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-015602 | Outreach suppressed pending steward Outreach | CLM-410726 (Jose Weber) held until CASE-002158 is decided |
| Held | — | ||
| ACT-015603 | Outreach suppressed pending steward Outreach | TPA-56446 (Kevin Morris) held until CASE-002159 is decided |
| Held | — | ||
| ACT-015604 | Outreach suppressed pending steward Outreach | PRV-24288 (Kevin Morris) held until CASE-002160 is decided |
| Held | — | ||
| ACT-015605 | Outreach suppressed pending steward Outreach | TPA-57004 (Alexander Johnston) held until CASE-002161 is decided |
| Held | — | ||
| ACT-015606 | Outreach suppressed pending steward Outreach | TPA-59410 (Santiago Green) held until CASE-002162 is decided |
| Held | — | ||
| ACT-015607 | Outreach suppressed pending steward Outreach | PRV-22809 (Jooyce Graham) held until CASE-002163 is decided |
| Held | — | ||
| ACT-015608 | Outreach suppressed pending steward Outreach | ENR-112758 (Joyce Graham) held until CASE-002164 is decided |
| Held | — | ||
| ACT-015609 | Outreach suppressed pending steward Outreach | CLM-419112 (Jacqueline Nelson) held until CASE-002165 is decided |
| Held | — | ||
| ACT-015610 | Outreach suppressed pending steward Outreach | TPA-63105 (Jose Long) held until CASE-002166 is decided |
| Held | — | ||
| ACT-015611 | Outreach suppressed pending steward Outreach | TPA-63106 (Jose Long) held until CASE-002167 is decided |
| Held | — | ||
| ACT-015612 | Outreach suppressed pending steward Outreach | TPA-54464 (Mateo Austin) held until CASE-002168 is decided |
| Held | — | ||
| ACT-015613 | Outreach suppressed pending steward Outreach | TPA-54465 (Mateo Austin) held until CASE-002169 is decided |
| Held | — | ||
| ACT-015614 | Outreach suppressed pending steward Outreach | CLM-421754 (Linda Johnson) held until CASE-002170 is decided |
| Held | — | ||
| ACT-015615 | Outreach suppressed pending steward Outreach | TPA-55663 (Judy Ortega) held until CASE-002171 is decided |
| Held | — | ||
| ACT-015616 | Outreach suppressed pending steward Outreach | TPA-54232 (Yuki Lynch) held until CASE-002172 is decided |
| Held | — | ||
| ACT-015617 | Outreach suppressed pending steward Outreach | TPA-50065 (Jennifer Cole) held until CASE-002173 is decided |
| Held | — | ||
| ACT-015618 | Outreach suppressed pending steward Outreach | PRV-22469 (Pamela Gardner) held until CASE-002174 is decided |
| Held | — | ||
| ACT-015619 | Outreach suppressed pending steward Outreach | CLM-408365 (Pamela Gardner) held until CASE-002175 is decided |
| Held | — | ||
| ACT-015620 | Outreach suppressed pending steward Outreach | CLM-401461 (Pat Bishop) held until CASE-002176 is decided |
| Held | — | ||
| ACT-015621 | Outreach suppressed pending steward Outreach | CLM-405424 (Maria Johnston) held until CASE-002177 is decided |
| Held | — | ||
| ACT-015622 | Outreach suppressed pending steward Outreach | TPA-52386 (Maria Johnston) held until CASE-002178 is decided |
| Held | — | ||
| ACT-015623 | Outreach suppressed pending steward Outreach | TPA-57163 (Kathleen Johnston) held until CASE-002179 is decided |
| Held | — | ||
| ACT-015624 | Outreach suppressed pending steward Outreach | TPA-56680 (Denise Gibson) held until CASE-002180 is decided |
| Held | — | ||
| ACT-015625 | Outreach suppressed pending steward Outreach | ENR-119990 (Denise Gibson) held until CASE-002181 is decided |
| Held | — | ||
| ACT-015626 | Outreach suppressed pending steward Outreach | TPA-62703 (Patricia Colleman) held until CASE-002182 is decided |
| Held | — | ||
