2021-02-16 15:57:52'),
(2836, 3040, 3739, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: 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 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 Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:33', '2021-02-26 13:34:33'),
(2837, 3040, 3739, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:23', '2021-03-08 15:50:23'),
(2838, 3040, 3739, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:51:23', '2021-03-19 13:51:23'),
(2839, 3040, 3739, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:49', '2021-05-26 17:03:49'),
(2840, 2027, 3740, NULL, NULL, 'In Process', 'To; Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(First Health)  May I know the current status of the application for the provider which we have submitted on 6/23/2020. Provider details are mentioned below: Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429   I am attaching the application for your reference. Kindly look into this and reply to me as soon as you get it.  Thanks.', NULL, NULL, '2020-07-15 17:47:38', '2020-07-15 17:47:38'),
(2841, 2027, 3740, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796429	First Health George, Jeemol	1497219067	27-0796429	First Health Jose, Julie	1447883061	27-0796429	First Health Joseph, Vibitha	1447883061	27-0796429	First Health Kourouma , Odette Tiranke	1134525868	27-0796429	First Health Piccione JR, James M	1356321509	27-0796429	First Health Stephen, Ani	1588959118	27-0796429	First Health Thomas, Cini	1134777238	27-0796429	First Health ', NULL, NULL, '2020-07-20 12:43:44', '2020-07-20 12:43:44'),
(2842, 2027, 3740, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Online application has been submitted', NULL, NULL, '2020-09-22 15:57:27', '2020-09-22 15:57:27'),
(2843, 2027, 3740, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the below mentioned providers:  Providers	NPI#	Group Name	Group Tax-ID Joseph, Vibitha	1952931560	Normandy Urgent Care Center	27-0796429 Kourouma , Odette Tiranke	1134525868	Normandy Urgent Care Center	27-0796429 Piccione JR, James M	1356321509	Normandy Urgent Care Center	27-0796429 Stephen, Ani	1588959118	Normandy Urgent Care Center	27-0796429 Thomas, Cini	1134777238	Normandy Urgent Care Center	27-0796429    Thanks.', NULL, NULL, '2020-10-21 17:15:21', '2020-10-21 17:15:21'),
(2844, 2037, 3740, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:12:08', '2020-10-29 14:12:08'),
(2845, 2037, 3740, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:52:02', '2020-11-13 16:52:02'),
(2846, 2037, 3740, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:01:03', '2020-11-20 11:01:03'),
(2847, 2037, 3740, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:03:29', '2020-12-01 10:03:29'),
(2848, 2037, 3740, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:45:51', '2020-12-08 13:45:51'),
(2849, 2037, 3740, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:19:27', '2020-12-11 13:19:27'),
(2850, 2037, 3740, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:19:49', '2020-12-11 13:19:49'),
(2851, 3040, 3740, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to:  AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  Subject:   (Providers)-(Normandy Urgent Care Center)-(First Health)  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned providers.    If you need any additional information please feel free to email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-16 15:57:53', '2021-02-16 15:57:53'),
(2852, 3040, 3740, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: 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 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 Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:37', '2021-02-26 13:34:37'),
(2853, 3040, 3740, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:28', '2021-03-08 15:50:28'),
(2854, 3040, 3740, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:51:37', '2021-03-19 13:51:37'),
(2855, 3040, 3740, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:54', '2021-05-26 17:03:54'),
(2856, 2027, 3741, NULL, NULL, 'In Process', 'To: Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com  Sub: (Joseph, Vibitha)-(Normandy Urgent Care Center)-(First Health)  May I know the current status of the application for the provider which we have submitted on 6/23/2020. Provider details are mentioned below: Provider Name: Joseph, Vibitha   Provider NPI# 1952931560  Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429   I am attaching the application for your reference. Kindly look into this and reply to me as soon as you get it.  Thanks.', NULL, NULL, '2020-07-15 17:41:43', '2020-07-15 17:41:43'),
(2857, 2027, 3741, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.   Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796429	First Health George, Jeemol	1497219067	27-0796429	First Health Jose, Julie	1447883061	27-0796429	First Health Joseph, Vibitha	1447883061	27-0796429	First Health Kourouma , Odette Tiranke	1134525868	27-0796429	First Health Piccione JR, James M	1356321509	27-0796429	First Health Stephen, Ani	1588959118	27-0796429	First Health Thomas, Cini	1134777238	27-0796429	First Health ', NULL, NULL, '2020-07-20 12:41:04', '2020-07-20 12:41:04'),
(2858, 2027, 3741, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Online application has been submitted', NULL, NULL, '2020-09-22 15:37:39', '2020-09-22 15:37:39'),
(2859, 2027, 3741, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the below mentioned providers:  Providers	NPI#	Group Name	Group Tax-ID Joseph, Vibitha	1952931560	Normandy Urgent Care Center	27-0796429 Kourouma , Odette Tiranke	1134525868	Normandy Urgent Care Center	27-0796429 Piccione JR, James M	1356321509	Normandy Urgent Care Center	27-0796429 Stephen, Ani	1588959118	Normandy Urgent Care Center	27-0796429 Thomas, Cini	1134777238	Normandy Urgent Care Center	27-0796429    Thanks.', NULL, NULL, '2020-10-21 17:08:27', '2020-10-21 17:08:27'),
(2860, 2037, 3741, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:12:01', '2020-10-29 14:12:01'),
(2861, 2037, 3741, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:52:07', '2020-11-13 16:52:07'),
(2862, 2037, 3741, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:01:15', '2020-11-20 11:01:15'),
(2863, 2037, 3741, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:03:27', '2020-12-01 10:03:27'),
(2864, 2037, 3741, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:46:03', '2020-12-08 13:46:03'),
(2865, 2037, 3741, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:19:40', '2020-12-11 13:19:40'),
(2866, 3040, 3741, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to:  AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  Subject:   (Providers)-(Normandy Urgent Care Center)-(First Health)  Greetings,  Hope you are doing well. Please advise me the enrollment status of the below mentioned providers.    If you need any additional information please feel free to email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-16 15:57:45', '2021-02-16 15:57:45'),
(2867, 3040, 3741, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: 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 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 Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:42', '2021-02-26 13:34:42'),
(2868, 3040, 3741, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:32', '2021-03-08 15:50:32'),
(2869, 3040, 3741, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: 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 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 Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:51:50', '2021-03-19 13:51:50'),
(2870, 3040, 3741, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:59', '2021-05-26 17:03:59'),
(2871, 1006, 3742, NULL, NULL, 'New/Not Initiated', 'Sent following email to Christina:  \"Hey Christina,   Here are all the filled out documents, please let me know if I\'m missing anything or if there\'s anything else to fill out. Also, How long do you think this process could take?   Thank you!\" ', NULL, NULL, '2020-06-23 10:59:27', '2020-06-23 10:59:27'),
(2872, 1006, 3742, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-23 10:59:35', '2020-06-23 10:59:35'),
(2873, 1006, 3742, NULL, NULL, 'In Process', 'Due to Covid, everyone\'s working from home and that has caused a massive delay of upto 90 days in processing. Please allow more time, check back in July.  Ref# Lisa T 06/23/2020', NULL, NULL, '2020-06-23 11:00:08', '2020-06-23 11:00:08'),
(2874, 1006, 3742, NULL, NULL, 'In Process', 'Received following reply from Frank_Mausolf@tufts-health.com:  Sub: Re: Fw: Group Enrollment Request - SNBCare  \"Hello Brad,  I have reached out internally for a status update as I see the implementation of this Agreement is still with our configuration and provider data teams. I have inquired as to how the implementation is going and will update you once I hear back.  I am also looking into your question about Peggy Pionke as I have received some conflicting information. I will provide an update shortly.\"', NULL, NULL, '2020-06-24 16:54:49', '2020-06-24 16:54:49'),
(2875, 1006, 3742, NULL, NULL, 'In Process', 'Received another reply from Frank:  \"Brad,   I have an update on the question about Peggy Pionke.   We do not credential LCSW, only LICSW. For as long the billing is done under the NPI/TaxID of another BH provider that is in-network, typically the supervisor provider or the clinic if they bill under the group, claims should be able to process as In-network.   I’m still waiting to receive an update on the implementation and will follow up again with that information.   Thank you,   Frank Mausolf Contract Manager, Public Plans Tufts Health Plan 705 Mount Auburn Street Watertown, MA  02472-1508 (617) 668-5179 - Office (617) 584-7780 - Cell Frank_Mausolf@tufts-health.com\"', NULL, NULL, '2020-06-25 17:23:38', '2020-06-25 17:23:38'),
(2876, 1006, 3742, NULL, NULL, 'In Process', 'Replied to him:  \"Hey Frank,   Thank you for the reply regarding Peggy, we just wanted to make sure if she could directly bill as LCSW but that\'s cleared up now.   Please get back to us as soon as you\'re able and if there\'s a way for us to backdate the effective date as well or will it be the same as initial Tufts Commercial Eff date?  Thanks!\"', NULL, NULL, '2020-06-25 17:24:09', '2020-06-25 17:24:09'),
(2877, 1006, 3742, NULL, NULL, 'In Process', 'Received following update from :  Sub:   \"Incident number - PRO0107032   Good morning Brad,   The Tufts Health Public Plans contract for Spectrum Neuro Behavioral Care LLC is in the process of being implemented in our internal systems.   Once this is complete the following providers will have an effective date of 6/1/2020:   Fauzia Wali-Khan MD Mahreen Rashid APRN Katie Tawakol NP Prisca Hefti LICSW   Thank you,   Holly Provider Information Management Specialist, Tufts Health Public Plans\"', NULL, NULL, '2020-06-29 10:38:34', '2020-06-29 10:38:34'),
(2878, 1006, 3742, NULL, NULL, 'In Process', 'Sent following email to Provider Data Request provider_data_request@tufts-health.com>:  Sub: Group Contract Update Request - SNBCare - TIN# 83-4482753  \"Good morning,   We wish to get a status update on our contracts for our group and providers:   Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753 NPI# 1356906572  Providers under the contract:  Fauzia Wali-Khan MD Mahreen Rashid APRN Katie Tawakol NP Prisca Hefti LICSW  Please get back to me regarding this update as soon as you\'re able, as this request has been in-process for a few months now.   Thank you. \"', NULL, NULL, '2020-07-15 09:59:13', '2020-07-15 09:59:13'),
(2879, 1006, 3742, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Received email that the contract is effective as of 06/01/2020, sent following email: \"Hello,  Appreciate the help, can we please get a copy of the executed contract or a welcome letter? Thanks. \"', NULL, NULL, '2020-08-05 15:39:50', '2020-08-05 15:39:50'),
(2880, 1006, 3742, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent another email requesting copy of group contract/welcome letter @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com', NULL, NULL, '2020-08-06 13:12:56', '2020-08-06 13:12:56'),
(2881, 1006, 3742, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent follow-up email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com ', NULL, NULL, '2020-08-18 10:25:53', '2020-08-18 10:25:53'),
(2882, 1006, 3742, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Sent a follow-up email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> to resend the welcome letter.  ', NULL, NULL, '2020-10-15 14:09:03', '2020-10-15 14:09:03'),
(2883, 1006, 3742, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Received following reply from Tufts_Health_Plan_Credentialing_Department@Tufts-Health.com:  \"Hi Brad   We are unable to send Welcome Letters for the 4 providers.  For Fauzia Wali-Khan MD, she was already credentialed before we received the application you sent.  For Mahreen Rashid APRN, Katie Tawakol NP and Prisca Hefti LICSW, they are contracted under Allied Contracting (via BH solo contracts.. the ones we send out for all initial BH enrollments).  Allied Contracting does not send Welcome Letters for newly enrolled BH enrollments.   Thanks\"  Sent reply:   \"Hello,   Appreciate the update but what about the group itself, do we not have a group contract with Tufts? and if so, how can we go about getting that process initiated.   Thanks. \"', NULL, NULL, '2020-10-22 18:07:29', '2020-10-22 18:07:29'),
(2884, 1006, 3742, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Received following reply from Tufts:  \"Hi Brad   Looking in our systems, Spectrum Neuro Behavioral Care LLC (TIN# 83-4482753, NPI# 1356906572) is not contracted.  Tufts primarily contracts at the provider level and links them to the group to bill for their individually contracted rates, so this is standard.  If you seek a group contract, I would email the BH Contracting dept (AHCBehavioralHealth@tufts-health.com) and CC us (Tufts Cred email).   Thank you Provider Operations\"  Sent email to AHCBehavioralHealth@tufts-health.com as instructed:  \"Good morning,  I hope you\'re doing well, I wanted to know what would be required from our end to initiate a group contract request for the following group: Group Name# Spectrum Neuro Behavioral Care LLCTIN# 83-4482753 Please get back to me as soon as you\'re able to. Thanks.\"', NULL, NULL, '2020-11-02 11:01:58', '2020-11-02 11:01:58'),
(2885, 1006, 3742, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a follow-up email regarding how to initiate the group contract. ', NULL, NULL, '2020-11-09 18:09:28', '2020-11-09 18:09:28'),
(2886, 1006, 3742, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Sent another follow-up email @ AHCBehavioralHealth@tufts-health.com/Tufts_Health_Plan_Credentialing_Department@tufts-health.com: \"Hello,   I still haven\'t heard anything regarding this query, it\'s been 2+ weeks. Please get back to me as soon as possible as we do not wish to delay this request any longer.  Thanks. \"', NULL, NULL, '2020-11-16 16:41:48', '2020-11-16 16:41:48'),
(2887, 1006, 3742, NULL, '2020-11-30 00:00:00.000', 'Rejected', 'Hi Brad,  I apologize for not getting back to you sooner. I did forward this to the commercial contract manager and he confirmed that we would not extend a group contract as we primarily contract at the individual level to keep access open to our members.          Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan  705 Mt. Auburn Street, MS 84  Watertown, MA 02472  P: 617-972-9400 ext 56009 | F: 617-673-0909  ', NULL, NULL, '2020-11-23 18:18:58', '2020-11-23 18:18:58'),
(2888, 1006, 3742, NULL, NULL, 'Revalidation', 'Sent following email with the Demographic Update form to Provider Data Request Provider_Data_Request@tufts-health.com:  Sub: Group Demographic Information Update - SNBCare - Tufts Public Plans  \"Hello,   Please find the attached application form, we wish to update our demographic information for the group with Tufts Public Plans. All of the information is listed on the form below, if you have any further questions please feel free to reach out to me.   Thank you. \"  The form is attached for reference.', NULL, NULL, '2021-04-22 11:57:05', '2021-04-22 11:57:05'),
(2889, 2028, 3743, NULL, NULL, 'New/Not Initiated', 'Online initiation is done and also the LOI has been sent.', NULL, NULL, '2020-06-24 10:10:39', '2020-06-24 10:10:39'),
(2890, 2028, 3743, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-24 10:11:10', '2020-06-24 10:11:10'),
(2891, 2028, 3743, NULL, NULL, 'In Process', 'TO: Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com SUB: Gonzalez, Mary C - Aetna - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Statcare Minor Emergency Clinic (Kingsville) Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-06 09:41:56', '2020-07-06 09:41:56'),
(2892, 2028, 3743, NULL, NULL, 'In Process', 'From: DavisE11@aetna.com Sub: Secure Messaging password reminder  Good morning,  Please do not copy PDS Dallas mailbox, as that mailbox is being retired. Any questions for Aetna, please direct to me. I can redirect as needed to any internal contacts.  TIN 460575924 is set up with on an urgent care facility  contract under Statcare Minor Emergency clinic. for that reason we do not perform roster loads. it is a global contact W/everything being billed under the UC facility. We do not need to add any professionals & do not need to credential physicians separately. Individual physicians/ professionals should not be loaded to the TIN/agreement b/c it is a facility agreement. if we find that are being added. it will be as non-par b/c they are not subject to the contract since it is a facility agreement. i will actually run periodic checks on the TIN and clean up any record that should not exit under the TIN. The only record that should exist under the TIN is the UC facility since it is a facility agreement    Thank you  Elizabeth', NULL, NULL, '2020-07-09 18:24:50', '2020-07-09 18:24:50'),
(2893, 2028, 3743, NULL, NULL, 'In Process', 'Rep:kristine will take maximum 60 days we are in contracting process the tracking no. is  (pvb1113005) also initiation date as per insurance is 6-23-2020 Ref: 5408297115', NULL, NULL, '2020-07-17 12:07:37', '2020-07-17 12:07:37'),
(2894, 2028, 3743, NULL, NULL, 'In Process', 'Rep: Sheldon As per rep, will take more 30 days for the Effective date provided the ticket no. naf353523  ref:5431889086', NULL, NULL, '2020-07-28 10:32:20', '2020-07-28 10:32:20'),
(2895, 1006, 3743, NULL, '2020-08-12 00:00:00.000', 'Approved', 'Received following email from SoTexasAncillary SoTexasAncillary@aetna.com>:  Sub: Gonzalez, Mary C - Aetna - RHC  \"Good afternoon Sharon/Rabagos HealthCare, Statcare Minor Emergency Clinic (Aetna provider # 4697325) holds a facility contract under contract # 5240633.  It is a global urgent care facility contract.  As such, we do not perform roster loads for individual physicians/providers or link them to the contract.  The UC facility agreement covers for everything, as it is a global agreement & everything is submitted under the facility.  We do not require separate credentialing for the physicians related to the UC agreement.     Unless the physicians are contracted separately under separate TINs, we do not need to credential or contract the physician(s) separately.  If they are wanting to do separate contracting under a different TIN, then that would need to be directed to the local market.  But it is not required when connected to the UC agreement.     Please let me know if you have any other questions/concerns.     Once UC agreements have been re-assigned, the new person can address any further concerns you might have.  At this time, I’ll continue to address via the SoTexasAncillary@AETNA.com should you have any further questions/concerns.     Thank you,  Elizabeth\"', NULL, NULL, '2020-08-05 17:55:21', '2020-08-05 17:55:21'),
(2896, 1006, 3743, NULL, '2020-08-12 00:00:00.000', 'Approved', 'All 3 locations are listed under the urgentcare contract, attached proof from the directory. ', NULL, NULL, '2020-08-05 18:06:21', '2020-08-05 18:06:21'),
(2897, 2028, 3745, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:35:06', '2020-06-24 10:35:06'),
(2898, 2028, 3745, NULL, NULL, 'Initiated', 'Online form submitted also attached  PARPLAN_Agreement of Mary_Gonzalez and RosterTemplate_TX  ', NULL, NULL, '2020-06-24 16:37:08', '2020-06-24 16:37:08'),
(2899, 2028, 3745, NULL, NULL, 'In Process', 'TO: Latrice_Thomas@bcbstx.com SUB: Gonzalez, Mary C - Blue Cross Blue Shield - BCBS - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Statcare Minor Emergency Clinic (Kingsville) Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083    Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-06 10:05:42', '2020-07-06 10:05:42'),
(2900, 2028, 3745, NULL, NULL, 'In Process', ' From:  Latrice_Thomas@bcbstx.com TO: Bel_Villarreal@bcbstx.com CC: sharon@claimsmedinc.com  Hi Bel,   Can you assist Sharon with status please?  Provider Center is showing you listed as the Contracting Rep for this group.', NULL, NULL, '2020-07-08 12:15:51', '2020-07-08 12:15:51'),
(2901, 2028, 3745, NULL, NULL, 'In Process', 'From: Bel_Villarreal@bcbstx.com Sub: (Gonzalez, Mary C) - (Blue Cross Blue Shield - BCBS) - (RHC) Good Afternoon Samuel,     The provider is in the queue to be processed; please feel free to check back in two weeks for a status update.        Thank You,  Bel Villarreal | Network Management Consultant Blue Cross Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company  4444 Corona Drive, Suite 148, Corpus Christi, TX 78411 Phone: (361) 878-1612 | Fax: (361) 852-0624 | Email: Bel_Villarreal@bcbstx.com', NULL, NULL, '2020-07-13 09:19:44', '2020-07-13 09:19:44'),
(2902, 2028, 3745, NULL, NULL, 'In Process', 'TO: Bel_Villarreal@bcbstx.com Sub: (Gonzalez, Mary C) - (Blue Cross Blue Shield - BCBS) - (RHC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-27 15:55:54', '2020-07-27 15:55:54'),
(2903, 2028, 3745, NULL, NULL, 'In Process', 'TO: Bel_Villarreal@bcbstx.com Sub: (Reminder) (Gonzalez, Mary C) - (Blue Cross Blue Shield - BCBS) - (RHC)  Hello,  Could you please update me with the status update of the provider Mary Gonzalez as in your previous email you said that the provider is in the queue to be processed. and the initiation date as per my records is 6/24/2020 The details are as follows Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083    Please get back to me as soon as you\'re able.  Thank you  ', NULL, NULL, '2020-07-30 16:37:29', '2020-07-30 16:37:29'),
(2904, 1006, 3745, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Asked for update on the status for the provider from Bel Villarreal Bel_Villarreal@bcbstx.com> ', NULL, NULL, '2020-08-13 10:47:30', '2020-08-13 10:47:30'),
(2905, 2037, 3745, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Hello, Could you please update me with the status update of the provider Mary Gonzalez.As per the last update the provider is in the queue to be processed.The initiation date as per our records is 6/24/2020.  The details are as follows: Group Name: Statcare Minor Emergency ClinicProvider Name: Gonzalez, Mary CTIN# 46-0575924NPI# 1952713083   Looking forward to hearing from you soon.', NULL, NULL, '2020-08-19 10:10:29', '2020-08-19 10:10:29'),
(2906, 1006, 3745, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Received approval letters for the main BCBS plans, Blue Essentials, HMO, PPO, STAR with effective date: 08/27/2020  Approval letters are attached for all the plans. ', NULL, NULL, '2020-08-26 17:42:17', '2020-08-26 17:42:17'),
(2907, 3040, 3745, NULL, NULL, 'Revalidation', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:51', '2021-03-29 13:04:51');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(2908, 1006, 3745, NULL, NULL, 'Revalidated', 'The provider is showing on Kingsville location now, approvals are already attached as is the location confirmation for reference.', NULL, NULL, '2021-04-27 12:26:36', '2021-04-27 12:26:36'),
(2909, 2028, 3746, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:39:05', '2020-06-24 10:39:05'),
(2910, 2028, 3746, NULL, NULL, 'Initiated', 'on call form submitted', NULL, NULL, '2020-07-10 17:27:02', '2020-07-10 17:27:02'),
(2911, 2028, 3746, NULL, NULL, 'Initiated', 'rep: Ellison will take 70-90 days and CAQH should be updated within 24 hours, on call form submitted Ref: 7-11-2020', NULL, NULL, '2020-07-10 17:30:27', '2020-07-10 17:30:27'),
(2912, 2028, 3746, NULL, NULL, 'On Hold', 'Rep: Red  As per rep, The Pannel is closed we can check once a month usually November or December panel should open Ref: Red 7-23-2020', NULL, NULL, '2020-07-23 12:07:42', '2020-07-23 12:07:42'),
(2913, 2037, 3746, NULL, '2021-01-15 00:00:00.000', 'On Hold', 'Panels Closed', NULL, NULL, '2020-10-08 10:36:40', '2020-10-08 10:36:40'),
(2914, 2037, 3746, NULL, '2020-11-18 00:00:00.000', 'In Process', 'As per live call to Cigna (Robert) the request is currently being reviewed waiting for the contracting approval. Ref: Robert:11/11/2020', NULL, NULL, '2020-11-11 09:44:08', '2020-11-11 09:44:08'),
(2915, 2037, 3746, NULL, '2020-11-18 00:00:00.000', 'In Process', 'They said that the panels show closed  as of now however we can submit a request but the certainty is subject to the approval of the initial request.', NULL, NULL, '2020-11-11 09:47:18', '2020-11-11 09:47:18'),
(2916, 2037, 3746, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent for the status of the request.', NULL, NULL, '2020-11-18 14:06:05', '2020-11-18 14:06:05'),
(2917, 2037, 3746, NULL, '2020-12-10 00:00:00.000', 'In Process', 'The application got approved and is currently being processed. As per the live call Application# 12366682', NULL, NULL, '2020-11-19 12:42:47', '2020-11-19 12:42:47'),
(2918, 2037, 3746, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Currently in process need to allow more time', NULL, NULL, '2020-12-11 13:06:37', '2020-12-11 13:06:37'),
(2919, 1006, 3746, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Sent a follow-up email @ intake_pdm@cigna.com ', NULL, NULL, '2021-01-04 18:35:34', '2021-01-04 18:35:34'),
(2920, 1006, 3746, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Sent follow up email for credentialing status to intake_pdm@cigna.com ', NULL, NULL, '2021-01-26 17:53:50', '2021-01-26 17:53:50'),
(2921, 1006, 3746, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Sent a follow-up email @ intake_pdm@cigna.com regarding status.  ', NULL, NULL, '2021-02-01 15:57:20', '2021-02-01 15:57:20'),
(2922, 1006, 3746, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Received the following request from Cigna: \"Dear Healthcare Professionals,     Please provide the following information to link an HCP - Mary Gonzalez to the TAX ID - 46-0575924  1.     Effective Date  2.     Office and Billing address and phone numbers  3.     Group Name  4.     Payee Name  5.     Hospital ( IL see GMI. No hospital loaded in provider\'s record, LA & TX for HBP providers)  6.     Network IDs  7.     Fee Schedule (if no GSI attached)  8.     TIN  9.     Degree  10.   Specialty  11.   Role  12.   Age range if PCP provider   13.   Place of Service (Hospital Based or not)  14.   License #  15.   A W-9 is required for TIN owner name and address for non-delegated TINS that do not exist in CPF.  16.   Market Suppression  17.   On Call required for PCP  18.   NPI (National Provider Identifier) Individual HCP\'s Note: This is required for all new Adds for non-atypical HCPs  19.   Internet Information - If given in source document and California HCP.        Sincerely,  PDM .\"  Replied back to them with all the information. ', NULL, NULL, '2021-02-09 17:54:42', '2021-02-09 17:54:42'),
(2923, 1006, 3746, NULL, '2021-02-24 00:00:00.000', 'Approved', 'Dear MARY GONZALEZ,  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 02/05/2021. Your provider identification number is‍ ‌0964158. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-02-17 18:17:30', '2021-02-17 18:17:30'),
(2924, 2028, 3747, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:45:23', '2020-06-24 10:45:23'),
(2925, 2028, 3747, NULL, NULL, 'In Process', 'Rep: jel S  Explained her about the error which shoes while submitting online form she provided an email address (stxnm@humana.com) and said to write in writing whatever issues your facing.    Ref: 2000137708161', NULL, NULL, '2020-07-13 15:43:27', '2020-07-13 15:43:27'),
(2926, 2028, 3747, NULL, NULL, 'In Process', 'To: stxnm@humana.com Sub: Gonzalez, Mary C - Humana - RHC  Hello,  Hope you\'re doing well, I have got your email address from the Customer service of humana and my question is that we\'ve been trying to enroll a provider into your network. While submitting an online request of the provider it shows that the group is already enrolled and it does not submit my request kindly let me know what would be the procedure in order to enroll the provider as she is new to the group.  Please get back to me as soon as possible  Thank you.', NULL, NULL, '2020-07-13 15:46:19', '2020-07-13 15:46:19'),
(2927, 2028, 3747, NULL, NULL, 'In Process', 'To: stxnm@humana.com Sub: (Reminder) Gonzalez, Mary C - Humana - RHC  Hello,  Hope you\'re doing well, I have got your email address from the Customer service of humana and my question is that we\'ve been trying to enroll a provider into your network. While submitting an online request of the provider it shows that the group is already enrolled and it does not submit my request kindly let me know what would be the procedure in order to enroll the provider as she is new to the group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic  Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083  Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-16 15:36:05', '2020-07-16 15:36:05'),
(2928, 2028, 3747, NULL, NULL, 'In Process', 'REP: jenny As per rep, we have to contact the email address which is provided, and try to re-Initiate Mary on the website once again. Ref: 200138595723', NULL, NULL, '2020-07-20 13:39:15', '2020-07-20 13:39:15'),
(2929, 2028, 3747, NULL, NULL, 'In Process', 'Name: ry As per rep, she said that if the group is enrolled then no need to initiate Mary for Humana she can take patients of our insurance within the facility. I asked her to send us a roster, a Wellcome letter, or an executed contract for our records she replied saying that I cannot do that it is not necessary still you can send an email regarding it on stxnm@humana.com. Ref: 2-30138852058', NULL, NULL, '2020-07-21 16:45:49', '2020-07-21 16:45:49'),
(2930, 2028, 3747, NULL, NULL, 'In Process', 'To: stxnm@humana.com Sub: Gonzalez, Mary C - Humana - RHC  Hello,  Hope you\'re doing great, We\'ve been trying to enroll a new provider with your insurance but it comes up with an error message says that the group is already enrolled. I\'ve been trying to reach numerous time with you on your email but no response as today again I contacted the Humana customer service for the solution they said that as the group is enrolled so the provider is also enrolled. We would like to request a roster, welcome letter, or executed contract for our records to confirm as if Mary Gonzales can take patients of Humana. The details are as follows: Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083  Please get back to me as soon as you\'re able. Thank you. ', NULL, NULL, '2020-07-21 16:47:03', '2020-07-21 16:47:03'),
(2931, 2028, 3747, NULL, NULL, 'In Process', 'From: stxnm@humana.com Sub: RE: (Reminder) Gonzalez, Mary C - Humana - RHC  Rabagos Healthcare has an Ancillary contract with Humana.  Individual practitioners are not added to ancillary contracts in our systems to print in our physician directory—the facility name is what will print for the par plans at the loaded service address locations.        Thank you Network Operations Coordinator /Provider Contracting  South Texas Network Management  Humana  8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229  T 800-626-2741  F 855.461.6048  stxnm@humana.com', NULL, NULL, '2020-07-22 18:01:15', '2020-07-22 18:01:15'),
(2932, 2028, 3747, NULL, NULL, 'Approved', 'Executed Contract attached', NULL, NULL, '2020-07-23 14:22:55', '2020-07-23 14:22:55'),
(2933, 2028, 3747, NULL, NULL, 'In Process', 'TO: stxnm@humana.com Sub: Gonzalez, Mary C - Humana - RHC Hope you\'re doing great, I would also like to confirm the address which you have in your records.  As the addresses should be as following: Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363. Secondary Address: 4042 River Hill Drive, Corpus Christi, TX   78410-5606. Tertiary Address: 6646 S Staples St #122, Corpus Christi, TX 78413-5426  Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 Group NPI# 1689924904    Please get back to me as soon as you\'re able Thank you', NULL, NULL, '2020-07-23 17:53:45', '2020-07-23 17:53:45'),
