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-016552 | Outreach suppressed pending steward Outreach | TPA-58260 (Sam Oliver) held until CASE-003108 is decided |
| Held | — | ||
| ACT-016553 | Outreach suppressed pending steward Outreach | TPA-59559 (Laura Bennett) held until CASE-003109 is decided |
| Held | — | ||
| ACT-016554 | Outreach suppressed pending steward Outreach | TPA-57072 (Charles Marshall) held until CASE-003110 is decided |
| Held | — | ||
| ACT-016555 | Outreach suppressed pending steward Outreach | CLM-415311 (Jacqueline Harvey) held until CASE-003111 is decided |
| Held | — | ||
| ACT-016556 | Outreach suppressed pending steward Outreach | ENR-120183 (Jackie Harvey) held until CASE-003112 is decided |
| Held | — | ||
| ACT-016557 | Outreach suppressed pending steward Outreach | TPA-59808 (Ryn Reed) held until CASE-003113 is decided |
| Held | — | ||
| ACT-016558 | Outreach suppressed pending steward Outreach | PRV-21038 (Dennis Gardner) held until CASE-003114 is decided |
| Held | — | ||
| ACT-016559 | Outreach suppressed pending steward Outreach | CLM-403690 (Dennis Gardner) held until CASE-003115 is decided |
| Held | — | ||
| ACT-016560 | Outreach suppressed pending steward Outreach | CLM-418106 (Melissa Padilla) held until CASE-003116 is decided |
| Held | — | ||
| ACT-016561 | Outreach suppressed pending steward Outreach | ENR-123802 (Melissa Padilla) held until CASE-003117 is decided |
| Held | — | ||
| ACT-016562 | Outreach suppressed pending steward Outreach | ENR-104201 (Tyler Carroll) held until CASE-003118 is decided |
| Held | — | ||
| ACT-016563 | Outreach suppressed pending steward Outreach | PRV-20931 (Tyler Carroll) held until CASE-003119 is decided |
| Held | — | ||
| ACT-016564 | Outreach suppressed pending steward Outreach | TPA-64346 (Jnaet Hernandez) held until CASE-003120 is decided |
| Held | — | ||
| ACT-016565 | Outreach suppressed pending steward Outreach | ENR-142703 (Janet Hernandez) held until CASE-003121 is decided |
| Held | — | ||
| ACT-016566 | Outreach suppressed pending steward Outreach | TPA-64345 (Janet Hernandez) held until CASE-003122 is decided |
| Held | — | ||
| ACT-016567 | Outreach suppressed pending steward Outreach | CLM-414598 (Luis Jenkins) held until CASE-003123 is decided |
| Held | — | ||
| ACT-016568 | Outreach suppressed pending steward Outreach | TPA-54656 (Fatima McDonald) held until CASE-003124 is decided |
| Held | — | ||
| ACT-016569 | Outreach suppressed pending steward Outreach | CLM-410621 (Fatima McDonald) held until CASE-003125 is decided |
| Held | — | ||
| ACT-016570 | Outreach suppressed pending steward Outreach | ENR-128802 (Grace Taylor) held until CASE-003126 is decided |
| Held | — | ||
| ACT-016571 | Outreach suppressed pending steward Outreach | PRV-26483 (Grace Taylor) held until CASE-003127 is decided |
| Held | — | ||
| ACT-016572 | Outreach suppressed pending steward Outreach | CLM-403165 (Dylan Morris) held until CASE-003128 is decided |
| Held | — | ||
| ACT-016573 | Outreach suppressed pending steward Outreach | ENR-104104 (Dyln Morris) held until CASE-003129 is decided |
| Held | — | ||
| ACT-016574 | Outreach suppressed pending steward Outreach | TPA-54706 (Jose Munoz) held until CASE-003130 is decided |
| Held | — | ||
| ACT-016575 | Outreach suppressed pending steward Outreach | CLM-410721 (Jose Munoz) held until CASE-003131 is decided |
| Held | — | ||
| ACT-016576 | Outreach suppressed pending steward Outreach | CLM-423066 (Frank Diaz) held until CASE-003132 is decided |
