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-017152 | Outreach suppressed pending steward Outreach | CLM-400674 (Randy Myers) held until CASE-003708 is decided |
| Held | — | ||
| ACT-017153 | Outreach suppressed pending steward Outreach | ENR-100912 (Randy Myers) held until CASE-003709 is decided |
| Held | — | ||
| ACT-017154 | Outreach suppressed pending steward Outreach | TPA-53015 (Susan Edwars) held until CASE-003710 is decided |
| Held | — | ||
| ACT-017155 | Outreach suppressed pending steward Outreach | CLM-416158 (Megan Diaz) held until CASE-003711 is decided |
| Held | — | ||
| ACT-017156 | Outreach suppressed pending steward Outreach | TPA-60022 (Terry Wlsh) held until CASE-003712 is decided |
| Held | — | ||
| ACT-017157 | Outreach suppressed pending steward Outreach | ENR-129856 (Terry Walsh) held until CASE-003713 is decided |
| Held | — | ||
| ACT-017158 | Outreach suppressed pending steward Outreach | TPA-53329 (Beverly Harris) held until CASE-003714 is decided |
| Held | — | ||
| ACT-017159 | Outreach suppressed pending steward Outreach | TPA-53328 (Beverly Harris) held until CASE-003715 is decided |
| Held | — | ||
| ACT-017160 | Outreach suppressed pending steward Outreach | TPA-56003 (Jerry Phillips) held until CASE-003716 is decided |
| Held | — | ||
| ACT-017161 | Outreach suppressed pending steward Outreach | TPA-58543 (Christina Morgan) held until CASE-003717 is decided |
| Held | — | ||
| ACT-017162 | Outreach suppressed pending steward Outreach | TPA-64370 (Dorothy Gomeez) held until CASE-003718 is decided |
| Held | — | ||
| ACT-017163 | Outreach suppressed pending steward Outreach | PRV-27592 (Bill Ellis) held until CASE-003719 is decided |
| Held | — | ||
| ACT-017164 | Outreach suppressed pending steward Outreach | CLM-401721 (Catherine Graham) held until CASE-003720 is decided |
| Held | — | ||
| ACT-017165 | Outreach suppressed pending steward Outreach | TPA-50757 (Catherine Graham) held until CASE-003721 is decided |
| Held | — | ||
| ACT-017166 | Outreach suppressed pending steward Outreach | CLM-411823 (Willie Black) held until CASE-003722 is decided |
| Held | — | ||
| ACT-017167 | Outreach suppressed pending steward Outreach | TPA-55209 (Willie Black) held until CASE-003723 is decided |
| Held | — | ||
| ACT-017168 | Outreach suppressed pending steward Outreach | TPA-62420 (James Hunt) held until CASE-003724 is decided |
| Held | — | ||
| ACT-017169 | Outreach suppressed pending steward Outreach | TPA-50690 (Luis Mejia) held until CASE-003725 is decided |
| Held | — | ||
| ACT-017170 | Outreach suppressed pending steward Outreach | TPA-50689 (Luis Mejia) held until CASE-003726 is decided |
| Held | — | ||
| ACT-017171 | Outreach suppressed pending steward Outreach | TPA-51486 (Dylan Dominguez) held until CASE-003727 is decided |
| Held | — | ||
| ACT-017172 | Outreach suppressed pending steward Outreach | CLM-417277 (Wei Hamilton) held until CASE-003728 is decided |
| Held | — | ||
| ACT-017173 | Outreach suppressed pending steward Outreach | CLM-417276 (Wei Hamilton) held until CASE-003729 is decided |
| Held | — | ||
| ACT-017174 | Outreach suppressed pending steward Outreach | TPA-58201 (Charles Armstrong) held until CASE-003730 is decided |
| Held | — | ||
| ACT-017175 | Outreach suppressed pending steward Outreach | TPA-61600 (Ruth Dixon) held until CASE-003731 is decided |
| Held | — | ||
| ACT-017176 | Outreach suppressed pending steward Outreach | TPA-58916 (Sarah Adams) held until CASE-003732 is decided |
