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