(2934, 2028, 3747, NULL, NULL, 'In Process', 'Rep: Moya R As per rep, the secondary address is not updated for the group in order to update we can email to stxnm@humana.com or go to www.availity.com, for any assistance on Availity you can call (18002824548), there are open Monday- Thursday 8 am 6 pm and on  Friday 8 am 5 pm', NULL, NULL, '2020-07-27 16:10:22', '2020-07-27 16:10:22'),
(2935, 2028, 3747, NULL, NULL, 'In Process', 'TO: stxnm@humana.com Sub: Gonzalez, Mary C - Humana - RHC  Hello, We have been noted that the secondary address for the group has not been updated kindly let us know the procedure or expedite our request for an address update. Also please double-check with the addresses so that there should be no mistake. As the addresses should be as following: Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363. Secondary Address: 4042 River Hill Drive, Corpus Christi, TX   78410-5606. Tertiary Address: 6646 S Staples St #122, Corpus Christi, TX 78413-5426 Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 Group NPI# 1689924904    Please get back to me as soon as you\'re able Thank you', NULL, NULL, '2020-07-31 04:59:43', '2020-07-31 04:59:43'),
(2936, 2037, 3747, NULL, '2020-08-26 00:00:00.000', 'In Process', 'As per live call to Humana provider services @ 800-448-6262 they said that the request is still under process and may take upto 90 to 120 Business days.need to allow more time.Call reference number: 1000155337528. Follow up email address: stxnm@humana.com', NULL, NULL, '2020-08-19 10:48:40', '2020-08-19 10:48:40'),
(2937, 2037, 3747, NULL, '2020-08-26 00:00:00.000', 'In Process', 'As per live call to Humana provider services @ 800-448-6262 they said that the request is still under process and may take upto 90 to 120 Business days.need to allow more time.Call reference number: 1000155337528. Follow up email address: stxnm@humana.com', NULL, NULL, '2020-08-19 12:26:10', '2020-08-19 12:26:10'),
(2938, 1005, 3747, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Currently in process.', NULL, NULL, '2020-09-24 14:24:18', '2020-09-24 14:24:18'),
(2939, 2037, 3747, NULL, '2020-10-30 00:00:00.000', 'In Process', 'As per live call to Humana the request for location addition was disregarded as proper procedure was not followed. Submitted completed credentialing application for secondary location addition and submitted back to stxnm@humana.com.', NULL, NULL, '2020-10-01 15:38:19', '2020-10-01 15:38:19'),
(2940, 2037, 3747, NULL, '2020-10-08 00:00:00.000', 'Approved', 'Address addition continues (Task Created for Callalen) Comments updated on there. As RHC is having an urgent care contract so adding address to Mary is not needed.', NULL, NULL, '2020-10-01 17:34:40', '2020-10-01 17:34:40'),
(2941, 2028, 3748, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:46:23', '2020-06-24 10:46:23'),
(2942, 2028, 3748, NULL, NULL, 'Initiated', 'Online form submitted', NULL, NULL, '2020-06-25 17:19:22', '2020-06-25 17:19:22'),
(2943, 1005, 3748, NULL, NULL, 'In Process', 'Ticket # 17019727 Status: Approved.  Awaiting Welcome Letter.', NULL, NULL, '2020-07-10 15:02:40', '2020-07-10 15:02:40'),
(2944, 2028, 3748, NULL, NULL, 'Approved', 'Rep: lisa agent explains about the locations only 1 location is added which is 6646 S. Staples St. # 122 Corpus Christi , TX 78410 for all the rest addresses we have to enroll Mary Gonzalez again and also for the welcome letter  Fax number provided... Ref: 39307644001', NULL, NULL, '2020-07-10 15:46:39', '2020-07-10 15:46:39'),
(2945, 2028, 3748, NULL, NULL, 'Approved', 'welcome letter received also attached.', NULL, NULL, '2020-07-13 10:00:45', '2020-07-13 10:00:45'),
(2946, 2028, 3749, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:47:39', '2020-06-24 10:47:39'),
(2947, 2028, 3749, NULL, NULL, 'Initiated', 'Case Number: 7272644    Submitter Name: Muhammad Asad Date of Submission: 06/25/2020    TIN: 46-0575924    Provider Name: Gonzalez, Mary Group Name: Statcare Minor Emergency Clinic Inquiry Type: Credentialing Status • Request to add Provider to existing group    Priority: Standard', NULL, NULL, '2020-06-25 10:47:26', '2020-06-25 10:47:26'),
(2948, 2028, 3749, NULL, NULL, 'Initiated', 'TIN Authorization Form and MultiPlan Group Cover Sheet for Applications is completed waiting for CAQH from Mary Gonzalez for the Texas Credentialing Application Form', NULL, NULL, '2020-06-25 17:14:02', '2020-06-25 17:14:02'),
(2949, 2028, 3749, NULL, NULL, 'In Process', 'TO:ProviderServices@multiplan.com Sub: Gonzalez, Mary C - Multiplan - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-13 16:53:16', '2020-07-13 16:53:16'),
(2950, 2028, 3749, NULL, NULL, 'In Process', 'Rep: Nate As per rep they have not received anything have to send it again on registrar@multiplan.com or fax us on 7814878273 Ref: 7294545', NULL, NULL, '2020-07-16 14:57:45', '2020-07-16 14:57:45'),
(2951, 2028, 3749, NULL, NULL, 'Initiated', 'To: registrar@multipaln.com Sub: Gonzalez, Mary C - Multiplan - RHC  Hello,  Hope you\'re doing great, Attached are the  Group cover sheet for Application and TIN Authorization Form   Regards,Samuel Sharon', NULL, NULL, '2020-07-16 15:21:51', '2020-07-16 15:21:51'),
(2952, 2028, 3749, NULL, NULL, 'In Process', 'TO: appmissinginfo@multiplan.com Sub: Gonzalez, Mary C - Multiplan - RHC  Hello, Hope you\'re doing great, attached is the Request for credentialing material form. The details are as follows: Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 NPI# 1952713083   Please get back to me as soon as you\'re able. Thank you.', NULL, NULL, '2020-07-21 17:49:10', '2020-07-21 17:49:10'),
(2953, 2028, 3749, NULL, NULL, 'In Process', 'Name: jaff Received effective date 07-21-2020 for the provider As per rep group all the address are updated also made the request for the approval letter rep said will be done as soon as possible Ref: 7294545 ', NULL, NULL, '2020-07-30 15:56:47', '2020-07-30 15:56:47'),
(2954, 1006, 3749, NULL, '2020-08-18 00:00:00.000', 'Approved', 'Provider is effective on 7/21/2020, all locations are updated. Welcome letter and location update is attached. ', NULL, NULL, '2020-08-11 17:31:58', '2020-08-11 17:31:58'),
(2955, 2028, 3750, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:48:53', '2020-06-24 10:48:53'),
(2956, 2028, 3750, NULL, NULL, 'Initiated', 'TO: TCHPNetworkManagemen@texaschildrens.org SUB: Gonzalez, Mary C - Texas Children Health Plan - RHC Hello, I would like to enroll  Mary C Gonzalez with Texas Children health plan Attached are the W-9 and LOI of the Provider.  Regards, Samuel Sharon', NULL, NULL, '2020-07-14 12:46:14', '2020-07-14 12:46:14'),
(2957, 2028, 3750, NULL, NULL, 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org Sub: Gonzalez, Mary C - Texas Children Health Plan - RHC  Hello,  Attached is a correction LOI form for Mary Gonzalez and we would also like to add two more addresses for the provider  4042 River Hill Drive Corpus Christi TX  78410,  6646 S Staples St #122 Corpus Christi 78413.  Regards, Samuel Sharon', NULL, NULL, '2020-07-14 16:30:54', '2020-07-14 16:30:54'),
(2958, 2028, 3750, NULL, NULL, 'In Process', 'Rep: Jmara Call back after a week as for now Mary is not showing in the provider listed Ref: Jmara 07-24-2020', NULL, NULL, '2020-07-24 13:12:05', '2020-07-24 13:12:05'),
(2959, 2037, 3750, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Called Texas Children Health Plan @ (832) 828-1001 Spoke to Marty. As per her Gonzalez, Mary C is still not showing as listed under the group .She has escalated the issue to Provider Relations \"Liz\" to look into and she will be giving a call back to us by Friday.', NULL, NULL, '2020-08-19 13:49:21', '2020-08-19 13:49:21'),
(2960, 2037, 3750, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Received an email from TCHP: --------------------------------------------- Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-08-31 16:42:29', '2020-08-31 16:42:29'),
(2961, 2037, 3750, NULL, '2020-09-07 00:00:00.000', 'Rejected', 'Not Covered in this service area.', NULL, NULL, '2020-08-31 17:16:49', '2020-08-31 17:16:49'),
(2962, 2028, 3751, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 10:52:01', '2020-06-24 10:52:01'),
(2963, 2028, 3751, NULL, NULL, 'New/Not Initiated', 'CAQH is still pending waiting on Katherine Rabagos,', NULL, NULL, '2020-07-09 17:43:07', '2020-07-09 17:43:07'),
(2964, 2028, 3751, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-10 16:57:42', '2020-07-10 16:57:42'),
(2965, 2028, 3751, NULL, NULL, 'In Process', 'Rep: As per rep, Mary is a hospital-based physician to change it contact the email address which is hpdemo@uhc.com for further assistance. Ref: 01742725', NULL, NULL, '2020-07-21 12:24:04', '2020-07-21 12:24:04'),
(2966, 2028, 3751, NULL, NULL, 'In Process', 'TO: hpdemo@uhc.com Sub: Gonzalez, Mary C - United HealthCare  - RHC  Hello, Hope you\'re doing great, I have got your email through the Network management Customer service center as they were providing the status update for the provider and said that Mary Gonzalez is hospital-based physician, I would like to make changes as Mary is a clinical practitioner. Please also let us know that is she in the process of credentialing or not? Details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 Provider NPI# 1952713083   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-21 12:39:50', '2020-07-21 12:39:50'),
(2967, 2028, 3751, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com Sub: 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-5396164  Received On: Jul 21, 2020 12:44:18 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2020-07-21 13:31:49', '2020-07-21 13:31:49'),
(2968, 2028, 3751, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com Sub: (Reminder) Gonzalez, Mary C - United HealthCare  - RHC  Hello,  Hope you\'re doing great, I have got your email address through the Network management Customer service center as they were providing the status update for the provider and said that Mary Gonzalez is hospital-based physician, I would like to make changes as Mary is a clinical practitioner. Please also let us know that is she in the process of credentialing or not?  Details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C TIN# 46-0575924 Provider NPI# 1952713083   Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-23 10:53:33', '2020-07-23 10:53:33'),
(2969, 2028, 3751, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com Sub: Secure message from United_Healthcare_Provider_Operations@uhc.com  Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5400720  Received On: Jul 23, 2020 10:58:25 AM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2020-07-23 10:58:46', '2020-07-23 10:58:46'),
(2970, 2028, 3751, NULL, NULL, 'In Process', 'Incoming call received REP: Angel As per rep, she is showing as a Nurse practitioner in their records and we can get in touch with whoever was assisting regarding her Status for any updates for her enrolment Process  Ref: 5400420', NULL, NULL, '2020-07-23 12:52:27', '2020-07-23 12:52:27'),
(2971, 2028, 3751, NULL, NULL, 'In Process', 'REP: Gary As per rep, the provider is credentialed as a group contract with the insurance Effective date: 9-4-2020 have to send email regarding a welcome letter or roster to (swproviderservices@uhc.com) Ref: 01759972', NULL, NULL, '2020-07-30 15:07:49', '2020-07-30 15:07:49'),
(2972, 2028, 3751, NULL, NULL, 'In Process', 'TO: swproviderservices@uhc.com Sub: Gonzalez, Mary C - United HealthCare  - RHC  Hello, Hope you\'re doing great, I would like to request for a welcome letter or a roster for Mary Gonzalez as she is credentialed with the Insurance in the group Contract, we need something for our records and also would like to confirm the addresses that are on your records should be as below. Details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Gonzalez, Mary C Effective Date: 9-4-2020TIN# 46-0575924 Provider NPI# 1952713083 Group NPI# 1689924904 Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 4042 River Hill Drive Corpus Christi TX  78410-5606Tertiary Address: 6646 S Staples St #122 Corpus Christi TX 78413-5426   Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-30 15:26:56', '2020-07-30 15:26:56'),
(2973, 1006, 3751, NULL, '2020-08-21 00:00:00.000', 'Approved', 'Attached provider roster with plans and effective date mentioned. ', NULL, NULL, '2020-08-14 14:30:18', '2020-08-14 14:30:18'),
(2974, 1006, 3752, NULL, NULL, 'New/Not Initiated', 'Sent following email to CCAContracting@commonwealthcare.org:   Sub: Prisca Hefti - Enrollment Request  \"Hello,   We wanted to add a provider to our group, her information is given below:  Provider Name: Prisca Hefti NPI# 1699307322 TIN# 83-4482753  Please let me know what is required to get added.  Thank you!\" ', NULL, NULL, '2020-06-24 13:10:09', '2020-06-24 13:10:09'),
(2975, 1006, 3752, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-24 13:10:23', '2020-06-24 13:10:23'),
(2976, 1006, 3752, NULL, NULL, 'In Process', 'Sent new email with HCAS to CCA', NULL, NULL, '2020-06-24 13:11:34', '2020-06-24 13:11:34'),
(2977, 1006, 3752, NULL, NULL, 'Approved', 'Received following email from Arrin Rines arines@commonwealthcare.org>:  Sub: Status of Credentialing & Enrollment Request  \"July 23, 2020 Prisca D Hefti, LICSW                RE: Status of Credentialing & Enrollment Request  The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 7/17/2020.  Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.  Sincerely, CCA Credentialing Department 529 Main St, Suite 216 Charlestown, MA 02129\"', NULL, NULL, '2020-07-23 09:29:45', '2020-07-23 09:29:45'),
(2978, 1006, 3753, NULL, NULL, 'New/Not Initiated', 'Submitted HCAS & W9 to :  Sub: Peggy Pionke - HCAS & W9 / Katie Tawakol - HCAS & W9  \"Hello,  Please find the attached HCAS form for our provider, we wish to get them linked as in-network for our group. Please let me know if anything else is needed.   Thank you!\" ', NULL, NULL, '2020-06-24 13:37:52', '2020-06-24 13:37:52'),
(2979, 1006, 3753, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-24 13:37:58', '2020-06-24 13:37:58'),
(2980, 1006, 3753, NULL, NULL, 'In Process', 'Sent followup email:  \"Hello,   Appreciate the reply, what is the expected time-frame for completion for these providers?  Also, there was another provider whose request should be in process their details are as follows:  Provider Name: Prisca Hefti NPI# 1508133182  Please get back to me as soon as you\'re able.  Thanks. \"', NULL, NULL, '2020-06-24 13:52:36', '2020-06-24 13:52:36'),
(2981, 1006, 3753, NULL, NULL, 'Approved', 'Received following email from Provider Networks pnetworks@commonwealthcare.org>:  Sub: Enrollment Status Update  Provider Name: Peggy Pionke NPI# 1699307322 Effective :03/19/2020 Hector Cruz Provider Data Mgmt Specialist Commonwealth Care Alliance 2 Avenue de Lafayette, 5th Flr Boston, MA 02108 ', NULL, NULL, '2020-06-24 14:12:37', '2020-06-24 14:12:37'),
(2982, 2028, 3755, NULL, NULL, 'New/Not Initiated', 'Railroad Medicare PTAN Lookup and Request Tool submitted,  reference number received 20176001238. ', NULL, NULL, '2020-06-24 17:27:18', '2020-06-24 17:27:18'),
(2983, 2028, 3755, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-24 17:28:14', '2020-06-24 17:28:14'),
(2984, 1005, 3755, NULL, NULL, 'In Process', 'Request is currently in process| Ref # 20176001238', NULL, NULL, '2020-07-10 15:11:21', '2020-07-10 15:11:21'),
(2985, 2028, 3755, NULL, NULL, 'In Process', 'Rep: Raven It takes 30 days till you submitted your request will take more time. REf: 20202003000690', NULL, NULL, '2020-07-20 14:01:21', '2020-07-20 14:01:21'),
(2986, 1006, 3755, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Request has been approved:   PROVIDER NAME           PROVIDER PTAN  PROVIDER NPI    EFFECTIVE DATE   END DATE MARY C GONZALEZ NP      P02490924       1952713083         05/01/2020             N/A', NULL, NULL, '2020-08-06 16:56:21', '2020-08-06 16:56:21'),
(2987, 1006, 3755, NULL, '2020-08-13 00:00:00.000', 'Approved', NULL, NULL, NULL, '2020-08-06 16:56:27', '2020-08-06 16:56:27'),
(2988, 1006, 3756, NULL, NULL, 'New/Not Initiated', 'Sent following email to Burgos Soto, Diana 244 Diana.BurgosSoto@cigna.com>:  Sub: Cigna Behavioral- Prisca Hefti  \"Hey Diana,  I\'ve updated Prisca\'s CAQH, there\'s no longer a work history gap.   Please let me know if there\'s anything else you need from me to finish processing her request.  Thank you!\" ', NULL, NULL, '2020-06-24 17:40:42', '2020-06-24 17:40:42'),
(2989, 1006, 3756, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-24 17:40:55', '2020-06-24 17:40:55'),
(2990, 1006, 3756, NULL, NULL, 'Approved', 'Received following reply from Emily:  \"Here is her effective date and networks:  Her effective date is 5/20/2020 and she’s contracted for all lines of business Cigna writes in the state.\" ', NULL, NULL, '2020-06-24 17:45:50', '2020-06-24 17:45:50'),
(2991, 1006, 3758, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-06-24 18:01:52', '2020-06-24 18:01:52'),
(2992, 1006, 3758, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-06-24 18:02:40', '2020-06-24 18:02:40'),
(2993, 1006, 3759, NULL, NULL, 'New/Not Initiated', 'BCBSRI has BlueCHiP Direct Advance EX that is not currently enrolled for Mahreen, need to get her enrolled ASAP.  ', NULL, NULL, '2020-06-25 12:05:17', '2020-06-25 12:05:17'),
(2994, 1006, 3759, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Provider Eff: 12/01/2019 Welcome Letter attached. ', NULL, NULL, '2020-10-02 15:32:36', '2020-10-02 15:32:36'),
(2995, 1006, 3760, NULL, NULL, 'New/Not Initiated', 'Sent following email to Cheryl:  \"Hello Cheryl,   I had a question, we are getting denials on claims for Mahreen Rashid for the above mentioned Fallon Health insurance plan (Commercial Standard CBHI) whereas on her welcome letter it mentions that we are in-network under all lines of Fallon Health insurance plans, could you please tell me under what insurance this plan comes under and how we could either get in-network or get our claims to paid?  Thank you!\' ', NULL, NULL, '2020-06-25 17:12:30', '2020-06-25 17:12:30'),
(2996, 1006, 3760, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-25 17:12:43', '2020-06-25 17:12:43'),
(2997, 1006, 3760, NULL, NULL, 'In Process', 'Received following reply from Cheryl:  \"Good afternoon,  I am sorry but this is still being worked on, I had asked claims dept. to advise when payments will be made by Fallon.  As soon as I get an answer I will send you an updated email.  Thank you, Cheryl Williams. Provider Relation Rep. I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 Office: 800.397.1630 Direct: 781-496-4014 www.beaconhealthoptions.com\"', NULL, NULL, '2020-06-25 17:13:22', '2020-06-25 17:13:22'),
(2998, 1006, 3760, NULL, NULL, 'In Process', 'Sent followup to Cheryl:  \"Good afternoon Cheryl,   Were you able to get any updates from the claim department regarding this?   Thank you!\"', NULL, NULL, '2020-06-29 12:07:55', '2020-06-29 12:07:55'),
(2999, 1006, 3760, NULL, NULL, 'In Process', 'Hello,     Unfortunately there is no time frame I can give on these claims. All they advised me is that these claims are a large scale project and it will take them a little longer to complete.     Thank You!     Kayla Moura  Provider Relations I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 103  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.970.6632     ', NULL, NULL, '2020-07-16 09:35:07', '2020-07-16 09:35:07'),
(3000, 1006, 3760, NULL, NULL, 'In Process', 'Sent followup email to provider.relations@beaconhealthoptions.com:   Sub: RE: Fallon Health CBHI Benefit Query - Middlesex County - 04282020-7566894-010000  \"Good morning Kayla,    I wanted to check in with you again regarding the status of this request, have all of the claims been reprocessed as of yet? Since this is an on-going claim project, none of them claims will be timely filed, right?   Waiting to hear back from you, thank you. \"', NULL, NULL, '2020-07-16 09:36:02', '2020-07-16 09:36:02'),
(3001, 1006, 3760, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Sent email to provider.relations@beaconhealthoptions.com:  \"Hello,  I write to you on behalf of Spectrum Neuro Behavioral Care LLC, (TID - 83-4482753, NPI - 1356906572). I want to get an update regarding our request to get the Fallon CBHI Benefit added to our group, it\'s been almost 3 months with no concrete updates regarding the status and most of those claims will start becoming timely filled. We wish to set up a meeting with someone that can get this issue resolved ASAP.   Thanks.   Regards,  Brad Peterson | Claims Med | Office: 713.893.6214 Ext: 405 | Fax: 718-640-2713 | aa@claimsmedinc.com\"', NULL, NULL, '2020-08-19 10:06:51', '2020-08-19 10:06:51'),
(3002, 1005, 3760, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Awaiting response. Sent a reminder', NULL, NULL, '2020-09-24 15:13:35', '2020-09-24 15:13:35'),
(3003, 1006, 3760, NULL, '2020-10-09 00:00:00.000', 'Approved', 'Plan has been added and claims are reprocessing as per Kayla. Attached provider directory update. ', NULL, NULL, '2020-10-02 16:00:14', '2020-10-02 16:00:14'),
(3004, 2027, 3761, NULL, '2020-09-25 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare and effective date is 06/16/2020. Welcome letter is attached ', NULL, NULL, '2020-09-18 10:47:49', '2020-09-18 10:47:49'),
(3005, 2027, 3762, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Application has been submitted for this provider for enrollment in medicaid. PEP ticket SS is attached. ', NULL, NULL, '2020-10-13 17:31:27', '2020-10-13 17:31:27'),
(3006, 1006, 3762, NULL, '2020-11-02 00:00:00.000', 'In Process', 'The request still shows up as in-process on the TMHP provider portal with no other requirements noted. ', NULL, NULL, '2020-10-26 16:40:55', '2020-10-26 16:40:55'),
(3007, 2027, 3762, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Provider is still in process', NULL, NULL, '2020-11-02 14:00:24', '2020-11-02 14:00:24'),
(3008, 2027, 3762, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-09 15:49:40', '2020-11-09 15:49:40'),
(3009, 2027, 3762, NULL, '2020-11-23 00:00:00.000', 'Approved', 'Provider is now showing linked with medicaid in all three locations of (VMUC). Screenshot is attached.', NULL, NULL, '2020-11-16 09:55:29', '2020-11-16 09:55:29'),
(3010, 1006, 3763, NULL, NULL, 'New/Not Initiated', 'Sent following email to MBHPNetworkOperations@beaconhealthoptions.com:   Sub: ATTN: Garland Russell   \"Hello,    Please find the attached LOI for our group, please let me know if anything else is required for this request.   Thank you! ', NULL, NULL, '2020-06-26 09:17:23', '2020-06-26 09:17:23'),
(3011, 1006, 3763, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-26 09:17:32', '2020-06-26 09:17:32'),
(3012, 1006, 3763, NULL, NULL, 'In Process', 'Sent following email to \"Tarpley, Randy\" Randy.Tarpley@beaconhealthoptions.com:  Sub: MBHP Credentialing Package  \"Good morning Randy,  Are there any updates regarding the status of the groups credentialing? What\'s the expected turnaround time? As previously mentioned we need to expedite the request. Thanks. \"', NULL, NULL, '2020-06-26 09:21:28', '2020-06-26 09:21:28'),
(3013, 1006, 3763, NULL, NULL, 'In Process', 'Sent followup email to Randy: \"Hey Randy,   I just wanted to check in with you again to see if there were any updates regarding the provider and group.   Thanks. \"', NULL, NULL, '2020-07-20 18:01:37', '2020-07-20 18:01:37'),
(3014, 1006, 3763, NULL, NULL, 'In Process', 'Received following reply from Randy:   Sub: MBHP Credentialing Package  \"Hi Brad,  The application for both are still being reviewed. We are trying to complete this as quick as we can.  Randy Tarpley Provider Relations Representative, Network Operations  ––––––––––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership Beacon Health Options 1000 Washington Street Suite 310 Boston, MA 02118 Office: 617-790-4159 Fax: 877-390-2324 Initial Applications/Letters of Intent/Contracts ONLY Fax: 866-989-0019 MBHPNetworkOperations@beaconhealthoptions.com www.masspartnership.com \"', NULL, NULL, '2020-07-21 12:25:02', '2020-07-21 12:25:02'),
(3015, 1006, 3763, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent followup email to Randy. ', NULL, NULL, '2020-08-18 10:19:18', '2020-08-18 10:19:18'),
(3016, 1006, 3763, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent another followup email to \"Tarpley, Randy\" Randy.Tarpley@beaconhealthoptions.com> regarding enrollment status. ', NULL, NULL, '2020-09-15 17:19:17', '2020-09-15 17:19:17'),
(3017, 1006, 3763, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received a reply from Randy that he would get in touch with a specialist, asked him to get back to me again. ', NULL, NULL, '2020-09-23 16:06:27', '2020-09-23 16:06:27'),
(3018, 1006, 3763, NULL, '2020-10-08 00:00:00.000', 'In Process', 'Received reply from Medrano, Miguel Miguel.Medrano@beaconhealthoptions.com> Sub: MBHP Credentialing | Spectrum Neuro Behavioral Care, LLC with queries for the group, sent an email to Furquan for further clarification so we can move forward with this request.   ', NULL, NULL, '2020-10-01 09:34:09', '2020-10-01 09:34:09'),
(3019, 1006, 3763, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent following reply to Miguel with the forms attached that he requested:   \"Hello Miguel,  I apologize for the delay, for some reason these emails were going into my spam folder, I\'ve attached the requested information and I have following queries:Regarding member language percentages, we have no data as all the members we have received so far have spoken english.Cultural Competency needs to be filled out by each individual provider that is mentioned on the roster?Days/Hours of operation: Mon-Fri - 9AM to 6PM | Sat - 10AM to 4PM Office is both handicap accessible as well as accessible via public transportation.I\'ll be sending you the copy of the malpractice as soon as I can. Thank you.  \"', NULL, NULL, '2020-10-12 17:44:04', '2020-10-12 17:44:04'),
(3020, 1006, 3763, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Received the following update from Miguel @ Medrano, Miguel Miguel.Medrano@beaconhealthoptions.com>: \"From: Medrano, Miguel Sent: Tuesday, October 13, 2020 10:27 AM To: \'Brad Peterson\' aa@claimsmedinc.com> Cc: snbc@claimsmedinc.com Subject: RE: MBHP Credentialing | Spectrum Neuro Behavioral Care, LLC  Regarding member language percentages, we have no data as all the members we have received so far have spoken english. ·         The percentage of a language is zero percent if no members speak that language.  Cultural Competency needs to be filled out by each individual provider that is mentioned on the roster? ·         One attestation on behalf of the whole group is acceptable for the group application.   Please submit:  Member language percentages. (attached) Attestation of Cultural Competency Training (attached) Malpractice insurance Credentialing applications for the following Massachusetts providers: Mahreen Rashid (NPI:1396393146) Fauzie Wali-Khan (NPI:1699761965) Peggy Pionke (NPI:1699307322) Jonathan Schubert (NPI:1235755505) Jennifer Ullrich (NPI:1710489760) Pandeeswari Raveendran (NPI:1124247267)   Thanks,  Miguel Medrano MBHP Network Operations ––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership a Beacon Health Options company 1000 Washington Street, Suite 310 Boston, MA 02118 Email: miguel.medrano@beaconhealthoptions.com Fax: 877.390.2324 www.masspartnership.com\"  Currently waiting on Furquan to send us updated Malpractice which mentions both groups on it. ', NULL, NULL, '2020-10-20 13:36:39', '2020-10-20 13:36:39'),
(3021, 1006, 3763, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Sent following reply to Miguel with all of the requested information:  \"Hey Miguel,  I\'ve attached the remaining information hopefully, this suffices but do let me know if anything else might be needed.  I didn\'t attach the credentialing applications for Peggy, Jonathan & Jennifer as they are all LCSW\'s or are we able to credential them as well under the group? Thank you. \"', NULL, NULL, '2020-10-21 18:10:55', '2020-10-21 18:10:55'),
(3022, 1006, 3763, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Received following update from Miguel:  \"Received, thank you. Yes, do also credential LCSW providers under group practices. Please submit applications for these as well if they will be seeing MBHP members.     Thank you,  Miguel Medrano MBHP Network Operations ––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership a Beacon Health Options company 1000 Washington Street, Suite 310 Boston, MA 02118 Email: miguel.medrano@beaconhealthoptions.com Fax: 877.390.2324 www.masspartnership.com\"', NULL, NULL, '2020-10-28 17:52:36', '2020-10-28 17:52:36'),
(3023, 1006, 3763, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Request pending due to the individual provider\'s enrollment currently. ', NULL, NULL, '2020-11-04 17:34:23', '2020-11-04 17:34:23'),
(3024, 1006, 3763, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Sent following email to Miguel with LCSW providers information:  \"Hey Miguel,   Here are the filled applications for the LCSW\'s, I\'ll reply to your email regarding Mahreen, Pandeeswari & Fauzia as soon as I\'m able to.   Thanks. \"', NULL, NULL, '2020-11-12 18:44:40', '2020-11-12 18:44:40'),
(3025, 1006, 3763, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Sent following email to Medrano Miguel: \"Hey Miguel,   I\'m sorry for the delay, would we be able to set up a meeting tomorrow so I can go over a few questions I had regarding all of the providers missing information? Please let me know what number I should reach out to you at and when you will be available.  Thanks.  \"', NULL, NULL, '2020-11-25 11:12:50', '2020-11-25 11:12:50'),
(3026, 1006, 3763, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request. ', NULL, NULL, '2020-12-11 17:40:02', '2020-12-11 17:40:02'),
(3027, 1006, 3763, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Received the following approval email from MBHP @ Ortiz, Leslie Leslie.Ortiz@beaconhealthoptions.com:  Sub: zx - Welcome Packet- Spectrum Neuro Behavioral Care LCC- Facility- CAS#101146  \"Good Morning,  Thank you for your interest in joining the Massachusetts Behavioral Health Partnership (MBHP) and the three Accountable Care Organizations (ACOs: Community Care Cooperative, Partners HealthCare Choice, and Steward Health Choice) provider networks. MBHP is in receipt of the completed Credentialing Application for Spectrum Neuro Behavioral Care LLC, Facility. Spectrum Neuro Behavioral Care LLC, Facility has been approved to participate in the MBHP provider network, effective December 15, 2020.  The facility internal provider number is 101146.  Please find attached the following documents:  1.                  Official Welcome Cover Letter  2.                  MBHP and the three Accountable Care Organizations (ACOs: Community Care Cooperative, Partners HealthCare Choice, and Steward Health Choice) Exhibit A – Contracted Site(s). Please note there is one for each location contracted. There two Exhibit As – Contracted Sites if contracted with MBHP.  3.                  MBHP and the three Accountable Care Organizations (ACOs: Community Care Cooperative, Partners HealthCare Choice, and Steward Health Choice) Participation Agreement(s) –  4.                  MBHP and the three Accountable Care Organizations (ACOs: Community Care Cooperative, Partners HealthCare Choice, and Steward Health Choice) Outpatient Fee Schedule(s) Exhibit C.  5.                  Online Services Account Request Form (When completed, please fax to Beacon Health Options’ fax number on the top right hand corner of the form. Please do NOT return to MBHP.)  Please read the Welcome Cover Letter carefully. Please be sure to sign and date all attached Exhibit A-Contract(s) and Participation Agreement(s). These must be returned to MBHP by fax, email, or mail. (Please note that if you fax or email the signed documents to MBHP, we will not require the hard copies. Please keep them for your record.)  Any documents or questions may be addressed to MBHP via:  Department Email:          MBHPNetworkOperations@BeaconHealthOptions.com  Fax:                                  866-989-0019  Mail:                                 MBHP Network Operations Department                                          1000 Washington Street, Suite 310                                          Boston, MA 02118-5002  Please let me know if you have any questions.    Thank you,   Leslie Ortiz Credentialing Associate, Network Operations –––––––––––––––––––––––––––––––––––––––– Massachusetts Behavioral Health Partnership Beacon Health Options 1000 Washington Street, Suite 310 Boston, MA 02118 Office: 617-790-4031 Fax: 877-390-2324 MBHPNetworkOperations@BeaconHealthOptions.com www.masspartnership.com\"', NULL, NULL, '2021-04-12 10:47:09', '2021-04-12 10:47:09'),
