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-016452 | Outreach suppressed pending steward Outreach | TPA-52697 (Mariana Peters) held until CASE-003008 is decided |
| Held | — | ||
| ACT-016453 | Outreach suppressed pending steward Outreach | CLM-406609 (Sophia Carroll) held until CASE-003009 is decided |
| Held | — | ||
| ACT-016454 | Outreach suppressed pending steward Outreach | CLM-407364 (Arthur Gilbert) held until CASE-003010 is decided |
| Held | — | ||
| ACT-016455 | Outreach suppressed pending steward Outreach | TPA-60105 (Diana Mills) held until CASE-003011 is decided |
| Held | — | ||
| ACT-016456 | Outreach suppressed pending steward Outreach | TPA-60106 (Diana Mills) held until CASE-003012 is decided |
| Held | — | ||
| ACT-016457 | Outreach suppressed pending steward Outreach | PRV-26830 (Henry Weaver) held until CASE-003013 is decided |
| Held | — | ||
| ACT-016458 | Outreach suppressed pending steward Outreach | TPA-60164 (Henry Weaver) held until CASE-003014 is decided |
| Held | — | ||
| ACT-016459 | Outreach suppressed pending steward Outreach | TPA-59115 (Gary Jenkins) held until CASE-003015 is decided |
| Held | — | ||
| ACT-016460 | Outreach suppressed pending steward Outreach | TPA-59114 (Gary Jenkins) held until CASE-003016 is decided |
| Held | — | ||
| ACT-016461 | Outreach suppressed pending steward Outreach | PRV-26599 (Dorothy Richards) held until CASE-003017 is decided |
| Held | — | ||
| ACT-016462 | Outreach suppressed pending steward Outreach | TPA-59820 (Dorothy Richards) held until CASE-003018 is decided |
| Held | — | ||
| ACT-016463 | Outreach suppressed pending steward Outreach | CLM-422342 (Dorothy Richards) held until CASE-003019 is decided |
| Held | — | ||
| ACT-016464 | Outreach suppressed pending steward Outreach | PRV-23333 (Santiago Miller) held until CASE-003020 is decided |
| Held | — | ||
| ACT-016465 | Outreach suppressed pending steward Outreach | TPA-58861 (Lauren Diza) held until CASE-003021 is decided |
| Held | — | ||
| ACT-016466 | Outreach suppressed pending steward Outreach | ENR-126470 (Lauren Diaz) held until CASE-003022 is decided |
| Held | — | ||
| ACT-016467 | Outreach suppressed pending steward Outreach | CLM-404203 (George Lewis) held until CASE-003023 is decided |
| Held | — | ||
| ACT-016468 | Outreach suppressed pending steward Outreach | TPA-51191 (Gary Martin) held until CASE-003024 is decided |
| Held | — | ||
| ACT-016469 | Outreach suppressed pending steward Outreach | CLM-403213 (Carolyn Knig) held until CASE-003025 is decided |
| Held | — | ||
| ACT-016470 | Outreach suppressed pending steward Outreach | TPA-51386 (Carolyn King) held until CASE-003026 is decided |
| Held | — | ||
| ACT-016471 | Outreach suppressed pending steward Outreach | CLM-405971 (Sophia Graham) held until CASE-003027 is decided |
| Held | — | ||
| ACT-016472 | Outreach suppressed pending steward Outreach | TPA-52655 (Sophia Graham) held until CASE-003028 is decided |
| Held | — | ||
| ACT-016473 | Outreach suppressed pending steward Outreach | TPA-50095 (Alice Le) held until CASE-003029 is decided |
| Held | — | ||
| ACT-016474 | Outreach suppressed pending steward Outreach | PRV-23671 (Melissa Dixon) held until CASE-003030 is decided |
| Held | — | ||
| ACT-016475 | Outreach suppressed pending steward Outreach | CLM-412705 (Melissa Dixon) held until CASE-003031 is decided |
| Held | — | ||
| ACT-016476 | Outreach suppressed pending steward Outreach | PRV-22578 (Nathan Bennett) held until CASE-003032 is decided |
