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-016302 | Outreach suppressed pending steward Outreach | CLM-400028 (Kathryn Austin) held until CASE-002858 is decided |
| Held | — | ||
| ACT-016303 | Outreach suppressed pending steward Outreach | CLM-419788 (Kevin Jordan) held until CASE-002859 is decided |
| Held | — | ||
| ACT-016304 | Outreach suppressed pending steward Outreach | PRV-23849 (Walter Bowmna) held until CASE-002860 is decided |
| Held | — | ||
| ACT-016305 | Outreach suppressed pending steward Outreach | PRV-21442 (Santago Ross) held until CASE-002861 is decided |
| Held | — | ||
| ACT-016306 | Outreach suppressed pending steward Outreach | ENR-106558 (Santiago Ross) held until CASE-002862 is decided |
| Held | — | ||
| ACT-016307 | Outreach suppressed pending steward Outreach | CLM-414769 (Susan Armstrong) held until CASE-002863 is decided |
| Held | — | ||
| ACT-016308 | Outreach suppressed pending steward Outreach | CLM-427414 (Heather Coleman) held until CASE-002864 is decided |
| Held | — | ||
| ACT-016309 | Outreach suppressed pending steward Outreach | TPA-62110 (Heather Coleman) held until CASE-002865 is decided |
| Held | — | ||
| ACT-016310 | Outreach suppressed pending steward Outreach | TPA-50296 (David Medina) held until CASE-002866 is decided |
| Held | — | ||
| ACT-016311 | Outreach suppressed pending steward Outreach | PRV-20196 (David Medina) held until CASE-002867 is decided |
| Held | — | ||
| ACT-016312 | Outreach suppressed pending steward Outreach | ENR-103836 (Christian Meidna) held until CASE-002868 is decided |
| Held | — | ||
| ACT-016313 | Outreach suppressed pending steward Outreach | CLM-402960 (Christian Medina) held until CASE-002869 is decided |
| Held | — | ||
| ACT-016314 | Outreach suppressed pending steward Outreach | TPA-50486 (Dnaiel Bailey) held until CASE-002870 is decided |
| Held | — | ||
| ACT-016315 | Outreach suppressed pending steward Outreach | ENR-122218 (Angela Peerz) held until CASE-002871 is decided |
| Held | — | ||
| ACT-016316 | Outreach suppressed pending steward Outreach | CLM-416909 (Angela Perez) held until CASE-002872 is decided |
| Held | — | ||
| ACT-016317 | Outreach suppressed pending steward Outreach | PRV-25166 (Sean Carpenter) held until CASE-002873 is decided |
| Held | — | ||
| ACT-016318 | Outreach suppressed pending steward Outreach | CLM-412857 (Barbara Fox) held until CASE-002874 is decided |
| Held | — | ||
| ACT-016319 | Outreach suppressed pending steward Outreach | CLM-403744 (Jennifer Perez) held until CASE-002875 is decided |
| Held | — | ||
| ACT-016320 | Outreach suppressed pending steward Outreach | TPA-51630 (Jennifer Perez) held until CASE-002876 is decided |
| Held | — | ||
| ACT-016321 | Outreach suppressed pending steward Outreach | CLM-422790 (Sharon Garza) held until CASE-002877 is decided |
| Held | — | ||
| ACT-016322 | Outreach suppressed pending steward Outreach | TPA-60006 (Sharon Garza) held until CASE-002878 is decided |
| Held | — | ||
| ACT-016323 | Outreach suppressed pending steward Outreach | TPA-52358 (Wayne Cunningham) held until CASE-002879 is decided |
| Held | — | ||
| ACT-016324 | Outreach suppressed pending steward Outreach | CLM-429976 (Alexys Duncan) held until CASE-002880 is decided |
| Held | — | ||
| ACT-016325 | Outreach suppressed pending steward Outreach | TPA-58687 (Isabella Li) held until CASE-002881 is decided |
| Held | — | ||
| ACT-016326 | Outreach suppressed pending steward Outreach | ENR-125914 (Isabella Li) held until CASE-002882 is decided |
