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-015402 | Outreach suppressed pending steward Outreach | CLM-412246 (Doris Mills) held until CASE-001958 is decided |
| Held | — | ||
| ACT-015403 | Outreach suppressed pending steward Outreach | TPA-55393 (Doris Mills) held until CASE-001959 is decided |
| Held | — | ||
| ACT-015404 | Outreach suppressed pending steward Outreach | CLM-429820 (Mateo Chen) held until CASE-001960 is decided |
| Held | — | ||
| ACT-015405 | Outreach suppressed pending steward Outreach | ENR-139105 (Mateo Chen) held until CASE-001961 is decided |
| Held | — | ||
| ACT-015406 | Outreach suppressed pending steward Outreach | CLM-418875 (Sofia Garrett) held until CASE-001962 is decided |
| Held | — | ||
| ACT-015407 | Outreach suppressed pending steward Outreach | TPA-58259 (Cynthia Yang) held until CASE-001963 is decided |
| Held | — | ||
| ACT-015408 | Outreach suppressed pending steward Outreach | CLM-418684 (Cynthia Yang) held until CASE-001964 is decided |
| Held | — | ||
| ACT-015409 | Outreach suppressed pending steward Outreach | PRV-26182 (Elijah Phillpis) held until CASE-001965 is decided |
| Held | — | ||
| ACT-015410 | Outreach suppressed pending steward Outreach | CLM-417696 (Denise Watkins) held until CASE-001966 is decided |
| Held | — | ||
| ACT-015411 | Outreach suppressed pending steward Outreach | TPA-57813 (Denise Watkins) held until CASE-001967 is decided |
| Held | — | ||
| ACT-015412 | Outreach suppressed pending steward Outreach | CLM-407570 (Ahmed Sanders) held until CASE-001968 is decided |
| Held | — | ||
| ACT-015413 | Outreach suppressed pending steward Outreach | CLM-407569 (Ahmed Sanders) held until CASE-001969 is decided |
| Held | — | ||
| ACT-015414 | Outreach suppressed pending steward Outreach | TPA-53319 (Ahmed Sanders) held until CASE-001970 is decided |
| Held | — | ||
| ACT-015415 | Outreach suppressed pending steward Outreach | TPA-53090 (Jennifer Hawkins) held until CASE-001971 is decided |
| Held | — | ||
| ACT-015416 | Outreach suppressed pending steward Outreach | CLM-407809 (Jean Burns) held until CASE-001972 is decided |
| Held | — | ||
| ACT-015417 | Outreach suppressed pending steward Outreach | CLM-409835 (Lucia Santos) held until CASE-001973 is decided |
| Held | — | ||
| ACT-015418 | Outreach suppressed pending steward Outreach | TPA-50685 (Johnny Santiago) held until CASE-001974 is decided |
| Held | — | ||
| ACT-015419 | Outreach suppressed pending steward Outreach | TPA-56812 (Jacob Young) held until CASE-001975 is decided |
| Held | — | ||
| ACT-015420 | Outreach suppressed pending steward Outreach | TPA-51054 (Karen Simpson) held until CASE-001976 is decided |
| Held | — | ||
| ACT-015421 | Outreach suppressed pending steward Outreach | ENR-134220 (Helen Lane) held until CASE-001977 is decided |
| Held | — | ||
| ACT-015422 | Outreach suppressed pending steward Outreach | PRV-27698 (Helen Lane) held until CASE-001978 is decided |
| Held | — | ||
| ACT-015423 | Outreach suppressed pending steward Outreach | CLM-413686 (Yuki Moreno) held until CASE-001979 is decided |
| Held | — | ||
| ACT-015424 | Outreach suppressed pending steward Outreach | ENR-117901 (Yuki Moreon) held until CASE-001980 is decided |
| Held | — | ||
| ACT-015425 | Outreach suppressed pending steward Outreach | TPA-53406 (Rachel Hart) held until CASE-001981 is decided |
| Held | — | ||
| ACT-015426 | Outreach suppressed pending steward Outreach | ENR-110166 (Rachel Hart) held until CASE-001982 is decided |
| Held | — | ||
