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-018221 | Care coordination outreach Next-best-action | Albert Ellis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018222 | Care coordination outreach Next-best-action | Vincent Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018223 | Care coordination outreach Next-best-action | Anna Baker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018224 | Care coordination outreach Next-best-action | Timothy Rios: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018225 | Care coordination outreach Next-best-action | Patricia Lawson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018226 | Care coordination outreach Next-best-action | Stephen McCoy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018227 | Care coordination outreach Next-best-action | Kyle Burns: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018228 | Care coordination outreach Next-best-action | Gloria Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018229 | Care coordination outreach Next-best-action | Marilyn West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018230 | Care coordination outreach Next-best-action | Evelyn Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018231 | Care coordination outreach Next-best-action | Gregory Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018232 | Care coordination outreach Next-best-action | Julia Cook: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018233 | Care coordination outreach Next-best-action | Lawrence Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018234 | Care coordination outreach Next-best-action | Donald Murray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018235 | Care coordination outreach Next-best-action | Priya Santos: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018236 | Care coordination outreach Next-best-action | Jack Barnes: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018237 | Care coordination outreach Next-best-action | Carolyn Ward: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018238 | Care coordination outreach Next-best-action | George Patterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018239 | Care coordination outreach Next-best-action | Gabriel Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018240 | Care coordination outreach Next-best-action | Gregory Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018241 | Care coordination outreach Next-best-action | Walter Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018242 | Care coordination outreach Next-best-action | Nicole Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018243 | Care coordination outreach Next-best-action | Emily Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018244 | Care coordination outreach Next-best-action | Benjamin Gibson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018245 | Care coordination outreach Next-best-action | Dylan Alexander: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018246 | Care coordination outreach Next-best-action | Samantha Reid: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018247 | Care coordination outreach Next-best-action | Bobby Chapman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018248 | Care coordination outreach Next-best-action | Jacqueline Ryan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018249 | Care coordination outreach Next-best-action | Scott Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018250 | Care coordination outreach Next-best-action | Mary Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018251 | Care coordination outreach Next-best-action | Sharon Bell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018252 | Care coordination outreach Next-best-action | Priya Spencer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018253 | Care coordination outreach Next-best-action | Brittany Hudson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018254 | Care coordination outreach Next-best-action | Ronald Herrera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018255 | Care coordination outreach Next-best-action | Jordan Duncan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018256 | Care coordination outreach Next-best-action | Ana Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018257 | Care coordination outreach Next-best-action | Ryan Edwards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018258 | Care coordination outreach Next-best-action | Ralph Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018259 | Care coordination outreach Next-best-action | Tyler Gomez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018260 | Care coordination outreach Next-best-action | Jessica Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018261 | Care coordination outreach Next-best-action | Ana Banks: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018262 | Care coordination outreach Next-best-action | Pamela Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018263 | Care coordination outreach Next-best-action | Scott Johnston: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018264 | Care coordination outreach Next-best-action | Sam Miller: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018265 | Care coordination outreach Next-best-action | Debra Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018266 | Care coordination outreach Next-best-action | Brandon Sandoval: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018267 | Care coordination outreach Next-best-action | Gregory Delgado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018268 | Care coordination outreach Next-best-action | Jonathan Davis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018269 | Care coordination outreach Next-best-action | Ruth Fisher: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018270 | Care coordination outreach Next-best-action | Doris Nunez: 3 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.