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-018671 | Care coordination outreach Next-best-action | Olivia Sanchez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018672 | Care coordination outreach Next-best-action | Jacqueline Hansen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018673 | Care coordination outreach Next-best-action | Emma Ortiz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018674 | Care coordination outreach Next-best-action | William Contreras: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018675 | Care coordination outreach Next-best-action | Carl Cole: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018676 | Care coordination outreach Next-best-action | Olivia Espinoza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018677 | Care coordination outreach Next-best-action | Virginia Hoffman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018678 | Care coordination outreach Next-best-action | Kayla Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018679 | Care coordination outreach Next-best-action | Shirley Alvarez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018680 | Care coordination outreach Next-best-action | Carolyn Jackson: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018681 | Care coordination outreach Next-best-action | Debra Aguilar: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018682 | Care coordination outreach Next-best-action | Walter Flores: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018683 | Care coordination outreach Next-best-action | Joshua Burke: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018684 | Care coordination outreach Next-best-action | Arthur Guzman: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018685 | Care coordination outreach Next-best-action | Jerry Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018686 | Care coordination outreach Next-best-action | Ruth Mills: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018687 | Care coordination outreach Next-best-action | Patrick Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018688 | Care coordination outreach Next-best-action | Evelyn Gray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018689 | Care coordination outreach Next-best-action | Stephen Murray: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018690 | Care coordination outreach Next-best-action | Doris Ford: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018691 | Care coordination outreach Next-best-action | Elijah Boyd: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018692 | Care coordination outreach Next-best-action | Jose Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018693 | Care coordination outreach Next-best-action | Jeffrey Richardson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018694 | Care coordination outreach Next-best-action | Mei Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018695 | Care coordination outreach Next-best-action | Teresa Hayes: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018696 | Care coordination outreach Next-best-action | Carlos Payne: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018697 | Care coordination outreach Next-best-action | Russell Holmes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018698 | Care coordination outreach Next-best-action | Yuki Vazquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018699 | Care coordination outreach Next-best-action | Jonathan Ortega: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018700 | Care coordination outreach Next-best-action | Hannah Bell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018701 | Care coordination outreach Next-best-action | Austin Harvey: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018702 | Care coordination outreach Next-best-action | Julie Simmons: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018703 | Care coordination outreach Next-best-action | George Boyd: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018704 | Care coordination outreach Next-best-action | Mark Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018705 | Care coordination outreach Next-best-action | Gabriel McDonald: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018706 | Care coordination outreach Next-best-action | Ralph Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018707 | Care coordination outreach Next-best-action | Wayne Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018708 | Care coordination outreach Next-best-action | Judith Schultz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018709 | Care coordination outreach Next-best-action | Maria Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018710 | Care coordination outreach Next-best-action | Willie Wang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018711 | Care coordination outreach Next-best-action | Tyler Reed: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018712 | Care coordination outreach Next-best-action | Benjamin Thompson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018713 | Care coordination outreach Next-best-action | Jesse Bennett: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018714 | Care coordination outreach Next-best-action | Elijah Williams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018715 | Care coordination outreach Next-best-action | Donna Myers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018716 | Care coordination outreach Next-best-action | Scott Rogers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018717 | Care coordination outreach Next-best-action | Diego Nguyen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018718 | Care coordination outreach Next-best-action | Jordan Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018719 | Care coordination outreach Next-best-action | Kimberly Crawford: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018720 | Care coordination outreach Next-best-action | Amanda Singh: 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.