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-019071 | Care coordination outreach Next-best-action | Amy Butler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019072 | Care coordination outreach Next-best-action | Joyce Williams: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019073 | Care coordination outreach Next-best-action | Luis Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019074 | Care coordination outreach Next-best-action | Debra Cox: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019075 | Care coordination outreach Next-best-action | Frank Padilla: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019076 | Care coordination outreach Next-best-action | Priya Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019077 | Care coordination outreach Next-best-action | Paul Bryant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019078 | Care coordination outreach Next-best-action | Andrew Hicks: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019079 | Care coordination outreach Next-best-action | Mateo Chapman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019080 | Care coordination outreach Next-best-action | Amy Castro: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019081 | Care coordination outreach Next-best-action | Hiroshi Ortega: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019082 | Care coordination outreach Next-best-action | Jessica Gordon: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019083 | Care coordination outreach Next-best-action | Diego Johnston: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019084 | Care coordination outreach Next-best-action | Denise King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019085 | Care coordination outreach Next-best-action | Douglas Edwards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019086 | Care coordination outreach Next-best-action | Jessica Wang: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019087 | Care coordination outreach Next-best-action | Anthony Rios: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019088 | Care coordination outreach Next-best-action | Mariana Gardner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019089 | Care coordination outreach Next-best-action | Megan Richardson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019090 | Care coordination outreach Next-best-action | Nicole Le: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019091 | Care coordination outreach Next-best-action | Elijah Owens: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019092 | Care coordination outreach Next-best-action | Beverly Padilla: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019093 | Care coordination outreach Next-best-action | Wayne Harper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019094 | Care coordination outreach Next-best-action | David Ryan: 6 claims, no attributed provider |
| Proposed | — | ||
| ACT-019095 | Care coordination outreach Next-best-action | Eric Watson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019096 | Care coordination outreach Next-best-action | Doris Dunn: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019097 | Care coordination outreach Next-best-action | Ethan Wood: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019098 | Care coordination outreach Next-best-action | Marilyn George: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019099 | Care coordination outreach Next-best-action | Robert Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019100 | Care coordination outreach Next-best-action | Rachel Richardson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019101 | Care coordination outreach Next-best-action | David Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019102 | Care coordination outreach Next-best-action | Scott Clark: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019103 | Care coordination outreach Next-best-action | Patrick Le: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019104 | Care coordination outreach Next-best-action | Noah Ortiz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019105 | Care coordination outreach Next-best-action | Rebecca Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019106 | Care coordination outreach Next-best-action | Joyce Carlson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019107 | Care coordination outreach Next-best-action | Ralph Sullivan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019108 | Care coordination outreach Next-best-action | Frank Weber: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019109 | Care coordination outreach Next-best-action | Stephen Lawson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019110 | Care coordination outreach Next-best-action | Steven Brooks: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019111 | Care coordination outreach Next-best-action | Gerald Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019112 | Care coordination outreach Next-best-action | Marcus Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019113 | Care coordination outreach Next-best-action | Judy Powell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019114 | Care coordination outreach Next-best-action | Carlos Wood: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019115 | Care coordination outreach Next-best-action | Jacob Grant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019116 | Care coordination outreach Next-best-action | Sara Reyes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019117 | Care coordination outreach Next-best-action | Virginia Ross: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019118 | Care coordination outreach Next-best-action | Dylan Bowman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019119 | Care coordination outreach Next-best-action | Jacob Holmes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019120 | Care coordination outreach Next-best-action | Amanda McDonald: 4 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.