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-017702 | Outreach suppressed pending steward Outreach | CLM-432382 (Kelly King) held until CASE-004258 is decided |
| Held | — | ||
| ACT-017703 | Outreach suppressed pending steward Outreach | ENR-142510 (Kelly King) held until CASE-004259 is decided |
| Held | — | ||
| ACT-017704 | Outreach suppressed pending steward Outreach | ENR-115315 (Bruce Gordon) held until CASE-004260 is decided |
| Held | — | ||
| ACT-017705 | Outreach suppressed pending steward Outreach | TPA-55133 (Bruce Gordon) held until CASE-004261 is decided |
| Held | — | ||
| ACT-017706 | Outreach suppressed pending steward Outreach | CLM-420578 (Juan Lewis) held until CASE-004262 is decided |
| Held | — | ||
| ACT-017707 | Outreach suppressed pending steward Outreach | ENR-134696 (Matthew Jones) held until CASE-004263 is decided |
| Held | — | ||
| ACT-017708 | Outreach suppressed pending steward Outreach | CLM-426459 (Matthew Jones) held until CASE-004264 is decided |
| Held | — | ||
| ACT-017709 | Outreach suppressed pending steward Outreach | CLM-400485 (Andrea Jordan) held until CASE-004265 is decided |
| Held | — | ||
| ACT-017710 | Outreach suppressed pending steward Outreach | TPA-50207 (Andrea Jordan) held until CASE-004266 is decided |
| Held | — | ||
| ACT-017711 | Outreach suppressed pending steward Outreach | ENR-108661 (James Butler) held until CASE-004267 is decided |
| Held | — | ||
| ACT-017712 | Outreach suppressed pending steward Outreach | TPA-52911 (Jimmy Butler) held until CASE-004268 is decided |
| Held | — | ||
| ACT-017713 | Outreach suppressed pending steward Outreach | CLM-414907 (Emma Weaver) held until CASE-004269 is decided |
| Held | — | ||
| ACT-017714 | Outreach suppressed pending steward Outreach | TPA-56572 (Emma Weaver) held until CASE-004270 is decided |
| Held | — | ||
| ACT-017715 | Outreach suppressed pending steward Outreach | TPA-53649 (Debra Guerrero) held until CASE-004271 is decided |
| Held | — | ||
| ACT-017716 | Outreach suppressed pending steward Outreach | ENR-110969 (Debra Guerrero) held until CASE-004272 is decided |
| Held | — | ||
| ACT-017717 | Outreach suppressed pending steward Outreach | TPA-63133 (Timothy Simmons) held until CASE-004273 is decided |
| Held | — | ||
| ACT-017718 | Outreach suppressed pending steward Outreach | TPA-52217 (Mark Palmer) held until CASE-004274 is decided |
| Held | — | ||
| ACT-017719 | Outreach suppressed pending steward Outreach | TPA-52216 (Mark Palmer) held until CASE-004275 is decided |
| Held | — | ||
| ACT-017720 | Outreach suppressed pending steward Outreach | ENR-120679 (Wong Maason) held until CASE-004276 is decided |
| Held | — | ||
| ACT-017721 | Outreach suppressed pending steward Outreach | TPA-55604 (Christian West) held until CASE-004277 is decided |
| Held | — | ||
| ACT-017722 | Outreach suppressed pending steward Outreach | ENR-116747 (Christian West) held until CASE-004278 is decided |
| Held | — | ||
| ACT-017723 | Outreach suppressed pending steward Outreach | TPA-50335 (Ana Ward) held until CASE-004279 is decided |
| Held | — | ||
| ACT-017724 | Outreach suppressed pending steward Outreach | ENR-100009 (Shirley Hernandez) held until CASE-004280 is decided |
| Held | — | ||
| ACT-017725 | Outreach suppressed pending steward Outreach | PRV-20003 (Shirley Hernandez) held until CASE-004281 is decided |
| Held | — | ||
| ACT-017726 | Outreach suppressed pending steward Outreach | ENR-140463 (Camila Russell) held until CASE-004282 is decided |
| Held | — | ||
