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-016202 | Outreach suppressed pending steward Outreach | PRV-25273 (Brandon Harper) held until CASE-002758 is decided |
| Held | — | ||
| ACT-016203 | Outreach suppressed pending steward Outreach | ENR-123382 (Brandon Harper) held until CASE-002759 is decided |
| Held | — | ||
| ACT-016204 | Outreach suppressed pending steward Outreach | TPA-53292 (Daniel Le) held until CASE-002760 is decided |
| Held | — | ||
| ACT-016205 | Outreach suppressed pending steward Outreach | CLM-407505 (Daniel Le) held until CASE-002761 is decided |
| Held | — | ||
| ACT-016206 | Outreach suppressed pending steward Outreach | TPA-55457 (Wei Dunn) held until CASE-002762 is decided |
| Held | — | ||
| ACT-016207 | Outreach suppressed pending steward Outreach | ENR-116290 (Wei Dunn) held until CASE-002763 is decided |
| Held | — | ||
| ACT-016208 | Outreach suppressed pending steward Outreach | ENR-107868 (Maria Bryant) held until CASE-002764 is decided |
| Held | — | ||
| ACT-016209 | Outreach suppressed pending steward Outreach | CLM-405972 (Maria Bryant) held until CASE-002765 is decided |
| Held | — | ||
| ACT-016210 | Outreach suppressed pending steward Outreach | TPA-60699 (Charles Murray) held until CASE-002766 is decided |
| Held | — | ||
| ACT-016211 | Outreach suppressed pending steward Outreach | ENR-107596 (Lauren Little) held until CASE-002767 is decided |
| Held | — | ||
| ACT-016212 | Outreach suppressed pending steward Outreach | CLM-409906 (Pamela Sandoval) held until CASE-002768 is decided |
| Held | — | ||
| ACT-016213 | Outreach suppressed pending steward Outreach | CLM-409907 (Pamela Snadoval) held until CASE-002769 is decided |
| Held | — | ||
| ACT-016214 | Outreach suppressed pending steward Outreach | TPA-53231 (Benjamin Webb) held until CASE-002770 is decided |
| Held | — | ||
| ACT-016215 | Outreach suppressed pending steward Outreach | CLM-405386 (Isabella Andrews) held until CASE-002771 is decided |
| Held | — | ||
| ACT-016216 | Outreach suppressed pending steward Outreach | ENR-111289 (Amber Fox) held until CASE-002772 is decided |
| Held | — | ||
| ACT-016217 | Outreach suppressed pending steward Outreach | TPA-53766 (Abmer Fox) held until CASE-002773 is decided |
| Held | — | ||
| ACT-016218 | Outreach suppressed pending steward Outreach | ENR-116618 (Terry Alvarado) held until CASE-002774 is decided |
| Held | — | ||
| ACT-016219 | Outreach suppressed pending steward Outreach | TPA-55561 (Terry Alvarado) held until CASE-002775 is decided |
| Held | — | ||
| ACT-016220 | Outreach suppressed pending steward Outreach | TPA-55560 (Terry Alvarado) held until CASE-002776 is decided |
| Held | — | ||
| ACT-016221 | Outreach suppressed pending steward Outreach | TPA-50844 (Rachel Duncan) held until CASE-002777 is decided |
| Held | — | ||
| ACT-016222 | Outreach suppressed pending steward Outreach | ENR-138263 (Aisha Powell) held until CASE-002778 is decided |
| Held | — | ||
| ACT-016223 | Outreach suppressed pending steward Outreach | PRV-28554 (Aisha Powell) held until CASE-002779 is decided |
| Held | — | ||
| ACT-016224 | Outreach suppressed pending steward Outreach | TPA-63892 (Jessse Bennett) held until CASE-002780 is decided |
| Held | — | ||
| ACT-016225 | Outreach suppressed pending steward Outreach | CLM-407884 (Alice Hayes) held until CASE-002781 is decided |
| Held | — | ||
| ACT-016226 | Outreach suppressed pending steward Outreach | ENR-141974 (Yuki Freeman) held until CASE-002782 is decided |
| Held | — | ||
