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-017102 | Outreach suppressed pending steward Outreach | CLM-430371 (Linda Burton) held until CASE-003658 is decided |
| Held | — | ||
| ACT-017103 | Outreach suppressed pending steward Outreach | CLM-430372 (Linda Burton) held until CASE-003659 is decided |
| Held | — | ||
| ACT-017104 | Outreach suppressed pending steward Outreach | CLM-432613 (Samantha Martiin) held until CASE-003660 is decided |
| Held | — | ||
| ACT-017105 | Outreach suppressed pending steward Outreach | ENR-142808 (Samantha Martin) held until CASE-003661 is decided |
| Held | — | ||
| ACT-017106 | Outreach suppressed pending steward Outreach | CLM-408627 (James Nguyen) held until CASE-003662 is decided |
| Held | — | ||
| ACT-017107 | Outreach suppressed pending steward Outreach | ENR-111374 (James Nguyen) held until CASE-003663 is decided |
| Held | — | ||
| ACT-017108 | Outreach suppressed pending steward Outreach | CLM-423664 (Janice Banks) held until CASE-003664 is decided |
| Held | — | ||
| ACT-017109 | Outreach suppressed pending steward Outreach | ENR-112459 (Perez Bobby) held until CASE-003665 is decided |
| Held | — | ||
| ACT-017110 | Outreach suppressed pending steward Outreach | PRV-22765 (Bobby Perz) held until CASE-003666 is decided |
| Held | — | ||
| ACT-017111 | Outreach suppressed pending steward Outreach | ENR-125124 (Brandon Kennedy) held until CASE-003667 is decided |
| Held | — | ||
| ACT-017112 | Outreach suppressed pending steward Outreach | CLM-419052 (Brandon Kennedy) held until CASE-003668 is decided |
| Held | — | ||
| ACT-017113 | Outreach suppressed pending steward Outreach | TPA-58607 (Kathryn Owens) held until CASE-003669 is decided |
| Held | — | ||
| ACT-017114 | Outreach suppressed pending steward Outreach | ENR-128611 (Ralph Pierce) held until CASE-003670 is decided |
| Held | — | ||
| ACT-017115 | Outreach suppressed pending steward Outreach | TPA-59603 (Ralph Pierce) held until CASE-003671 is decided |
| Held | — | ||
| ACT-017116 | Outreach suppressed pending steward Outreach | TPA-53637 (Elizabeth Ramirez) held until CASE-003672 is decided |
| Held | — | ||
| ACT-017117 | Outreach suppressed pending steward Outreach | TPA-53636 (Elizabeth Ramirez) held until CASE-003673 is decided |
| Held | — | ||
| ACT-017118 | Outreach suppressed pending steward Outreach | TPA-53635 (Elizabeth Ramirez) held until CASE-003674 is decided |
| Held | — | ||
| ACT-017119 | Outreach suppressed pending steward Outreach | TPA-54408 (Steen Nelson) held until CASE-003675 is decided |
| Held | — | ||
| ACT-017120 | Outreach suppressed pending steward Outreach | TPA-63242 (Jack Pierce) held until CASE-003676 is decided |
| Held | — | ||
| ACT-017121 | Outreach suppressed pending steward Outreach | TPA-53645 (Brenda Banks) held until CASE-003677 is decided |
| Held | — | ||
| ACT-017122 | Outreach suppressed pending steward Outreach | ENR-141659 (Omar Vasquez) held until CASE-003678 is decided |
| Held | — | ||
| ACT-017123 | Outreach suppressed pending steward Outreach | CLM-431760 (Omar Vasquez) held until CASE-003679 is decided |
| Held | — | ||
| ACT-017124 | Outreach suppressed pending steward Outreach | ENR-118036 (Christina Vasquez) held until CASE-003680 is decided |
| Held | — | ||
| ACT-017125 | Outreach suppressed pending steward Outreach | CLM-408084 (Randy Wod) held until CASE-003681 is decided |
| Held | — | ||
| ACT-017126 | Outreach suppressed pending steward Outreach | CLM-428541 (John Marshall) held until CASE-003682 is decided |
