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
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-013445 | Outreach suppressed pending steward Outreach | CLM-402482 (Jackie Reyes) held until CASE-000001 is decided |
| Held | — | ||
| ACT-013446 | Outreach suppressed pending steward Outreach | TPA-51738 (Ethan Rios) held until CASE-000002 is decided |
| Held | — | ||
| ACT-013447 | Outreach suppressed pending steward Outreach | CLM-430743 (Larry Hansen) held until CASE-000003 is decided |
| Held | — | ||
| ACT-013448 | Outreach suppressed pending steward Outreach | TPA-60827 (Keith Varggas) held until CASE-000004 is decided |
| Held | — | ||
| ACT-013449 | Outreach suppressed pending steward Outreach | TPA-56717 (Kim Marquez) held until CASE-000005 is decided |
| Held | — | ||
| ACT-013450 | Outreach suppressed pending steward Outreach | CLM-406008 (Christine Knight) held until CASE-000006 is decided |
| Held | — | ||
| ACT-013451 | Outreach suppressed pending steward Outreach | ENR-101256 (Cristian Knight) held until CASE-000007 is decided |
| Held | — | ||
| ACT-013452 | Outreach suppressed pending steward Outreach | CLM-418429 (Diego Snyder) held until CASE-000008 is decided |
| Held | — | ||
| ACT-013453 | Outreach suppressed pending steward Outreach | CLM-427068 (Sean Gordon) held until CASE-000009 is decided |
| Held | — | ||
| ACT-013454 | Outreach suppressed pending steward Outreach | CLM-406583 (Nancy Wright) held until CASE-000010 is decided |
| Held | — | ||
| ACT-013455 | Outreach suppressed pending steward Outreach | CLM-403782 (Heather Walsh) held until CASE-000011 is decided |
| Held | — | ||
| ACT-013456 | Outreach suppressed pending steward Outreach | ENR-140230 (Julie Miller) held until CASE-000012 is decided |
| Held | — | ||
| ACT-013457 | Outreach suppressed pending steward Outreach | PRV-28967 (Julie Miller) held until CASE-000013 is decided |
| Held | — | ||
| ACT-013458 | Outreach suppressed pending steward Outreach | PRV-22634 (Kathryn Bailey) held until CASE-000014 is decided |
| Held | — | ||
| ACT-013459 | Outreach suppressed pending steward Outreach | ENR-122342 (Tyler Bell) held until CASE-000015 is decided |
| Held | — | ||
| ACT-013460 | Outreach suppressed pending steward Outreach | TPA-57098 (Jeremy Williamson) held until CASE-000016 is decided |
| Held | — | ||
| ACT-013461 | Outreach suppressed pending steward Outreach | PRV-28485 (Arthur Johnson) held until CASE-000017 is decided |
| Held | — | ||
| ACT-013462 | Outreach suppressed pending steward Outreach | TPA-64406 (Richard Perry) held until CASE-000018 is decided |
| Held | — | ||
| ACT-013463 | Outreach suppressed pending steward Outreach | TPA-64407 (Richard Perry) held until CASE-000019 is decided |
| Held | — | ||
| ACT-013464 | Outreach suppressed pending steward Outreach | ENR-141702 (Brian Rogers) held until CASE-000020 is decided |
| Held | — | ||
| ACT-013465 | Outreach suppressed pending steward Outreach | PRV-29290 (Brian Rogers) held until CASE-000021 is decided |
| Held | — | ||
| ACT-013466 | Outreach suppressed pending steward Outreach | TPA-61792 (Kelly Richardson) held until CASE-000022 is decided |
| Held | — | ||
| ACT-013467 | Outreach suppressed pending steward Outreach | ENR-135020 (Kelly Richardson) held until CASE-000023 is decided |
| Held | — | ||
| ACT-013468 | Outreach suppressed pending steward Outreach | PRV-28673 (Albert Richardson) held until CASE-000024 is decided |
| Held | — | ||
| ACT-013469 | Outreach suppressed pending steward Outreach | TPA-63091 (Albert Richardson) held until CASE-000025 is decided |