| ACT-015627 | Outreach suppressed pending steward Outreach | CLM-415898 (Brenda Nichools) held until CASE-002183 is decided |
| Held | — | ||
| ACT-015628 | Outreach suppressed pending steward Outreach | CLM-403512 (Ronald Alvarado) held until CASE-002184 is decided |
| Held | — | ||
| ACT-015629 | Outreach suppressed pending steward Outreach | CLM-406721 (Kathleen Bailey) held until CASE-002185 is decided |
| Held | — | ||
| ACT-015630 | Outreach suppressed pending steward Outreach | CLM-416651 (Emily Diaz) held until CASE-002186 is decided |
| Held | — | ||
| ACT-015631 | Outreach suppressed pending steward Outreach | PRV-24933 (Emily Diaz) held until CASE-002187 is decided |
| Held | — | ||
| ACT-015632 | Outreach suppressed pending steward Outreach | TPA-50099 (Evelyn Knight) held until CASE-002188 is decided |
| Held | — | ||
| ACT-015633 | Outreach suppressed pending steward Outreach | CLM-418124 (Donald Sullivan) held until CASE-002189 is decided |
| Held | — | ||
| ACT-015634 | Outreach suppressed pending steward Outreach | TPA-51446 (Evelyn Delgado) held until CASE-002190 is decided |
| Held | — | ||
| ACT-015635 | Outreach suppressed pending steward Outreach | ENR-104325 (Evelyn Delgado) held until CASE-002191 is decided |
| Held | — | ||
| ACT-015636 | Outreach suppressed pending steward Outreach | CLM-416969 (Sara Burton) held until CASE-002192 is decided |
| Held | — | ||
| ACT-015637 | Outreach suppressed pending steward Outreach | TPA-62105 (Jason Scott) held until CASE-002193 is decided |
| Held | — | ||
| ACT-015638 | Outreach suppressed pending steward Outreach | ENR-135906 (Jason Scott) held until CASE-002194 is decided |
| Held | — | ||
| ACT-015639 | Outreach suppressed pending steward Outreach | ENR-113104 (Beverly Crawwford) held until CASE-002195 is decided |
| Held | — | ||
| ACT-015640 | Outreach suppressed pending steward Outreach | PRV-22894 (Beverly Crawford) held until CASE-002196 is decided |
| Held | — | ||
| ACT-015641 | Outreach suppressed pending steward Outreach | ENR-139244 (Jose Boyd) held until CASE-002197 is decided |
| Held | — | ||
| ACT-015642 | Outreach suppressed pending steward Outreach | CLM-420333 (Samuel Green) held until CASE-002198 is decided |
| Held | — | ||
| ACT-015643 | Outreach suppressed pending steward Outreach | CLM-418552 (Luis Adams) held until CASE-002199 is decided |
| Held | — | ||
| ACT-015644 | Outreach suppressed pending steward Outreach | CLM-408761 (Jack Mitchell) held until CASE-002200 is decided |
| Held | — | ||
| ACT-015645 | Outreach suppressed pending steward Outreach | PRV-22599 (Jack Mitchell) held until CASE-002201 is decided |
| Held | — | ||
| ACT-015646 | Outreach suppressed pending steward Outreach | CLM-427162 (Alexander Hudson) held until CASE-002202 is decided |
| Held | — | ||
| ACT-015647 | Outreach suppressed pending steward Outreach | ENR-103845 (Amanda Herrera) held until CASE-002203 is decided |
| Held | — | ||
| ACT-015648 | Outreach suppressed pending steward Outreach | PRV-20843 (Amanda Herrera) held until CASE-002204 is decided |
| Held | — | ||
| ACT-015649 | Outreach suppressed pending steward Outreach | CLM-403034 (Noah Morales) held until CASE-002205 is decided |
| Held | — | ||
| ACT-015650 | Outreach suppressed pending steward Outreach | TPA-51720 (Bryan Moreno) held until CASE-002206 is decided |
| Held | — | ||
| ACT-015651 | Outreach suppressed pending steward Outreach | TPA-60141 (Kenneth Nguyeen) held until CASE-002207 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.