(3028, 1006, 3764, NULL, NULL, 'New/Not Initiated', 'Sent following email to provider relations @ Beacon provider.relations@beaconhealthoptions.com:  Sub: Pricing Issue & Request  \"Hello,   I hope you\'re doing well, we wanted to discuss what we could do to get our reimbursements increased for our claims as currently we are getting the following average payments based on the CPTs, 90792: $95.06 | 99213 = $54.84   Whereas for other insurance\'s the average is much higher for initial & followup visits, around $170 & $70 respectively. Please let me know what we can do to rectify this and get our claims reprocessed.  Thanks.\"', NULL, NULL, '2020-06-29 12:25:57', '2020-06-29 12:25:57'),
(3029, 1006, 3764, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-06-29 12:28:36', '2020-06-29 12:28:36'),
(3030, 1006, 3764, NULL, NULL, 'In Process', 'Good morning,     For any rate increases, please fill out the attached amendment request and I will have it sent to the contracting department for processing.     Thank You!     Kayla Moura  Provider Relations I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 103  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.970.6632', NULL, NULL, '2020-07-16 09:34:04', '2020-07-16 09:34:04'),
(3031, 1006, 3764, NULL, '2020-08-12 00:00:00.000', 'In Process', 'Notes updated with relevant information. Will need to wait. ', NULL, NULL, '2020-08-05 15:43:01', '2020-08-05 15:43:01'),
(3032, 1006, 3764, NULL, '2020-09-04 00:00:00.000', 'In Process', 'Spoke to Sam @ 781-315-7000. Conversation is in Notes. ', NULL, NULL, '2020-08-28 14:11:49', '2020-08-28 14:11:49'),
(3033, 1006, 3764, NULL, '2020-12-01 00:00:00.000', 'On Hold', 'Request needs to be put on hold as we cannot increase the rates for the group currently.', NULL, NULL, '2020-10-15 15:06:28', '2020-10-15 15:06:28'),
(3034, 1019, 3764, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Group enrolled effective date 11/27/2019, attached is the Welcome Letter', NULL, NULL, '2021-08-30 10:21:32', '2021-08-30 10:21:32'),
(3035, 1006, 3765, NULL, NULL, 'New/Not Initiated', 'Submitted request online via PECOS', NULL, NULL, '2020-06-29 16:54:21', '2020-06-29 16:54:21'),
(3036, 1006, 3765, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-06-29 16:54:30', '2020-06-29 16:54:30'),
(3037, 1006, 3765, NULL, NULL, 'Approved', 'Group Member Provider/Supplier Name: MARY GONZALEZ Primary Practice Location: 500 E CAESAR AVE, STATCARE MINOR EMERGENCY CLINIC, KINGSVILLE, TX 78363-6322 Group Member National Provider Identifier (NPI): 1952713083 Group Member Provider Transaction Access Number (PTAN): 1D8276 Group Member Specialty: NURSE PRACTITIONER You are a: PARTICIPATING PROVIDER Effective Date: MAY 01, 2020 Group Legal Business Name/PTAN: RABAGOS HEALTH CARE PLLC 369376 Group National Provider Identifier (NPI): 1689924904', NULL, NULL, '2020-06-29 16:54:51', '2020-06-29 16:54:51'),
(3038, 1006, 3766, NULL, NULL, 'New/Not Initiated', 'Received following email from Hyacinth Reid: \"Hi Brad,   State of MA   Peggy Pionke, 6507988 – effective date  6/15/2020 Prisca Hefti, 6846902-effective date  7/1/2020   The first Health products for the providers above will also  be loaded by our Provider data services and may take a few weeks to reflect in the system   Provider Katie Tawakol  address has been updated in the system to reflect the  61 Lincoln Street location.   Thank you\" ', NULL, NULL, '2020-06-29 17:53:50', '2020-06-29 17:53:50'),
(3039, 1006, 3766, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-06-29 17:54:12', '2020-06-29 17:54:12'),
(3040, 1006, 3766, NULL, NULL, 'In Process', 'Sent followup email: \"Hello,   I wanted to check in with you again, we wanted to verify if the following providers had first health products effective:  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Peggy Pionke NPI# 1699307322  TIN# 83-4482753  Please get back to me as soon as you\'re able.  Thanks.\"', NULL, NULL, '2020-06-29 18:04:14', '2020-06-29 18:04:14'),
(3041, 1006, 3766, NULL, NULL, 'Approved', 'Received following email from Reid, Hyacinth ReidH@rfl.com>:  Sub: FW: Re: Re: Re: Re: FW: Re: Re: Re: Re: Re: Provider Status Update - Peggy Pionke, 6507988 and Prisca Hefti, 6846902  \"Good Morning, The first Health products are listed for the providers Pionke and Hefffi Thank you,\" ', NULL, NULL, '2020-07-01 10:26:55', '2020-07-01 10:26:55'),
(3042, 1006, 3766, NULL, NULL, 'Approved', '\"Good Morning,   Provider Name: Peggy Pionke effective date for First health -6/15/2020 NPI# 1699307322  Provider Name: Prisca Hefti- effective date for First health -7/1/2020 NPI# 1508133182  Thank you, Hyacinth Reid NE Network Relations Specialist Aetna Behavioral Health\"', NULL, NULL, '2020-07-02 10:50:44', '2020-07-02 10:50:44');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(3043, 1006, 3768, NULL, NULL, 'New/Not Initiated', 'Received following email from Hyacinth Reid: \"Hi Brad,   State of MA   Peggy Pionke, 6507988 – effective date  6/15/2020 Prisca Hefti, 6846902-effective date  7/1/2020   The first Health products for the providers above will also  be loaded by our Provider data services and may take a few weeks to reflect in the system   Provider Katie Tawakol  address has been updated in the system to reflect the  61 Lincoln Street location.   Thank you\" ', NULL, NULL, '2020-06-29 17:58:21', '2020-06-29 17:58:21'),
(3044, 1006, 3768, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-06-29 17:58:41', '2020-06-29 17:58:41'),
(3045, 1006, 3768, NULL, NULL, 'In Process', 'Sent followup email: \"Hello,   I wanted to check in with you again, we wanted to verify if the following providers had first health products effective:  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Peggy Pionke NPI# 1699307322  TIN# 83-4482753  Please get back to me as soon as you\'re able.  Thanks.\"', NULL, NULL, '2020-06-29 18:04:02', '2020-06-29 18:04:02'),
(3046, 1006, 3768, NULL, NULL, 'Approved', 'Received following email from Reid, Hyacinth ReidH@rfl.com>:  Sub: FW: Re: Re: Re: Re: FW: Re: Re: Re: Re: Re: Provider Status Update - Peggy Pionke, 6507988 and Prisca Hefti, 6846902  \"Good Morning, The first Health products are listed for the providers Pionke and Hefffi Thank you,\" ', NULL, NULL, '2020-07-01 09:29:09', '2020-07-01 09:29:09'),
(3047, 1006, 3768, NULL, NULL, 'Approved', '\"Good Morning,   Provider Name: Peggy Pionke effective date for First health -6/15/2020 NPI# 1699307322  Provider Name: Prisca Hefti- effective date for First health -7/1/2020 NPI# 1508133182  Thank you, Hyacinth Reid NE Network Relations Specialist Aetna Behavioral Health\"', NULL, NULL, '2020-07-02 10:51:02', '2020-07-02 10:51:02'),
(3048, 1006, 3769, NULL, NULL, 'New/Not Initiated', 'Submitted HCAS & W9:  Sub: Katie Tawakol - HCAS & W9  \"Hello,   Please find the attached HCAS form for our provider, we wish to get them linked as in-network for our group. Please let me know if anything else is needed.   Thank you!\"', NULL, NULL, '2020-07-01 10:57:48', '2020-07-01 10:57:48'),
(3049, 1006, 3769, NULL, NULL, 'Approved', 'Received following email from Arrin Rines arines@commonwealthcare.org>:  Sub: RE: Status of Credentialing & Enrollment Request  \"July 1, 2020  Katie Tawakol, NP  RE: Status of Credentialing & Enrollment Request  The Commonwealth Care Alliance (CCA) Credentialing Department is pleased to inform you that your credentialing application has been approved on 6/26/2020.  Should you have any questions or concerns regarding your credentialing status, please direct inquiries to: Credentialing@commonwealthcare.org.  Sincerely, CCA Credentialing Department 529 Main St, Suite 216 Charlestown, MA 02129\"', NULL, NULL, '2020-07-01 10:59:39', '2020-07-01 10:59:39'),
(3050, 1006, 4764, NULL, NULL, 'New/Not Initiated', 'Received a contract from Triwest:   \"TriWest Healthcare Alliance providercontracting@triwest.com The new Department of Veterans Affairs (VA) Community Care Network (CCN) will begin rolling out June 8, 2020.  All providers in CCN Region 4 must be fully CCN contracted and credentialed with TriWest Healthcare Alliance in order to continue receiving referrals for Veterans under CCN.  A CCN contract has been sent to your office. However, it has not yet been returned to TriWest. To expedite this process, we have attached your new CCN contract which can be signed electronically. Please sign and return by May 18, 2020.  If you are unsure of your office’s contract status or if you have any questions, please contact Provider Services at 866-284-3743 or providerservices@triwest.com.  Thank you for continuing to support our Veterans.\"', NULL, NULL, '2020-07-02 14:41:11', '2020-07-02 14:41:11'),
(3051, 1006, 4764, NULL, NULL, 'In Process', 'Contract has been signed and sent back to Triwest. ', NULL, NULL, '2020-07-02 14:41:28', '2020-07-02 14:41:28'),
(3052, 2027, 4764, NULL, '2020-09-24 00:00:00.000', 'In Process', 'To: providercontracting@triwest.com  Sub: (For Group)-(Normandy Urgent Care Center)-(TriWest)  May i know the current status of the group mentioned below: Group Name: Normandy Urgent Care Center   Group Tax-ID: 27-0796429   Group NPI# 1407171077   Thanks. ', NULL, NULL, '2020-09-17 13:40:26', '2020-09-17 13:40:26'),
(3053, 2027, 4764, NULL, '2020-10-27 00:00:00.000', 'In Process', 'From: imilazzo@triwest.com  Sub: (For Group)-(Normandy Urgent Care Center)-(TriWest)  Good morning,     I was able to take a look at the contract for Normandy Urgent Care Center PA for a current status.  It seems that TriWest never received a signed contract by the provider. I do apologize for inconvenience. If you could please send a signed contract back to this email or providercontracting@triwest.com  that would be wonderful. I can then get that contract processed for you.     Warm regards,     Isabella Milazzo  Contract Support Specialist  TriWest Healthcare Alliance', NULL, NULL, '2020-10-20 13:33:54', '2020-10-20 13:33:54'),
(3054, 2027, 4764, NULL, '2020-10-27 00:00:00.000', 'In Process', 'To: 	providercontracting@triwest.com  Please find the signed contract attached in this email as per your request to start the contracting process.  Thanks.', NULL, NULL, '2020-10-20 13:34:25', '2020-10-20 13:34:25'),
(3055, 2037, 4764, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email sent to imilazzo@triwest.com: -------------- Kindly confirm the receiving of the signed contract for below:  Group Name: Normandy Urgent Care Center   Group Tax-ID: 27-0796429   Group NPI# 1407171077 ', NULL, NULL, '2020-10-28 17:18:54', '2020-10-28 17:18:54'),
(3056, 2037, 4764, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-18 16:43:02', '2020-11-18 16:43:02'),
(3057, 2037, 4764, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Confirmation of receiving of the contract: ------------------- Good morning,   The contract for Normandy Urgent Care Center PA was received and uploaded into our system on October 21,2020. This contract is currently in process with the Net Sub BCBSTX for signatures. Once signatures are received the contract will continue its process for execution.    Warm regards,     Isabella Milazzo  Contract Support Specialist  TriWest Healthcare Alliance', NULL, NULL, '2020-11-20 10:44:38', '2020-11-20 10:44:38'),
(3058, 2037, 4764, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Follow up email sent to imilazzo@triwest.com', NULL, NULL, '2020-12-11 17:41:02', '2020-12-11 17:41:02'),
(3059, 2037, 4764, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-12-21 13:23:18', '2020-12-21 13:23:18'),
(3060, 2037, 4764, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Response received which is as follows.Need to allow more time. --------------  Milazzo, Isabella Tue, Dec 22, 12:42 PM (7 days ago) to me  Good morning,     I was able to  pull up the contract for Normandy Urgent Care. This contract is still in process with the NetSub for signatures. Once we receive signatures from the NetSub the contract will then continue its process down the line for execution. Thank you for your patience as Triwest is working as fast as they can to get contracts executed.', NULL, NULL, '2020-12-29 10:57:17', '2020-12-29 10:57:17'),
(3061, 1006, 4764, NULL, '2021-01-26 00:00:00.000', 'Approved', 'Welcome letter received for approval, attached for reference. ', NULL, NULL, '2021-01-19 17:54:45', '2021-01-19 17:54:45'),
(3062, 3040, 4764, NULL, '2021-06-25 00:00:00.000', 'Revalidation', 'I had a word with (Noiali) Triwest representative and she said the credentialing still in process.   Ref: PH-1315236-N6N2N8 ', NULL, NULL, '2021-06-18 10:08:41', '2021-06-18 10:08:41'),
(3063, 3040, 4764, NULL, '2021-07-15 00:00:00.000', 'Revalidation', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-08 11:54:27', '2021-07-08 11:54:27'),
(3064, 3040, 4764, NULL, '2021-07-29 00:00:00.000', 'Revalidated', 'Email rcvd from: jmonson@triwest.com  Subject:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  HI Adil,     I’ve attached the executed agreement. Please let me know if need anything further.     Thank you,  Jess ', NULL, NULL, '2021-07-22 14:23:33', '2021-07-22 14:23:33'),
(3065, 2027, 5764, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-06 14:16:11', '2020-07-06 14:16:11'),
(3066, 2027, 5764, NULL, NULL, 'Approved', 'Good afternoon Mr. Martin Rodriguez     This is the information that you provided back in June 29, 2020.  An update has been completed for Valley Med Urgent Care LLC, new service location:  800 E Alton Gloor Blvd, Brownsville, Please review the attached Change of Information and W-9 and let me know if this is correct.      VALLEY MED URGENT CARE PLLC, 2534 BOCA CHICA BLVD  SERVICE  2534 BOCA CHICA BLVD BROWNSVILLE, TX     VALLEY MED URGENT CARE PLLC, 800 E ALTON GLOOR BLVD  SERVICE  800 E ALTON GLOOR BLVD BROWNSVILLE              Thank you', NULL, NULL, '2020-07-06 14:17:36', '2020-07-06 14:17:36'),
(3067, 1006, 5764, NULL, NULL, 'Approved', 'Test ', NULL, NULL, '2020-07-22 09:06:25', '2020-07-22 09:06:25'),
(3068, 1006, 5765, NULL, NULL, 'New/Not Initiated', '      Application Tracking ID: T070620200004002        NPI: 1710489760        Medicare ID:         Name: JENNIFER LEE ULLRICH          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149 ', NULL, NULL, '2020-07-06 17:46:22', '2020-07-06 17:46:22'),
(3069, 1006, 5765, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-06 17:46:28', '2020-07-06 17:46:28'),
(3070, 1006, 5765, NULL, NULL, 'In Process', 'Status update via NGS Enrollment Status Tool:   \"Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-07-21 10:21:07', '2020-07-21 10:21:07'),
(3071, 1006, 5765, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Received deficiency from Medicare requesting masters degree of Jennifer, attached on PECOS and sent out. ', NULL, NULL, '2020-08-06 11:53:39', '2020-08-06 11:53:39'),
(3072, 1006, 5765, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Left a VM to Michael Thompson @ 781-741-3245 regarding the status of this query. ', NULL, NULL, '2020-08-17 12:24:11', '2020-08-17 12:24:11'),
(3073, 1006, 5765, NULL, '2020-09-02 00:00:00.000', 'In Process', 'CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000024970	 CMS855I Web	 07/06/2020	  Status:  This application is in process. Please expect to receive more information in 3 – 4 weeks.', NULL, NULL, '2020-08-26 09:42:23', '2020-08-26 09:42:23'),
(3074, 1006, 5765, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Application Tracking ID: T070620200004002 NPI ID: 1710489760 Medicare ID: S400676729 Name: JENNIFER ULLRICH State: MA Form Type: 855I Date: 08/26/2020 Status: APPROVED', NULL, NULL, '2020-08-26 10:06:08', '2020-08-26 10:06:08'),
(3075, 1006, 5766, NULL, NULL, 'New/Not Initiated', 'Application Status       PEP Ticket Number Submitted                           17041990', NULL, NULL, '2020-07-07 11:59:17', '2020-07-07 11:59:17'),
(3076, 1005, 5766, NULL, NULL, 'In Process', 'Application Status   In Progress PEP Ticket Number 17041990', NULL, NULL, '2020-07-09 12:04:12', '2020-07-09 12:04:12'),
(3077, 2027, 5766, NULL, NULL, 'In Process', 'Application still in process. Ticket#17041990', NULL, NULL, '2020-07-13 15:35:30', '2020-07-13 15:35:30'),
(3078, 1005, 5766, NULL, NULL, 'In Process', 'Received a D.Letter from TMHP. Copy attached.', NULL, NULL, '2020-07-14 12:20:29', '2020-07-14 12:20:29'),
(3079, 1005, 5766, NULL, NULL, 'In Process', 'Corrected application has been submitted. Application Status: In Progress PEP Ticket Number: 17041990', NULL, NULL, '2020-07-14 12:25:06', '2020-07-14 12:25:06'),
(3080, 1005, 5766, NULL, NULL, 'In Process', 'Spoke with Evelyn, She asked me to update the address First via PIMS - Provider Information section and said once this gets approved then we can add additional rendering providers. Request submitted | PEP Transaction ID 17081914', NULL, NULL, '2020-07-20 16:49:57', '2020-07-20 16:49:57'),
(3081, 2027, 5766, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Group is enrolled with medicaid screenshot from tmhp is attached for the confirmation', NULL, NULL, '2020-08-18 16:34:30', '2020-08-18 16:34:30'),
(3082, 1006, 5767, NULL, NULL, 'New/Not Initiated', 'Application Status      PEP Ticket Number Submitted                     17041990', NULL, NULL, '2020-07-07 12:01:13', '2020-07-07 12:01:13'),
(3083, 1005, 5767, NULL, NULL, 'In Process', 'Application Status   In Process                         PEP Ticket Number 17041990', NULL, NULL, '2020-07-09 12:03:22', '2020-07-09 12:03:22'),
(3084, 2027, 5767, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and effective date is 5/8/2020', NULL, NULL, '2020-08-19 10:41:21', '2020-08-19 10:41:21'),
(3085, 2027, 5768, NULL, NULL, 'New/Not Initiated', 'Location updated alton gloor', NULL, NULL, '2020-07-07 13:30:44', '2020-07-07 13:30:44'),
(3086, 2027, 5768, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:30:58', '2020-07-07 13:30:58'),
(3087, 2027, 5769, NULL, NULL, 'New/Not Initiated', 'Location updated alton gloor', NULL, NULL, '2020-07-07 13:32:40', '2020-07-07 13:32:40'),
(3088, 2027, 5769, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:32:53', '2020-07-07 13:32:53'),
(3089, 2027, 5770, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:34:17', '2020-07-07 13:34:17'),
(3090, 2027, 5770, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:34:25', '2020-07-07 13:34:25'),
(3091, 2027, 5772, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:37:46', '2020-07-07 13:37:46'),
(3092, 2027, 5772, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:37:58', '2020-07-07 13:37:58'),
(3093, 2027, 5773, NULL, NULL, 'New/Not Initiated', 'Location updated alton gloor', NULL, NULL, '2020-07-07 13:39:10', '2020-07-07 13:39:10'),
(3094, 2027, 5773, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:39:18', '2020-07-07 13:39:18'),
(3095, 3040, 5773, NULL, NULL, 'Revalidation', 'Email sent to: TXMAContracting@cigna.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Greetings,   Hope you are doing well. Please find the attached Facility/Ancillary network interest form to enroll in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 14:20:18', '2021-06-01 14:20:18'),
(3096, 3040, 5773, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-06-21 08:58:32', '2021-06-21 08:58:32'),
(3097, 3040, 5773, NULL, '2021-07-15 00:00:00.000', 'Revalidation', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-08 16:48:00', '2021-07-08 16:48:00'),
(3098, 3040, 5773, NULL, '2021-08-04 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-07-28 14:32:49', '2021-07-28 14:32:49'),
(3099, 3040, 5773, NULL, '2021-08-24 00:00:00.000', 'Revalidation', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:15', '2021-08-17 09:37:15'),
(3100, 10057, 5773, NULL, '2021-11-08 00:00:00.000', 'Revalidation', 'Email Sent To : TXMAContracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Good Morning,  Hope all is well. I\'m writing this email to follow-up about our group locations credentialing request. Please get back to me once you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-01 11:53:32', '2021-11-01 11:53:32'),
(3101, 10057, 5773, NULL, '2021-12-07 00:00:00.000', 'Revalidation', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:08:38', '2021-11-30 13:08:38'),
(3102, 10057, 5773, NULL, '2021-12-13 00:00:00.000', 'Revalidation', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:42:12', '2021-12-06 17:42:12'),
(3103, 10057, 5773, NULL, '2021-12-20 00:00:00.000', 'Revalidation', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:47:11', '2021-12-13 12:47:11'),
(3104, 10057, 5773, NULL, '2021-12-27 00:00:00.000', 'Revalidation', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:49:14', '2021-12-20 11:49:14'),
(3105, 10057, 5773, NULL, '2022-01-03 00:00:00.000', 'Revalidation', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:11:25', '2021-12-27 11:11:25'),
(3106, 20067, 5773, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch.', NULL, NULL, '2022-01-18 10:56:49', '2022-01-18 10:56:49'),
(3107, 20067, 5773, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 11:03:39', '2022-01-18 11:03:39'),
(3108, 20067, 5773, NULL, '2022-02-04 00:00:00.000', 'Revalidation', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:57:25', '2022-01-28 17:57:25'),
(3109, 2027, 5776, NULL, NULL, 'New/Not Initiated', 'Location updated alton gloor', NULL, NULL, '2020-07-07 13:45:47', '2020-07-07 13:45:47'),
(3110, 2027, 5776, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:45:57', '2020-07-07 13:45:57'),
(3111, 2027, 5777, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:46:56', '2020-07-07 13:46:56'),
(3112, 2027, 5777, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:47:05', '2020-07-07 13:47:05'),
(3113, 3040, 5777, NULL, NULL, 'Revalidation', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:36:05', '2021-04-14 13:36:05'),
(3114, 3040, 5777, NULL, NULL, 'Revalidated', 'Location added with Galaxy Health Plan.   Please see attachment. ', NULL, NULL, '2021-05-04 13:56:35', '2021-05-04 13:56:35'),
(3115, 2027, 5779, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:49:40', '2020-07-07 13:49:40'),
(3116, 2027, 5779, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:49:50', '2020-07-07 13:49:50'),
(3117, 3040, 5779, NULL, NULL, 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Type of Contract || Valley Med Urgent Care PLLC ||Health Smart ||  Greetings,  I just wanted to follow up regarding my previous email.   Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-23 08:17:08', '2021-04-23 08:17:08'),
(3118, 3040, 5779, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com, mdiprsupport@healthsmart.com, MDIPR@healthsmart.com  Subject: Type of Contract || Valley Med Urgent Care PLLC ||Health Smart ||  Greetings,   Hope you are doing well. I wanted to find the type of contract for the below mentioned group. Can you please check and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-21 09:19:05', '2021-06-21 09:19:05'),
(3119, 3040, 5779, NULL, '2021-06-29 00:00:00.000', 'Revalidated', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Type of Contract || Valley Med Urgent Care PLLC ||Health Smart ||  Hi,  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 82294)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-22 08:32:59', '2021-06-22 08:32:59'),
(3120, 2027, 5780, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:50:56', '2020-07-07 13:50:56'),
(3121, 2027, 5780, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:51:04', '2020-07-07 13:51:04'),
(3122, 3040, 5780, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-03-25 09:29:47', '2021-03-25 09:29:47'),
(3123, 3040, 5780, NULL, NULL, 'Revalidated', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana || Greetings,   Hope you are doing well. Please find the attached facility credentialing application form as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-04-14 14:21:28', '2021-04-14 14:21:28'),
(3124, 3040, 5780, NULL, '2021-06-23 00:00:00.000', 'Revalidated', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:06:06', '2021-06-16 15:06:06'),
(3125, 3040, 5780, NULL, '2021-06-29 00:00:00.000', 'Revalidated', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:43:58', '2021-06-22 11:43:58'),
(3126, 3040, 5780, NULL, '2021-07-16 00:00:00.000', 'Revalidated', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Hello,   This is a follow up email regarding the additional location status for the below group in Humana in our group Valley Med Urgent Care PLLC under the below locations.    Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Waiting for your response.   Thank you', NULL, NULL, '2021-07-09 12:03:37', '2021-07-09 12:03:37'),
(3127, 2027, 5782, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:54:06', '2020-07-07 13:54:06'),
(3128, 2027, 5782, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:54:13', '2020-07-07 13:54:13'),
(3129, 2027, 5783, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:55:10', '2020-07-07 13:55:10'),
(3130, 2027, 5783, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:55:18', '2020-07-07 13:55:18'),
(3131, 2027, 5784, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 13:56:31', '2020-07-07 13:56:31'),
(3132, 2027, 5784, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 13:56:39', '2020-07-07 13:56:39'),
(3133, 2027, 5785, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 14:04:35', '2020-07-07 14:04:35'),
(3134, 2027, 5785, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:04:44', '2020-07-07 14:04:44'),
(3135, 2027, 5786, NULL, NULL, 'New/Not Initiated', 'Location updated alton gloor', NULL, NULL, '2020-07-07 14:10:48', '2020-07-07 14:10:48'),
(3136, 2027, 5786, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:10:59', '2020-07-07 14:10:59'),
(3137, 2027, 5788, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 14:13:08', '2020-07-07 14:13:08'),
(3138, 2027, 5788, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:13:20', '2020-07-07 14:13:20'),
(3139, 1006, 5788, NULL, NULL, 'Revalidation', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:47:27', '2021-04-30 15:47:27'),
(3140, 11056, 5788, NULL, '2021-06-26 00:00:00.000', 'Revalidation', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:52:14', '2021-06-18 16:52:14'),
(3141, 3040, 5788, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:10', '2021-07-05 14:48:10'),
(3142, 3040, 5788, NULL, '2021-07-29 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-22 16:41:30', '2021-07-22 16:41:30'),
(3143, 2027, 5789, NULL, NULL, 'New/Not Initiated', 'location updated alton gloor', NULL, NULL, '2020-07-07 14:14:22', '2020-07-07 14:14:22'),
(3144, 2027, 5789, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:14:31', '2020-07-07 14:14:31'),
(3145, 2027, 5791, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor', NULL, NULL, '2020-07-07 14:20:52', '2020-07-07 14:20:52'),
(3146, 2027, 5791, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:20:59', '2020-07-07 14:20:59'),
(3147, 2027, 5792, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:22:20', '2020-07-07 14:22:20'),
(3148, 2027, 5792, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:22:26', '2020-07-07 14:22:26'),
(3149, 2027, 5793, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:23:19', '2020-07-07 14:23:19'),
(3150, 2027, 5793, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:23:27', '2020-07-07 14:23:27'),
(3151, 2027, 5793, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 14:25:34', '2020-07-23 14:25:34'),
(3152, 2027, 5793, NULL, NULL, 'In Process', 'From:  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 14:26:00', '2020-07-23 14:26:00'),
(3153, 2027, 5793, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Hernandez, Eder Francisco    Provider NPI#  1386956852     Group Name: Valley Med Urgent Care PLLC      Tax ID:  81-5123542    Thanks.', NULL, NULL, '2020-10-11 16:45:24', '2020-10-11 16:45:24'),
(3154, 2037, 5793, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Follow up email sent to ProfessionalProviderNetworkDept@bcbstx.com', NULL, NULL, '2020-10-28 17:31:47', '2020-10-28 17:31:47'),
(3155, 2027, 5793, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  This is a follow up email. Please reply to me as soon as possible  Thanks.', NULL, NULL, '2020-11-06 14:28:57', '2020-11-06 14:28:57'),
(3156, 2027, 5793, NULL, '2020-11-13 00:00:00.000', 'Approved', 'Provider is linked with the insurance on this location. effective date is 3/9/2018', NULL, NULL, '2020-11-06 16:39:24', '2020-11-06 16:39:24'),
(3157, 2027, 5795, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:25:42', '2020-07-07 14:25:42'),
(3158, 2027, 5795, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:25:48', '2020-07-07 14:25:48'),
(3159, 2027, 5796, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:26:52', '2020-07-07 14:26:52'),
(3160, 2027, 5796, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:27:03', '2020-07-07 14:27:03'),
(3161, 2027, 5798, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:29:57', '2020-07-07 14:29:57'),
(3162, 2027, 5798, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:30:03', '2020-07-07 14:30:03'),
(3163, 3040, 5798, NULL, NULL, 'Revalidation', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:10', '2021-04-14 13:39:10'),
(3164, 3040, 5798, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:29', '2021-05-04 14:10:29'),
(3165, 2027, 5800, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:32:24', '2020-07-07 14:32:24'),
(3166, 2027, 5800, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:32:32', '2020-07-07 14:32:32'),
(3167, 2027, 5801, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:33:28', '2020-07-07 14:33:28'),
(3168, 2027, 5801, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:33:40', '2020-07-07 14:33:40'),
(3169, 3040, 5801, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you  ', NULL, NULL, '2021-03-25 09:47:50', '2021-03-25 09:47:50'),
(3170, 3040, 5801, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:06:02', '2021-06-16 15:06:02'),
(3171, 3040, 5801, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:53', '2021-06-22 11:47:53'),
(3172, 3040, 5801, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:17', '2021-07-09 12:02:17'),
(3173, 3040, 5801, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:49:37', '2021-07-20 11:49:37'),
(3174, 2027, 5803, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:36:41', '2020-07-07 14:36:41'),
(3175, 2027, 5803, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:36:48', '2020-07-07 14:36:48'),
(3176, 2027, 5804, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:38:42', '2020-07-07 14:38:42'),
(3177, 2027, 5804, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:38:48', '2020-07-07 14:38:48'),
(3178, 2027, 5805, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:41:47', '2020-07-07 14:41:47'),
(3179, 2027, 5805, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:41:54', '2020-07-07 14:41:54'),
(3180, 2027, 5806, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:45:03', '2020-07-07 14:45:03'),
(3181, 2027, 5806, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:45:10', '2020-07-07 14:45:10'),
(3182, 2027, 5807, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:46:14', '2020-07-07 14:46:14'),
(3183, 2027, 5807, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:46:20', '2020-07-07 14:46:20'),
(3184, 2027, 5809, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:48:56', '2020-07-07 14:48:56'),
(3185, 2027, 5809, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:49:04', '2020-07-07 14:49:04');
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
(3186, 1006, 5809, NULL, NULL, 'Revalidation', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:47:23', '2021-04-30 15:47:23'),
(3187, 11056, 5809, NULL, '2021-06-26 00:00:00.000', 'Revalidation', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:51:54', '2021-06-18 16:51:54'),
(3188, 3040, 5809, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:09', '2021-07-05 14:48:09'),
(3189, 3040, 5809, NULL, '2021-07-22 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:56:35', '2021-07-15 11:56:35'),
(3190, 2027, 5810, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 14:52:06', '2020-07-07 14:52:06'),
(3191, 2027, 5810, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-07 14:52:13', '2020-07-07 14:52:13'),
(3192, 2027, 5810, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 14:52:20', '2020-07-07 14:52:20'),
(3193, 2027, 5812, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:20:33', '2020-07-07 15:20:33'),
(3194, 2027, 5812, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:20:39', '2020-07-07 15:20:39'),
