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-018271 | Care coordination outreach Next-best-action | Ashley Bowman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018272 | Care coordination outreach Next-best-action | Don Richardson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018273 | Care coordination outreach Next-best-action | Patricia Marshall: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018274 | Care coordination outreach Next-best-action | Helen Wright: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018275 | Care coordination outreach Next-best-action | Bryan Carter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018276 | Care coordination outreach Next-best-action | Nathan Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018277 | Care coordination outreach Next-best-action | Keith Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018278 | Care coordination outreach Next-best-action | Brenda Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018279 | Care coordination outreach Next-best-action | Patricia Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018280 | Care coordination outreach Next-best-action | Logan Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018281 | Care coordination outreach Next-best-action | Lauren Hill: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018282 | Care coordination outreach Next-best-action | Gabriel Gonzalez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018283 | Care coordination outreach Next-best-action | Sophia Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018284 | Care coordination outreach Next-best-action | Nicole Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018285 | Care coordination outreach Next-best-action | Judith Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018286 | Care coordination outreach Next-best-action | Dorothy Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018287 | Care coordination outreach Next-best-action | Jesse Armstrong: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018288 | Care coordination outreach Next-best-action | Ashley Bowman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018289 | Care coordination outreach Next-best-action | Jennifer Powell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018290 | Care coordination outreach Next-best-action | Mateo Estrada: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018291 | Care coordination outreach Next-best-action | Roger Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018292 | Care coordination outreach Next-best-action | Keith Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018293 | Care coordination outreach Next-best-action | Julie Rios: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018294 | Care coordination outreach Next-best-action | Madison Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018295 | Care coordination outreach Next-best-action | Richard Luna: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018296 | Care coordination outreach Next-best-action | Fatima Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018297 | Care coordination outreach Next-best-action | Natalie Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018298 | Care coordination outreach Next-best-action | Isabella Wood: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018299 | Care coordination outreach Next-best-action | Wei Morrison: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018300 | Care coordination outreach Next-best-action | Kathryn Pierce: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018301 | Care coordination outreach Next-best-action | Lucia Rios: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018302 | Care coordination outreach Next-best-action | Ray Garza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018303 | Care coordination outreach Next-best-action | Jacob Hall: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018304 | Care coordination outreach Next-best-action | Danielle Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018305 | Care coordination outreach Next-best-action | Judith Rivera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018306 | Care coordination outreach Next-best-action | Pamela Hayes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018307 | Care coordination outreach Next-best-action | Aisha Hughes: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018308 | Care coordination outreach Next-best-action | Emma Fields: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018309 | Care coordination outreach Next-best-action | Bruce Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018310 | Care coordination outreach Next-best-action | Anna Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018311 | Care coordination outreach Next-best-action | Judith Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018312 | Care coordination outreach Next-best-action | Angela Sanders: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018313 | Care coordination outreach Next-best-action | Shirley Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018314 | Care coordination outreach Next-best-action | Brittany Lucas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018315 | Care coordination outreach Next-best-action | Christian Hayes: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018316 | Care coordination outreach Next-best-action | Amber Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018317 | Care coordination outreach Next-best-action | Nathan Hall: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018318 | Care coordination outreach Next-best-action | Gregory Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018319 | Care coordination outreach Next-best-action | Jacqueline Soto: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018320 | Care coordination outreach Next-best-action | Isabella Gutierrez: 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.