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-014345 | Outreach suppressed pending steward Outreach | TPA-59518 (Richard Hamilton) held until CASE-000901 is decided |
| Held | — | ||
| ACT-014346 | Outreach suppressed pending steward Outreach | TPA-61227 (Logan Hoffman) held until CASE-000902 is decided |
| Held | — | ||
| ACT-014347 | Outreach suppressed pending steward Outreach | ENR-106036 (Megan Hoffman) held until CASE-000903 is decided |
| Held | — | ||
| ACT-014348 | Outreach suppressed pending steward Outreach | CLM-413786 (Alice Baker) held until CASE-000904 is decided |
| Held | — | ||
| ACT-014349 | Outreach suppressed pending steward Outreach | TPA-51264 (Anthoony Gilbert) held until CASE-000905 is decided |
| Held | — | ||
| ACT-014350 | Outreach suppressed pending steward Outreach | ENR-103805 (Tony Gilbert) held until CASE-000906 is decided |
| Held | — | ||
| ACT-014351 | Outreach suppressed pending steward Outreach | TPA-53239 (Arthhur Gilbert) held until CASE-000907 is decided |
| Held | — | ||
| ACT-014352 | Outreach suppressed pending steward Outreach | CLM-400700 (Marcus Collins) held until CASE-000908 is decided |
| Held | — | ||
| ACT-014353 | Outreach suppressed pending steward Outreach | CLM-405293 (Albert Hall) held until CASE-000909 is decided |
| Held | — | ||
| ACT-014354 | Outreach suppressed pending steward Outreach | TPA-55057 (Luis Ortiz) held until CASE-000910 is decided |
| Held | — | ||
| ACT-014355 | Outreach suppressed pending steward Outreach | ENR-115101 (Luis Ortyz) held until CASE-000911 is decided |
| Held | — | ||
| ACT-014356 | Outreach suppressed pending steward Outreach | ENR-111924 (Bobby Ortiz) held until CASE-000912 is decided |
| Held | — | ||
| ACT-014357 | Outreach suppressed pending steward Outreach | TPA-60285 (Charles Li) held until CASE-000913 is decided |
| Held | — | ||
| ACT-014358 | Outreach suppressed pending steward Outreach | CLM-426044 (Russell Mendoza) held until CASE-000914 is decided |
| Held | — | ||
| ACT-014359 | Outreach suppressed pending steward Outreach | PRV-25759 (Carl Castro) held until CASE-000915 is decided |
| Held | — | ||
| ACT-014360 | Outreach suppressed pending steward Outreach | CLM-419394 (Carl Castro) held until CASE-000916 is decided |
| Held | — | ||
| ACT-014361 | Outreach suppressed pending steward Outreach | TPA-61787 (Tyler Wag) held until CASE-000917 is decided |
| Held | — | ||
| ACT-014362 | Outreach suppressed pending steward Outreach | TPA-50357 (Wei Patterson) held until CASE-000918 is decided |
| Held | — | ||
| ACT-014363 | Outreach suppressed pending steward Outreach | TPA-58169 (Bruce Jones) held until CASE-000919 is decided |
| Held | — | ||
| ACT-014364 | Outreach suppressed pending steward Outreach | ENR-111246 (Victoria Hunnt) held until CASE-000920 is decided |
| Held | — | ||
| ACT-014365 | Outreach suppressed pending steward Outreach | PRV-28261 (Joshua Hicks) held until CASE-000921 is decided |
| Held | — | ||
| ACT-014366 | Outreach suppressed pending steward Outreach | TPA-54352 (Teresa Hayes) held until CASE-000922 is decided |
| Held | — | ||
| ACT-014367 | Outreach suppressed pending steward Outreach | TPA-54351 (Teresa Hayes) held until CASE-000923 is decided |
| Held | — | ||
| ACT-014368 | Outreach suppressed pending steward Outreach | CLM-401215 (Carl Morrison) held until CASE-000924 is decided |
| Held | — | ||
| ACT-014369 | Outreach suppressed pending steward Outreach | CLM-425973 (Dorothy Salazar) held until CASE-000925 is decided |
