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-016002 | Outreach suppressed pending steward Outreach | CLM-426403 (Dorothy Alexander) held until CASE-002558 is decided |
| Held | — | ||
| ACT-016003 | Outreach suppressed pending steward Outreach | CLM-419677 (Abigail Armstrong) held until CASE-002559 is decided |
| Held | — | ||
| ACT-016004 | Outreach suppressed pending steward Outreach | TPA-52657 (Zachary Romero) held until CASE-002560 is decided |
| Held | — | ||
| ACT-016005 | Outreach suppressed pending steward Outreach | TPA-57734 (Judy Vega) held until CASE-002561 is decided |
| Held | — | ||
| ACT-016006 | Outreach suppressed pending steward Outreach | ENR-118360 (Arthur Vega) held until CASE-002562 is decided |
| Held | — | ||
| ACT-016007 | Outreach suppressed pending steward Outreach | CLM-414023 (Arthur Vega) held until CASE-002563 is decided |
| Held | — | ||
| ACT-016008 | Outreach suppressed pending steward Outreach | ENR-105658 (Joshua Vega) held until CASE-002564 is decided |
| Held | — | ||
| ACT-016009 | Outreach suppressed pending steward Outreach | TPA-58119 (Michelle Kennedy) held until CASE-002565 is decided |
| Held | — | ||
| ACT-016010 | Outreach suppressed pending steward Outreach | CLM-431381 (Carolyn Payne) held until CASE-002566 is decided |
| Held | — | ||
| ACT-016011 | Outreach suppressed pending steward Outreach | TPA-54027 (Daniel Pena) held until CASE-002567 is decided |
| Held | — | ||
| ACT-016012 | Outreach suppressed pending steward Outreach | CLM-414671 (Frank Walker) held until CASE-002568 is decided |
| Held | — | ||
| ACT-016013 | Outreach suppressed pending steward Outreach | CLM-427245 (Stephen Carter) held until CASE-002569 is decided |
| Held | — | ||
| ACT-016014 | Outreach suppressed pending steward Outreach | TPA-59901 (Ssan Sandoval) held until CASE-002570 is decided |
| Held | — | ||
| ACT-016015 | Outreach suppressed pending steward Outreach | PRV-25904 (Christopher Bishop) held until CASE-002571 is decided |
| Held | — | ||
| ACT-016016 | Outreach suppressed pending steward Outreach | CLM-419883 (Chris Bishop) held until CASE-002572 is decided |
| Held | — | ||
| ACT-016017 | Outreach suppressed pending steward Outreach | CLM-419760 (Mei Moreno) held until CASE-002573 is decided |
| Held | — | ||
| ACT-016018 | Outreach suppressed pending steward Outreach | CLM-404562 (Kathryn Burns) held until CASE-002574 is decided |
| Held | — | ||
| ACT-016019 | Outreach suppressed pending steward Outreach | TPA-64110 (Evelyn Simmons) held until CASE-002575 is decided |
| Held | — | ||
| ACT-016020 | Outreach suppressed pending steward Outreach | ENR-141983 (Evelyn Siimmons) held until CASE-002576 is decided |
| Held | — | ||
| ACT-016021 | Outreach suppressed pending steward Outreach | ENR-120674 (Astin Kennedy) held until CASE-002577 is decided |
| Held | — | ||
| ACT-016022 | Outreach suppressed pending steward Outreach | CLM-403972 (Tyler Wagner) held until CASE-002578 is decided |
| Held | — | ||
| ACT-016023 | Outreach suppressed pending steward Outreach | TPA-62740 (Hannah Santiago) held until CASE-002579 is decided |
| Held | — | ||
| ACT-016024 | Outreach suppressed pending steward Outreach | CLM-428854 (Hannah Santiago) held until CASE-002580 is decided |
| Held | — | ||
| ACT-016025 | Outreach suppressed pending steward Outreach | CLM-432365 (Maria Russell) held until CASE-002581 is decided |
| Held | — | ||
| ACT-016026 | Outreach suppressed pending steward Outreach | CLM-432366 (Maria Russll) held until CASE-002582 is decided |
