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-018871 | Care coordination outreach Next-best-action | Betty Daniels: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018872 | Care coordination outreach Next-best-action | Elizabeth Reyes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018873 | Care coordination outreach Next-best-action | Samantha Romero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018874 | Care coordination outreach Next-best-action | Julia McDonald: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018875 | Care coordination outreach Next-best-action | Bruce Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018876 | Care coordination outreach Next-best-action | Christian Woods: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018877 | Care coordination outreach Next-best-action | Jordan Evans: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018878 | Care coordination outreach Next-best-action | Gregory Roberts: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018879 | Care coordination outreach Next-best-action | Ethan Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018880 | Care coordination outreach Next-best-action | Charlotte Wheeler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018881 | Care coordination outreach Next-best-action | Jeffrey Singh: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018882 | Care coordination outreach Next-best-action | Sharon Stone: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018883 | Care coordination outreach Next-best-action | Ryan Howard: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018884 | Care coordination outreach Next-best-action | Judith Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018885 | Care coordination outreach Next-best-action | Dylan King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018886 | Care coordination outreach Next-best-action | Maria Fields: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018887 | Care coordination outreach Next-best-action | Nathan Olson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018888 | Care coordination outreach Next-best-action | Bradley Jones: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018889 | Care coordination outreach Next-best-action | Stephen Watkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018890 | Care coordination outreach Next-best-action | Douglas Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018891 | Care coordination outreach Next-best-action | Kenneth Martinez: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018892 | Care coordination outreach Next-best-action | Omar Stone: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018893 | Care coordination outreach Next-best-action | Cynthia Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018894 | Care coordination outreach Next-best-action | Donna Morris: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018895 | Care coordination outreach Next-best-action | Katherine Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018896 | Care coordination outreach Next-best-action | Santiago Thompson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018897 | Care coordination outreach Next-best-action | Jdy Wells: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018898 | Care coordination outreach Next-best-action | Karen Wagner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018899 | Care coordination outreach Next-best-action | Kimberly Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018900 | Care coordination outreach Next-best-action | Donna Jenkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018901 | Care coordination outreach Next-best-action | Amber Greene: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018902 | Care coordination outreach Next-best-action | Dylan Rivera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018903 | Care coordination outreach Next-best-action | Lawrence Chapman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018904 | Care coordination outreach Next-best-action | Dennis Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018905 | Care coordination outreach Next-best-action | Joyce Reid: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018906 | Care coordination outreach Next-best-action | Amanda Hill: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018907 | Care coordination outreach Next-best-action | Jacqueline Webb: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018908 | Care coordination outreach Next-best-action | Nicholas Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018909 | Care coordination outreach Next-best-action | Steve Guerrero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018910 | Care coordination outreach Next-best-action | Helen Washington: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018911 | Care coordination outreach Next-best-action | Grace Hawkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018912 | Care coordination outreach Next-best-action | Shirley Lopez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018913 | Care coordination outreach Next-best-action | Theresa Henry: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018914 | Care coordination outreach Next-best-action | Luis Dominguez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018915 | Care coordination outreach Next-best-action | Natalie Ferguson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018916 | Care coordination outreach Next-best-action | Joe Green: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018917 | Care coordination outreach Next-best-action | Bryan Grant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018918 | Care coordination outreach Next-best-action | Judith Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018919 | Care coordination outreach Next-best-action | Julia Alexander: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018920 | Care coordination outreach Next-best-action | Karen Welch: 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.