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-016952 | Outreach suppressed pending steward Outreach | CLM-417034 (Steve Anderson) held until CASE-003508 is decided |
| Held | — | ||
| ACT-016953 | Outreach suppressed pending steward Outreach | ENR-122415 (Steven Anderson) held until CASE-003509 is decided |
| Held | — | ||
| ACT-016954 | Outreach suppressed pending steward Outreach | TPA-58155 (Gerald Ortega) held until CASE-003510 is decided |
| Held | — | ||
| ACT-016955 | Outreach suppressed pending steward Outreach | PRV-22730 (Ann Obrien) held until CASE-003511 is decided |
| Held | — | ||
| ACT-016956 | Outreach suppressed pending steward Outreach | CLM-409321 (Ann Obrien) held until CASE-003512 is decided |
| Held | — | ||
| ACT-016957 | Outreach suppressed pending steward Outreach | ENR-120554 (Anna Ortega) held until CASE-003513 is decided |
| Held | — | ||
| ACT-016958 | Outreach suppressed pending steward Outreach | CLM-415593 (Anna Ortega) held until CASE-003514 is decided |
| Held | — | ||
| ACT-016959 | Outreach suppressed pending steward Outreach | TPA-61786 (Carl Ray) held until CASE-003515 is decided |
| Held | — | ||
| ACT-016960 | Outreach suppressed pending steward Outreach | TPA-56223 (Fatima Nunez) held until CASE-003516 is decided |
| Held | — | ||
| ACT-016961 | Outreach suppressed pending steward Outreach | TPA-53980 (Wei Nelson) held until CASE-003517 is decided |
| Held | — | ||
| ACT-016962 | Outreach suppressed pending steward Outreach | TPA-57274 (Margaret Tucker) held until CASE-003518 is decided |
| Held | — | ||
| ACT-016963 | Outreach suppressed pending steward Outreach | CLM-412390 (Jack Russell) held until CASE-003519 is decided |
| Held | — | ||
| ACT-016964 | Outreach suppressed pending steward Outreach | ENR-116298 (Jack Russell) held until CASE-003520 is decided |
| Held | — | ||
| ACT-016965 | Outreach suppressed pending steward Outreach | CLM-421993 (Grace Taylor) held until CASE-003521 is decided |
| Held | — | ||
| ACT-016966 | Outreach suppressed pending steward Outreach | ENR-121951 (Jerry Willlis) held until CASE-003522 is decided |
| Held | — | ||
| ACT-016967 | Outreach suppressed pending steward Outreach | TPA-57356 (Jerry Willis) held until CASE-003523 is decided |
| Held | — | ||
| ACT-016968 | Outreach suppressed pending steward Outreach | CLM-431056 (Judith Hernandez) held until CASE-003524 is decided |
| Held | — | ||
| ACT-016969 | Outreach suppressed pending steward Outreach | TPA-63723 (Judith Hernandez) held until CASE-003525 is decided |
| Held | — | ||
| ACT-016970 | Outreach suppressed pending steward Outreach | CLM-424516 (Santiago Silva) held until CASE-003526 is decided |
| Held | — | ||
| ACT-016971 | Outreach suppressed pending steward Outreach | TPA-58795 (Doris Jordan) held until CASE-003527 is decided |
| Held | — | ||
| ACT-016972 | Outreach suppressed pending steward Outreach | CLM-409149 (Sandra Maldonado) held until CASE-003528 is decided |
| Held | — | ||
| ACT-016973 | Outreach suppressed pending steward Outreach | ENR-112075 (Sandar Maldonado) held until CASE-003529 is decided |
| Held | — | ||
| ACT-016974 | Outreach suppressed pending steward Outreach | CLM-428008 (Sophia Johnston) held until CASE-003530 is decided |
| Held | — | ||
| ACT-016975 | Outreach suppressed pending steward Outreach | PRV-27687 (Martha Snyder) held until CASE-003531 is decided |
| Held | — | ||
| ACT-016976 | Outreach suppressed pending steward Outreach | TPA-64442 (Eugene Obrien) held until CASE-003532 is decided |
| Held | — | ||
