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-015952 | Outreach suppressed pending steward Outreach | TPA-59427 (Timothy Hicks) held until CASE-002508 is decided |
| Held | — | ||
| ACT-015953 | Outreach suppressed pending steward Outreach | CLM-423252 (Peter Patterson) held until CASE-002509 is decided |
| Held | — | ||
| ACT-015954 | Outreach suppressed pending steward Outreach | ENR-130406 (Peter Patterson) held until CASE-002510 is decided |
| Held | — | ||
| ACT-015955 | Outreach suppressed pending steward Outreach | ENR-126806 (Ronald Espinoza) held until CASE-002511 is decided |
| Held | — | ||
| ACT-015956 | Outreach suppressed pending steward Outreach | CLM-420384 (Ronald Espinoza) held until CASE-002512 is decided |
| Held | — | ||
| ACT-015957 | Outreach suppressed pending steward Outreach | TPA-51299 (Ethan Kennedy) held until CASE-002513 is decided |
| Held | — | ||
| ACT-015958 | Outreach suppressed pending steward Outreach | ENR-103940 (Ethan Kennedy) held until CASE-002514 is decided |
| Held | — | ||
| ACT-015959 | Outreach suppressed pending steward Outreach | ENR-124614 (Martha Bennett) held until CASE-002515 is decided |
| Held | — | ||
| ACT-015960 | Outreach suppressed pending steward Outreach | TPA-58270 (Martha Bennett) held until CASE-002516 is decided |
| Held | — | ||
| ACT-015961 | Outreach suppressed pending steward Outreach | TPA-58271 (Martha Bennett) held until CASE-002517 is decided |
| Held | — | ||
| ACT-015962 | Outreach suppressed pending steward Outreach | ENR-133222 (Wayne Bennett) held until CASE-002518 is decided |
| Held | — | ||
| ACT-015963 | Outreach suppressed pending steward Outreach | ENR-103278 (Jason Garza) held until CASE-002519 is decided |
| Held | — | ||
| ACT-015964 | Outreach suppressed pending steward Outreach | PRV-20743 (Jason Garza) held until CASE-002520 is decided |
| Held | — | ||
| ACT-015965 | Outreach suppressed pending steward Outreach | TPA-51091 (Jazon Garza) held until CASE-002521 is decided |
| Held | — | ||
| ACT-015966 | Outreach suppressed pending steward Outreach | PRV-20745 (Kelly Carter) held until CASE-002522 is decided |
| Held | — | ||
| ACT-015967 | Outreach suppressed pending steward Outreach | PRV-21952 (William Vasquez) held until CASE-002523 is decided |
| Held | — | ||
| ACT-015968 | Outreach suppressed pending steward Outreach | CLM-402509 (Olivia Vasquez) held until CASE-002524 is decided |
| Held | — | ||
| ACT-015969 | Outreach suppressed pending steward Outreach | TPA-53348 (Sofia Castro) held until CASE-002525 is decided |
| Held | — | ||
| ACT-015970 | Outreach suppressed pending steward Outreach | CLM-410392 (Jeffrey Matthews) held until CASE-002526 is decided |
| Held | — | ||
| ACT-015971 | Outreach suppressed pending steward Outreach | ENR-113656 (Jeffrey Matthews) held until CASE-002527 is decided |
| Held | — | ||
| ACT-015972 | Outreach suppressed pending steward Outreach | CLM-423127 (Arthur Anderson) held until CASE-002528 is decided |
| Held | — | ||
| ACT-015973 | Outreach suppressed pending steward Outreach | TPA-54795 (Lawrence Ortega) held until CASE-002529 is decided |
| Held | — | ||
| ACT-015974 | Outreach suppressed pending steward Outreach | CLM-427945 (Nicholas Garcia) held until CASE-002530 is decided |
| Held | — | ||
| ACT-015975 | Outreach suppressed pending steward Outreach | ENR-134138 (Marcus Singh) held until CASE-002531 is decided |
| Held | — | ||
| ACT-015976 | Outreach suppressed pending steward Outreach | CLM-426071 (Markus Singh) held until CASE-002532 is decided |