| Held | — | ||
| ACT-016477 | Outreach suppressed pending steward Outreach | CLM-416671 (Pamela Sanders) held until CASE-003033 is decided |
| Held | — | ||
| ACT-016478 | Outreach suppressed pending steward Outreach | TPA-57333 (Pamela Sanders) held until CASE-003034 is decided |
| Held | — | ||
| ACT-016479 | Outreach suppressed pending steward Outreach | TPA-50677 (Sam Mejia) held until CASE-003035 is decided |
| Held | — | ||
| ACT-016480 | Outreach suppressed pending steward Outreach | CLM-426431 (Abigail Banks) held until CASE-003036 is decided |
| Held | — | ||
| ACT-016481 | Outreach suppressed pending steward Outreach | TPA-56164 (Luis Walker) held until CASE-003037 is decided |
| Held | — | ||
| ACT-016482 | Outreach suppressed pending steward Outreach | TPA-52990 (Martha Walker) held until CASE-003038 is decided |
| Held | — | ||
| ACT-016483 | Outreach suppressed pending steward Outreach | TPA-61854 (Charlotte Kennedy) held until CASE-003039 is decided |
| Held | — | ||
| ACT-016484 | Outreach suppressed pending steward Outreach | PRV-22976 (Shirley James) held until CASE-003040 is decided |
| Held | — | ||
| ACT-016485 | Outreach suppressed pending steward Outreach | TPA-55212 (Juan Singh) held until CASE-003041 is decided |
| Held | — | ||
| ACT-016486 | Outreach suppressed pending steward Outreach | TPA-53630 (Alan Wilson) held until CASE-003042 is decided |
| Held | — | ||
| ACT-016487 | Outreach suppressed pending steward Outreach | CLM-411514 (Michael Rivera) held until CASE-003043 is decided |
| Held | — | ||
| ACT-016488 | Outreach suppressed pending steward Outreach | ENR-115144 (Michael Rivera) held until CASE-003044 is decided |
| Held | — | ||
| ACT-016489 | Outreach suppressed pending steward Outreach | CLM-410110 (Judy Alvarez) held until CASE-003045 is decided |
| Held | — | ||
| ACT-016490 | Outreach suppressed pending steward Outreach | CLM-410109 (Judy Alvarez) held until CASE-003046 is decided |
| Held | — | ||
| ACT-016491 | Outreach suppressed pending steward Outreach | PRV-22051 (Danielle Knight) held until CASE-003047 is decided |
| Held | — | ||
| ACT-016492 | Outreach suppressed pending steward Outreach | PRV-23120 (Billy Morris) held until CASE-003048 is decided |
| Held | — | ||
| ACT-016493 | Outreach suppressed pending steward Outreach | CLM-401723 (Juan Mills) held until CASE-003049 is decided |
| Held | — | ||
| ACT-016494 | Outreach suppressed pending steward Outreach | TPA-62316 (Steven Guerrero) held until CASE-003050 is decided |
| Held | — | ||
| ACT-016495 | Outreach suppressed pending steward Outreach | CLM-420021 (Hiroshi Guerrero) held until CASE-003051 is decided |
| Held | — | ||
| ACT-016496 | Outreach suppressed pending steward Outreach | CLM-426726 (Bobby Ferguson) held until CASE-003052 is decided |
| Held | — | ||
| ACT-016497 | Outreach suppressed pending steward Outreach | TPA-61805 (Bobby Ferguson) held until CASE-003053 is decided |
| Held | — | ||
| ACT-016498 | Outreach suppressed pending steward Outreach | CLM-412286 (Janice Cook) held until CASE-003054 is decided |
| Held | — | ||
| ACT-016499 | Outreach suppressed pending steward Outreach | TPA-55414 (Jnice Cook) held until CASE-003055 is decided |
| Held | — | ||
| ACT-016500 | Outreach suppressed pending steward Outreach | PRV-26647 (Nicole Thomas) held until CASE-003056 is decided |
| Held | — | ||
| ACT-016501 | Outreach suppressed pending steward Outreach | ENR-129530 (Nicole Thomas) held until CASE-003057 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.