| Held | — | ||
| ACT-016027 | Outreach suppressed pending steward Outreach | CLM-416055 (Brenda Harper) held until CASE-002583 is decided |
| Held | — | ||
| ACT-016028 | Outreach suppressed pending steward Outreach | TPA-63067 (Luis Nichols) held until CASE-002584 is decided |
| Held | — | ||
| ACT-016029 | Outreach suppressed pending steward Outreach | TPA-63068 (Luis Nichols) held until CASE-002585 is decided |
| Held | — | ||
| ACT-016030 | Outreach suppressed pending steward Outreach | PRV-20380 (Donald Brown) held until CASE-002586 is decided |
| Held | — | ||
| ACT-016031 | Outreach suppressed pending steward Outreach | TPA-62527 (David Hernandez) held until CASE-002587 is decided |
| Held | — | ||
| ACT-016032 | Outreach suppressed pending steward Outreach | TPA-55657 (Jezse Lopez) held until CASE-002588 is decided |
| Held | — | ||
| ACT-016033 | Outreach suppressed pending steward Outreach | ENR-116897 (Jesse Lopez) held until CASE-002589 is decided |
| Held | — | ||
| ACT-016034 | Outreach suppressed pending steward Outreach | CLM-409853 (Denise Stephens) held until CASE-002590 is decided |
| Held | — | ||
| ACT-016035 | Outreach suppressed pending steward Outreach | TPA-52828 (Abigail Vazquez) held until CASE-002591 is decided |
| Held | — | ||
| ACT-016036 | Outreach suppressed pending steward Outreach | PRV-22964 (Bryan Lynch) held until CASE-002592 is decided |
| Held | — | ||
| ACT-016037 | Outreach suppressed pending steward Outreach | ENR-113452 (Bryan Lynch) held until CASE-002593 is decided |
| Held | — | ||
| ACT-016038 | Outreach suppressed pending steward Outreach | CLM-418537 (Samantha Anderson) held until CASE-002594 is decided |
| Held | — | ||
| ACT-016039 | Outreach suppressed pending steward Outreach | TPA-54976 (Cheryl Andrews) held until CASE-002595 is decided |
| Held | — | ||
| ACT-016040 | Outreach suppressed pending steward Outreach | ENR-136119 (Michael Robertson) held until CASE-002596 is decided |
| Held | — | ||
| ACT-016041 | Outreach suppressed pending steward Outreach | PRV-28072 (Michael Robertson) held until CASE-002597 is decided |
| Held | — | ||
| ACT-016042 | Outreach suppressed pending steward Outreach | TPA-60995 (Debrah Luna) held until CASE-002598 is decided |
| Held | — | ||
| ACT-016043 | Outreach suppressed pending steward Outreach | CLM-408971 (Meyer Diego) held until CASE-002599 is decided |
| Held | — | ||
| ACT-016044 | Outreach suppressed pending steward Outreach | ENR-111861 (Diego Meyer) held until CASE-002600 is decided |
| Held | — | ||
| ACT-016045 | Outreach suppressed pending steward Outreach | ENR-142214 (Diane Gordon) held until CASE-002601 is decided |
| Held | — | ||
| ACT-016046 | Outreach suppressed pending steward Outreach | CLM-423387 (Janice Lucas) held until CASE-002602 is decided |
| Held | — | ||
| ACT-016047 | Outreach suppressed pending steward Outreach | TPA-51081 (Larry Powell) held until CASE-002603 is decided |
| Held | — | ||
| ACT-016048 | Outreach suppressed pending steward Outreach | ENR-103259 (Larry Powell) held until CASE-002604 is decided |
| Held | — | ||
| ACT-016049 | Outreach suppressed pending steward Outreach | ENR-110682 (Diego Mason) held until CASE-002605 is decided |
| Held | — | ||
| ACT-016050 | Outreach suppressed pending steward Outreach | PRV-22385 (Diego Mason) held until CASE-002606 is decided |
| Held | — | ||
| ACT-016051 | Outreach suppressed pending steward Outreach | TPA-52947 (Douglas Schultz) held until CASE-002607 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.