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-014245 | Outreach suppressed pending steward Outreach | TPA-62491 (Bobby Gardner) held until CASE-000801 is decided |
| Held | — | ||
| ACT-014246 | Outreach suppressed pending steward Outreach | CLM-428460 (Kyle Peters) held until CASE-000802 is decided |
| Held | — | ||
| ACT-014247 | Outreach suppressed pending steward Outreach | CLM-428461 (Kyle Peters) held until CASE-000803 is decided |
| Held | — | ||
| ACT-014248 | Outreach suppressed pending steward Outreach | TPA-57094 (Marcus Valdez) held until CASE-000804 is decided |
| Held | — | ||
| ACT-014249 | Outreach suppressed pending steward Outreach | CLM-416189 (Marcus Valdez) held until CASE-000805 is decided |
| Held | — | ||
| ACT-014250 | Outreach suppressed pending steward Outreach | TPA-57161 (Sandra Ortega) held until CASE-000806 is decided |
| Held | — | ||
| ACT-014251 | Outreach suppressed pending steward Outreach | TPA-52847 (Evelyn Simmons) held until CASE-000807 is decided |
| Held | — | ||
| ACT-014252 | Outreach suppressed pending steward Outreach | TPA-52846 (Evelyn Simmons) held until CASE-000808 is decided |
| Held | — | ||
| ACT-014253 | Outreach suppressed pending steward Outreach | CLM-402507 (William Simmons) held until CASE-000809 is decided |
| Held | — | ||
| ACT-014254 | Outreach suppressed pending steward Outreach | CLM-420531 (Luis Patterson) held until CASE-000810 is decided |
| Held | — | ||
| ACT-014255 | Outreach suppressed pending steward Outreach | TPA-59592 (Wei Lawrence) held until CASE-000811 is decided |
| Held | — | ||
| ACT-014256 | Outreach suppressed pending steward Outreach | TPA-50258 (Anthony Nunez) held until CASE-000812 is decided |
| Held | — | ||
| ACT-014257 | Outreach suppressed pending steward Outreach | ENR-100769 (Anthony Nunze) held until CASE-000813 is decided |
| Held | — | ||
| ACT-014258 | Outreach suppressed pending steward Outreach | ENR-108107 (Dylan Williamson) held until CASE-000814 is decided |
| Held | — | ||
| ACT-014259 | Outreach suppressed pending steward Outreach | TPA-64051 (Austin Williamson) held until CASE-000815 is decided |
| Held | — | ||
| ACT-014260 | Outreach suppressed pending steward Outreach | PRV-29313 (Austin Williamson) held until CASE-000816 is decided |
| Held | — | ||
| ACT-014261 | Outreach suppressed pending steward Outreach | TPA-64322 (Valentina Mejia) held until CASE-000817 is decided |
| Held | — | ||
| ACT-014262 | Outreach suppressed pending steward Outreach | TPA-55120 (Lawrencce Mejia) held until CASE-000818 is decided |
| Held | — | ||
| ACT-014263 | Outreach suppressed pending steward Outreach | TPA-54842 (Alice Vasquez) held until CASE-000819 is decided |
| Held | — | ||
| ACT-014264 | Outreach suppressed pending steward Outreach | PRV-23215 (Alice Vasquez) held until CASE-000820 is decided |
| Held | — | ||
| ACT-014265 | Outreach suppressed pending steward Outreach | TPA-63050 (George Park) held until CASE-000821 is decided |
| Held | — | ||
| ACT-014266 | Outreach suppressed pending steward Outreach | CLM-415473 (James Reid) held until CASE-000822 is decided |
| Held | — | ||
| ACT-014267 | Outreach suppressed pending steward Outreach | CLM-419770 (Hannah Schultz) held until CASE-000823 is decided |
| Held | — | ||
| ACT-014268 | Outreach suppressed pending steward Outreach | TPA-52851 (Ralph Schultz) held until CASE-000824 is decided |
| Held | — | ||
| ACT-014269 | Outreach suppressed pending steward Outreach | TPA-53162 (Gloria Rogers) held until CASE-000825 is decided |
