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-016752 | Outreach suppressed pending steward Outreach | TPA-53697 (Jacqueline Adams) held until CASE-003308 is decided |
| Held | — | ||
| ACT-016753 | Outreach suppressed pending steward Outreach | CLM-420005 (Angela Sims) held until CASE-003309 is decided |
| Held | — | ||
| ACT-016754 | Outreach suppressed pending steward Outreach | PRV-26239 (Brittany Sims) held until CASE-003310 is decided |
| Held | — | ||
| ACT-016755 | Outreach suppressed pending steward Outreach | TPA-55583 (Jacqueline Simpson) held until CASE-003311 is decided |
| Held | — | ||
| ACT-016756 | Outreach suppressed pending steward Outreach | ENR-116674 (Jackie Simpson) held until CASE-003312 is decided |
| Held | — | ||
| ACT-016757 | Outreach suppressed pending steward Outreach | ENR-109177 (Judith Hamilton) held until CASE-003313 is decided |
| Held | — | ||
| ACT-016758 | Outreach suppressed pending steward Outreach | TPA-53081 (Judith Hamilton) held until CASE-003314 is decided |
| Held | — | ||
| ACT-016759 | Outreach suppressed pending steward Outreach | CLM-411735 (Juan Kelly) held until CASE-003315 is decided |
| Held | — | ||
| ACT-016760 | Outreach suppressed pending steward Outreach | PRV-26836 (Shirley Fields) held until CASE-003316 is decided |
| Held | — | ||
| ACT-016761 | Outreach suppressed pending steward Outreach | TPA-54808 (Melissa Sims) held until CASE-003317 is decided |
| Held | — | ||
| ACT-016762 | Outreach suppressed pending steward Outreach | TPA-54807 (Melissa Sims) held until CASE-003318 is decided |
| Held | — | ||
| ACT-016763 | Outreach suppressed pending steward Outreach | PRV-22922 (Sharon Ellis) held until CASE-003319 is decided |
| Held | — | ||
| ACT-016764 | Outreach suppressed pending steward Outreach | CLM-402453 (Kelly Miller) held until CASE-003320 is decided |
| Held | — | ||
| ACT-016765 | Outreach suppressed pending steward Outreach | CLM-420932 (Jessica Romero) held until CASE-003321 is decided |
| Held | — | ||
| ACT-016766 | Outreach suppressed pending steward Outreach | CLM-420934 (Jessica Roemro) held until CASE-003322 is decided |
| Held | — | ||
| ACT-016767 | Outreach suppressed pending steward Outreach | ENR-124735 (Brian Warren) held until CASE-003323 is decided |
| Held | — | ||
| ACT-016768 | Outreach suppressed pending steward Outreach | PRV-25588 (Brian Warren) held until CASE-003324 is decided |
| Held | — | ||
| ACT-016769 | Outreach suppressed pending steward Outreach | CLM-428620 (Valentina Scott) held until CASE-003325 is decided |
| Held | — | ||
| ACT-016770 | Outreach suppressed pending steward Outreach | CLM-411750 (Jessica Jones) held until CASE-003326 is decided |
| Held | — | ||
| ACT-016771 | Outreach suppressed pending steward Outreach | ENR-115496 (Jessica Jones) held until CASE-003327 is decided |
| Held | — | ||
| ACT-016772 | Outreach suppressed pending steward Outreach | TPA-63478 (Tony Johnston) held until CASE-003328 is decided |
| Held | — | ||
| ACT-016773 | Outreach suppressed pending steward Outreach | ENR-106340 (Chuck Peterson) held until CASE-003329 is decided |
| Held | — | ||
| ACT-016774 | Outreach suppressed pending steward Outreach | ENR-138419 (Amber Fowler) held until CASE-003330 is decided |
| Held | — | ||
| ACT-016775 | Outreach suppressed pending steward Outreach | TPA-62947 (Amber Fowler) held until CASE-003331 is decided |
| Held | — | ||
| ACT-016776 | Outreach suppressed pending steward Outreach | TPA-57624 (Adam Dunn) held until CASE-003332 is decided |
