{
  "mailbox": {
    "email": "a.costa@mojavecrest.com",
    "name": "Ari Costa"
  },
  "contacts": [
    {
      "email": "t.reyes@mojavecrest.com",
      "name": "Tamra Reyes"
    },
    {
      "email": "d.whitfield@mojavecrest.com",
      "name": "Darnell Whitfield"
    },
    {
      "email": "p.annadurai@mojavecrest.com",
      "name": "Priya Annadurai"
    },
    {
      "email": "h.bergstrom@mojavecrest.com",
      "name": "Dr. Helena Bergstrom, MD"
    },
    {
      "email": "a.ontario@mojavecrest.com",
      "name": "Dr. Ayla Ontario, MD"
    },
    {
      "email": "m.alvarado@mojavecrest.com",
      "name": "Marisol Alvarado, RN"
    },
    {
      "email": "j.henning@mojavecrest.com",
      "name": "Dr. Jules Henning, PharmD"
    },
    {
      "email": "k.dufree@mojavecrest.com",
      "name": "Kendel Dufree"
    },
    {
      "email": "parity@mojavecrest.com",
      "name": "Parity Review Committee"
    },
    {
      "email": "m.quill@mojavecrest.com",
      "name": "Marin Quill"
    },
    {
      "email": "intake@canyonridgereview.com",
      "name": "Canyon Ridge Review Services"
    },
    {
      "email": "urgent-intake@canyonridgereview.com",
      "name": "Canyon Ridge Review Services (Urgent)"
    },
    {
      "email": "hr@mojavecrest.com",
      "name": "Mojave Crest HR"
    },
    {
      "email": "it@mojavecrest.com",
      "name": "Mojave Crest IT"
    },
    {
      "email": "facilities@mojavecrest.com",
      "name": "Facilities Management"
    },
    {
      "email": "appeals@mojavecrest.com",
      "name": "Appeals Unit"
    },
    {
      "email": "noreply@efaxsolutions.com",
      "name": "eFax Solutions"
    },
    {
      "email": "newsletter@ahip.org",
      "name": "AHIP"
    },
    {
      "email": "newsletter@nvinsurance.org",
      "name": "Nevada Association of Health Plans"
    },
    {
      "email": "info@healthplanweek.com",
      "name": "Health Plan Week"
    },
    {
      "email": "noreply@claimsiq.io",
      "name": "ClaimsIQ Platform"
    },
    {
      "email": "marketing@benefitspro.com",
      "name": "BenefitsPro"
    },
    {
      "email": "no-reply@calendar.mojavecrest.com",
      "name": "Mojave Crest Calendar"
    },
    {
      "email": "shaines@outlook.com",
      "name": "Sandra Haines"
    },
    {
      "email": "jcaldwell55@gmail.com",
      "name": "James Caldwell"
    },
    {
      "email": "darcy.okonkwo@gmail.com",
      "name": "Darcy Okonkwo"
    },
    {
      "email": "theresa.montoya@yahoo.com",
      "name": "Theresa Montoya"
    },
    {
      "email": "ethan.brockman@hotmail.com",
      "name": "Ethan Brockman"
    },
    {
      "email": "noah.vickers@gmail.com",
      "name": "Noah Vickers"
    },
    {
      "email": "pybarra.family@gmail.com",
      "name": "Priscilla Ybarra"
    },
    {
      "email": "camille.durand.health@gmail.com",
      "name": "Camille Durand"
    },
    {
      "email": "office@carsonlawgroup.com",
      "name": "Carson Law Group (AOR for R. Haines)"
    },
    {
      "email": "asolis@griffinmedical.org",
      "name": "Dr. Avery Solis"
    },
    {
      "email": "j.arden.71@gmail.com",
      "name": "Jules Arden"
    }
  ],
  "folders": [
    {
      "name": "Appeals - Active"
    },
    {
      "name": "Appeals - Closed"
    },
    {
      "name": "External Review"
    },
    {
      "name": "Admin"
    }
  ],
  "emails": [
    {
      "email_id": "1",
      "folder": "INBOX",
      "subject": "Welcome Back \u2013 April Kick-Off Memo",
      "from_addr": "t.reyes@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com,p.annadurai@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-01T08:15:00Z",
      "message_id": "<apr-kickoff-001@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Team,\n\nHappy April! A few reminders as we head into Q2:\n\n1. All appeal acknowledgment letters must go out within 5 business days of receipt \u2014 no exceptions.\n2. The new external review tracking spreadsheet is live in SharePoint. Please log all Case #s by EOD Friday.\n3. Our next team huddle is Thursday, April 9, at 10:00 AM in Conference Room B.\n\nLet's have a great quarter.\n\nTamra Reyes\nDirector, Appeals & Grievances\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "2",
      "folder": "INBOX",
      "subject": "\ud83c\udf82 Happy Birthday, Priya!",
      "from_addr": "hr@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-02T09:00:00Z",
      "message_id": "<bday-priya-0402@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi team,\n\nPlease join us in wishing Priya Annadurai a very happy birthday today! There will be cupcakes in the break room at 2:00 PM.\n\nHR Team\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "3",
      "folder": "INBOX",
      "subject": "Action Required: Reset Your MCA Network Password",
      "from_addr": "it@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-03T07:45:00Z",
      "message_id": "<pwd-reset-0403@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nYour Mojave Crest network password will expire in 14 days. Please reset it before April 17 to avoid losing access.\n\nTo reset: go to https://myaccount.mojavecrest.com and click \"Change Password.\"\n\nIf you need assistance, contact the IT Help Desk at ext. 5555 or helpdesk@mojavecrest.com.\n\nIT Department\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "4",
      "folder": "INBOX",
      "subject": "Appeal Submission \u2013 Robert Haines / QTR583920174",
      "from_addr": "office@carsonlawgroup.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": "a.costa@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-04T11:22:00Z",
      "message_id": "<haines-appeal-0404@carsonlawgroup.com>",
      "in_reply_to": null,
      "body_text": "To Whom It May Concern:\n\nCarson Law Group submits this formal appeal on behalf of our client, Robert Haines (Member ID: QTR583920174), regarding the denial of pre-service authorization for a lumbar spinal fusion (CPT 22612) dated March 28, 2026. The denial cited lack of medical necessity under MCA Medical Policy MP-SPINE-04.\n\nEnclosed please find:\n  - Signed Authorized Representative designation\n  - Treating physician's letter of medical necessity (Dr. S. Park, MD)\n  - Operative and diagnostic imaging reports\n\nWe request an expedited review given the member's functional limitations.\n\nSincerely,\nCarson Law Group\nPhone: (702) 555-0991",
      "body_html": null,
      "is_read": true,
      "is_important": true,
      "attachments": []
    },
    {
      "email_id": "5",
      "folder": "INBOX",
      "subject": "Quick Q \u2013 Case routing for spinal auth denials",
      "from_addr": "d.whitfield@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-05T09:10:00Z",
      "message_id": "<dw-routing-0405@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nHey \u2013 for the new spinal auth denial appeals coming in, are you routing those to Helena or straight to the panel? I want to make sure we're consistent across the team.\n\nAlso, did Carson Law's submission for Haines come through to you? I see it cc'd you.\n\nThanks,\nDarnell",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "7",
      "folder": "INBOX",