| Held | — | ||
| ACT-014270 | Outreach suppressed pending steward Outreach | TPA-63624 (Pamela Wheeler) held until CASE-000826 is decided |
| Held | — | ||
| ACT-014271 | Outreach suppressed pending steward Outreach | CLM-407094 (Joseph Wheeler) held until CASE-000827 is decided |
| Held | — | ||
| ACT-014272 | Outreach suppressed pending steward Outreach | TPA-53938 (Brittany Wheeler) held until CASE-000828 is decided |
| Held | — | ||
| ACT-014273 | Outreach suppressed pending steward Outreach | TPA-53969 (Billy Le) held until CASE-000829 is decided |
| Held | — | ||
| ACT-014274 | Outreach suppressed pending steward Outreach | CLM-423405 (Scott Duncan) held until CASE-000830 is decided |
| Held | — | ||
| ACT-014275 | Outreach suppressed pending steward Outreach | TPA-62328 (Kevin Fernandez) held until CASE-000831 is decided |
| Held | — | ||
| ACT-014276 | Outreach suppressed pending steward Outreach | ENR-120098 (Peter Gray) held until CASE-000832 is decided |
| Held | — | ||
| ACT-014277 | Outreach suppressed pending steward Outreach | CLM-406167 (Helen Graay) held until CASE-000833 is decided |
| Held | — | ||
| ACT-014278 | Outreach suppressed pending steward Outreach | CLM-405901 (Jacob Fulleer) held until CASE-000834 is decided |
| Held | — | ||
| ACT-014279 | Outreach suppressed pending steward Outreach | ENR-107770 (Jacob Fuller) held until CASE-000835 is decided |
| Held | — | ||
| ACT-014280 | Outreach suppressed pending steward Outreach | TPA-63383 (Ethan Weber) held until CASE-000836 is decided |
| Held | — | ||
| ACT-014281 | Outreach suppressed pending steward Outreach | TPA-58994 (Jennifer Watkins) held until CASE-000837 is decided |
| Held | — | ||
| ACT-014282 | Outreach suppressed pending steward Outreach | TPA-59197 (Denise Lucas) held until CASE-000838 is decided |
| Held | — | ||
| ACT-014283 | Outreach suppressed pending steward Outreach | PRV-21947 (Joyce Perry) held until CASE-000839 is decided |
| Held | — | ||
| ACT-014284 | Outreach suppressed pending steward Outreach | TPA-53106 (Maria Collins) held until CASE-000840 is decided |
| Held | — | ||
| ACT-014285 | Outreach suppressed pending steward Outreach | TPA-50682 (Megan Peters) held until CASE-000841 is decided |
| Held | — | ||
| ACT-014286 | Outreach suppressed pending steward Outreach | ENR-102040 (Megan Peters) held until CASE-000842 is decided |
| Held | — | ||
| ACT-014287 | Outreach suppressed pending steward Outreach | TPA-53683 (Alyce Butler) held until CASE-000843 is decided |
| Held | — | ||
| ACT-014288 | Outreach suppressed pending steward Outreach | CLM-408395 (Alice Butler) held until CASE-000844 is decided |
| Held | — | ||
| ACT-014289 | Outreach suppressed pending steward Outreach | TPA-54391 (Amber Hamilton) held until CASE-000845 is decided |
| Held | — | ||
| ACT-014290 | Outreach suppressed pending steward Outreach | PRV-29465 (Lucia Jimenez) held until CASE-000846 is decided |
| Held | — | ||
| ACT-014291 | Outreach suppressed pending steward Outreach | TPA-59384 (Ben Dean) held until CASE-000847 is decided |
| Held | — | ||
| ACT-014292 | Outreach suppressed pending steward Outreach | CLM-421347 (Benjamin Dean) held until CASE-000848 is decided |
| Held | — | ||
| ACT-014293 | Outreach suppressed pending steward Outreach | CLM-415509 (Carolin Fields) held until CASE-000849 is decided |
| Held | — | ||
| ACT-014294 | Outreach suppressed pending steward Outreach | CLM-432331 (Brittany Torres) held until CASE-000850 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.