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-016802 | Outreach suppressed pending steward Outreach | CLM-431347 (Tyler Ortiz) held until CASE-003358 is decided |
| Held | — | ||
| ACT-016803 | Outreach suppressed pending steward Outreach | TPA-56921 (Randy Griffin) held until CASE-003359 is decided |
| Held | — | ||
| ACT-016804 | Outreach suppressed pending steward Outreach | CLM-414053 (Logan Wang) held until CASE-003360 is decided |
| Held | — | ||
| ACT-016805 | Outreach suppressed pending steward Outreach | CLM-402242 (Jesse Stewart) held until CASE-003361 is decided |
| Held | — | ||
| ACT-016806 | Outreach suppressed pending steward Outreach | CLM-428917 (Donald Cooper) held until CASE-003362 is decided |
| Held | — | ||
| ACT-016807 | Outreach suppressed pending steward Outreach | CLM-410252 (David Wheeler) held until CASE-003363 is decided |
| Held | — | ||
| ACT-016808 | Outreach suppressed pending steward Outreach | CLM-411727 (Karen Watsn) held until CASE-003364 is decided |
| Held | — | ||
| ACT-016809 | Outreach suppressed pending steward Outreach | ENR-115470 (Karen Watson) held until CASE-003365 is decided |
| Held | — | ||
| ACT-016810 | Outreach suppressed pending steward Outreach | CLM-401420 (Priya Li) held until CASE-003366 is decided |
| Held | — | ||
| ACT-016811 | Outreach suppressed pending steward Outreach | CLM-400981 (David Moreno) held until CASE-003367 is decided |
| Held | — | ||
| ACT-016812 | Outreach suppressed pending steward Outreach | TPA-60871 (Bradley Russell) held until CASE-003368 is decided |
| Held | — | ||
| ACT-016813 | Outreach suppressed pending steward Outreach | TPA-53779 (Harold Bailey) held until CASE-003369 is decided |
| Held | — | ||
| ACT-016814 | Outreach suppressed pending steward Outreach | ENR-119766 (Arjun Rojas) held until CASE-003370 is decided |
| Held | — | ||
| ACT-016815 | Outreach suppressed pending steward Outreach | CLM-411250 (Luis Watsno) held until CASE-003371 is decided |
| Held | — | ||
| ACT-016816 | Outreach suppressed pending steward Outreach | ENR-114796 (Luis Watson) held until CASE-003372 is decided |
| Held | — | ||
| ACT-016817 | Outreach suppressed pending steward Outreach | TPA-52253 (Martha Jones) held until CASE-003373 is decided |
| Held | — | ||
| ACT-016818 | Outreach suppressed pending steward Outreach | CLM-400971 (Beverly Gonzales) held until CASE-003374 is decided |
| Held | — | ||
| ACT-016819 | Outreach suppressed pending steward Outreach | TPA-54888 (Kenneth Fuller) held until CASE-003375 is decided |
| Held | — | ||
| ACT-016820 | Outreach suppressed pending steward Outreach | CLM-432671 (Ahmed Luna) held until CASE-003376 is decided |
| Held | — | ||
| ACT-016821 | Outreach suppressed pending steward Outreach | ENR-142888 (Ahmed Luna) held until CASE-003377 is decided |
| Held | — | ||
| ACT-016822 | Outreach suppressed pending steward Outreach | ENR-100105 (Natalie Salazar) held until CASE-003378 is decided |
| Held | — | ||
| ACT-016823 | Outreach suppressed pending steward Outreach | TPA-50026 (Natalie Salazar) held until CASE-003379 is decided |
| Held | — | ||
| ACT-016824 | Outreach suppressed pending steward Outreach | CLM-400076 (Natalie Salazar) held until CASE-003380 is decided |
| Held | — | ||
| ACT-016825 | Outreach suppressed pending steward Outreach | PRV-26033 (Mason Foster) held until CASE-003381 is decided |
| Held | — | ||
| ACT-016826 | Outreach suppressed pending steward Outreach | TPA-62096 (Mei Vasquez) held until CASE-003382 is decided |
| Held | — | ||
