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-015652 | Outreach suppressed pending steward Outreach | CLM-410919 (Ashleey Espinoza) held until CASE-002208 is decided |
| Held | — | ||
| ACT-015653 | Outreach suppressed pending steward Outreach | CLM-406620 (Brenda Porter) held until CASE-002209 is decided |
| Held | — | ||
| ACT-015654 | Outreach suppressed pending steward Outreach | TPA-58962 (Carol Ortega) held until CASE-002210 is decided |
| Held | — | ||
| ACT-015655 | Outreach suppressed pending steward Outreach | PRV-29233 (Wayne Rios) held until CASE-002211 is decided |
| Held | — | ||
| ACT-015656 | Outreach suppressed pending steward Outreach | TPA-55330 (Mike Mills) held until CASE-002212 is decided |
| Held | — | ||
| ACT-015657 | Outreach suppressed pending steward Outreach | TPA-64376 (Evelyn Hughes) held until CASE-002213 is decided |
| Held | — | ||
| ACT-015658 | Outreach suppressed pending steward Outreach | TPA-62377 (Drew James) held until CASE-002214 is decided |
| Held | — | ||
| ACT-015659 | Outreach suppressed pending steward Outreach | TPA-54307 (Santiago Garza) held until CASE-002215 is decided |
| Held | — | ||
| ACT-015660 | Outreach suppressed pending steward Outreach | CLM-422355 (Marcus Yang) held until CASE-002216 is decided |
| Held | — | ||
| ACT-015661 | Outreach suppressed pending steward Outreach | TPA-52788 (Ryan Rios) held until CASE-002217 is decided |
| Held | — | ||
| ACT-015662 | Outreach suppressed pending steward Outreach | TPA-52787 (Ryan Rioos) held until CASE-002218 is decided |
| Held | — | ||
| ACT-015663 | Outreach suppressed pending steward Outreach | ENR-109277 (Henry Rodriguez) held until CASE-002219 is decided |
| Held | — | ||
| ACT-015664 | Outreach suppressed pending steward Outreach | TPA-53107 (Henry Rodriguez) held until CASE-002220 is decided |
| Held | — | ||
| ACT-015665 | Outreach suppressed pending steward Outreach | CLM-425415 (Willie Roberts) held until CASE-002221 is decided |
| Held | — | ||
| ACT-015666 | Outreach suppressed pending steward Outreach | CLM-405527 (Denise Dunn) held until CASE-002222 is decided |
| Held | — | ||
| ACT-015667 | Outreach suppressed pending steward Outreach | CLM-414229 (Jesse Reyes) held until CASE-002223 is decided |
| Held | — | ||
| ACT-015668 | Outreach suppressed pending steward Outreach | CLM-431392 (Jerry Roberts) held until CASE-002224 is decided |
| Held | — | ||
| ACT-015669 | Outreach suppressed pending steward Outreach | TPA-51824 (Jonathan Richards) held until CASE-002225 is decided |
| Held | — | ||
| ACT-015670 | Outreach suppressed pending steward Outreach | CLM-422126 (Donald Patel) held until CASE-002226 is decided |
| Held | — | ||
| ACT-015671 | Outreach suppressed pending steward Outreach | CLM-425815 (Thomas Jordan) held until CASE-002227 is decided |
| Held | — | ||
| ACT-015672 | Outreach suppressed pending steward Outreach | CLM-406383 (Vincent Jenkins) held until CASE-002228 is decided |
| Held | — | ||
| ACT-015673 | Outreach suppressed pending steward Outreach | ENR-120000 (Terry Diaz) held until CASE-002229 is decided |
| Held | — | ||
| ACT-015674 | Outreach suppressed pending steward Outreach | TPA-56684 (Terry Diaz) held until CASE-002230 is decided |
| Held | — | ||
| ACT-015675 | Outreach suppressed pending steward Outreach | TPA-50380 (Brandon Russell) held until CASE-002231 is decided |
| Held | — | ||
| ACT-015676 | Outreach suppressed pending steward Outreach | CLM-422811 (Christina Burke) held until CASE-002232 is decided |
| Held | — | ||