(3195, 2027, 5813, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:22:20', '2020-07-07 15:22:20'),
(3196, 2027, 5813, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:22:32', '2020-07-07 15:22:32'),
(3197, 2027, 5814, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:23:33', '2020-07-07 15:23:33'),
(3198, 2027, 5814, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:23:39', '2020-07-07 15:23:39'),
(3199, 2027, 5816, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:26:47', '2020-07-07 15:26:47'),
(3200, 2027, 5816, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:26:56', '2020-07-07 15:26:56'),
(3201, 2027, 5817, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:29:04', '2020-07-07 15:29:04'),
(3202, 2027, 5817, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:29:10', '2020-07-07 15:29:10'),
(3203, 3040, 5817, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-03-25 09:44:55', '2021-03-25 09:44:55'),
(3204, 3040, 5817, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:58', '2021-06-16 15:05:58'),
(3205, 3040, 5817, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:52', '2021-06-22 11:47:52'),
(3206, 3040, 5817, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:18', '2021-07-09 12:02:18'),
(3207, 3040, 5817, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:29', '2021-07-20 11:50:29'),
(3208, 2027, 5819, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:34:11', '2020-07-07 15:34:11'),
(3209, 2027, 5819, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:34:18', '2020-07-07 15:34:18'),
(3210, 2027, 5820, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:54:28', '2020-07-07 15:54:28'),
(3211, 2027, 5820, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:54:34', '2020-07-07 15:54:34'),
(3212, 2027, 5821, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:57:34', '2020-07-07 15:57:34'),
(3213, 2027, 5821, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:57:41', '2020-07-07 15:57:41'),
(3214, 2027, 5822, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 15:59:21', '2020-07-07 15:59:21'),
(3215, 2027, 5822, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 15:59:30', '2020-07-07 15:59:30'),
(3216, 2027, 5823, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:32:14', '2020-07-07 16:32:14'),
(3217, 2027, 5823, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:32:21', '2020-07-07 16:32:21'),
(3218, 1006, 5823, NULL, NULL, 'Revalidation', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:47:19', '2021-04-30 15:47:19'),
(3219, 11056, 5823, NULL, '2021-06-26 00:00:00.000', 'Revalidation', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:51:15', '2021-06-18 16:51:15'),
(3220, 3040, 5823, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:08', '2021-07-05 14:48:08'),
(3221, 3040, 5823, NULL, '2021-07-22 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:37:12', '2021-07-15 11:37:12'),
(3222, 2027, 5824, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:33:24', '2020-07-07 16:33:24'),
(3223, 2027, 5824, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:33:32', '2020-07-07 16:33:32'),
(3224, 2027, 5826, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-07 16:36:09', '2020-07-07 16:36:09'),
(3225, 2027, 5826, NULL, NULL, 'Approved', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:36:17', '2020-07-07 16:36:17'),
(3226, 2027, 5827, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:36:58', '2020-07-07 16:36:58'),
(3227, 2027, 5827, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:37:05', '2020-07-07 16:37:05'),
(3228, 2027, 5829, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:38:46', '2020-07-07 16:38:46'),
(3229, 2027, 5829, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:38:51', '2020-07-07 16:38:51'),
(3230, 2027, 5830, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:39:38', '2020-07-07 16:39:38'),
(3231, 2027, 5830, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:39:45', '2020-07-07 16:39:45'),
(3232, 2027, 5832, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:41:33', '2020-07-07 16:41:33'),
(3233, 2027, 5832, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:41:40', '2020-07-07 16:41:40'),
(3234, 2027, 5833, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:42:21', '2020-07-07 16:42:21'),
(3235, 2027, 5833, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:42:27', '2020-07-07 16:42:27'),
(3236, 2027, 5835, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:44:10', '2020-07-07 16:44:10'),
(3237, 2027, 5835, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:44:15', '2020-07-07 16:44:15'),
(3238, 2027, 5836, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:44:54', '2020-07-07 16:44:54'),
(3239, 2027, 5836, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:45:00', '2020-07-07 16:45:00'),
(3240, 2027, 5837, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:45:56', '2020-07-07 16:45:56'),
(3241, 2027, 5837, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:46:03', '2020-07-07 16:46:03'),
(3242, 2027, 5838, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:46:48', '2020-07-07 16:46:48'),
(3243, 2027, 5838, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:46:54', '2020-07-07 16:46:54'),
(3244, 2027, 5839, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:47:49', '2020-07-07 16:47:49'),
(3245, 2027, 5839, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:47:55', '2020-07-07 16:47:55'),
(3246, 1006, 5839, NULL, NULL, 'Revalidation', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:47:16', '2021-04-30 15:47:16'),
(3247, 1005, 5839, NULL, '2021-06-08 00:00:00.000', 'Revalidated', 'Provider is not longer working with us. Updating the Task status to Revalidated to close it since there is no other status option available.', NULL, NULL, '2021-06-01 13:05:09', '2021-06-01 13:05:09'),
(3248, 2027, 5840, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:48:34', '2020-07-07 16:48:34'),
(3249, 2027, 5840, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:48:40', '2020-07-07 16:48:40'),
(3250, 2027, 5842, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:55:04', '2020-07-07 16:55:04'),
(3251, 2027, 5842, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:55:11', '2020-07-07 16:55:11'),
(3252, 2027, 5843, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:57:49', '2020-07-07 16:57:49'),
(3253, 2027, 5843, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:57:55', '2020-07-07 16:57:55'),
(3254, 2027, 5844, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 16:58:40', '2020-07-07 16:58:40'),
(3255, 2027, 5844, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 16:58:47', '2020-07-07 16:58:47'),
(3256, 2027, 5846, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:01:04', '2020-07-07 17:01:04'),
(3257, 2027, 5846, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:01:11', '2020-07-07 17:01:11'),
(3258, 3040, 5846, NULL, NULL, 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. I wanted to add the below mentioned group and providers in Health smart for our group Valley Med Urgent Care PLLC under the below mentioned locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Effective Date: 07/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Effective Date: 02/01/2013 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Effective Date: 03/01/2020 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 4: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852 Effective Date: 05/01/2018 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 5: Provider Name: Garcia, Homero Provider NPI# 1730564857 Effective Date: 02/01/2019 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 6: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Effective Date: 08/01/2020 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:06:44', '2021-04-14 13:06:44'),
(3259, 3040, 5846, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject; Re: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Hello,  Hope you are doing well. I wanted to add the below mentioned locations for our group and providers in Health smart for our group Valley Med Urgent Care PLLC under the below mentioned locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Effective Date: 07/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Effective Date: 02/01/2013 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Effective Date: 03/01/2020 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 4: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852 Effective Date: 05/01/2018 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 5: Provider Name: Garcia, Homero Provider NPI# 1730564857 Effective Date: 02/01/2019 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 6: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Effective Date: 08/01/2020 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 7: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Effective Date: 12/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-16 14:02:47', '2021-06-16 14:02:47'),
(3260, 3040, 5846, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Hi,  Please provide the listed below information.  * All practice location\'s phone and fax #  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to mdipr@healthsmart.com  (Inventory Log ID : 81973)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-07-05 10:59:03', '2021-07-05 10:59:03'),
(3261, 3040, 5846, NULL, '2021-07-30 00:00:00.000', 'Revalidated', 'Provider is participating with Health Smart. Please see attachment. ', NULL, NULL, '2021-07-23 14:13:22', '2021-07-23 14:13:22'),
(3262, 2027, 5847, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:01:59', '2020-07-07 17:01:59'),
(3263, 2027, 5847, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:02:06', '2020-07-07 17:02:06'),
(3264, 3040, 5847, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-03-25 09:31:01', '2021-03-25 09:31:01'),
(3265, 3040, 5847, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:52', '2021-06-16 15:05:52'),
(3266, 3040, 5847, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:48', '2021-06-22 11:47:48'),
(3267, 3040, 5847, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:19', '2021-07-09 12:02:19'),
(3268, 3040, 5847, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:30', '2021-07-20 11:50:30'),
(3269, 2027, 5849, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:03:38', '2020-07-07 17:03:38'),
(3270, 2027, 5849, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:03:44', '2020-07-07 17:03:44'),
(3271, 2027, 5850, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:04:46', '2020-07-07 17:04:46'),
(3272, 2027, 5850, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:04:52', '2020-07-07 17:04:52'),
(3273, 2027, 5851, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:05:42', '2020-07-07 17:05:42'),
(3274, 2027, 5851, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:05:49', '2020-07-07 17:05:49'),
(3275, 2027, 5852, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:06:43', '2020-07-07 17:06:43'),
(3276, 2027, 5852, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:06:51', '2020-07-07 17:06:51'),
(3277, 2027, 5853, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:07:39', '2020-07-07 17:07:39'),
(3278, 2027, 5853, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:07:48', '2020-07-07 17:07:48'),
(3279, 1006, 5853, NULL, NULL, 'Revalidation', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:47:12', '2021-04-30 15:47:12'),
(3280, 11056, 5853, NULL, '2021-06-26 00:00:00.000', 'Revalidation', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:50:43', '2021-06-18 16:50:43'),
(3281, 3040, 5853, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:08', '2021-07-05 14:48:08'),
(3282, 3040, 5853, NULL, '2021-07-22 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:44:44', '2021-07-15 11:44:44'),
(3283, 3040, 5853, NULL, '2021-07-22 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:50:36', '2021-07-15 11:50:36'),
(3284, 2027, 5854, NULL, NULL, 'New/Not Initiated', 'location updated to alton gloor ', NULL, NULL, '2020-07-07 17:08:40', '2020-07-07 17:08:40'),
(3285, 2027, 5854, NULL, NULL, 'Approved', NULL, NULL, NULL, '2020-07-07 17:08:48', '2020-07-07 17:08:48'),
(3286, 1006, 5856, NULL, NULL, 'New/Not Initiated', 'Submitted Contracting Application to BCBSMA via fax (617) 246-5053 ', NULL, NULL, '2020-07-07 18:01:07', '2020-07-07 18:01:07'),
(3287, 1006, 5856, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-07 18:01:19', '2020-07-07 18:01:19'),
(3288, 1006, 5856, NULL, NULL, 'In Process', 'Received a contract to sign from Signature requested on \"Spectrum Neuro Behav_BHG__Jennifer Ullrich_0720_Attachment A.pdf\". Request was signed and sent back for review.  ', NULL, NULL, '2020-07-17 17:27:59', '2020-07-17 17:27:59'),
(3289, 1006, 5856, NULL, NULL, 'In Process', 'Received following reply from Response to your Case 00007423: I.LICSW.Ullrich, Jennifer:  \"Dear Provider:  This is an automatic reply from an email box that is not monitored.  Blue Cross Blue Shield of Massachusetts acknowledges receipt of your recent submission.  It will be worked in the order it was received.  Any questions, please contact Network Management & Credentialing Services at  800-316-BLUE (2583).\"', NULL, NULL, '2020-07-17 17:29:58', '2020-07-17 17:29:58'),
(3290, 1006, 5856, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Contract is being processed, it should take 45 to 55 days of processing.  Ref# Terry 08/06/2020', NULL, NULL, '2020-08-06 15:34:09', '2020-08-06 15:34:09'),
(3291, 1006, 5856, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Sent a followup email to providerapplicationstatus@bcbsma.com', NULL, NULL, '2020-09-02 16:44:16', '2020-09-02 16:44:16'),
(3292, 1006, 5856, NULL, '2020-09-10 00:00:00.000', 'In Process', 'Received following reply from BCBSMA:  \"Hello,  We did receive Jennifer Ullrich’s contract on 07-17-2020 and the process has started. Standard processing time is approximately 50-60 days from receipt date. Once complete a welcome letter will be sent stating the effective date claims can be submitted to Blue Cross Blue Shield of Massachusetts.  Regards, Network Management Services Blue Cross Blue Shield of Massachusetts\" ', NULL, NULL, '2020-09-03 17:08:14', '2020-09-03 17:08:14'),
(3293, 1006, 5856, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Sent a follow-up email to them @ providerapplicationstatus@bcbsma.com . ', NULL, NULL, '2020-09-08 10:01:27', '2020-09-08 10:01:27'),
(3294, 1006, 5856, NULL, '2020-09-22 00:00:00.000', 'In Process', 'No response received, sent another follow-up email to providerapplicationstatus@bcbsma.com ', NULL, NULL, '2020-09-15 16:47:41', '2020-09-15 16:47:41'),
(3295, 1006, 5856, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Received following response from BCBS from providerapplicationstatus@bcbsma.com:  Sub: Infosecure RE: Jennifer Ullrich - Enrollment Status  \"Hello,  This is still in process. However it is in the final stages. You should be receiving a welcome letter stating the effective date within a few days.  Regards,   Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-09-16 09:10:16', '2020-09-16 09:10:16'),
(3296, 1006, 5856, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Received following response from BCBS from providerapplicationstatus@bcbsma.com:  Sub: Infosecure RE: Jennifer Ullrich - Enrollment Status  \"Hello,  This is still in process. However it is in the final stages. You should be receiving a welcome letter stating the effective date within a few days.  Regards,   Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-09-16 09:20:25', '2020-09-16 09:20:25'),
(3297, 1006, 5856, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Received welcome letter & executed contract. Both are attached.   Eff: 09/11/2020 ', NULL, NULL, '2020-09-16 14:19:31', '2020-09-16 14:19:31'),
(3298, 1006, 5857, NULL, NULL, 'New/Not Initiated', 'Online Behavioral Health Request Submitted', NULL, NULL, '2020-07-07 18:16:12', '2020-07-07 18:16:12'),
(3299, 1006, 5857, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-07 18:16:33', '2020-07-07 18:16:33'),
(3300, 1006, 5857, NULL, NULL, 'In Process', 'Sent followup email to \"Bevin, Laura J\" Laura.Bevin@aetna.com>:  Sub: Jennifer Ullrich - LCSW - SNBCare  \"Good morning Laura,  I wanted to check in with you regarding a status update for our provider, I sent in an online application to enroll the provider on 07/07/2020 and wanted to know the status of her enrollment.   Her details are below: Provider Name: Jennifer Lee Ullrich NPI# 1710489760 TIN# 83-4482753  Please get back to me as soon as you\'re able.   Thank you. \"', NULL, NULL, '2020-07-21 10:39:15', '2020-07-21 10:39:15'),
(3301, 1006, 5857, NULL, NULL, 'In Process', 'Received following reply from Laura Bevin:   Sub: Jennifer Ullrich - LCSW - SNBCare   \"Hello,  The application is in the early credentialing stages.  Thank you Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-07-21 12:21:04', '2020-07-21 12:21:04'),
(3302, 1006, 5857, NULL, '2020-08-16 00:00:00.000', 'In Process', 'Requested another followup from \"Bevin, Laura J\" Laura.Bevin@aetna.com> regarding the status of enrollment. ', NULL, NULL, '2020-08-06 15:44:30', '2020-08-06 15:44:30'),
(3303, 1006, 5857, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Providers CAQH is being verified for information currently.', NULL, NULL, '2020-08-10 09:52:38', '2020-08-10 09:52:38'),
(3304, 1006, 5857, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent followup email to \"Bevin, Laura J\" Laura.Bevin@aetna.com>, regarding status for the request.  ', NULL, NULL, '2020-08-18 13:20:21', '2020-08-18 13:20:21'),
(3305, 1006, 5857, NULL, '2020-08-28 00:00:00.000', 'In Process', 'No response, sent another follow-up email to Laura Bevin. ', NULL, NULL, '2020-08-21 09:36:40', '2020-08-21 09:36:40'),
(3306, 1006, 5857, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Received following update from Laura:   \"Hello,  Jennifer Lee Ullrich, 6913357 – her credentialing was discontinued due to her license. Can you please advise if she is able to practice independently without the need to be supervised?  Jonathan Schubert, 6249193 - his credentialing was discontinued due to her license. Can you please advise if he is able to practice independently without the need to be supervised?  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-08-25 09:30:35', '2020-08-25 09:30:35'),
(3307, 1006, 5857, NULL, '2020-09-09 00:00:00.000', 'Rejected', '\"Aetna is unable to credential Jennifer Lee Ullrich, 6913357 and Jonathan Schubert, 6249193 since they need to be supervised.  Aetna requires providers to be able to practice independently without the need to be supervised.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-09-02 16:04:42', '2020-09-02 16:04:42'),
(3308, 2027, 5858, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:41:09', '2020-07-08 13:41:09'),
(3309, 2027, 5858, NULL, NULL, 'Initiated', 'To: Karla.Claunch@dchstx.org  Sub: (Adding New Location)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Driscoll)  Please find the attached LOI and W9 to add a new location in this group. Details are mentioned below: Group Name: Valley Med Urgent Care PLLC  Tax ID: 81-5123542.  Thanks.', NULL, NULL, '2020-07-13 17:45:41', '2020-07-13 17:45:41'),
(3310, 2027, 5858, NULL, NULL, 'Initiated', 'To: 	Dominique.Silva@dchstx.org  Sub: (Add New Location)-(Valley Med Urgent Care PLLC (Alton Gloor)-Driscoll  Hello, Hope you are doing great, we want to add two new locations (1) 800 E Alton Gloor Blvd Brownsville , TX 78526-4248. (2) 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166. under our existing group: Valley Med Urgent Care PLLC and also two of our providers need to be added under these new locations as well, their information is as follows: Group Name: Valley Med Urgent Care PLLC  Group Tax ID: 81-5123542 Provider Name:, Eder Hernandez Francisco (PA) NPI# 1386956852 Provider Name: Abdur Rauf (MD) NPI# 1497726202.  We have some other providers also and we want them to add in these locations also, so kindly let me know what the procedure is.  Thanks. ', NULL, NULL, '2020-07-14 13:52:05', '2020-07-14 13:52:05');
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
(3311, 2027, 5858, NULL, NULL, 'In Process', 'From: Martha.Butler@dchstx.org  Good evening Martin,     As per your request, below is the information needed to complete the addition of a secondary location change as well as to update a practice location. I have also attached the Request to Credential for Existing Group form, and included a contact point for your reference and/or credentialing inquires in the future. Please submit the Request to Credential for Existing Group Form to Karla Claunch, and submit the company letterhead to me with the necessary information.     Do not hesitate to contact me with questions or concerns.   Company Letterhead  Information needed upon submitting a request to DHP:  Brief statement-explaining if you’re add/terming/changing a practice location, provider, Tax ID (attach page 6 and 18 & 19 of TSCA) Provider Name:  Group Name:  Tax ID#:  Address:  Phone#  Fax #:  Business Hours:  Age Limitations:  Individual NPI#  Individual TPI#:  Group NPI:  Group TPI:  Mailing Address:  Billing Address:  Pay to Address:  Credentialing Address:  W-9:', NULL, NULL, '2020-07-16 13:01:39', '2020-07-16 13:01:39'),
(3312, 2027, 5858, NULL, NULL, 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Request To Add 2 New Locations)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Drsicoll)  Please find the attached LOI and W9 on the company\'s letterhead to add 2 new locations under the existing group as per your request.  Thanks.', NULL, NULL, '2020-07-16 13:02:22', '2020-07-16 13:02:22'),
(3313, 2027, 5858, NULL, NULL, 'In Process', 'From: Martha.Butler@dchstx.org  Hi Martin,     I have received your request and will submit the Record Change Request form to add the new location. Thank you.     Thank You,', NULL, NULL, '2020-07-16 17:35:08', '2020-07-16 17:35:08'),
(3314, 2027, 5858, NULL, NULL, 'In Process', 'From: Miguel.Zamora@dchstx.org  Good morning Martin,     Can you provide me with the list of the providers that are under this Group? I need to make sure all providers get added to these addresses correctly. If you have any questions, please feel free to contact me.     Thank you,', NULL, NULL, '2020-07-20 10:23:02', '2020-07-20 10:23:02'),
(3315, 2027, 5858, NULL, NULL, 'In Process', 'To: Miguel.Zamora@dchstx.org  Please find the below mentioned list of providers with their NPI# you requested to add under this group in two new locations.  Providers	NPI # Soto, Mayleen	1053818054 Saavedra, Teresa	1255676151 Rodriguez, Cynthia	1124282553 Rauf, Abdur	1497726202 Lopez, Mayra Alejandra	1265945125 Hernandez, Eder Francisco	1386956852 Garcia, Homero	1730564857 Escobar, Angiollet Solis	1962917997  Thanks.', NULL, NULL, '2020-07-20 10:23:48', '2020-07-20 10:23:48'),
(3316, 2027, 5858, NULL, NULL, 'In Process', 'From: Miguel.Zamora@dchstx.org  Thank you Matin. If I need any other information, I will reach out to you.     Thanks,  ', NULL, NULL, '2020-07-20 13:06:42', '2020-07-20 13:06:42'),
(3317, 2027, 5858, NULL, NULL, 'In Process', 'From: Karla.Claunch@dchstx.org  Good afternoon Martin,  I have 3 questions J  1 Does the 800 E Alton Gloor have a separate NPI or does it share the same as the current location?  2 Which providers are affected by the address?   3 Do we need to move any of them or add the 800 E Alton Gloor address to the existing providers records?', NULL, NULL, '2020-07-20 14:02:54', '2020-07-20 14:02:54'),
(3318, 2027, 5858, NULL, NULL, 'In Process', 'To: Karla.Claunch@dchstx.org  Good afternoon. The answer for your first question is 800 E Alton Gloor has the same NPI as the current location, for your second question I am adding a list of providers affected by the address Providers	NPI # Soto, Mayleen	1053818054 Saavedra, Teresa	1255676151 Rodriguez, Cynthia	1124282553 Rauf, Abdur	1497726202 Lopez, Mayra Alejandra	1265945125 Hernandez, Eder Francisco	1386956852 Garcia, Homero	1730564857 Escobar, Angiollet Solis	1962917997  and your 3rd question\'s answer is we need to add the providers in 800 E Alton Gloor address no need to move them from current location let them stay there also  Thanks. ', NULL, NULL, '2020-07-20 14:07:34', '2020-07-20 14:07:34'),
(3319, 2027, 5858, NULL, NULL, 'In Process', 'From: Karla.Claunch@dchstx.org  Thank you for your quick response Martin, You are awesome!  I am making those changes now so, today is the effective date of this additional location.', NULL, NULL, '2020-07-20 14:26:46', '2020-07-20 14:26:46'),
(3320, 2027, 5858, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: Miguel.Zamora@dchstx.org  (For Group)-(Valley Med Urgent Care PLLC (Alton Gloor))-(Driscoll)  May I know the current enrollment status of the group:  Group Name: Valley Med Urgent Care PLLC  Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-11 16:36:39', '2020-10-11 16:36:39'),
(3321, 2037, 5858, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to Miguel.Zamora@dchstx.org', NULL, NULL, '2020-10-26 17:33:45', '2020-10-26 17:33:45'),
(3322, 2027, 5858, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: Miguel.Zamora@dchstx.org  Can you please confirm how many locations are showing under (Valley Med Urgent Care)? ', NULL, NULL, '2020-11-13 14:10:29', '2020-11-13 14:10:29'),
(3323, 2027, 5858, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: Miguel.Zamora@dchstx.org  Could you please confirm how many locations are showing linked under (Valley Med Urgent Care)?', NULL, NULL, '2020-11-20 10:49:58', '2020-11-20 10:49:58'),
(3324, 2027, 5858, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: Miguel.Zamora@dchstx.org  Could you please confirm how many locations are showing linked under (Valley Med Urgent Care)?   ', NULL, NULL, '2020-11-30 12:55:14', '2020-11-30 12:55:14'),
(3325, 2037, 5858, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 13:39:53', '2020-12-08 13:39:53'),
(3326, 2027, 5858, NULL, '2020-12-17 00:00:00.000', 'Approved', 'All the three locations are showing linked with (Driscoll) and this is an urgent care contract. Executed signed contract is attached in the attachments.', NULL, NULL, '2020-12-10 09:23:14', '2020-12-10 09:23:14'),
(3327, 2027, 5859, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:42:13', '2020-07-08 13:42:13'),
(3328, 2027, 5859, NULL, NULL, 'Initiated', 'To: Daniel.Velez@superiorhealthplan.com, shp.networkdevelopment@centene.com, SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com, Credentialing@superiorhealthplan.com   Sub: (Adding New Location)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Superior Health)  Please find the attached LOI and W9 to add a new location in this group. Details are mentioned below: Group Name: Valley Med Urgent Care PLLC  Tax ID: 81-5123542.  Thanks.', NULL, NULL, '2020-07-13 17:56:39', '2020-07-13 17:56:39'),
(3329, 2027, 5859, NULL, NULL, 'In Process', 'From: Daniel.Velez@superiorhealthplan.com  Hello Martin,     I created ticket ID 17826 to add secondary address.     Please allow a minimum of 30 days to be processed.     Feel free to request status updates.     Respectfully,', NULL, NULL, '2020-07-16 17:39:24', '2020-07-16 17:39:24'),
(3330, 1006, 5859, NULL, NULL, 'Approved', 'Address is updated for the group in the provider directory. Proof is attached. ', NULL, NULL, '2020-07-31 05:13:05', '2020-07-31 05:13:05'),
(3331, 2027, 5860, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:43:22', '2020-07-08 13:43:22'),
(3332, 2027, 5860, NULL, NULL, 'Initiated', 'To: credentialing@centene.com  Sub: (Adding New Location)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Ambetter)  Please find the attached LOI and W9 to add a new location in this group. Details are mentioned below: Group Name: Valley Med Urgent Care PLLC  Tax ID: 81-5123542.  Thanks.', NULL, NULL, '2020-07-14 10:28:08', '2020-07-14 10:28:08'),
(3333, 1006, 5860, NULL, NULL, 'Approved', 'Address is updated for the group in the provider directory. Proof is attached.  ', NULL, NULL, '2020-07-31 05:14:06', '2020-07-31 05:14:06'),
(3334, 2027, 5861, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:46:06', '2020-07-08 13:46:06'),
(3335, 2027, 5861, NULL, NULL, 'Initiated', 'To: mhtxproviderservices@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub: (Adding New Location)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Molina Marketplace)  Please find the attached LOI and W9 to add a new location in this group. Details are mentioned below: Group Name: Valley Med Urgent Care PLLC  Tax ID: 81-5123542.  Thanks.', NULL, NULL, '2020-07-14 12:07:41', '2020-07-14 12:07:41'),
(3336, 2027, 5861, NULL, NULL, 'In Process', 'From: MHTXProviderServices@molinahealthcare.com  Thank you for reaching out to Molina Healthcare of Texas (MHT) Provider Services department.  We will review your email and respond shortly. ', NULL, NULL, '2020-07-14 12:10:04', '2020-07-14 12:10:04'),
(3337, 2027, 5861, NULL, NULL, 'In Process', 'From: MHTContractrequest@molinahealthcare.com  Good Afternoon,     May you please fill the attached CRF. Once completed please submit along with an updated W9.     Thank you!', NULL, NULL, '2020-07-28 16:42:58', '2020-07-28 16:42:58'),
(3338, 2027, 5861, NULL, NULL, 'In Process', 'from: MHTContractrequest@molinahealthcare.com  Good morning,     Yes each address needs to be credentialed so that is the reason we will need the form. Since it’s a facility we would not credential providers under the group. Any service performed will be billed under the facility.     Thank you!', NULL, NULL, '2020-07-30 10:53:44', '2020-07-30 10:53:44'),
(3339, 2027, 5861, NULL, NULL, 'In Process', 'To: MHTContractrequest@molinahealthcare.com  Hello, Hope you are doing great, actually i want to confirm one more thing before going to submit the CRF for molina marketplace that the primary location Valley Med Urgent Care PLLC (Brownsville) 2534 Boca Chica Blvd Brownsville , TX 78521-3496 is it showing in your network or i have to submit the CRF for this location also. because if this address is updated in you network then i will request to add 2 locations in Valley Med Urgent Care.  Please advise  Thanks.', NULL, NULL, '2020-07-30 10:54:22', '2020-07-30 10:54:22'),
(3340, 2027, 5861, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: MHTContractrequest@molinahealthcare.com  May I know the current enrollment status of the group:  Group Name: Valley Med Urgent Care PLLC  Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-11 16:39:30', '2020-10-11 16:39:30'),
(3341, 2027, 5861, NULL, '2020-10-22 00:00:00.000', 'In Process', 'From: MHTContractrequest@molinahealthcare.com  Sub: (For Group)-(Valley Med Urgent Care PLLC (Alton Gloor))-(Molina Marketplace)  Good morning,     Per the email below I see the record has been in missing info since last year. Please reach out to your coordinator for further assistance. Thank you!     VALLEY & HIDALGO  Jamie Brown  Jamie.Brown@molinahealthcare.com ', NULL, NULL, '2020-10-15 09:36:11', '2020-10-15 09:36:11'),
(3342, 2027, 5861, NULL, '2020-10-22 00:00:00.000', 'In Process', 'To: 	Jamie.Brown@molinahealthcare.com  Sub: (For Group)-(Valley Med Urgent Care PLLC (Alton Gloor))-(Molina Marketplace)  May I know the current enrollment status of the group:  Group Name: Valley Med Urgent Care PLLC  Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-15 09:37:02', '2020-10-15 09:37:02'),
(3343, 2037, 5861, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email sent to Jamie.Brown@molinahealthcare.com : ----------------', NULL, NULL, '2020-10-28 17:28:47', '2020-10-28 17:28:47'),
(3344, 2027, 5861, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: Jamie.Brown@molinahealthcare.com  This is a follow up email. Please reply to me as soon as possible.', NULL, NULL, '2020-11-04 15:04:31', '2020-11-04 15:04:31'),
(3345, 2027, 5861, NULL, '2020-11-17 00:00:00.000', 'Approved', 'Executed signed contract is attached. Task is approved', NULL, NULL, '2020-11-10 10:16:24', '2020-11-10 10:16:24'),
(3346, 3040, 5861, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:35:48', '2021-04-26 10:35:48'),
(3347, 3040, 5861, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:18:09', '2021-05-31 09:18:09'),
(3348, 2027, 5863, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:49:25', '2020-07-08 13:49:25'),
(3349, 2027, 5863, NULL, NULL, 'In Process', 'To: Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com, Machado-petrys@aetna.com   Sub: (Group Credentialing)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Aetna Better Health)  Please find the attached LOI and W9 to add a new location in this group. Details are mentioned below: Group Name: Valley Med Urgent Care PLLC  Tax ID: 81-5123542.  Thanks.', NULL, NULL, '2020-07-13 17:06:40', '2020-07-13 17:06:40'),
