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
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-014045 | Outreach suppressed pending steward Outreach | ENR-121561 (Theresa Gutierrez) held until CASE-000601 is decided |
| Held | — | ||
| ACT-014046 | Outreach suppressed pending steward Outreach | CLM-427126 (Eugene Phillips) held until CASE-000602 is decided |
| Held | — | ||
| ACT-014047 | Outreach suppressed pending steward Outreach | CLM-427127 (Eugene Phillips) held until CASE-000603 is decided |
| Held | — | ||
| ACT-014048 | Outreach suppressed pending steward Outreach | TPA-53500 (Julia Soto) held until CASE-000604 is decided |
| Held | — | ||
| ACT-014049 | Outreach suppressed pending steward Outreach | TPA-55613 (Logan Adams) held until CASE-000605 is decided |
| Held | — | ||
| ACT-014050 | Outreach suppressed pending steward Outreach | CLM-412773 (Logan Adams) held until CASE-000606 is decided |
| Held | — | ||
| ACT-014051 | Outreach suppressed pending steward Outreach | CLM-415859 (Janet Vega) held until CASE-000607 is decided |
| Held | — | ||
| ACT-014052 | Outreach suppressed pending steward Outreach | CLM-403200 (Samantha Watson) held until CASE-000608 is decided |
| Held | — | ||
| ACT-014053 | Outreach suppressed pending steward Outreach | TPA-51375 (Sam Watson) held until CASE-000609 is decided |
| Held | — | ||
| ACT-014054 | Outreach suppressed pending steward Outreach | ENR-115970 (Jona Watson) held until CASE-000610 is decided |
| Held | — | ||
| ACT-014055 | Outreach suppressed pending steward Outreach | CLM-431873 (Diana Chavez) held until CASE-000611 is decided |
| Held | — | ||
| ACT-014056 | Outreach suppressed pending steward Outreach | CLM-411380 (Judy Miller) held until CASE-000612 is decided |
| Held | — | ||
| ACT-014057 | Outreach suppressed pending steward Outreach | TPA-57350 (Albert Stephens) held until CASE-000613 is decided |
| Held | — | ||
| ACT-014058 | Outreach suppressed pending steward Outreach | TPA-63496 (Albert Stephens) held until CASE-000614 is decided |
| Held | — | ||
| ACT-014059 | Outreach suppressed pending steward Outreach | ENR-140136 (Albert Stephens) held until CASE-000615 is decided |
| Held | — | ||
| ACT-014060 | Outreach suppressed pending steward Outreach | ENR-110731 (Kelly Park) held until CASE-000616 is decided |
| Held | — | ||
| ACT-014061 | Outreach suppressed pending steward Outreach | CLM-408147 (Kelly Park) held until CASE-000617 is decided |
| Held | — | ||
| ACT-014062 | Outreach suppressed pending steward Outreach | ENR-139906 (John Vasquez) held until CASE-000618 is decided |
| Held | — | ||
| ACT-014063 | Outreach suppressed pending steward Outreach | TPA-63417 (Jack Vasquez) held until CASE-000619 is decided |
| Held | — | ||
| ACT-014064 | Outreach suppressed pending steward Outreach | TPA-58172 (Mark Lynch) held until CASE-000620 is decided |
| Held | — | ||
| ACT-014065 | Outreach suppressed pending steward Outreach | TPA-50182 (Barbara Lynch) held until CASE-000621 is decided |
| Held | — | ||
| ACT-014066 | Outreach suppressed pending steward Outreach | ENR-100588 (Barb Lynch) held until CASE-000622 is decided |
| Held | — | ||
| ACT-014067 | Outreach suppressed pending steward Outreach | CLM-404546 (Katherine Wang) held until CASE-000623 is decided |
| Held | — | ||
| ACT-014068 | Outreach suppressed pending steward Outreach | CLM-426457 (Roy Lawrence) held until CASE-000624 is decided |
| Held | — | ||
| ACT-014069 | Outreach suppressed pending steward Outreach | TPA-61690 (Roy Lawrence) held until CASE-000625 is decided |
