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-015902 | Outreach suppressed pending steward Outreach | ENR-117810 (Gerald Gordon) held until CASE-002458 is decided |
| Held | — | ||
| ACT-015903 | Outreach suppressed pending steward Outreach | CLM-413614 (Gerald Gordon) held until CASE-002459 is decided |
| Held | — | ||
| ACT-015904 | Outreach suppressed pending steward Outreach | TPA-52757 (William Stewart) held until CASE-002460 is decided |
| Held | — | ||
| ACT-015905 | Outreach suppressed pending steward Outreach | TPA-52597 (Deborah Baker) held until CASE-002461 is decided |
| Held | — | ||
| ACT-015906 | Outreach suppressed pending steward Outreach | TPA-52136 (Zachary Simpson) held until CASE-002462 is decided |
| Held | — | ||
| ACT-015907 | Outreach suppressed pending steward Outreach | TPA-60442 (Jacqueline Daniels) held until CASE-002463 is decided |
| Held | — | ||
| ACT-015908 | Outreach suppressed pending steward Outreach | CLM-431672 (Jaackie Singh) held until CASE-002464 is decided |
| Held | — | ||
| ACT-015909 | Outreach suppressed pending steward Outreach | ENR-114172 (Jacob Lucas) held until CASE-002465 is decided |
| Held | — | ||
| ACT-015910 | Outreach suppressed pending steward Outreach | CLM-410793 (Jacob Lucas) held until CASE-002466 is decided |
| Held | — | ||
| ACT-015911 | Outreach suppressed pending steward Outreach | PRV-25473 (Kayla Brooks) held until CASE-002467 is decided |
| Held | — | ||
| ACT-015912 | Outreach suppressed pending steward Outreach | ENR-100734 (Scott Stephens) held until CASE-002468 is decided |
| Held | — | ||
| ACT-015913 | Outreach suppressed pending steward Outreach | TPA-50242 (Scott Stephens) held until CASE-002469 is decided |
| Held | — | ||
| ACT-015914 | Outreach suppressed pending steward Outreach | PRV-28660 (Stevens Zachary) held until CASE-002470 is decided |
| Held | — | ||
| ACT-015915 | Outreach suppressed pending steward Outreach | TPA-55492 (Jonathan Morgan) held until CASE-002471 is decided |
| Held | — | ||
| ACT-015916 | Outreach suppressed pending steward Outreach | CLM-424826 (Dennis Thompson) held until CASE-002472 is decided |
| Held | — | ||
| ACT-015917 | Outreach suppressed pending steward Outreach | CLM-415676 (Shirley Chavez) held until CASE-002473 is decided |
| Held | — | ||
| ACT-015918 | Outreach suppressed pending steward Outreach | CLM-415680 (Shirley Chavez) held until CASE-002474 is decided |
| Held | — | ||
| ACT-015919 | Outreach suppressed pending steward Outreach | CLM-415678 (Shirley Chavez) held until CASE-002475 is decided |
| Held | — | ||
| ACT-015920 | Outreach suppressed pending steward Outreach | TPA-60252 (Thomas Gibson) held until CASE-002476 is decided |
| Held | — | ||
| ACT-015921 | Outreach suppressed pending steward Outreach | ENR-119938 (Mariana Morrison) held until CASE-002477 is decided |
| Held | — | ||
| ACT-015922 | Outreach suppressed pending steward Outreach | CLM-415142 (Mariana Morrison) held until CASE-002478 is decided |
| Held | — | ||
| ACT-015923 | Outreach suppressed pending steward Outreach | ENR-130875 (Palu Morgan) held until CASE-002479 is decided |
| Held | — | ||
| ACT-015924 | Outreach suppressed pending steward Outreach | PRV-26950 (Paul Morgan) held until CASE-002480 is decided |
| Held | — | ||
| ACT-015925 | Outreach suppressed pending steward Outreach | ENR-133970 (Isabella Ferguson) held until CASE-002481 is decided |
| Held | — | ||
| ACT-015926 | Outreach suppressed pending steward Outreach | CLM-426665 (Roger Banks) held until CASE-002482 is decided |