(3350, 2027, 5863, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the group:  Group Name: Valley Med Urgent Care PLLC  Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-11 16:42:24', '2020-10-11 16:42:24'),
(3351, 2037, 5863, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email Sent:  ---------------- Greetings, May I know the current enrollment status of the group:  Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 81-5123542', NULL, NULL, '2020-10-22 17:25:17', '2020-10-22 17:25:17'),
(3352, 2027, 5863, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  This is a follow up email. Please reply to me as soon as possible.', NULL, NULL, '2020-11-04 15:14:05', '2020-11-04 15:14:05'),
(3353, 2027, 5863, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  This is a follow up email. Please reply to me as soon as possible.', NULL, NULL, '2020-11-11 12:19:42', '2020-11-11 12:19:42'),
(3354, 2027, 5863, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: BharathB@aetna.com  This is a follow up email. Please reply to me as soon as possible.', NULL, NULL, '2020-11-18 09:24:51', '2020-11-18 09:24:51'),
(3355, 2027, 5863, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: BharathB@aetna.com abhtxcredentialing@aetna.com  Greetings,  May I know the current enrollment status of the group:  Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-11-25 10:03:42', '2020-11-25 10:03:42'),
(3356, 2027, 5863, NULL, '2020-12-02 00:00:00.000', 'Rejected', 'From: ABHTXCredentialing@aetna.com  Our records show that provider representative Lawrence Goodman reached out to you a couple weeks ago, confirmed that you do not currently have a contract with Aetna Better Health, and informed you that, based on your location in the Hidalgo region, we are not accepting additional contracts at this time, as we are not live in that region at this time. Please let us know if there was something else you need.', NULL, NULL, '2020-11-25 12:26:43', '2020-11-25 12:26:43'),
(3357, 2027, 5865, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:51:13', '2020-07-08 13:51:13'),
(3358, 2027, 5865, NULL, '2020-10-23 00:00:00.000', 'Approved', 'Assured Benefits Administrators is associated with cigna insurance and this practice is already enrolled with cigna so this task is approved. I am attaching an executed signed  contract as confirmation', NULL, NULL, '2020-10-16 15:01:56', '2020-10-16 15:01:56'),
(3359, 2027, 5866, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 13:51:56', '2020-07-08 13:51:56'),
(3360, 1005, 5866, NULL, NULL, 'In Process', 'Location has been added. Stanely Sy is Effective from 11/26/2019 for VMUC-Alton. Adding other providers as well.', NULL, NULL, '2020-07-10 15:22:56', '2020-07-10 15:22:56'),
(3361, 2027, 5866, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub: Need to add more providers under (VMUC) Alton Gloor & McAllen-(Tricare)  Need to add some more providers under the existing group Valley Med Urgent Care in two new locations (1) 800 E Alton Gloor BlvdBrownsville , TX 78526-4248. (2) 101 E. Expressway 83,Suite#170 McAllen, TX 78501-1166. kindly let me know what the procedure is.  Thanks. ', NULL, NULL, '2020-07-14 14:27:20', '2020-07-14 14:27:20'),
(3362, 2027, 5866, NULL, '2020-09-29 00:00:00.000', 'Approved', 'Location has been added in tricare and screenshot is attached for confirmation', NULL, NULL, '2020-09-22 12:12:39', '2020-09-22 12:12:39'),
(3363, 2027, 5867, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:00:39', '2020-07-08 14:00:39'),
(3364, 2027, 5867, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:43:57', '2020-10-02 15:43:57'),
(3365, 2027, 5867, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 16:53:45', '2020-10-02 16:53:45'),
(3366, 1005, 5867, NULL, '2020-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:26:24', '2020-10-12 14:26:24'),
(3367, 2027, 5868, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:01:52', '2020-07-08 14:01:52'),
(3368, 2027, 5868, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:47:25', '2020-10-02 15:47:25'),
(3369, 2027, 5868, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 16:58:35', '2020-10-02 16:58:35'),
(3370, 1005, 5868, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:26:39', '2020-10-12 14:26:39'),
(3371, 2027, 5869, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:03:05', '2020-07-08 14:03:05'),
(3372, 2027, 5869, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:48:54', '2020-10-02 15:48:54'),
(3373, 2027, 5869, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 16:59:44', '2020-10-02 16:59:44'),
(3374, 1005, 5869, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:26:49', '2020-10-12 14:26:49'),
(3375, 2027, 5870, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:03:55', '2020-07-08 14:03:55'),
(3376, 2027, 5870, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:50:18', '2020-10-02 15:50:18'),
(3377, 2027, 5870, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 17:00:28', '2020-10-02 17:00:28'),
(3378, 1005, 5870, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:26:58', '2020-10-12 14:26:58'),
(3379, 2027, 5871, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:04:57', '2020-07-08 14:04:57'),
(3380, 2027, 5871, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:51:47', '2020-10-02 15:51:47'),
(3381, 2027, 5871, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 17:01:15', '2020-10-02 17:01:15'),
(3382, 1005, 5871, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:27:23', '2020-10-12 14:27:23'),
(3383, 2027, 5872, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:05:56', '2020-07-08 14:05:56'),
(3384, 2027, 5872, NULL, '2020-08-26 00:00:00.000', 'Approved', 'Provider is contracted with medicaid and the effective date is 6/14/2018', NULL, NULL, '2020-08-19 14:35:29', '2020-08-19 14:35:29'),
(3385, 2027, 5873, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:06:55', '2020-07-08 14:06:55'),
(3386, 2027, 5873, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:52:51', '2020-10-02 15:52:51'),
(3387, 2027, 5873, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 17:04:11', '2020-10-02 17:04:11'),
(3388, 1005, 5873, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:23:52', '2020-10-12 14:23:52'),
(3389, 1006, 5874, NULL, NULL, 'New/Not Initiated', 'Submitted request online via providerxpress', NULL, NULL, '2020-07-08 14:07:44', '2020-07-08 14:07:44'),
(3390, 1006, 5874, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-08 14:07:48', '2020-07-08 14:07:48'),
(3391, 1006, 5874, NULL, NULL, 'In Process', 'Sent email to Hamel Sherzer, Wendy L asking if we can set up the new LCSW\'s the same way as Prisca/Peggy. ', NULL, NULL, '2020-07-16 15:49:51', '2020-07-16 15:49:51'),
(3392, 1006, 5874, NULL, NULL, 'In Process', 'Rep: Earl She is undergoing process of review for individual credentialing, which takes 2~3 weeks after which her credentialing/contracting can take upto 90~120 days.', NULL, NULL, '2020-07-28 09:09:20', '2020-07-28 09:09:20'),
(3393, 1006, 5874, NULL, '2020-08-10 00:00:00.000', 'In Process', 'Sent another email to \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com> asking what the procedure will be to add supervisory protocols under the provider with Prisac Hefti. Waiting on response.', NULL, NULL, '2020-08-06 17:12:52', '2020-08-06 17:12:52'),
(3394, 1006, 5874, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Received email from Wendy asking for their licensure level & state they will work in, informed her for both. That they\'re LCSW and will work in MA. ', NULL, NULL, '2020-08-10 09:23:49', '2020-08-10 09:23:49'),
(3395, 1006, 5874, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Sent a followup email regarding status. ', NULL, NULL, '2020-08-13 10:58:43', '2020-08-13 10:58:43'),
(3396, 1006, 5874, NULL, '2020-09-09 00:00:00.000', 'In Process', 'As per Wendy the request was forwarded to MA representatives, sent a new followup request today. ', NULL, NULL, '2020-09-02 16:52:56', '2020-09-02 16:52:56'),
(3397, 1006, 5874, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Sent another followup email to Wendy Sherzer. ', NULL, NULL, '2020-09-08 10:03:12', '2020-09-08 10:03:12'),
(3398, 1006, 5874, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Left a VM to wendy to call me back regarding this query at the earliest. ', NULL, NULL, '2020-09-09 13:02:03', '2020-09-09 13:02:03'),
(3399, 1006, 5874, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent another followup email to both \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com>, ian.evans@optum.com regarding the status of the request.  ', NULL, NULL, '2020-09-15 16:52:11', '2020-09-15 16:52:11'),
(3400, 1006, 5874, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent another followup email to \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com> & ian.evans@optum.com regarding the status of enrollment. ', NULL, NULL, '2020-09-23 18:16:13', '2020-09-23 18:16:13'),
(3401, 1006, 5874, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Received the following reply from Wendy:  \"Good Afternoon Brad,  I have followed up with a colleague who handles the Massachusetts territory so that they can further assist you for the providers below given their location, they should be outreaching to you directly. Unfortunately as discussed prior Stacie and myself can only address these types of requests for you RI location. Should you have any additional questions please let me know.  Thank you,  We at Optum Behavioral Health would like to express our sincere appreciation for the services you are providing to our members during this difficult time.  Please frequently visit Provider Express at the link listed below for the most current COVID19 information and updates on telehealth policies, coding, reimbursement and member resources.   If you require any assistance and have any questions that are not available on the Provider Express Portal please email me.  Link to Optum Provider Express:  https://www.providerexpress.com/content/ope-provexpr/us/en/COVID-19_Provider_Updates.html  Providers make it possible. Thank you!  Wendy Hamel Sherzer  Network Manager - Rhode Island  Phone: 401-732-7120 Fax: 1-844-606-9423\"', NULL, NULL, '2020-09-24 16:56:25', '2020-09-24 16:56:25'),
(3402, 1006, 5874, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to Wendy regarding the status of the request.  ', NULL, NULL, '2020-10-05 18:10:08', '2020-10-05 18:10:08'),
(3403, 1006, 5874, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Received following reply from Wendy:   \"Hello Brad,   I had sent the MA provider information over to my colleague Janet for follow up for that state and should be outreached by a provider relations representative assigned to that area.\"  Sent her reply:  \"I\'m still waiting to be reached out to in-regards to the MA supervisory protocol request, it\'s been more than 3 months at this point and we\'re hoping we can move it along as those specific providers have not been able to see any UBH patients due to this. I would appreciate if you could just let me know which MA provider representative I need to get in touch with to get updates on this.   Thank you!\"', NULL, NULL, '2020-10-13 10:12:10', '2020-10-13 10:12:10'),
(3404, 1006, 5874, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Received an update from Janet Choup, sent her the following email @ janet.choup@optum.com:  \"Good Afternoon Janet,  I\'ve been reaching out to Wendy for the past few months in regards to setting up a supervisory protocol for our providers as they aren\'t able to be enrolled with UBH due to being LCSW\'s, we already have a supervisory protocol like this set up already for our RI providers. Group and provider information is as follows:  Group TIN# 2753 Group NPI# 1356906572 Provider Name: Jennifer Lee Ullrich Provider NPI# 1710489760 Provider Name: Jonathan Schubert Provider NPI# 1235755505  Please let me know what else is required to get this process finished ASAP as it\'s already been a few months that we\'ve been trying to get this protocol in place.  Thank you.\"', NULL, NULL, '2020-10-20 10:56:08', '2020-10-20 10:56:08'),
(3405, 1006, 5874, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Received following reply from Janet:  \"Are you planning to bill with the same TIN? If so, it’s the same contract that supervisory is already allowed.\"  Sent reply:  Hello Janet,   Appreciate the update and yes it will be under the same TIN# 83-4482753, but I have a query for the supervisory protocol that\'s currently in place under it as we\'ve submitted a few claims under the protocol with the rendering provider being the LCSW and the supervising provider being the LICSW but those claims were denied stating that the provider was not enrolled. Would you be able to look into this for me? As I haven\'t been able to get in touch with Wendy.   Thank you. \"', NULL, NULL, '2020-10-30 14:35:28', '2020-10-30 14:35:28'),
(3406, 1006, 5874, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Choup, Janet\" janet.choup@optum.com regarding query. ', NULL, NULL, '2020-11-06 18:07:17', '2020-11-06 18:07:17'),
(3407, 1006, 5874, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Sent a follow-up email to Wendy asking if it\'s feasible for us to submit claims under all of our LCSW\'s via the supervisory protocol. ', NULL, NULL, '2020-11-13 18:18:56', '2020-11-13 18:18:56'),
(3408, 1006, 5874, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Hamel Sherzer, Wendy L\" wendy.hamel.sherzer@optum.com: \"Hello,  I hope you\'re doing well, I wanted to follow-up on my previous email:\"Hello Wendy,  Appreciate the update, so we should be using the supervising provider as the rendering on all the claims. Also, I just wanted to re-confirm that since the supervisory protocols are in place we should be able to bill all the claims under Prisca Hefti? I\'m asking this since we now have 4 different LCSW providers in RI & MA and as per the supervisory protocol, we should be able to bill in both states.  Thanks.\"  Please get back to me as soon as you\'re able to.\"', NULL, NULL, '2020-11-20 12:03:11', '2020-11-20 12:03:11'),
(3409, 1006, 5874, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Received following response in regards to MA providers: \"Good Afternoon,  As previously advised Stacie and I can address questions regarding RI only and as stated you are able to bill Prisca Hefti for Supervisory Protocol. Please be aware that all claims billed by non-licensed providers should be billed under the applicable supervisor (which may not necessarily all be under Prisca Hefti ). If you have additional providers to be credentialed in the roll of Supervisor that have yet to be for RI please let us know.  Thank you,  Wendy Hamel Sherzer  Network Manager - Rhode Island  Phone: 401-732-7120 Fax: 1-844-606-9423 Behavioral Network online resources:  www.providerexpress.com\"', NULL, NULL, '2020-11-20 14:08:25', '2020-11-20 14:08:25'),
(3410, 2027, 5876, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:09:08', '2020-07-08 14:09:08'),
(3411, 2027, 5876, NULL, '2020-10-09 00:00:00.000', 'Rejected', 'This provider is no longer working with (Valley Med Urgent Care). Task rejected and screenshot is attached as a proof', NULL, NULL, '2020-10-02 15:54:38', '2020-10-02 15:54:38'),
(3412, 2027, 5876, NULL, '2020-10-09 00:00:00.000', 'On Hold', 'This provider is no longer working with (Valley Med Urgent Care). Screenshot is attached as a proof', NULL, NULL, '2020-10-02 17:05:07', '2020-10-02 17:05:07'),
(3413, 1005, 5876, NULL, '2022-10-19 00:00:00.000', 'Rejected', 'Provider has left the group.', NULL, NULL, '2020-10-12 14:27:16', '2020-10-12 14:27:16'),
(3414, 2027, 5877, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:09:57', '2020-07-08 14:09:57'),
(3415, 1005, 5877, NULL, NULL, 'In Process', 'As per rep Carl, Alton Gloor location is in network for the Group VMUC. Stanley P. Sy (In Network) Ref# 7845122 Need to confirm the effective date and covered plan(s).', NULL, NULL, '2020-07-09 17:23:38', '2020-07-09 17:23:38'),
(3416, 2027, 5877, NULL, '2020-09-29 00:00:00.000', 'Approved', 'Provider is now showing linked with tricare and the effective date is 11/26/2019', NULL, NULL, '2020-09-22 12:27:54', '2020-09-22 12:27:54'),
(3417, 2027, 5878, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:50:42', '2020-07-08 14:50:42'),
(3418, 2027, 5878, NULL, '2020-10-20 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Driscoll)  I want to enroll this provider in all three locations of (Valley Med Urgent Care) with (Driscoll). Please assist me how I can start the enrollment process. Details of the provider are mentioned below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-13 10:21:37', '2020-10-13 10:21:37'),
(3419, 1006, 5878, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Sent a follow-up email to Martha Butler Martha.Butler@dchstx.org> regarding the initiation guidelines. ', NULL, NULL, '2020-10-26 17:00:36', '2020-10-26 17:00:36'),
(3420, 2027, 5878, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Sent follow up email', NULL, NULL, '2020-11-06 15:55:03', '2020-11-06 15:55:03'),
(3421, 2027, 5878, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org  Please find the requested document attached in this email.  Thanks.', NULL, NULL, '2020-11-13 14:28:51', '2020-11-13 14:28:51'),
(3422, 2027, 5878, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: Karla.Claunch@dchstx.org  Please find the requested documents attached in this email.', NULL, NULL, '2020-11-16 12:51:48', '2020-11-16 12:51:48'),
(3423, 2027, 5878, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: DHPContracting@dchstx.org Karla.Claunch@dchstx.org  May I know the current status of my request?  Thanks.', NULL, NULL, '2020-11-23 09:27:06', '2020-11-23 09:27:06'),
(3424, 2027, 5878, NULL, '2020-11-30 00:00:00.000', 'In Process', 'From: Karla.Claunch@dchstx.org  Good morning Martin,  Saavedra-received 11/16/2020 and is in process.  The credentialing process ranges from 60 to 90 days but in some instances may take up to 180 days.  You will receive a Welcome Packet along when complete.  If anything is needed, someone will contact you.  Be sure the CAQH is complete, current and accurate to avoid delays in processing.  If Aperture contacts you regarding any missing information, please respond to them promptly.  Have a great short week.  Karla Claunch ', NULL, NULL, '2020-11-23 10:12:37', '2020-11-23 10:12:37'),
(3425, 2027, 5878, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-30 12:57:10', '2020-11-30 12:57:10'),
(3426, 2037, 5878, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Request is still in process need to allow more time', NULL, NULL, '2020-12-08 13:40:31', '2020-12-08 13:40:31'),
(3427, 2027, 5878, NULL, '2020-12-17 00:00:00.000', 'In Process', 'From: Christine.Rodriguez@dchstx.org   RE:               Teresa G Saavedra, DO  NPI #:          1255676151  Tax ID#:      81-5123542     Good Afternoon,     I am currently working on the application for Teresa G Saavedra, DO for the Driscoll  Health Plan; and I need some additional documents in order to complete the paperwork  Process.   (see attached)  ·       Page 1 of TSA needs place of birth City & State  ·       Page 3 of TSA needs the Work History to match what’s on page 6 (Primary location)  ·       Page 6  of TSA needs to be filled out completely starting from Office Manager on down  ·       Copy of W-9 form  Please forward all requested documents to my attention via email.  Feel free to contact me if  you have any questions.     Thank you,  Christine S Rodriguez', NULL, NULL, '2020-12-10 11:01:16', '2020-12-10 11:01:16'),
(3428, 2027, 5878, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To; Christine.Rodriguez@dchstx.org  Please find the requested documents attached in this email.  Thanks.', NULL, NULL, '2020-12-10 11:01:48', '2020-12-10 11:01:48'),
(3429, 3040, 5878, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to  Christine.Rodriguez@dchstx.org  Greetings,  Hope you are doing well. Please update me regarding the status for the below provider.   Practice Name: Valley Med Urgent Care PLLC Provider Name: Teresa G Saavedra NPI # 1255676151 Tax ID# 81-5123542  If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2020-12-17 10:40:38', '2020-12-17 10:40:38'),
(3430, 3040, 5878, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: Teresa Saavedra, DO  Greetings,  Hope you are doing well. First and foremost I really appreciate your prompt response.  Please find the attached the resume for Teresa Saavedra.   I will send you the updated liability insurance once I get it.   If you have any questions please let me know. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-21 13:26:16', '2020-12-21 13:26:16'),
(3431, 3040, 5878, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Waiting for LOI from Eder Hernandez.  Brad already send the email. ', NULL, NULL, '2020-12-28 17:57:08', '2020-12-28 17:57:08'),
(3432, 3040, 5878, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Waiting for the response from Eder', NULL, NULL, '2021-01-04 16:34:02', '2021-01-04 16:34:02'),
(3433, 3040, 5878, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Waiting for the response from Eder.', NULL, NULL, '2021-01-11 13:56:33', '2021-01-11 13:56:33'),
(3434, 1006, 5878, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Received an email from Christine requesting COI, informed her that we\'re still waiting on it and will get it to her ASAP. ', NULL, NULL, '2021-01-29 16:03:45', '2021-01-29 16:03:45'),
(3435, 1006, 5878, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Finally received a copy of the updated COI from Eder, sent to Christine Rodriguez, and received the following response:  \"Good Morning Brad,  I will reinstate the application for Teresa G Saavedra, DO, my supervisor also asked me to get Call Coverage for Dr. Saavedra.  Please put in the name of Doctor Ramegowda Belakere on page 5 of the application (see attached).  Please return ASAP.  Feel free to contact me if you have any questions. \"', NULL, NULL, '2021-02-08 13:47:28', '2021-02-08 13:47:28'),
(3436, 3040, 5878, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-02-15 14:03:03', '2021-02-15 14:03:03'),
(3437, 3040, 5878, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: Christine.Rodriguez@dchstx.org  Subject: Teresa G Saavedra, DO  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Detail: Provider Name: Teresa G Saavedra NPI # 1255676151  If you need any additional information please feel free to email me. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-23 11:03:23', '2021-02-23 11:03:23'),
(3438, 3040, 5878, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: Christine.Rodriguez@dchstx.org  Subject: Teresa G Saavedra, DO  Good Morning,  Application is still processing at this time. ', NULL, NULL, '2021-03-02 14:30:32', '2021-03-02 14:30:32'),
(3439, 3040, 5878, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Application is still processing at this time. ', NULL, NULL, '2021-03-10 17:10:06', '2021-03-10 17:10:06'),
(3440, 3040, 5878, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org, Christine.Rodriguez@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Greetings,   Hope you are doing well. I wanted to add the provider in the Driscoll Health plan for our group Valley Med Urgent Care PLLC under below locations.  Provider 1:   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  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 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 15:45:00', '2021-03-23 15:45:00'),
(3441, 3040, 5878, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Good Morning Diana,   Can you please send me the provider representative contact information for adding the locations.   Thank you ', NULL, NULL, '2021-03-29 09:38:24', '2021-03-29 09:38:24'),
(3442, 3040, 5878, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Good morning Adi,  I looked up Dr. Saavedra’s account only has primary location listed to add additional locations, Please Contact your provider representative to add the additional locations  Thank you  Sincerely  Diana R. Flores Credentialing Specialist', NULL, NULL, '2021-03-29 09:39:01', '2021-03-29 09:39:01'),
(3443, 3040, 5878, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Good morning Adi,  Please contact your provider representative  Thank you     Sincerely     Diana R. Flores  Credentialing Specialist', NULL, NULL, '2021-03-29 09:39:30', '2021-03-29 09:39:30'),
(3444, 3040, 5878, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Christine.Rodriguez@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Hello,  I will forward this information to our Provider Relations Department; they  will reach out to you for further assistance.   Have a Great Day.   Thank you, Christine S Rodriguez', NULL, NULL, '2021-03-29 09:40:43', '2021-03-29 09:40:43'),
(3445, 3040, 5878, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:35:49', '2021-04-13 13:35:49'),
(3446, 3040, 5878, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,  Thank you so much for your prompt response. Can you please advise me the time frame?   Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-04-15 15:40:02', '2021-04-15 15:40:02'),
(3447, 3040, 5878, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello again Adil,  Wanted to let you know that only 2 of these providers needed the locations added  Cynthia Rodriguez PA andTeresa Saavedra DO', NULL, NULL, '2021-04-15 15:41:57', '2021-04-15 15:41:57'),
(3448, 3040, 5878, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   I checked the below providers on the Driscoll Health Plan provider directory and the providers are not showing in below locations which I requested in my previous email. Can you please check and let me know when they will be updated in the directory.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-04 13:16:04', '2021-05-04 13:16:04'),
(3449, 3040, 5878, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   Has there been any update regarding the additional locations.   Thanks  ', NULL, NULL, '2021-05-28 08:59:46', '2021-05-28 08:59:46'),
(3450, 3040, 5878, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject:Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  These were added on the date of the request 4/13/2021', NULL, NULL, '2021-06-03 15:41:03', '2021-06-03 15:41:03'),
(3451, 2027, 5879, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:51:38', '2020-07-08 14:51:38'),
(3452, 2027, 5879, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Call to insurance: Talk to the representative the provider is now showing in network with effective date 7/1/2020 Screenshot from provider directory is attached and plans are mentioned below. Teresa Saavedra-Star+plus-All 3 locations  Teresa Saavedra-Star Kids-All 3 locations  Teresa Saavedra-Star Health-All 3 locations  Teresa Saavedra-Star-All 3 locations  Teresa Saavedra-Chip RSA-All 3 locations  Teresa Saavedra-Chip Perinate-All 3 locations Teresa Saavedra-Chip-All 3 locations Teresa Saavedra- Allwell Medicare HMO-All 3 locations Teresa Saavedra-Allwell Dual Medicare HMO SNP-All 3 locations ', NULL, NULL, '2020-08-18 10:32:00', '2020-08-18 10:32:00'),
(3453, 2027, 5880, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:52:49', '2020-07-08 14:52:49'),
(3454, 2027, 5880, NULL, '2020-08-25 00:00:00.000', 'Approved', 'Call to insurance: Talk to the representative the provider is now showing in network with effective date 7/1/2020 Screenshot from provider directory is attached', NULL, NULL, '2020-08-18 13:21:18', '2020-08-18 13:21:18'),
(3455, 2027, 5881, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:54:52', '2020-07-08 14:54:52'),
(3456, 2027, 5881, NULL, '2020-10-20 00:00:00.000', 'In Process', 'To: MHTContractrequest@molinahealthcare.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Molina Marketplace)  I want to enroll this provider in all three locations of (Valley Med Urgent Care) with (Molina Marketplace). Please assist me how I can start the enrollment process. Details of the provider are mentioned below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-13 10:27:16', '2020-10-13 10:27:16'),
(3457, 2027, 5881, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: MHTContractrequest@molinahealthcare.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Molina Marketplace)  Good morning,     Per the email below please fill out the attached- Once completed please return with a W9 copy.     Thank you in advance!', NULL, NULL, '2020-10-26 16:55:59', '2020-10-26 16:55:59'),
(3458, 2027, 5881, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: MHTContractrequest@molinahealthcare.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Molina Marketplace)  Please confirm if this below mentioned provider is enrolled with (Molina Marketplace) in all three locations of (Valley Med Urgent Care). Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-02 12:58:27', '2020-11-02 12:58:27'),
(3459, 2027, 5881, NULL, '2020-11-09 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Molina Marketplace)  Thank you for that!     However for urgent care records we do not add providers under urgent cares Any services performed at the urgent care will be billed through the urgent care.     Please contact your coordinator for further assistance- Thank you!     VALLEY & HIDALGO  Jasmine Guerrero  Jasmine.Guerrero@molinahealthcare.com  888-562-5442 x208473  ', NULL, NULL, '2020-11-02 15:03:02', '2020-11-02 15:03:02');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(3460, 2027, 5881, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  If it is an urgent care contract please send me the executed signed contract.  Thanks.', NULL, NULL, '2020-11-09 16:44:21', '2020-11-09 16:44:21'),
(3461, 2027, 5881, NULL, '2020-11-17 00:00:00.000', 'Approved', 'From: MHTContractrequest@molinahealthcare.com  Thank you for that!     However for urgent care records we do not add providers under urgent cares Any services performed at the urgent care will be billed through the urgent care.     Please contact your coordinator for further assistance- Thank you!', NULL, NULL, '2020-11-10 10:03:04', '2020-11-10 10:03:04'),
(3462, 3040, 5881, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:23', '2021-04-26 10:41:23'),
(3463, 3040, 5881, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:18:15', '2021-05-31 09:18:15'),
(3464, 2027, 5882, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:56:02', '2020-07-08 14:56:02'),
(3465, 2027, 5882, NULL, '2020-10-20 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Molina Health)  Hello Jasmine,  Please confirm if the below mentioned provider is linked with (Molina Health) under (Valley Med Urgent Care) in all three locations. Also let me know if it is an ancillary contract or a group contract. Details of the provider are mentioned below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-13 10:39:36', '2020-10-13 10:39:36'),
(3466, 2027, 5882, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: MHTContractrequest@molinahealthcare.com  Good morning,     Per the email below please fill out the attached- Once completed please return with a W9 copy.     Thank you in advance!', NULL, NULL, '2020-10-26 16:57:50', '2020-10-26 16:57:50'),
(3467, 2027, 5882, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: MHTContractrequest@molinahealthcare.com  Sub: (Saavedra, Teresa)-(Valley Med Urgent Care)-(Molina Marketplace)  Please confirm if this below mentioned provider is enrolled with (Molina Marketplace) in all three locations of (Valley Med Urgent Care). Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-02 13:04:43', '2020-11-02 13:04:43'),
(3468, 2027, 5882, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: MHTXproviderservices@molinahealthcare.com  May I know the current status of the request above in this email?', NULL, NULL, '2020-11-09 17:28:29', '2020-11-09 17:28:29'),
(3469, 2027, 5882, NULL, '2020-11-18 00:00:00.000', 'Approved', 'This is an urgent care contract and we have confirmed that providers don\'t need to be enrolled separately. So this task is completed and executed signed contract has been attached with email confirmation from the insurance.  ', NULL, NULL, '2020-11-11 09:46:56', '2020-11-11 09:46:56'),
(3470, 3040, 5882, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:40', '2021-04-26 10:46:40'),
(3471, 3040, 5882, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:08', '2021-05-31 09:11:08'),
(3472, 2027, 5883, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 14:58:02', '2020-07-08 14:58:02'),
