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
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-014195 | Outreach suppressed pending steward Outreach | TPA-54459 (Charles Rice) held until CASE-000751 is decided |
| Held | — | ||
| ACT-014196 | Outreach suppressed pending steward Outreach | PRV-21623 (Omar Richardson) held until CASE-000752 is decided |
| Held | — | ||
| ACT-014197 | Outreach suppressed pending steward Outreach | CLM-424242 (Lawrence Richards) held until CASE-000753 is decided |
| Held | — | ||
| ACT-014198 | Outreach suppressed pending steward Outreach | CLM-432474 (Juan Snyder) held until CASE-000754 is decided |
| Held | — | ||
| ACT-014199 | Outreach suppressed pending steward Outreach | ENR-123868 (Sarah Knight) held until CASE-000755 is decided |
| Held | — | ||
| ACT-014200 | Outreach suppressed pending steward Outreach | TPA-58020 (Sarah Knight) held until CASE-000756 is decided |
| Held | — | ||
| ACT-014201 | Outreach suppressed pending steward Outreach | CLM-404282 (Aisha Fowler) held until CASE-000757 is decided |
| Held | — | ||
| ACT-014202 | Outreach suppressed pending steward Outreach | CLM-404281 (Aisha Fowler) held until CASE-000758 is decided |
| Held | — | ||
| ACT-014203 | Outreach suppressed pending steward Outreach | CLM-403630 (Harold Ward) held until CASE-000759 is decided |
| Held | — | ||
| ACT-014204 | Outreach suppressed pending steward Outreach | TPA-51571 (Harold Ward) held until CASE-000760 is decided |
| Held | — | ||
| ACT-014205 | Outreach suppressed pending steward Outreach | PRV-24476 (Steven Banks) held until CASE-000761 is decided |
| Held | — | ||
| ACT-014206 | Outreach suppressed pending steward Outreach | ENR-120030 (Steven Banks) held until CASE-000762 is decided |
| Held | — | ||
| ACT-014207 | Outreach suppressed pending steward Outreach | TPA-62423 (Christopher Wells) held until CASE-000763 is decided |
| Held | — | ||
| ACT-014208 | Outreach suppressed pending steward Outreach | CLM-427621 (Jose Bradley) held until CASE-000764 is decided |
| Held | — | ||
| ACT-014209 | Outreach suppressed pending steward Outreach | ENR-121138 (Linda Robinson) held until CASE-000765 is decided |
| Held | — | ||
| ACT-014210 | Outreach suppressed pending steward Outreach | TPA-57031 (Linda Robinson) held until CASE-000766 is decided |
| Held | — | ||
| ACT-014211 | Outreach suppressed pending steward Outreach | CLM-430187 (Ronald Thomas) held until CASE-000767 is decided |
| Held | — | ||
| ACT-014212 | Outreach suppressed pending steward Outreach | ENR-129552 (Susan Gray) held until CASE-000768 is decided |
| Held | — | ||
| ACT-014213 | Outreach suppressed pending steward Outreach | TPA-59910 (Susan Gray) held until CASE-000769 is decided |
| Held | — | ||
| ACT-014214 | Outreach suppressed pending steward Outreach | CLM-403128 (Charlotte Gray) held until CASE-000770 is decided |
| Held | — | ||
| ACT-014215 | Outreach suppressed pending steward Outreach | ENR-104050 (Charlotte Gray) held until CASE-000771 is decided |
| Held | — | ||
| ACT-014216 | Outreach suppressed pending steward Outreach | TPA-51224 (Olivia Chpman) held until CASE-000772 is decided |
| Held | — | ||
| ACT-014217 | Outreach suppressed pending steward Outreach | CLM-425762 (Gerald Cook) held until CASE-000773 is decided |
| Held | — | ||
| ACT-014218 | Outreach suppressed pending steward Outreach | ENR-133689 (Gerald Cook) held until CASE-000774 is decided |
| Held | — | ||
| ACT-014219 | Outreach suppressed pending steward Outreach | CLM-405061 (Michelle Smith) held until CASE-000775 is decided |
