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-018371 | Care coordination outreach Next-best-action | Laura Berry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018372 | Care coordination outreach Next-best-action | Wayne Weaver: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018373 | Care coordination outreach Next-best-action | Joseph Mitchell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018374 | Care coordination outreach Next-best-action | Betty Vega: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018375 | Care coordination outreach Next-best-action | Steven Turner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018376 | Care coordination outreach Next-best-action | Kimberly Wood: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018377 | Care coordination outreach Next-best-action | Brenda Butler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018378 | Care coordination outreach Next-best-action | Alexis Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018379 | Care coordination outreach Next-best-action | Judy Burns: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018380 | Care coordination outreach Next-best-action | Russell Weaver: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018381 | Care coordination outreach Next-best-action | Eric Davis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018382 | Care coordination outreach Next-best-action | Mateo Diaz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018383 | Care coordination outreach Next-best-action | Lori Porter: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018384 | Care coordination outreach Next-best-action | Abigail Aguilar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018385 | Care coordination outreach Next-best-action | Anthony Martin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018386 | Care coordination outreach Next-best-action | Tyler Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018387 | Care coordination outreach Next-best-action | Mariana Clark: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018388 | Care coordination outreach Next-best-action | George Foster: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018389 | Care coordination outreach Next-best-action | Tyler Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018390 | Care coordination outreach Next-best-action | Brittany Arnold: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018391 | Care coordination outreach Next-best-action | Juan Murray: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018392 | Care coordination outreach Next-best-action | William Estrada: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018393 | Care coordination outreach Next-best-action | Victoria Ross: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018394 | Care coordination outreach Next-best-action | Terry Burns: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018395 | Care coordination outreach Next-best-action | Christine Wagner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018396 | Care coordination outreach Next-best-action | Roy Brooks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018397 | Care coordination outreach Next-best-action | Jesse Alvarez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018398 | Care coordination outreach Next-best-action | Alice Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018399 | Care coordination outreach Next-best-action | Christopher Duncan: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018400 | Care coordination outreach Next-best-action | Emily Greene: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018401 | Care coordination outreach Next-best-action | Alexander Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018402 | Care coordination outreach Next-best-action | Kathy Morgan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018403 | Care coordination outreach Next-best-action | Matthew Hanson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018404 | Care coordination outreach Next-best-action | Debra Hoffman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018405 | Care coordination outreach Next-best-action | Philip Valdez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018406 | Care coordination outreach Next-best-action | Stephanie Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018407 | Care coordination outreach Next-best-action | Jason Watson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018408 | Care coordination outreach Next-best-action | Santiago Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018409 | Care coordination outreach Next-best-action | Janice Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018410 | Care coordination outreach Next-best-action | Sharon Hanson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018411 | Care coordination outreach Next-best-action | Jessica Schmidt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018412 | Care coordination outreach Next-best-action | Jonathan Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018413 | Care coordination outreach Next-best-action | Joe Weaver: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018414 | Care coordination outreach Next-best-action | Samantha Nunez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018415 | Care coordination outreach Next-best-action | Marilyn Hill: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018416 | Care coordination outreach Next-best-action | Catherine Myers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018417 | Care coordination outreach Next-best-action | Mason Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018418 | Care coordination outreach Next-best-action | Helen Johnson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018419 | Care coordination outreach Next-best-action | Karen Padilla: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018420 | Care coordination outreach Next-best-action | Santiago Rios: 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.