| Held | — | ||
| ACT-016577 | Outreach suppressed pending steward Outreach | TPA-60137 (Frank Diaz) held until CASE-003133 is decided |
| Held | — | ||
| ACT-016578 | Outreach suppressed pending steward Outreach | TPA-61848 (Theresa Gonzales) held until CASE-003134 is decided |
| Held | — | ||
| ACT-016579 | Outreach suppressed pending steward Outreach | TPA-59140 (Nathan Salazar) held until CASE-003135 is decided |
| Held | — | ||
| ACT-016580 | Outreach suppressed pending steward Outreach | PRV-26153 (Nathan Salazar) held until CASE-003136 is decided |
| Held | — | ||
| ACT-016581 | Outreach suppressed pending steward Outreach | TPA-63154 (Julia Chapman) held until CASE-003137 is decided |
| Held | — | ||
| ACT-016582 | Outreach suppressed pending steward Outreach | TPA-63153 (Julia Chapman) held until CASE-003138 is decided |
| Held | — | ||
| ACT-016583 | Outreach suppressed pending steward Outreach | TPA-59891 (Emily Chapman) held until CASE-003139 is decided |
| Held | — | ||
| ACT-016584 | Outreach suppressed pending steward Outreach | CLM-422517 (Emily Chapman) held until CASE-003140 is decided |
| Held | — | ||
| ACT-016585 | Outreach suppressed pending steward Outreach | TPA-56531 (Dnise Harrison) held until CASE-003141 is decided |
| Held | — | ||
| ACT-016586 | Outreach suppressed pending steward Outreach | TPA-57231 (Olyvia Maldonado) held until CASE-003142 is decided |
| Held | — | ||
| ACT-016587 | Outreach suppressed pending steward Outreach | CLM-420686 (Debra Warren) held until CASE-003143 is decided |
| Held | — | ||
| ACT-016588 | Outreach suppressed pending steward Outreach | CLM-420687 (Debra Warren) held until CASE-003144 is decided |
| Held | — | ||
| ACT-016589 | Outreach suppressed pending steward Outreach | CLM-401608 (Abigil Jordan) held until CASE-003145 is decided |
| Held | — | ||
| ACT-016590 | Outreach suppressed pending steward Outreach | TPA-61443 (Diana Casttro) held until CASE-003146 is decided |
| Held | — | ||
| ACT-016591 | Outreach suppressed pending steward Outreach | CLM-401995 (Vincent Salazar) held until CASE-003147 is decided |
| Held | — | ||
| ACT-016592 | Outreach suppressed pending steward Outreach | ENR-102564 (Vincent Salazar) held until CASE-003148 is decided |
| Held | — | ||
| ACT-016593 | Outreach suppressed pending steward Outreach | TPA-60940 (Benjamin Henry) held until CASE-003149 is decided |
| Held | — | ||
| ACT-016594 | Outreach suppressed pending steward Outreach | CLM-409559 (Andrew Bennett) held until CASE-003150 is decided |
| Held | — | ||
| ACT-016595 | Outreach suppressed pending steward Outreach | CLM-421530 (Omar Webb) held until CASE-003151 is decided |
| Held | — | ||
| ACT-016596 | Outreach suppressed pending steward Outreach | CLM-421529 (Omar Webb) held until CASE-003152 is decided |
| Held | — | ||
| ACT-016597 | Outreach suppressed pending steward Outreach | TPA-56434 (Jonathan Carter) held until CASE-003153 is decided |
| Held | — | ||
| ACT-016598 | Outreach suppressed pending steward Outreach | TPA-56435 (Jonathan Carter) held until CASE-003154 is decided |
| Held | — | ||
| ACT-016599 | Outreach suppressed pending steward Outreach | CLM-419813 (Jordan Sims) held until CASE-003155 is decided |
| Held | — | ||
| ACT-016600 | Outreach suppressed pending steward Outreach | TPA-58741 (Jordan Siims) held until CASE-003156 is decided |
| Held | — | ||
| ACT-016601 | Outreach suppressed pending steward Outreach | ENR-117556 (Mills Ana) held until CASE-003157 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.