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-019171 | Care coordination outreach Next-best-action | Kelly Jensen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019172 | Care coordination outreach Next-best-action | Julie Garrett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019173 | Care coordination outreach Next-best-action | Douglas Pierce: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019174 | Care coordination outreach Next-best-action | Alexander Marquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019175 | Care coordination outreach Next-best-action | Sandra Brown: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019176 | Care coordination outreach Next-best-action | Alexis Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019177 | Care coordination outreach Next-best-action | Evelyn Wilson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019178 | Care coordination outreach Next-best-action | Wei Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019179 | Care coordination outreach Next-best-action | Evelyn Brooks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019180 | Care coordination outreach Next-best-action | Judy Wells: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019181 | Care coordination outreach Next-best-action | Joshua Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019182 | Care coordination outreach Next-best-action | Maria Stewart: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019183 | Care coordination outreach Next-best-action | Doris Bradley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019184 | Care coordination outreach Next-best-action | Kimberly Robinson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019185 | Care coordination outreach Next-best-action | Tyler Taylor: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019186 | Care coordination outreach Next-best-action | Madison McCoy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019187 | Care coordination outreach Next-best-action | Jerry Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019188 | Care coordination outreach Next-best-action | Eugene Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019189 | Care coordination outreach Next-best-action | David Hansen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019190 | Care coordination outreach Next-best-action | Diego Bishop: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019191 | Care coordination outreach Next-best-action | Fatima Thomas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019192 | Care coordination outreach Next-best-action | Maria Jenkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019193 | Care coordination outreach Next-best-action | Sarah Mitchell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019194 | Care coordination outreach Next-best-action | Charlotte Weber: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019195 | Care coordination outreach Next-best-action | Peter Baker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019196 | Care coordination outreach Next-best-action | Dennis Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019197 | Care coordination outreach Next-best-action | Albert Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019198 | Care coordination outreach Next-best-action | Gary Kelly: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019199 | Care coordination outreach Next-best-action | Kenneth Ray: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019200 | Care coordination outreach Next-best-action | Jackie Diaz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019201 | Care coordination outreach Next-best-action | Douglas Lewis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019202 | Care coordination outreach Next-best-action | Martha Rogers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019203 | Care coordination outreach Next-best-action | Noah Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019204 | Care coordination outreach Next-best-action | Olivia Peterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019205 | Care coordination outreach Next-best-action | Thomas Campbell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019206 | Care coordination outreach Next-best-action | Douglas Jensen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019207 | Care coordination outreach Next-best-action | Donald Luna: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019208 | Care coordination outreach Next-best-action | Isabella Vargas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019209 | Care coordination outreach Next-best-action | Doris Ryan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019210 | Care coordination outreach Next-best-action | Maria Snyder: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019211 | Care coordination outreach Next-best-action | Timothy Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019212 | Care coordination outreach Next-best-action | Isabella Walsh: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019213 | Care coordination outreach Next-best-action | Heather Singh: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019214 | Care coordination outreach Next-best-action | Mason Garcia: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019215 | Care coordination outreach Next-best-action | Isabella Bowman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019216 | Care coordination outreach Next-best-action | Danielle Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019217 | Care coordination outreach Next-best-action | Santiago Peterson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019218 | Care coordination outreach Next-best-action | Jack Jack: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019219 | Care coordination outreach Next-best-action | Amanda Campbell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019220 | Care coordination outreach Next-best-action | Jerry Romero: 5 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.