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-018571 | Care coordination outreach Next-best-action | Jonathan Kelly: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018572 | Care coordination outreach Next-best-action | Donald Fowler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018573 | Care coordination outreach Next-best-action | Theresa Ruiz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018574 | Care coordination outreach Next-best-action | Elizabeth Baker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018575 | Care coordination outreach Next-best-action | Julia Lucas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018576 | Care coordination outreach Next-best-action | Billy Anderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018577 | Care coordination outreach Next-best-action | Janice Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018578 | Care coordination outreach Next-best-action | James Rodriguez: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018579 | Care coordination outreach Next-best-action | Victoria Peterson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018580 | Care coordination outreach Next-best-action | Joshua Jenkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018581 | Care coordination outreach Next-best-action | Philip Watson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018582 | Care coordination outreach Next-best-action | Lisa Castro: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018583 | Care coordination outreach Next-best-action | Vincent Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018584 | Care coordination outreach Next-best-action | Andrew Foster: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018585 | Care coordination outreach Next-best-action | Eric Sullivan: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018586 | Care coordination outreach Next-best-action | Betty Rojas: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018587 | Care coordination outreach Next-best-action | Randy Austin: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018588 | Care coordination outreach Next-best-action | Sara Willis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018589 | Care coordination outreach Next-best-action | Isabella Gomez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018590 | Care coordination outreach Next-best-action | Kevin Nelson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018591 | Care coordination outreach Next-best-action | Nancy Marshall: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018592 | Care coordination outreach Next-best-action | Janet Brown: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018593 | Care coordination outreach Next-best-action | Marilyn Bradley: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018594 | Care coordination outreach Next-best-action | Steven Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018595 | Care coordination outreach Next-best-action | Brenda Stephens: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018596 | Care coordination outreach Next-best-action | Brenda Green: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018597 | Care coordination outreach Next-best-action | Theresa Parker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018598 | Care coordination outreach Next-best-action | Abigail Armstrong: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018599 | Care coordination outreach Next-best-action | Gloria Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018600 | Care coordination outreach Next-best-action | Rachel Walker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018601 | Care coordination outreach Next-best-action | Emily Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018602 | Care coordination outreach Next-best-action | Kyle Delgado: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018603 | Care coordination outreach Next-best-action | Jennifer Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018604 | Care coordination outreach Next-best-action | Roger Gordon: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018605 | Care coordination outreach Next-best-action | Nancy Carr: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018606 | Care coordination outreach Next-best-action | Abigail Hicks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018607 | Care coordination outreach Next-best-action | Roger Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018608 | Care coordination outreach Next-best-action | Jacob Patterson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018609 | Care coordination outreach Next-best-action | Brenda Tran: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018610 | Care coordination outreach Next-best-action | Megan Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018611 | Care coordination outreach Next-best-action | Tyler Moore: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018612 | Care coordination outreach Next-best-action | Stephen Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018613 | Care coordination outreach Next-best-action | Christina Singh: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018614 | Care coordination outreach Next-best-action | Jacqueline Williams: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018615 | Care coordination outreach Next-best-action | Cynthia Green: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018616 | Care coordination outreach Next-best-action | Walter Reyes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018617 | Care coordination outreach Next-best-action | Ralph Howell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018618 | Care coordination outreach Next-best-action | Alice Robinson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018619 | Care coordination outreach Next-best-action | Abby Vazquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018620 | Care coordination outreach Next-best-action | Richard Hansen: 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.