(3473, 2027, 5883, NULL, '2020-10-20 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  Sub: I want to enroll this provider in all three locations of (Valley Med Urgent Care) with (Aetna Better Health). Please assist me how I can start the enrollment process. Details of the provider are mentioned below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-13 10:46:43', '2020-10-13 10:46:43'),
(3474, 2037, 5883, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Follow up email sent @ abhtxcredentialing@aetna.com -------------------------  (Valley Med Urgent Care PLLC)-(LOCATION ADDITION REQUEST)-(Aetna Better Health)  Greetings, May I please have the status of the request submitted to add secondary and tertiary service location addresses for the below mentioned Group: Valley Med Urgent Care Tax ID  81-5123542NPI     1518404631  Thank you!', NULL, NULL, '2020-10-22 17:43:44', '2020-10-22 17:43:44'),
(3475, 2037, 5883, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email Sent.@ abhtxcredentialing@aetna.com ----------------------------- (Valley Med Urgent Care PLLC)-(Aetna Better Health)-Saavedra, Teresa  I want to enroll this provider in all three locations of (Valley Med Urgent Care) with (Aetna Better Health). Please assist me how I can start the enrollment process. Details of the provider are mentioned below: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-12 16:49:01', '2020-11-12 16:49:01'),
(3476, 2027, 5883, NULL, '2021-02-20 00:00:00.000', 'On Hold', 'From: GoodmanL@AETNA.com  Hello Mrs. Deen.     My sincerest apologies.    After we hung up, I called back and spoke with a gentleman, in regards to your 3 service locations. He informed me the locations are in the Hidalgo service area. Unfortunately, based on the state\'s decision to cancel the STAR+PLUS contract award earlier this year, Aetna Better Health is no longer expanding into the Harris or Hidalgo Service Areas at this time. For that reason, we are discontinuing additional contract activity in those regions. Currently we are only live in Dallas, Bexar and Tarrant regions. We look forward to further expansion in Texas soon and will be in touch when that occurs.     Again, my apologies.     Thank you.     Lawrence Goodman Network Manager   Network Value Based Solutions', NULL, NULL, '2020-11-13 17:05:43', '2020-11-13 17:05:43'),
(3477, 3040, 5883, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'From: GoodmanL@AETNA.com  Hello Mrs. Deen.     My sincerest apologies.    After we hung up, I called back and spoke with a gentleman, in regards to your 3 service locations. He informed me the locations are in the Hidalgo service area. Unfortunately, based on the state\'s decision to cancel the STAR+PLUS contract award earlier this year, Aetna Better Health is no longer expanding into the Harris or Hidalgo Service Areas at this time. For that reason, we are discontinuing additional contract activity in those regions. Currently we are only live in Dallas, Bexar and Tarrant regions. We look forward to further expansion in Texas soon and will be in touch when that occurs.     Again, my apologies.     Thank you.     Lawrence Goodman Network Manager   Network Value Based Solution', NULL, NULL, '2021-07-12 09:41:29', '2021-07-12 09:41:29'),
(3478, 2027, 5885, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 15:00:40', '2020-07-08 15:00:40'),
(3479, 2027, 5885, NULL, '2020-10-23 00:00:00.000', 'Approved', 'This insurance is associated with cigna and the provider is already linked under it. effective date is 4/24/2020', NULL, NULL, '2020-10-16 15:36:07', '2020-10-16 15:36:07'),
(3480, 2027, 5886, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-08 15:01:25', '2020-07-08 15:01:25'),
(3481, 2027, 5886, NULL, NULL, 'Initiated', 'sent request to KMoten4@humana.com  to add this provider in the new location Valley Med Urgent Care PLLC (Alton Gloor) at  800 E Alton Gloor Blvd Brownsville , TX 78526-4248. under the tax id : 81-5123542 with tricare', NULL, NULL, '2020-07-10 10:40:23', '2020-07-10 10:40:23'),
(3482, 2027, 5886, NULL, '2020-10-14 00:00:00.000', 'Approved', 'Provider is now showing linked with insurance in all three locations of (VMUC) and the effective date is 09/14/2020', NULL, NULL, '2020-10-07 14:13:29', '2020-10-07 14:13:29'),
(3483, 3040, 5886, NULL, NULL, 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under 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: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:17:24', '2021-03-26 17:17:24'),
(3484, 3040, 5886, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com   Subject: Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare   Hello Katherine,  Hope you had a great weekend. I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to loaded correctly. Can you please check and advise.   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: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-21 11:01:01', '2021-06-21 11:01:01'),
(3485, 3040, 5886, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare  Hello Katherine,  Hope you had a great weekend. I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to be loaded correctly. Can you please check and advise?  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: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you  ', NULL, NULL, '2021-07-09 11:21:48', '2021-07-09 11:21:48'),
(3486, 3040, 5886, NULL, '2021-09-16 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Re: Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare  Hello Katherine,  I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to be loaded correctly. Can you please check and advise?  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: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks ', NULL, NULL, '2021-09-09 16:19:17', '2021-09-09 16:19:17'),
(3487, 10057, 5886, NULL, '2021-11-12 00:00:00.000', 'Revalidation', 'Email Sent To : KMoten4@humana.com  Sub : Add Location || Valley Med Urgent Care PLLC || Saavedra, Teresa || Tricare  Good Afternoon,  Hope this email finds you well. I wanted to know the status of additional locations for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC under the below locations. As per your last email on 06/01/2021 the request was sent out to be loaded correctly. Highlighted locations need to be updated, can you please check and confirm?  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Saavedra, Teresa	1255676151  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 14:31:22', '2021-11-02 14:31:22'),
(3488, 10057, 5886, NULL, '2021-12-08 00:00:00.000', 'Revalidation', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:50', '2021-12-01 16:24:50'),
(3489, 10057, 5886, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good morning,  NPI 1700960556  Not certified.  Please visit humanamilitary.com, click on Provider link, click on Forms. Locate appropriate certification application, complete and fax to WPS at number located on application.  Please allow 90 days for processing  NPI 1225617558 Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice). Please see screenshot below to submit.  NPI 1659919702  Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  NPI 1568929800  Prov credentialing complete effect 8/31/21. Prov is affiliated with three locations listed.  NPI 1730564857  Prov credentialing complete effective 9/28/21. Prov is affiliated with three locations listed.  NPI 1245789502  Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice) and work history. Email request sent 6/9/21  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-09 10:34:48', '2021-12-09 10:34:48'),
(3490, 10057, 5886, NULL, '2021-12-21 00:00:00.000', 'Revalidation', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:51', '2021-12-14 13:39:51'),
(3491, 10057, 5886, NULL, '2021-12-28 00:00:00.000', 'Revalidation', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:57', '2021-12-21 13:39:57'),
(3492, 10057, 5886, NULL, '2022-01-04 00:00:00.000', 'Revalidation', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:30:00', '2021-12-28 15:30:00'),
(3493, 20067, 5886, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub:  Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Hope this email finds you in good health. I would like to know the enrollment status of the below mentioned providers.  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631  Provider 1: Garcia Homero NPI: 17303564857 Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496  Provider 2: Teresa Saavedra NPI:1255676151 Location 1:  800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Location 2: 101 E. Expressway 83, Suite #170  McAllen, TX 78501-1166  Your early response will be highly appreciated.  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-13 14:19:39', '2022-01-13 14:19:39'),
(3494, 20067, 5886, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2022-01-13 16:36:09', '2022-01-13 16:36:09'),
(3495, 20067, 5886, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Thanks for the update. Can you please provide me with their welcome kits?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-13 16:40:50', '2022-01-13 16:40:50'),
(3496, 20067, 5886, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:10:11', '2022-01-18 14:10:11'),
(3497, 20067, 5886, NULL, '2022-02-23 00:00:00.000', 'Revalidation', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:31:07', '2022-02-16 17:31:07'),
(3498, 20067, 5886, NULL, '2022-03-09 00:00:00.000', 'Revalidated', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   ood afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East ', NULL, NULL, '2022-03-02 16:46:47', '2022-03-02 16:46:47'),
(3499, 1006, 5887, NULL, NULL, 'New/Not Initiated', 'Submitted Practitioner Group Addition form via fax to 866-612-7790', NULL, NULL, '2020-07-08 17:17:20', '2020-07-08 17:17:20'),
(3500, 1006, 5887, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-08 17:17:26', '2020-07-08 17:17:26'),
(3501, 1005, 5887, NULL, NULL, 'New/Not Initiated', 'Test ', NULL, NULL, '2020-07-21 10:53:54', '2020-07-21 10:53:54'),
(3502, 1006, 5887, NULL, NULL, 'In Process', 'Sent followup email to provider.relations@beaconhealthoptions.com:  Sub: Status Update - SNBCare - Enrollment Query  \"Hello,   I wanted to get a status update on two Group Addition forms that I sent a few weeks ago, I wanted to check on their status and see how long they\'ll take to get processed and the providers to be credentialed & contracted? Provider/Group info is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Provider Name: Jennifer Lee Ullrich NPI# 1356906572  Provider Name: Jonathan Schubert NPI# 1235755505  Please get back to me as soon as you\'re able.   Thanks. \"', NULL, NULL, '2020-07-21 11:02:06', '2020-07-21 11:02:06'),
(3503, 1006, 5887, NULL, NULL, 'In Process', 'Received following status update from provider.relations@beaconhealthoptions.com:  Sub: RE: Status Update - SNBCare - Enrollment Query  \"Good afternoon,  Looking into Jennifer Ullrich, the NPI number given is pulling up the group and not the provider herself. When I looked into the provider it seem a full application was not sent into beacon.  Please fill out the full application for the provider.  Thank You!   Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-07-30 12:15:36', '2020-07-30 12:15:36'),
(3504, 1006, 5887, NULL, NULL, 'In Process', 'Sent email to RFA@beaconhealthoptions.com:  Sub: Jennifer Ullrich - SNBCare  \"Hello,   We wish to enroll the following provider with Beacon and add her to our group as well. Here\'s the RFA, please let me know if anything else is required.   Thank you. \"', NULL, NULL, '2020-07-30 17:35:33', '2020-07-30 17:35:33'),
(3505, 1006, 5887, NULL, '2020-08-10 00:00:00.000', 'In Process', 'Received reply from Beacon RFA department to initiate request online via their online portal. Request initiated and sent out, attached. ', NULL, NULL, '2020-08-03 15:49:47', '2020-08-03 15:49:47'),
(3506, 1006, 5887, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Request is currently @ Under Review: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.\"', NULL, NULL, '2020-08-10 10:26:58', '2020-08-10 10:26:58'),
(3507, 1006, 5887, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Checked via https://join.beaconhealthoptions.com/ received following update: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.  Your application was submitted on 08/03/2020 at 04:51:35 PM EST\" ', NULL, NULL, '2020-08-18 17:16:41', '2020-08-18 17:16:41'),
(3508, 1006, 5887, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Jennifer Ullrich - Application is still in process, nothing else is currently required. Need to check back in a few weeks.  Ref# 09022020-8814267', NULL, NULL, '2020-09-02 17:17:44', '2020-09-02 17:17:44'),
(3509, 1006, 5887, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Called in and received the following update: Jennifer - Contracted as of 08/27/2020 Ref: Aloie O 09/09/2020   Also sent an email @ larissa.pugh@cigna.com requesting welcome letter. Attached provider portal address. ', NULL, NULL, '2020-09-09 09:56:56', '2020-09-09 09:56:56'),
(3510, 1006, 5887, NULL, '2020-09-16 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-09-09 10:09:22', '2020-09-09 10:09:22'),
(3511, 1006, 5887, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com regarding the status of the request as well as to expedite it. ', NULL, NULL, '2020-09-15 17:00:53', '2020-09-15 17:00:53'),
(3512, 1006, 5887, NULL, '2020-09-23 00:00:00.000', 'In Process', 'Received following email from @ provider.relations@beaconhealthoptions.com:  \"Good morning,  Looking into the request below, I am seeing for the provider Joanna Wood that the application is currently being processed to have her linked to the group.  For the provider Jennifer Lee Ullrich I am unable to see the application yet on file since the provider is not already in our system. If the application as sent in the same way and around the same time this should be in process as well, and a shell should be in the process of being created for this provider.  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-09-16 15:59:39', '2020-09-16 15:59:39'),
(3513, 1006, 5887, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent a follow-up email to Kayla @ provider.relations@beaconhealthoptions.com to expedite the request.  ', NULL, NULL, '2020-09-23 15:10:31', '2020-09-23 15:10:31'),
(3514, 1006, 5887, NULL, '2020-10-14 00:00:00.000', 'In Process', 'Received the following update from Kayla:  \"Good Afternoon,  The application is still in process for both of the below providers. Applications typically take from 90-120 days business days and unfortunately there is no way for us to expedite it unless it is past the 120 days.  Thank You!   Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632 www.beaconhealthoptions.com\"', NULL, NULL, '2020-10-05 15:26:03', '2020-10-05 15:26:03'),
(3515, 1006, 5887, NULL, '2020-10-21 00:00:00.000', 'In Process', 'Received the following update: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. Your application was submitted on 08/03/2020 at 04:51:35 PM EST If you have any questions on the enrollment process, please call our National Provider Service Line at 800-397-1630 (Monday through Friday, 8 a.m. to 8 p.m. EST).\"', NULL, NULL, '2020-10-14 17:38:41', '2020-10-14 17:38:41'),
(3516, 1006, 5887, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Sent a followup email to Kayla @ provider.relations@beaconhealthoptions.com:  Hey Kayla,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider:   Provider Name: Jennifer Ullrich NPI# 1710489760 TIN# 83-4482753  Please get back to me as soon as you can.   Thanks.   ', NULL, NULL, '2020-10-22 18:04:35', '2020-10-22 18:04:35'),
(3517, 1006, 5887, NULL, '2020-11-13 00:00:00.000', 'In Process', 'The request still shows up as in-process:  \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required. Your application was submitted on 08/03/2020 at 04:51:35 PM EST\"', NULL, NULL, '2020-11-02 13:49:43', '2020-11-02 13:49:43'),
(3518, 1006, 5887, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com:  \"Hello,   I hope you\'re doing well, I wanted to follow-up on the status of enrollment for the following providers as it\'s been close to 90~120 days since the request for their enrollment was submitted:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Erin Oliva NPI# 1407349632  TIN# 83-4482753  Please get back to me ASAP and expedite the request as we are getting quite a few patients that we aren\'t able to see due to this delay.  Thank you.\"', NULL, NULL, '2020-11-13 18:23:13', '2020-11-13 18:23:13'),
(3519, 1006, 5887, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received following reply from Kayla @ provider.relations@beaconhealthoptions.com:  \"Good afternoon,  Both application for the below providers are still in process. I have provided the number of days this has been in process so far.   Jennifer Ullrich:          75 business days Erin Oliva:                  36 business days  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632\"', NULL, NULL, '2020-11-16 14:52:13', '2020-11-16 14:52:13'),
(3520, 1006, 5887, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Update from Provider Enrollment website: \"Your application is currently being reviewed by a member of Beacon\'s onboarding team. You will be contacted in the event that more information is required.\"', NULL, NULL, '2020-11-25 11:09:53', '2020-11-25 11:09:53'),
(3521, 1006, 5887, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Sent another followup @ provider.relations@beaconhealthoptions.com:  \"Hello,   I want to get an update regarding the enrollment status for the following providers:  Provider Name: Joanna Wood NPI# 1801986054 Provider Name: Jennifer Ullrich NPI# 1710489760 Group NPI# 1356906572  Please get back to me as soon as possible as both these requests have been processing for quite a while.  Thanks.\"', NULL, NULL, '2020-12-07 17:08:47', '2020-12-07 17:08:47'),
(3522, 1006, 5887, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Received reply from Kayla stating that they\'re still processing sent her this email: \"Good afternoon Kayla,   I see, the reason I\'m checking in on these providers is that they\'re both still showing up as \"Under Review\" and neither of their credentialing looks to have been started as of yet. Could you please get them expedited?  Thanks. \"', NULL, NULL, '2020-12-09 14:28:42', '2020-12-09 14:28:42'),
(3523, 1006, 5887, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com.  Sub: Provider Enrollment Status - SNBCare', NULL, NULL, '2020-12-18 15:51:34', '2020-12-18 15:51:34'),
(3524, 1006, 5887, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Request still shows as in-process but representative sent in a request to get it re-evaluated as it\'s been 90+ days. Event# 8773081 Ref# 12292020-0058739 Rep: John N ', NULL, NULL, '2020-12-29 18:03:09', '2020-12-29 18:03:09'),
(3525, 1006, 5887, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Called Beacon but wasn\'t able to reach anyone, requested a call back from them. ', NULL, NULL, '2021-01-15 17:04:55', '2021-01-15 17:04:55'),
(3526, 1006, 5887, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Credentialing is still in process, need to allow more time for the contracts to be sent out.  Ref# 01202021-0292859', NULL, NULL, '2021-01-20 13:05:45', '2021-01-20 13:05:45'),
(3527, 1006, 5887, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:19:44', '2021-02-11 15:19:44'),
(3528, 1006, 5887, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:08:20', '2021-03-03 18:08:20'),
(3529, 1019, 5887, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:41:06', '2021-03-23 10:41:06'),
(3530, 1019, 5887, NULL, '2021-04-12 00:00:00.000', 'In Process', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-05 09:17:03', '2021-04-05 09:17:03'),
(3531, 1019, 5887, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:10:54', '2021-04-14 07:10:54'),
(3532, 1019, 5887, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-04-14 08:11:31', '2021-04-14 08:11:31'),
(3533, 1019, 5887, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:53:19', '2021-04-22 15:53:19'),
(3534, 1019, 5887, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:45:49', '2021-05-03 12:45:49'),
(3535, 1019, 5887, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Received the Welcome letter, Effective date 05/04/2021. see attachment for ref.', NULL, NULL, '2021-05-05 10:03:20', '2021-05-05 10:03:20'),
(3536, 1006, 5888, NULL, NULL, 'New/Not Initiated', 'Submitted addition/enrollment form to Tufts_Health_Plan_Credentialing_Department@tufts-health.com ', NULL, NULL, '2020-07-08 17:39:26', '2020-07-08 17:39:26'),
(3537, 1006, 5888, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-08 17:39:32', '2020-07-08 17:39:32'),
(3538, 1006, 5888, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent followup email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com for updated status on the application.  ', NULL, NULL, '2020-08-06 13:23:56', '2020-08-06 13:23:56'),
(3539, 1006, 5888, NULL, '2020-08-18 00:00:00.000', 'In Process', 'Sent another followup email to kody_dunnett@tufts-health.com:  Sub: Jennifer Ullrich/Jonathan Schubert/Joanna Wood - SNBCare - Provider Status Update   \"Hey Kody,   I hope you\'re doing well, I wanted to get an update regarding the status of my providers and see if there was any way we could get their request for enrollment expedited, their info is as follows:  Provider Name: Jennifer Ullrich NPI# 1710489760 Provider Name: Jonathan Schubert NPI# 1235755505 Provider Name: Joanna Wood NPI# 1801986054 Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Please get back to me as soon as you\'re able, as no one from the Tufts credentialing has been able to get back to me.   Thank you!\"', NULL, NULL, '2020-08-11 15:14:52', '2020-08-11 15:14:52'),
(3540, 1006, 5888, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Received following update from Kody Dunnett Kody_Dunnett@tufts-health.com>:  \"Hi Brad  Jennifer Ullrich, LICSW – needs contract selected, reached out to BH Contracting.  Once signed, returned, and processed, she will be put into credentialing.  After cred is complete, she will be all set.  Jonathan Schubert, LICSW – same as Jennifer  Joanna C Wood, LICSW – credentialed, in network, but not linked to TIN.  Can you resubmit that app to me?  BH Contracting has been backlogged and a bit understaffed, so their response times have been delayed.  I apologize for the inconvenience.  Thanks Kody\"', NULL, NULL, '2020-08-17 10:42:12', '2020-08-17 10:42:12'),
(3541, 1006, 5888, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent a followup email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, Kody Dunnett Kody_Dunnett@tufts-health.com> regarding the status of enrollment. ', NULL, NULL, '2020-08-26 14:28:23', '2020-08-26 14:28:23'),
(3542, 1006, 5888, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Received contract for signing, signed and sent back to @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> ', NULL, NULL, '2020-09-08 14:49:42', '2020-09-08 14:49:42'),
(3543, 1006, 5888, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent a followup email to Kody Dunnet regarding the status of credentialing. ', NULL, NULL, '2020-09-15 17:06:33', '2020-09-15 17:06:33'),
(3544, 1006, 5888, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received the following reply from Kody Dunnet:  \"Hi Brad  Jennifer Lee Ullrich, CSW – in cred  Jonathan Schubert, CSW – in cred  I would check in with me later next week to get a status on them.   Thanks Kody\"', NULL, NULL, '2020-09-23 17:35:50', '2020-09-23 17:35:50'),
(3545, 1006, 5888, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to Kody Dunnett Kody_Dunnett@tufts-health.com regarding the status of enrollment. ', NULL, NULL, '2020-10-05 18:13:24', '2020-10-05 18:13:24'),
(3546, 1006, 5888, NULL, '2020-10-20 00:00:00.000', 'Rejected', 'Received following rejection from Kody: \"Hi Brad  Jennifer Lee Ullrich, LICSW and Jonathan Schubert, LCSW both had their apps discontinued.  The Cred Specialist wrote “Discontinued as provider only holds LCSW and not required LICSW”  Thanks\"', NULL, NULL, '2020-10-13 10:25:46', '2020-10-13 10:25:46'),
(3547, 1006, 5890, NULL, NULL, 'New/Not Initiated', 'Applicant Name: JONATHAN SCHUBERT   Tracking ID: T071020200001025  Reassignment Tracking ID: T071020200001061  Submitted Date: FRI - JULY 10 2020 11:05:30 AM EST  Submitted By: Jonathan Schubert  Contact Email(s): SNBC@CLAIMSMEDINC.COM JONATHANRICHARDSCHUBERT@GMAIL.COM Reason(s) for submission: A Medicare Part B practitioner is enrolling in the Medicare program for the first time to bill for Part B services. A reassignment of benefits may exist. ', NULL, NULL, '2020-07-10 10:03:31', '2020-07-10 10:03:31'),
(3548, 1006, 5890, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-10 10:03:56', '2020-07-10 10:03:56'),
(3549, 1006, 5890, NULL, NULL, 'In Process', 'Status update via NGS Status Enrollment Tool:   \"CASE NUMBER	APPLICATION TYPE	RECEIVED DATE	STATUS DATE  PE0000029540	 CMS855I Web	 07/10/2020	  Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks.\"', NULL, NULL, '2020-07-21 10:22:16', '2020-07-21 10:22:16'),
(3550, 1006, 5890, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Request still shows up as in-process, no changes. ', NULL, NULL, '2020-08-06 14:54:13', '2020-08-06 14:54:13'),
(3551, 1006, 5890, NULL, '2020-08-18 00:00:00.000', 'Approved', 'Application Tracking ID: T071020200001025   NPI ID: 1235755505   Medicare ID: S400672892   Name: JONATHAN SCHUBERT  State: MA   Form Type: 855I  Date: 08/11/2020  Status: APPROVED', NULL, NULL, '2020-08-11 17:49:46', '2020-08-11 17:49:46'),
(3552, 2027, 5891, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-10 10:47:14', '2020-07-10 10:47:14'),
(3553, 2027, 5891, NULL, NULL, 'Initiated', 'sent request to KMoten4@humana.com  to add this provider in the new location Valley Med Urgent Care PLLC (Alton Gloor) at  800 E Alton Gloor Blvd Brownsville , TX 78526-4248. under the tax id : 81-5123542 with tricare', NULL, NULL, '2020-07-10 10:47:35', '2020-07-10 10:47:35');
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
(3554, 2027, 5891, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Providers)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Tricare)  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care):  Providers	Provider NPI#	Group Name	Group Tax-ID Hernandez, Eder Francisco	1386956852	Valley Med Urgent Care 	81-5123542 Lopez, Mayra Alejandra	1265945125	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542   Thanks.', NULL, NULL, '2020-10-11 16:53:36', '2020-10-11 16:53:36'),
(3555, 2027, 5891, NULL, '2020-10-23 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Hernandez, Eder Francisco)-(Valley Med Urgent Care )-(Tricare)  Please find the requested documents attached in this email to start the credentialing process for this provider.  Thanks.', NULL, NULL, '2020-10-16 14:25:12', '2020-10-16 14:25:12'),
(3556, 2027, 5891, NULL, '2020-10-23 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Thank you, This application has been submitted for processing. Please allow 90 days.        Respectfully,  Katherine Moten', NULL, NULL, '2020-10-16 15:46:24', '2020-10-16 15:46:24'),
(3557, 1006, 5891, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Sent a follow-up email to KMoten4@humana.com:  \"Hello,   I wanted to get an update regarding the status of enrollment for the following providers under our group:   Provider Names: Eder Francisco Hernandez NPI# 1386956852 Provider Name: Cynthia Rodriguez NPI# 1124282553  Both of these providers should be coming up under three locations under the given TIN# 81-5123542. Please let me know if you need any additional information.  Thank you. \"', NULL, NULL, '2020-10-23 18:11:31', '2020-10-23 18:11:31'),
(3558, 2027, 5891, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hi Katherine, Hope you are doing well, I have sent a request for this below mentioned provider to add in all three locations of (Valley Med Urgent Care) with (Tricare). May I know the current status of this request: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852   Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-11-03 13:44:57', '2020-11-03 13:44:57'),
(3559, 2027, 5891, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-10 13:31:12', '2020-11-10 13:31:12'),
(3560, 2027, 5891, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-18 10:23:07', '2020-11-18 10:23:07'),
(3561, 2027, 5891, NULL, '2020-12-02 00:00:00.000', 'In Process', 'The request is still in process, checked through provider self service portal of tricare.', NULL, NULL, '2020-11-25 10:52:47', '2020-11-25 10:52:47'),
(3562, 2027, 5891, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-02 12:52:55', '2020-12-02 12:52:55'),
(3563, 2027, 5891, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:19:20', '2020-12-10 13:19:20'),
(3564, 3040, 5891, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to KMoten4@humana.com  Subject: Location Update || Hernandez, Eder Francisco - || Valley Med Urgent Care || Tricare  Greetings,  Hope you are doing well. I wanted to know the status of the request for the below mentioned provider to add in all three locations of (Valley Med Urgent Care).   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852   Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please reply to me back as soon as possible. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2020-12-17 10:55:02', '2020-12-17 10:55:02'),
(3565, 3040, 5891, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks  ', NULL, NULL, '2020-12-17 15:43:01', '2020-12-17 15:43:01'),
(3566, 3040, 5891, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks  ', NULL, NULL, '2020-12-17 15:44:46', '2020-12-17 15:44:46'),
(3567, 3040, 5891, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks   ', NULL, NULL, '2020-12-24 10:38:37', '2020-12-24 10:38:37'),
(3568, 3040, 5891, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-31 13:21:54', '2020-12-31 13:21:54'),
(3569, 3040, 5891, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  I am inquiring on what information is missing, once I receive a response, I will let you know.  Thank you.', NULL, NULL, '2021-01-04 15:20:32', '2021-01-04 15:20:32'),
(3570, 3040, 5891, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Thank you.  This has been submitted for review; please allow 30 days.', NULL, NULL, '2021-01-11 12:13:15', '2021-01-11 12:13:15'),
(3571, 3040, 5891, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-01-19 16:48:50', '2021-01-19 16:48:50'),
(3572, 3040, 5891, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of 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 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  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 10:41:03', '2021-01-26 10:41:03'),
(3573, 3040, 5891, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. I just wanted to follow up email regarding 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 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  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 12:46:00', '2021-02-02 12:46:00'),
(3574, 3040, 5891, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. I just wanted to follow up email regarding 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 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  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 12:23:44', '2021-02-09 12:23:44'),
(3575, 3040, 5891, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Good Morning,  This provider is showing under all 3 locations.  Thank you.', NULL, NULL, '2021-02-09 13:57:56', '2021-02-09 13:57:56'),
(3576, 3040, 5891, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Can you please send me the copy of welcome letter or provider roster.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 13:58:05', '2021-02-09 13:58:05'),
(3577, 3040, 5891, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)3  I do not have a welcome letter for providers; please log into the Humana Military provider portal to see all your provider information. You can register at the below link if you have not done so already: https://infocenter.humana-military.com/provider/service/Account/Login  ', NULL, NULL, '2021-02-09 13:58:15', '2021-02-09 13:58:15'),
(3578, 3040, 5891, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  I checked on the Humana Military provider portal and it\'s showing me only 2 addresses over there and under one address the provider Eder Harnandez is showing in process. For your reference I attached the addresses screen shot.  Waiting for your response.  Thanks', NULL, NULL, '2021-02-09 13:58:29', '2021-02-09 13:58:29'),
