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-016902 | Outreach suppressed pending steward Outreach | TPA-50423 (Betty Howard) held until CASE-003458 is decided |
| Held | — | ||
| ACT-016903 | Outreach suppressed pending steward Outreach | CLM-417666 (Frank James) held until CASE-003459 is decided |
| Held | — | ||
| ACT-016904 | Outreach suppressed pending steward Outreach | CLM-417665 (Frank James) held until CASE-003460 is decided |
| Held | — | ||
| ACT-016905 | Outreach suppressed pending steward Outreach | PRV-20154 (Joseph Jordan) held until CASE-003461 is decided |
| Held | — | ||
| ACT-016906 | Outreach suppressed pending steward Outreach | TPA-61540 (Hiroshi Garza) held until CASE-003462 is decided |
| Held | — | ||
| ACT-016907 | Outreach suppressed pending steward Outreach | TPA-60415 (Arjun Jones) held until CASE-003463 is decided |
| Held | — | ||
| ACT-016908 | Outreach suppressed pending steward Outreach | TPA-60414 (Arjun Jones) held until CASE-003464 is decided |
| Held | — | ||
| ACT-016909 | Outreach suppressed pending steward Outreach | TPA-54150 (Jacob Aguilar) held until CASE-003465 is decided |
| Held | — | ||
| ACT-016910 | Outreach suppressed pending steward Outreach | ENR-106052 (Mei Morales) held until CASE-003466 is decided |
| Held | — | ||
| ACT-016911 | Outreach suppressed pending steward Outreach | CLM-404587 (Mei Morales) held until CASE-003467 is decided |
| Held | — | ||
| ACT-016912 | Outreach suppressed pending steward Outreach | CLM-405576 (Steve Silva) held until CASE-003468 is decided |
| Held | — | ||
| ACT-016913 | Outreach suppressed pending steward Outreach | ENR-107334 (Steven Silva) held until CASE-003469 is decided |
| Held | — | ||
| ACT-016914 | Outreach suppressed pending steward Outreach | CLM-429143 (Heather Nelson) held until CASE-003470 is decided |
| Held | — | ||
| ACT-016915 | Outreach suppressed pending steward Outreach | CLM-422844 (Ana Gilbert) held until CASE-003471 is decided |
| Held | — | ||
| ACT-016916 | Outreach suppressed pending steward Outreach | CLM-431213 (Sophia Daniiels) held until CASE-003472 is decided |
| Held | — | ||
| ACT-016917 | Outreach suppressed pending steward Outreach | PRV-23209 (Alan Morgan) held until CASE-003473 is decided |
| Held | — | ||
| ACT-016918 | Outreach suppressed pending steward Outreach | CLM-405919 (Nancy Taylor) held until CASE-003474 is decided |
| Held | — | ||
| ACT-016919 | Outreach suppressed pending steward Outreach | CLM-423819 (Niccholas Gonzalez) held until CASE-003475 is decided |
| Held | — | ||
| ACT-016920 | Outreach suppressed pending steward Outreach | ENR-139171 (Ralph Wagner) held until CASE-003476 is decided |
| Held | — | ||
| ACT-016921 | Outreach suppressed pending steward Outreach | CLM-429876 (Ralph Wagner) held until CASE-003477 is decided |
| Held | — | ||
| ACT-016922 | Outreach suppressed pending steward Outreach | CLM-404085 (Jacqueline Black) held until CASE-003478 is decided |
| Held | — | ||
| ACT-016923 | Outreach suppressed pending steward Outreach | CLM-428569 (Angela Burns) held until CASE-003479 is decided |
| Held | — | ||
| ACT-016924 | Outreach suppressed pending steward Outreach | TPA-62624 (Angela Burns) held until CASE-003480 is decided |
| Held | — | ||
| ACT-016925 | Outreach suppressed pending steward Outreach | TPA-52625 (Beverly Burns) held until CASE-003481 is decided |
| Held | — | ||
| ACT-016926 | Outreach suppressed pending steward Outreach | TPA-52624 (Beverly Burns) held until CASE-003482 is decided |
| Held | — | ||
