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-017052 | Outreach suppressed pending steward Outreach | TPA-62659 (Pamela Herrera) held until CASE-003608 is decided |
| Held | — | ||
| ACT-017053 | Outreach suppressed pending steward Outreach | CLM-418902 (Heather Vazquez) held until CASE-003609 is decided |
| Held | — | ||
| ACT-017054 | Outreach suppressed pending steward Outreach | CLM-421716 (Jessica Gutierrez) held until CASE-003610 is decided |
| Held | — | ||
| ACT-017055 | Outreach suppressed pending steward Outreach | ENR-128430 (Jess Gutierrez) held until CASE-003611 is decided |
| Held | — | ||
| ACT-017056 | Outreach suppressed pending steward Outreach | PRV-29144 (Teresa Munoz) held until CASE-003612 is decided |
| Held | — | ||
| ACT-017057 | Outreach suppressed pending steward Outreach | TPA-55262 (Ana Mejia) held until CASE-003613 is decided |
| Held | — | ||
| ACT-017058 | Outreach suppressed pending steward Outreach | CLM-402003 (Dnald Grant) held until CASE-003614 is decided |
| Held | — | ||
| ACT-017059 | Outreach suppressed pending steward Outreach | TPA-51767 (Jsoeph Pena) held until CASE-003615 is decided |
| Held | — | ||
| ACT-017060 | Outreach suppressed pending steward Outreach | ENR-105332 (Joseph Pena) held until CASE-003616 is decided |
| Held | — | ||
| ACT-017061 | Outreach suppressed pending steward Outreach | ENR-129557 (Larry Foster) held until CASE-003617 is decided |
| Held | — | ||
| ACT-017062 | Outreach suppressed pending steward Outreach | CLM-422560 (Larry Foster) held until CASE-003618 is decided |
| Held | — | ||
| ACT-017063 | Outreach suppressed pending steward Outreach | TPA-59360 (Jimmy Gardner) held until CASE-003619 is decided |
| Held | — | ||
| ACT-017064 | Outreach suppressed pending steward Outreach | TPA-55413 (Samuel Hoffman) held until CASE-003620 is decided |
| Held | — | ||
| ACT-017065 | Outreach suppressed pending steward Outreach | TPA-50056 (Laura Chapman) held until CASE-003621 is decided |
| Held | — | ||
| ACT-017066 | Outreach suppressed pending steward Outreach | ENR-100199 (Laura Chapman) held until CASE-003622 is decided |
| Held | — | ||
| ACT-017067 | Outreach suppressed pending steward Outreach | CLM-404912 (Bruce Ferguson) held until CASE-003623 is decided |
| Held | — | ||
| ACT-017068 | Outreach suppressed pending steward Outreach | CLM-423299 (Nathan Turner) held until CASE-003624 is decided |
| Held | — | ||
| ACT-017069 | Outreach suppressed pending steward Outreach | ENR-129712 (Eric Perkins) held until CASE-003625 is decided |
| Held | — | ||
| ACT-017070 | Outreach suppressed pending steward Outreach | CLM-432015 (Roy Stewart) held until CASE-003626 is decided |
| Held | — | ||
| ACT-017071 | Outreach suppressed pending steward Outreach | TPA-64121 (Roy Stewart) held until CASE-003627 is decided |
| Held | — | ||
| ACT-017072 | Outreach suppressed pending steward Outreach | ENR-126858 (Terry Singh) held until CASE-003628 is decided |
| Held | — | ||
| ACT-017073 | Outreach suppressed pending steward Outreach | CLM-420417 (Terry Singh) held until CASE-003629 is decided |
| Held | — | ||
| ACT-017074 | Outreach suppressed pending steward Outreach | TPA-53316 (Thomas Mendoza) held until CASE-003630 is decided |
| Held | — | ||
| ACT-017075 | Outreach suppressed pending steward Outreach | CLM-417261 (Patrick Ellis) held until CASE-003631 is decided |
| Held | — | ||
| ACT-017076 | Outreach suppressed pending steward Outreach | TPA-51462 (Christine Ruzi) held until CASE-003632 is decided |
| Held | — | ||