(3579, 3040, 5891, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Thank you Adil for the screen shot. I submitted to our IT Team to review this issue. I will email once it has been corrected.', NULL, NULL, '2021-02-09 13:58:39', '2021-02-09 13:58:39'),
(3580, 3040, 5891, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  As you mentioned in your previous email the provider is showing under all 3 locations. I attached the screenshot from Tricare portal for your reference its not showing the provider completed only once location showing the provider is in process.  Waiting for your response.  Thanks', NULL, NULL, '2021-02-16 13:16:13', '2021-02-16 13:16:13'),
(3581, 3040, 5891, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. Has there been any update regarding adding locations? Also provider still showing in process in only in one location. For your reference I attached the screenshot.   Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-23 12:23:47', '2021-02-23 12:23:47'),
(3582, 3040, 5891, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. Please find the attached screenshot for your reference its not showing the provider in-network or completed. As per your previous email that provider is already in-network with all 03 locations. Can you please check and advise.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-02 15:10:22', '2021-03-02 15:10:22'),
(3583, 3040, 5891, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,  Hope you are doing well. Please find the attached the screenshot for your reference in which its showing the below mentioned provider in process only 02 locations. For the location McAllen the provider name is not showing. Can you please check & advise.  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: Hernandez, Eder Francisco Provider NPI# 1386956852  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-11 14:36:09', '2021-03-11 14:36:09'),
(3584, 3040, 5891, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Same for Eder Francisco, his application is still pending review.', NULL, NULL, '2021-03-11 14:37:19', '2021-03-11 14:37:19'),
(3585, 3040, 5891, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,  I am asking for Hernandez, Eder Francisco. Please advise.  Thanks', NULL, NULL, '2021-03-11 14:38:14', '2021-03-11 14:38:14'),
(3586, 3040, 5891, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  > Good Afternoon,  If you are talking about Moses Campos, his application is still under review for credentialing.  Please allow more time. ', NULL, NULL, '2021-03-11 14:39:00', '2021-03-11 14:39:00'),
(3587, 3040, 5891, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,   Hope you are doing well. Please advise me the status for additional location for the below mentioned provider. Also I need the effective date.   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: Hernandez, Eder Francisco (Provider is not showing on portal) Provider NPI# 1386956852 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-15 13:57:55', '2021-04-15 13:57:55'),
(3588, 3040, 5891, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Provider participating with Tricare.   Approval confirmation attached. ', NULL, NULL, '2021-05-05 10:54:20', '2021-05-05 10:54:20'),
(3589, 2027, 5892, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-10 10:49:30', '2020-07-10 10:49:30'),
(3590, 2027, 5892, NULL, NULL, 'Initiated', 'sent request to KMoten4@humana.com  to add this provider in the new location Valley Med Urgent Care PLLC (Alton Gloor) at  800 E Alton Gloor Blvd Brownsville , TX 78526-4248. under the tax id : 81-5123542 with tricare', NULL, NULL, '2020-07-10 10:49:57', '2020-07-10 10:49:57'),
(3591, 2027, 5892, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Alton Gloor))-(Tricare)  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Escobar, Angiollet Solis   Provider NPI#  1962917997   Group Name: Valley Med Urgent Care PLLC      Tax ID:  81-5123542    Thanks. ', NULL, NULL, '2020-10-11 16:24:06', '2020-10-11 16:24:06'),
(3592, 2037, 5892, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Follow up email sent to K_Moten', NULL, NULL, '2020-10-26 17:29:52', '2020-10-26 17:29:52'),
(3593, 1006, 5892, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Sent a followup email to KMoten4@humana.com regarding the status of the request. ', NULL, NULL, '2020-11-24 17:39:26', '2020-11-24 17:39:26'),
(3594, 1006, 5892, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Good Afternoon,     The location was added but it is not showing in the system for some reason. I sent an escalated request to have this looked at. Once I receive a response, I will send an email.     Thank you.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com  ', NULL, NULL, '2020-11-24 18:12:58', '2020-11-24 18:12:58'),
(3595, 2027, 5892, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Request is in process', NULL, NULL, '2020-12-02 12:53:29', '2020-12-02 12:53:29'),
(3596, 2027, 5892, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 13:20:01', '2020-12-10 13:20:01'),
(3597, 3040, 5892, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to KMoten4@humana.com  Subject: Location Update || Escobar, Angiollet Solis || Valley Med Urgent Care PLLC (Alton Gloor || Tricare  Greetings,  Hope you are doing well. I wanted to know the status of the request for the below mentioned provider to add in the location of Valley Med Urgent Care PLLC Alton Gloor.   Provider Name: Eder Francisco Hernandez Provider NPI# 1962917997   Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please reply to me back as soon as possible. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-17 11:05:38', '2020-12-17 11:05:38'),
(3598, 3040, 5892, NULL, '2020-12-31 00:00:00.000', 'Approved', 'Location updated in Tricare.  Approved attached', NULL, NULL, '2020-12-24 11:03:03', '2020-12-24 11:03:03'),
(3599, 2027, 5893, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-10 10:51:22', '2020-07-10 10:51:22'),
(3600, 2027, 5893, NULL, NULL, 'Initiated', 'sent request to KMoten4@humana.com  to add this provider in the new location Valley Med Urgent Care PLLC (Alton Gloor) at  800 E Alton Gloor Blvd Brownsville , TX 78526-4248. under the tax id : 81-5123542 with tricare', NULL, NULL, '2020-07-10 10:51:36', '2020-07-10 10:51:36'),
(3601, 2027, 5893, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  (Garcia, Homero)-(Valley Med Urgent Care PLLC (Alton Gloor))-(Tricare)  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Garcia, Homero    Provider NPI# 1730564857   Group Name: Valley Med Urgent Care PLLC      Tax ID:  81-5123542    Thanks. ', NULL, NULL, '2020-10-11 16:27:08', '2020-10-11 16:27:08'),
(3602, 2037, 5893, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-28 17:25:10', '2020-10-28 17:25:10'),
(3603, 2027, 5893, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent follow up', NULL, NULL, '2020-11-04 14:58:13', '2020-11-04 14:58:13'),
(3604, 2027, 5893, NULL, '2020-11-18 00:00:00.000', 'Rejected', 'This provider is no longer work with us so. I am rejecting this task because this task could not be completed. ', NULL, NULL, '2020-11-11 15:11:01', '2020-11-11 15:11:01'),
(3605, 3040, 5893, NULL, NULL, 'Revalidation', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Good Morning Katherine,  Hope you had a great weekend. Please advise me if the below mentioned providers are enrolled with Tricare. Because the providers are showing on provider portal but not all three locations. I wanted to add their additional locations.  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-03-29 09:30:03', '2021-03-29 09:30:03'),
(3606, 3040, 5893, NULL, NULL, 'Revalidated', 'Email rcvd from: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  > Good Morning,  Please provide a credentialing application for both providers: Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Respectfully, Katherine Moten TRICARE Community Liaison II Humana', NULL, NULL, '2021-03-29 09:32:00', '2021-03-29 09:32:00'),
(3607, 3040, 5893, NULL, '2021-06-28 00:00:00.000', 'Revalidated', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:45:45', '2021-06-21 10:45:45'),
(3608, 3040, 5893, NULL, '2021-06-28 00:00:00.000', 'Revalidated', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   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: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:49:00', '2021-06-21 10:49:00'),
(3609, 2027, 5894, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-10 10:53:01', '2020-07-10 10:53:01'),
(3610, 2027, 5894, NULL, NULL, 'Initiated', 'sent request to KMoten4@humana.com  to add this provider in the new location Valley Med Urgent Care PLLC (Alton Gloor) at  800 E Alton Gloor Blvd Brownsville , TX 78526-4248. under the tax id : 81-5123542 with tricare', NULL, NULL, '2020-07-10 10:53:13', '2020-07-10 10:53:13'),
(3611, 2027, 5894, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Providers)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Tricare)  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care):  Providers	Provider NPI#	Group Name	Group Tax-ID Hernandez, Eder Francisco	1386956852	Valley Med Urgent Care 	81-5123542 Lopez, Mayra Alejandra	1265945125	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542   Thanks.', NULL, NULL, '2020-10-11 16:54:01', '2020-10-11 16:54:01'),
(3612, 2037, 5894, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email sent to K Moten', NULL, NULL, '2020-10-28 17:32:33', '2020-10-28 17:32:33'),
(3613, 2027, 5894, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Please provide me with a  credentialing application for this provider.        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com', NULL, NULL, '2020-11-04 16:49:46', '2020-11-04 16:49:46'),
(3614, 2027, 5894, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Please find the requested documents along with the credentialing application attached in this email as per your request.  Thanks.', NULL, NULL, '2020-11-11 17:33:06', '2020-11-11 17:33:06'),
(3615, 2027, 5894, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  May I know the current status of this request ?  Thanks.', NULL, NULL, '2020-11-18 10:25:31', '2020-11-18 10:25:31'),
(3616, 2027, 5894, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-25 10:57:06', '2020-11-25 10:57:06'),
(3617, 2027, 5894, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Request is in process still', NULL, NULL, '2020-12-02 12:54:30', '2020-12-02 12:54:30'),
(3618, 2037, 5894, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Got the following update from Katherine Moten. ---------- Dr. Lopez – pending to be credentialed – application was submitted on 11/13/2020, please allow 90 days for review.   ', NULL, NULL, '2020-12-09 13:30:58', '2020-12-09 13:30:58'),
(3619, 3040, 5894, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-13 13:56:09', '2021-01-13 13:56:09'),
(3620, 3040, 5894, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: 	KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of enrollment for the below mentioned provider. Application was submitted on 11/13/2020.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-20 13:13:49', '2021-01-20 13:13:49'),
(3621, 3040, 5894, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.   Thanks ', NULL, NULL, '2021-01-28 17:08:11', '2021-01-28 17:08:11'),
(3622, 3040, 5894, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject:  Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Provider effective date: 02/02/2021.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.  Thanks', NULL, NULL, '2021-02-04 13:18:27', '2021-02-04 13:18:27'),
(3623, 3040, 5894, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached screenshot from Tricare portal and it shows the provider application completed but still it\'s not showing all three locations in the portal.  Please get back to me as soon as possible. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-11 13:32:22', '2021-02-11 13:32:22'),
(3624, 3040, 5894, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider in all three locations.   Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-18 15:03:52', '2021-02-18 15:03:52'),
(3625, 3040, 5894, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Provider has been added to all 3 locations. Please allow 3 business days for system to update.', NULL, NULL, '2021-02-25 10:35:40', '2021-02-25 10:35:40'),
(3626, 3040, 5894, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. I checked the Tricare provider directory for Mayra A Lopez and its showing on only 02 locations. Can you please check and advise because its not showing on our primary location which is 2534 Boca Chica Blvd Brownsville , TX 78521-3496 for your reference I attached the screenshot from website.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-04 17:17:20', '2021-03-04 17:17:20'),
(3627, 3040, 5894, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 17:10:16', '2021-03-12 17:10:16'),
(3628, 3040, 5894, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Provider enroll with Tricare.  Effective Date: 02/02/2021.', NULL, NULL, '2021-04-15 13:35:08', '2021-04-15 13:35:08'),
(3629, 3040, 5894, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Provider enroll with Tricare.  Effective Date: 02/02/2021.', NULL, NULL, '2021-04-15 13:36:39', '2021-04-15 13:36:39'),
(3630, 2027, 5895, NULL, NULL, 'New/Not Initiated', 'sent request to KMoten4@humana.com  to add this provider in the new location Valley Med Urgent Care PLLC (Alton Gloor) at  800 E Alton Gloor Blvd Brownsville , TX 78526-4248. under the tax id : 81-5123542 with tricare', NULL, NULL, '2020-07-10 10:55:11', '2020-07-10 10:55:11'),
(3631, 1005, 5895, NULL, NULL, 'Initiated', 'Request to add the provider under the group contract has been submitted to Katherine Moten | KMoten4@humana.com', NULL, NULL, '2020-07-10 15:26:29', '2020-07-10 15:26:29'),
(3632, 2027, 5895, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Providers)-(Valley Med Urgent Care PLLC (Alton Gloor)-(Tricare)  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care):  Providers	Provider NPI#	Group Name	Group Tax-ID Hernandez, Eder Francisco	1386956852	Valley Med Urgent Care 	81-5123542 Lopez, Mayra Alejandra	1265945125	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542   Thanks.', NULL, NULL, '2020-10-11 16:53:50', '2020-10-11 16:53:50'),
(3633, 2037, 5895, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Follow up email sent to K Moten', NULL, NULL, '2020-10-28 17:33:13', '2020-10-28 17:33:13'),
(3634, 2027, 5895, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Tricare)  Hi Katherine,  I want to know if this below mentioned provider is enrolled in all three locations of (Valley Med Urgent Care). Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-29 13:38:01', '2020-10-29 13:38:01'),
(3635, 2027, 5895, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-05 15:17:48', '2020-11-05 15:17:48'),
(3636, 2037, 5895, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent to K-Moten --------------- (Rodriguez, Cynthia)-(Valley Med Urgent Care )-(Tricare)  Hi Katherine,  I want to know if this below mentioned provider is enrolled in all three locations of (Valley Med Urgent Care). Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-11-12 17:13:34', '2020-11-12 17:13:34'),
(3637, 2027, 5895, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-19 10:44:56', '2020-11-19 10:44:56'),
(3638, 2027, 5895, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  May I know the current status of the below mentioned provider: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-11-30 15:18:41', '2020-11-30 15:18:41'),
(3639, 2037, 5895, NULL, '2020-12-17 00:00:00.000', 'In Process', 'May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1) Group Name: Columbus Urgent Care PA     Group Tax-ID: 471914151       Provider Name: Jose, Julie                Provider NPI# 1447883061     --------------------------------------- 2)  Group Name: Valley Med Urgent Care (All three locations)      Group Tax-ID: 81-5123542     Provider Name: Rodriguez, Cynthia     Provider NPI# 1124282553      Provider Name: Campos, Moses                Provider NPI# 1558680009      Provider Name: Wright, Larry Donald                Provider NPI# 1033769765', NULL, NULL, '2020-12-08 15:08:55', '2020-12-08 15:08:55'),
(3640, 3040, 5895, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 14:12:43', '2020-12-17 14:12:43'),
(3641, 3040, 5895, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-17 14:13:30', '2020-12-17 14:13:30'),
(3642, 3040, 5895, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Follow up email send to : HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached spreadsheet to add locations for the below providers.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Kindly send me the credentialing application form for Campos, Moses.  Please feel free to email me if you need anything else from my end. Waiting to hear from you soon.  Thanks', NULL, NULL, '2020-12-18 09:45:18', '2020-12-18 09:45:18'),
(3643, 3040, 5895, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia|| || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.  The use of Humana Military’s standard roster template is highly encouraged and will result in more efficient processing times.  The use of other formats requires significant manual processing and slower load times.', NULL, NULL, '2020-12-18 16:00:43', '2020-12-18 16:00:43'),
(3644, 3040, 5895, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email rcvd from:HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion. ', NULL, NULL, '2020-12-28 12:12:31', '2020-12-28 12:12:31'),
(3645, 3040, 5895, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Email sent to: 	HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the update on the enrollment status of below mentioned providers. We already sent the credential application form for Moses Campos.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-04 16:44:29', '2021-01-04 16:44:29'),
(3646, 3040, 5895, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Follow up Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-11 14:42:57', '2021-01-11 14:42:57'),
(3647, 3040, 5895, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com,   HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-18 13:56:03', '2021-01-18 13:56:03'),
(3648, 3040, 5895, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. The two providers are already certified and the dates are mentioned below.  Practice Detail: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Can you please advise that did you received the credentialing application for below provider.  Provider 3: Provider Name: Wright, Larry Donald Provider NPI# 1033769765   Please feel free to email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:34:48', '2021-01-25 13:34:48'),
(3649, 3040, 5895, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-02-01 15:35:21', '2021-02-01 15:35:21'),
(3650, 3040, 5895, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-02-08 13:52:25', '2021-02-08 13:52:25'),
(3651, 3040, 5895, NULL, '2021-02-22 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,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  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 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  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-02-15 13:36:22', '2021-02-15 13:36:22'),
(3652, 3040, 5895, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks  ', NULL, NULL, '2021-02-22 13:34:57', '2021-02-22 13:34:57');
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
(3653, 3040, 5895, NULL, '2021-03-08 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 are doing well. Please note the I checked the provider enrollment status on Tricare portal for below mentioned providers its shows the credentialing is completed but on Tricare provider directory its not showing up. Can you please check and advise.  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: Cynthia Rodriguez PA Provider NPI# 1124282553  Provider Name: Larry D Wright NP Provider NPI# 1033769765  Also I checked the provider enrollment status for the below mentioned provider its only showing in 02 locations in-process. In McAllen location provider is not showing up. Can you please check this and advise.   Provider Name: Deborah Potter NP Provider NPI# 1861914053  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 16:52:12', '2021-03-01 16:52:12'),
(3654, 3040, 5895, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Missing on Directory || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please find the attached screenshot from the provider directory where the provider is showing at one location only. While on the provider portal the provider is showing in all three locations. Can you please check and advise.   Find below are the details for the facility and 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: Cynthia Rodriguez  Provider NPI# 1124282553  I really appreciate all your help. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-11 15:16:11', '2021-03-11 15:16:11'),
(3655, 3040, 5895, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Missing on Directory || Rodriguez, Cynthia || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update for me?  Thanks  ', NULL, NULL, '2021-03-18 16:02:42', '2021-03-18 16:02:42'),
(3656, 3040, 5895, 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 08:07:31', '2021-04-15 08:07:31'),
(3657, 3040, 5895, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 2: Provider Name: Campos, Moses - eff: 3/16/2021 (showing under all 3 locations) Provider NPI# 1558680009 ', NULL, NULL, '2021-04-15 10:22:29', '2021-04-15 10:22:29'),
(3658, 1006, 5896, NULL, NULL, 'New/Not Initiated', 'You have successfully submitted your application. Please print a copy of this page for your records.  CBP-0000163355  First Name	Jennifer Middle Name	Lee Last Name	Ullrich Confirmation Number	CBP-0000163355', NULL, NULL, '2020-07-10 11:22:17', '2020-07-10 11:22:17'),
(3659, 1006, 5896, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-10 11:22:23', '2020-07-10 11:22:23'),
(3660, 1006, 5896, NULL, NULL, 'In Process', 'Received following email from Cigna \'Vanessa Puente Saenz via DocuSign\':   Sub: MA 14639567 Jennifer Ullrich Cigna behavioral Contract BID  \"Dear Jennifer Ullrich Tin becoming a part of our behavioral health care professional network. We are pleased to extend a Cigna Behavioral Onboarding Packet to you. Please review and complete the attached documents within the next 10 business days and submit them electronically via DocuSign with your signature. Once received, we will review your credentialing information via online source verification systems. Please note: You will not be considered in network until your credentials are verified and you receive notification from Cigna that your Onboarding is complete. If you have any questions, please contact me directly using the contact information located at the bottom of this email. Thank you, Vanessa Puente\"', NULL, NULL, '2020-07-13 15:01:36', '2020-07-13 15:01:36'),
(3661, 1006, 5896, NULL, NULL, 'In Process', 'Received contract BID was filled out, signed and sent back. ', NULL, NULL, '2020-07-21 10:26:14', '2020-07-21 10:26:14'),
(3662, 1006, 5896, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent follow-up email to \"Ford, Emily R HHHH\" emily.ford3@cigna.com> regarding the status of enrollment. ', NULL, NULL, '2020-08-18 17:40:52', '2020-08-18 17:40:52'),
(3663, 1006, 5896, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Haven\'t received any response from Emily, sent a follow-up email to Behavioral Contracting BehavioralContracting@cigna.com>:  \"Good morning,  I hope you\'re doing well, I wanted to get an update regarding the credentialing/contracting status of the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760 Provider Name: Joanna Wood NPI# 1801986054 Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Please get back to me as soon as you\'re able and please expedite the request.  Thank you!\"', NULL, NULL, '2020-08-21 09:44:43', '2020-08-21 09:44:43'),
(3664, 1006, 5896, NULL, '2020-09-09 00:00:00.000', 'In Process', 'Received following update from Ramesh, Ambresh Kausip (CTR) AmbreshKausip.Ramesh@cigna.com>:  \"Hello,  Provider name : JENNIFER ULLRICH We have received your credentialing application for participation or continued participation in our Network.  The materials we received did not include the following required information.  This information is needed before we can proceed further with the processing of your application:  Kindly submit the Resume or please provide the information on provider’s Professional school.(Master degree with start and end date along with area of study)  Thank you for your cooperation.  Provider SOLUTIONS & OPERATIONS Ambresh Kausip Ramesh Credentialing Specialist T: 844.468.3272 Extn: 885444  |  F: 860.697.7784 E: Ambreshkausip.Ramesh@Cigna.com\"  Informed them. ', NULL, NULL, '2020-09-02 15:47:36', '2020-09-02 15:47:36'),
(3665, 1006, 5896, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Sent a follow-up email to Ambresh regarding the status. ', NULL, NULL, '2020-09-08 10:06:07', '2020-09-08 10:06:07'),
(3666, 1006, 5896, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Called in and received the following update: Jennifer - Contracted as of 08/27/2020 Ref: Aloie O 09/09/2020   Also sent an email @ larissa.pugh@cigna.com requesting welcome letter. Attached provider portal address.  ', NULL, NULL, '2020-09-09 10:10:08', '2020-09-09 10:10:08'),
(3667, 1006, 5896, NULL, '2020-09-17 00:00:00.000', 'In Process', 'Received following email from Cigna, as previously given approval was done so by mistake by their contracting department:   \"Hi,  Thank you for the information provided.Credentialing process will be completed within 5 business days.   Provider SOLUTIONS & OPERATIONS  Rokesh S Credentialing Specialist T: 844.468.3272 | EXT: 491221  | F: 860.683.9534 | E: Rokesh.Sundarrajan@Cigna.com Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.©Copyright 2020 Cigna\"', NULL, NULL, '2020-09-10 12:47:11', '2020-09-10 12:47:11'),
(3668, 1006, 5896, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent followup email to \"Sundarrajan, Rokesh (CTR)\" Rokesh.Sundarrajan@cigna.com> regarding the status. ', NULL, NULL, '2020-09-15 17:09:06', '2020-09-15 17:09:06'),
(3669, 1006, 5896, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Sent followup email to Behavioral Contracting BehavioralContracting@cigna.com>', NULL, NULL, '2020-09-17 18:08:43', '2020-09-17 18:08:43'),
(3670, 1006, 5896, NULL, '2020-09-28 00:00:00.000', 'Rejected', 'Received the following email from Puente Saenz, Vanessa (Vanessa Puente Saenz) HHHH Vanessa.PuenteSaenz@cigna.com>:  \"Hello,  Thank you for applying to join Cigna Behavioral. Unfortunately at this time your process has been stopped during the Provider Verification stage of credentialing due to the following: Invalid License- LCSW is not valid for the state of MA  A letter containing the details of the process stop was sent to snbc@claimsmedinc.com.  If you have any further questions, please include the confidential email/mailing address where you wish to be contacted.   Thank you,  ConnectedCare PROVIDER OPERATIONS Vanessa Puente Saenz Behavioral NCU | Provider Relations Associate Analyst T: 770.281.3801 | F: 860.298.6461\" ', NULL, NULL, '2020-09-21 14:48:49', '2020-09-21 14:48:49'),
(3671, 1006, 5897, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-10 13:12:53', '2020-07-10 13:12:53'),
(3672, 1006, 5897, NULL, NULL, 'Approved', 'Good Morning Ben,   I have received all paper work required, and we have the provider in the network with Contract ID 69114, Effective Date 07/10/2018.     Hopeton McLean ', NULL, NULL, '2020-07-10 13:15:02', '2020-07-10 13:15:02'),
(3673, 1006, 5898, NULL, NULL, 'New/Not Initiated', 'Location credentialed /contracting, adding additional providers under group contract.  ', NULL, NULL, '2020-07-10 13:18:39', '2020-07-10 13:18:39'),
(3674, 1005, 5898, NULL, NULL, 'In Process', 'Roster has been received to add additional providers.', NULL, NULL, '2020-07-10 15:21:05', '2020-07-10 15:21:05'),
(3675, 2027, 5898, NULL, '2020-08-31 00:00:00.000', 'In Process', 'From: colbee.snyder@primehealthservices.com  Good Afternoon,     Note: If sent in error, please forward this message to the person/department responsible for credentialing.  Thank you for participating with Prime Health Services. Our records indicate that the below facilities within your group’s contract are due to be credentialed/re-credentialed.  Tax ID 760612416  NPI 1770763815 LONGPOINT MEDICAL PA     Please fill out the attached facility application and included the requested documentation on the bottom of the application.  If a facility is no longer part of your group, please return the date of closure.  We request this information be return to us withing the next ten business days. If you have any questions, please feel free to contact me below. If you choose to fax, please mark it to my attention.  Thank you,  Colbee Snyder', NULL, NULL, '2020-08-24 13:15:59', '2020-08-24 13:15:59'),
(3676, 2027, 5898, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: colbee.snyder@primehealthservices.com  Please find the documents attached which you have asked along with the PHS Facility Application for Re-credentialing.', NULL, NULL, '2020-08-24 14:05:31', '2020-08-24 14:05:31'),
(3677, 2027, 5898, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: colbee.snyder@primehealthservices.com  Sub: (For Group)-(Longpoint Medical Center)-(Prime Health Services)  May i know the current status of the group mentioned below: Group Name-Longpoint Medical Center Group Tax-ID-76-0612416 Group NPI#1770763815 Thanks.', NULL, NULL, '2020-09-01 16:58:30', '2020-09-01 16:58:30'),
(3678, 2027, 5898, NULL, '2020-09-09 00:00:00.000', 'In Process', 'From: colbee.snyder@primehealthservices.com  Sub: (For Group)-(Longpoint Medical Center)-(Prime Health Services)  Good Morning,     Credentialing for this group is still processing.     Thank you,', NULL, NULL, '2020-09-02 09:37:09', '2020-09-02 09:37:09'),
(3679, 1005, 5898, NULL, '2020-10-05 00:00:00.000', 'In Process', ' Martin Rodriguez 1:23 AM (29 minutes ago) to Colbee, lpmc, me   May i know the current status of the group mentioned below: Group Name-Longpoint Medical Center Group Tax-ID-76-0612416 Group NPI#1770763815 Thanks.', NULL, NULL, '2020-09-24 15:57:27', '2020-09-24 15:57:27'),
(3680, 2027, 5898, NULL, '2020-10-02 00:00:00.000', 'Approved', 'Re-credentialing has been done and effective date is 07/10/2018.', NULL, NULL, '2020-09-25 10:57:25', '2020-09-25 10:57:25'),
(3681, 1006, 5899, NULL, NULL, 'New/Not Initiated', 'Group roster sent to Updates@primehealthservices.com', NULL, NULL, '2020-07-10 16:00:11', '2020-07-10 16:00:11'),
(3682, 1006, 5899, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-10 16:00:16', '2020-07-10 16:00:16'),
(3683, 2027, 5899, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: colbee.snyder@primehealthservices.com  Sub: (For Group)-(Normandy Urgent Care Center)-(Prime Health Services)  May i know the current status of the group mentioned below: Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429 Group NPI# 1407171077 Thanks.', NULL, NULL, '2020-09-02 17:10:18', '2020-09-02 17:10:18'),
(3684, 2027, 5899, NULL, '2020-09-10 00:00:00.000', 'In Process', 'To: colbee.snyder@primehealthservices.com  Sub: (For Group)-(Normandy Urgent Care Center)-(Prime Health Services)  Please find the requested documents attached in this email.  Thanks.', NULL, NULL, '2020-09-03 16:57:09', '2020-09-03 16:57:09'),
(3685, 2027, 5899, NULL, '2020-09-10 00:00:00.000', 'In Process', 'From: colbee.snyder@primehealthservices.com  Hi Martin,     Would you please send or resend the credentialing form/documentation? It doesn’t seem that the credentialing process has been started.     Thank you,', NULL, NULL, '2020-09-03 16:59:33', '2020-09-03 16:59:33'),
(3686, 1005, 5899, NULL, '2020-10-05 00:00:00.000', 'In Process', ' Martin Rodriguez 1:22 AM (31 minutes ago) to Colbee, nucc, me  Hello Colbee,   Hope you are doing well, May I know the current status of my request as I have already sent you the documents you have asked to send. The details of the  group are mentioned below:  Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429 Group NPI# 1407171077 Thanks. ', NULL, NULL, '2020-09-24 15:57:01', '2020-09-24 15:57:01'),
(3687, 2037, 5899, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent another follow up email to Colbee for the status:  Hello Colbee,   Hope you are doing well, May I know the current status of my request as I have already sent you the documents you have asked to send.  The details of the  group are mentioned below:  Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429 Group NPI# 1407171077  Thank you!', NULL, NULL, '2020-10-22 16:51:21', '2020-10-22 16:51:21'),