| Held | — | ||
| ACT-017127 | Outreach suppressed pending steward Outreach | TPA-62529 (Juan Marshall) held until CASE-003683 is decided |
| Held | — | ||
| ACT-017128 | Outreach suppressed pending steward Outreach | CLM-400096 (Justin Cooper) held until CASE-003684 is decided |
| Held | — | ||
| ACT-017129 | Outreach suppressed pending steward Outreach | ENR-102555 (Walter Allen) held until CASE-003685 is decided |
| Held | — | ||
| ACT-017130 | Outreach suppressed pending steward Outreach | CLM-401984 (Walter Allen) held until CASE-003686 is decided |
| Held | — | ||
| ACT-017131 | Outreach suppressed pending steward Outreach | CLM-423572 (Megan Larson) held until CASE-003687 is decided |
| Held | — | ||
| ACT-017132 | Outreach suppressed pending steward Outreach | ENR-130850 (Megan Larson) held until CASE-003688 is decided |
| Held | — | ||
| ACT-017133 | Outreach suppressed pending steward Outreach | CLM-427431 (Michelle Gray) held until CASE-003689 is decided |
| Held | — | ||
| ACT-017134 | Outreach suppressed pending steward Outreach | ENR-135952 (Michelle Gray) held until CASE-003690 is decided |
| Held | — | ||
| ACT-017135 | Outreach suppressed pending steward Outreach | TPA-63334 (Larry Moreno) held until CASE-003691 is decided |
| Held | — | ||
| ACT-017136 | Outreach suppressed pending steward Outreach | ENR-107399 (Timothy Garza) held until CASE-003692 is decided |
| Held | — | ||
| ACT-017137 | Outreach suppressed pending steward Outreach | CLM-405622 (Timothy Garza) held until CASE-003693 is decided |
| Held | — | ||
| ACT-017138 | Outreach suppressed pending steward Outreach | CLM-411270 (Debra Ramos) held until CASE-003694 is decided |
| Held | — | ||
| ACT-017139 | Outreach suppressed pending steward Outreach | ENR-114828 (Debra Ramos) held until CASE-003695 is decided |
| Held | — | ||
| ACT-017140 | Outreach suppressed pending steward Outreach | ENR-118949 (Gregory Cruz) held until CASE-003696 is decided |
| Held | — | ||
| ACT-017141 | Outreach suppressed pending steward Outreach | CLM-414392 (Gregory Cruz) held until CASE-003697 is decided |
| Held | — | ||
| ACT-017142 | Outreach suppressed pending steward Outreach | TPA-51520 (Michael Kelly) held until CASE-003698 is decided |
| Held | — | ||
| ACT-017143 | Outreach suppressed pending steward Outreach | TPA-51397 (Rachel Washington) held until CASE-003699 is decided |
| Held | — | ||
| ACT-017144 | Outreach suppressed pending steward Outreach | TPA-53146 (Kevin Peters) held until CASE-003700 is decided |
| Held | — | ||
| ACT-017145 | Outreach suppressed pending steward Outreach | CLM-407191 (Kevin Peters) held until CASE-003701 is decided |
| Held | — | ||
| ACT-017146 | Outreach suppressed pending steward Outreach | CLM-418904 (Mei Stevens) held until CASE-003702 is decided |
| Held | — | ||
| ACT-017147 | Outreach suppressed pending steward Outreach | ENR-106510 (Ann Ryan) held until CASE-003703 is decided |
| Held | — | ||
| ACT-017148 | Outreach suppressed pending steward Outreach | CLM-404938 (Ann Ryan) held until CASE-003704 is decided |
| Held | — | ||
| ACT-017149 | Outreach suppressed pending steward Outreach | PRV-27838 (Roy Powell) held until CASE-003705 is decided |
| Held | — | ||
| ACT-017150 | Outreach suppressed pending steward Outreach | CLM-401481 (Kayla Peters) held until CASE-003706 is decided |
| Held | — | ||
| ACT-017151 | Outreach suppressed pending steward Outreach | ENR-101927 (Kayla Peters) held until CASE-003707 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.