| Held | — | ||
| ACT-014220 | Outreach suppressed pending steward Outreach | CLM-421101 (Ryan Li) held until CASE-000776 is decided |
| Held | — | ||
| ACT-014221 | Outreach suppressed pending steward Outreach | TPA-62449 (Kevin Matthews) held until CASE-000777 is decided |
| Held | — | ||
| ACT-014222 | Outreach suppressed pending steward Outreach | TPA-58435 (Jack Jenkins) held until CASE-000778 is decided |
| Held | — | ||
| ACT-014223 | Outreach suppressed pending steward Outreach | CLM-419026 (Jack Jenkins) held until CASE-000779 is decided |
| Held | — | ||
| ACT-014224 | Outreach suppressed pending steward Outreach | CLM-406421 (Christine Reid) held until CASE-000780 is decided |
| Held | — | ||
| ACT-014225 | Outreach suppressed pending steward Outreach | ENR-108431 (Christine Reid) held until CASE-000781 is decided |
| Held | — | ||
| ACT-014226 | Outreach suppressed pending steward Outreach | ENR-108670 (Pamela Lawrence) held until CASE-000782 is decided |
| Held | — | ||
| ACT-014227 | Outreach suppressed pending steward Outreach | TPA-52917 (Pamela Lawrence) held until CASE-000783 is decided |
| Held | — | ||
| ACT-014228 | Outreach suppressed pending steward Outreach | TPA-57866 (Aisha Nguyen) held until CASE-000784 is decided |
| Held | — | ||
| ACT-014229 | Outreach suppressed pending steward Outreach | CLM-408568 (Vincent Pena) held until CASE-000785 is decided |
| Held | — | ||
| ACT-014230 | Outreach suppressed pending steward Outreach | CLM-406711 (Jess Johnson) held until CASE-000786 is decided |
| Held | — | ||
| ACT-014231 | Outreach suppressed pending steward Outreach | CLM-411535 (Kenneth Santos) held until CASE-000787 is decided |
| Held | — | ||
| ACT-014232 | Outreach suppressed pending steward Outreach | PRV-26998 (Jacqueline Wang) held until CASE-000788 is decided |
| Held | — | ||
| ACT-014233 | Outreach suppressed pending steward Outreach | ENR-131058 (Jacqueline Wang) held until CASE-000789 is decided |
| Held | — | ||
| ACT-014234 | Outreach suppressed pending steward Outreach | TPA-59300 (Scott Rogers) held until CASE-000790 is decided |
| Held | — | ||
| ACT-014235 | Outreach suppressed pending steward Outreach | TPA-56752 (Sophia Williamson) held until CASE-000791 is decided |
| Held | — | ||
| ACT-014236 | Outreach suppressed pending steward Outreach | CLM-430880 (Sophia Williamson) held until CASE-000792 is decided |
| Held | — | ||
| ACT-014237 | Outreach suppressed pending steward Outreach | PRV-23839 (Jordan Elliott) held until CASE-000793 is decided |
| Held | — | ||
| ACT-014238 | Outreach suppressed pending steward Outreach | CLM-413220 (Jordan Elliott) held until CASE-000794 is decided |
| Held | — | ||
| ACT-014239 | Outreach suppressed pending steward Outreach | TPA-53361 (Jose Munoz) held until CASE-000795 is decided |
| Held | — | ||
| ACT-014240 | Outreach suppressed pending steward Outreach | TPA-53360 (Jose Munoz) held until CASE-000796 is decided |
| Held | — | ||
| ACT-014241 | Outreach suppressed pending steward Outreach | ENR-110066 (Jose Munoz) held until CASE-000797 is decided |
| Held | — | ||
| ACT-014242 | Outreach suppressed pending steward Outreach | TPA-64172 (Jesse Coleman) held until CASE-000798 is decided |
| Held | — | ||
| ACT-014243 | Outreach suppressed pending steward Outreach | TPA-54252 (Mei Johnson) held until CASE-000799 is decided |
| Held | — | ||
| ACT-014244 | Outreach suppressed pending steward Outreach | TPA-64229 (Danielle Herrera) held until CASE-000800 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.