      "subject": "Insurance Appeal \u2013 Caldwell / LXM104857293",
      "from_addr": "jcaldwell55@gmail.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": "a.costa@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-07T16:44:00Z",
      "message_id": "<caldwell-appeal-0407@gmail.com>",
      "in_reply_to": null,
      "body_text": "Hello,\n\nMy name is James Caldwell, Member ID LXM104857293. I received an Explanation of Benefits dated March 30, 2026, showing a claim for my colonoscopy on March 12 was processed as out-of-network, but my gastroenterologist is listed in-network on your website. I was charged $1,840 that I should not owe.\n\nI am appealing this claim processing decision. Please let me know what else you need.\n\nThank you,\nJames Caldwell\n(702) 555-3867",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "8",
      "folder": "INBOX",
      "subject": "AHIP This Week: CMS Proposed Rule Highlights & State Round-Up",
      "from_addr": "newsletter@ahip.org",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-08T06:00:00Z",
      "message_id": "<ahip-weekly-0408@ahip.org>",
      "in_reply_to": null,
      "body_text": "AHIP This Week | April 8, 2026\n\n\u2022 CMS releases proposed rule on prior authorization timelines \u2014 comment period open through May 20\n\u2022 Nevada Division of Insurance issues market conduct guidance on grievance turnaround times\n\u2022 Federal court upholds ACA Section 1557 nondiscrimination protections\n\u2022 New AHIP webinar: Managing External Review Obligations Under State Law \u2014 April 22, 1 PM ET\n\nTo unsubscribe, visit ahip.org/unsubscribe.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "10",
      "folder": "INBOX",
      "subject": "Calendar Invite: Appeals Team Huddle \u2013 Thur Apr 9 @ 10 AM",
      "from_addr": "no-reply@calendar.mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-08T15:00:00Z",
      "message_id": "<cal-huddle-0409@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "You have been invited to the following event:\n\nEvent: Appeals Team Huddle\nDate: Thursday, April 9, 2026\nTime: 10:00 AM \u2013 11:00 AM (PST)\nLocation: Conference Room B / Teams Link: https://teams.mojavecrest.com/join/huddle-apr9\nOrganizer: Tamra Reyes\n\nAgenda:\n1. Q2 caseload review\n2. External review tracking update\n3. Open items\n\nPlease accept or decline this invitation.",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "11",
      "folder": "INBOX",
      "subject": "Parking Lot B Closure \u2013 April 14\u201315 (Resurfacing)",
      "from_addr": "facilities@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-10T08:00:00Z",
      "message_id": "<parking-closure-0410@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "All Staff,\n\nPlease be advised that Parking Lot B (west side of building) will be closed on Tuesday, April 14 and Wednesday, April 15 for resurfacing.\n\nDuring this time, please use Parking Lot A or the Spring Valley Garage (validated parking stickers available at the front desk).\n\nWe apologize for the inconvenience.\n\nFacilities Management\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "12",
      "folder": "INBOX",
      "subject": "Formal Appeal \u2013 Darcy Okonkwo, Member ID ZPN672491058",
      "from_addr": "darcy.okonkwo@gmail.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-11T13:05:00Z",
      "message_id": "<okonkwo-appeal-0411@gmail.com>",
      "in_reply_to": null,
      "body_text": "Hello,\n\nI am writing to appeal the denial of my outpatient intensive psychiatric program (IOP). Your denial letter dated April 4, 2026 stated the treatment was not medically necessary. My psychiatrist, Dr. Renata Miles, disagrees and has submitted documentation supporting the medical necessity of IOP following my recent inpatient stay.\n\nMember: Darcy Okonkwo\nMember ID: ZPN672491058\nDate of Denial: April 4, 2026\nService: Outpatient IOP \u2013 Behavioral Health\n\nPlease review at your earliest convenience.\n\nSincerely,\nDarcy Okonkwo",
      "body_html": null,
      "is_read": true,
      "is_important": true,
      "attachments": []
    },
    {
      "email_id": "13",
      "folder": "Sent",
      "subject": "Mojave Crest Appeals Case #CASE-2026-00695 - Acknowledgment of Your Appeal",
      "from_addr": "a.costa@mojavecrest.com",
      "to_addr": "darcy.okonkwo@gmail.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-12T09:47:00Z",
      "message_id": "<ack-695-0412@mojavecrest.com>",
      "in_reply_to": "<okonkwo-appeal-0411@gmail.com>",
      "body_text": "Dear Darcy Okonkwo,\n\nThis letter confirms that Mojave Crest Assurance Company has received your appeal regarding the denial of outpatient intensive psychiatric program (IOP) services.\n\nYour case details:\n  Case Number: CASE-2026-00695\n  Member Name: Darcy Okonkwo\n  Member ID: ZPN672491058\n  Date Received: April 11, 2026\n  Appeal Type: Pre-Service / Behavioral Health\n  Decision Due By: May 11, 2026\n\nI will be your Appeals Coordinator throughout this case. I may contact you if additional information is needed to complete the review. You or your Authorized Representative may submit additional information in support of your appeal at any time before the decision date.\n\nIf you have questions about your case, please reply to this email or call the Appeals Unit at (702) 555-0148, referencing your Case Number above.\n\nSincerely,\nAri Costa\nAppeals & Grievances Coordinator\nMojave Crest Assurance Company\nCase #: CASE-2026-00695",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "14",
      "folder": "INBOX",
      "subject": "Case 695 \u2013 parity flag?",
      "from_addr": "d.whitfield@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-13T10:22:00Z",
      "message_id": "<dw-695-parity-0413@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nFor the Okonkwo IOP appeal (695) \u2013 is that being flagged for parity review? The original denial was based on medical necessity but if the same criteria wouldn't apply to a comparable med/surg condition, Ayla will want to loop in the parity committee early.\n\nLet me know where you land.\n\nDarnell",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "15",
      "folder": "INBOX",
      "subject": "NAHP Nevada Update \u2013 April 2026",
      "from_addr": "newsletter@nvinsurance.org",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-14T06:30:00Z",
      "message_id": "<nahp-apr2026@nvinsurance.org>",
      "in_reply_to": null,
      "body_text": "Nevada Association of Health Plans | April 2026 Newsletter\n\nHighlights:\n\u2022 NV DOI issues guidance on grievance acknowledgment timelines \u2013 compliance date June 1\n\u2022 Legislative session recap: SB 412 on prior authorization reform signed by Governor\n\u2022 Upcoming: Annual Nevada Health Plan Summit, June 10\u201311, Las Vegas\n\u2022 Member spotlight: Effective parity compliance programs\n\nVisit nvinsurance.org for full articles.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "16",
      "folder": "INBOX",
      "subject": "Appeal of Claim Denial \u2013 Theresa Montoya",
      "from_addr": "theresa.montoya@yahoo.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": "a.costa@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-15T14:18:00Z",
