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-017402 | Outreach suppressed pending steward Outreach | CLM-414927 (Margaret Turner) held until CASE-003958 is decided |
| Held | — | ||
| ACT-017403 | Outreach suppressed pending steward Outreach | CLM-414928 (Maggie Turner) held until CASE-003959 is decided |
| Held | — | ||
| ACT-017404 | Outreach suppressed pending steward Outreach | TPA-63008 (Brandon Salazar) held until CASE-003960 is decided |
| Held | — | ||
| ACT-017405 | Outreach suppressed pending steward Outreach | TPA-54899 (Russell Andrews) held until CASE-003961 is decided |
| Held | — | ||
| ACT-017406 | Outreach suppressed pending steward Outreach | CLM-409616 (Martha Singh) held until CASE-003962 is decided |
| Held | — | ||
| ACT-017407 | Outreach suppressed pending steward Outreach | TPA-54183 (Martha Singh) held until CASE-003963 is decided |
| Held | — | ||
| ACT-017408 | Outreach suppressed pending steward Outreach | ENR-110849 (Nicholas Williamson) held until CASE-003964 is decided |
| Held | — | ||
| ACT-017409 | Outreach suppressed pending steward Outreach | PRV-21372 (Brandon Garrett) held until CASE-003965 is decided |
| Held | — | ||
| ACT-017410 | Outreach suppressed pending steward Outreach | ENR-106233 (Brandon Garrett) held until CASE-003966 is decided |
| Held | — | ||
| ACT-017411 | Outreach suppressed pending steward Outreach | CLM-417703 (Austin Collins) held until CASE-003967 is decided |
| Held | — | ||
| ACT-017412 | Outreach suppressed pending steward Outreach | ENR-123318 (Austin Collins) held until CASE-003968 is decided |
| Held | — | ||
| ACT-017413 | Outreach suppressed pending steward Outreach | ENR-130536 (Jon Burke) held until CASE-003969 is decided |
| Held | — | ||
| ACT-017414 | Outreach suppressed pending steward Outreach | TPA-60279 (Jonathan Burke) held until CASE-003970 is decided |
| Held | — | ||
| ACT-017415 | Outreach suppressed pending steward Outreach | ENR-126994 (Michelle Murphy) held until CASE-003971 is decided |
| Held | — | ||
| ACT-017416 | Outreach suppressed pending steward Outreach | CLM-420517 (Michelle Murphy) held until CASE-003972 is decided |
| Held | — | ||
| ACT-017417 | Outreach suppressed pending steward Outreach | PRV-26710 (Arjun Carter) held until CASE-003973 is decided |
| Held | — | ||
| ACT-017418 | Outreach suppressed pending steward Outreach | TPA-62400 (Marcus Webb) held until CASE-003974 is decided |
| Held | — | ||
| ACT-017419 | Outreach suppressed pending steward Outreach | CLM-413013 (Roger Holmes) held until CASE-003975 is decided |
| Held | — | ||
| ACT-017420 | Outreach suppressed pending steward Outreach | CLM-417257 (Carl Robinson) held until CASE-003976 is decided |
| Held | — | ||
| ACT-017421 | Outreach suppressed pending steward Outreach | ENR-122744 (Carl Robinson) held until CASE-003977 is decided |
| Held | — | ||
| ACT-017422 | Outreach suppressed pending steward Outreach | CLM-430016 (Diego Chavez) held until CASE-003978 is decided |
| Held | — | ||
| ACT-017423 | Outreach suppressed pending steward Outreach | CLM-424797 (Santiago Jacobs) held until CASE-003979 is decided |
| Held | — | ||
| ACT-017424 | Outreach suppressed pending steward Outreach | CLM-424796 (Santiago Jacobs) held until CASE-003980 is decided |
| Held | — | ||
| ACT-017425 | Outreach suppressed pending steward Outreach | TPA-55169 (Melissa Stephens) held until CASE-003981 is decided |
| Held | — | ||
| ACT-017426 | Outreach suppressed pending steward Outreach | TPA-54064 (Kathryn Nichols) held until CASE-003982 is decided |