| ACT-016827 | Outreach suppressed pending steward Outreach | TPA-60834 (Carlos Hoffman) held until CASE-003383 is decided |
| Held | — | ||
| ACT-016828 | Outreach suppressed pending steward Outreach | ENR-141796 (Ryan Aguilar) held until CASE-003384 is decided |
| Held | — | ||
| ACT-016829 | Outreach suppressed pending steward Outreach | TPA-64044 (Ryan Aguilar) held until CASE-003385 is decided |
| Held | — | ||
| ACT-016830 | Outreach suppressed pending steward Outreach | CLM-414817 (Jeffrey Aguilar) held until CASE-003386 is decided |
| Held | — | ||
| ACT-016831 | Outreach suppressed pending steward Outreach | TPA-54421 (Ruth Herrera) held until CASE-003387 is decided |
| Held | — | ||
| ACT-016832 | Outreach suppressed pending steward Outreach | TPA-54420 (Ruth Herrera) held until CASE-003388 is decided |
| Held | — | ||
| ACT-016833 | Outreach suppressed pending steward Outreach | CLM-416434 (Ray Lynch) held until CASE-003389 is decided |
| Held | — | ||
| ACT-016834 | Outreach suppressed pending steward Outreach | CLM-401282 (Charlotte Guzman) held until CASE-003390 is decided |
| Held | — | ||
| ACT-016835 | Outreach suppressed pending steward Outreach | TPA-50389 (Marcus Wallace) held until CASE-003391 is decided |
| Held | — | ||
| ACT-016836 | Outreach suppressed pending steward Outreach | CLM-419734 (George Delgado) held until CASE-003392 is decided |
| Held | — | ||
| ACT-016837 | Outreach suppressed pending steward Outreach | CLM-406794 (Julie Pena) held until CASE-003393 is decided |
| Held | — | ||
| ACT-016838 | Outreach suppressed pending steward Outreach | PRV-21701 (Terry James) held until CASE-003394 is decided |
| Held | — | ||
| ACT-016839 | Outreach suppressed pending steward Outreach | CLM-418079 (Ann Webb) held until CASE-003395 is decided |
| Held | — | ||
| ACT-016840 | Outreach suppressed pending steward Outreach | TPA-57986 (Ann Webb) held until CASE-003396 is decided |
| Held | — | ||
| ACT-016841 | Outreach suppressed pending steward Outreach | CLM-416946 (Ralph Montgomery) held until CASE-003397 is decided |
| Held | — | ||
| ACT-016842 | Outreach suppressed pending steward Outreach | TPA-55835 (Katherine Gomez) held until CASE-003398 is decided |
| Held | — | ||
| ACT-016843 | Outreach suppressed pending steward Outreach | PRV-23850 (Katherine Gomez) held until CASE-003399 is decided |
| Held | — | ||
| ACT-016844 | Outreach suppressed pending steward Outreach | ENR-140130 (Kathryn Ray) held until CASE-003400 is decided |
| Held | — | ||
| ACT-016845 | Outreach suppressed pending steward Outreach | PRV-28939 (Kathryn Ray) held until CASE-003401 is decided |
| Held | — | ||
| ACT-016846 | Outreach suppressed pending steward Outreach | CLM-403358 (Jose Dixon) held until CASE-003402 is decided |
| Held | — | ||
| ACT-016847 | Outreach suppressed pending steward Outreach | TPA-60341 (Vincent Perry) held until CASE-003403 is decided |
| Held | — | ||
| ACT-016848 | Outreach suppressed pending steward Outreach | ENR-113386 (Katherine Romero) held until CASE-003404 is decided |
| Held | — | ||
| ACT-016849 | Outreach suppressed pending steward Outreach | CLM-410172 (Romero Katherine) held until CASE-003405 is decided |
| Held | — | ||
| ACT-016850 | Outreach suppressed pending steward Outreach | ENR-137879 (Madison Flores) held until CASE-003406 is decided |
| Held | — | ||
| ACT-016851 | Outreach suppressed pending steward Outreach | CLM-428889 (Madison Flores) held until CASE-003407 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.