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-016052 | Outreach suppressed pending steward Outreach | CLM-401763 (Nicholas Wilson) held until CASE-002608 is decided |
| Held | — | ||
| ACT-016053 | Outreach suppressed pending steward Outreach | ENR-102313 (Nicholas Wilson) held until CASE-002609 is decided |
| Held | — | ||
| ACT-016054 | Outreach suppressed pending steward Outreach | CLM-429568 (Christopher Wilson) held until CASE-002610 is decided |
| Held | — | ||
| ACT-016055 | Outreach suppressed pending steward Outreach | TPA-60500 (Lauren Johnston) held until CASE-002611 is decided |
| Held | — | ||
| ACT-016056 | Outreach suppressed pending steward Outreach | TPA-59143 (Emily Jones) held until CASE-002612 is decided |
| Held | — | ||
| ACT-016057 | Outreach suppressed pending steward Outreach | TPA-60926 (Keith Silva) held until CASE-002613 is decided |
| Held | — | ||
| ACT-016058 | Outreach suppressed pending steward Outreach | CLM-417290 (Jacob Russell) held until CASE-002614 is decided |
| Held | — | ||
| ACT-016059 | Outreach suppressed pending steward Outreach | CLM-425903 (Megan Aguilar) held until CASE-002615 is decided |
| Held | — | ||
| ACT-016060 | Outreach suppressed pending steward Outreach | TPA-59807 (Lauren Chen) held until CASE-002616 is decided |
| Held | — | ||
| ACT-016061 | Outreach suppressed pending steward Outreach | TPA-63445 (Juan Munoz) held until CASE-002617 is decided |
| Held | — | ||
| ACT-016062 | Outreach suppressed pending steward Outreach | CLM-430452 (Juan Munoz) held until CASE-002618 is decided |
| Held | — | ||
| ACT-016063 | Outreach suppressed pending steward Outreach | ENR-136822 (Michael Munoz) held until CASE-002619 is decided |
| Held | — | ||
| ACT-016064 | Outreach suppressed pending steward Outreach | CLM-416860 (Amber Jackson) held until CASE-002620 is decided |
| Held | — | ||
| ACT-016065 | Outreach suppressed pending steward Outreach | ENR-120295 (Carolyn Schultz) held until CASE-002621 is decided |
| Held | — | ||
| ACT-016066 | Outreach suppressed pending steward Outreach | CLM-415411 (Carolyn Schultz) held until CASE-002622 is decided |
| Held | — | ||
| ACT-016067 | Outreach suppressed pending steward Outreach | PRV-27695 (Emily Lucas) held until CASE-002623 is decided |
| Held | — | ||
| ACT-016068 | Outreach suppressed pending steward Outreach | TPA-63815 (Dorothy Lopez) held until CASE-002624 is decided |
| Held | — | ||
| ACT-016069 | Outreach suppressed pending steward Outreach | ENR-141057 (Dorothy Lopez) held until CASE-002625 is decided |
| Held | — | ||
| ACT-016070 | Outreach suppressed pending steward Outreach | TPA-57243 (Keith Henderson) held until CASE-002626 is decided |
| Held | — | ||
| ACT-016071 | Outreach suppressed pending steward Outreach | TPA-51195 (Joseph Alexander) held until CASE-002627 is decided |
| Held | — | ||
| ACT-016072 | Outreach suppressed pending steward Outreach | TPA-57307 (Beverly Woods) held until CASE-002628 is decided |
| Held | — | ||
| ACT-016073 | Outreach suppressed pending steward Outreach | PRV-28837 (Judy Munoz) held until CASE-002629 is decided |
| Held | — | ||
| ACT-016074 | Outreach suppressed pending steward Outreach | CLM-430171 (Judy Munoz) held until CASE-002630 is decided |
| Held | — | ||
| ACT-016075 | Outreach suppressed pending steward Outreach | TPA-62372 (Lisa Hoffman) held until CASE-002631 is decided |
| Held | — | ||
| ACT-016076 | Outreach suppressed pending steward Outreach | CLM-426445 (Scott Garcia) held until CASE-002632 is decided |
