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-015802 | Outreach suppressed pending steward Outreach | TPA-57240 (Aisha Gibsson) held until CASE-002358 is decided |
| Held | — | ||
| ACT-015803 | Outreach suppressed pending steward Outreach | TPA-53440 (Elizabeth Stevens) held until CASE-002359 is decided |
| Held | — | ||
| ACT-015804 | Outreach suppressed pending steward Outreach | PRV-22311 (Elizabeth Stevens) held until CASE-002360 is decided |
| Held | — | ||
| ACT-015805 | Outreach suppressed pending steward Outreach | PRV-26368 (Santiago Washington) held until CASE-002361 is decided |
| Held | — | ||
| ACT-015806 | Outreach suppressed pending steward Outreach | CLM-421605 (Santiago Washington) held until CASE-002362 is decided |
| Held | — | ||
| ACT-015807 | Outreach suppressed pending steward Outreach | CLM-407954 (Joshua Hayes) held until CASE-002363 is decided |
| Held | — | ||
| ACT-015808 | Outreach suppressed pending steward Outreach | PRV-22879 (Linda Lawrence) held until CASE-002364 is decided |
| Held | — | ||
| ACT-015809 | Outreach suppressed pending steward Outreach | TPA-56907 (Omar Lawrence) held until CASE-002365 is decided |
| Held | — | ||
| ACT-015810 | Outreach suppressed pending steward Outreach | ENR-120768 (Omer Lawrence) held until CASE-002366 is decided |
| Held | — | ||
| ACT-015811 | Outreach suppressed pending steward Outreach | CLM-405856 (Dylan Gibson) held until CASE-002367 is decided |
| Held | — | ||
| ACT-015812 | Outreach suppressed pending steward Outreach | CLM-417259 (Patrick Ellis) held until CASE-002368 is decided |
| Held | — | ||
| ACT-015813 | Outreach suppressed pending steward Outreach | TPA-56504 (Brenda Singh) held until CASE-002369 is decided |
| Held | — | ||
| ACT-015814 | Outreach suppressed pending steward Outreach | ENR-105652 (Patrick Singh) held until CASE-002370 is decided |
| Held | — | ||
| ACT-015815 | Outreach suppressed pending steward Outreach | CLM-404305 (Patrick Singh) held until CASE-002371 is decided |
| Held | — | ||
| ACT-015816 | Outreach suppressed pending steward Outreach | ENR-101613 (Brenda Singh) held until CASE-002372 is decided |
| Held | — | ||
| ACT-015817 | Outreach suppressed pending steward Outreach | PRV-22602 (Bruce Fowler) held until CASE-002373 is decided |
| Held | — | ||
| ACT-015818 | Outreach suppressed pending steward Outreach | TPA-63839 (Tyler Ortiz) held until CASE-002374 is decided |
| Held | — | ||
| ACT-015819 | Outreach suppressed pending steward Outreach | CLM-431346 (Tyelr Ortiz) held until CASE-002375 is decided |
| Held | — | ||
| ACT-015820 | Outreach suppressed pending steward Outreach | TPA-57604 (Edward Gomez) held until CASE-002376 is decided |
| Held | — | ||
| ACT-015821 | Outreach suppressed pending steward Outreach | PRV-22659 (Raymond Pierce) held until CASE-002377 is decided |
| Held | — | ||
| ACT-015822 | Outreach suppressed pending steward Outreach | ENR-129854 (Bruce Wells) held until CASE-002378 is decided |
| Held | — | ||
| ACT-015823 | Outreach suppressed pending steward Outreach | CLM-427862 (Keith Simmons) held until CASE-002379 is decided |
| Held | — | ||
| ACT-015824 | Outreach suppressed pending steward Outreach | ENR-136525 (Keith Simmons) held until CASE-002380 is decided |
| Held | — | ||
| ACT-015825 | Outreach suppressed pending steward Outreach | CLM-426216 (Nancy Peters) held until CASE-002381 is decided |
| Held | — | ||
| ACT-015826 | Outreach suppressed pending steward Outreach | CLM-432394 (Justin Crawford) held until CASE-002382 is decided |