| ACT-017727 | Outreach suppressed pending steward Outreach | CLM-430790 (Camila Russell) held until CASE-004283 is decided |
| Held | — | ||
| ACT-017728 | Outreach suppressed pending steward Outreach | CLM-404639 (Douglas Salazar) held until CASE-004284 is decided |
| Held | — | ||
| ACT-017729 | Outreach suppressed pending steward Outreach | CLM-418574 (Terry Tran) held until CASE-004285 is decided |
| Held | — | ||
| ACT-017730 | Outreach suppressed pending steward Outreach | ENR-124447 (Terry Tran) held until CASE-004286 is decided |
| Held | — | ||
| ACT-017731 | Outreach suppressed pending steward Outreach | ENR-136168 (Barbara Hill) held until CASE-004287 is decided |
| Held | — | ||
| ACT-017732 | Outreach suppressed pending steward Outreach | CLM-427589 (Barbara Hill) held until CASE-004288 is decided |
| Held | — | ||
| ACT-017733 | Outreach suppressed pending steward Outreach | ENR-106992 (Frances Jensen) held until CASE-004289 is decided |
| Held | — | ||
| ACT-017734 | Outreach suppressed pending steward Outreach | CLM-405338 (Frances Jensen) held until CASE-004290 is decided |
| Held | — | ||
| ACT-017735 | Outreach suppressed pending steward Outreach | PRV-24093 (Christian Hghes) held until CASE-004291 is decided |
| Held | — | ||
| ACT-017736 | Outreach suppressed pending steward Outreach | TPA-56220 (Christian Hughes) held until CASE-004292 is decided |
| Held | — | ||
| ACT-017737 | Outreach suppressed pending steward Outreach | PRV-20602 (Natalie Palmer) held until CASE-004293 is decided |
| Held | — | ||
| ACT-017738 | Outreach suppressed pending steward Outreach | CLM-402050 (Natalie Palmer) held until CASE-004294 is decided |
| Held | — | ||
| ACT-017739 | Outreach suppressed pending steward Outreach | CLM-431631 (Kayla Roojas) held until CASE-004295 is decided |
| Held | — | ||
| ACT-017740 | Outreach suppressed pending steward Outreach | ENR-141531 (Kayla Rojas) held until CASE-004296 is decided |
| Held | — | ||
| ACT-017741 | Outreach suppressed pending steward Outreach | ENR-126352 (Ryan Parker) held until CASE-004297 is decided |
| Held | — | ||
| ACT-017742 | Outreach suppressed pending steward Outreach | TPA-59251 (Gabriel Ford) held until CASE-004298 is decided |
| Held | — | ||
| ACT-017743 | Outreach suppressed pending steward Outreach | ENR-127630 (Gabriel Ford) held until CASE-004299 is decided |
| Held | — | ||
| ACT-017744 | Outreach suppressed pending steward Outreach | CLM-429540 (Ahmed Senders) held until CASE-004300 is decided |
| Held | — | ||
| ACT-017745 | Outreach suppressed pending steward Outreach | CLM-419466 (Samuel Tucker) held until CASE-004301 is decided |
| Held | — | ||
| ACT-017746 | Outreach suppressed pending steward Outreach | CLM-419467 (Samuel Tucker) held until CASE-004302 is decided |
| Held | — | ||
| ACT-017747 | Outreach suppressed pending steward Outreach | CLM-409267 (Hiroshi Miller) held until CASE-004303 is decided |
| Held | — | ||
| ACT-017748 | Outreach suppressed pending steward Outreach | ENR-142652 (Julie Romero) held until CASE-004304 is decided |
| Held | — | ||
| ACT-017749 | Outreach suppressed pending steward Outreach | CLM-400031 (Jennifer Matthews) held until CASE-004305 is decided |
| Held | — | ||
| ACT-017750 | Outreach suppressed pending steward Outreach | ENR-100039 (Jennifer Matthews) held until CASE-004306 is decided |
| Held | — | ||
| ACT-017751 | Outreach suppressed pending steward Outreach | PRV-25071 (Susan Jakkson) held until CASE-004307 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.