Operate, actions
Actions
Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.
Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed
Actions
26,640 derived from the last resolution run
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-005890 | Orphan claim re-pointed Claims processor | CLM-421871 → UHC-87776-07 (Mari Mejia) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005891 | Orphan claim re-pointed Claims processor | CLM-416485 → UHC-64249-21 (Martha Black) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005892 | Orphan claim re-pointed Claims processor | CLM-427894 → UHC-95721-09 (Aaron Knight) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005893 | Orphan claim re-pointed Claims processor | CLM-419820 → UHC-35066-30 (Nicholas Bowman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005894 | Orphan claim re-pointed Claims processor | CLM-415540 → UHC-50444-71 (Kenneth Morgan) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005895 | Orphan claim re-pointed Claims processor | CLM-425020 → UHC-83756-69 (Jerry Alvarez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005896 | Orphan claim re-pointed Claims processor | CLM-402862 → UHC-53509-18 (Jason White) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005897 | Orphan claim re-pointed Claims processor | CLM-421640 → UHC-74387-24 (Janet Myers) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005898 | Orphan claim re-pointed Claims processor | CLM-417774 → UHC-42386-79 (Patricia Phillips) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005899 | Orphan claim re-pointed Claims processor | CLM-417625 → UHC-33386-33 (Keith Bell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005900 | Orphan claim re-pointed Claims processor | CLM-411886 → UHC-85455-92 (Pamela Lucas) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005901 | Orphan claim re-pointed Claims processor | CLM-430885 → UHC-24395-12 (Priya Dunn) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005902 | Orphan claim re-pointed Claims processor | CLM-415359 → UHC-19167-90 (Bobby Gilbert) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005903 | Orphan claim re-pointed Claims processor | CLM-422237 → UHC-26322-25 (Joseph Daniels) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005904 | Orphan claim re-pointed Claims processor | CLM-410493 → UHC-08616-48 (Maria Silva) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005905 | Orphan claim re-pointed Claims processor | CLM-410628 → UHC-08656-71 (Ronald Olson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005906 | Orphan claim re-pointed Claims processor | CLM-405492 → UHC-27595-69 (Theresa Harvey) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005907 | Orphan claim re-pointed Claims processor | CLM-415029 → UHC-11917-91 (Lori Campbell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005908 | Orphan claim re-pointed Claims processor | CLM-418503 → UHC-77781-56 (Ralph Montgomery) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005909 | Orphan claim re-pointed Claims processor | CLM-417550 → UHC-76647-45 (Janice Johnson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005910 | Orphan claim re-pointed Claims processor | CLM-427226 → UHC-15972-91 (Kimberly Lucas) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005911 | Orphan claim re-pointed Claims processor | CLM-424348 → UHC-51683-44 (Teresa Thompson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005912 | Orphan claim re-pointed Claims processor | CLM-429090 → UHC-51214-95 (Peter Carlson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005913 | Orphan claim re-pointed Claims processor | CLM-422323 → UHC-48098-19 (Heather Cox) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005914 | Orphan claim re-pointed Claims processor | CLM-416663 → UHC-14238-55 (Janice Estrada) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005915 | Orphan claim re-pointed Claims processor | CLM-404545 → UHC-68477-97 (Katherine Wang) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005916 | Orphan claim re-pointed Claims processor | CLM-407369 → UHC-17804-04 (Charlotte Saanchez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005917 | Orphan claim re-pointed Claims processor | CLM-417202 → UHC-33529-32 (Marilyn Ferguson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005918 | Orphan claim re-pointed Claims processor | CLM-426368 → UHC-84044-69 (Christian Wlison) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005919 | Orphan claim re-pointed Claims processor | CLM-408108 → UHC-43255-16 (Ralph Lewis) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005920 | Orphan claim re-pointed Claims processor | CLM-417149 → UHC-09268-60 (Maria Hansen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005921 | Orphan claim re-pointed Claims processor | CLM-417426 → UHC-46623-02 (Donna Evans) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005922 | Orphan claim re-pointed Claims processor | CLM-416458 → UHC-52938-21 (Kenneth Miller) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005923 | Orphan claim re-pointed Claims processor | CLM-400188 → UHC-68096-32 (Danielle Gordon) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005924 | Orphan claim re-pointed Claims processor | CLM-416394 → UHC-27931-26 (Vincent Ruiz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005925 | Orphan claim re-pointed Claims processor | CLM-409758 → UHC-39860-37 (Bryan Martinez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005926 | Orphan claim re-pointed Claims processor | CLM-429907 → UHC-21868-51 (John Carlson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005927 | Orphan claim re-pointed Claims processor | CLM-427997 → UHC-01048-26 (Raymond Reed) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005928 | Orphan claim re-pointed Claims processor | CLM-420519 → UHC-56404-63 (Omar Myers) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005929 | Orphan claim re-pointed Claims processor | CLM-411249 → UHC-83791-96 (Julie Wright) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005930 | Orphan claim re-pointed Claims processor | CLM-413210 → UHC-90583-29 (Kathryn Bradley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005931 | Orphan claim re-pointed Claims processor | CLM-430882 → UHC-00961-08 (Austin Espinoza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005932 | Orphan claim re-pointed Claims processor | CLM-424377 → UHC-60990-54 (Anna Morris) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005933 | Orphan claim re-pointed Claims processor | CLM-426242 → UHC-67975-18 (Hannah Munoz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005934 | Orphan claim re-pointed Claims processor | CLM-403814 → UHC-20741-25 (Jesse Alvarez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005935 | Orphan claim re-pointed Claims processor | CLM-416019 → UHC-49073-83 (Fatima Butler) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005936 | Orphan claim re-pointed Claims processor | CLM-416233 → UHC-74762-12 (Andrew Dominguez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005937 | Orphan claim re-pointed Claims processor | CLM-431555 → UHC-06184-67 (Yuki Simpson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005938 | Orphan claim re-pointed Claims processor | CLM-417912 → UHC-05769-17 (Carlos Gordon) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005939 | Orphan claim re-pointed Claims processor | CLM-413795 → UHC-19461-15 (Denise Ortega) |
| Executed | resolution_agent 2026-10-22 12:47:23 |
Derivation rules
Evaluated after every gold rebuild
- 1Eligibility conflict resolvedThe records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
- 2Orphan claim re-pointedA claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
- 3Outreach address correctedThe most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
- 4Outreach suppressed pending stewardThe record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
- 5Care coordination outreachThree or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
- 6New member onboardingA single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
- 7Duplicate member record retiredTwo or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.