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-017202 | Outreach suppressed pending steward Outreach | TPA-51723 (Jennifer Schmidt) held until CASE-003758 is decided |
| Held | — | ||
| ACT-017203 | Outreach suppressed pending steward Outreach | CLM-429064 (Margaret Stewart) held until CASE-003759 is decided |
| Held | — | ||
| ACT-017204 | Outreach suppressed pending steward Outreach | TPA-61275 (Denise Adams) held until CASE-003760 is decided |
| Held | — | ||
| ACT-017205 | Outreach suppressed pending steward Outreach | CLM-425565 (Denise Adams) held until CASE-003761 is decided |
| Held | — | ||
| ACT-017206 | Outreach suppressed pending steward Outreach | ENR-133448 (Denise Adams) held until CASE-003762 is decided |
| Held | — | ||
| ACT-017207 | Outreach suppressed pending steward Outreach | TPA-50769 (Patrick Espinoza) held until CASE-003763 is decided |
| Held | — | ||
| ACT-017208 | Outreach suppressed pending steward Outreach | CLM-423058 (Janice Rice) held until CASE-003764 is decided |
| Held | — | ||
| ACT-017209 | Outreach suppressed pending steward Outreach | CLM-429242 (George Howell) held until CASE-003765 is decided |
| Held | — | ||
| ACT-017210 | Outreach suppressed pending steward Outreach | ENR-126024 (Ethan Kelley) held until CASE-003766 is decided |
| Held | — | ||
| ACT-017211 | Outreach suppressed pending steward Outreach | TPA-58716 (Ethan Kelley) held until CASE-003767 is decided |
| Held | — | ||
| ACT-017212 | Outreach suppressed pending steward Outreach | CLM-423400 (Carolyn Martin) held until CASE-003768 is decided |
| Held | — | ||
| ACT-017213 | Outreach suppressed pending steward Outreach | ENR-142132 (Carolyn Gonzalez) held until CASE-003769 is decided |
| Held | — | ||
| ACT-017214 | Outreach suppressed pending steward Outreach | TPA-64171 (Carolyn Gonzalez) held until CASE-003770 is decided |
| Held | — | ||
| ACT-017215 | Outreach suppressed pending steward Outreach | CLM-401519 (Melissa Collins) held until CASE-003771 is decided |
| Held | — | ||
| ACT-017216 | Outreach suppressed pending steward Outreach | PRV-20567 (Sara Holmes) held until CASE-003772 is decided |
| Held | — | ||
| ACT-017217 | Outreach suppressed pending steward Outreach | CLM-413909 (Lori Carter) held until CASE-003773 is decided |
| Held | — | ||
| ACT-017218 | Outreach suppressed pending steward Outreach | CLM-413908 (Loi Carter) held until CASE-003774 is decided |
| Held | — | ||
| ACT-017219 | Outreach suppressed pending steward Outreach | CLM-420401 (Charles Fowler) held until CASE-003775 is decided |
| Held | — | ||
| ACT-017220 | Outreach suppressed pending steward Outreach | ENR-126829 (Charles Fowelr) held until CASE-003776 is decided |
| Held | — | ||
| ACT-017221 | Outreach suppressed pending steward Outreach | CLM-411288 (Diego Gray) held until CASE-003777 is decided |
| Held | — | ||
| ACT-017222 | Outreach suppressed pending steward Outreach | TPA-56114 (Kathleen Stavens) held until CASE-003778 is decided |
| Held | — | ||
| ACT-017223 | Outreach suppressed pending steward Outreach | TPA-56113 (Kathleen Stevens) held until CASE-003779 is decided |
| Held | — | ||
| ACT-017224 | Outreach suppressed pending steward Outreach | ENR-113751 (Olivia Riz) held until CASE-003780 is decided |
| Held | — | ||
| ACT-017225 | Outreach suppressed pending steward Outreach | PRV-23020 (Olivia Ruiz) held until CASE-003781 is decided |
| Held | — | ||
| ACT-017226 | Outreach suppressed pending steward Outreach | ENR-119072 (Diego Boyd) held until CASE-003782 is decided |
| Held | — | ||
