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-017652 | Outreach suppressed pending steward Outreach | ENR-125705 (Philip Ferguson) held until CASE-004208 is decided |
| Held | — | ||
| ACT-017653 | Outreach suppressed pending steward Outreach | TPA-58604 (Philip Ferguson) held until CASE-004209 is decided |
| Held | — | ||
| ACT-017654 | Outreach suppressed pending steward Outreach | TPA-51239 (Randy Tucker) held until CASE-004210 is decided |
| Held | — | ||
| ACT-017655 | Outreach suppressed pending steward Outreach | ENR-103734 (Randy Tucker) held until CASE-004211 is decided |
| Held | — | ||
| ACT-017656 | Outreach suppressed pending steward Outreach | PRV-20600 (Roger Bryant) held until CASE-004212 is decided |
| Held | — | ||
| ACT-017657 | Outreach suppressed pending steward Outreach | ENR-102623 (Roger Bryant) held until CASE-004213 is decided |
| Held | — | ||
| ACT-017658 | Outreach suppressed pending steward Outreach | ENR-139477 (Walter Burns) held until CASE-004214 is decided |
| Held | — | ||
| ACT-017659 | Outreach suppressed pending steward Outreach | CLM-430090 (Walter Burns) held until CASE-004215 is decided |
| Held | — | ||
| ACT-017660 | Outreach suppressed pending steward Outreach | TPA-55251 (Kenneth Kim) held until CASE-004216 is decided |
| Held | — | ||
| ACT-017661 | Outreach suppressed pending steward Outreach | ENR-115683 (Kenneth Kim) held until CASE-004217 is decided |
| Held | — | ||
| ACT-017662 | Outreach suppressed pending steward Outreach | CLM-400875 (Timothy Kelly) held until CASE-004218 is decided |
| Held | — | ||
| ACT-017663 | Outreach suppressed pending steward Outreach | CLM-407624 (Betty Perkins) held until CASE-004219 is decided |
| Held | — | ||
| ACT-017664 | Outreach suppressed pending steward Outreach | CLM-427328 (Anderson Melissa) held until CASE-004220 is decided |
| Held | — | ||
| ACT-017665 | Outreach suppressed pending steward Outreach | CLM-427327 (Melissa Anderson) held until CASE-004221 is decided |
| Held | — | ||
| ACT-017666 | Outreach suppressed pending steward Outreach | TPA-53053 (Brian Contreras) held until CASE-004222 is decided |
| Held | — | ||
| ACT-017667 | Outreach suppressed pending steward Outreach | ENR-118015 (Jean Edwards) held until CASE-004223 is decided |
| Held | — | ||
| ACT-017668 | Outreach suppressed pending steward Outreach | CLM-428080 (Teresa Vargas) held until CASE-004224 is decided |
| Held | — | ||
| ACT-017669 | Outreach suppressed pending steward Outreach | CLM-428081 (Teresa Vargas) held until CASE-004225 is decided |
| Held | — | ||
| ACT-017670 | Outreach suppressed pending steward Outreach | ENR-139714 (Albert Lynch) held until CASE-004226 is decided |
| Held | — | ||
| ACT-017671 | Outreach suppressed pending steward Outreach | CLM-430256 (Albert Lynch) held until CASE-004227 is decided |
| Held | — | ||
| ACT-017672 | Outreach suppressed pending steward Outreach | CLM-402806 (Laura Harper) held until CASE-004228 is decided |
| Held | — | ||
| ACT-017673 | Outreach suppressed pending steward Outreach | ENR-103614 (Laura Harper) held until CASE-004229 is decided |
| Held | — | ||
| ACT-017674 | Outreach suppressed pending steward Outreach | CLM-430233 (Cynthai Ross) held until CASE-004230 is decided |
| Held | — | ||
| ACT-017675 | Outreach suppressed pending steward Outreach | PRV-28858 (Cynthia Ross) held until CASE-004231 is decided |
| Held | — | ||
| ACT-017676 | Outreach suppressed pending steward Outreach | TPA-53610 (Isabella Fernandez) held until CASE-004232 is decided |