| ACT-016227 | Outreach suppressed pending steward Outreach | TPA-64105 (Yuki Freeman) held until CASE-002783 is decided |
| Held | — | ||
| ACT-016228 | Outreach suppressed pending steward Outreach | CLM-419048 (David Yang) held until CASE-002784 is decided |
| Held | — | ||
| ACT-016229 | Outreach suppressed pending steward Outreach | PRV-24592 (Samntha Harris) held until CASE-002785 is decided |
| Held | — | ||
| ACT-016230 | Outreach suppressed pending steward Outreach | PRV-24593 (Samantha Harris) held until CASE-002786 is decided |
| Held | — | ||
| ACT-016231 | Outreach suppressed pending steward Outreach | ENR-101321 (Terry Wels) held until CASE-002787 is decided |
| Held | — | ||
| ACT-016232 | Outreach suppressed pending steward Outreach | PRV-20323 (Terry Wells) held until CASE-002788 is decided |
| Held | — | ||
| ACT-016233 | Outreach suppressed pending steward Outreach | TPA-63825 (Frank Cox) held until CASE-002789 is decided |
| Held | — | ||
| ACT-016234 | Outreach suppressed pending steward Outreach | CLM-427574 (Deb Nichols) held until CASE-002790 is decided |
| Held | — | ||
| ACT-016235 | Outreach suppressed pending steward Outreach | TPA-62183 (Deborah Nichols) held until CASE-002791 is decided |
| Held | — | ||
| ACT-016236 | Outreach suppressed pending steward Outreach | CLM-410482 (Sean Bishop) held until CASE-002792 is decided |
| Held | — | ||
| ACT-016237 | Outreach suppressed pending steward Outreach | CLM-406134 (Theresa Reid) held until CASE-002793 is decided |
| Held | — | ||
| ACT-016238 | Outreach suppressed pending steward Outreach | CLM-420454 (Sharon Haarper) held until CASE-002794 is decided |
| Held | — | ||
| ACT-016239 | Outreach suppressed pending steward Outreach | TPA-58991 (Sharon Harper) held until CASE-002795 is decided |
| Held | — | ||
| ACT-016240 | Outreach suppressed pending steward Outreach | CLM-425222 (Jacqueline Hayes) held until CASE-002796 is decided |
| Held | — | ||
| ACT-016241 | Outreach suppressed pending steward Outreach | ENR-132971 (Jacqueline Hayes) held until CASE-002797 is decided |
| Held | — | ||
| ACT-016242 | Outreach suppressed pending steward Outreach | ENR-131914 (Isabella Adams) held until CASE-002798 is decided |
| Held | — | ||
| ACT-016243 | Outreach suppressed pending steward Outreach | TPA-51469 (Green Deba) held until CASE-002799 is decided |
| Held | — | ||
| ACT-016244 | Outreach suppressed pending steward Outreach | TPA-51468 (Green Deba) held until CASE-002800 is decided |
| Held | — | ||
| ACT-016245 | Outreach suppressed pending steward Outreach | TPA-61522 (Douglas Woods) held until CASE-002801 is decided |
| Held | — | ||
| ACT-016246 | Outreach suppressed pending steward Outreach | CLM-409030 (Patricia Andrews) held until CASE-002802 is decided |
| Held | — | ||
| ACT-016247 | Outreach suppressed pending steward Outreach | TPA-61984 (Santiago Sandoval) held until CASE-002803 is decided |
| Held | — | ||
| ACT-016248 | Outreach suppressed pending steward Outreach | CLM-429834 (Brian Ramos) held until CASE-002804 is decided |
| Held | — | ||
| ACT-016249 | Outreach suppressed pending steward Outreach | TPA-55774 (Christina Carter) held until CASE-002805 is decided |
| Held | — | ||
| ACT-016250 | Outreach suppressed pending steward Outreach | TPA-54723 (Rachel Guzman) held until CASE-002806 is decided |
| Held | — | ||
| ACT-016251 | Outreach suppressed pending steward Outreach | CLM-410774 (Rachel Guzman) held until CASE-002807 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.