| Held | — | ||
| ACT-015927 | Outreach suppressed pending steward Outreach | TPA-53765 (Olivia Banks) held until CASE-002483 is decided |
| Held | — | ||
| ACT-015928 | Outreach suppressed pending steward Outreach | ENR-111288 (Olivia Banks) held until CASE-002484 is decided |
| Held | — | ||
| ACT-015929 | Outreach suppressed pending steward Outreach | ENR-108259 (Kathryn Lawson) held until CASE-002485 is decided |
| Held | — | ||
| ACT-015930 | Outreach suppressed pending steward Outreach | TPA-52786 (Kathryn Lawson) held until CASE-002486 is decided |
| Held | — | ||
| ACT-015931 | Outreach suppressed pending steward Outreach | TPA-60554 (Luis Hunt) held until CASE-002487 is decided |
| Held | — | ||
| ACT-015932 | Outreach suppressed pending steward Outreach | TPA-57720 (Santiago Romero) held until CASE-002488 is decided |
| Held | — | ||
| ACT-015933 | Outreach suppressed pending steward Outreach | TPA-64464 (Jennifer Cunningham) held until CASE-002489 is decided |
| Held | — | ||
| ACT-015934 | Outreach suppressed pending steward Outreach | TPA-52213 (Donna Torres) held until CASE-002490 is decided |
| Held | — | ||
| ACT-015935 | Outreach suppressed pending steward Outreach | CLM-405066 (Donna Torres) held until CASE-002491 is decided |
| Held | — | ||
| ACT-015936 | Outreach suppressed pending steward Outreach | CLM-403594 (Harold Adams) held until CASE-002492 is decided |
| Held | — | ||
| ACT-015937 | Outreach suppressed pending steward Outreach | ENR-122226 (Amber Hudson) held until CASE-002493 is decided |
| Held | — | ||
| ACT-015938 | Outreach suppressed pending steward Outreach | PRV-25010 (Amber Hudson) held until CASE-002494 is decided |
| Held | — | ||
| ACT-015939 | Outreach suppressed pending steward Outreach | TPA-51536 (Jakc Gibson) held until CASE-002495 is decided |
| Held | — | ||
| ACT-015940 | Outreach suppressed pending steward Outreach | CLM-403526 (Jack Gibson) held until CASE-002496 is decided |
| Held | — | ||
| ACT-015941 | Outreach suppressed pending steward Outreach | CLM-416230 (Larry Richardson) held until CASE-002497 is decided |
| Held | — | ||
| ACT-015942 | Outreach suppressed pending steward Outreach | PRV-24158 (Wei Moore) held until CASE-002498 is decided |
| Held | — | ||
| ACT-015943 | Outreach suppressed pending steward Outreach | ENR-118717 (Wei Moore) held until CASE-002499 is decided |
| Held | — | ||
| ACT-015944 | Outreach suppressed pending steward Outreach | CLM-421733 (Mason Murray) held until CASE-002500 is decided |
| Held | — | ||
| ACT-015945 | Outreach suppressed pending steward Outreach | TPA-59547 (Mason Murray) held until CASE-002501 is decided |
| Held | — | ||
| ACT-015946 | Outreach suppressed pending steward Outreach | CLM-402645 (Roy Payne) held until CASE-002502 is decided |
| Held | — | ||
| ACT-015947 | Outreach suppressed pending steward Outreach | CLM-416058 (Grcae Burns) held until CASE-002503 is decided |
| Held | — | ||
| ACT-015948 | Outreach suppressed pending steward Outreach | ENR-121130 (Grace Burns) held until CASE-002504 is decided |
| Held | — | ||
| ACT-015949 | Outreach suppressed pending steward Outreach | CLM-428668 (Vincent Jordan) held until CASE-002505 is decided |
| Held | — | ||
| ACT-015950 | Outreach suppressed pending steward Outreach | TPA-62677 (Vincent Jordan) held until CASE-002506 is decided |
| Held | — | ||
| ACT-015951 | Outreach suppressed pending steward Outreach | ENR-128084 (Tiimothy Hicks) held until CASE-002507 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.