| Held | — | ||
| ACT-017427 | Outreach suppressed pending steward Outreach | TPA-54065 (Kathryn Nichols) held until CASE-003983 is decided |
| Held | — | ||
| ACT-017428 | Outreach suppressed pending steward Outreach | CLM-426648 (Olivia Berry) held until CASE-003984 is decided |
| Held | — | ||
| ACT-017429 | Outreach suppressed pending steward Outreach | ENR-134943 (Olivia Berry) held until CASE-003985 is decided |
| Held | — | ||
| ACT-017430 | Outreach suppressed pending steward Outreach | TPA-50779 (Ross Edward) held until CASE-003986 is decided |
| Held | — | ||
| ACT-017431 | Outreach suppressed pending steward Outreach | ENR-102336 (Edward Ross) held until CASE-003987 is decided |
| Held | — | ||
| ACT-017432 | Outreach suppressed pending steward Outreach | CLM-420195 (Sharon Woods) held until CASE-003988 is decided |
| Held | — | ||
| ACT-017433 | Outreach suppressed pending steward Outreach | PRV-21198 (James Cunningham) held until CASE-003989 is decided |
| Held | — | ||
| ACT-017434 | Outreach suppressed pending steward Outreach | ENR-105593 (James Cunningham) held until CASE-003990 is decided |
| Held | — | ||
| ACT-017435 | Outreach suppressed pending steward Outreach | CLM-417234 (Sophia Larson) held until CASE-003991 is decided |
| Held | — | ||
| ACT-017436 | Outreach suppressed pending steward Outreach | TPA-61009 (Barbara Ruiz) held until CASE-003992 is decided |
| Held | — | ||
| ACT-017437 | Outreach suppressed pending steward Outreach | ENR-107284 (Jesse Tucker) held until CASE-003993 is decided |
| Held | — | ||
| ACT-017438 | Outreach suppressed pending steward Outreach | ENR-114467 (Denie Harper) held until CASE-003994 is decided |
| Held | — | ||
| ACT-017439 | Outreach suppressed pending steward Outreach | TPA-54818 (Denise Harper) held until CASE-003995 is decided |
| Held | — | ||
| ACT-017440 | Outreach suppressed pending steward Outreach | CLM-417502 (Justin Reyes) held until CASE-003996 is decided |
| Held | — | ||
| ACT-017441 | Outreach suppressed pending steward Outreach | CLM-429178 (Jake Collins) held until CASE-003997 is decided |
| Held | — | ||
| ACT-017442 | Outreach suppressed pending steward Outreach | PRV-28560 (Jacob Collins) held until CASE-003998 is decided |
| Held | — | ||
| ACT-017443 | Outreach suppressed pending steward Outreach | CLM-406779 (Donna Russell) held until CASE-003999 is decided |
| Held | — | ||
| ACT-017444 | Outreach suppressed pending steward Outreach | CLM-406780 (Donna Russell) held until CASE-004000 is decided |
| Held | — | ||
| ACT-017445 | Outreach suppressed pending steward Outreach | TPA-58092 (Gary Hart) held until CASE-004001 is decided |
| Held | — | ||
| ACT-017446 | Outreach suppressed pending steward Outreach | TPA-58091 (Gary Hart) held until CASE-004002 is decided |
| Held | — | ||
| ACT-017447 | Outreach suppressed pending steward Outreach | ENR-134074 (Elijah Mitchell) held until CASE-004003 is decided |
| Held | — | ||
| ACT-017448 | Outreach suppressed pending steward Outreach | CLM-426031 (Eliijah Mitchell) held until CASE-004004 is decided |
| Held | — | ||
| ACT-017449 | Outreach suppressed pending steward Outreach | TPA-53713 (Roy Mendez) held until CASE-004005 is decided |
| Held | — | ||
| ACT-017450 | Outreach suppressed pending steward Outreach | CLM-430590 (Brittany Holmes) held until CASE-004006 is decided |
| Held | — | ||
| ACT-017451 | Outreach suppressed pending steward Outreach | CLM-423244 (Kyle Harper) held until CASE-004007 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.