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-017252 | Outreach suppressed pending steward Outreach | CLM-406060 (Thomas Ruiz) held until CASE-003808 is decided |
| Held | — | ||
| ACT-017253 | Outreach suppressed pending steward Outreach | ENR-107986 (Tom Ruiz) held until CASE-003809 is decided |
| Held | — | ||
| ACT-017254 | Outreach suppressed pending steward Outreach | CLM-400139 (Sofia Nunez) held until CASE-003810 is decided |
| Held | — | ||
| ACT-017255 | Outreach suppressed pending steward Outreach | CLM-411607 (Noah Burton) held until CASE-003811 is decided |
| Held | — | ||
| ACT-017256 | Outreach suppressed pending steward Outreach | TPA-54474 (Sarah Edwards) held until CASE-003812 is decided |
| Held | — | ||
| ACT-017257 | Outreach suppressed pending steward Outreach | PRV-25696 (Theresa McDonald) held until CASE-003813 is decided |
| Held | — | ||
| ACT-017258 | Outreach suppressed pending steward Outreach | ENR-125240 (Theresa McDonald) held until CASE-003814 is decided |
| Held | — | ||
| ACT-017259 | Outreach suppressed pending steward Outreach | ENR-102956 (Aaron Chapan) held until CASE-003815 is decided |
| Held | — | ||
| ACT-017260 | Outreach suppressed pending steward Outreach | TPA-50976 (Aaron Chapman) held until CASE-003816 is decided |
| Held | — | ||
| ACT-017261 | Outreach suppressed pending steward Outreach | ENR-109543 (Peter Elliott) held until CASE-003817 is decided |
| Held | — | ||
| ACT-017262 | Outreach suppressed pending steward Outreach | PRV-22164 (Peter Elliott) held until CASE-003818 is decided |
| Held | — | ||
| ACT-017263 | Outreach suppressed pending steward Outreach | CLM-430001 (Kyle Powell) held until CASE-003819 is decided |
| Held | — | ||
| ACT-017264 | Outreach suppressed pending steward Outreach | TPA-54405 (Jerry Flores) held until CASE-003820 is decided |
| Held | — | ||
| ACT-017265 | Outreach suppressed pending steward Outreach | TPA-57573 (Carlos Berry) held until CASE-003821 is decided |
| Held | — | ||
| ACT-017266 | Outreach suppressed pending steward Outreach | CLM-419045 (Fatima Bryant) held until CASE-003822 is decided |
| Held | — | ||
| ACT-017267 | Outreach suppressed pending steward Outreach | CLM-407929 (Bryan Ryan) held until CASE-003823 is decided |
| Held | — | ||
| ACT-017268 | Outreach suppressed pending steward Outreach | PRV-25024 (Sharon Little) held until CASE-003824 is decided |
| Held | — | ||
| ACT-017269 | Outreach suppressed pending steward Outreach | CLM-422163 (Gloria Obrien) held until CASE-003825 is decided |
| Held | — | ||
| ACT-017270 | Outreach suppressed pending steward Outreach | TPA-59727 (Gloria Obrien) held until CASE-003826 is decided |
| Held | — | ||
| ACT-017271 | Outreach suppressed pending steward Outreach | TPA-62101 (Justin Ruiz) held until CASE-003827 is decided |
| Held | — | ||
| ACT-017272 | Outreach suppressed pending steward Outreach | CLM-424388 (Sofia Montgomery) held until CASE-003828 is decided |
| Held | — | ||
| ACT-017273 | Outreach suppressed pending steward Outreach | CLM-425275 (Joan Webb) held until CASE-003829 is decided |
| Held | — | ||
| ACT-017274 | Outreach suppressed pending steward Outreach | TPA-61161 (Joan Webb) held until CASE-003830 is decided |
| Held | — | ||
| ACT-017275 | Outreach suppressed pending steward Outreach | CLM-428065 (Jason Hunt) held until CASE-003831 is decided |
| Held | — | ||
| ACT-017276 | Outreach suppressed pending steward Outreach | CLM-417516 (Denise Oliver) held until CASE-003832 is decided |
| Held | — | ||