      "message_id": "<montoya-appeal-0415@yahoo.com>",
      "in_reply_to": null,
      "body_text": "To Whom It May Concern:\n\nI am appealing the partial denial of my claim for physical therapy services rendered in February and March 2026. My plan approved 12 sessions but my therapist says I need 20 for my rotator cuff repair recovery. The additional 8 sessions were denied as \"exceeding plan limits.\"\n\nI believe this limit is being applied incorrectly per my Evidence of Coverage. My PT notes are attached.\n\nMember Name: Theresa Montoya\nMember ID: KDV938205761\nDates of Service: Feb 3 \u2013 Mar 28, 2026\n\nPlease advise.\n\nTheresa Montoya\n(702) 555-2204",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "19",
      "folder": "INBOX",
      "subject": "Scheduled Maintenance: ClaimsIQ Portal \u2013 Sunday Apr 19, 12\u20134 AM",
      "from_addr": "noreply@claimsiq.io",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-17T08:00:00Z",
      "message_id": "<maint-0419@claimsiq.io>",
      "in_reply_to": null,
      "body_text": "Hi Ari Costa,\n\nClaimsIQ will be undergoing scheduled maintenance on Sunday, April 19 from 12:00 AM to 4:00 AM PST. During this window, the portal and API will be unavailable.\n\nNo action is required on your part. If you experience issues after 4:00 AM, contact support@claimsiq.io.\n\nThank you,\nClaimsIQ Platform Team",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "20",
      "folder": "INBOX",
      "subject": "Re: Case load \u2013 can you take 705?",
      "from_addr": "p.annadurai@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-18T11:30:00Z",
      "message_id": "<priya-caseload-0418@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nI'm at capacity this week with the Vickers expedited and two parity reviews. Darnell approved me to offload CASE-2026-00705 (Durand \u2013 denied DME request). Are you able to pick it up? File is in SharePoint under Appeals Active. Deadline is May 10.\n\nLet me know!\nPriya",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "21",
      "folder": "INBOX",
      "subject": "Re: External Review Request \u2013 Case #CASE-2026-00689 \u2013 STANDARD",
      "from_addr": "intake@canyonridgereview.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "k.dufree@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-19T15:02:00Z",
      "message_id": "<crr-ack-689-0419@canyonridgereview.com>",
      "in_reply_to": "<extrev-689-0419@mojavecrest.com>",
      "body_text": "Ari,\n\nThank you \u2013 we have received and logged the external review request for Case #CASE-2026-00689 (Member: R.H.). Our file has been assigned reference number CRR-2026-04-1188. We confirm receipt of the case file via secure transfer.\n\nExpected decision: within 45 calendar days (by June 3, 2026).\n\nPlease route any supplemental materials to the same secure transfer portal.\n\nClear Skies,\nCanyon Ridge Review Services Intake Team",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "22",
      "folder": "Sent",
      "subject": "External Review Request - Case #CASE-2026-00689 - STANDARD",
      "from_addr": "a.costa@mojavecrest.com",
      "to_addr": "intake@canyonridgereview.com",
      "cc_addr": "k.dufree@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-19T10:45:00Z",
      "message_id": "<extrev-689-0419@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Canyon Ridge Review Services Intake Team,\n\nMojave Crest Assurance Company is forwarding the following case for independent external review:\n\n  Case Number: CASE-2026-00689\n  Member Initials: R.H.\n  Member ID: QTR583920174\n  Plan: Vista Access PPO\n  Review Type: STANDARD\n  Date of Final Internal Determination: April 15, 2026\n  Date of External Review Request from Member: April 18, 2026\n  Disputed Service: Pre-service authorization for lumbar spinal fusion (CPT 22612)\n  MCA Decision: DENIED\n\nThe complete case file, including clinical records, internal determination letters, applicable medical policies, and the Evidence of Coverage, has been uploaded to the secure file transfer link provided separately.\n\nThe MCA point of contact for this case is Kendel Dufree, Compliance Officer, copied on this email.\n\nAri Costa\nAppeals & Grievances Coordinator\nMojave Crest Assurance Company\nPhone: (702) 555-0148\nCase #: CASE-2026-00689",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "23",
      "folder": "INBOX",
      "subject": "Re: Mojave Crest Appeals Case #CASE-2026-00698 \u2013 Additional PT Records",
      "from_addr": "theresa.montoya@yahoo.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-20T09:55:00Z",
      "message_id": "<montoya-addl-0420@yahoo.com>",
      "in_reply_to": "<ack-698-0416@mojavecrest.com>",
      "body_text": "Hi Ari,\n\nThank you for your acknowledgment. My physical therapist's office just faxed over my complete treatment notes and a letter of medical necessity. Can you confirm you received them? They said they sent it to (702) 555-0199.\n\nAlso, my EOC says I'm entitled to \"medically necessary\" therapy without a set visit cap under Section 9.4. Can I include that in my appeal?\n\nThank you,\nTheresa",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "25",
      "folder": "INBOX",
      "subject": "Q1 2026 Appeals Metrics \u2013 Please Review Before Huddle",
      "from_addr": "t.reyes@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com,p.annadurai@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-21T08:45:00Z",
      "message_id": "<q1-metrics-0421@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Team,\n\nAttached are the Q1 2026 appeals metrics for your review ahead of our huddle. Key items:\n\n\u2022 Average acknowledgment turnaround: 3.1 days (target: \u22645) \u2713\n\u2022 Average decision turnaround: 22.4 days (target: \u226430) \u2713\n\u2022 External review rate: 14% (up from 9% in Q4 2025 \u2014 we should discuss)\n\u2022 Parity-flagged cases: 6 (all resolved within period)\n\nPlease come to the huddle prepared to discuss your open case queues.\n\nTamra",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "26",
      "folder": "INBOX",
      "subject": "Is Your Appeals Platform Ready for 2026 Regulation Changes?",
      "from_addr": "marketing@benefitspro.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-22T05:30:00Z",
      "message_id": "<bpro-ad-0422@benefitspro.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nAre you confident your appeals management system keeps you compliant with the latest CMS and state regulations? BenefitsPro's AppealTrack 360 automates acknowledgment letters, tracks external review deadlines, and generates audit-ready reports.\n\nJoin 200+ health plans already using AppealTrack 360.\n\n\u2192 Book a 15-minute demo: benefitspro.com/demo\n\nTo unsubscribe, click here.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "28",
      "folder": "INBOX",
      "subject": "Appeal Request \u2013 Ethan Brockman / HRC751093482",
      "from_addr": "ethan.brockman@hotmail.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-24T10:00:00Z",
      "message_id": "<brockman-appeal-0424@hotmail.com>",
      "in_reply_to": null,