| Held | — | ||
| ACT-013470 | Outreach suppressed pending steward Outreach | ENR-107861 (Adam Riley) held until CASE-000026 is decided |
| Held | — | ||
| ACT-013471 | Outreach suppressed pending steward Outreach | CLM-405967 (Adam Riley) held until CASE-000027 is decided |
| Held | — | ||
| ACT-013472 | Outreach suppressed pending steward Outreach | CLM-430009 (Tyler Moreno) held until CASE-000028 is decided |
| Held | — | ||
| ACT-013473 | Outreach suppressed pending steward Outreach | CLM-428337 (Frances Hunter) held until CASE-000029 is decided |
| Held | — | ||
| ACT-013474 | Outreach suppressed pending steward Outreach | TPA-62514 (Frances Hunter) held until CASE-000030 is decided |
| Held | — | ||
| ACT-013475 | Outreach suppressed pending steward Outreach | CLM-429375 (Mason Walsh) held until CASE-000031 is decided |
| Held | — | ||
| ACT-013476 | Outreach suppressed pending steward Outreach | CLM-430591 (Frank Willis) held until CASE-000032 is decided |
| Held | — | ||
| ACT-013477 | Outreach suppressed pending steward Outreach | TPA-63509 (Frank Willis) held until CASE-000033 is decided |
| Held | — | ||
| ACT-013478 | Outreach suppressed pending steward Outreach | CLM-413208 (Matthew Burke) held until CASE-000034 is decided |
| Held | — | ||
| ACT-013479 | Outreach suppressed pending steward Outreach | ENR-115466 (William Brooks) held until CASE-000035 is decided |
| Held | — | ||
| ACT-013480 | Outreach suppressed pending steward Outreach | ENR-112951 (Jose Jackson) held until CASE-000036 is decided |
| Held | — | ||
| ACT-013481 | Outreach suppressed pending steward Outreach | ENR-126848 (Alexander Jackson) held until CASE-000037 is decided |
| Held | — | ||
| ACT-013482 | Outreach suppressed pending steward Outreach | CLM-422333 (Andrew Jackson) held until CASE-000038 is decided |
| Held | — | ||
| ACT-013483 | Outreach suppressed pending steward Outreach | PRV-25896 (Sandra Lawis) held until CASE-000039 is decided |
| Held | — | ||
| ACT-013484 | Outreach suppressed pending steward Outreach | TPA-59395 (Cynthia Baker) held until CASE-000040 is decided |
| Held | — | ||
| ACT-013485 | Outreach suppressed pending steward Outreach | TPA-59396 (Cyntiha Baker) held until CASE-000041 is decided |
| Held | — | ||
| ACT-013486 | Outreach suppressed pending steward Outreach | ENR-128007 (Cynthia Baker) held until CASE-000042 is decided |
| Held | — | ||
| ACT-013487 | Outreach suppressed pending steward Outreach | ENR-130444 (Christine Robinnson) held until CASE-000043 is decided |
| Held | — | ||
| ACT-013488 | Outreach suppressed pending steward Outreach | PRV-26873 (Christine Robinson) held until CASE-000044 is decided |
| Held | — | ||
| ACT-013489 | Outreach suppressed pending steward Outreach | TPA-57030 (Nancy Freeman) held until CASE-000045 is decided |
| Held | — | ||
| ACT-013490 | Outreach suppressed pending steward Outreach | TPA-51230 (Michael Fernandez) held until CASE-000046 is decided |
| Held | — | ||
| ACT-013491 | Outreach suppressed pending steward Outreach | ENR-103705 (Michael Fernandez) held until CASE-000047 is decided |
| Held | — | ||
| ACT-013492 | Outreach suppressed pending steward Outreach | ENR-100604 (Austin Fernandez) held until CASE-000048 is decided |
| Held | — | ||
| ACT-013493 | Outreach suppressed pending steward Outreach | TPA-56952 (Doris Meyer) held until CASE-000049 is decided |
| Held | — | ||
| ACT-013494 | Outreach suppressed pending steward Outreach | ENR-112895 (Russell Price) held until CASE-000050 is decided |
| Held | — |
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.