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-017502 | Outreach suppressed pending steward Outreach | CLM-416322 (Alice Sanders) held until CASE-004058 is decided |
| Held | — | ||
| ACT-017503 | Outreach suppressed pending steward Outreach | ENR-130569 (Alexander Gardner) held until CASE-004059 is decided |
| Held | — | ||
| ACT-017504 | Outreach suppressed pending steward Outreach | TPA-60292 (Alexander Gardner) held until CASE-004060 is decided |
| Held | — | ||
| ACT-017505 | Outreach suppressed pending steward Outreach | TPA-55386 (Adam Gordon) held until CASE-004061 is decided |
| Held | — | ||
| ACT-017506 | Outreach suppressed pending steward Outreach | TPA-62690 (Kimberly Spencer) held until CASE-004062 is decided |
| Held | — | ||
| ACT-017507 | Outreach suppressed pending steward Outreach | TPA-62691 (Kimberly Spencer) held until CASE-004063 is decided |
| Held | — | ||
| ACT-017508 | Outreach suppressed pending steward Outreach | TPA-54977 (Melissa Wong) held until CASE-004064 is decided |
| Held | — | ||
| ACT-017509 | Outreach suppressed pending steward Outreach | CLM-411327 (Melissa Woong) held until CASE-004065 is decided |
| Held | — | ||
| ACT-017510 | Outreach suppressed pending steward Outreach | ENR-141525 (Terry Hansen) held until CASE-004066 is decided |
| Held | — | ||
| ACT-017511 | Outreach suppressed pending steward Outreach | CLM-421151 (Scott Rogers) held until CASE-004067 is decided |
| Held | — | ||
| ACT-017512 | Outreach suppressed pending steward Outreach | TPA-56043 (Aisha Braadley) held until CASE-004068 is decided |
| Held | — | ||
| ACT-017513 | Outreach suppressed pending steward Outreach | ENR-128917 (Brittany Carpenter) held until CASE-004069 is decided |
| Held | — | ||
| ACT-017514 | Outreach suppressed pending steward Outreach | CLM-422078 (Brittany Carpenter) held until CASE-004070 is decided |
| Held | — | ||
| ACT-017515 | Outreach suppressed pending steward Outreach | CLM-404644 (Sean Torres) held until CASE-004071 is decided |
| Held | — | ||
| ACT-017516 | Outreach suppressed pending steward Outreach | TPA-57463 (Bill Wallace) held until CASE-004072 is decided |
| Held | — | ||
| ACT-017517 | Outreach suppressed pending steward Outreach | TPA-63235 (Hannah Miller) held until CASE-004073 is decided |
| Held | — | ||
| ACT-017518 | Outreach suppressed pending steward Outreach | PRV-28773 (Hannah Miller) held until CASE-004074 is decided |
| Held | — | ||
| ACT-017519 | Outreach suppressed pending steward Outreach | CLM-415941 (Nancy Hart) held until CASE-004075 is decided |
| Held | — | ||
| ACT-017520 | Outreach suppressed pending steward Outreach | TPA-56983 (Nanncy Hart) held until CASE-004076 is decided |
| Held | — | ||
| ACT-017521 | Outreach suppressed pending steward Outreach | ENR-136036 (Maria Henderson) held until CASE-004077 is decided |
| Held | — | ||
| ACT-017522 | Outreach suppressed pending steward Outreach | CLM-427493 (Maria Henderson) held until CASE-004078 is decided |
| Held | — | ||
| ACT-017523 | Outreach suppressed pending steward Outreach | ENR-114003 (Carlos Thompson) held until CASE-004079 is decided |
| Held | — | ||
| ACT-017524 | Outreach suppressed pending steward Outreach | TPA-54682 (Carlos Thompson) held until CASE-004080 is decided |
| Held | — | ||
| ACT-017525 | Outreach suppressed pending steward Outreach | TPA-54273 (Hiroshi Rice) held until CASE-004081 is decided |
| Held | — | ||
| ACT-017526 | Outreach suppressed pending steward Outreach | ENR-109733 (Priya Ortiz) held until CASE-004082 is decided |