| ACT-017227 | Outreach suppressed pending steward Outreach | PRV-23831 (Karen Barnes) held until CASE-003783 is decided |
| Held | — | ||
| ACT-017228 | Outreach suppressed pending steward Outreach | CLM-413203 (Karen Barnes) held until CASE-003784 is decided |
| Held | — | ||
| ACT-017229 | Outreach suppressed pending steward Outreach | CLM-419397 (Nicole Barnes) held until CASE-003785 is decided |
| Held | — | ||
| ACT-017230 | Outreach suppressed pending steward Outreach | TPA-58884 (Wei Griffin) held until CASE-003786 is decided |
| Held | — | ||
| ACT-017231 | Outreach suppressed pending steward Outreach | ENR-142464 (Amy Powell) held until CASE-003787 is decided |
| Held | — | ||
| ACT-017232 | Outreach suppressed pending steward Outreach | ENR-142465 (Amy Powell) held until CASE-003788 is decided |
| Held | — | ||
| ACT-017233 | Outreach suppressed pending steward Outreach | CLM-421418 (Jean Jones) held until CASE-003789 is decided |
| Held | — | ||
| ACT-017234 | Outreach suppressed pending steward Outreach | CLM-409410 (Carlos Mendez) held until CASE-003790 is decided |
| Held | — | ||
| ACT-017235 | Outreach suppressed pending steward Outreach | ENR-112378 (Carlos Mendez) held until CASE-003791 is decided |
| Held | — | ||
| ACT-017236 | Outreach suppressed pending steward Outreach | CLM-422479 (Dorothy Wood) held until CASE-003792 is decided |
| Held | — | ||
| ACT-017237 | Outreach suppressed pending steward Outreach | CLM-428816 (Betty Stephens) held until CASE-003793 is decided |
| Held | — | ||
| ACT-017238 | Outreach suppressed pending steward Outreach | TPA-50992 (Gibson Gabriel) held until CASE-003794 is decided |
| Held | — | ||
| ACT-017239 | Outreach suppressed pending steward Outreach | ENR-103003 (Gabriel Gibsson) held until CASE-003795 is decided |
| Held | — | ||
| ACT-017240 | Outreach suppressed pending steward Outreach | CLM-420945 (Frances Hudson) held until CASE-003796 is decided |
| Held | — | ||
| ACT-017241 | Outreach suppressed pending steward Outreach | TPA-62759 (Diane George) held until CASE-003797 is decided |
| Held | — | ||
| ACT-017242 | Outreach suppressed pending steward Outreach | TPA-57281 (Ethan Welch) held until CASE-003798 is decided |
| Held | — | ||
| ACT-017243 | Outreach suppressed pending steward Outreach | TPA-64197 (Nicholas Kennedy) held until CASE-003799 is decided |
| Held | — | ||
| ACT-017244 | Outreach suppressed pending steward Outreach | ENR-114204 (Benjamin Turner) held until CASE-003800 is decided |
| Held | — | ||
| ACT-017245 | Outreach suppressed pending steward Outreach | TPA-54743 (Benjamin Turner) held until CASE-003801 is decided |
| Held | — | ||
| ACT-017246 | Outreach suppressed pending steward Outreach | ENR-141629 (Christine Gonzales) held until CASE-003802 is decided |
| Held | — | ||
| ACT-017247 | Outreach suppressed pending steward Outreach | ENR-141628 (Christine Gonzales) held until CASE-003803 is decided |
| Held | — | ||
| ACT-017248 | Outreach suppressed pending steward Outreach | ENR-103739 (Elizabeth Mendez) held until CASE-003804 is decided |
| Held | — | ||
| ACT-017249 | Outreach suppressed pending steward Outreach | CLM-402900 (Elizabeth Mendez) held until CASE-003805 is decided |
| Held | — | ||
| ACT-017250 | Outreach suppressed pending steward Outreach | ENR-127814 (Brenda Simmons) held until CASE-003806 is decided |
| Held | — | ||
| ACT-017251 | Outreach suppressed pending steward Outreach | TPA-59325 (Brenda Simmons) held until CASE-003807 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.