| Held | — | ||
| ACT-015827 | Outreach suppressed pending steward Outreach | TPA-64199 (Kenneth Gilbert) held until CASE-002383 is decided |
| Held | — | ||
| ACT-015828 | Outreach suppressed pending steward Outreach | ENR-142229 (Kenneth Gilbert) held until CASE-002384 is decided |
| Held | — | ||
| ACT-015829 | Outreach suppressed pending steward Outreach | CLM-412992 (Justin Walker) held until CASE-002385 is decided |
| Held | — | ||
| ACT-015830 | Outreach suppressed pending steward Outreach | CLM-412993 (Justin Walker) held until CASE-002386 is decided |
| Held | — | ||
| ACT-015831 | Outreach suppressed pending steward Outreach | CLM-417739 (Jacob Ferguson) held until CASE-002387 is decided |
| Held | — | ||
| ACT-015832 | Outreach suppressed pending steward Outreach | TPA-57834 (Jacob Ferguson) held until CASE-002388 is decided |
| Held | — | ||
| ACT-015833 | Outreach suppressed pending steward Outreach | PRV-28729 (Samuel Daniels) held until CASE-002389 is decided |
| Held | — | ||
| ACT-015834 | Outreach suppressed pending steward Outreach | ENR-104504 (Joyce Freeman) held until CASE-002390 is decided |
| Held | — | ||
| ACT-015835 | Outreach suppressed pending steward Outreach | CLM-403683 (Rachel Fernandez) held until CASE-002391 is decided |
| Held | — | ||
| ACT-015836 | Outreach suppressed pending steward Outreach | CLM-429233 (Natalie Bennett) held until CASE-002392 is decided |
| Held | — | ||
| ACT-015837 | Outreach suppressed pending steward Outreach | ENR-129909 (Joyce Porter) held until CASE-002393 is decided |
| Held | — | ||
| ACT-015838 | Outreach suppressed pending steward Outreach | PRV-26763 (Joyce Porter) held until CASE-002394 is decided |
| Held | — | ||
| ACT-015839 | Outreach suppressed pending steward Outreach | CLM-410691 (Lori Webb) held until CASE-002395 is decided |
| Held | — | ||
| ACT-015840 | Outreach suppressed pending steward Outreach | ENR-114504 (David Knight) held until CASE-002396 is decided |
| Held | — | ||
| ACT-015841 | Outreach suppressed pending steward Outreach | TPA-54828 (Daivd Knight) held until CASE-002397 is decided |
| Held | — | ||
| ACT-015842 | Outreach suppressed pending steward Outreach | CLM-427137 (Judith Jenkins) held until CASE-002398 is decided |
| Held | — | ||
| ACT-015843 | Outreach suppressed pending steward Outreach | CLM-405209 (Beverly Mntgomery) held until CASE-002399 is decided |
| Held | — | ||
| ACT-015844 | Outreach suppressed pending steward Outreach | CLM-426398 (Juan Santos) held until CASE-002400 is decided |
| Held | — | ||
| ACT-015845 | Outreach suppressed pending steward Outreach | CLM-426397 (Juan Santos) held until CASE-002401 is decided |
| Held | — | ||
| ACT-015846 | Outreach suppressed pending steward Outreach | CLM-426396 (Jan Santos) held until CASE-002402 is decided |
| Held | — | ||
| ACT-015847 | Outreach suppressed pending steward Outreach | TPA-62886 (Bobby Ramos) held until CASE-002403 is decided |
| Held | — | ||
| ACT-015848 | Outreach suppressed pending steward Outreach | CLM-429148 (Bobby Ramos) held until CASE-002404 is decided |
| Held | — | ||
| ACT-015849 | Outreach suppressed pending steward Outreach | CLM-410548 (Danielle Ford) held until CASE-002405 is decided |
| Held | — | ||
| ACT-015850 | Outreach suppressed pending steward Outreach | TPA-57130 (Andrea Collins) held until CASE-002406 is decided |
| Held | — | ||
| ACT-015851 | Outreach suppressed pending steward Outreach | TPA-63990 (Jason Bailey) held until CASE-002407 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.