Action	Type	Title	Detail	Linked to	Status	Executed
ACT-001301	Eligibility conflict resolved Eligibility engine	Beverly Hughes: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed SELECT-EPO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-039856	Proposed	—
ACT-001302	Eligibility conflict resolved Eligibility engine	Betty Martinez: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed OPTIONS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-039881	Proposed	—
ACT-001303	Eligibility conflict resolved Eligibility engine	Paul Nguyen: 3 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed OPTIONS-PPO, MEDICARE-ADV-B, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-039966	Proposed	—
ACT-001304	Eligibility conflict resolved Eligibility engine	Juhn Simpson: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed MEDICARE-ADV-B, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-040028	Proposed	—
ACT-001305	Eligibility conflict resolved Eligibility engine	Carl Ruiz: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed MEDICARE-ADV-A, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-040121	Proposed	—
ACT-001306	Eligibility conflict resolved Eligibility engine	Kennteh Flores: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed OPTIONS-PPO, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-040358	Proposed	—
ACT-001307	Eligibility conflict resolved Eligibility engine	Grace Johnston: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed OPTIONS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-040541	Proposed	—
ACT-001308	Eligibility conflict resolved Eligibility engine	Marcus Ford: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-040550	Proposed	—
ACT-001309	Eligibility conflict resolved Eligibility engine	Kyle Silva: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed CORE-HMO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-040888	Proposed	—
ACT-001310	Eligibility conflict resolved Eligibility engine	Nicholas Le: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-040944	Proposed	—
ACT-001311	Eligibility conflict resolved Eligibility engine	Isabella Andrews: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed SELECT-EPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-041046	Proposed	—
ACT-001312	Eligibility conflict resolved Eligibility engine	Isabella Carter: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed CHOICE-PLUS-PPO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-041129	Proposed	—
ACT-001313	Eligibility conflict resolved Eligibility engine	Mei Robertson: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed OPTIONS-PPO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-041217	Proposed	—
ACT-001314	Eligibility conflict resolved Eligibility engine	Ronald Lawrence: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-041372	Proposed	—
ACT-001315	Eligibility conflict resolved Eligibility engine	Amanda Daniels: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed MEDICARE-ADV-B, SELECT-EPO Rule survivorship: ENR plan wins	MBR-041556	Proposed	—
ACT-001316	Eligibility conflict resolved Eligibility engine	Jimmy Guzman: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed SELECT-EPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-041617	Proposed	—
ACT-001317	Eligibility conflict resolved Eligibility engine	Abby Woods: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed OPTIONS-PPO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-041648	Proposed	—
ACT-001318	Eligibility conflict resolved Eligibility engine	Madison Foster: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed NAVIGATE-HMO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-041785	Proposed	—
ACT-001319	Eligibility conflict resolved Eligibility engine	Nancy Patel: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed NAVIGATE-HMO, CORE-HMO Rule survivorship: ENR plan wins	MBR-041802	Proposed	—
ACT-001320	Eligibility conflict resolved Eligibility engine	Justin Brooks: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed MEDICARE-ADV-A, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-041956	Proposed	—
ACT-001321	Eligibility conflict resolved Eligibility engine	Nancy Wallace: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CHOICE-PLUS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-042091	Proposed	—
ACT-001322	Eligibility conflict resolved Eligibility engine	Benjamin Ward: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed NAVIGATE-HMO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-042273	Proposed	—
ACT-001323	Eligibility conflict resolved Eligibility engine	Matthew Chavez: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-042608	Proposed	—
ACT-001324	Eligibility conflict resolved Eligibility engine	Janice Rojes: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed OPTIONS-PPO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-042673	Proposed	—
ACT-001325	Eligibility conflict resolved Eligibility engine	Betty Fox: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed OPTIONS-PPO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-042727	Proposed	—
ACT-001326	Eligibility conflict resolved Eligibility engine	Carolyn Wheeler: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed MEDICARE-ADV-B, SELECT-EPO Rule survivorship: ENR plan wins	MBR-042845	Proposed	—
ACT-001327	Eligibility conflict resolved Eligibility engine	Marcus Jimenez: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed OPTIONS-PPO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-042869	Proposed	—
ACT-001328	Eligibility conflict resolved Eligibility engine	Henry Chen: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed CORE-HMO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-043002	Proposed	—
ACT-001329	Eligibility conflict resolved Eligibility engine	Samantha Fowler: 3 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed NAVIGATE-HMO, CORE-HMO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-043278	Proposed	—
ACT-001330	Eligibility conflict resolved Eligibility engine	Diana Hernandez: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed OPTIONS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-043348	Proposed	—
ACT-001331	Eligibility conflict resolved Eligibility engine	Jesse Berry: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed CHOICE-PLUS-PPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-043350	Proposed	—
ACT-001332	Eligibility conflict resolved Eligibility engine	Carolyn Dixon: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-043410	Proposed	—
ACT-001333	Eligibility conflict resolved Eligibility engine	Nancy Carr: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed NAVIGATE-HMO, CORE-HMO Rule survivorship: ENR plan wins	MBR-043437	Proposed	—
ACT-001334	Eligibility conflict resolved Eligibility engine	Lawrence King: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed MEDICARE-ADV-B, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-043783	Proposed	—
ACT-001335	Eligibility conflict resolved Eligibility engine	Christopher Harris: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-044156	Proposed	—
ACT-001336	Eligibility conflict resolved Eligibility engine	Joshua Hoffman: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed MEDICARE-ADV-B, SELECT-EPO Rule survivorship: ENR plan wins	MBR-044196	Proposed	—
ACT-001337	Eligibility conflict resolved Eligibility engine	Camila Nelson: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed MEDICARE-ADV-B, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-044436	Proposed	—
ACT-001338	Eligibility conflict resolved Eligibility engine	Brenda Lee: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-045302	Proposed	—
ACT-001339	Eligibility conflict resolved Eligibility engine	Alice Silva: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed NAVIGATE-HMO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-045856	Proposed	—

1,339 rows, page 27 of 27Previous Next

Derivation rules

Evaluated after every gold rebuild

1
Eligibility conflict resolved
The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
2
Orphan claim re-pointed
A 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.
3
Outreach address corrected
The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
4
Outreach suppressed pending steward
The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
5
Care coordination outreach
Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
6
New member onboarding
A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
7
Duplicate member record retired
Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.