| ACT-016977 | Outreach suppressed pending steward Outreach | CLM-423185 (Stephen Henry) held until CASE-003533 is decided |
| Held | — | ||
| ACT-016978 | Outreach suppressed pending steward Outreach | CLM-429100 (Brenda Phillips) held until CASE-003534 is decided |
| Held | — | ||
| ACT-016979 | Outreach suppressed pending steward Outreach | TPA-57143 (Greg Valdez) held until CASE-003535 is decided |
| Held | — | ||
| ACT-016980 | Outreach suppressed pending steward Outreach | CLM-416272 (Greegory Valdez) held until CASE-003536 is decided |
| Held | — | ||
| ACT-016981 | Outreach suppressed pending steward Outreach | PRV-23204 (Larua Li) held until CASE-003537 is decided |
| Held | — | ||
| ACT-016982 | Outreach suppressed pending steward Outreach | ENR-104058 (Deb Ortega) held until CASE-003538 is decided |
| Held | — | ||
| ACT-016983 | Outreach suppressed pending steward Outreach | PRV-20883 (Deborah Ortaga) held until CASE-003539 is decided |
| Held | — | ||
| ACT-016984 | Outreach suppressed pending steward Outreach | CLM-421234 (Virginia Ray) held until CASE-003540 is decided |
| Held | — | ||
| ACT-016985 | Outreach suppressed pending steward Outreach | CLM-414759 (Alice Marquez) held until CASE-003541 is decided |
| Held | — | ||
| ACT-016986 | Outreach suppressed pending steward Outreach | CLM-413039 (Rachel Black) held until CASE-003542 is decided |
| Held | — | ||
| ACT-016987 | Outreach suppressed pending steward Outreach | ENR-117110 (Rachel Black) held until CASE-003543 is decided |
| Held | — | ||
| ACT-016988 | Outreach suppressed pending steward Outreach | CLM-421813 (Camila Lawrence) held until CASE-003544 is decided |
| Held | — | ||
| ACT-016989 | Outreach suppressed pending steward Outreach | TPA-59579 (Camila Lawrence) held until CASE-003545 is decided |
| Held | — | ||
| ACT-016990 | Outreach suppressed pending steward Outreach | TPA-62242 (Jen McCoy) held until CASE-003546 is decided |
| Held | — | ||
| ACT-016991 | Outreach suppressed pending steward Outreach | CLM-427713 (Jennifer McCoy) held until CASE-003547 is decided |
| Held | — | ||
| ACT-016992 | Outreach suppressed pending steward Outreach | ENR-107793 (Alice Carroll) held until CASE-003548 is decided |
| Held | — | ||
| ACT-016993 | Outreach suppressed pending steward Outreach | TPA-52629 (Carroll Alice) held until CASE-003549 is decided |
| Held | — | ||
| ACT-016994 | Outreach suppressed pending steward Outreach | TPA-56000 (Bobby Watson) held until CASE-003550 is decided |
| Held | — | ||
| ACT-016995 | Outreach suppressed pending steward Outreach | ENR-117870 (Bobby Watson) held until CASE-003551 is decided |
| Held | — | ||
| ACT-016996 | Outreach suppressed pending steward Outreach | CLM-413613 (Jacqueline Espinoza) held until CASE-003552 is decided |
| Held | — | ||
| ACT-016997 | Outreach suppressed pending steward Outreach | ENR-117809 (Jacqueline Espinoza) held until CASE-003553 is decided |
| Held | — | ||
| ACT-016998 | Outreach suppressed pending steward Outreach | TPA-64068 (Cynthia Le) held until CASE-003554 is decided |
| Held | — | ||
| ACT-016999 | Outreach suppressed pending steward Outreach | CLM-424727 (Jerry Jordan) held until CASE-003555 is decided |
| Held | — | ||
| ACT-017000 | Outreach suppressed pending steward Outreach | CLM-418151 (Christine Boyd) held until CASE-003556 is decided |
| Held | — | ||
| ACT-017001 | Outreach suppressed pending steward Outreach | ENR-123861 (Christine Boyd) held until CASE-003557 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.