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-019021 | Care coordination outreach Next-best-action | Andrew Little: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019022 | Care coordination outreach Next-best-action | Mariana Nguyen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019023 | Care coordination outreach Next-best-action | Peter Patterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019024 | Care coordination outreach Next-best-action | Kimberly Bell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019025 | Care coordination outreach Next-best-action | Priya Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019026 | Care coordination outreach Next-best-action | Judy Robinson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019027 | Care coordination outreach Next-best-action | Andrea Anderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019028 | Care coordination outreach Next-best-action | Diego Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019029 | Care coordination outreach Next-best-action | Logan Davis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019030 | Care coordination outreach Next-best-action | Karen Thomas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019031 | Care coordination outreach Next-best-action | Stephen Gibson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019032 | Care coordination outreach Next-best-action | Ana Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019033 | Care coordination outreach Next-best-action | Judy Williams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019034 | Care coordination outreach Next-best-action | Ryan Mendez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019035 | Care coordination outreach Next-best-action | Nancy Delgado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019036 | Care coordination outreach Next-best-action | Judy Watkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019037 | Care coordination outreach Next-best-action | Alice Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019038 | Care coordination outreach Next-best-action | Lori Campbell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019039 | Care coordination outreach Next-best-action | Sofia Wallace: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019040 | Care coordination outreach Next-best-action | Alexander Thompson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019041 | Care coordination outreach Next-best-action | Evelyn Nguyen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019042 | Care coordination outreach Next-best-action | Carolyn King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019043 | Care coordination outreach Next-best-action | Gloria Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019044 | Care coordination outreach Next-best-action | Kathryn Holmes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019045 | Care coordination outreach Next-best-action | Sharon Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019046 | Care coordination outreach Next-best-action | Scott Bryant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019047 | Care coordination outreach Next-best-action | Noah Cooper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019048 | Care coordination outreach Next-best-action | Mei Vega: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019049 | Care coordination outreach Next-best-action | Juan Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019050 | Care coordination outreach Next-best-action | Juan Williams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019051 | Care coordination outreach Next-best-action | Catherine Simpson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019052 | Care coordination outreach Next-best-action | Lucia Holmes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019053 | Care coordination outreach Next-best-action | John Burke: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019054 | Care coordination outreach Next-best-action | Kelly Ellis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019055 | Care coordination outreach Next-best-action | Joe Matthews: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019056 | Care coordination outreach Next-best-action | Christina Castro: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019057 | Care coordination outreach Next-best-action | Maria Palmer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019058 | Care coordination outreach Next-best-action | Margaret Chavez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019059 | Care coordination outreach Next-best-action | Evelyn Hawkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019060 | Care coordination outreach Next-best-action | Heather Porter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019061 | Care coordination outreach Next-best-action | Thomas Matthews: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019062 | Care coordination outreach Next-best-action | Christina Harrison: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019063 | Care coordination outreach Next-best-action | Peter Hart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019064 | Care coordination outreach Next-best-action | Teresa Dixon: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019065 | Care coordination outreach Next-best-action | Wei Garza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019066 | Care coordination outreach Next-best-action | Philip Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019067 | Care coordination outreach Next-best-action | Randy Dixon: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019068 | Care coordination outreach Next-best-action | Samantha Morris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019069 | Care coordination outreach Next-best-action | Keith Thompson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019070 | Care coordination outreach Next-best-action | Arthur Torres: 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.