| Held | — | ||
| ACT-017527 | Outreach suppressed pending steward Outreach | CLM-407424 (Priya Ortiz) held until CASE-004083 is decided |
| Held | — | ||
| ACT-017528 | Outreach suppressed pending steward Outreach | ENR-119004 (Nancy Wright) held until CASE-004084 is decided |
| Held | — | ||
| ACT-017529 | Outreach suppressed pending steward Outreach | PRV-24232 (Nancy Wright) held until CASE-004085 is decided |
| Held | — | ||
| ACT-017530 | Outreach suppressed pending steward Outreach | CLM-429139 (Fatima Payne) held until CASE-004086 is decided |
| Held | — | ||
| ACT-017531 | Outreach suppressed pending steward Outreach | ENR-138207 (Fatima Payne) held until CASE-004087 is decided |
| Held | — | ||
| ACT-017532 | Outreach suppressed pending steward Outreach | ENR-123200 (Rachel Maldonado) held until CASE-004088 is decided |
| Held | — | ||
| ACT-017533 | Outreach suppressed pending steward Outreach | CLM-417600 (Racchel Maldonado) held until CASE-004089 is decided |
| Held | — | ||
| ACT-017534 | Outreach suppressed pending steward Outreach | ENR-119871 (Douglas Lawrence) held until CASE-004090 is decided |
| Held | — | ||
| ACT-017535 | Outreach suppressed pending steward Outreach | CLM-415089 (Doglas Lawence) held until CASE-004091 is decided |
| Held | — | ||
| ACT-017536 | Outreach suppressed pending steward Outreach | ENR-111456 (Austin Lopez) held until CASE-004092 is decided |
| Held | — | ||
| ACT-017537 | Outreach suppressed pending steward Outreach | CLM-408696 (Austin Lopez) held until CASE-004093 is decided |
| Held | — | ||
| ACT-017538 | Outreach suppressed pending steward Outreach | PRV-27525 (Aisha Maldonado) held until CASE-004094 is decided |
| Held | — | ||
| ACT-017539 | Outreach suppressed pending steward Outreach | TPA-50223 (Isabella Harrisun) held until CASE-004095 is decided |
| Held | — | ||
| ACT-017540 | Outreach suppressed pending steward Outreach | TPA-55323 (Grace Sandoval) held until CASE-004096 is decided |
| Held | — | ||
| ACT-017541 | Outreach suppressed pending steward Outreach | TPA-55322 (Grace Sandoval) held until CASE-004097 is decided |
| Held | — | ||
| ACT-017542 | Outreach suppressed pending steward Outreach | CLM-420168 (Carolyn Morales) held until CASE-004098 is decided |
| Held | — | ||
| ACT-017543 | Outreach suppressed pending steward Outreach | CLM-416194 (Dylan Williams) held until CASE-004099 is decided |
| Held | — | ||
| ACT-017544 | Outreach suppressed pending steward Outreach | ENR-133043 (Maria Williamson) held until CASE-004100 is decided |
| Held | — | ||
| ACT-017545 | Outreach suppressed pending steward Outreach | TPA-55667 (Kimberly Mitchell) held until CASE-004101 is decided |
| Held | — | ||
| ACT-017546 | Outreach suppressed pending steward Outreach | TPA-55668 (Kimberly Mitkhell) held until CASE-004102 is decided |
| Held | — | ||
| ACT-017547 | Outreach suppressed pending steward Outreach | CLM-420453 (Yuki Elliott) held until CASE-004103 is decided |
| Held | — | ||
| ACT-017548 | Outreach suppressed pending steward Outreach | TPA-52224 (Sean Soto) held until CASE-004104 is decided |
| Held | — | ||
| ACT-017549 | Outreach suppressed pending steward Outreach | ENR-106683 (Sean Soto) held until CASE-004105 is decided |
| Held | — | ||
| ACT-017550 | Outreach suppressed pending steward Outreach | TPA-62684 (Lauren Reid) held until CASE-004106 is decided |
| Held | — | ||
| ACT-017551 | Outreach suppressed pending steward Outreach | TPA-54589 (Juan Santos) held until CASE-004107 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.