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-018721 | Care coordination outreach Next-best-action | Benjamin Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018722 | Care coordination outreach Next-best-action | Russell Gibson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018723 | Care coordination outreach Next-best-action | Kathryn Knight: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018724 | Care coordination outreach Next-best-action | Paul Russell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018725 | Care coordination outreach Next-best-action | Vincent Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018726 | Care coordination outreach Next-best-action | Gabriel Sanders: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018727 | Care coordination outreach Next-best-action | Carl Coleman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018728 | Care coordination outreach Next-best-action | Kathleen Andrews: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018729 | Care coordination outreach Next-best-action | Catherine Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018730 | Care coordination outreach Next-best-action | Patricia Adams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018731 | Care coordination outreach Next-best-action | Barbara Edwards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018732 | Care coordination outreach Next-best-action | Hiroshi Rogers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018733 | Care coordination outreach Next-best-action | Debra Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018734 | Care coordination outreach Next-best-action | Hannah Roberts: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018735 | Care coordination outreach Next-best-action | Gerald Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018736 | Care coordination outreach Next-best-action | Billy Fisher: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018737 | Care coordination outreach Next-best-action | Stephanie Hamilton: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018738 | Care coordination outreach Next-best-action | Eric Lane: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018739 | Care coordination outreach Next-best-action | Mark Jimenez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018740 | Care coordination outreach Next-best-action | Sharon Davis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018741 | Care coordination outreach Next-best-action | Stephen Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018742 | Care coordination outreach Next-best-action | Joe Ford: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018743 | Care coordination outreach Next-best-action | Mariana Reid: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018744 | Care coordination outreach Next-best-action | Nancy Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018745 | Care coordination outreach Next-best-action | Cheryl Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018746 | Care coordination outreach Next-best-action | Lauren Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018747 | Care coordination outreach Next-best-action | Randy Edwards: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018748 | Care coordination outreach Next-best-action | Jason Meyer: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018749 | Care coordination outreach Next-best-action | Patricia Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018750 | Care coordination outreach Next-best-action | Kathleen Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018751 | Care coordination outreach Next-best-action | Benjamin Contreras: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018752 | Care coordination outreach Next-best-action | Gary Fields: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018753 | Care coordination outreach Next-best-action | Ronald Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018754 | Care coordination outreach Next-best-action | Victoria Knight: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018755 | Care coordination outreach Next-best-action | Arthur Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018756 | Care coordination outreach Next-best-action | Nathan Tran: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018757 | Care coordination outreach Next-best-action | Walter Harris: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018758 | Care coordination outreach Next-best-action | Judy Martin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018759 | Care coordination outreach Next-best-action | Wei Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018760 | Care coordination outreach Next-best-action | Luis Greene: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018761 | Care coordination outreach Next-best-action | Terry Gomez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018762 | Care coordination outreach Next-best-action | Alan Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018763 | Care coordination outreach Next-best-action | Jerry Hughes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018764 | Care coordination outreach Next-best-action | Sean Watkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018765 | Care coordination outreach Next-best-action | Susan Morris: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018766 | Care coordination outreach Next-best-action | Bryan Scott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018767 | Care coordination outreach Next-best-action | Mason Santiago: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018768 | Care coordination outreach Next-best-action | Willie Medina: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018769 | Care coordination outreach Next-best-action | Kathleen Carter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018770 | Care coordination outreach Next-best-action | Daniel Elliott: 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.