| Held | — | ||
| ACT-016077 | Outreach suppressed pending steward Outreach | TPA-52263 (Brian Fernandez) held until CASE-002633 is decided |
| Held | — | ||
| ACT-016078 | Outreach suppressed pending steward Outreach | CLM-409090 (Jose Espinoza) held until CASE-002634 is decided |
| Held | — | ||
| ACT-016079 | Outreach suppressed pending steward Outreach | CLM-416351 (Yuki Bryant) held until CASE-002635 is decided |
| Held | — | ||
| ACT-016080 | Outreach suppressed pending steward Outreach | TPA-57175 (Yuki Bryant) held until CASE-002636 is decided |
| Held | — | ||
| ACT-016081 | Outreach suppressed pending steward Outreach | PRV-20507 (Bryan Mitchell) held until CASE-002637 is decided |
| Held | — | ||
| ACT-016082 | Outreach suppressed pending steward Outreach | PRV-20506 (Bryan Mitchell) held until CASE-002638 is decided |
| Held | — | ||
| ACT-016083 | Outreach suppressed pending steward Outreach | ENR-111118 (Arjun Vega) held until CASE-002639 is decided |
| Held | — | ||
| ACT-016084 | Outreach suppressed pending steward Outreach | PRV-25183 (Daniel Mendez) held until CASE-002640 is decided |
| Held | — | ||
| ACT-016085 | Outreach suppressed pending steward Outreach | CLM-411947 (Elijah Wood) held until CASE-002641 is decided |
| Held | — | ||
| ACT-016086 | Outreach suppressed pending steward Outreach | TPA-50903 (Philip White) held until CASE-002642 is decided |
| Held | — | ||
| ACT-016087 | Outreach suppressed pending steward Outreach | TPA-57293 (Evelyn Baker) held until CASE-002643 is decided |
| Held | — | ||
| ACT-016088 | Outreach suppressed pending steward Outreach | TPA-56410 (Paul Cooper) held until CASE-002644 is decided |
| Held | — | ||
| ACT-016089 | Outreach suppressed pending steward Outreach | TPA-62793 (Priya Rios) held until CASE-002645 is decided |
| Held | — | ||
| ACT-016090 | Outreach suppressed pending steward Outreach | PRV-27898 (Kathryn Thompson) held until CASE-002646 is decided |
| Held | — | ||
| ACT-016091 | Outreach suppressed pending steward Outreach | PRV-20733 (Julia Ortega) held until CASE-002647 is decided |
| Held | — | ||
| ACT-016092 | Outreach suppressed pending steward Outreach | CLM-402512 (Julia Ortega) held until CASE-002648 is decided |
| Held | — | ||
| ACT-016093 | Outreach suppressed pending steward Outreach | PRV-20734 (Julia Ortega) held until CASE-002649 is decided |
| Held | — | ||
| ACT-016094 | Outreach suppressed pending steward Outreach | TPA-58182 (Mei Cunningham) held until CASE-002650 is decided |
| Held | — | ||
| ACT-016095 | Outreach suppressed pending steward Outreach | CLM-428013 (Emily Sullivan) held until CASE-002651 is decided |
| Held | — | ||
| ACT-016096 | Outreach suppressed pending steward Outreach | TPA-62370 (Emily Sullivan) held until CASE-002652 is decided |
| Held | — | ||
| ACT-016097 | Outreach suppressed pending steward Outreach | CLM-402315 (Laura Alvarado) held until CASE-002653 is decided |
| Held | — | ||
| ACT-016098 | Outreach suppressed pending steward Outreach | CLM-408706 (Theresa Porter) held until CASE-002654 is decided |
| Held | — | ||
| ACT-016099 | Outreach suppressed pending steward Outreach | ENR-111472 (Theresa Porter) held until CASE-002655 is decided |
| Held | — | ||
| ACT-016100 | Outreach suppressed pending steward Outreach | TPA-51257 (Elijah Porter) held until CASE-002656 is decided |
| Held | — | ||
| ACT-016101 | Outreach suppressed pending steward Outreach | PRV-28255 (Logan Larson) held until CASE-002657 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.