| Held | — | ||
| ACT-017677 | Outreach suppressed pending steward Outreach | CLM-416361 (Betty Rodriguez) held until CASE-004233 is decided |
| Held | — | ||
| ACT-017678 | Outreach suppressed pending steward Outreach | ENR-121509 (Betty Rodriguez) held until CASE-004234 is decided |
| Held | — | ||
| ACT-017679 | Outreach suppressed pending steward Outreach | CLM-431802 (Carolyn Dominguez) held until CASE-004235 is decided |
| Held | — | ||
| ACT-017680 | Outreach suppressed pending steward Outreach | ENR-141722 (Carolyn Dominguez) held until CASE-004236 is decided |
| Held | — | ||
| ACT-017681 | Outreach suppressed pending steward Outreach | CLM-415120 (Ana Webb) held until CASE-004237 is decided |
| Held | — | ||
| ACT-017682 | Outreach suppressed pending steward Outreach | ENR-119903 (Ana Webb) held until CASE-004238 is decided |
| Held | — | ||
| ACT-017683 | Outreach suppressed pending steward Outreach | TPA-63958 (Yuki Park) held until CASE-004239 is decided |
| Held | — | ||
| ACT-017684 | Outreach suppressed pending steward Outreach | TPA-59649 (Sean Chen) held until CASE-004240 is decided |
| Held | — | ||
| ACT-017685 | Outreach suppressed pending steward Outreach | ENR-134564 (Raymond Wesst) held until CASE-004241 is decided |
| Held | — | ||
| ACT-017686 | Outreach suppressed pending steward Outreach | PRV-27772 (Raymond West) held until CASE-004242 is decided |
| Held | — | ||
| ACT-017687 | Outreach suppressed pending steward Outreach | CLM-403088 (Frank Ramireez) held until CASE-004243 is decided |
| Held | — | ||
| ACT-017688 | Outreach suppressed pending steward Outreach | TPA-59657 (Alice Mills) held until CASE-004244 is decided |
| Held | — | ||
| ACT-017689 | Outreach suppressed pending steward Outreach | PRV-23111 (Bryan West) held until CASE-004245 is decided |
| Held | — | ||
| ACT-017690 | Outreach suppressed pending steward Outreach | ENR-114156 (Bryan West) held until CASE-004246 is decided |
| Held | — | ||
| ACT-017691 | Outreach suppressed pending steward Outreach | TPA-58425 (Katherine Perry) held until CASE-004247 is decided |
| Held | — | ||
| ACT-017692 | Outreach suppressed pending steward Outreach | ENR-125032 (Kathy Perry) held until CASE-004248 is decided |
| Held | — | ||
| ACT-017693 | Outreach suppressed pending steward Outreach | TPA-61629 (Albert Wells) held until CASE-004249 is decided |
| Held | — | ||
| ACT-017694 | Outreach suppressed pending steward Outreach | CLM-426326 (Albert Wells) held until CASE-004250 is decided |
| Held | — | ||
| ACT-017695 | Outreach suppressed pending steward Outreach | TPA-53626 (Patrick Gibson) held until CASE-004251 is decided |
| Held | — | ||
| ACT-017696 | Outreach suppressed pending steward Outreach | CLM-408269 (Patrick Gibson) held until CASE-004252 is decided |
| Held | — | ||
| ACT-017697 | Outreach suppressed pending steward Outreach | TPA-64334 (Isabella Gordon) held until CASE-004253 is decided |
| Held | — | ||
| ACT-017698 | Outreach suppressed pending steward Outreach | TPA-56144 (Joseph Meyer) held until CASE-004254 is decided |
| Held | — | ||
| ACT-017699 | Outreach suppressed pending steward Outreach | ENR-118228 (Joseph Meyer) held until CASE-004255 is decided |
| Held | — | ||
| ACT-017700 | Outreach suppressed pending steward Outreach | PRV-26351 (Marcus Nichols) held until CASE-004256 is decided |
| Held | — | ||
| ACT-017701 | Outreach suppressed pending steward Outreach | PRV-26352 (Marcus Nichols) held until CASE-004257 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.