| Held | — | ||
| ACT-016327 | Outreach suppressed pending steward Outreach | TPA-51393 (Michael Campbell) held until CASE-002883 is decided |
| Held | — | ||
| ACT-016328 | Outreach suppressed pending steward Outreach | CLM-424279 (Adam Taylor) held until CASE-002884 is decided |
| Held | — | ||
| ACT-016329 | Outreach suppressed pending steward Outreach | CLM-401103 (Jacqueline Kelley) held until CASE-002885 is decided |
| Held | — | ||
| ACT-016330 | Outreach suppressed pending steward Outreach | TPA-60783 (Mason Kelley) held until CASE-002886 is decided |
| Held | — | ||
| ACT-016331 | Outreach suppressed pending steward Outreach | TPA-55165 (Andrew Phillips) held until CASE-002887 is decided |
| Held | — | ||
| ACT-016332 | Outreach suppressed pending steward Outreach | PRV-28565 (Ken Hunter) held until CASE-002888 is decided |
| Held | — | ||
| ACT-016333 | Outreach suppressed pending steward Outreach | ENR-138312 (Kenneth Hunter) held until CASE-002889 is decided |
| Held | — | ||
| ACT-016334 | Outreach suppressed pending steward Outreach | TPA-58502 (Wei Hamilton) held until CASE-002890 is decided |
| Held | — | ||
| ACT-016335 | Outreach suppressed pending steward Outreach | PRV-23802 (Sean Hunter) held until CASE-002891 is decided |
| Held | — | ||
| ACT-016336 | Outreach suppressed pending steward Outreach | TPA-55769 (Sean Hunter) held until CASE-002892 is decided |
| Held | — | ||
| ACT-016337 | Outreach suppressed pending steward Outreach | ENR-113768 (Sara Hicks) held until CASE-002893 is decided |
| Held | — | ||
| ACT-016338 | Outreach suppressed pending steward Outreach | CLM-404959 (Bryan Henderson) held until CASE-002894 is decided |
| Held | — | ||
| ACT-016339 | Outreach suppressed pending steward Outreach | ENR-126533 (Helen Gibson) held until CASE-002895 is decided |
| Held | — | ||
| ACT-016340 | Outreach suppressed pending steward Outreach | CLM-420160 (Helen Gibosn) held until CASE-002896 is decided |
| Held | — | ||
| ACT-016341 | Outreach suppressed pending steward Outreach | PRV-26793 (Jefffrey Payne) held until CASE-002897 is decided |
| Held | — | ||
| ACT-016342 | Outreach suppressed pending steward Outreach | CLM-406363 (Jordan Richards) held until CASE-002898 is decided |
| Held | — | ||
| ACT-016343 | Outreach suppressed pending steward Outreach | ENR-128220 (Wane Washington) held until CASE-002899 is decided |
| Held | — | ||
| ACT-016344 | Outreach suppressed pending steward Outreach | CLM-427930 (Jack Taylor) held until CASE-002900 is decided |
| Held | — | ||
| ACT-016345 | Outreach suppressed pending steward Outreach | PRV-25556 (Wei Schultz) held until CASE-002901 is decided |
| Held | — | ||
| ACT-016346 | Outreach suppressed pending steward Outreach | CLM-429325 (Albert Flores) held until CASE-002902 is decided |
| Held | — | ||
| ACT-016347 | Outreach suppressed pending steward Outreach | CLM-427315 (Barb Le) held until CASE-002903 is decided |
| Held | — | ||
| ACT-016348 | Outreach suppressed pending steward Outreach | CLM-410219 (David Yang) held until CASE-002904 is decided |
| Held | — | ||
| ACT-016349 | Outreach suppressed pending steward Outreach | TPA-60323 (Joseph Kim) held until CASE-002905 is decided |
| Held | — | ||
| ACT-016350 | Outreach suppressed pending steward Outreach | PRV-26915 (Joseph Kim) held until CASE-002906 is decided |
| Held | — | ||
| ACT-016351 | Outreach suppressed pending steward Outreach | CLM-425130 (Wei Medina) held until CASE-002907 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.