| Held | — | ||
| ACT-014370 | Outreach suppressed pending steward Outreach | ENR-133999 (Dorothy Salazar) held until CASE-000926 is decided |
| Held | — | ||
| ACT-014371 | Outreach suppressed pending steward Outreach | CLM-401071 (Eric Jimenez) held until CASE-000927 is decided |
| Held | — | ||
| ACT-014372 | Outreach suppressed pending steward Outreach | ENR-138523 (Sanndra Howell) held until CASE-000928 is decided |
| Held | — | ||
| ACT-014373 | Outreach suppressed pending steward Outreach | PRV-28614 (Sandra Howell) held until CASE-000929 is decided |
| Held | — | ||
| ACT-014374 | Outreach suppressed pending steward Outreach | CLM-425486 (Priya Smith) held until CASE-000930 is decided |
| Held | — | ||
| ACT-014375 | Outreach suppressed pending steward Outreach | TPA-55222 (Patrick Le) held until CASE-000931 is decided |
| Held | — | ||
| ACT-014376 | Outreach suppressed pending steward Outreach | ENR-122428 (Jonathan Ford) held until CASE-000932 is decided |
| Held | — | ||
| ACT-014377 | Outreach suppressed pending steward Outreach | ENR-118630 (Priya Ford) held until CASE-000933 is decided |
| Held | — | ||
| ACT-014378 | Outreach suppressed pending steward Outreach | CLM-414207 (Priya Ford) held until CASE-000934 is decided |
| Held | — | ||
| ACT-014379 | Outreach suppressed pending steward Outreach | CLM-414313 (Carolyn Harrison) held until CASE-000935 is decided |
| Held | — | ||
| ACT-014380 | Outreach suppressed pending steward Outreach | ENR-137472 (Olivia Jenkins) held until CASE-000936 is decided |
| Held | — | ||
| ACT-014381 | Outreach suppressed pending steward Outreach | TPA-62612 (Olivia Jenkins) held until CASE-000937 is decided |
| Held | — | ||
| ACT-014382 | Outreach suppressed pending steward Outreach | TPA-63749 (Joe Vargas) held until CASE-000938 is decided |
| Held | — | ||
| ACT-014383 | Outreach suppressed pending steward Outreach | PRV-27644 (Brittany Wang) held until CASE-000939 is decided |
| Held | — | ||
| ACT-014384 | Outreach suppressed pending steward Outreach | TPA-61520 (Samantha Wang) held until CASE-000940 is decided |
| Held | — | ||
| ACT-014385 | Outreach suppressed pending steward Outreach | CLM-425107 (Kayla Padilla) held until CASE-000941 is decided |
| Held | — | ||
| ACT-014386 | Outreach suppressed pending steward Outreach | ENR-132806 (Kayla Padilla) held until CASE-000942 is decided |
| Held | — | ||
| ACT-014387 | Outreach suppressed pending steward Outreach | TPA-51526 (Danielle Bradley) held until CASE-000943 is decided |
| Held | — | ||
| ACT-014388 | Outreach suppressed pending steward Outreach | TPA-57765 (Henry Graham) held until CASE-000944 is decided |
| Held | — | ||
| ACT-014389 | Outreach suppressed pending steward Outreach | TPA-57764 (Henry Graham) held until CASE-000945 is decided |
| Held | — | ||
| ACT-014390 | Outreach suppressed pending steward Outreach | PRV-25786 (Jose Yang) held until CASE-000946 is decided |
| Held | — | ||
| ACT-014391 | Outreach suppressed pending steward Outreach | TPA-51079 (Lucia Hansen) held until CASE-000947 is decided |
| Held | — | ||
| ACT-014392 | Outreach suppressed pending steward Outreach | CLM-429286 (Bobby Wilson) held until CASE-000948 is decided |
| Held | — | ||
| ACT-014393 | Outreach suppressed pending steward Outreach | PRV-23164 (Mari Vazquez) held until CASE-000949 is decided |
| Held | — | ||
| ACT-014394 | Outreach suppressed pending steward Outreach | TPA-53463 (Alexander Perry) held until CASE-000950 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.