(3688, 2027, 5899, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: colbee.snyder@primehealthservices.com  Can I have the welcome letter for this practice if the contracting is complete? ', NULL, NULL, '2020-11-10 13:29:01', '2020-11-10 13:29:01'),
(3689, 2037, 5899, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent to colbee for welcome letter', NULL, NULL, '2020-11-18 14:38:08', '2020-11-18 14:38:08'),
(3690, 2037, 5899, NULL, '2020-12-17 00:00:00.000', 'In Process', 'As per the response from Ryan credentialing is completed but signed contract was not received . Signed and submitted back. --------------  Ryan Incrocci 11:17 AM (1 hour ago) to me  Hi Sherry,     I emailed Martin an agreement 2 months ago. It’s showing that there hasn’t been a contract received. Can you please send me the agreement signed again?     Ryan Incrocci National Network Development Executive Prime Health Services, Inc. | 331 Mallory Station Rd Franklin, TN 37067 office 615-970-7808 | ryan.incrocci@primehealthservices.com www.PrimeHealthServices.com Follow us on...       Sherry Deen Attachments 1:11 PM (1 minute ago) to Ryan  Hi Ryan,  Apologies for the delay. Kindly find the attached signed agreements to proceed further with the contracting process.  Please let me know if you need any additional information. Regards:', NULL, NULL, '2020-11-19 14:17:27', '2020-11-19 14:17:27'),
(3691, 2037, 5899, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Confirmation of receiving of the contract from Ryan -------------------- Ryan Incrocci 8:59 AM (30 minutes ago) to me  Hi Sherry,     I’ll get it turned in!', NULL, NULL, '2020-11-20 10:35:35', '2020-11-20 10:35:35'),
(3692, 2037, 5899, NULL, '2020-12-11 00:00:00.000', 'Approved', 'Received confirmation email and Welcome packet with executed signed contract for group effective 11/19/2020. Uploaded on EMRBS', NULL, NULL, '2020-12-04 15:38:09', '2020-12-04 15:38:09'),
(3693, 1006, 5900, NULL, NULL, 'New/Not Initiated', 'Group roster sent to Updates@primehealthservices.com ', NULL, NULL, '2020-07-10 16:01:30', '2020-07-10 16:01:30'),
(3694, 1006, 5900, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-10 16:01:34', '2020-07-10 16:01:34'),
(3695, 2027, 5900, NULL, '2020-08-17 00:00:00.000', 'In Process', 'To: austin.owens@primehealthservices.com  Please find the attached Provider agreement form which you have requested in the morning.  Thanks.', NULL, NULL, '2020-08-10 14:06:56', '2020-08-10 14:06:56'),
(3696, 2027, 5900, NULL, '2020-08-17 00:00:00.000', 'In Process', 'From: austin.owens@primehealthservices.com  Thank you, I will send this over to be submitted.', NULL, NULL, '2020-08-10 14:12:04', '2020-08-10 14:12:04'),
(3697, 2027, 5900, NULL, '2020-08-18 00:00:00.000', 'In Process', 'From: austin.owens@primehealthservices.com  Good Morning Martin,     I hope you are doing well. I do need one more document signed for the TX HCN addendum for the contract that you had sent over to me. Let me know if you have any questions, I would be happy to help.     Best,', NULL, NULL, '2020-08-11 10:47:46', '2020-08-11 10:47:46'),
(3698, 2027, 5900, NULL, '2020-08-18 00:00:00.000', 'In Process', 'To: austin.owens@primehealthservices.com  Please find the attached document which you have requested for.  Thanks.', NULL, NULL, '2020-08-11 10:48:31', '2020-08-11 10:48:31'),
(3699, 2027, 5900, NULL, '2020-08-18 00:00:00.000', 'In Process', 'From: austin.owens@primehealthservices.com  Thank you Martin! I will send this over to be submitted.', NULL, NULL, '2020-08-11 10:53:28', '2020-08-11 10:53:28'),
(3700, 2027, 5900, NULL, '2020-09-17 00:00:00.000', 'In Process', 'To: austin.owens@primehealthservices.com  Sub: (For Group)-(Columbus Urgent Care PA)-(Prime Health Services)  Hello,  Hope you are doing great, I want to know about the current status of the group. Following are the details:  Group Name: Columbus Urgent Care PA Tax-ID: 471914151 Group NPI# 1215330501 Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-09-10 16:49:32', '2020-09-10 16:49:32'),
(3701, 2027, 5900, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Group contract request has been completed and now showing linked with insurance and effective date is 8/10/2020. Executed signed contract is attached ', NULL, NULL, '2020-09-11 09:54:29', '2020-09-11 09:54:29'),
(3702, 1006, 5901, NULL, NULL, 'New/Not Initiated', 'Submitted certification request via fax to 608-221-7535', NULL, NULL, '2020-07-10 18:02:15', '2020-07-10 18:02:15'),
(3703, 1006, 5901, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-10 18:05:36', '2020-07-10 18:05:36'),
(3704, 1006, 5901, NULL, NULL, 'Rejected', 'Tricare is unable to certify or credential LCSW providers. ', NULL, NULL, '2020-07-22 14:46:48', '2020-07-22 14:46:48'),
(3705, 1006, 5902, NULL, NULL, 'New/Not Initiated', 'Sent contracting application via fax to 617-246-5053', NULL, NULL, '2020-07-13 10:39:04', '2020-07-13 10:39:04'),
(3706, 1006, 5902, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-13 10:39:08', '2020-07-13 10:39:08'),
(3707, 1006, 5902, NULL, NULL, 'In Process', 'Received following email from BCBS @ Blue Cross Case Response noreply-contracting@bcbsma.com>:    \"Dear Provider: This is an automatic reply from an email box that is not monitored. Blue Cross Blue Shield of Massachusetts acknowledges receipt of your recent submission.  It will be worked in the order it was received. Any questions, please contact Network Management & Credentialing Services at  800-316-BLUE (2583).\"', NULL, NULL, '2020-07-20 09:22:49', '2020-07-20 09:22:49'),
(3708, 1006, 5902, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Application is still in review - contract should be received in a week. Ref# Terry 08/06/2020', NULL, NULL, '2020-08-06 15:34:55', '2020-08-06 15:34:55'),
(3709, 1006, 5902, NULL, '2020-08-17 00:00:00.000', 'In Process', 'As per BCBSMA, they aren\'t accepted LCSW. Asked them if we can setup supervisory protocols or if there\'s anything else that we can do. ', NULL, NULL, '2020-08-10 11:13:45', '2020-08-10 11:13:45'),
(3710, 1006, 5902, NULL, '2020-08-25 00:00:00.000', 'Rejected', 'Received update, as per them we cannot enroll LCSW under a supervising physician:  \"Hi Brad,  Our policy does not allow for credentialing for CSW’s even under a supervisor.  Thank you  Deb Draheim, CPCS Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com\"', NULL, NULL, '2020-08-18 10:32:33', '2020-08-18 10:32:33'),
(3711, 1006, 5902, NULL, '2020-09-21 00:00:00.000', 'In Process', 'Received a contract to sign and process BCBSMA request, even though they had previously notified us that request could not be processed due to LCSW deficiency. Contract signed and sent back. Attached for reference. ', NULL, NULL, '2020-09-14 16:44:55', '2020-09-14 16:44:55'),
(3712, 1006, 5902, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Sent a follow-up email to providerapplicationstatus@bcbsma.com regarding status update. ', NULL, NULL, '2020-10-06 13:58:56', '2020-10-06 13:58:56'),
(3713, 1006, 5902, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Received following reply from BCBS:  \"Hello,  Contracts were received for this provider Jonathan Schubert on 9/14/20. Credentialing is still in process. This takes 50-60 days to complete. A welcome letter will be sent with providers effective date once process is completed.  Thank you,  Network Management Services Blue Cross and Blue Shield of Massachusetts AB\"', NULL, NULL, '2020-10-13 13:10:10', '2020-10-13 13:10:10'),
(3714, 1006, 5902, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Sent a followup email to providerapplicationstatus@bcbsma.com:  \"Good morning,   I hope you\'re doing well, I wanted to check in again regarding the enrollment status for the below provider: Provider Name: Jonathan Schubert NPI# 1235755505 TIN# 83-4482753  I\'d appreciate it if this request could be expedited as well since we have quite a few BCBS patients.  Thank you. \"', NULL, NULL, '2020-10-26 10:03:02', '2020-10-26 10:03:02'),
(3715, 1006, 5902, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent a follow-up email to providerapplicationstatus@bcbsma.com for status.  ', NULL, NULL, '2020-11-04 17:30:37', '2020-11-04 17:30:37'),
(3716, 1006, 5902, NULL, '2020-11-12 00:00:00.000', 'Rejected', 'Received following rejection email from BCBS: \"Hello,  We were unable to credential Jonathan Schubert as he is showing as having only a LCSW license and no LICSW. Notification sent to snbc@claimsmedinc.com on 08-10-2020.  Regards, Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-11-05 09:08:53', '2020-11-05 09:08:53'),
(3717, 1019, 5902, NULL, '2021-10-06 00:00:00.000', 'Revalidation', 'Faxed the application to BCBS MA via fax. ', NULL, NULL, '2021-09-29 10:33:58', '2021-09-29 10:33:58'),
(3718, 11056, 5902, NULL, '2021-12-09 00:00:00.000', 'Revalidation', 'Email sent to: providerapplicationstatus@bcbsma.com  Sub:  Enrollment Status Updates - SNBCARE - BCBS  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers under the facility TIN with both locations with BCBS.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jessica Hartman	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jessica Hartman	1326665472	100 New State Highway, Raynham, MA, 02767. Jonathan Schubert	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jonathan Schubert	1235755505	100 New State Highway, Raynham, MA, 02767.  If you have any concerns or queries feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-12-02 17:12:41', '2021-12-02 17:12:41'),
(3719, 11056, 5902, NULL, '2021-12-10 00:00:00.000', 'Revalidation', 'RE: Infosecure RE: Enrollment Status Updates - SNBCARE - BCBS', NULL, NULL, '2021-12-03 10:11:06', '2021-12-03 10:11:06'),
(3720, 19067, 5902, NULL, '2022-03-29 00:00:00.000', 'Revalidated', 'Effective date: 02/17/2022. Agreement is attached.', NULL, NULL, '2022-03-22 14:09:05', '2022-03-22 14:09:05'),
(3721, 1006, 5903, NULL, NULL, 'New/Not Initiated', 'Submitted online application for enrollment ', NULL, NULL, '2020-07-13 11:00:56', '2020-07-13 11:00:56'),
(3722, 1006, 5903, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-13 12:03:48', '2020-07-13 12:03:48'),
(3723, 1006, 5903, NULL, '2020-08-16 00:00:00.000', 'In Process', 'Requested followup from \"Bevin, Laura J\" Laura.Bevin@aetna.com> regarding the status of enrollment. ', NULL, NULL, '2020-08-06 15:43:16', '2020-08-06 15:43:16'),
(3724, 1006, 5903, NULL, '2020-08-17 00:00:00.000', 'In Process', 'Providers CAQH is being verified for information currently.', NULL, NULL, '2020-08-10 09:52:29', '2020-08-10 09:52:29'),
(3725, 1006, 5903, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent followup email to \"Bevin, Laura J\" Laura.Bevin@aetna.com>, regarding status for the request.  ', NULL, NULL, '2020-08-18 13:20:12', '2020-08-18 13:20:12'),
(3726, 1006, 5903, NULL, '2020-08-28 00:00:00.000', 'In Process', 'No response, sent another follow-up email to Laura Bevin. ', NULL, NULL, '2020-08-21 09:36:10', '2020-08-21 09:36:10'),
(3727, 1006, 5903, NULL, '2020-09-01 00:00:00.000', 'In Process', 'Received following update from Laura:   \"Hello,  Jennifer Lee Ullrich, 6913357 – her credentialing was discontinued due to her license. Can you please advise if she is able to practice independently without the need to be supervised?  Jonathan Schubert, 6249193 - his credentialing was discontinued due to her license. Can you please advise if he is able to practice independently without the need to be supervised?  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-08-25 09:30:27', '2020-08-25 09:30:27'),
(3728, 1006, 5903, NULL, '2020-09-09 00:00:00.000', 'Rejected', '\"Aetna is unable to credential Jennifer Lee Ullrich, 6913357 and Jonathan Schubert, 6249193 since they need to be supervised.  Aetna requires providers to be able to practice independently without the need to be supervised.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\" ', NULL, NULL, '2020-09-02 16:54:36', '2020-09-02 16:54:36'),
(3729, 1019, 5903, NULL, NULL, 'Revalidation', 'As discussed with the rep we need to reprocessed the application because they had rejected our application because Jonathan LCSW license was not showing in CAQH.  Sent the following email to credentialingbackinprocess-bip@aetna.com SUB: Reprocess Application || Jonathan Schubert || SNBCARE || Aetna  Hello, As we have spoken with the Rep, as per her Jonathan Schubert LCSW license was not showing up in CAQH on your end, Can you please reprocess our application, details are mentioned below for the request. Attached is the copy of his License, let me know if you need any further assistance for this request.  Provider Information: Jonathan Schubert  NPI: 1235755505 Provider ID: 6249193 CAQH: 14878838  Regards, Alex', NULL, NULL, '2021-04-22 10:08:24', '2021-04-22 10:08:24'),
(3730, 1006, 5904, NULL, NULL, 'New/Not Initiated', 'Submitted enrollment request via online portal ', NULL, NULL, '2020-07-13 15:20:06', '2020-07-13 15:20:06'),
(3731, 1006, 5904, NULL, NULL, 'In Process', 'Received following reply from Jones-Wright, Judith JJonesWright@magellanhealth.com>:  Sub: Jennifer Ullrich MIS 601467-471  \"Good Day,  CAQH ID: 14639567  If all of the information is showing correctly in the CAQH application, such as the work history and malpractice insurance, then send nothing more.  Judy Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management\"', NULL, NULL, '2020-07-13 15:21:19', '2020-07-13 15:21:19'),
(3732, 1006, 5904, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Requested followup regarding the status from JJonesWright@magellanhealth.com', NULL, NULL, '2020-08-06 13:32:59', '2020-08-06 13:32:59'),
(3733, 1006, 5904, NULL, '2020-08-13 00:00:00.000', 'Approved', 'Received following reply from Judith:   \"The provider has been linked to your group effective date 7/27/2020.\"', NULL, NULL, '2020-08-06 14:12:19', '2020-08-06 14:12:19'),
(3734, 1006, 6902, NULL, NULL, 'New/Not Initiated', 'Cigna Behavioral Provider Application You have successfully submitted your application. Please print a copy of this page for your records. CBP-0000163803 Hide Section - Application InformationApplication Information First Name	Jonathan Middle Name	 Last Name	Schubert Confirmation Number	CBP-0000163803', NULL, NULL, '2020-07-14 10:32:52', '2020-07-14 10:32:52'),
(3735, 1006, 6902, NULL, NULL, 'In Process', NULL, NULL, NULL, '2020-07-14 10:33:20', '2020-07-14 10:33:20'),
(3736, 1006, 6902, NULL, NULL, 'On Hold', 'Received following email from behPWS@cigna.com:  Sub: Cigna: Response to your Inquiry  \"Dear Jonathan Schubert, Thank you for your interest in Cigna\'s behavioral provider network. Although Cigna\'s network is always open to new providers, we develop specialized networks for our participants. At present, network needs are based upon multiple criteria including: 1) the demographics of current membership in your area; 2) potential new business growth; and 3) our contracting and credentialing requirements.  After a thorough assessment, you do not meet our minimum requirements.  Thank you again for your interest in Cigna,  Sincerely, Cigna Behavioral Credentialing\"', NULL, NULL, '2020-07-15 10:18:41', '2020-07-15 10:18:41'),
(3737, 1006, 6902, NULL, NULL, 'In Process', 'Sent email to \"Ford, Emily R      HHHH\" emily.ford3@cigna.com>:  Sub: Enrollment Issue - Jonathan Schubert - SNBCare  \"Hey Emily, I hope you\'re doing well, we were trying to enroll a new LCSW to our group and received a rejection letter, could you please take a look into why/how this happened? As we\'ve enrolled other LCSW\'s under our group and haven\'t had this issue.  The providers details are as follows: Provider Name: Jonathan SchubertNPI# 1235755505Group TIN# 83-4482753  Thank you!\"', NULL, NULL, '2020-07-29 11:24:19', '2020-07-29 11:24:19'),
(3738, 1006, 6902, NULL, NULL, 'In Process', 'Submitted application again:   \"You have successfully submitted your application. Please print a copy of this page for your records.  Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number.   If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273.\"', NULL, NULL, '2020-07-29 12:42:15', '2020-07-29 12:42:15'),
(3739, 1006, 6902, NULL, NULL, 'In Process', 'Received reply from Cigna telling us that we can\'t enroll as LCSW isn\'t meeting the minimum requirements, sent following email to Pugh, Larissa R HHHH Larissa.Pugh@cigna.com> & Julia.perkins@cigna.com:  Sub: Enrollment Issue - Jonathan Schubert - SNBCare  \"Hello Larissa,   As I mentioned in my previous email, we already have a few other LCSW\'s working under the group that are already enrolled with Cigna and the online application itself also allows us to enroll as an LCSW.   Is there any way to rectify this issue and start the enrollment process?  Thank you. \"', NULL, NULL, '2020-07-31 03:19:58', '2020-07-31 03:19:58'),
(3740, 1006, 6902, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Informed them of the other LCSW providers that are already enrolled or are in the process of being enrolled @ \"Pugh, Larissa R HHHH\" Larissa.Pugh@cigna.com>', NULL, NULL, '2020-08-06 17:40:51', '2020-08-06 17:40:51'),
(3741, 1006, 6902, NULL, '2020-08-25 00:00:00.000', 'Rejected', 'As per our discussion with Furquan, I\'ve notified him that trying to keep going forward with this might effect the enrollment for our other LCSW providers after Cigna has been notified of their enrollment. Rejecting this task. ', NULL, NULL, '2020-08-18 10:48:11', '2020-08-18 10:48:11'),
(3742, 1006, 6903, NULL, NULL, 'New/Not Initiated', 'Hello,  Please find the two HCAS for our providers, we want to get them enrolled ASAP under our group. Please let me know if anything else is needed to process this request.  Thank you. ', NULL, NULL, '2020-07-15 13:32:50', '2020-07-15 13:32:50'),
(3743, 1006, 6903, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-15 13:33:00', '2020-07-15 13:33:00'),
(3744, 1006, 6903, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent a followup request to #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> asking for an update.  ', NULL, NULL, '2020-08-06 13:48:45', '2020-08-06 13:48:45'),
(3745, 1006, 6903, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent another followup email to #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding status update.  ', NULL, NULL, '2020-08-18 17:49:20', '2020-08-18 17:49:20'),
(3746, 1006, 6903, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent another followup email to #Credentialing Credentialing@commonwealthcare.org>, providerrelations@commonwealthcare.org, PNM Department PNMDepartment@commonwealthcare.org> to get the updated status of credentialing/contracting.  ', NULL, NULL, '2020-08-26 14:40:42', '2020-08-26 14:40:42'),
(3747, 1006, 6903, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Received following reply from Provider Relations providerrelations@commonwealthcare.org>:  Sub: Credentialing Status Update - Jennifer Ullrich/Jonathan Schubert - SNBCare  \"Good Morning,  This is confirmation that Provider Relations received this email.  Please note:  PDM reviews requests in the order in which they are received, and they are currently experiencing a backlog of requests but will respond accordingly to your request.  I would also like to note that enrollment requests can take 90-120 days.  Thank you, Reed\"', NULL, NULL, '2020-08-31 13:41:41', '2020-08-31 13:41:41'),
(3748, 1006, 6903, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Sent another followup email to Provider Relations providerrelations@commonwealthcare.org>  #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding the status of enrollment.', NULL, NULL, '2020-09-09 13:31:57', '2020-09-09 13:31:57'),
(3749, 1006, 6903, NULL, '2020-09-17 00:00:00.000', 'In Process', 'Received following update from Common Wealthcare Alliance:  \"Hi Brad,  Thanks for confirming.  If the HCAS forms were submitted on 07/15/2020, then these would still be within the normal processing timeframes. Please allow for more time.  Once completed, PNM will respond to your email. If you do not receive a response within the normal processing timeframes, please let us know.\"', NULL, NULL, '2020-09-10 09:51:08', '2020-09-10 09:51:08'),
(3750, 1006, 6903, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Sent a followup email to PNM Department PNMDepartment@commonwealthcare.org> regarding status of enrollment. ', NULL, NULL, '2020-09-23 18:19:41', '2020-09-23 18:19:41'),
(3751, 1006, 6903, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Sent a followup email regarding the status of enrollment to #Credentialing Credentialing@commonwealthcare.org>. ', NULL, NULL, '2020-09-28 14:53:02', '2020-09-28 14:53:02'),
(3752, 1006, 6903, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to credentialing asking to get back to me ASAP regarding the status of enrollment. ', NULL, NULL, '2020-10-05 18:00:31', '2020-10-05 18:00:31'),
(3753, 1006, 6903, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent followup email to #Credentialing Credentialing@commonwealthcare.org> & PNM Department PNMDepartment@commonwealthcare.org>, waiting on response. ', NULL, NULL, '2020-10-13 10:22:45', '2020-10-13 10:22:45'),
(3754, 1006, 6903, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Sent a follow-up email to Provider Relations providerrelations@commonwealthcare.org>, #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding the updated status of enrollment. ', NULL, NULL, '2020-10-20 15:48:14', '2020-10-20 15:48:14'),
(3755, 1006, 6903, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received following update from Provider Relations providerrelations@commonwealthcare.org>:  \"Good Morning Brad,  Do you have copies of the paperwork that was submitted for the below providers? If so, are you able to submit the paperwork directly to me  I want to make sure I have the right paperwork and the appropriate information is being reviewed when I reach out to our enrollment team.\" ', NULL, NULL, '2020-10-23 11:03:12', '2020-10-23 11:03:12'),
(3756, 1006, 6903, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received following update from CCA @ providerrelations@commonwealthcare.org:    \"Good Afternoon,  Thank you so much for the attached documents. I have reached out internally regarding the enrollment requests and I have asked for them to be expedited.  I will follow up once I have an update.  Thank you, Reed\"', NULL, NULL, '2020-10-23 13:48:11', '2020-10-23 13:48:11'),
(3757, 1006, 6903, NULL, '2020-11-06 00:00:00.000', 'Approved', 'Received following email with the providers approval info from providerrelations@commonwealthcare.org:   Sub: RE: Credentialing Status Update - Jennifer Ullrich/Jonathan Schubert - SNBCare  \"Good Afternoon,  I’ve received confirmation that both Jennifer Ullrich and Jonathan Schubert are effective with CCA and Spectrum Neuro Behavioral Health as of 01/01/2020-  Thank you, Reed\"', NULL, NULL, '2020-10-30 14:27:52', '2020-10-30 14:27:52'),
(3758, 1006, 6904, NULL, NULL, 'New/Not Initiated', 'Hello,  Please find the two HCAS for our providers, we want to get them enrolled ASAP under our group. Please let me know if anything else is needed to process this request.  Thank you. ', NULL, NULL, '2020-07-15 13:32:51', '2020-07-15 13:32:51'),
(3759, 1006, 6904, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-15 13:32:56', '2020-07-15 13:32:56'),
(3760, 1006, 6904, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent a followup request to #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> asking for an update.  ', NULL, NULL, '2020-08-06 13:48:57', '2020-08-06 13:48:57'),
(3761, 1006, 6904, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Sent another followup email to #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding status update.  ', NULL, NULL, '2020-08-18 17:49:29', '2020-08-18 17:49:29'),
(3762, 1006, 6904, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent another followup email to #Credentialing Credentialing@commonwealthcare.org>, providerrelations@commonwealthcare.org, PNM Department PNMDepartment@commonwealthcare.org> to get the updated status of credentialing/contracting.  ', NULL, NULL, '2020-08-26 14:40:30', '2020-08-26 14:40:30'),
(3763, 1006, 6904, NULL, '2020-09-07 00:00:00.000', 'In Process', 'Received following reply from Provider Relations providerrelations@commonwealthcare.org>:  Sub: Credentialing Status Update - Jennifer Ullrich/Jonathan Schubert - SNBCare  \"Good Morning,  This is confirmation that Provider Relations received this email.  Please note:  PDM reviews requests in the order in which they are received, and they are currently experiencing a backlog of requests but will respond accordingly to your request.  I would also like to note that enrollment requests can take 90-120 days.  Thank you, Reed\"', NULL, NULL, '2020-08-31 13:41:35', '2020-08-31 13:41:35'),
(3764, 1006, 6904, NULL, '2020-09-16 00:00:00.000', 'In Process', 'Sent another followup email to Provider Relations providerrelations@commonwealthcare.org>  #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding the status of enrollment.', NULL, NULL, '2020-09-09 13:32:27', '2020-09-09 13:32:27'),
(3765, 1006, 6904, NULL, '2020-09-17 00:00:00.000', 'In Process', 'Received following update from Common Wealthcare Alliance:  \"Hi Brad,  Thanks for confirming.  If the HCAS forms were submitted on 07/15/2020, then these would still be within the normal processing timeframes. Please allow for more time.  Once completed, PNM will respond to your email. If you do not receive a response within the normal processing timeframes, please let us know.\"', NULL, NULL, '2020-09-10 09:51:04', '2020-09-10 09:51:04'),
(3766, 1006, 6904, NULL, '2020-10-10 00:00:00.000', 'In Process', 'Sent a followup email to PNM Department PNMDepartment@commonwealthcare.org> regarding status of enrollment. ', NULL, NULL, '2020-09-23 18:19:32', '2020-09-23 18:19:32'),
(3767, 1006, 6904, NULL, '2020-10-05 00:00:00.000', 'In Process', 'Sent a followup email regarding the status of enrollment to #Credentialing Credentialing@commonwealthcare.org>. ', NULL, NULL, '2020-09-28 14:52:18', '2020-09-28 14:52:18'),
(3768, 1006, 6904, NULL, '2020-10-12 00:00:00.000', 'In Process', 'Sent a followup email to credentialing asking to get back to me ASAP regarding the status of enrollment. ', NULL, NULL, '2020-10-05 18:00:26', '2020-10-05 18:00:26'),
(3769, 1006, 6904, NULL, '2020-10-19 00:00:00.000', 'In Process', 'Sent followup email to #Credentialing Credentialing@commonwealthcare.org> & PNM Department PNMDepartment@commonwealthcare.org>, waiting on response. ', NULL, NULL, '2020-10-13 10:23:41', '2020-10-13 10:23:41'),
(3770, 1006, 6904, NULL, '2020-11-01 00:00:00.000', 'In Process', 'Sent a follow-up email to Provider Relations providerrelations@commonwealthcare.org>, #Credentialing Credentialing@commonwealthcare.org>, PNM Department PNMDepartment@commonwealthcare.org> regarding the updated status of enrollment. ', NULL, NULL, '2020-10-20 15:48:05', '2020-10-20 15:48:05'),
(3771, 1006, 6904, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Received following update from Provider Relations providerrelations@commonwealthcare.org>:  \"Good Morning Brad,  Do you have copies of the paperwork that was submitted for the below providers? If so, are you able to submit the paperwork directly to me  I want to make sure I have the right paperwork and the appropriate information is being reviewed when I reach out to our enrollment team.\" ', NULL, NULL, '2020-10-23 11:02:44', '2020-10-23 11:02:44'),
(3772, 1006, 6904, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Received following update from CCA @ providerrelations@commonwealthcare.org:    \"Good Afternoon,  Thank you so much for the attached documents. I have reached out internally regarding the enrollment requests and I have asked for them to be expedited.  I will follow up once I have an update.  Thank you, Reed\"', NULL, NULL, '2020-10-23 13:48:02', '2020-10-23 13:48:02'),
(3773, 1006, 6904, NULL, '2020-11-06 00:00:00.000', 'Approved', 'Received following email with the providers approval info from providerrelations@commonwealthcare.org:   Sub: RE: Credentialing Status Update - Jennifer Ullrich/Jonathan Schubert - SNBCare  \"Good Afternoon,  I’ve received confirmation that both Jennifer Ullrich and Jonathan Schubert are effective with CCA and Spectrum Neuro Behavioral Health as of 01/01/2020-  Thank you, Reed\"', NULL, NULL, '2020-10-30 14:27:38', '2020-10-30 14:27:38'),
(3774, 2027, 6905, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-15 15:42:54', '2020-07-15 15:42:54'),
(3775, 2027, 6905, NULL, NULL, 'Initiated', 'To: CredentialingInquiries@humana.com  Sub: (Re-credentialing)-(Normandy Urgent Care Center)-(Humana)  Thanks for notifying about the re-credentialing, please find the attached documents which you have requested to start the re-credentialing process. followed by a humana re-credentialing notification letter.  Thanks.', NULL, NULL, '2020-07-15 15:43:49', '2020-07-15 15:43:49'),
(3776, 2027, 6905, NULL, '2020-09-16 00:00:00.000', 'In Process', 'To: CredentialingInquiries@humana.com  Sub: (For Group)-(Normandy Urgent Care Center)-(Humana)  May I know the current status of  the re-credentialing of the group. Details are mentioned below: Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429  Group NPI# 1407171077  Thanks.', NULL, NULL, '2020-09-09 17:02:25', '2020-09-09 17:02:25'),
(3777, 2027, 6905, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Re-credentialing request has been approved effective date is same 12/01/2012 and next re-credentialing due date is 08/13/2023. Screenshot of confirmation email and executed signed contract is attached. ', NULL, NULL, '2020-09-10 10:23:31', '2020-09-10 10:23:31'),
(3778, 1006, 6906, NULL, NULL, 'New/Not Initiated', 'Sent request to Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hello,   Please find the attached application to add the provider to our group as in-network/PAR. Let me know if anything else is required to process the request.  Thank you. \"', NULL, NULL, '2020-07-15 16:44:51', '2020-07-15 16:44:51'),
(3779, 1006, 6906, NULL, NULL, 'Initiated', NULL, NULL, NULL, '2020-07-15 16:44:55', '2020-07-15 16:44:55'),
(3780, 1006, 6906, NULL, '2020-08-13 00:00:00.000', 'In Process', 'Sent followup email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com for updated status on the application.  ', NULL, NULL, '2020-08-06 13:23:49', '2020-08-06 13:23:49'),
(3781, 1006, 6906, NULL, '2020-08-18 00:00:00.000', 'In Process', 'Sent another followup email to kody_dunnett@tufts-health.com:  Sub: Jennifer Ullrich/Jonathan Schubert/Joanna Wood - SNBCare - Provider Status Update   \"Hey Kody,   I hope you\'re doing well, I wanted to get an update regarding the status of my providers and see if there was any way we could get their request for enrollment expedited, their info is as follows:  Provider Name: Jennifer Ullrich NPI# 1710489760 Provider Name: Jonathan Schubert NPI# 1235755505 Provider Name: Joanna Wood NPI# 1801986054 Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753  Please get back to me as soon as you\'re able, as no one from the Tufts credentialing has been able to get back to me.   Thank you!\"', NULL, NULL, '2020-08-11 15:14:45', '2020-08-11 15:14:45'),
(3782, 1006, 6906, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Received following update from Kody Dunnett Kody_Dunnett@tufts-health.com>:  \"Hi Brad  Jennifer Ullrich, LICSW – needs contract selected, reached out to BH Contracting.  Once signed, returned, and processed, she will be put into credentialing.  After cred is complete, she will be all set.  Jonathan Schubert, LICSW – same as Jennifer  Joanna C Wood, LICSW – credentialed, in network, but not linked to TIN.  Can you resubmit that app to me?  BH Contracting has been backlogged and a bit understaffed, so their response times have been delayed.  I apologize for the inconvenience.  Thanks Kody\"', NULL, NULL, '2020-08-17 10:42:02', '2020-08-17 10:42:02'),
(3783, 1006, 6906, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Sent a followup email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, Kody Dunnett Kody_Dunnett@tufts-health.com> regarding the status of enrollment. ', NULL, NULL, '2020-08-26 14:28:31', '2020-08-26 14:28:31'),
(3784, 1006, 6906, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Received contract for signing, signed and sent back to @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> ', NULL, NULL, '2020-09-08 14:49:40', '2020-09-08 14:49:40'),
(3785, 1006, 6906, NULL, '2020-09-22 00:00:00.000', 'In Process', 'Sent a followup email to Kody Dunnet regarding the status of credentialing. ', NULL, NULL, '2020-09-15 17:07:07', '2020-09-15 17:07:07');
