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
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-013995 | Outreach suppressed pending steward Outreach | TPA-56902 (Pamela Lucas) held until CASE-000551 is decided |
| Held | — | ||
| ACT-013996 | Outreach suppressed pending steward Outreach | TPA-51124 (Donna Torres) held until CASE-000552 is decided |
| Held | — | ||
| ACT-013997 | Outreach suppressed pending steward Outreach | CLM-401010 (Andrea Meyer) held until CASE-000553 is decided |
| Held | — | ||
| ACT-013998 | Outreach suppressed pending steward Outreach | CLM-401009 (Andrea Meyer) held until CASE-000554 is decided |
| Held | — | ||
| ACT-013999 | Outreach suppressed pending steward Outreach | TPA-59070 (Russell Hart) held until CASE-000555 is decided |
| Held | — | ||
| ACT-014000 | Outreach suppressed pending steward Outreach | TPA-62601 (Victoria Hart) held until CASE-000556 is decided |
| Held | — | ||
| ACT-014001 | Outreach suppressed pending steward Outreach | ENR-103633 (Eugene Espinoza) held until CASE-000557 is decided |
| Held | — | ||
| ACT-014002 | Outreach suppressed pending steward Outreach | CLM-401405 (Fetima Ramos) held until CASE-000558 is decided |
| Held | — | ||
| ACT-014003 | Outreach suppressed pending steward Outreach | ENR-101790 (Fatima Ramos) held until CASE-000559 is decided |
| Held | — | ||
| ACT-014004 | Outreach suppressed pending steward Outreach | PRV-27860 (Sandra Ward) held until CASE-000560 is decided |
| Held | — | ||
| ACT-014005 | Outreach suppressed pending steward Outreach | ENR-134967 (Sandra Ward) held until CASE-000561 is decided |
| Held | — | ||
| ACT-014006 | Outreach suppressed pending steward Outreach | CLM-400295 (Valentina Ausstin) held until CASE-000562 is decided |
| Held | — | ||
| ACT-014007 | Outreach suppressed pending steward Outreach | CLM-420261 (Raymond Austin) held until CASE-000563 is decided |
| Held | — | ||
| ACT-014008 | Outreach suppressed pending steward Outreach | TPA-52079 (Katherine Knight) held until CASE-000564 is decided |
| Held | — | ||
| ACT-014009 | Outreach suppressed pending steward Outreach | CLM-415612 (Beverly Hunter) held until CASE-000565 is decided |
| Held | — | ||
| ACT-014010 | Outreach suppressed pending steward Outreach | TPA-56842 (Beverly Hunter) held until CASE-000566 is decided |
| Held | — | ||
| ACT-014011 | Outreach suppressed pending steward Outreach | TPA-61207 (Jason Hansen) held until CASE-000567 is decided |
| Held | — | ||
| ACT-014012 | Outreach suppressed pending steward Outreach | TPA-61206 (Jason Hansen) held until CASE-000568 is decided |
| Held | — | ||
| ACT-014013 | Outreach suppressed pending steward Outreach | CLM-404719 (Karen Walker) held until CASE-000569 is decided |
| Held | — | ||
| ACT-014014 | Outreach suppressed pending steward Outreach | TPA-53472 (Tyler Long) held until CASE-000570 is decided |
| Held | — | ||
| ACT-014015 | Outreach suppressed pending steward Outreach | CLM-429155 (Anna Wallace) held until CASE-000571 is decided |
| Held | — | ||
| ACT-014016 | Outreach suppressed pending steward Outreach | TPA-50442 (Mary Willis) held until CASE-000572 is decided |
| Held | — | ||
| ACT-014017 | Outreach suppressed pending steward Outreach | TPA-61155 (Bruce Evans) held until CASE-000573 is decided |
| Held | — | ||
| ACT-014018 | Outreach suppressed pending steward Outreach | CLM-424736 (Joe Thomas) held until CASE-000574 is decided |
| Held | — | ||
| ACT-014019 | Outreach suppressed pending steward Outreach | ENR-115183 (Alice Harrison) held until CASE-000575 is decided |
