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-017352 | Outreach suppressed pending steward Outreach | TPA-62356 (Diego Brown) held until CASE-003908 is decided |
| Held | — | ||
| ACT-017353 | Outreach suppressed pending steward Outreach | ENR-136670 (Dego Brown) held until CASE-003909 is decided |
| Held | — | ||
| ACT-017354 | Outreach suppressed pending steward Outreach | ENR-102466 (Doris Crawford) held until CASE-003910 is decided |
| Held | — | ||
| ACT-017355 | Outreach suppressed pending steward Outreach | CLM-401912 (Doris Crawford) held until CASE-003911 is decided |
| Held | — | ||
| ACT-017356 | Outreach suppressed pending steward Outreach | TPA-53651 (Susn Estrada) held until CASE-003912 is decided |
| Held | — | ||
| ACT-017357 | Outreach suppressed pending steward Outreach | PRV-28640 (Maria Rose) held until CASE-003913 is decided |
| Held | — | ||
| ACT-017358 | Outreach suppressed pending steward Outreach | PRV-28641 (Maria Rose) held until CASE-003914 is decided |
| Held | — | ||
| ACT-017359 | Outreach suppressed pending steward Outreach | TPA-54312 (Bruce Alvraez) held until CASE-003915 is decided |
| Held | — | ||
| ACT-017360 | Outreach suppressed pending steward Outreach | CLM-404943 (Russell Morales) held until CASE-003916 is decided |
| Held | — | ||
| ACT-017361 | Outreach suppressed pending steward Outreach | TPA-59967 (Willie Gomez) held until CASE-003917 is decided |
| Held | — | ||
| ACT-017362 | Outreach suppressed pending steward Outreach | CLM-422682 (Willie Gomez) held until CASE-003918 is decided |
| Held | — | ||
| ACT-017363 | Outreach suppressed pending steward Outreach | CLM-416774 (Melissa Guzman) held until CASE-003919 is decided |
| Held | — | ||
| ACT-017364 | Outreach suppressed pending steward Outreach | ENR-136759 (Ralph Lee) held until CASE-003920 is decided |
| Held | — | ||
| ACT-017365 | Outreach suppressed pending steward Outreach | CLM-428030 (Ralph Lee) held until CASE-003921 is decided |
| Held | — | ||
| ACT-017366 | Outreach suppressed pending steward Outreach | CLM-415334 (Sofia Lopez) held until CASE-003922 is decided |
| Held | — | ||
| ACT-017367 | Outreach suppressed pending steward Outreach | ENR-138638 (Richard Murphy) held until CASE-003923 is decided |
| Held | — | ||
| ACT-017368 | Outreach suppressed pending steward Outreach | TPA-63027 (Richard Murphy) held until CASE-003924 is decided |
| Held | — | ||
| ACT-017369 | Outreach suppressed pending steward Outreach | PRV-27007 (Christopher Reynolds) held until CASE-003925 is decided |
| Held | — | ||
| ACT-017370 | Outreach suppressed pending steward Outreach | CLM-423781 (Christopher Reynolds) held until CASE-003926 is decided |
| Held | — | ||
| ACT-017371 | Outreach suppressed pending steward Outreach | ENR-134229 (Douglas Edwards) held until CASE-003927 is decided |
| Held | — | ||
| ACT-017372 | Outreach suppressed pending steward Outreach | TPA-61538 (Douglas Edwards) held until CASE-003928 is decided |
| Held | — | ||
| ACT-017373 | Outreach suppressed pending steward Outreach | TPA-55999 (Amber Dean) held until CASE-003929 is decided |
| Held | — | ||
| ACT-017374 | Outreach suppressed pending steward Outreach | CLM-426971 (Timothy Flores) held until CASE-003930 is decided |
| Held | — | ||
| ACT-017375 | Outreach suppressed pending steward Outreach | CLM-426972 (Timothy Floores) held until CASE-003931 is decided |
| Held | — | ||
| ACT-017376 | Outreach suppressed pending steward Outreach | CLM-416627 (Christopher Bryant) held until CASE-003932 is decided |
