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-016102 | Outreach suppressed pending steward Outreach | TPA-63623 (Linda Duncan) held until CASE-002658 is decided |
| Held | — | ||
| ACT-016103 | Outreach suppressed pending steward Outreach | PRV-29019 (Linda Duncan) held until CASE-002659 is decided |
| Held | — | ||
| ACT-016104 | Outreach suppressed pending steward Outreach | TPA-59532 (Laura Ellis) held until CASE-002660 is decided |
| Held | — | ||
| ACT-016105 | Outreach suppressed pending steward Outreach | TPA-58790 (Wayne Davis) held until CASE-002661 is decided |
| Held | — | ||
| ACT-016106 | Outreach suppressed pending steward Outreach | TPA-53729 (Margaret Obrien) held until CASE-002662 is decided |
| Held | — | ||
| ACT-016107 | Outreach suppressed pending steward Outreach | ENR-111183 (Margaret Obrien) held until CASE-002663 is decided |
| Held | — | ||
| ACT-016108 | Outreach suppressed pending steward Outreach | TPA-58151 (Jordan Gilbert) held until CASE-002664 is decided |
| Held | — | ||
| ACT-016109 | Outreach suppressed pending steward Outreach | TPA-58152 (Jordan Gilbert) held until CASE-002665 is decided |
| Held | — | ||
| ACT-016110 | Outreach suppressed pending steward Outreach | ENR-103317 (Joyce Martin) held until CASE-002666 is decided |
| Held | — | ||
| ACT-016111 | Outreach suppressed pending steward Outreach | TPA-50544 (Karen Martinez) held until CASE-002667 is decided |
| Held | — | ||
| ACT-016112 | Outreach suppressed pending steward Outreach | TPA-50545 (Karen Martinez) held until CASE-002668 is decided |
| Held | — | ||
| ACT-016113 | Outreach suppressed pending steward Outreach | PRV-27256 (Andrew Vargas) held until CASE-002669 is decided |
| Held | — | ||
| ACT-016114 | Outreach suppressed pending steward Outreach | ENR-132234 (Andrew Vargas) held until CASE-002670 is decided |
| Held | — | ||
| ACT-016115 | Outreach suppressed pending steward Outreach | PRV-28698 (Charles Hunter) held until CASE-002671 is decided |
| Held | — | ||
| ACT-016116 | Outreach suppressed pending steward Outreach | ENR-138968 (Charles Hunter) held until CASE-002672 is decided |
| Held | — | ||
| ACT-016117 | Outreach suppressed pending steward Outreach | CLM-428985 (Harold Hall) held until CASE-002673 is decided |
| Held | — | ||
| ACT-016118 | Outreach suppressed pending steward Outreach | CLM-426338 (Roy Campbell) held until CASE-002674 is decided |
| Held | — | ||
| ACT-016119 | Outreach suppressed pending steward Outreach | ENR-100300 (Gerald Knight) held until CASE-002675 is decided |
| Held | — | ||
| ACT-016120 | Outreach suppressed pending steward Outreach | CLM-400204 (Gerald Knight) held until CASE-002676 is decided |
| Held | — | ||
| ACT-016121 | Outreach suppressed pending steward Outreach | TPA-55256 (Christine Scott) held until CASE-002677 is decided |
| Held | — | ||
| ACT-016122 | Outreach suppressed pending steward Outreach | ENR-104146 (Collins Scoott) held until CASE-002678 is decided |
| Held | — | ||
| ACT-016123 | Outreach suppressed pending steward Outreach | TPA-53207 (Ann Washington) held until CASE-002679 is decided |
| Held | — | ||
| ACT-016124 | Outreach suppressed pending steward Outreach | CLM-421906 (Stephanie Campbell) held until CASE-002680 is decided |
| Held | — | ||
| ACT-016125 | Outreach suppressed pending steward Outreach | CLM-413842 (Jonathan Nguyen) held until CASE-002681 is decided |
| Held | — | ||
| ACT-016126 | Outreach suppressed pending steward Outreach | ENR-118100 (Jonathan Nguyen) held until CASE-002682 is decided |