| Held | — | ||
| ACT-014020 | Outreach suppressed pending steward Outreach | CLM-401022 (Margaret Powell) held until CASE-000576 is decided |
| Held | — | ||
| ACT-014021 | Outreach suppressed pending steward Outreach | ENR-101335 (Margaret Powell) held until CASE-000577 is decided |
| Held | — | ||
| ACT-014022 | Outreach suppressed pending steward Outreach | CLM-412418 (Priya Wilson) held until CASE-000578 is decided |
| Held | — | ||
| ACT-014023 | Outreach suppressed pending steward Outreach | ENR-116337 (Priya Wilson) held until CASE-000579 is decided |
| Held | — | ||
| ACT-014024 | Outreach suppressed pending steward Outreach | ENR-102892 (Samantha Padilla) held until CASE-000580 is decided |
| Held | — | ||
| ACT-014025 | Outreach suppressed pending steward Outreach | CLM-402268 (Samantha Padilla) held until CASE-000581 is decided |
| Held | — | ||
| ACT-014026 | Outreach suppressed pending steward Outreach | TPA-61112 (Bryan Morgan) held until CASE-000582 is decided |
| Held | — | ||
| ACT-014027 | Outreach suppressed pending steward Outreach | ENR-102025 (Jordan Rice) held until CASE-000583 is decided |
| Held | — | ||
| ACT-014028 | Outreach suppressed pending steward Outreach | TPA-50678 (Jordan Rice) held until CASE-000584 is decided |
| Held | — | ||
| ACT-014029 | Outreach suppressed pending steward Outreach | CLM-406714 (Kelly Richardson) held until CASE-000585 is decided |
| Held | — | ||
| ACT-014030 | Outreach suppressed pending steward Outreach | ENR-108751 (Kelly Richardson) held until CASE-000586 is decided |
| Held | — | ||
| ACT-014031 | Outreach suppressed pending steward Outreach | CLM-419765 (Chris Schmidt) held until CASE-000587 is decided |
| Held | — | ||
| ACT-014032 | Outreach suppressed pending steward Outreach | ENR-126022 (Christine Schmidt) held until CASE-000588 is decided |
| Held | — | ||
| ACT-014033 | Outreach suppressed pending steward Outreach | CLM-402358 (Philip Morgan) held until CASE-000589 is decided |
| Held | — | ||
| ACT-014034 | Outreach suppressed pending steward Outreach | PRV-27604 (Donna Silva) held until CASE-000590 is decided |
| Held | — | ||
| ACT-014035 | Outreach suppressed pending steward Outreach | PRV-21864 (Judith Collins) held until CASE-000591 is decided |
| Held | — | ||
| ACT-014036 | Outreach suppressed pending steward Outreach | TPA-62272 (Austin Gibson) held until CASE-000592 is decided |
| Held | — | ||
| ACT-014037 | Outreach suppressed pending steward Outreach | TPA-58525 (Madisn Rodriguez) held until CASE-000593 is decided |
| Held | — | ||
| ACT-014038 | Outreach suppressed pending steward Outreach | TPA-59487 (Natalie Johnson) held until CASE-000594 is decided |
| Held | — | ||
| ACT-014039 | Outreach suppressed pending steward Outreach | TPA-54940 (Kayla Wheeler) held until CASE-000595 is decided |
| Held | — | ||
| ACT-014040 | Outreach suppressed pending steward Outreach | ENR-114798 (Kayla Wheeler) held until CASE-000596 is decided |
| Held | — | ||
| ACT-014041 | Outreach suppressed pending steward Outreach | CLM-430266 (Anna Knight) held until CASE-000597 is decided |
| Held | — | ||
| ACT-014042 | Outreach suppressed pending steward Outreach | ENR-122155 (Samantha Tran) held until CASE-000598 is decided |
| Held | — | ||
| ACT-014043 | Outreach suppressed pending steward Outreach | CLM-416867 (Samantha Tran) held until CASE-000599 is decided |
| Held | — | ||
| ACT-014044 | Outreach suppressed pending steward Outreach | PRV-24863 (Theresa Gutierrez) held until CASE-000600 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.