      "body_text": "Hello,\n\nI was denied coverage for a continuous glucose monitor (CGM) prescribed by my endocrinologist, Dr. V. Shah. The denial letter said CGMs are not covered under my plan for Type 2 diabetes, only Type 1. I believe this is incorrect based on the plan documents I was given when I enrolled.\n\nMember: Ethan Brockman\nMember ID: HRC751093482\nPrescribing provider: Dr. V. Shah, MD\nDevice: Dexcom G7 CGM\n\nPlease help.\n\nEthan Brockman",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "29",
      "folder": "INBOX",
      "subject": "Health Plan Week \u2013 Prior Auth & External Review Edition",
      "from_addr": "info@healthplanweek.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-25T06:00:00Z",
      "message_id": "<hpw-0425@healthplanweek.com>",
      "in_reply_to": null,
      "body_text": "Health Plan Week | April 25, 2026\n\n\u2022 DOL issues FAQ on ERISA external review for self-funded plans\n\u2022 State spotlight: Nevada's new 72-hour expedited decision rule for concurrent care\n\u2022 Analysis: How plans are managing the post-No Surprises Act appeals surge\n\u2022 Webinar replay: Behavioral health parity compliance checklist\n\nRead more at healthplanweek.com.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "31",
      "folder": "Sent",
      "subject": "Mojave Crest Appeals Case #CASE-2026-00701 - Acknowledgment of Your Appeal",
      "from_addr": "a.costa@mojavecrest.com",
      "to_addr": "ethan.brockman@hotmail.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-25T10:30:00Z",
      "message_id": "<ack-701-0425@mojavecrest.com>",
      "in_reply_to": "<brockman-appeal-0424@hotmail.com>",
      "body_text": "Dear Ethan Brockman,\n\nThis letter confirms that Mojave Crest Assurance Company has received your appeal regarding the denial of coverage for a continuous glucose monitor (CGM \u2013 Dexcom G7).\n\nYour case details:\n  Case Number: CASE-2026-00701\n  Member Name: Ethan Brockman\n  Member ID: HRC751093482\n  Date Received: April 24, 2026\n  Appeal Type: Pre-Service / Pharmacy & DME Benefit\n  Decision Due By: May 24, 2026\n\nI will be your Appeals Coordinator throughout this case. I may contact you if additional information is needed to complete the review. You or your Authorized Representative may submit additional information in support of your appeal at any time before the decision date.\n\nIf you have questions about your case, please reply to this email or call the Appeals Unit at (702) 555-0148, referencing your Case Number above.\n\nSincerely,\nAri Costa\nAppeals & Grievances Coordinator\nMojave Crest Assurance Company\nCase #: CASE-2026-00701",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "32",
      "folder": "INBOX",
      "subject": "Reminder: Annual Compliance Training Due April 30",
      "from_addr": "hr@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-26T09:00:00Z",
      "message_id": "<compliance-training-0426@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nThis is a reminder that your annual compliance training (HIPAA, Code of Conduct, and Fraud, Waste & Abuse) is due by April 30, 2026.\n\nTo complete the training, log in to the Learning Management System at lms.mojavecrest.com. Estimated time: 45 minutes.\n\nIf you have questions, contact hr@mojavecrest.com.\n\nHR Department\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "33",
      "folder": "INBOX",
      "subject": "CASE-2026-00701 \u2013 CGM coverage clarification",
      "from_addr": "h.bergstrom@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "j.henning@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-27T11:15:00Z",
      "message_id": "<bergstrom-701-0427@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nFor the Brockman CGM case (701), Jules and I are looking at the EOC language together. The 2025 EOC addendum actually expanded DME coverage for CGMs to members with insulin-requiring Type 2 diabetes \u2014 Dr. Shah's notes confirm the member is on basal insulin. This looks like it should be approved on appeal.\n\nI'll have my formal clinical review memo to you by tomorrow afternoon.\n\nHelena",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "34",
      "folder": "INBOX",
      "subject": "Re: Mojave Crest Appeals Case #CASE-2026-00689 \u2013 External Review Status",
      "from_addr": "office@carsonlawgroup.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-28T14:00:00Z",
      "message_id": "<carson-extrev-followup-0428@carsonlawgroup.com>",
      "in_reply_to": "<extrev-689-0419@mojavecrest.com>",
      "body_text": "Ari,\n\nThank you for forwarding the case to Canyon Ridge Review Services. Our client, Mr. Haines, would like to submit an additional letter from his physiatrist, Dr. M. Kaur, documenting his failed conservative treatments. Can we send this directly to Canyon Ridge, or does it go through you?\n\nAlso, can you confirm the expected decision date?\n\nThank you,\nCarson Law Group",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "35",
      "folder": "INBOX",
      "subject": "Office HVAC Maintenance \u2013 Floor 3, Wed Apr 30, 8\u201310 AM",
      "from_addr": "facilities@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-29T16:00:00Z",
      "message_id": "<hvac-0430@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "All Staff \u2013 Floor 3,\n\nRoutine HVAC maintenance is scheduled for Wednesday, April 30, from 8:00 AM to 10:00 AM. During this time, expect some noise and possible temperature fluctuation in offices 304\u2013318.\n\nIf you need to step out during this window, the 2nd floor breakout rooms are available.\n\nThank you for your patience.\n\nFacilities Management",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "36",
      "folder": "INBOX",
      "subject": "Case 698 \u2013 Montoya \u2013 clock check",
      "from_addr": "d.whitfield@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-30T09:05:00Z",
      "message_id": "<dw-698-0430@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nJust checking in \u2013 where are we on Montoya (698)? Due date is May 15 but I'd like the decision out by May 9 if possible given Marisol is out that week. Has Helena's review come in yet?\n\nAlso \u2013 did you get the Caldwell corrected EOB confirmation from Claims? Marin should have sent it yesterday.\n\nDarnell",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "38",
      "folder": "INBOX",
      "subject": "May Kickoff \u2013 Caseload, Staffing & Compliance Reminder",
      "from_addr": "t.reyes@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com,p.annadurai@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-01T08:30:00Z",
      "message_id": "<may-kickoff-0501@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Team,\n\nHappy May! A few things:\n\n1. Marisol will be out May 5\u20139 for vacation. Clinical reviews during that period should be routed to Dr. Bergstrom or Dr. Ontario as appropriate.\n2. The NV DOI market conduct exam window opens June 1 \u2013 please make sure all case files in SharePoint are complete and dated correctly.\n3. Reminder: if a member requests external review on a partially approved case, the denied portion must be forwarded to Canyon Ridge within 5 business days.\n\nGreat work in April, everyone.\n\nTamra",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "39",
