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

TypeAllOutreach address corrected2,993Outreach suppressed pending steward4,326
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-017752
Outreach suppressed pending steward
Outreach
ENR-122527 (Susan Jackson) held until CASE-004308 is decided
Case id
CASE-004308
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-122527
Held—
ACT-017753
Outreach suppressed pending steward
Outreach
ENR-130770 (Amber Maldonado) held until CASE-004309 is decided
Case id
CASE-004309
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-130770
Held—
ACT-017754
Outreach suppressed pending steward
Outreach
CLM-408872 (Maria Ortiz) held until CASE-004310 is decided
Case id
CASE-004310
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-408872
Held—
ACT-017755
Outreach suppressed pending steward
Outreach
ENR-111717 (Maria Ortiz) held until CASE-004311 is decided
Case id
CASE-004311
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-111717
Held—
ACT-017756
Outreach suppressed pending steward
Outreach
ENR-102895 (Dnenis Sanders) held until CASE-004312 is decided
Case id
CASE-004312
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-102895
Held—
ACT-017757
Outreach suppressed pending steward
Outreach
ENR-112809 (Jennifer Carr) held until CASE-004313 is decided
Case id
CASE-004313
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-112809
Held—
ACT-017758
Outreach suppressed pending steward
Outreach
CLM-409744 (Jennifer Carr) held until CASE-004314 is decided
Case id
CASE-004314
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-409744
Held—
ACT-017759
Outreach suppressed pending steward
Outreach
PRV-26870 (Karen Hoffmman) held until CASE-004315 is decided
Case id
CASE-004315
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-26870
Held—
ACT-017760
Outreach suppressed pending steward
Outreach
ENR-130419 (Karen Hoffman) held until CASE-004316 is decided
Case id
CASE-004316
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-130419
Held—
ACT-017761
Outreach suppressed pending steward
Outreach
ENR-141338 (Joan Jimeenz) held until CASE-004317 is decided
Case id
CASE-004317
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-141338
Held—
ACT-017762
Outreach suppressed pending steward
Outreach
TPA-63902 (Joan Jimenez) held until CASE-004318 is decided
Case id
CASE-004318
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-63902
Held—
ACT-017763
Outreach suppressed pending steward
Outreach
TPA-60823 (Deborah Ferrnandez) held until CASE-004319 is decided
Case id
CASE-004319
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-60823
Held—
ACT-017764
Outreach suppressed pending steward
Outreach
CLM-412287 (Ssan Hansen) held until CASE-004320 is decided
Case id
CASE-004320
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-412287
Held—
ACT-017765
Outreach suppressed pending steward
Outreach
ENR-116165 (Susan Hansen) held until CASE-004321 is decided
Case id
CASE-004321
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-116165
Held—
ACT-017766
Outreach suppressed pending steward
Outreach
CLM-400459 (Janice Santiago) held until CASE-004322 is decided
Case id
CASE-004322
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-400459
Held—
ACT-017767
Outreach suppressed pending steward
Outreach
ENR-142313 (Priya Burke) held until CASE-004323 is decided
Case id
CASE-004323
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-142313
Held—
ACT-017768
Outreach suppressed pending steward
Outreach
TPA-64226 (Piya Burke) held until CASE-004324 is decided
Case id
CASE-004324
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-64226
Held—
ACT-017769
Outreach suppressed pending steward
Outreach
ENR-133613 (Rebecca Foster) held until CASE-004325 is decided
Case id
CASE-004325
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-133613
Held—
ACT-017770
Outreach suppressed pending steward
Outreach
TPA-61342 (Rebecca Foster) held until CASE-004326 is decided
Case id
CASE-004326
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-61342
Held—
7,319 rows, page 147 of 147PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A 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.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.