Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Actions

26,640 derived from the last resolution run

ActionTypeTitleDetailLinked toStatusExecuted
ACT-018321
Care coordination outreach
Next-best-action
Heather Rice: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018322
Care coordination outreach
Next-best-action
Frank Richards: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018323
Care coordination outreach
Next-best-action
Rebecca Carlson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018324
Care coordination outreach
Next-best-action
Gary Ryan: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018325
Care coordination outreach
Next-best-action
Isabella Gordon: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018326
Care coordination outreach
Next-best-action
Kayla Henry: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018327
Care coordination outreach
Next-best-action
Jerry Dunn: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018328
Care coordination outreach
Next-best-action
Karen Powell: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018329
Care coordination outreach
Next-best-action
Brandon Wagner: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018330
Care coordination outreach
Next-best-action
Aisha Simmons: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018331
Care coordination outreach
Next-best-action
Janet Ryan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018332
Care coordination outreach
Next-best-action
Abigail Hicks: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018333
Care coordination outreach
Next-best-action
Bobby Cooper: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018334
Care coordination outreach
Next-best-action
Sandra Reed: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018335
Care coordination outreach
Next-best-action
Mariana Gordon: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018336
Care coordination outreach
Next-best-action
William Hamilton: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018337
Care coordination outreach
Next-best-action
Teresa Richards: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018338
Care coordination outreach
Next-best-action
Ethan Estrada: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018339
Care coordination outreach
Next-best-action
Eugene Cruz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018340
Care coordination outreach
Next-best-action
Bradley Hall: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018341
Care coordination outreach
Next-best-action
Omar Bryant: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018342
Care coordination outreach
Next-best-action
Billy Wong: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018343
Care coordination outreach
Next-best-action
Lori Austin: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018344
Care coordination outreach
Next-best-action
Priya McDonald: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018345
Care coordination outreach
Next-best-action
Lawrence Ray: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018346
Care coordination outreach
Next-best-action
Donna Stephens: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018347
Care coordination outreach
Next-best-action
Mark Cole: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018348
Care coordination outreach
Next-best-action
Randy Luna: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018349
Care coordination outreach
Next-best-action
Santiago Moore: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018350
Care coordination outreach
Next-best-action
Jennifer Hansen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018351
Care coordination outreach
Next-best-action
Abigail Johnston: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018352
Care coordination outreach
Next-best-action
Jose Williamson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018353
Care coordination outreach
Next-best-action
Andrea King: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018354
Care coordination outreach
Next-best-action
Austin Bell: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018355
Care coordination outreach
Next-best-action
Dorothy Padilla: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018356
Care coordination outreach
Next-best-action
Barbara Oliver: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018357
Care coordination outreach
Next-best-action
Doris Mendez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018358
Care coordination outreach
Next-best-action
Theresa Cruz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018359
Care coordination outreach
Next-best-action
Debra Garza: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018360
Care coordination outreach
Next-best-action
Sharon Miller: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018361
Care coordination outreach
Next-best-action
Richard Simmons: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018362
Care coordination outreach
Next-best-action
Margaret Dean: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018363
Care coordination outreach
Next-best-action
Elijah Harper: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018364
Care coordination outreach
Next-best-action
Jeffrey Allen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018365
Care coordination outreach
Next-best-action
Nathan Shaw: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018366
Care coordination outreach
Next-best-action
Maria Cooper: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018367
Care coordination outreach
Next-best-action
Adam Bailey: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018368
Care coordination outreach
Next-best-action
Maria Armstrong: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018369
Care coordination outreach
Next-best-action
Jordan Wood: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018370
Care coordination outreach
Next-best-action
Jacob Coleman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
3,896 rows, page 12 of 78PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 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. 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. 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. 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. 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. 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. 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.