| Held | — | ||
| ACT-016127 | Outreach suppressed pending steward Outreach | TPA-57112 (Larry Richardson) held until CASE-002683 is decided |
| Held | — | ||
| ACT-016128 | Outreach suppressed pending steward Outreach | PRV-28290 (Edward Jenkins) held until CASE-002684 is decided |
| Held | — | ||
| ACT-016129 | Outreach suppressed pending steward Outreach | CLM-415237 (Martha Ferguson) held until CASE-002685 is decided |
| Held | — | ||
| ACT-016130 | Outreach suppressed pending steward Outreach | CLM-411274 (Diego George) held until CASE-002686 is decided |
| Held | — | ||
| ACT-016131 | Outreach suppressed pending steward Outreach | TPA-56873 (Mason Wong) held until CASE-002687 is decided |
| Held | — | ||
| ACT-016132 | Outreach suppressed pending steward Outreach | ENR-128673 (Julie Carroll) held until CASE-002688 is decided |
| Held | — | ||
| ACT-016133 | Outreach suppressed pending steward Outreach | TPA-59615 (Julie Carroll) held until CASE-002689 is decided |
| Held | — | ||
| ACT-016134 | Outreach suppressed pending steward Outreach | CLM-423205 (Keith Griffin) held until CASE-002690 is decided |
| Held | — | ||
| ACT-016135 | Outreach suppressed pending steward Outreach | TPA-62620 (Nathan Bryannt) held until CASE-002691 is decided |
| Held | — | ||
| ACT-016136 | Outreach suppressed pending steward Outreach | TPA-51899 (Pamela Harvey) held until CASE-002692 is decided |
| Held | — | ||
| ACT-016137 | Outreach suppressed pending steward Outreach | CLM-404357 (Pamela Harvey) held until CASE-002693 is decided |
| Held | — | ||
| ACT-016138 | Outreach suppressed pending steward Outreach | TPA-63842 (Carl Sims) held until CASE-002694 is decided |
| Held | — | ||
| ACT-016139 | Outreach suppressed pending steward Outreach | ENR-116385 (Nathan Hanson) held until CASE-002695 is decided |
| Held | — | ||
| ACT-016140 | Outreach suppressed pending steward Outreach | TPA-55483 (Nathan Hanson) held until CASE-002696 is decided |
| Held | — | ||
| ACT-016141 | Outreach suppressed pending steward Outreach | PRV-25145 (Roger Edwards) held until CASE-002697 is decided |
| Held | — | ||
| ACT-016142 | Outreach suppressed pending steward Outreach | CLM-419821 (Kyle Garrett) held until CASE-002698 is decided |
| Held | — | ||
| ACT-016143 | Outreach suppressed pending steward Outreach | ENR-133284 (Kayla Turner) held until CASE-002699 is decided |
| Held | — | ||
| ACT-016144 | Outreach suppressed pending steward Outreach | PRV-27497 (Kayla Turner) held until CASE-002700 is decided |
| Held | — | ||
| ACT-016145 | Outreach suppressed pending steward Outreach | CLM-419389 (Shirley Gutierrez) held until CASE-002701 is decided |
| Held | — | ||
| ACT-016146 | Outreach suppressed pending steward Outreach | CLM-431785 (Christina Howard) held until CASE-002702 is decided |
| Held | — | ||
| ACT-016147 | Outreach suppressed pending steward Outreach | ENR-141693 (Christina Howard) held until CASE-002703 is decided |
| Held | — | ||
| ACT-016148 | Outreach suppressed pending steward Outreach | ENR-103909 (Aaron Hernandez) held until CASE-002704 is decided |
| Held | — | ||
| ACT-016149 | Outreach suppressed pending steward Outreach | CLM-403021 (Aaron Hernandez) held until CASE-002705 is decided |
| Held | — | ||
| ACT-016150 | Outreach suppressed pending steward Outreach | CLM-420739 (Sara Carpenter) held until CASE-002706 is decided |
| Held | — | ||
| ACT-016151 | Outreach suppressed pending steward Outreach | ENR-127265 (Sara Carpenter) held until CASE-002707 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.