      "folder": "INBOX",
      "subject": "Re: Mojave Crest Appeals Case #CASE-2026-00695 \u2013 I Want External Review",
      "from_addr": "darcy.okonkwo@gmail.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-02T10:10:00Z",
      "message_id": "<okonkwo-extrev-req-0502@gmail.com>",
      "in_reply_to": "<decision-695-0425@mojavecrest.com>",
      "body_text": "Hi Ari,\n\nI received your letter about my appeal being denied. I disagree with the decision and want to request the independent external review mentioned in your letter.\n\nPlease proceed with sending my case to the independent review organization.\n\nThank you,\nDarcy Okonkwo",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "40",
      "folder": "INBOX",
      "subject": "URGENT \u2013 Expedited Appeal \u2013 Noah Vickers / WFA620483915",
      "from_addr": "noah.vickers@gmail.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": "a.costa@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-02T14:30:00Z",
      "message_id": "<vickers-appeal-0502@gmail.com>",
      "in_reply_to": null,
      "body_text": "URGENT \u2013 EXPEDITED REVIEW REQUESTED\n\nMy name is Noah Vickers, Member ID WFA620483915. I am currently receiving inpatient rehabilitation services at Desert Valley Rehab Center following a stroke on April 18. My insurance just informed me that coverage will be terminated effective May 4 because I've reached 60 inpatient rehab days. My physiatrist says I am not yet medically stable enough for discharge and that stopping now would seriously jeopardize my health.\n\nI am requesting an expedited concurrent care appeal. Please contact me or my wife Renee Vickers at (702) 555-7791.\n\nNoah Vickers\nWFA620483915",
      "body_html": null,
      "is_read": true,
      "is_important": true,
      "attachments": []
    },
    {
      "email_id": "41",
      "folder": "Sent",
      "subject": "External Review Request - Case #CASE-2026-00695 - STANDARD",
      "from_addr": "a.costa@mojavecrest.com",
      "to_addr": "intake@canyonridgereview.com",
      "cc_addr": "k.dufree@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-02T16:00:00Z",
      "message_id": "<extrev-695-0502@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Canyon Ridge Review Services Intake Team,\n\nMojave Crest Assurance Company is forwarding the following case for independent external review:\n\n  Case Number: CASE-2026-00695\n  Member Initials: D.O.\n  Member ID: ZPN672491058\n  Plan: Vista Access PPO\n  Review Type: STANDARD\n  Date of Final Internal Determination: April 25, 2026\n  Date of External Review Request from Member: May 2, 2026\n  Disputed Service: Outpatient intensive psychiatric program (IOP) \u2013 Behavioral Health\n  MCA Decision: DENIED\n\nThe complete case file, including clinical records, internal determination letters, applicable medical policies, and the Evidence of Coverage, has been uploaded to the secure file transfer link provided separately.\n\nThe MCA point of contact for this case is Kendel Dufree, Compliance Officer, copied on this email.\n\nAri Costa\nAppeals & Grievances Coordinator\nMojave Crest Assurance Company\nPhone: (702) 555-0148\nCase #: CASE-2026-00695",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "43",
      "folder": "INBOX",
      "subject": "Reminder: Password Expiration \u2013 Change by May 10",
      "from_addr": "it@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-03T07:30:00Z",
      "message_id": "<pwd-expire-0503@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nYour Mojave Crest network password will expire on May 10, 2026. Please reset it before then to maintain uninterrupted access.\n\nReset your password at: https://myaccount.mojavecrest.com\n\nIT Help Desk | ext. 5555",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "44",
      "folder": "INBOX",
      "subject": "Case 695 \u2013 Parity Committee Review Complete",
      "from_addr": "a.ontario@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-04T14:20:00Z",
      "message_id": "<ontario-695-0504@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nThe Parity Committee completed its review of CASE-2026-00695. The final memo is in SharePoint. Summary: parity analysis confirmed our criteria for IOP are comparable to med/surg sub-acute placement criteria; the case file is compliant. The denial stands on clinical grounds.\n\nSince I see you've already issued the decision and forwarded to Canyon Ridge, this is just for the file record.\n\nAyla Ontario, MD\nMedical Director, Behavioral Health",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "45",
      "folder": "INBOX",
      "subject": "Quick question \u2013 Case 705 update",
      "from_addr": "p.annadurai@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-05T10:45:00Z",
      "message_id": "<priya-705-0505@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hey Ari,\n\nDid you end up picking up Case 705 (Durand)? I never heard back. Darnell pinged me about it this morning. The clinical file is in SharePoint / Appeals Active / 705-Durand.\n\nThanks!\nPriya",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "46",
      "folder": "INBOX",
      "subject": "AHIP Webinar Tomorrow: Managing External Review Obligations Under State Law",
      "from_addr": "newsletter@ahip.org",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-05T06:00:00Z",
      "message_id": "<ahip-webinar-0505@ahip.org>",
      "in_reply_to": null,
      "body_text": "AHIP Reminder | May 5, 2026\n\nJoin us tomorrow, May 6, at 1:00 PM ET for our webinar:\nManaging External Review Obligations Under State Law\n\nTopics include:\n\u2022 State vs. federal external review standards\n\u2022 IRO selection and turnaround compliance\n\u2022 Documentation best practices for audit readiness\n\nRegister: ahip.org/webinars/external-review-2026\n\nCPE credit available.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "47",
      "folder": "INBOX",
      "subject": "Member Appeal \u2013 Priscilla Ybarra / BJS849201376",
      "from_addr": "pybarra.family@gmail.com",
      "to_addr": "appeals@mojavecrest.com",
      "cc_addr": "a.costa@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-06T09:12:00Z",
      "message_id": "<ybarra-appeal-0506@gmail.com>",
      "in_reply_to": null,
      "body_text": "Hello,\n\nI am appealing the denial of my Humira (adalimumab) prescription. The denial says a step-therapy requirement applies and I must try methotrexate first. I tried methotrexate for 6 months in 2024 and it was ineffective and caused liver toxicity. My rheumatologist has documented this.\n\nMember: Priscilla Ybarra\nMember ID: BJS849201376\nPrescribing Provider: Dr. C. Torres, MD (Rheumatology)\nMedication: Humira 40mg/0.8mL pen\n\nPlease consider my appeal.\n\nPriscilla Ybarra",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "48",
      "folder": "INBOX",
      "subject": "You're Invited: Free Webinar \u2013 AI-Powered Denial Management for Health Plans",
      "from_addr": "marketing@benefitspro.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-06T05:45:00Z",
