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-018421
Care coordination outreach
Next-best-action
Megan Kim: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018422
Care coordination outreach
Next-best-action
Donna Moore: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018423
Care coordination outreach
Next-best-action
Terry Edwards: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018424
Care coordination outreach
Next-best-action
James Banks: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018425
Care coordination outreach
Next-best-action
Henry Espinoza: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018426
Care coordination outreach
Next-best-action
Andrew Dean: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018427
Care coordination outreach
Next-best-action
Karen Montgomery: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018428
Care coordination outreach
Next-best-action
Joshua Armstrong: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018429
Care coordination outreach
Next-best-action
Madison Franklin: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018430
Care coordination outreach
Next-best-action
Jonathan Vega: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018431
Care coordination outreach
Next-best-action
Elijah Jensen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018432
Care coordination outreach
Next-best-action
Natalie Elliott: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018433
Care coordination outreach
Next-best-action
Donald Simpson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018434
Care coordination outreach
Next-best-action
Maria Hoffman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018435
Care coordination outreach
Next-best-action
Amber Reed: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018436
Care coordination outreach
Next-best-action
Vincent Delgado: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018437
Care coordination outreach
Next-best-action
Catherine Hart: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018438
Care coordination outreach
Next-best-action
Nancy Vazquez: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018439
Care coordination outreach
Next-best-action
Carlos Campbell: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018440
Care coordination outreach
Next-best-action
Ruth Owens: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018441
Care coordination outreach
Next-best-action
Keith Ortiz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018442
Care coordination outreach
Next-best-action
Ann Ferguson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018443
Care coordination outreach
Next-best-action
Brandon Bennett: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018444
Care coordination outreach
Next-best-action
Zachary Carlson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018445
Care coordination outreach
Next-best-action
Patrick Sanders: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018446
Care coordination outreach
Next-best-action
Christian Henry: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018447
Care coordination outreach
Next-best-action
Susan Matthews: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018448
Care coordination outreach
Next-best-action
Douglas Banks: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018449
Care coordination outreach
Next-best-action
Adam Henry: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018450
Care coordination outreach
Next-best-action
Hiroshi Lewis: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018451
Care coordination outreach
Next-best-action
Donna Hoffman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018452
Care coordination outreach
Next-best-action
Amy Morris: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018453
Care coordination outreach
Next-best-action
Arthur Little: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018454
Care coordination outreach
Next-best-action
Kimberly Jordan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018455
Care coordination outreach
Next-best-action
Patrick Patel: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018456
Care coordination outreach
Next-best-action
Alan Sanchez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018457
Care coordination outreach
Next-best-action
George Reynolds: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018458
Care coordination outreach
Next-best-action
Anthony Weaver: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018459
Care coordination outreach
Next-best-action
Ralph Lewis: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018460
Care coordination outreach
Next-best-action
Mason Hamilton: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018461
Care coordination outreach
Next-best-action
Christian Meyer: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018462
Care coordination outreach
Next-best-action
Arjun White: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018463
Care coordination outreach
Next-best-action
Kathryn Carlson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018464
Care coordination outreach
Next-best-action
Mary Torres: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018465
Care coordination outreach
Next-best-action
Frank Armstrong: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018466
Care coordination outreach
Next-best-action
Joan Edwards: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018467
Care coordination outreach
Next-best-action
Alice Porter: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018468
Care coordination outreach
Next-best-action
Alice Singh: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018469
Care coordination outreach
Next-best-action
Rachel Coleman: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-018470
Care coordination outreach
Next-best-action
Jeffrey Green: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
3,896 rows, page 14 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.