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-017002 | Outreach suppressed pending steward Outreach | ENR-113015 (Ronald Hunt) held until CASE-003558 is decided |
| Held | — | ||
| ACT-017003 | Outreach suppressed pending steward Outreach | TPA-54310 (Ronald Hunt) held until CASE-003559 is decided |
| Held | — | ||
| ACT-017004 | Outreach suppressed pending steward Outreach | TPA-50601 (Mason Guzman) held until CASE-003560 is decided |
| Held | — | ||
| ACT-017005 | Outreach suppressed pending steward Outreach | CLM-411806 (Gabriel Woods) held until CASE-003561 is decided |
| Held | — | ||
| ACT-017006 | Outreach suppressed pending steward Outreach | TPA-60796 (Ramirez Ryan) held until CASE-003562 is decided |
| Held | — | ||
| ACT-017007 | Outreach suppressed pending steward Outreach | ENR-135696 (Edward Henry) held until CASE-003563 is decided |
| Held | — | ||
| ACT-017008 | Outreach suppressed pending steward Outreach | CLM-407066 (Brenda Wells) held until CASE-003564 is decided |
| Held | — | ||
| ACT-017009 | Outreach suppressed pending steward Outreach | PRV-25250 (Mariana Ryan) held until CASE-003565 is decided |
| Held | — | ||
| ACT-017010 | Outreach suppressed pending steward Outreach | TPA-50321 (Matthew Johnston) held until CASE-003566 is decided |
| Held | — | ||
| ACT-017011 | Outreach suppressed pending steward Outreach | ENR-100945 (Matthew Johnston) held until CASE-003567 is decided |
| Held | — | ||
| ACT-017012 | Outreach suppressed pending steward Outreach | TPA-60227 (Stephen Gonzales) held until CASE-003568 is decided |
| Held | — | ||
| ACT-017013 | Outreach suppressed pending steward Outreach | CLM-427002 (Daniel Jensen) held until CASE-003569 is decided |
| Held | — | ||
| ACT-017014 | Outreach suppressed pending steward Outreach | CLM-408598 (Amber Weber) held until CASE-003570 is decided |
| Held | — | ||
| ACT-017015 | Outreach suppressed pending steward Outreach | CLM-408599 (Amber Weber) held until CASE-003571 is decided |
| Held | — | ||
| ACT-017016 | Outreach suppressed pending steward Outreach | CLM-418199 (Laura Guzman) held until CASE-003572 is decided |
| Held | — | ||
| ACT-017017 | Outreach suppressed pending steward Outreach | CLM-424070 (Jackie Yang) held until CASE-003573 is decided |
| Held | — | ||
| ACT-017018 | Outreach suppressed pending steward Outreach | CLM-424069 (Jacqueline Yang) held until CASE-003574 is decided |
| Held | — | ||
| ACT-017019 | Outreach suppressed pending steward Outreach | TPA-60983 (Nicole Gilbert) held until CASE-003575 is decided |
| Held | — | ||
| ACT-017020 | Outreach suppressed pending steward Outreach | ENR-124928 (Sofia Gilbert) held until CASE-003576 is decided |
| Held | — | ||
| ACT-017021 | Outreach suppressed pending steward Outreach | CLM-406309 (Joseph Thompson) held until CASE-003577 is decided |
| Held | — | ||
| ACT-017022 | Outreach suppressed pending steward Outreach | ENR-108285 (Joseph Thompson) held until CASE-003578 is decided |
| Held | — | ||
| ACT-017023 | Outreach suppressed pending steward Outreach | TPA-59130 (Eric Johnston) held until CASE-003579 is decided |
| Held | — | ||
| ACT-017024 | Outreach suppressed pending steward Outreach | ENR-127346 (Eric Johnston) held until CASE-003580 is decided |
| Held | — | ||
| ACT-017025 | Outreach suppressed pending steward Outreach | CLM-422892 (Douglas Matthews) held until CASE-003581 is decided |
| Held | — | ||
| ACT-017026 | Outreach suppressed pending steward Outreach | CLM-415075 (Janet Lawson) held until CASE-003582 is decided |
