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-015752 | Outreach suppressed pending steward Outreach | TPA-59535 (Jeffrey Bradley) held until CASE-002308 is decided |
| Held | — | ||
| ACT-015753 | Outreach suppressed pending steward Outreach | PRV-25330 (Jean Bell) held until CASE-002309 is decided |
| Held | — | ||
| ACT-015754 | Outreach suppressed pending steward Outreach | CLM-417961 (Jean Bell) held until CASE-002310 is decided |
| Held | — | ||
| ACT-015755 | Outreach suppressed pending steward Outreach | ENR-104173 (Alice Black) held until CASE-002311 is decided |
| Held | — | ||
| ACT-015756 | Outreach suppressed pending steward Outreach | TPA-51388 (Alice Black) held until CASE-002312 is decided |
| Held | — | ||
| ACT-015757 | Outreach suppressed pending steward Outreach | CLM-427153 (Heather Austin) held until CASE-002313 is decided |
| Held | — | ||
| ACT-015758 | Outreach suppressed pending steward Outreach | PRV-25429 (Joan Anderson) held until CASE-002314 is decided |
| Held | — | ||
| ACT-015759 | Outreach suppressed pending steward Outreach | CLM-425343 (Lawrence Gutierrez) held until CASE-002315 is decided |
| Held | — | ||
| ACT-015760 | Outreach suppressed pending steward Outreach | CLM-425344 (Lawrence Gutierrez) held until CASE-002316 is decided |
| Held | — | ||
| ACT-015761 | Outreach suppressed pending steward Outreach | TPA-59085 (Stephanie Armstrong) held until CASE-002317 is decided |
| Held | — | ||
| ACT-015762 | Outreach suppressed pending steward Outreach | TPA-59086 (Stephanie Armstrong) held until CASE-002318 is decided |
| Held | — | ||
| ACT-015763 | Outreach suppressed pending steward Outreach | ENR-140644 (Joan Santiago) held until CASE-002319 is decided |
| Held | — | ||
| ACT-015764 | Outreach suppressed pending steward Outreach | CLM-430944 (Joan Santiago) held until CASE-002320 is decided |
| Held | — | ||
| ACT-015765 | Outreach suppressed pending steward Outreach | ENR-101651 (Sharon Owens) held until CASE-002321 is decided |
| Held | — | ||
| ACT-015766 | Outreach suppressed pending steward Outreach | TPA-50550 (Sharon Owens) held until CASE-002322 is decided |
| Held | — | ||
| ACT-015767 | Outreach suppressed pending steward Outreach | CLM-414842 (Sara Jimenez) held until CASE-002323 is decided |
| Held | — | ||
| ACT-015768 | Outreach suppressed pending steward Outreach | TPA-55856 (Lisa Chapman) held until CASE-002324 is decided |
| Held | — | ||
| ACT-015769 | Outreach suppressed pending steward Outreach | ENR-117481 (Lisa Chapman) held until CASE-002325 is decided |
| Held | — | ||
| ACT-015770 | Outreach suppressed pending steward Outreach | CLM-413326 (Lisa Chapman) held until CASE-002326 is decided |
| Held | — | ||
| ACT-015771 | Outreach suppressed pending steward Outreach | CLM-413325 (Lisa Chapmman) held until CASE-002327 is decided |
| Held | — | ||
| ACT-015772 | Outreach suppressed pending steward Outreach | CLM-416638 (Cerlos Ford) held until CASE-002328 is decided |
| Held | — | ||
| ACT-015773 | Outreach suppressed pending steward Outreach | TPA-51466 (Dorothy Rogers) held until CASE-002329 is decided |
| Held | — | ||
| ACT-015774 | Outreach suppressed pending steward Outreach | PRV-23950 (Pamela Santiago) held until CASE-002330 is decided |
| Held | — | ||
| ACT-015775 | Outreach suppressed pending steward Outreach | CLM-413632 (Pamela Santiago) held until CASE-002331 is decided |
| Held | — | ||
| ACT-015776 | Outreach suppressed pending steward Outreach | PRV-26101 (Carl Santos) held until CASE-002332 is decided |
