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-016252 | Outreach suppressed pending steward Outreach | CLM-416560 (Nathan Gonzalez) held until CASE-002808 is decided |
| Held | — | ||
| ACT-016253 | Outreach suppressed pending steward Outreach | ENR-121758 (Nathan Gonzalez) held until CASE-002809 is decided |
| Held | — | ||
| ACT-016254 | Outreach suppressed pending steward Outreach | CLM-430658 (Chriistian Gonzales) held until CASE-002810 is decided |
| Held | — | ||
| ACT-016255 | Outreach suppressed pending steward Outreach | TPA-56331 (Billy Parkeer) held until CASE-002811 is decided |
| Held | — | ||
| ACT-016256 | Outreach suppressed pending steward Outreach | TPA-55922 (Isabella Nelson) held until CASE-002812 is decided |
| Held | — | ||
| ACT-016257 | Outreach suppressed pending steward Outreach | CLM-411100 (Emma Aguilar) held until CASE-002813 is decided |
| Held | — | ||
| ACT-016258 | Outreach suppressed pending steward Outreach | CLM-406865 (Amanda Hicks) held until CASE-002814 is decided |
| Held | — | ||
| ACT-016259 | Outreach suppressed pending steward Outreach | CLM-413712 (Frank Baker) held until CASE-002815 is decided |
| Held | — | ||
| ACT-016260 | Outreach suppressed pending steward Outreach | CLM-425307 (Gloria King) held until CASE-002816 is decided |
| Held | — | ||
| ACT-016261 | Outreach suppressed pending steward Outreach | TPA-61175 (Glooria King) held until CASE-002817 is decided |
| Held | — | ||
| ACT-016262 | Outreach suppressed pending steward Outreach | TPA-54230 (Jeremy Kim) held until CASE-002818 is decided |
| Held | — | ||
| ACT-016263 | Outreach suppressed pending steward Outreach | CLM-422329 (Mei Garcia) held until CASE-002819 is decided |
| Held | — | ||
| ACT-016264 | Outreach suppressed pending steward Outreach | CLM-422328 (Mei Garcia) held until CASE-002820 is decided |
| Held | — | ||
| ACT-016265 | Outreach suppressed pending steward Outreach | CLM-423782 (Sam Andrews) held until CASE-002821 is decided |
| Held | — | ||
| ACT-016266 | Outreach suppressed pending steward Outreach | CLM-424450 (Emma Rogers) held until CASE-002822 is decided |
| Held | — | ||
| ACT-016267 | Outreach suppressed pending steward Outreach | ENR-131965 (Emma Rogers) held until CASE-002823 is decided |
| Held | — | ||
| ACT-016268 | Outreach suppressed pending steward Outreach | TPA-53051 (Nicole Daniels) held until CASE-002824 is decided |
| Held | — | ||
| ACT-016269 | Outreach suppressed pending steward Outreach | ENR-114609 (Nicholas Daniels) held until CASE-002825 is decided |
| Held | — | ||
| ACT-016270 | Outreach suppressed pending steward Outreach | CLM-412575 (Joe Ford) held until CASE-002826 is decided |
| Held | — | ||
| ACT-016271 | Outreach suppressed pending steward Outreach | TPA-52636 (Amber Oliver) held until CASE-002827 is decided |
| Held | — | ||
| ACT-016272 | Outreach suppressed pending steward Outreach | TPA-55615 (Christina Larson) held until CASE-002828 is decided |
| Held | — | ||
| ACT-016273 | Outreach suppressed pending steward Outreach | CLM-432744 (Rachel Young) held until CASE-002829 is decided |
| Held | — | ||
| ACT-016274 | Outreach suppressed pending steward Outreach | CLM-432745 (Rachel Young) held until CASE-002830 is decided |
| Held | — | ||
| ACT-016275 | Outreach suppressed pending steward Outreach | CLM-411142 (Juan Gilbert) held until CASE-002831 is decided |
| Held | — | ||
| ACT-016276 | Outreach suppressed pending steward Outreach | PRV-23224 (Juan Gilbert) held until CASE-002832 is decided |
