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-017771 | Care coordination outreach Next-best-action | Willie Martin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017772 | Care coordination outreach Next-best-action | Kimberly Marquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017773 | Care coordination outreach Next-best-action | Michelle Carr: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017774 | Care coordination outreach Next-best-action | Jack Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017775 | Care coordination outreach Next-best-action | Gerald Marquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017776 | Care coordination outreach Next-best-action | Richard Santiago: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017777 | Care coordination outreach Next-best-action | Kyle Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017778 | Care coordination outreach Next-best-action | Diego West: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017779 | Care coordination outreach Next-best-action | Lauren Wang: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017780 | Care coordination outreach Next-best-action | Kyle Phillips: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017781 | Care coordination outreach Next-best-action | Robert Robinson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017782 | Care coordination outreach Next-best-action | Wayne Marshall: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017783 | Care coordination outreach Next-best-action | Barbara Ruiz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017784 | Care coordination outreach Next-best-action | Gary Knight: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017785 | Care coordination outreach Next-best-action | Pamela Matthews: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017786 | Care coordination outreach Next-best-action | Albert Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017787 | Care coordination outreach Next-best-action | Raymond Walsh: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017788 | Care coordination outreach Next-best-action | Judith Soto: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017789 | Care coordination outreach Next-best-action | Joe Anderson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017790 | Care coordination outreach Next-best-action | Mateo Snyder: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017791 | Care coordination outreach Next-best-action | Juan Snyder: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017792 | Care coordination outreach Next-best-action | Megan Burton: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017793 | Care coordination outreach Next-best-action | Lori Contreras: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017794 | Care coordination outreach Next-best-action | Sophia Lawrence: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017795 | Care coordination outreach Next-best-action | Thomas Snyder: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017796 | Care coordination outreach Next-best-action | Patrick Valdez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017797 | Care coordination outreach Next-best-action | Frank Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017798 | Care coordination outreach Next-best-action | Albert Richards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017799 | Care coordination outreach Next-best-action | Susan Garrett: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017800 | Care coordination outreach Next-best-action | Willie Le: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017801 | Care coordination outreach Next-best-action | Gerald Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017802 | Care coordination outreach Next-best-action | Kayla Rice: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017803 | Care coordination outreach Next-best-action | Stephanie Ruiz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017804 | Care coordination outreach Next-best-action | Joshua Holmes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017805 | Care coordination outreach Next-best-action | Willie Garcia: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017806 | Care coordination outreach Next-best-action | Ann Adams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017807 | Care coordination outreach Next-best-action | Alice Ortiz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017808 | Care coordination outreach Next-best-action | Vincent Morgan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017809 | Care coordination outreach Next-best-action | Sandra Kim: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017810 | Care coordination outreach Next-best-action | Sara Burton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017811 | Care coordination outreach Next-best-action | Frank Howard: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017812 | Care coordination outreach Next-best-action | Martha Weaver: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017813 | Care coordination outreach Next-best-action | Kathleen Hanson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017814 | Care coordination outreach Next-best-action | Susan Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017815 | Care coordination outreach Next-best-action | Jessica Vargas: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017816 | Care coordination outreach Next-best-action | Arthur Turner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017817 | Care coordination outreach Next-best-action | Emma Silva: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017818 | Care coordination outreach Next-best-action | Mike Simmons: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017819 | Care coordination outreach Next-best-action | Martha Rodriguez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017820 | Care coordination outreach Next-best-action | Fatima Cook: 4 claims, no attributed provider |
| Proposed | — |
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.