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-015452 | Outreach suppressed pending steward Outreach | TPA-50830 (Santiago Carter) held until CASE-002008 is decided |
| Held | — | ||
| ACT-015453 | Outreach suppressed pending steward Outreach | CLM-401922 (Santiago Carter) held until CASE-002009 is decided |
| Held | — | ||
| ACT-015454 | Outreach suppressed pending steward Outreach | CLM-407421 (Gloria Fowler) held until CASE-002010 is decided |
| Held | — | ||
| ACT-015455 | Outreach suppressed pending steward Outreach | CLM-422728 (Benjamin Fuller) held until CASE-002011 is decided |
| Held | — | ||
| ACT-015456 | Outreach suppressed pending steward Outreach | TPA-56654 (Fatima Ford) held until CASE-002012 is decided |
| Held | — | ||
| ACT-015457 | Outreach suppressed pending steward Outreach | CLM-415105 (Fatima Ford) held until CASE-002013 is decided |
| Held | — | ||
| ACT-015458 | Outreach suppressed pending steward Outreach | PRV-27240 (Jose Ford) held until CASE-002014 is decided |
| Held | — | ||
| ACT-015459 | Outreach suppressed pending steward Outreach | CLM-430280 (Ruth Baker) held until CASE-002015 is decided |
| Held | — | ||
| ACT-015460 | Outreach suppressed pending steward Outreach | PRV-28441 (Heather Gardner) held until CASE-002016 is decided |
| Held | — | ||
| ACT-015461 | Outreach suppressed pending steward Outreach | PRV-20849 (David Turner) held until CASE-002017 is decided |
| Held | — | ||
| ACT-015462 | Outreach suppressed pending steward Outreach | CLM-411368 (Jonathan Wheeler) held until CASE-002018 is decided |
| Held | — | ||
| ACT-015463 | Outreach suppressed pending steward Outreach | TPA-59173 (Vincent Castro) held until CASE-002019 is decided |
| Held | — | ||
| ACT-015464 | Outreach suppressed pending steward Outreach | PRV-20158 (Harold Carter) held until CASE-002020 is decided |
| Held | — | ||
| ACT-015465 | Outreach suppressed pending steward Outreach | PRV-23828 (Christine Carter) held until CASE-002021 is decided |
| Held | — | ||
| ACT-015466 | Outreach suppressed pending steward Outreach | CLM-416244 (Joyce Hanson) held until CASE-002022 is decided |
| Held | — | ||
| ACT-015467 | Outreach suppressed pending steward Outreach | CLM-407674 (Birttany Knight) held until CASE-002023 is decided |
| Held | — | ||
| ACT-015468 | Outreach suppressed pending steward Outreach | CLM-404524 (Rachel Pierce) held until CASE-002024 is decided |
| Held | — | ||
| ACT-015469 | Outreach suppressed pending steward Outreach | CLM-404525 (Rachel Pirce) held until CASE-002025 is decided |
| Held | — | ||
| ACT-015470 | Outreach suppressed pending steward Outreach | CLM-404183 (Sofia Carr) held until CASE-002026 is decided |
| Held | — | ||
| ACT-015471 | Outreach suppressed pending steward Outreach | ENR-119999 (Martha Kim) held until CASE-002027 is decided |
| Held | — | ||
| ACT-015472 | Outreach suppressed pending steward Outreach | CLM-415179 (Martha Kim) held until CASE-002028 is decided |
| Held | — | ||
| ACT-015473 | Outreach suppressed pending steward Outreach | CLM-406912 (Priya Barnes) held until CASE-002029 is decided |
| Held | — | ||
| ACT-015474 | Outreach suppressed pending steward Outreach | CLM-432760 (Jesse Hunter) held until CASE-002030 is decided |
| Held | — | ||
| ACT-015475 | Outreach suppressed pending steward Outreach | TPA-53457 (Kevin Chapman) held until CASE-002031 is decided |
| Held | — | ||
| ACT-015476 | Outreach suppressed pending steward Outreach | ENR-107142 (Willie Chapman) held until CASE-002032 is decided |