| Held | — | ||
| ACT-016277 | Outreach suppressed pending steward Outreach | CLM-400753 (Christina Peters) held until CASE-002833 is decided |
| Held | — | ||
| ACT-016278 | Outreach suppressed pending steward Outreach | CLM-422223 (William Morales) held until CASE-002834 is decided |
| Held | — | ||
| ACT-016279 | Outreach suppressed pending steward Outreach | ENR-127413 (Noah Hall) held until CASE-002835 is decided |
| Held | — | ||
| ACT-016280 | Outreach suppressed pending steward Outreach | ENR-127968 (Lysa Pena) held until CASE-002836 is decided |
| Held | — | ||
| ACT-016281 | Outreach suppressed pending steward Outreach | CLM-421337 (Lisa Pena) held until CASE-002837 is decided |
| Held | — | ||
| ACT-016282 | Outreach suppressed pending steward Outreach | TPA-56228 (Jonathan Peterson) held until CASE-002838 is decided |
| Held | — | ||
| ACT-016283 | Outreach suppressed pending steward Outreach | CLM-425910 (Aisha Lopez) held until CASE-002839 is decided |
| Held | — | ||
| ACT-016284 | Outreach suppressed pending steward Outreach | TPA-62076 (Karen Lopez) held until CASE-002840 is decided |
| Held | — | ||
| ACT-016285 | Outreach suppressed pending steward Outreach | PRV-22263 (Jacob Mills) held until CASE-002841 is decided |
| Held | — | ||
| ACT-016286 | Outreach suppressed pending steward Outreach | TPA-59783 (Henry Burtn) held until CASE-002842 is decided |
| Held | — | ||
| ACT-016287 | Outreach suppressed pending steward Outreach | PRV-26578 (Henry Burton) held until CASE-002843 is decided |
| Held | — | ||
| ACT-016288 | Outreach suppressed pending steward Outreach | TPA-56852 (Martha Campbell) held until CASE-002844 is decided |
| Held | — | ||
| ACT-016289 | Outreach suppressed pending steward Outreach | CLM-415547 (Carol Guzman) held until CASE-002845 is decided |
| Held | — | ||
| ACT-016290 | Outreach suppressed pending steward Outreach | CLM-415546 (Carol Guzman) held until CASE-002846 is decided |
| Held | — | ||
| ACT-016291 | Outreach suppressed pending steward Outreach | PRV-26548 (Mariana Franlkin) held until CASE-002847 is decided |
| Held | — | ||
| ACT-016292 | Outreach suppressed pending steward Outreach | ENR-129073 (Mariana Franklin) held until CASE-002848 is decided |
| Held | — | ||
| ACT-016293 | Outreach suppressed pending steward Outreach | CLM-414735 (Shirley Alvarez) held until CASE-002849 is decided |
| Held | — | ||
| ACT-016294 | Outreach suppressed pending steward Outreach | PRV-25561 (Amanda McCoy) held until CASE-002850 is decided |
| Held | — | ||
| ACT-016295 | Outreach suppressed pending steward Outreach | TPA-57250 (Janet Dean) held until CASE-002851 is decided |
| Held | — | ||
| ACT-016296 | Outreach suppressed pending steward Outreach | TPA-60861 (Frances Boyd) held until CASE-002852 is decided |
| Held | — | ||
| ACT-016297 | Outreach suppressed pending steward Outreach | TPA-50784 (Walter Harris) held until CASE-002853 is decided |
| Held | — | ||
| ACT-016298 | Outreach suppressed pending steward Outreach | CLM-416606 (Abigail Palmer) held until CASE-002854 is decided |
| Held | — | ||
| ACT-016299 | Outreach suppressed pending steward Outreach | TPA-53661 (Brandon Johnston) held until CASE-002855 is decided |
| Held | — | ||
| ACT-016300 | Outreach suppressed pending steward Outreach | PRV-22478 (Arjun Chavez) held until CASE-002856 is decided |
| Held | — | ||
| ACT-016301 | Outreach suppressed pending steward Outreach | TPA-50007 (Kathryn Austin) held until CASE-002857 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.