| Held | — | ||
| ACT-014070 | Outreach suppressed pending steward Outreach | TPA-60359 (Ann Lawrence) held until CASE-000626 is decided |
| Held | — | ||
| ACT-014071 | Outreach suppressed pending steward Outreach | CLM-417765 (Mason Rose) held until CASE-000627 is decided |
| Held | — | ||
| ACT-014072 | Outreach suppressed pending steward Outreach | CLM-403410 (Eric Ruiz) held until CASE-000628 is decided |
| Held | — | ||
| ACT-014073 | Outreach suppressed pending steward Outreach | ENR-104440 (Eric Ruiz) held until CASE-000629 is decided |
| Held | — | ||
| ACT-014074 | Outreach suppressed pending steward Outreach | PRV-24673 (Brandon Hicks) held until CASE-000630 is decided |
| Held | — | ||
| ACT-014075 | Outreach suppressed pending steward Outreach | TPA-56920 (Brandon Hicks) held until CASE-000631 is decided |
| Held | — | ||
| ACT-014076 | Outreach suppressed pending steward Outreach | CLM-400455 (Nicole Chen) held until CASE-000632 is decided |
| Held | — | ||
| ACT-014077 | Outreach suppressed pending steward Outreach | TPA-63484 (Justin Fowler) held until CASE-000633 is decided |
| Held | — | ||
| ACT-014078 | Outreach suppressed pending steward Outreach | TPA-50791 (Carlos Wood) held until CASE-000634 is decided |
| Held | — | ||
| ACT-014079 | Outreach suppressed pending steward Outreach | CLM-403121 (Barbara Welhc) held until CASE-000635 is decided |
| Held | — | ||
| ACT-014080 | Outreach suppressed pending steward Outreach | TPA-58559 (Jeffrey Wells) held until CASE-000636 is decided |
| Held | — | ||
| ACT-014081 | Outreach suppressed pending steward Outreach | ENR-141286 (Benjamin Parker) held until CASE-000637 is decided |
| Held | — | ||
| ACT-014082 | Outreach suppressed pending steward Outreach | TPA-63247 (Denise Knight) held until CASE-000638 is decided |
| Held | — | ||
| ACT-014083 | Outreach suppressed pending steward Outreach | CLM-430018 (Denise Knight) held until CASE-000639 is decided |
| Held | — | ||
| ACT-014084 | Outreach suppressed pending steward Outreach | CLM-402526 (Sarah Cruz) held until CASE-000640 is decided |
| Held | — | ||
| ACT-014085 | Outreach suppressed pending steward Outreach | PRV-20736 (Sarah Cruz) held until CASE-000641 is decided |
| Held | — | ||
| ACT-014086 | Outreach suppressed pending steward Outreach | TPA-61753 (Sara Cruz) held until CASE-000642 is decided |
| Held | — | ||
| ACT-014087 | Outreach suppressed pending steward Outreach | TPA-61752 (Sara Cruz) held until CASE-000643 is decided |
| Held | — | ||
| ACT-014088 | Outreach suppressed pending steward Outreach | PRV-29260 (Gloria Hudson) held until CASE-000644 is decided |
| Held | — | ||
| ACT-014089 | Outreach suppressed pending steward Outreach | CLM-431681 (Gloria Hudson) held until CASE-000645 is decided |
| Held | — | ||
| ACT-014090 | Outreach suppressed pending steward Outreach | CLM-420419 (Christian Cruz) held until CASE-000646 is decided |
| Held | — | ||
| ACT-014091 | Outreach suppressed pending steward Outreach | TPA-57248 (Yuki Aguilar) held until CASE-000647 is decided |
| Held | — | ||
| ACT-014092 | Outreach suppressed pending steward Outreach | CLM-426987 (Christine Hunter) held until CASE-000648 is decided |
| Held | — | ||
| ACT-014093 | Outreach suppressed pending steward Outreach | CLM-418741 (Ronald Long) held until CASE-000649 is decided |
| Held | — | ||
| ACT-014094 | Outreach suppressed pending steward Outreach | CLM-412365 (Steven Mason) held until CASE-000650 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.