      "message_id": "<bpro-webinar-0506@benefitspro.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nJoin us for a free webinar on how AI is transforming appeals and denial management at top health plans.\n\nDate: May 20, 2026 | 2:00 PM ET\nSpeakers: Industry leaders from top-10 health plans\n\nRegister: benefitspro.com/webinar-ai-denial\n\nUnsubscribe | Manage Preferences",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "49",
      "folder": "INBOX",
      "subject": "Happy Birthday, Darnell!",
      "from_addr": "hr@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-07T09:00:00Z",
      "message_id": "<bday-darnell-0507@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi everyone,\n\nPlease join us in wishing Darnell Whitfield a very happy birthday! Cake will be in the break room at 3:00 PM today.\n\nHR Team\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "50",
      "folder": "Sent",
      "subject": "Mojave Crest Appeals Case #CASE-2026-00715 - Acknowledgment of Your Appeal",
      "from_addr": "a.costa@mojavecrest.com",
      "to_addr": "pybarra.family@gmail.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-07T10:50:00Z",
      "message_id": "<ack-715-0507@mojavecrest.com>",
      "in_reply_to": "<ybarra-appeal-0506@gmail.com>",
      "body_text": "Dear Priscilla Ybarra,\n\nThis letter confirms that Mojave Crest Assurance Company has received your appeal regarding the denial of Humira (adalimumab) due to step-therapy requirements.\n\nYour case details:\n  Case Number: CASE-2026-00715\n  Member Name: Priscilla Ybarra\n  Member ID: BJS849201376\n  Date Received: May 6, 2026\n  Appeal Type: Pre-Service / Pharmacy\n  Decision Due By: June 5, 2026\n\nI will be your Appeals Coordinator throughout this case. I may contact you if additional information is needed to complete the review. You or your Authorized Representative may submit additional information in support of your appeal at any time before the decision date.\n\nIf you have questions about your case, please reply to this email or call the Appeals Unit at (702) 555-0148, referencing your Case Number above.\n\nSincerely,\nAri Costa\nAppeals & Grievances Coordinator\nMojave Crest Assurance Company\nCase #: CASE-2026-00715",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "51",
      "folder": "INBOX",
      "subject": "External Review Decision \u2013 Case #CASE-2026-00689 / CRR-2026-04-1188",
      "from_addr": "intake@canyonridgereview.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "k.dufree@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-07T16:00:00Z",
      "message_id": "<crr-decision-689-0507@canyonridgereview.com>",
      "in_reply_to": "<crr-ack-689-0419@canyonridgereview.com>",
      "body_text": "Ari,\n\nCanyon Ridge Review Services has issued its independent external review decision for Case #CASE-2026-00689 (CRR ref: CRR-2026-04-1188).\n\nExternal Review Decision: UPHOLD (MCA denial affirmed)\n\nSummary: The independent reviewing physician concurred that the submitted clinical record does not demonstrate exhaustion of conservative therapies as required for surgical coverage. The formal decision letter has been mailed to the member and to MCA Compliance.\n\nThis case is now closed at the external review level.\n\nCanyon Ridge Review Services",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "52",
      "folder": "INBOX",
      "subject": "Cases 701 and 715 \u2013 status check",
      "from_addr": "d.whitfield@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-08T08:55:00Z",
      "message_id": "<dw-701-715-0508@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nTwo quick questions:\n\n1. Case 701 (Brockman CGM) \u2013 Helena sent you a clinical memo last week, right? What's the timeline on a decision? Jules flagged it as a potential approval.\n\n2. Case 715 (Ybarra, Humira) \u2013 Jules is reviewing the step therapy exemption request now. If methotrexate failure and toxicity are documented from 2024, that should qualify under the Nevada step therapy exemption law. Keep an eye on Jules's review.\n\nThanks,\nDarnell",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "53",
      "folder": "INBOX",
      "subject": "NEW POLICY: Updated Expedited Review Turnaround SLA \u2013 Effective June 1",
      "from_addr": "t.reyes@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com,p.annadurai@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-08T10:00:00Z",
      "message_id": "<policy-expedited-0508@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Team,\n\nEffective June 1, 2026, our internal SLA for expedited appeals decisions is reduced from 72 hours to 48 hours from the time of receipt. This aligns with the new NV DOI guidance issued last month.\n\nPlease make note of this for any cases received on or after June 1. I'll be updating the Appeals Procedures Manual this week.\n\nQuestions? See me or Darnell.\n\nTamra Reyes\nDirector, Appeals & Grievances\nMojave Crest Assurance Company",
      "body_html": null,
      "is_read": true,
      "is_important": true,
      "attachments": []
    },
    {
      "email_id": "54",
      "folder": "INBOX",
      "subject": "Re: Mojave Crest Appeals Case #CASE-2026-00698 \u2013 Still disputing sessions 19-20",
      "from_addr": "theresa.montoya@yahoo.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-09T13:20:00Z",
      "message_id": "<montoya-dispute-0509@yahoo.com>",
      "in_reply_to": "<decision-698-0430@mojavecrest.com>",
      "body_text": "Hi Ari,\n\nThank you for the partial approval on my appeal. I'm glad sessions 13\u201318 were approved, but I still feel sessions 19 and 20 were medically necessary. My PT says I was not at functional goals at session 18.\n\nDo I need to appeal again, or can I go straight to the external review you mentioned in your letter?\n\nThank you,\nTheresa Montoya",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "56",
      "folder": "INBOX",
      "subject": "FINAL REMINDER: Reset Your Password Before May 10",
      "from_addr": "it@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-09T08:00:00Z",
      "message_id": "<pwd-final-0509@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nThis is your final reminder. Your Mojave Crest password expires TOMORROW, May 10. If you do not reset it, you will be locked out of all systems.\n\nReset now: https://myaccount.mojavecrest.com\n\nIT Help Desk | helpdesk@mojavecrest.com | ext. 5555",
      "body_html": null,
      "is_read": false,
      "is_important": true,
      "attachments": []
    },
    {
      "email_id": "57",
      "folder": "INBOX",
      "subject": "Discover MedReview Pro \u2013 The #1 Clinical Decision Support for Health Plans",
      "from_addr": "marketing@benefitspro.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-10T06:00:00Z",
      "message_id": "<medreview-ad-0510@benefitspro.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nIs your clinical review team spending too much time pulling medical policy documents?\n\nMedReview Pro integrates directly with your appeals workflow, surfacing the right policy version in seconds.\n\nSee a live demo: benefitspro.com/medreviewpro\n\nUnsubscribe",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "58",
