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-015852 | Outreach suppressed pending steward Outreach | CLM-432637 (Joan Silva) held until CASE-002408 is decided |
| Held | — | ||
| ACT-015853 | Outreach suppressed pending steward Outreach | TPA-64391 (Joan Silva) held until CASE-002409 is decided |
| Held | — | ||
| ACT-015854 | Outreach suppressed pending steward Outreach | TPA-63946 (Andrea Silva) held until CASE-002410 is decided |
| Held | — | ||
| ACT-015855 | Outreach suppressed pending steward Outreach | PRV-29236 (Andrea Silva) held until CASE-002411 is decided |
| Held | — | ||
| ACT-015856 | Outreach suppressed pending steward Outreach | CLM-419069 (Christine Banks) held until CASE-002412 is decided |
| Held | — | ||
| ACT-015857 | Outreach suppressed pending steward Outreach | TPA-59049 (Bryan Ryan) held until CASE-002413 is decided |
| Held | — | ||
| ACT-015858 | Outreach suppressed pending steward Outreach | ENR-114303 (Joseph Watkins) held until CASE-002414 is decided |
| Held | — | ||
| ACT-015859 | Outreach suppressed pending steward Outreach | CLM-410912 (Joseph Watkins) held until CASE-002415 is decided |
| Held | — | ||
| ACT-015860 | Outreach suppressed pending steward Outreach | CLM-407623 (William McDonald) held until CASE-002416 is decided |
| Held | — | ||
| ACT-015861 | Outreach suppressed pending steward Outreach | CLM-407622 (William McDonald) held until CASE-002417 is decided |
| Held | — | ||
| ACT-015862 | Outreach suppressed pending steward Outreach | ENR-119741 (Eugene Moreno) held until CASE-002418 is decided |
| Held | — | ||
| ACT-015863 | Outreach suppressed pending steward Outreach | PRV-24395 (Eugene Moreno) held until CASE-002419 is decided |
| Held | — | ||
| ACT-015864 | Outreach suppressed pending steward Outreach | CLM-431181 (Debra Bennett) held until CASE-002420 is decided |
| Held | — | ||
| ACT-015865 | Outreach suppressed pending steward Outreach | TPA-63780 (Deebra Bennett) held until CASE-002421 is decided |
| Held | — | ||
| ACT-015866 | Outreach suppressed pending steward Outreach | TPA-63779 (Debra Bennett) held until CASE-002422 is decided |
| Held | — | ||
| ACT-015867 | Outreach suppressed pending steward Outreach | ENR-122509 (Nicole Owens) held until CASE-002423 is decided |
| Held | — | ||
| ACT-015868 | Outreach suppressed pending steward Outreach | CLM-432158 (Amber Greene) held until CASE-002424 is decided |
| Held | — | ||
| ACT-015869 | Outreach suppressed pending steward Outreach | CLM-400460 (Julia Obrien) held until CASE-002425 is decided |
| Held | — | ||
| ACT-015870 | Outreach suppressed pending steward Outreach | TPA-51202 (Luis Wallace) held until CASE-002426 is decided |
| Held | — | ||
| ACT-015871 | Outreach suppressed pending steward Outreach | CLM-419401 (Edward Green) held until CASE-002427 is decided |
| Held | — | ||
| ACT-015872 | Outreach suppressed pending steward Outreach | ENR-125559 (Edward Green) held until CASE-002428 is decided |
| Held | — | ||
| ACT-015873 | Outreach suppressed pending steward Outreach | CLM-402103 (Laura Rojas) held until CASE-002429 is decided |
| Held | — | ||
| ACT-015874 | Outreach suppressed pending steward Outreach | TPA-62207 (Jordan Banks) held until CASE-002430 is decided |
| Held | — | ||
| ACT-015875 | Outreach suppressed pending steward Outreach | TPA-62208 (Jordan Banks) held until CASE-002431 is decided |
| Held | — | ||
| ACT-015876 | Outreach suppressed pending steward Outreach | TPA-63264 (Billy Medina) held until CASE-002432 is decided |
| Held | — | ||