| ACT-015427 | Outreach suppressed pending steward Outreach | TPA-51364 (Timothy Arnold) held until CASE-001983 is decided |
| Held | — | ||
| ACT-015428 | Outreach suppressed pending steward Outreach | CLM-406451 (Sophia Marquez) held until CASE-001984 is decided |
| Held | — | ||
| ACT-015429 | Outreach suppressed pending steward Outreach | ENR-131682 (Sandra Harrison) held until CASE-001985 is decided |
| Held | — | ||
| ACT-015430 | Outreach suppressed pending steward Outreach | PRV-27134 (Sandra Harrison) held until CASE-001986 is decided |
| Held | — | ||
| ACT-015431 | Outreach suppressed pending steward Outreach | CLM-404588 (Anna Sanchez) held until CASE-001987 is decided |
| Held | — | ||
| ACT-015432 | Outreach suppressed pending steward Outreach | ENR-106056 (Anna Sanchez) held until CASE-001988 is decided |
| Held | — | ||
| ACT-015433 | Outreach suppressed pending steward Outreach | TPA-64126 (Jose Carpenter) held until CASE-001989 is decided |
| Held | — | ||
| ACT-015434 | Outreach suppressed pending steward Outreach | TPA-58935 (Nathan Bell) held until CASE-001990 is decided |
| Held | — | ||
| ACT-015435 | Outreach suppressed pending steward Outreach | TPA-61078 (Madison Black) held until CASE-001991 is decided |
| Held | — | ||
| ACT-015436 | Outreach suppressed pending steward Outreach | ENR-132837 (Madison Black) held until CASE-001992 is decided |
| Held | — | ||
| ACT-015437 | Outreach suppressed pending steward Outreach | TPA-58708 (Camila Maldonado) held until CASE-001993 is decided |
| Held | — | ||
| ACT-015438 | Outreach suppressed pending steward Outreach | TPA-58417 (Gary Jordan) held until CASE-001994 is decided |
| Held | — | ||
| ACT-015439 | Outreach suppressed pending steward Outreach | CLM-422967 (Barbara Brooks) held until CASE-001995 is decided |
| Held | — | ||
| ACT-015440 | Outreach suppressed pending steward Outreach | TPA-52750 (Janice Gonzales) held until CASE-001996 is decided |
| Held | — | ||
| ACT-015441 | Outreach suppressed pending steward Outreach | TPA-57552 (Danny Cooper) held until CASE-001997 is decided |
| Held | — | ||
| ACT-015442 | Outreach suppressed pending steward Outreach | CLM-425361 (Steven Park) held until CASE-001998 is decided |
| Held | — | ||
| ACT-015443 | Outreach suppressed pending steward Outreach | CLM-419659 (Jenkins Bryan) held until CASE-001999 is decided |
| Held | — | ||
| ACT-015444 | Outreach suppressed pending steward Outreach | TPA-55573 (Kimberly Rooberts) held until CASE-002000 is decided |
| Held | — | ||
| ACT-015445 | Outreach suppressed pending steward Outreach | CLM-425369 (Juan Graham) held until CASE-002001 is decided |
| Held | — | ||
| ACT-015446 | Outreach suppressed pending steward Outreach | CLM-417511 (Debra Obrien) held until CASE-002002 is decided |
| Held | — | ||
| ACT-015447 | Outreach suppressed pending steward Outreach | PRV-26935 (Laura Tran) held until CASE-002003 is decided |
| Held | — | ||
| ACT-015448 | Outreach suppressed pending steward Outreach | ENR-130785 (Laura Tran) held until CASE-002004 is decided |
| Held | — | ||
| ACT-015449 | Outreach suppressed pending steward Outreach | CLM-411707 (Adnrea Guerrero) held until CASE-002005 is decided |
| Held | — | ||
| ACT-015450 | Outreach suppressed pending steward Outreach | ENR-115427 (Andrea Guerrero) held until CASE-002006 is decided |
| Held | — | ||
| ACT-015451 | Outreach suppressed pending steward Outreach | TPA-50120 (Lauren Castro) held until CASE-002007 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.