| Held | — | ||
| ACT-017027 | Outreach suppressed pending steward Outreach | ENR-119852 (Janet Lawson) held until CASE-003583 is decided |
| Held | — | ||
| ACT-017028 | Outreach suppressed pending steward Outreach | TPA-52343 (Edward Herrera) held until CASE-003584 is decided |
| Held | — | ||
| ACT-017029 | Outreach suppressed pending steward Outreach | ENR-106988 (Edward Herrera) held until CASE-003585 is decided |
| Held | — | ||
| ACT-017030 | Outreach suppressed pending steward Outreach | CLM-414537 (Joyce Tran) held until CASE-003586 is decided |
| Held | — | ||
| ACT-017031 | Outreach suppressed pending steward Outreach | CLM-429348 (Terry Wlsh) held until CASE-003587 is decided |
| Held | — | ||
| ACT-017032 | Outreach suppressed pending steward Outreach | ENR-138510 (Terry Walsh) held until CASE-003588 is decided |
| Held | — | ||
| ACT-017033 | Outreach suppressed pending steward Outreach | ENR-111714 (Mei Johnston) held until CASE-003589 is decided |
| Held | — | ||
| ACT-017034 | Outreach suppressed pending steward Outreach | PRV-22628 (Mei Johnston) held until CASE-003590 is decided |
| Held | — | ||
| ACT-017035 | Outreach suppressed pending steward Outreach | ENR-104717 (Aaron Snigh) held until CASE-003591 is decided |
| Held | — | ||
| ACT-017036 | Outreach suppressed pending steward Outreach | ENR-107067 (Zachary Berry) held until CASE-003592 is decided |
| Held | — | ||
| ACT-017037 | Outreach suppressed pending steward Outreach | TPA-52361 (Zachary Berry) held until CASE-003593 is decided |
| Held | — | ||
| ACT-017038 | Outreach suppressed pending steward Outreach | CLM-411664 (Jacoob Richards) held until CASE-003594 is decided |
| Held | — | ||
| ACT-017039 | Outreach suppressed pending steward Outreach | ENR-115366 (Jacob Richards) held until CASE-003595 is decided |
| Held | — | ||
| ACT-017040 | Outreach suppressed pending steward Outreach | TPA-51539 (Anna Grant) held until CASE-003596 is decided |
| Held | — | ||
| ACT-017041 | Outreach suppressed pending steward Outreach | ENR-104608 (Anna Grant) held until CASE-003597 is decided |
| Held | — | ||
| ACT-017042 | Outreach suppressed pending steward Outreach | TPA-62480 (Karen Fisher) held until CASE-003598 is decided |
| Held | — | ||
| ACT-017043 | Outreach suppressed pending steward Outreach | CLM-402205 (Lucia Sims) held until CASE-003599 is decided |
| Held | — | ||
| ACT-017044 | Outreach suppressed pending steward Outreach | TPA-61287 (Paul Richards) held until CASE-003600 is decided |
| Held | — | ||
| ACT-017045 | Outreach suppressed pending steward Outreach | TPA-61288 (Paul Richards) held until CASE-003601 is decided |
| Held | — | ||
| ACT-017046 | Outreach suppressed pending steward Outreach | TPA-50385 (Crl Obrien) held until CASE-003602 is decided |
| Held | — | ||
| ACT-017047 | Outreach suppressed pending steward Outreach | ENR-132352 (Douglas Santos) held until CASE-003603 is decided |
| Held | — | ||
| ACT-017048 | Outreach suppressed pending steward Outreach | TPA-60921 (Douglas Santos) held until CASE-003604 is decided |
| Held | — | ||
| ACT-017049 | Outreach suppressed pending steward Outreach | CLM-405621 (Hirohsi Kennedy) held until CASE-003605 is decided |
| Held | — | ||
| ACT-017050 | Outreach suppressed pending steward Outreach | ENR-107396 (Hiroshi Kennedy) held until CASE-003606 is decided |
| Held | — | ||
| ACT-017051 | Outreach suppressed pending steward Outreach | CLM-428637 (Pamela Herrera) held until CASE-003607 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.