| ACT-017077 | Outreach suppressed pending steward Outreach | TPA-56543 (Debbie Gonzalez) held until CASE-003633 is decided |
| Held | — | ||
| ACT-017078 | Outreach suppressed pending steward Outreach | TPA-57065 (Albert Vargas) held until CASE-003634 is decided |
| Held | — | ||
| ACT-017079 | Outreach suppressed pending steward Outreach | CLM-416130 (Albert Vargas) held until CASE-003635 is decided |
| Held | — | ||
| ACT-017080 | Outreach suppressed pending steward Outreach | CLM-431372 (William Collins) held until CASE-003636 is decided |
| Held | — | ||
| ACT-017081 | Outreach suppressed pending steward Outreach | TPA-51643 (Cheryl Collins) held until CASE-003637 is decided |
| Held | — | ||
| ACT-017082 | Outreach suppressed pending steward Outreach | TPA-51642 (Cherl Collins) held until CASE-003638 is decided |
| Held | — | ||
| ACT-017083 | Outreach suppressed pending steward Outreach | CLM-428574 (Nicholas Tran) held until CASE-003639 is decided |
| Held | — | ||
| ACT-017084 | Outreach suppressed pending steward Outreach | CLM-428575 (Nicholas Tran) held until CASE-003640 is decided |
| Held | — | ||
| ACT-017085 | Outreach suppressed pending steward Outreach | PRV-24521 (Timothy Weber) held until CASE-003641 is decided |
| Held | — | ||
| ACT-017086 | Outreach suppressed pending steward Outreach | CLM-430459 (Ben Ferguson) held until CASE-003642 is decided |
| Held | — | ||
| ACT-017087 | Outreach suppressed pending steward Outreach | CLM-420848 (Emily Harper) held until CASE-003643 is decided |
| Held | — | ||
| ACT-017088 | Outreach suppressed pending steward Outreach | CLM-420847 (Emily Herper) held until CASE-003644 is decided |
| Held | — | ||
| ACT-017089 | Outreach suppressed pending steward Outreach | CLM-424690 (Julia Dan) held until CASE-003645 is decided |
| Held | — | ||
| ACT-017090 | Outreach suppressed pending steward Outreach | CLM-426965 (Keith Collins) held until CASE-003646 is decided |
| Held | — | ||
| ACT-017091 | Outreach suppressed pending steward Outreach | CLM-426966 (Keith Collins) held until CASE-003647 is decided |
| Held | — | ||
| ACT-017092 | Outreach suppressed pending steward Outreach | PRV-21667 (Daniel Herrera) held until CASE-003648 is decided |
| Held | — | ||
| ACT-017093 | Outreach suppressed pending steward Outreach | CLM-412969 (Heather Pierce) held until CASE-003649 is decided |
| Held | — | ||
| ACT-017094 | Outreach suppressed pending steward Outreach | PRV-23757 (Heather Pierce) held until CASE-003650 is decided |
| Held | — | ||
| ACT-017095 | Outreach suppressed pending steward Outreach | TPA-59668 (Olivia Reed) held until CASE-003651 is decided |
| Held | — | ||
| ACT-017096 | Outreach suppressed pending steward Outreach | ENR-100091 (Isabella Russell) held until CASE-003652 is decided |
| Held | — | ||
| ACT-017097 | Outreach suppressed pending steward Outreach | TPA-50650 (Kimberly Russell) held until CASE-003653 is decided |
| Held | — | ||
| ACT-017098 | Outreach suppressed pending steward Outreach | TPA-50651 (Kimbberly Russell) held until CASE-003654 is decided |
| Held | — | ||
| ACT-017099 | Outreach suppressed pending steward Outreach | TPA-56991 (Sandra Russell) held until CASE-003655 is decided |
| Held | — | ||
| ACT-017100 | Outreach suppressed pending steward Outreach | TPA-58394 (Amber Fernandez) held until CASE-003656 is decided |
| Held | — | ||
| ACT-017101 | Outreach suppressed pending steward Outreach | ENR-124929 (Amber Fernandez) held until CASE-003657 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.