| Held | — | ||
| ACT-017177 | Outreach suppressed pending steward Outreach | PRV-25448 (Gloria Johnston) held until CASE-003733 is decided |
| Held | — | ||
| ACT-017178 | Outreach suppressed pending steward Outreach | CLM-418380 (Gloria Johnston) held until CASE-003734 is decided |
| Held | — | ||
| ACT-017179 | Outreach suppressed pending steward Outreach | ENR-142964 (Wagner Jacob) held until CASE-003735 is decided |
| Held | — | ||
| ACT-017180 | Outreach suppressed pending steward Outreach | PRV-25061 (Sarah Jenkins) held until CASE-003736 is decided |
| Held | — | ||
| ACT-017181 | Outreach suppressed pending steward Outreach | ENR-122469 (Sarah Jenkins) held until CASE-003737 is decided |
| Held | — | ||
| ACT-017182 | Outreach suppressed pending steward Outreach | TPA-60526 (Albert Garrett) held until CASE-003738 is decided |
| Held | — | ||
| ACT-017183 | Outreach suppressed pending steward Outreach | ENR-126630 (Autin Ray) held until CASE-003739 is decided |
| Held | — | ||
| ACT-017184 | Outreach suppressed pending steward Outreach | TPA-54075 (Alan Nichols) held until CASE-003740 is decided |
| Held | — | ||
| ACT-017185 | Outreach suppressed pending steward Outreach | ENR-112368 (Alan Nichols) held until CASE-003741 is decided |
| Held | — | ||
| ACT-017186 | Outreach suppressed pending steward Outreach | CLM-432078 (Terry Ward) held until CASE-003742 is decided |
| Held | — | ||
| ACT-017187 | Outreach suppressed pending steward Outreach | CLM-432079 (Terry Ward) held until CASE-003743 is decided |
| Held | — | ||
| ACT-017188 | Outreach suppressed pending steward Outreach | CLM-406188 (Jerry Meyer) held until CASE-003744 is decided |
| Held | — | ||
| ACT-017189 | Outreach suppressed pending steward Outreach | ENR-108140 (Jerry Meyer) held until CASE-003745 is decided |
| Held | — | ||
| ACT-017190 | Outreach suppressed pending steward Outreach | CLM-416976 (Contreras Mark) held until CASE-003746 is decided |
| Held | — | ||
| ACT-017191 | Outreach suppressed pending steward Outreach | ENR-141465 (Sean Cunningham) held until CASE-003747 is decided |
| Held | — | ||
| ACT-017192 | Outreach suppressed pending steward Outreach | ENR-140492 (Roy Coleman) held until CASE-003748 is decided |
| Held | — | ||
| ACT-017193 | Outreach suppressed pending steward Outreach | CLM-430823 (Roy Coleman) held until CASE-003749 is decided |
| Held | — | ||
| ACT-017194 | Outreach suppressed pending steward Outreach | CLM-424943 (Dylan Harper) held until CASE-003750 is decided |
| Held | — | ||
| ACT-017195 | Outreach suppressed pending steward Outreach | ENR-116176 (Jake James) held until CASE-003751 is decided |
| Held | — | ||
| ACT-017196 | Outreach suppressed pending steward Outreach | TPA-55420 (Jacob James) held until CASE-003752 is decided |
| Held | — | ||
| ACT-017197 | Outreach suppressed pending steward Outreach | TPA-59112 (Caarlos Dean) held until CASE-003753 is decided |
| Held | — | ||
| ACT-017198 | Outreach suppressed pending steward Outreach | TPA-58287 (Hannah Owens) held until CASE-003754 is decided |
| Held | — | ||
| ACT-017199 | Outreach suppressed pending steward Outreach | PRV-25048 (Frank Knight) held until CASE-003755 is decided |
| Held | — | ||
| ACT-017200 | Outreach suppressed pending steward Outreach | TPA-56667 (Margaret Cox) held until CASE-003756 is decided |
| Held | — | ||
| ACT-017201 | Outreach suppressed pending steward Outreach | CLM-428645 (William Wong) held until CASE-003757 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.