| Held | — | ||
| ACT-016777 | Outreach suppressed pending steward Outreach | CLM-418580 (Samuel Santiago) held until CASE-003333 is decided |
| Held | — | ||
| ACT-016778 | Outreach suppressed pending steward Outreach | TPA-62644 (Aisha Rojas) held until CASE-003334 is decided |
| Held | — | ||
| ACT-016779 | Outreach suppressed pending steward Outreach | CLM-411477 (Christina Maldonado) held until CASE-003335 is decided |
| Held | — | ||
| ACT-016780 | Outreach suppressed pending steward Outreach | CLM-401884 (Sean Ramirez) held until CASE-003336 is decided |
| Held | — | ||
| ACT-016781 | Outreach suppressed pending steward Outreach | ENR-102432 (Sean Ramirez) held until CASE-003337 is decided |
| Held | — | ||
| ACT-016782 | Outreach suppressed pending steward Outreach | CLM-422062 (Janet Aguilar) held until CASE-003338 is decided |
| Held | — | ||
| ACT-016783 | Outreach suppressed pending steward Outreach | TPA-61749 (Theresa Rios) held until CASE-003339 is decided |
| Held | — | ||
| ACT-016784 | Outreach suppressed pending steward Outreach | CLM-410452 (Charlotte Warren) held until CASE-003340 is decided |
| Held | — | ||
| ACT-016785 | Outreach suppressed pending steward Outreach | PRV-22988 (Keith Torres) held until CASE-003341 is decided |
| Held | — | ||
| ACT-016786 | Outreach suppressed pending steward Outreach | TPA-56521 (Janet Shw) held until CASE-003342 is decided |
| Held | — | ||
| ACT-016787 | Outreach suppressed pending steward Outreach | CLM-414806 (Janet Shaw) held until CASE-003343 is decided |
| Held | — | ||
| ACT-016788 | Outreach suppressed pending steward Outreach | TPA-54006 (Olivia Ramos) held until CASE-003344 is decided |
| Held | — | ||
| ACT-016789 | Outreach suppressed pending steward Outreach | CLM-413400 (Lauren Shaw) held until CASE-003345 is decided |
| Held | — | ||
| ACT-016790 | Outreach suppressed pending steward Outreach | PRV-21877 (Ruth McCoy) held until CASE-003346 is decided |
| Held | — | ||
| ACT-016791 | Outreach suppressed pending steward Outreach | ENR-108428 (Ruht McCoy) held until CASE-003347 is decided |
| Held | — | ||
| ACT-016792 | Outreach suppressed pending steward Outreach | TPA-60938 (Karen Perez) held until CASE-003348 is decided |
| Held | — | ||
| ACT-016793 | Outreach suppressed pending steward Outreach | CLM-429702 (Henry King) held until CASE-003349 is decided |
| Held | — | ||
| ACT-016794 | Outreach suppressed pending steward Outreach | PRV-28696 (Henry King) held until CASE-003350 is decided |
| Held | — | ||
| ACT-016795 | Outreach suppressed pending steward Outreach | CLM-432247 (Frank Allen) held until CASE-003351 is decided |
| Held | — | ||
| ACT-016796 | Outreach suppressed pending steward Outreach | TPA-56193 (Brian Anderson) held until CASE-003352 is decided |
| Held | — | ||
| ACT-016797 | Outreach suppressed pending steward Outreach | ENR-100117 (Nicole Andrews) held until CASE-003353 is decided |
| Held | — | ||
| ACT-016798 | Outreach suppressed pending steward Outreach | CLM-414028 (Brian Anderson) held until CASE-003354 is decided |
| Held | — | ||
| ACT-016799 | Outreach suppressed pending steward Outreach | CLM-415211 (Lucia Holmes) held until CASE-003355 is decided |
| Held | — | ||
| ACT-016800 | Outreach suppressed pending steward Outreach | CLM-428016 (Jack Chen) held until CASE-003356 is decided |
| Held | — | ||
| ACT-016801 | Outreach suppressed pending steward Outreach | CLM-416725 (Joyce Cole) held until CASE-003357 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.