      "folder": "INBOX",
      "subject": "Re: Case 693 \u2013 Caldwell corrected EOB",
      "from_addr": "m.quill@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-10T11:20:00Z",
      "message_id": "<mquill-693-0510@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Hi Ari,\n\nConfirming the Caldwell (Case 693) claim reprocessing is complete. The corrected EOB was issued May 7 and the refund check of $1,590.00 was mailed to the address on file. The corrected remittance advice was sent to the provider as well.\n\nLet me know if you need anything else for the file.\n\nMarin Quill\nClaims Coordinator",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "59",
      "folder": "INBOX",
      "subject": "Parking Update \u2013 Lot B Now Open / New Visitor Spaces",
      "from_addr": "facilities@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-11T08:00:00Z",
      "message_id": "<parking-open-0511@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "All Staff,\n\nGreat news \u2013 Parking Lot B has reopened following resurfacing. Additionally, eight new visitor spaces have been added near the main entrance. Please remind external guests to park in the marked visitor spaces only.\n\nThank you,\nFacilities Management",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "60",
      "folder": "INBOX",
      "subject": "Open Case Check-In \u2013 May 11",
      "from_addr": "d.whitfield@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-11T09:30:00Z",
      "message_id": "<dw-checkin-0511@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nOpen case status from my end for your queue:\n\n\u2022 CASE-2026-00695 (Okonkwo) \u2013 External review pending at Canyon Ridge \u2713\n\u2022 CASE-2026-00701 (Brockman) \u2013 Decision issued May 9, approved \u2713\n\u2022 CASE-2026-00710 (Vickers) \u2013 Expedited approved May 3, concurrent review scheduled May 17 \u2713\n\u2022 CASE-2026-00715 (Ybarra) \u2013 Jules's review still pending; due June 5 \u2013 OK to wait\n\u2022 CASE-2026-00698 (Montoya) \u2013 Partial approval issued; member may request external review on denied portion\n\u2022 CASE-2026-00705 (Durand) \u2013 Did you pick this one up? Still shows unassigned in the system\n\nWe're in good shape. DOI audit window coming June 1 \u2013 make sure all case notes are finalized.\n\nDarnell",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "61",
      "folder": "INBOX",
      "subject": "Reminder: Appeals Team Huddle \u2013 Tomorrow, May 12 @ 10 AM",
      "from_addr": "no-reply@calendar.mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-11T15:00:00Z",
      "message_id": "<cal-remind-0511@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Reminder: You have an upcoming event.\n\nEvent: Appeals Team Huddle\nDate: Tuesday, May 12, 2026\nTime: 10:00 AM \u2013 11:00 AM (PST)\nLocation: Conference Room B / Teams Link: https://teams.mojavecrest.com/join/huddle-may12\nOrganizer: Tamra Reyes\n\nAgenda: Open case review, DOI audit prep, external review tracking.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "62",
      "folder": "INBOX",
      "subject": "Fax Received \u2013 2026.5.12 - KPX658320914",
      "from_addr": "noreply@efaxsolutions.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-12T09:11:00Z",
      "message_id": "<fax-KPX658320914-0512@efaxsolutions.com>",
      "in_reply_to": null,
      "body_text": "You have received a fax via eFax Solutions.\n\nFax Details:\n  Date/Time Received: May 12, 2026 at 9:11 AM PST\n  Fax Reference: KPX658320914\n  Pages: 7\n  Sender Fax Number: (702) 555-0447\n\nThe fax is attached as a PDF. Please do not reply to this email.\n\neFax Solutions | efaxsolutions.com",
      "body_html": null,
      "is_read": false,
      "is_important": true,
      "attachments": [
        {
          "filename": "2026.5.12 - KPX658320914.pdf",
          "content_type": "application/pdf",
          "content_base64": "JVBERi0xLjQKMSAwIG9iago8PAovVHlwZSAvQ2F0YWxvZwovUGFnZXMgMiAwIFIKPj4KZW5kb2JqCjIgMCBvYmoKPDwKL1R5cGUgL1BhZ2VzCi9LaWRzIFszIDAgUl0KL0NvdW50IDEKPJ4KZW5kb2JqCjMgMCBvYmoKPDwKL1R5cGUgL1BhZ2UKL1BhcmVudCAyIDAgUgovTWVkaWFCb3ggWzAgMCA2MTIgNzkyXQo+PgplbmRvYmoKeHJlZgowIDQKMDAwMDAwMDAwMCA2NTUzNSBmIAowMDAwMDAwMDA5IDAwMDAwIG4gCjAwMDAwMDAwNTggMDAwMDAgbiAKMDAwMDAwMDExNSAwMDAwMCBuIAp0cmFpbGVyCjw8Ci9TaXplIDQKL1Jvb3QgMSAwIFIKPj4Kc3RhcnR4cmVmCjE5MAolJUVPRgo="
        }
      ]
    },
    {
      "email_id": "63",
      "folder": "INBOX",
      "subject": "Re: CASE-2026-00710 \u2013 Vickers Concurrent Review Schedule",
      "from_addr": "h.bergstrom@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-04T09:00:00Z",
      "message_id": "<bergstrom-710-0504@mojavecrest.com>",
      "in_reply_to": "<expedited-710-0503@mojavecrest.com>",
      "body_text": "Ari,\n\nGood work getting the Vickers expedited decision out quickly. I've scheduled the concurrent care review for May 17. Desert Valley will submit updated clinical notes by May 14. Let me know if you need anything from me before then.\n\nHelena",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "64",
      "folder": "INBOX",
      "subject": "Re: Appeal \u2013 Ethan Brockman / CASE-2026-00701 \u2013 CGM Decision",
      "from_addr": "ethan.brockman@hotmail.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-10T16:45:00Z",
      "message_id": "<brockman-reply-0510@hotmail.com>",
      "in_reply_to": "<decision-701-0509@mojavecrest.com>",
      "body_text": "Hi Ari,\n\nThank you so much! I received your approval letter today. I'm so relieved. I'll share it with Dr. Shah's office right away.\n\nThank you for all your help with this.\n\nEthan Brockman",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "65",
      "folder": "INBOX",
      "subject": "Re: Case 695 \u2013 external review forwarded",
      "from_addr": "k.dufree@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-03T10:00:00Z",
      "message_id": "<kdufree-695-0503@mojavecrest.com>",
      "in_reply_to": "<extrev-695-0502@mojavecrest.com>",
      "body_text": "Ari,\n\nConfirmed \u2013 I see the Canyon Ridge submission for 695. I've logged it in the compliance tracker. I'll monitor for the acknowledgment from CRR and will keep you in the loop.\n\nKendel Dufree\nCompliance Officer",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "66",
      "folder": "INBOX",
      "subject": "Dr. Henning \u2013 Step Therapy Exemption Review / Case 715",
      "from_addr": "j.henning@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-09T14:00:00Z",
      "message_id": "<henning-715-0509@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nI've completed my pharmacy review for Case 715 (Ybarra). The 2024 medical records documenting methotrexate failure and hepatotoxicity are clear and meet the Nevada step therapy exemption criteria (NRS 695G.210). My recommendation is to approve the Humira authorization. Full memo will be in SharePoint by EOD.\n\nJules Henning, PharmD\nPharmacy Director",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "67",
      "folder": "INBOX",
      "subject": "April Office Supply Order \u2013 Reminder to Submit Requests by Apr 17",