| ACT-016927 | Outreach suppressed pending steward Outreach | ENR-109136 (Eric Bishop) held until CASE-003483 is decided |
| Held | — | ||
| ACT-016928 | Outreach suppressed pending steward Outreach | CLM-406992 (Eric Bishop) held until CASE-003484 is decided |
| Held | — | ||
| ACT-016929 | Outreach suppressed pending steward Outreach | TPA-52814 (Marcus Munoz) held until CASE-003485 is decided |
| Held | — | ||
| ACT-016930 | Outreach suppressed pending steward Outreach | CLM-406295 (Sarah Smith) held until CASE-003486 is decided |
| Held | — | ||
| ACT-016931 | Outreach suppressed pending steward Outreach | CLM-427010 (Joe Dean) held until CASE-003487 is decided |
| Held | — | ||
| ACT-016932 | Outreach suppressed pending steward Outreach | CLM-407145 (Brenda Mills) held until CASE-003488 is decided |
| Held | — | ||
| ACT-016933 | Outreach suppressed pending steward Outreach | PRV-27520 (Adnrea Salazar) held until CASE-003489 is decided |
| Held | — | ||
| ACT-016934 | Outreach suppressed pending steward Outreach | TPA-51960 (Ykui Mitchell) held until CASE-003490 is decided |
| Held | — | ||
| ACT-016935 | Outreach suppressed pending steward Outreach | ENR-105917 (Yuki Mitchell) held until CASE-003491 is decided |
| Held | — | ||
| ACT-016936 | Outreach suppressed pending steward Outreach | CLM-405624 (Timothy Howell) held until CASE-003492 is decided |
| Held | — | ||
| ACT-016937 | Outreach suppressed pending steward Outreach | CLM-428137 (Sarah Howell) held until CASE-003493 is decided |
| Held | — | ||
| ACT-016938 | Outreach suppressed pending steward Outreach | CLM-428136 (Sarah Howell) held until CASE-003494 is decided |
| Held | — | ||
| ACT-016939 | Outreach suppressed pending steward Outreach | TPA-61486 (Christian Salazar) held until CASE-003495 is decided |
| Held | — | ||
| ACT-016940 | Outreach suppressed pending steward Outreach | CLM-401852 (Jacob Holmes) held until CASE-003496 is decided |
| Held | — | ||
| ACT-016941 | Outreach suppressed pending steward Outreach | CLM-425236 (Brittany Morales) held until CASE-003497 is decided |
| Held | — | ||
| ACT-016942 | Outreach suppressed pending steward Outreach | TPA-55403 (David Hansen) held until CASE-003498 is decided |
| Held | — | ||
| ACT-016943 | Outreach suppressed pending steward Outreach | ENR-118575 (Grace Collins) held until CASE-003499 is decided |
| Held | — | ||
| ACT-016944 | Outreach suppressed pending steward Outreach | CLM-414172 (Grace Collins) held until CASE-003500 is decided |
| Held | — | ||
| ACT-016945 | Outreach suppressed pending steward Outreach | CLM-415383 (Santiago Tayllor) held until CASE-003501 is decided |
| Held | — | ||
| ACT-016946 | Outreach suppressed pending steward Outreach | ENR-116655 (Teresa Taylor) held until CASE-003502 is decided |
| Held | — | ||
| ACT-016947 | Outreach suppressed pending steward Outreach | CLM-406694 (Arjun Hunt) held until CASE-003503 is decided |
| Held | — | ||
| ACT-016948 | Outreach suppressed pending steward Outreach | CLM-413681 (Madison Fields) held until CASE-003504 is decided |
| Held | — | ||
| ACT-016949 | Outreach suppressed pending steward Outreach | CLM-400458 (Janice Santiago) held until CASE-003505 is decided |
| Held | — | ||
| ACT-016950 | Outreach suppressed pending steward Outreach | TPA-50196 (Janice Santiago) held until CASE-003506 is decided |
| Held | — | ||
| ACT-016951 | Outreach suppressed pending steward Outreach | TPA-53725 (Donald Fields) held until CASE-003507 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.