Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Actions

26,640 derived from the last resolution run

ActionTypeTitleDetailLinked toStatusExecuted
ACT-019471
Care coordination outreach
Next-best-action
Bradley Armstrong: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019472
Care coordination outreach
Next-best-action
Amber Riley: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019473
Care coordination outreach
Next-best-action
Grace Burton: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019474
Care coordination outreach
Next-best-action
Chris Baker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019475
Care coordination outreach
Next-best-action
Lori Fowler: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019476
Care coordination outreach
Next-best-action
Philip Willis: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019477
Care coordination outreach
Next-best-action
Mariana Reynolds: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019478
Care coordination outreach
Next-best-action
Patrick Lawrence: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019479
Care coordination outreach
Next-best-action
Patrick Spencer: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019480
Care coordination outreach
Next-best-action
Kelly Tucker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019481
Care coordination outreach
Next-best-action
Adam Young: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019482
Care coordination outreach
Next-best-action
Arjun Cruz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019483
Care coordination outreach
Next-best-action
Yuki Ortega: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019484
Care coordination outreach
Next-best-action
Denise Davis: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019485
Care coordination outreach
Next-best-action
Wayne Castillo: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019486
Care coordination outreach
Next-best-action
Barbara Burton: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019487
Care coordination outreach
Next-best-action
Mateo Jackson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019488
Care coordination outreach
Next-best-action
Mary Mason: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019489
Care coordination outreach
Next-best-action
Katherine Ross: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019490
Care coordination outreach
Next-best-action
Gabriel Burns: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019491
Care coordination outreach
Next-best-action
Eric Gonzales: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019492
Care coordination outreach
Next-best-action
Amanda Li: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019493
Care coordination outreach
Next-best-action
Charles Gonzalez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019494
Care coordination outreach
Next-best-action
George Jensen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019495
Care coordination outreach
Next-best-action
Diana Mills: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019496
Care coordination outreach
Next-best-action
Andrew Fernandez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019497
Care coordination outreach
Next-best-action
Teresa Lawrence: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019498
Care coordination outreach
Next-best-action
Grace Alexander: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019499
Care coordination outreach
Next-best-action
Linda Obrien: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019500
Care coordination outreach
Next-best-action
Heather Lopez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019501
Care coordination outreach
Next-best-action
Diane Mendez: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019502
Care coordination outreach
Next-best-action
Nicole Evans: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019503
Care coordination outreach
Next-best-action
Priya Williams: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019504
Care coordination outreach
Next-best-action
Ahmed Jordan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019505
Care coordination outreach
Next-best-action
Jack Fowler: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019506
Care coordination outreach
Next-best-action
Angela Nelson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019507
Care coordination outreach
Next-best-action
Bradley Lane: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019508
Care coordination outreach
Next-best-action
Robert Perkins: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019509
Care coordination outreach
Next-best-action
Dennis Hunt: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019510
Care coordination outreach
Next-best-action
Teresa Sims: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019511
Care coordination outreach
Next-best-action
Doris Armstrong: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019512
Care coordination outreach
Next-best-action
Sara Andrews: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019513
Care coordination outreach
Next-best-action
Linda Reid: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019514
Care coordination outreach
Next-best-action
Richard Washington: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019515
Care coordination outreach
Next-best-action
Betsy Perez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019516
Care coordination outreach
Next-best-action
Shirley Rojas: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019517
Care coordination outreach
Next-best-action
Mark Arnold: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019518
Care coordination outreach
Next-best-action
Ashley Pena: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019519
Care coordination outreach
Next-best-action
Daniel Holmes: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019520
Care coordination outreach
Next-best-action
James Ortiz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
3,896 rows, page 35 of 78PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A 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.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.