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-018521 | Care coordination outreach Next-best-action | Raymond Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018522 | Care coordination outreach Next-best-action | Diane Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018523 | Care coordination outreach Next-best-action | Donna Perez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018524 | Care coordination outreach Next-best-action | Daniel Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018525 | Care coordination outreach Next-best-action | Brandon Torres: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018526 | Care coordination outreach Next-best-action | Larry Arnold: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018527 | Care coordination outreach Next-best-action | Sandra Hansen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018528 | Care coordination outreach Next-best-action | Keneth Schultz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018529 | Care coordination outreach Next-best-action | Kayla Lee: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018530 | Care coordination outreach Next-best-action | Danielle Martinez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018531 | Care coordination outreach Next-best-action | Sofia Kelley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018532 | Care coordination outreach Next-best-action | Julia Jackson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018533 | Care coordination outreach Next-best-action | Rachel Munoz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018534 | Care coordination outreach Next-best-action | Charles Hunter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018535 | Care coordination outreach Next-best-action | Rebecca Mitchell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018536 | Care coordination outreach Next-best-action | Michael Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018537 | Care coordination outreach Next-best-action | Linda Wood: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018538 | Care coordination outreach Next-best-action | Raymond Kim: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018539 | Care coordination outreach Next-best-action | Austin Franklin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018540 | Care coordination outreach Next-best-action | Eugene Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018541 | Care coordination outreach Next-best-action | Jacob Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018542 | Care coordination outreach Next-best-action | Tyler Weber: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018543 | Care coordination outreach Next-best-action | Christopher Young: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018544 | Care coordination outreach Next-best-action | Peter Walker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018545 | Care coordination outreach Next-best-action | Eric Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018546 | Care coordination outreach Next-best-action | Barbara Cox: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018547 | Care coordination outreach Next-best-action | Camila Hart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018548 | Care coordination outreach Next-best-action | Yuki Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018549 | Care coordination outreach Next-best-action | Joan Bennett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018550 | Care coordination outreach Next-best-action | Emma Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018551 | Care coordination outreach Next-best-action | Jonathan Brooks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018552 | Care coordination outreach Next-best-action | Nancy Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018553 | Care coordination outreach Next-best-action | Omar Ferguson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018554 | Care coordination outreach Next-best-action | Margaret Stone: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018555 | Care coordination outreach Next-best-action | Ronald Alvarado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018556 | Care coordination outreach Next-best-action | Jonathan Carlson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018557 | Care coordination outreach Next-best-action | John Hughes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018558 | Care coordination outreach Next-best-action | Dylan Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018559 | Care coordination outreach Next-best-action | Samuel Russell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018560 | Care coordination outreach Next-best-action | Victoria Schmidt: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018561 | Care coordination outreach Next-best-action | Deborah Henderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018562 | Care coordination outreach Next-best-action | Arthur Myers: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018563 | Care coordination outreach Next-best-action | Evelyn Williams: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018564 | Care coordination outreach Next-best-action | Donald Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018565 | Care coordination outreach Next-best-action | Nancy Munoz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018566 | Care coordination outreach Next-best-action | Frances Grant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018567 | Care coordination outreach Next-best-action | Douglas Nunez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018568 | Care coordination outreach Next-best-action | Michael Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018569 | Care coordination outreach Next-best-action | Maria Carlson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018570 | Care coordination outreach Next-best-action | Susan Alvarez: 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.