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-017302 | Outreach suppressed pending steward Outreach | CLM-401263 (Sarah Morgan) held until CASE-003858 is decided |
| Held | — | ||
| ACT-017303 | Outreach suppressed pending steward Outreach | ENR-101634 (Sarah Morgan) held until CASE-003859 is decided |
| Held | — | ||
| ACT-017304 | Outreach suppressed pending steward Outreach | TPA-60356 (Eugeen Harper) held until CASE-003860 is decided |
| Held | — | ||
| ACT-017305 | Outreach suppressed pending steward Outreach | CLM-425143 (Michael Jimenez) held until CASE-003861 is decided |
| Held | — | ||
| ACT-017306 | Outreach suppressed pending steward Outreach | ENR-132838 (Michael Jimenez) held until CASE-003862 is decided |
| Held | — | ||
| ACT-017307 | Outreach suppressed pending steward Outreach | TPA-51715 (Brittany Maldonado) held until CASE-003863 is decided |
| Held | — | ||
| ACT-017308 | Outreach suppressed pending steward Outreach | TPA-55800 (Nathan Fernandez) held until CASE-003864 is decided |
| Held | — | ||
| ACT-017309 | Outreach suppressed pending steward Outreach | PRV-20096 (Philip Cole) held until CASE-003865 is decided |
| Held | — | ||
| ACT-017310 | Outreach suppressed pending steward Outreach | ENR-100488 (Philip Cole) held until CASE-003866 is decided |
| Held | — | ||
| ACT-017311 | Outreach suppressed pending steward Outreach | TPA-63886 (Jason Banks) held until CASE-003867 is decided |
| Held | — | ||
| ACT-017312 | Outreach suppressed pending steward Outreach | ENR-141289 (Jason Banks) held until CASE-003868 is decided |
| Held | — | ||
| ACT-017313 | Outreach suppressed pending steward Outreach | TPA-61987 (Santiago Sandoval) held until CASE-003869 is decided |
| Held | — | ||
| ACT-017314 | Outreach suppressed pending steward Outreach | TPA-54247 (Megan Hunter) held until CASE-003870 is decided |
| Held | — | ||
| ACT-017315 | Outreach suppressed pending steward Outreach | ENR-112868 (Megan Hunter) held until CASE-003871 is decided |
| Held | — | ||
| ACT-017316 | Outreach suppressed pending steward Outreach | CLM-411221 (Martha Estrada) held until CASE-003872 is decided |
| Held | — | ||
| ACT-017317 | Outreach suppressed pending steward Outreach | ENR-114761 (Martha Estrada) held until CASE-003873 is decided |
| Held | — | ||
| ACT-017318 | Outreach suppressed pending steward Outreach | TPA-51470 (Margaret Daniels) held until CASE-003874 is decided |
| Held | — | ||
| ACT-017319 | Outreach suppressed pending steward Outreach | TPA-63625 (Jerry Stevens) held until CASE-003875 is decided |
| Held | — | ||
| ACT-017320 | Outreach suppressed pending steward Outreach | TPA-59385 (Benjamin Dean) held until CASE-003876 is decided |
| Held | — | ||
| ACT-017321 | Outreach suppressed pending steward Outreach | CLM-409478 (Bryan Owens) held until CASE-003877 is decided |
| Held | — | ||
| ACT-017322 | Outreach suppressed pending steward Outreach | TPA-54112 (Bryan Owens) held until CASE-003878 is decided |
| Held | — | ||
| ACT-017323 | Outreach suppressed pending steward Outreach | TPA-60404 (Doris Torres) held until CASE-003879 is decided |
| Held | — | ||
| ACT-017324 | Outreach suppressed pending steward Outreach | CLM-425805 (Scott Sullivan) held until CASE-003880 is decided |
| Held | — | ||
| ACT-017325 | Outreach suppressed pending steward Outreach | CLM-425806 (Scott Sulivan) held until CASE-003881 is decided |
| Held | — | ||
| ACT-017326 | Outreach suppressed pending steward Outreach | ENR-111250 (Helen Ray) held until CASE-003882 is decided |
