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-016402 | Outreach suppressed pending steward Outreach | ENR-134739 (Bradley Reid) held until CASE-002958 is decided |
| Held | — | ||
| ACT-016403 | Outreach suppressed pending steward Outreach | ENR-110699 (Thomas Cox) held until CASE-002959 is decided |
| Held | — | ||
| ACT-016404 | Outreach suppressed pending steward Outreach | CLM-408120 (Thomas Cox) held until CASE-002960 is decided |
| Held | — | ||
| ACT-016405 | Outreach suppressed pending steward Outreach | PRV-20825 (Cynthia Gibson) held until CASE-002961 is decided |
| Held | — | ||
| ACT-016406 | Outreach suppressed pending steward Outreach | CLM-404775 (Albert Griffin) held until CASE-002962 is decided |
| Held | — | ||
| ACT-016407 | Outreach suppressed pending steward Outreach | PRV-21385 (Albert Griffin) held until CASE-002963 is decided |
| Held | — | ||
| ACT-016408 | Outreach suppressed pending steward Outreach | TPA-52520 (Sandra Baker) held until CASE-002964 is decided |
| Held | — | ||
| ACT-016409 | Outreach suppressed pending steward Outreach | ENR-107509 (Sandra Baker) held until CASE-002965 is decided |
| Held | — | ||
| ACT-016410 | Outreach suppressed pending steward Outreach | CLM-413248 (Susan Adams) held until CASE-002966 is decided |
| Held | — | ||
| ACT-016411 | Outreach suppressed pending steward Outreach | TPA-58611 (Roy Obrien) held until CASE-002967 is decided |
| Held | — | ||
| ACT-016412 | Outreach suppressed pending steward Outreach | TPA-58610 (Roy Obrien) held until CASE-002968 is decided |
| Held | — | ||
| ACT-016413 | Outreach suppressed pending steward Outreach | ENR-138992 (Christina Jimenez) held until CASE-002969 is decided |
| Held | — | ||
| ACT-016414 | Outreach suppressed pending steward Outreach | TPA-63134 (Christina Jimenez) held until CASE-002970 is decided |
| Held | — | ||
| ACT-016415 | Outreach suppressed pending steward Outreach | CLM-415799 (Alan Ramos) held until CASE-002971 is decided |
| Held | — | ||
| ACT-016416 | Outreach suppressed pending steward Outreach | CLM-416496 (Aisha Gibson) held until CASE-002972 is decided |
| Held | — | ||
| ACT-016417 | Outreach suppressed pending steward Outreach | CLM-423594 (Tyler West) held until CASE-002973 is decided |
| Held | — | ||
| ACT-016418 | Outreach suppressed pending steward Outreach | TPA-60380 (Tyler West) held until CASE-002974 is decided |
| Held | — | ||
| ACT-016419 | Outreach suppressed pending steward Outreach | CLM-422802 (Sharon Sims) held until CASE-002975 is decided |
| Held | — | ||
| ACT-016420 | Outreach suppressed pending steward Outreach | TPA-63182 (Lauren Sullivan) held until CASE-002976 is decided |
| Held | — | ||
| ACT-016421 | Outreach suppressed pending steward Outreach | CLM-400739 (David Sullivan) held until CASE-002977 is decided |
| Held | — | ||
| ACT-016422 | Outreach suppressed pending steward Outreach | ENR-100985 (David Sullivan) held until CASE-002978 is decided |
| Held | — | ||
| ACT-016423 | Outreach suppressed pending steward Outreach | TPA-57206 (Noah Woods) held until CASE-002979 is decided |
| Held | — | ||
| ACT-016424 | Outreach suppressed pending steward Outreach | TPA-57205 (Noah Woods) held until CASE-002980 is decided |
| Held | — | ||
| ACT-016425 | Outreach suppressed pending steward Outreach | CLM-420304 (Gregory Rivera) held until CASE-002981 is decided |
| Held | — | ||
| ACT-016426 | Outreach suppressed pending steward Outreach | ENR-126694 (Gregory Rivera) held until CASE-002982 is decided |