| Held | — | ||
| ACT-015777 | Outreach suppressed pending steward Outreach | CLM-429648 (Kenneth Cox) held until CASE-002333 is decided |
| Held | — | ||
| ACT-015778 | Outreach suppressed pending steward Outreach | TPA-59298 (Amy Palmer) held until CASE-002334 is decided |
| Held | — | ||
| ACT-015779 | Outreach suppressed pending steward Outreach | ENR-123493 (Raymond Palmer) held until CASE-002335 is decided |
| Held | — | ||
| ACT-015780 | Outreach suppressed pending steward Outreach | TPA-57884 (Raymond Palmer) held until CASE-002336 is decided |
| Held | — | ||
| ACT-015781 | Outreach suppressed pending steward Outreach | TPA-54788 (Adam Lnua) held until CASE-002337 is decided |
| Held | — | ||
| ACT-015782 | Outreach suppressed pending steward Outreach | CLM-410935 (Adam Luna) held until CASE-002338 is decided |
| Held | — | ||
| ACT-015783 | Outreach suppressed pending steward Outreach | CLM-415084 (Joseph Vasquez) held until CASE-002339 is decided |
| Held | — | ||
| ACT-015784 | Outreach suppressed pending steward Outreach | ENR-119868 (Joseph Vasquez) held until CASE-002340 is decided |
| Held | — | ||
| ACT-015785 | Outreach suppressed pending steward Outreach | CLM-410167 (Gabriel Evans) held until CASE-002341 is decided |
| Held | — | ||
| ACT-015786 | Outreach suppressed pending steward Outreach | TPA-54455 (Gabriel Evaans) held until CASE-002342 is decided |
| Held | — | ||
| ACT-015787 | Outreach suppressed pending steward Outreach | CLM-400017 (Nancy Campbell) held until CASE-002343 is decided |
| Held | — | ||
| ACT-015788 | Outreach suppressed pending steward Outreach | ENR-116139 (Ralph Guerrero) held until CASE-002344 is decided |
| Held | — | ||
| ACT-015789 | Outreach suppressed pending steward Outreach | PRV-23539 (Ralph Guerrero) held until CASE-002345 is decided |
| Held | — | ||
| ACT-015790 | Outreach suppressed pending steward Outreach | TPA-57252 (Janet Dean) held until CASE-002346 is decided |
| Held | — | ||
| ACT-015791 | Outreach suppressed pending steward Outreach | PRV-24269 (Mateo Elliott) held until CASE-002347 is decided |
| Held | — | ||
| ACT-015792 | Outreach suppressed pending steward Outreach | TPA-62163 (Dougls Ortega) held until CASE-002348 is decided |
| Held | — | ||
| ACT-015793 | Outreach suppressed pending steward Outreach | TPA-63064 (Ahmde Sanders) held until CASE-002349 is decided |
| Held | — | ||
| ACT-015794 | Outreach suppressed pending steward Outreach | ENR-116911 (Steven Clark) held until CASE-002350 is decided |
| Held | — | ||
| ACT-015795 | Outreach suppressed pending steward Outreach | CLM-412866 (Steven Clark) held until CASE-002351 is decided |
| Held | — | ||
| ACT-015796 | Outreach suppressed pending steward Outreach | TPA-63837 (Rachel Nichols) held until CASE-002352 is decided |
| Held | — | ||
| ACT-015797 | Outreach suppressed pending steward Outreach | CLM-408321 (Gregory Pierce) held until CASE-002353 is decided |
| Held | — | ||
| ACT-015798 | Outreach suppressed pending steward Outreach | CLM-408320 (Gregory Pierce) held until CASE-002354 is decided |
| Held | — | ||
| ACT-015799 | Outreach suppressed pending steward Outreach | CLM-425932 (Theresa Ortiz) held until CASE-002355 is decided |
| Held | — | ||
| ACT-015800 | Outreach suppressed pending steward Outreach | ENR-133938 (Theresa Ortiz) held until CASE-002356 is decided |
| Held | — | ||
| ACT-015801 | Outreach suppressed pending steward Outreach | CLM-408178 (Linda Munoz) held until CASE-002357 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.