| ACT-017277 | Outreach suppressed pending steward Outreach | ENR-123082 (Denise Oliver) held until CASE-003833 is decided |
| Held | — | ||
| ACT-017278 | Outreach suppressed pending steward Outreach | TPA-53158 (Christine Munoz) held until CASE-003834 is decided |
| Held | — | ||
| ACT-017279 | Outreach suppressed pending steward Outreach | ENR-109428 (Chris Munoz) held until CASE-003835 is decided |
| Held | — | ||
| ACT-017280 | Outreach suppressed pending steward Outreach | PRV-22165 (Joyce Thompson) held until CASE-003836 is decided |
| Held | — | ||
| ACT-017281 | Outreach suppressed pending steward Outreach | CLM-428774 (Michael Duncan) held until CASE-003837 is decided |
| Held | — | ||
| ACT-017282 | Outreach suppressed pending steward Outreach | CLM-428775 (Michael Duncan) held until CASE-003838 is decided |
| Held | — | ||
| ACT-017283 | Outreach suppressed pending steward Outreach | TPA-51850 (Maria Estrada) held until CASE-003839 is decided |
| Held | — | ||
| ACT-017284 | Outreach suppressed pending steward Outreach | TPA-51849 (Maria Estrada) held until CASE-003840 is decided |
| Held | — | ||
| ACT-017285 | Outreach suppressed pending steward Outreach | CLM-415052 (Albert Hall) held until CASE-003841 is decided |
| Held | — | ||
| ACT-017286 | Outreach suppressed pending steward Outreach | CLM-424455 (Walter Estrada) held until CASE-003842 is decided |
| Held | — | ||
| ACT-017287 | Outreach suppressed pending steward Outreach | ENR-131971 (Walter Estrada) held until CASE-003843 is decided |
| Held | — | ||
| ACT-017288 | Outreach suppressed pending steward Outreach | TPA-53856 (Randy Hernandez) held until CASE-003844 is decided |
| Held | — | ||
| ACT-017289 | Outreach suppressed pending steward Outreach | CLM-411665 (Emma Washington) held until CASE-003845 is decided |
| Held | — | ||
| ACT-017290 | Outreach suppressed pending steward Outreach | CLM-410194 (Rob Phillips) held until CASE-003846 is decided |
| Held | — | ||
| ACT-017291 | Outreach suppressed pending steward Outreach | PRV-28988 (Angela Nelson) held until CASE-003847 is decided |
| Held | — | ||
| ACT-017292 | Outreach suppressed pending steward Outreach | ENR-120362 (Joyce Grza) held until CASE-003848 is decided |
| Held | — | ||
| ACT-017293 | Outreach suppressed pending steward Outreach | CLM-415463 (Joyce Garza) held until CASE-003849 is decided |
| Held | — | ||
| ACT-017294 | Outreach suppressed pending steward Outreach | TPA-63471 (Omar Espinoza) held until CASE-003850 is decided |
| Held | — | ||
| ACT-017295 | Outreach suppressed pending steward Outreach | TPA-50804 (Betty Peters) held until CASE-003851 is decided |
| Held | — | ||
| ACT-017296 | Outreach suppressed pending steward Outreach | ENR-104472 (Roy Miller) held until CASE-003852 is decided |
| Held | — | ||
| ACT-017297 | Outreach suppressed pending steward Outreach | PRV-20982 (Roy Miller) held until CASE-003853 is decided |
| Held | — | ||
| ACT-017298 | Outreach suppressed pending steward Outreach | ENR-122833 (Mark Gibson) held until CASE-003854 is decided |
| Held | — | ||
| ACT-017299 | Outreach suppressed pending steward Outreach | CLM-417336 (Mark Gibson) held until CASE-003855 is decided |
| Held | — | ||
| ACT-017300 | Outreach suppressed pending steward Outreach | ENR-116192 (Gabriel Romero) held until CASE-003856 is decided |
| Held | — | ||
| ACT-017301 | Outreach suppressed pending steward Outreach | TPA-55426 (Gabriel Romero) held until CASE-003857 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.