| ACT-015877 | Outreach suppressed pending steward Outreach | CLM-429870 (Austin Contreras) held until CASE-002433 is decided |
| Held | — | ||
| ACT-015878 | Outreach suppressed pending steward Outreach | CLM-405929 (Julie Peters) held until CASE-002434 is decided |
| Held | — | ||
| ACT-015879 | Outreach suppressed pending steward Outreach | TPA-61546 (Ryan Gibson) held until CASE-002435 is decided |
| Held | — | ||
| ACT-015880 | Outreach suppressed pending steward Outreach | TPA-60868 (Dorothhy Fox) held until CASE-002436 is decided |
| Held | — | ||
| ACT-015881 | Outreach suppressed pending steward Outreach | TPA-60867 (Doorthy Fox) held until CASE-002437 is decided |
| Held | — | ||
| ACT-015882 | Outreach suppressed pending steward Outreach | TPA-54698 (Evelyn Williams) held until CASE-002438 is decided |
| Held | — | ||
| ACT-015883 | Outreach suppressed pending steward Outreach | PRV-20029 (Nancy Morrison) held until CASE-002439 is decided |
| Held | — | ||
| ACT-015884 | Outreach suppressed pending steward Outreach | TPA-51511 (Sharon Boyd) held until CASE-002440 is decided |
| Held | — | ||
| ACT-015885 | Outreach suppressed pending steward Outreach | TPA-60307 (Aaron Dominguez) held until CASE-002441 is decided |
| Held | — | ||
| ACT-015886 | Outreach suppressed pending steward Outreach | ENR-130632 (Aaron Dominguez) held until CASE-002442 is decided |
| Held | — | ||
| ACT-015887 | Outreach suppressed pending steward Outreach | CLM-401152 (Deborah Dominguez) held until CASE-002443 is decided |
| Held | — | ||
| ACT-015888 | Outreach suppressed pending steward Outreach | CLM-411982 (Christian Fuller) held until CASE-002444 is decided |
| Held | — | ||
| ACT-015889 | Outreach suppressed pending steward Outreach | CLM-418194 (Peter Santiago) held until CASE-002445 is decided |
| Held | — | ||
| ACT-015890 | Outreach suppressed pending steward Outreach | ENR-117993 (Ruth Johnson) held until CASE-002446 is decided |
| Held | — | ||
| ACT-015891 | Outreach suppressed pending steward Outreach | CLM-431248 (Katherine Jenkins) held until CASE-002447 is decided |
| Held | — | ||
| ACT-015892 | Outreach suppressed pending steward Outreach | CLM-419001 (Daniel Johnson) held until CASE-002448 is decided |
| Held | — | ||
| ACT-015893 | Outreach suppressed pending steward Outreach | TPA-58426 (Danny Johnson) held until CASE-002449 is decided |
| Held | — | ||
| ACT-015894 | Outreach suppressed pending steward Outreach | PRV-27518 (Aaron Watkins) held until CASE-002450 is decided |
| Held | — | ||
| ACT-015895 | Outreach suppressed pending steward Outreach | TPA-55389 (Melissa Mendez) held until CASE-002451 is decided |
| Held | — | ||
| ACT-015896 | Outreach suppressed pending steward Outreach | CLM-412232 (Melissa Mendez) held until CASE-002452 is decided |
| Held | — | ||
| ACT-015897 | Outreach suppressed pending steward Outreach | CLM-413077 (Cheryl Ray) held until CASE-002453 is decided |
| Held | — | ||
| ACT-015898 | Outreach suppressed pending steward Outreach | CLM-411260 (Evelyn Castro) held until CASE-002454 is decided |
| Held | — | ||
| ACT-015899 | Outreach suppressed pending steward Outreach | PRV-24347 (Christine Garcia) held until CASE-002455 is decided |
| Held | — | ||
| ACT-015900 | Outreach suppressed pending steward Outreach | CLM-417589 (Andrea Le) held until CASE-002456 is decided |
| Held | — | ||
| ACT-015901 | Outreach suppressed pending steward Outreach | CLM-421745 (Donadl Fowleer) held until CASE-002457 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.