| Held | — | ||
| ACT-017377 | Outreach suppressed pending steward Outreach | CLM-416626 (Christopher Bryant) held until CASE-003933 is decided |
| Held | — | ||
| ACT-017378 | Outreach suppressed pending steward Outreach | ENR-108176 (Kathryn Perkins) held until CASE-003934 is decided |
| Held | — | ||
| ACT-017379 | Outreach suppressed pending steward Outreach | PRV-21814 (Kathryn Perkins) held until CASE-003935 is decided |
| Held | — | ||
| ACT-017380 | Outreach suppressed pending steward Outreach | TPA-57058 (Frances Reed) held until CASE-003936 is decided |
| Held | — | ||
| ACT-017381 | Outreach suppressed pending steward Outreach | CLM-409639 (Bryan Gonzalez) held until CASE-003937 is decided |
| Held | — | ||
| ACT-017382 | Outreach suppressed pending steward Outreach | ENR-112695 (Bryan Gonzalez) held until CASE-003938 is decided |
| Held | — | ||
| ACT-017383 | Outreach suppressed pending steward Outreach | ENR-116294 (Brandon Munoz) held until CASE-003939 is decided |
| Held | — | ||
| ACT-017384 | Outreach suppressed pending steward Outreach | TPA-60386 (Thomas Day) held until CASE-003940 is decided |
| Held | — | ||
| ACT-017385 | Outreach suppressed pending steward Outreach | ENR-140991 (Matthew Ford) held until CASE-003941 is decided |
| Held | — | ||
| ACT-017386 | Outreach suppressed pending steward Outreach | CLM-431212 (Matt Ford) held until CASE-003942 is decided |
| Held | — | ||
| ACT-017387 | Outreach suppressed pending steward Outreach | ENR-111902 (Margaret Ramirez) held until CASE-003943 is decided |
| Held | — | ||
| ACT-017388 | Outreach suppressed pending steward Outreach | CLM-408996 (Margaret Ramirez) held until CASE-003944 is decided |
| Held | — | ||
| ACT-017389 | Outreach suppressed pending steward Outreach | PRV-28823 (Zachary Harvey) held until CASE-003945 is decided |
| Held | — | ||
| ACT-017390 | Outreach suppressed pending steward Outreach | TPA-60205 (William Knight) held until CASE-003946 is decided |
| Held | — | ||
| ACT-017391 | Outreach suppressed pending steward Outreach | TPA-62285 (Jack Moore) held until CASE-003947 is decided |
| Held | — | ||
| ACT-017392 | Outreach suppressed pending steward Outreach | TPA-59978 (Daniel Guerrero) held until CASE-003948 is decided |
| Held | — | ||
| ACT-017393 | Outreach suppressed pending steward Outreach | ENR-129738 (Danny Guerrero) held until CASE-003949 is decided |
| Held | — | ||
| ACT-017394 | Outreach suppressed pending steward Outreach | TPA-54187 (Bradley Lynch) held until CASE-003950 is decided |
| Held | — | ||
| ACT-017395 | Outreach suppressed pending steward Outreach | TPA-62518 (Megan Maldonado) held until CASE-003951 is decided |
| Held | — | ||
| ACT-017396 | Outreach suppressed pending steward Outreach | ENR-137199 (Megan Maldonado) held until CASE-003952 is decided |
| Held | — | ||
| ACT-017397 | Outreach suppressed pending steward Outreach | TPA-60575 (Marcus Ramireez) held until CASE-003953 is decided |
| Held | — | ||
| ACT-017398 | Outreach suppressed pending steward Outreach | CLM-423939 (Gerald Foster) held until CASE-003954 is decided |
| Held | — | ||
| ACT-017399 | Outreach suppressed pending steward Outreach | TPA-51021 (Diana Hudson) held until CASE-003955 is decided |
| Held | — | ||
| ACT-017400 | Outreach suppressed pending steward Outreach | TPA-61891 (Frank Garcia) held until CASE-003956 is decided |
| Held | — | ||
| ACT-017401 | Outreach suppressed pending steward Outreach | PRV-28633 (Diego Harveey) held until CASE-003957 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.