| Held | — | ||
| ACT-017327 | Outreach suppressed pending steward Outreach | TPA-53752 (Ray Helen) held until CASE-003883 is decided |
| Held | — | ||
| ACT-017328 | Outreach suppressed pending steward Outreach | TPA-51701 (Margaret Kelley) held until CASE-003884 is decided |
| Held | — | ||
| ACT-017329 | Outreach suppressed pending steward Outreach | ENR-132498 (Kenneth West) held until CASE-003885 is decided |
| Held | — | ||
| ACT-017330 | Outreach suppressed pending steward Outreach | CLM-413313 (Teresa Larson) held until CASE-003886 is decided |
| Held | — | ||
| ACT-017331 | Outreach suppressed pending steward Outreach | ENR-126135 (Ahmed Elliiott) held until CASE-003887 is decided |
| Held | — | ||
| ACT-017332 | Outreach suppressed pending steward Outreach | TPA-58749 (Ahmed Elliott) held until CASE-003888 is decided |
| Held | — | ||
| ACT-017333 | Outreach suppressed pending steward Outreach | CLM-428804 (Billy Bailey) held until CASE-003889 is decided |
| Held | — | ||
| ACT-017334 | Outreach suppressed pending steward Outreach | CLM-417902 (Ana Fernandez) held until CASE-003890 is decided |
| Held | — | ||
| ACT-017335 | Outreach suppressed pending steward Outreach | ENR-123547 (Ana Fernandez) held until CASE-003891 is decided |
| Held | — | ||
| ACT-017336 | Outreach suppressed pending steward Outreach | CLM-421231 (Catherine Anderson) held until CASE-003892 is decided |
| Held | — | ||
| ACT-017337 | Outreach suppressed pending steward Outreach | ENR-119140 (Sharon Walsh) held until CASE-003893 is decided |
| Held | — | ||
| ACT-017338 | Outreach suppressed pending steward Outreach | CLM-414543 (Sharon Walsh) held until CASE-003894 is decided |
| Held | — | ||
| ACT-017339 | Outreach suppressed pending steward Outreach | CLM-406921 (Bobby Ward) held until CASE-003895 is decided |
| Held | — | ||
| ACT-017340 | Outreach suppressed pending steward Outreach | ENR-109041 (Bobby Ward) held until CASE-003896 is decided |
| Held | — | ||
| ACT-017341 | Outreach suppressed pending steward Outreach | ENR-138843 (Ryan Moore) held until CASE-003897 is decided |
| Held | — | ||
| ACT-017342 | Outreach suppressed pending steward Outreach | CLM-429610 (Ryan Moore) held until CASE-003898 is decided |
| Held | — | ||
| ACT-017343 | Outreach suppressed pending steward Outreach | CLM-422188 (Marilyn Hoffman) held until CASE-003899 is decided |
| Held | — | ||
| ACT-017344 | Outreach suppressed pending steward Outreach | ENR-140625 (Alice Russell) held until CASE-003900 is decided |
| Held | — | ||
| ACT-017345 | Outreach suppressed pending steward Outreach | TPA-51429 (Arthur Halll) held until CASE-003901 is decided |
| Held | — | ||
| ACT-017346 | Outreach suppressed pending steward Outreach | CLM-428720 (Tim Silva) held until CASE-003902 is decided |
| Held | — | ||
| ACT-017347 | Outreach suppressed pending steward Outreach | TPA-53483 (Teresa Gutierrez) held until CASE-003903 is decided |
| Held | — | ||
| ACT-017348 | Outreach suppressed pending steward Outreach | CLM-407895 (Teresa Gutierrez) held until CASE-003904 is decided |
| Held | — | ||
| ACT-017349 | Outreach suppressed pending steward Outreach | CLM-406336 (Raymond Dunn) held until CASE-003905 is decided |
| Held | — | ||
| ACT-017350 | Outreach suppressed pending steward Outreach | ENR-108313 (Raymond Dunn) held until CASE-003906 is decided |
| Held | — | ||
| ACT-017351 | Outreach suppressed pending steward Outreach | PRV-26921 (Yuki Harris) held until CASE-003907 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.