| ACT-015677 | Outreach suppressed pending steward Outreach | CLM-422812 (Christina Burke) held until CASE-002233 is decided |
| Held | — | ||
| ACT-015678 | Outreach suppressed pending steward Outreach | CLM-419371 (Mateo Nichols) held until CASE-002234 is decided |
| Held | — | ||
| ACT-015679 | Outreach suppressed pending steward Outreach | ENR-125523 (Mateo Nichols) held until CASE-002235 is decided |
| Held | — | ||
| ACT-015680 | Outreach suppressed pending steward Outreach | CLM-422588 (Bobby Freeman) held until CASE-002236 is decided |
| Held | — | ||
| ACT-015681 | Outreach suppressed pending steward Outreach | PRV-29061 (Natalie Medina) held until CASE-002237 is decided |
| Held | — | ||
| ACT-015682 | Outreach suppressed pending steward Outreach | ENR-140699 (Natalie Medina) held until CASE-002238 is decided |
| Held | — | ||
| ACT-015683 | Outreach suppressed pending steward Outreach | ENR-111295 (Nathan Guerrero) held until CASE-002239 is decided |
| Held | — | ||
| ACT-015684 | Outreach suppressed pending steward Outreach | CLM-408558 (Nathan Guerrero) held until CASE-002240 is decided |
| Held | — | ||
| ACT-015685 | Outreach suppressed pending steward Outreach | CLM-415738 (Brian Wells) held until CASE-002241 is decided |
| Held | — | ||
| ACT-015686 | Outreach suppressed pending steward Outreach | CLM-415737 (Brian Wells) held until CASE-002242 is decided |
| Held | — | ||
| ACT-015687 | Outreach suppressed pending steward Outreach | TPA-58857 (Kimberly Reynolds) held until CASE-002243 is decided |
| Held | — | ||
| ACT-015688 | Outreach suppressed pending steward Outreach | CLM-405007 (Billy Mendez) held until CASE-002244 is decided |
| Held | — | ||
| ACT-015689 | Outreach suppressed pending steward Outreach | PRV-26205 (Sara Powell) held until CASE-002245 is decided |
| Held | — | ||
| ACT-015690 | Outreach suppressed pending steward Outreach | TPA-56769 (Cheryl Walker) held until CASE-002246 is decided |
| Held | — | ||
| ACT-015691 | Outreach suppressed pending steward Outreach | TPA-57598 (George Porter) held until CASE-002247 is decided |
| Held | — | ||
| ACT-015692 | Outreach suppressed pending steward Outreach | ENR-122676 (George Porter) held until CASE-002248 is decided |
| Held | — | ||
| ACT-015693 | Outreach suppressed pending steward Outreach | ENR-139483 (Dylan Munoz) held until CASE-002249 is decided |
| Held | — | ||
| ACT-015694 | Outreach suppressed pending steward Outreach | CLM-430102 (Dylan Munoz) held until CASE-002250 is decided |
| Held | — | ||
| ACT-015695 | Outreach suppressed pending steward Outreach | CLM-418477 (Theresa Grray) held until CASE-002251 is decided |
| Held | — | ||
| ACT-015696 | Outreach suppressed pending steward Outreach | TPA-61583 (Wei James) held until CASE-002252 is decided |
| Held | — | ||
| ACT-015697 | Outreach suppressed pending steward Outreach | CLM-414556 (Brandon Warren) held until CASE-002253 is decided |
| Held | — | ||
| ACT-015698 | Outreach suppressed pending steward Outreach | CLM-414555 (Brandon Warren) held until CASE-002254 is decided |
| Held | — | ||
| ACT-015699 | Outreach suppressed pending steward Outreach | CLM-404136 (Emiyl Valdez) held until CASE-002255 is decided |
| Held | — | ||
| ACT-015700 | Outreach suppressed pending steward Outreach | PRV-21165 (Emily Valdez) held until CASE-002256 is decided |
| Held | — | ||
| ACT-015701 | Outreach suppressed pending steward Outreach | CLM-400432 (Bradley Caarroll) held until CASE-002257 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.