| Held | — | ||
| ACT-015977 | Outreach suppressed pending steward Outreach | CLM-412724 (Cheryl Carr) held until CASE-002533 is decided |
| Held | — | ||
| ACT-015978 | Outreach suppressed pending steward Outreach | ENR-116715 (Cheryl Carr) held until CASE-002534 is decided |
| Held | — | ||
| ACT-015979 | Outreach suppressed pending steward Outreach | CLM-414662 (Sue Carr) held until CASE-002535 is decided |
| Held | — | ||
| ACT-015980 | Outreach suppressed pending steward Outreach | ENR-105110 (Albert Patel) held until CASE-002536 is decided |
| Held | — | ||
| ACT-015981 | Outreach suppressed pending steward Outreach | TPA-51702 (Albert Patel) held until CASE-002537 is decided |
| Held | — | ||
| ACT-015982 | Outreach suppressed pending steward Outreach | TPA-51778 (Beverly Fuller) held until CASE-002538 is decided |
| Held | — | ||
| ACT-015983 | Outreach suppressed pending steward Outreach | TPA-51777 (Beverly Fuller) held until CASE-002539 is decided |
| Held | — | ||
| ACT-015984 | Outreach suppressed pending steward Outreach | CLM-405010 (Richard Morgan) held until CASE-002540 is decided |
| Held | — | ||
| ACT-015985 | Outreach suppressed pending steward Outreach | TPA-53995 (Kelly Bailye) held until CASE-002541 is decided |
| Held | — | ||
| ACT-015986 | Outreach suppressed pending steward Outreach | CLM-402151 (Henry Montgomery) held until CASE-002542 is decided |
| Held | — | ||
| ACT-015987 | Outreach suppressed pending steward Outreach | ENR-102741 (Henry Montgomery) held until CASE-002543 is decided |
| Held | — | ||
| ACT-015988 | Outreach suppressed pending steward Outreach | TPA-55407 (Alice Gomez) held until CASE-002544 is decided |
| Held | — | ||
| ACT-015989 | Outreach suppressed pending steward Outreach | TPA-55406 (Alice Gomez) held until CASE-002545 is decided |
| Held | — | ||
| ACT-015990 | Outreach suppressed pending steward Outreach | CLM-400099 (Joseph Simpson) held until CASE-002546 is decided |
| Held | — | ||
| ACT-015991 | Outreach suppressed pending steward Outreach | CLM-421276 (Janet Brown) held until CASE-002547 is decided |
| Held | — | ||
| ACT-015992 | Outreach suppressed pending steward Outreach | PRV-24875 (Priya Brown) held until CASE-002548 is decided |
| Held | — | ||
| ACT-015993 | Outreach suppressed pending steward Outreach | ENR-103171 (Karen Simspon) held until CASE-002549 is decided |
| Held | — | ||
| ACT-015994 | Outreach suppressed pending steward Outreach | ENR-138936 (Brandon West) held until CASE-002550 is decided |
| Held | — | ||
| ACT-015995 | Outreach suppressed pending steward Outreach | CLM-430727 (Janice West) held until CASE-002551 is decided |
| Held | — | ||
| ACT-015996 | Outreach suppressed pending steward Outreach | CLM-407323 (Jean Black) held until CASE-002552 is decided |
| Held | — | ||
| ACT-015997 | Outreach suppressed pending steward Outreach | CLM-424686 (Teresa Johnson) held until CASE-002553 is decided |
| Held | — | ||
| ACT-015998 | Outreach suppressed pending steward Outreach | TPA-51136 (Amy Murray) held until CASE-002554 is decided |
| Held | — | ||
| ACT-015999 | Outreach suppressed pending steward Outreach | CLM-424275 (Charlees Murray) held until CASE-002555 is decided |
| Held | — | ||
| ACT-016000 | Outreach suppressed pending steward Outreach | TPA-60264 (Harold Ramirez) held until CASE-002556 is decided |
| Held | — | ||
| ACT-016001 | Outreach suppressed pending steward Outreach | TPA-58046 (Isabella Harper) held until CASE-002557 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.