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-013495 | Outreach suppressed pending steward Outreach | CLM-409790 (Russell Price) held until CASE-000051 is decided |
| Held | — | ||
| ACT-013496 | Outreach suppressed pending steward Outreach | CLM-424584 (Alexander Moore) held until CASE-000052 is decided |
| Held | — | ||
| ACT-013497 | Outreach suppressed pending steward Outreach | TPA-61064 (Martha Dixno) held until CASE-000053 is decided |
| Held | — | ||
| ACT-013498 | Outreach suppressed pending steward Outreach | ENR-100007 (Evelyn Watkins) held until CASE-000054 is decided |
| Held | — | ||
| ACT-013499 | Outreach suppressed pending steward Outreach | CLM-401470 (Jerry Pierce) held until CASE-000055 is decided |
| Held | — | ||
| ACT-013500 | Outreach suppressed pending steward Outreach | TPA-61309 (Ahmed Li) held until CASE-000056 is decided |
| Held | — | ||
| ACT-013501 | Outreach suppressed pending steward Outreach | TPA-61310 (Ahmed Li) held until CASE-000057 is decided |
| