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-016152 | Outreach suppressed pending steward Outreach | CLM-413045 (Brandon Kim) held until CASE-002708 is decided |
| Held | — | ||
| ACT-016153 | Outreach suppressed pending steward Outreach | CLM-413044 (Brandon Kim) held until CASE-002709 is decided |
| Held | — | ||
| ACT-016154 | Outreach suppressed pending steward Outreach | CLM-426428 (Arjun Le) held until CASE-002710 is decided |
| Held | — | ||
| ACT-016155 | Outreach suppressed pending steward Outreach | ENR-134651 (Arjun Le) held until CASE-002711 is decided |
| Held | — | ||
| ACT-016156 | Outreach suppressed pending steward Outreach | TPA-59097 (Christopher Lucas) held until CASE-002712 is decided |
| Held | — | ||
| ACT-016157 | Outreach suppressed pending steward Outreach | CLM-429342 (Diana Bishop) held until CASE-002713 is decided |
| Held | — | ||
| ACT-016158 | Outreach suppressed pending steward Outreach | ENR-138503 (Dyana Bishop) held until CASE-002714 is decided |
| Held | — | ||
| ACT-016159 | Outreach suppressed pending steward Outreach | CLM-406686 (Virginia Hoffman) held until CASE-002715 is decided |
| Held | — | ||
| ACT-016160 | Outreach suppressed pending steward Outreach | TPA-50939 (Kimberly Morris) held until CASE-002716 is decided |
| Held | — | ||
| ACT-016161 | Outreach suppressed pending steward Outreach | TPA-50938 (Kimberly Morris) held until CASE-002717 is decided |
| Held | — | ||
| ACT-016162 | Outreach suppressed pending steward Outreach | ENR-140858 (Ahmed Coleman) held until CASE-002718 is decided |
| Held | — | ||
| ACT-016163 | Outreach suppressed pending steward Outreach | CLM-422677 (Sophia Foster) held until CASE-002719 is decided |
| Held | — | ||
| ACT-016164 | Outreach suppressed pending steward Outreach | CLM-426906 (Aaron Vazquez) held until CASE-002720 is decided |
| Held | — | ||
| ACT-016165 | Outreach suppressed pending steward Outreach | ENR-135292 (Aaron Vazquez) held until CASE-002721 is decided |
| Held | — | ||
| ACT-016166 | Outreach suppressed pending steward Outreach | CLM-426210 (Victoria Burke) held until CASE-002722 is decided |
| Held | — | ||
| ACT-016167 | Outreach suppressed pending steward Outreach | ENR-134341 (Vicky Burke) held until CASE-002723 is decided |
| Held | — | ||
| ACT-016168 | Outreach suppressed pending steward Outreach | TPA-57528 (Brian Gutierrez) held until CASE-002724 is decided |
| Held | — | ||
| ACT-016169 | Outreach suppressed pending steward Outreach | TPA-57529 (Brian Gutierrez) held until CASE-002725 is decided |
| Held | — | ||
| ACT-016170 | Outreach suppressed pending steward Outreach | TPA-59354 (Randy Lawrence) held until CASE-002726 is decided |
| Held | — | ||
| ACT-016171 | Outreach suppressed pending steward Outreach | CLM-421005 (Adam McDonald) held until CASE-002727 is decided |
| Held | — | ||
| ACT-016172 | Outreach suppressed pending steward Outreach | CLM-414436 (Wei Washington) held until CASE-002728 is decided |
| Held | — | ||
| ACT-016173 | Outreach suppressed pending steward Outreach | CLM-430587 (Ahmed Ford) held until CASE-002729 is decided |
| Held | — | ||
| ACT-016174 | Outreach suppressed pending steward Outreach | TPA-58646 (Valentina Santiago) held until CASE-002730 is decided |
| Held | — | ||
| ACT-016175 | Outreach suppressed pending steward Outreach | ENR-113447 (Lauren Butler) held until CASE-002731 is decided |
| Held | — | ||
| ACT-016176 | Outreach suppressed pending steward Outreach | TPA-57785 (Josh Snyder) held until CASE-002732 is decided |
| Held | — | ||
| ACT-016177 | Outreach suppressed pending steward Outreach | TPA-57784 (Joshua Snyder) held until CASE-002733 is decided |
| Held | — | ||
| ACT-016178 | Outreach suppressed pending steward Outreach | ENR-123229 (Joshua Snyder) held until CASE-002734 is decided |
| Held | — | ||
| ACT-016179 | Outreach suppressed pending steward Outreach | TPA-59092 (Kelly Johnston) held until CASE-002735 is decided |
| Held | — | ||
| ACT-016180 | Outreach suppressed pending steward Outreach | CLM-406740 (Samantha Russell) held until CASE-002736 is decided |
| Held | — | ||
| ACT-016181 | Outreach suppressed pending steward Outreach | TPA-52958 (Samantha Russell) held until CASE-002737 is decided |
| Held | — | ||
| ACT-016182 | Outreach suppressed pending steward Outreach | PRV-23294 (Tyler Rojas) held until CASE-002738 is decided |
| Held | — | ||
| ACT-016183 | Outreach suppressed pending steward Outreach | CLM-424064 (Jessica Dean) held until CASE-002739 is decided |
| Held | — | ||
| ACT-016184 | Outreach suppressed pending steward Outreach | CLM-400895 (Ethan Hudson) held until CASE-002740 is decided |
| Held | — | ||
| ACT-016185 | Outreach suppressed pending steward Outreach | PRV-20279 (Ethan Hudson) held until CASE-002741 is decided |
| Held | — | ||
| ACT-016186 | Outreach suppressed pending steward Outreach | ENR-137322 (Willie Rojas) held until CASE-002742 is decided |
| Held | — | ||
| ACT-016187 | Outreach suppressed pending steward Outreach | ENR-126905 (Patricia Vazquez) held until CASE-002743 is decided |
| Held | — | ||
| ACT-016188 | Outreach suppressed pending steward Outreach | ENR-137334 (Kylle Peters) held until CASE-002744 is decided |
| Held | — | ||
| ACT-016189 | Outreach suppressed pending steward Outreach | ENR-123610 (Benjamin Chen) held until CASE-002745 is decided |
| Held | — | ||
| ACT-016190 | Outreach suppressed pending steward Outreach | CLM-407949 (Sara Sanders) held until CASE-002746 is decided |
| Held | — | ||
| ACT-016191 | Outreach suppressed pending steward Outreach | CLM-428099 (Dot Baker) held until CASE-002747 is decided |
| Held | — | ||
| ACT-016192 | Outreach suppressed pending steward Outreach | CLM-421333 (Marcus Riley) held until CASE-002748 is decided |
| Held | — | ||
| ACT-016193 | Outreach suppressed pending steward Outreach | TPA-54389 (Fatima Simmons) held until CASE-002749 is decided |
| Held | — | ||
| ACT-016194 | Outreach suppressed pending steward Outreach | ENR-133528 (Terry Soto) held until CASE-002750 is decided |
| Held | — | ||
| ACT-016195 | Outreach suppressed pending steward Outreach | CLM-425621 (Terry Soto) held until CASE-002751 is decided |
| Held | — | ||
| ACT-016196 | Outreach suppressed pending steward Outreach | ENR-141396 (Sttephen Burke) held until CASE-002752 is decided |
| Held | — | ||
| ACT-016197 | Outreach suppressed pending steward Outreach | CLM-431518 (Stephen Burke) held until CASE-002753 is decided |
| Held | — | ||
| ACT-016198 | Outreach suppressed pending steward Outreach | CLM-417314 (Jason Wheeler) held until CASE-002754 is decided |
| Held | — | ||
| ACT-016199 | Outreach suppressed pending steward Outreach | CLM-419176 (Marilyn Barnes) held until CASE-002755 is decided |
| Held | — | ||
| ACT-016200 | Outreach suppressed pending steward Outreach | CLM-415298 (Alan Cole) held until CASE-002756 is decided |
| Held | — | ||
| ACT-016201 | Outreach suppressed pending steward Outreach | ENR-110677 (Andrew Cole) held until CASE-002757 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.