| Held | — | ||
| ACT-015477 | Outreach suppressed pending steward Outreach | TPA-52822 (Logan Nychols) held until CASE-002033 is decided |
| Held | — | ||
| ACT-015478 | Outreach suppressed pending steward Outreach | CLM-406430 (Logan Nichols) held until CASE-002034 is decided |
| Held | — | ||
| ACT-015479 | Outreach suppressed pending steward Outreach | TPA-57907 (Carlos Gordon) held until CASE-002035 is decided |
| Held | — | ||
| ACT-015480 | Outreach suppressed pending steward Outreach | TPA-51059 (Deborah Lopez) held until CASE-002036 is decided |
| Held | — | ||
| ACT-015481 | Outreach suppressed pending steward Outreach | ENR-103192 (Deborah Lopez) held until CASE-002037 is decided |
| Held | — | ||
| ACT-015482 | Outreach suppressed pending steward Outreach | CLM-431061 (Jonathan Hunt) held until CASE-002038 is decided |
| Held | — | ||
| ACT-015483 | Outreach suppressed pending steward Outreach | ENR-100651 (Samuel Allen) held until CASE-002039 is decided |
| Held | — | ||
| ACT-015484 | Outreach suppressed pending steward Outreach | PRV-20142 (Samuel Allen) held until CASE-002040 is decided |
| Held | — | ||
| ACT-015485 | Outreach suppressed pending steward Outreach | TPA-62983 (Jordan Payne) held until CASE-002041 is decided |
| Held | — | ||
| ACT-015486 | Outreach suppressed pending steward Outreach | ENR-138569 (Jordan Paayne) held until CASE-002042 is decided |
| Held | — | ||
| ACT-015487 | Outreach suppressed pending steward Outreach | CLM-416083 (Lori George) held until CASE-002043 is decided |
| Held | — | ||
| ACT-015488 | Outreach suppressed pending steward Outreach | TPA-61978 (Lias Graham) held until CASE-002044 is decided |
| Held | — | ||
| ACT-015489 | Outreach suppressed pending steward Outreach | CLM-428929 (Hannah Valdez) held until CASE-002045 is decided |
| Held | — | ||
| ACT-015490 | Outreach suppressed pending steward Outreach | ENR-123651 (Pual Herrera) held until CASE-002046 is decided |
| Held | — | ||
| ACT-015491 | Outreach suppressed pending steward Outreach | CLM-417975 (Paul Herrera) held until CASE-002047 is decided |
| Held | — | ||
| ACT-015492 | Outreach suppressed pending steward Outreach | ENR-108476 (Paul Herrera) held until CASE-002048 is decided |
| Held | — | ||
| ACT-015493 | Outreach suppressed pending steward Outreach | CLM-430838 (Scott Fowler) held until CASE-002049 is decided |
| Held | — | ||
| ACT-015494 | Outreach suppressed pending steward Outreach | TPA-63631 (Scott Fowler) held until CASE-002050 is decided |
| Held | — | ||
| ACT-015495 | Outreach suppressed pending steward Outreach | CLM-421828 (Karen Mills) held until CASE-002051 is decided |
| Held | — | ||
| ACT-015496 | Outreach suppressed pending steward Outreach | TPA-63669 (Doris Carlson) held until CASE-002052 is decided |
| Held | — | ||
| ACT-015497 | Outreach suppressed pending steward Outreach | CLM-409898 (Ethan Maldonado) held until CASE-002053 is decided |
| Held | — | ||
| ACT-015498 | Outreach suppressed pending steward Outreach | ENR-113049 (Ethan Maldonado) held until CASE-002054 is decided |
| Held | — | ||
| ACT-015499 | Outreach suppressed pending steward Outreach | ENR-131622 (Johny Weber) held until CASE-002055 is decided |
| Held | — | ||
| ACT-015500 | Outreach suppressed pending steward Outreach | TPA-57596 (Charlotte Haansen) held until CASE-002056 is decided |
| Held | — | ||
| ACT-015501 | Outreach suppressed pending steward Outreach | CLM-417211 (Charlotte Hansen) held until CASE-002057 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.