      "from_addr": "facilities@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-14T10:00:00Z",
      "message_id": "<supplies-0414@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "All Staff,\n\nThe monthly office supply order will be placed on Friday, April 17. If you need any supplies (paper, pens, toner, etc.), please submit your requests to facilities@mojavecrest.com by Thursday, April 16 at 5:00 PM.\n\nFacilities Management",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "68",
      "folder": "INBOX",
      "subject": "Re: CASE-2026-00698 \u2013 Montoya \u2013 Marisol clinical review attached",
      "from_addr": "m.alvarado@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-29T15:30:00Z",
      "message_id": "<alvarado-698-0429@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nHere is my clinical review summary for Case 698 (Montoya):\n\nSessions 13\u201318 are clinically supported. The PT notes show the member was still working toward range-of-motion and strength goals consistent with her post-op protocol at session 12. Sessions 19\u201320: the progress notes at session 18 show the member had reached 90% of functional benchmarks with plateau noted. I cannot support sessions 19\u201320 on the current record.\n\nMy full memo is in SharePoint. Feel free to call if you have questions before drafting the letter.\n\nMarisol Alvarado, RN\nLead RN Reviewer",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "69",
      "folder": "INBOX",
      "subject": "Health Plan Week \u2013 Concurrent Care & Step Therapy Updates",
      "from_addr": "info@healthplanweek.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-09T06:00:00Z",
      "message_id": "<hpw-0509@healthplanweek.com>",
      "in_reply_to": null,
      "body_text": "Health Plan Week | May 9, 2026\n\n\u2022 Nevada amends concurrent care termination notice requirements \u2013 10-day notice now required for non-expedited terminations\n\u2022 Step therapy exemption laws: state comparison chart updated for 2026\n\u2022 CMS posts final rule on behavioral health network adequacy \u2014 effective January 2027\n\u2022 Webinar: Preparing for state market conduct exams \u2013 May 19, 12 PM ET\n\nRead more at healthplanweek.com.",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "70",
      "folder": "INBOX",
      "subject": "Re: Case 693 \u2013 Caldwell \u2013 Thank You",
      "from_addr": "jcaldwell55@gmail.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-04-22T12:10:00Z",
      "message_id": "<caldwell-thanks-0422@gmail.com>",
      "in_reply_to": "<decision-693-0420@mojavecrest.com>",
      "body_text": "Hi Ari,\n\nThank you so much for resolving this. I received confirmation that the claim was reprocessed. I'll be watching for the refund check. I really appreciate how quickly this was handled.\n\nBest,\nJames Caldwell",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "71",
      "folder": "INBOX",
      "subject": "Reminder: DOI Audit Prep \u2013 Case File Checklist Due May 30",
      "from_addr": "k.dufree@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com,t.reyes@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-08T13:00:00Z",
      "message_id": "<doi-audit-prep-0508@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Team,\n\nAs a reminder, the NV DOI market conduct exam window opens June 1. Please complete the case file checklist for all closed cases from January through April 2026 by May 30.\n\nThe checklist template is in SharePoint > Compliance > 2026 DOI Exam Prep. Key items:\n  - Acknowledgment letter date vs. receipt date (must be \u22645 BD)\n  - Decision letter date vs. receipt date (standard: \u226430 days; expedited: \u226472 hours)\n  - External review forwarding timeliness (\u22645 BD of member request)\n  - Case file completeness (clinical memo, policy citation, member notice)\n\nPlease reach out if you have questions.\n\nKendel Dufree\nCompliance Officer",
      "body_html": null,
      "is_read": true,
      "is_important": true,
      "attachments": []
    },
    {
      "email_id": "72",
      "folder": "INBOX",
      "subject": "Case 689 \u2013 Canyon Ridge Decision \u2013 Next Steps?",
      "from_addr": "office@carsonlawgroup.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-09T10:30:00Z",
      "message_id": "<carson-postcrr-0509@carsonlawgroup.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nWe received the Canyon Ridge external review decision upholding the denial for Mr. Haines. We understand this closes the external review process.\n\nFor our records, can you confirm whether any further administrative appeals are available under the plan, or whether the next step would be to pursue legal or DOI complaint channels?\n\nThank you,\nCarson Law Group",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "73",
      "folder": "INBOX",
      "subject": "CASE-2026-00695 \u2013 Canyon Ridge Acknowledgment",
      "from_addr": "intake@canyonridgereview.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "k.dufree@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-05-04T14:00:00Z",
      "message_id": "<crr-ack-695-0504@canyonridgereview.com>",
      "in_reply_to": "<extrev-695-0502@mojavecrest.com>",
      "body_text": "Ari,\n\nCanyon Ridge Review Services acknowledges receipt of the external review request for Case #CASE-2026-00695 (Member: D.O., CRR ref: CRR-2026-05-1204). Secure file transfer received.\n\nExpected decision: within 45 calendar days (by June 18, 2026).\n\nCanyon Ridge Review Services Intake Team",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "74",
      "folder": "INBOX",
      "subject": "Lunch order today \u2013 who's in?",
      "from_addr": "p.annadurai@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": "d.whitfield@mojavecrest.com",
      "bcc_addr": null,
      "date": "2026-04-16T11:45:00Z",
      "message_id": "<lunch-0416@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari, Darnell \u2013\n\nOrdering from Cactus Kitchen today, want in? I'm placing the order at 12:15. Text me or reply here.\n\nPriya",
      "body_html": null,
      "is_read": true,
      "is_important": false,
      "attachments": []
    },
    {
      "email_id": "75",
      "folder": "INBOX",
      "subject": "Vickers (710) \u2013 Wife called re: May 17 review",
      "from_addr": "d.whitfield@mojavecrest.com",
      "to_addr": "a.costa@mojavecrest.com",
      "cc_addr": null,
      "bcc_addr": null,
      "date": "2026-05-11T14:00:00Z",
      "message_id": "<dw-vickers-0511@mojavecrest.com>",
      "in_reply_to": null,
      "body_text": "Ari,\n\nRenee Vickers called the main line asking what the outcome of the May 17 concurrent care review will mean for Noah. She's worried he'll be discharged before he's ready again. I told her Helena's review on the 17th will determine if continued stay is supported, and that we'll notify them within 24 hours of the determination. I told her to also ask Desert Valley's care coordinator to prepare updated progress notes.\n\nJust keeping you in the loop. Might be worth a quick call to the family.\n\nDarnell",
      "body_html": null,
      "is_read": false,
      "is_important": false,
      "attachments": []
    }
  ],
  "next_email_id": 76
}