| Held | — | ||
| ACT-016427 | Outreach suppressed pending steward Outreach | ENR-130801 (Tyler Li) held until CASE-002983 is decided |
| Held | — | ||
| ACT-016428 | Outreach suppressed pending steward Outreach | CLM-423544 (Tyler Li) held until CASE-002984 is decided |
| Held | — | ||
| ACT-016429 | Outreach suppressed pending steward Outreach | ENR-100435 (Danielle Oliver) held until CASE-002985 is decided |
| Held | — | ||
| ACT-016430 | Outreach suppressed pending steward Outreach | TPA-62575 (Megan Edwards) held until CASE-002986 is decided |
| Held | — | ||
| ACT-016431 | Outreach suppressed pending steward Outreach | CLM-422981 (Omar Schultz) held until CASE-002987 is decided |
| Held | — | ||
| ACT-016432 | Outreach suppressed pending steward Outreach | TPA-58674 (Lisa Varges) held until CASE-002988 is decided |
| Held | — | ||
| ACT-016433 | Outreach suppressed pending steward Outreach | TPA-53254 (Tony Holmes) held until CASE-002989 is decided |
| Held | — | ||
| ACT-016434 | Outreach suppressed pending steward Outreach | PRV-20672 (Denny Sandeers) held until CASE-002990 is decided |
| Held | — | ||
| ACT-016435 | Outreach suppressed pending steward Outreach | CLM-402272 (Denny Sanders) held until CASE-002991 is decided |
| Held | — | ||
| ACT-016436 | Outreach suppressed pending steward Outreach | CLM-407360 (Robert Patel) held until CASE-002992 is decided |
| Held | — | ||
| ACT-016437 | Outreach suppressed pending steward Outreach | PRV-20118 (William Burton) held until CASE-002993 is decided |
| Held | — | ||
| ACT-016438 | Outreach suppressed pending steward Outreach | ENR-100561 (William Burton) held until CASE-002994 is decided |
| Held | — | ||
| ACT-016439 | Outreach suppressed pending steward Outreach | PRV-21617 (Sofia Sims) held until CASE-002995 is decided |
| Held | — | ||
| ACT-016440 | Outreach suppressed pending steward Outreach | ENR-126089 (Brian Hart) held until CASE-002996 is decided |
| Held | — | ||
| ACT-016441 | Outreach suppressed pending steward Outreach | TPA-50359 (Billy Thomas) held until CASE-002997 is decided |
| Held | — | ||
| ACT-016442 | Outreach suppressed pending steward Outreach | ENR-120083 (Nancy Marshall) held until CASE-002998 is decided |
| Held | — | ||
| ACT-016443 | Outreach suppressed pending steward Outreach | CLM-415235 (Nancy Marshall) held until CASE-002999 is decided |
| Held | — | ||
| ACT-016444 | Outreach suppressed pending steward Outreach | PRV-22598 (Willie Rivera) held until CASE-003000 is decided |
| Held | — | ||
| ACT-016445 | Outreach suppressed pending steward Outreach | ENR-131364 (Margaret Roberts) held until CASE-003001 is decided |
| Held | — | ||
| ACT-016446 | Outreach suppressed pending steward Outreach | TPA-63757 (Kenneth Ryan) held until CASE-003002 is decided |
| Held | — | ||
| ACT-016447 | Outreach suppressed pending steward Outreach | CLM-431137 (Kenneth Ryan) held until CASE-003003 is decided |
| Held | — | ||
| ACT-016448 | Outreach suppressed pending steward Outreach | PRV-25004 (Adam Jimenez) held until CASE-003004 is decided |
| Held | — | ||
| ACT-016449 | Outreach suppressed pending steward Outreach | ENR-122205 (Adam Jimenez) held until CASE-003005 is decided |
| Held | — | ||
| ACT-016450 | Outreach suppressed pending steward Outreach | TPA-57576 (William Jimenez) held until CASE-003006 is decided |
| Held | — | ||
| ACT-016451 | Outreach suppressed pending steward Outreach | TPA-52698 (Mraiana Peters) held until CASE-003007 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.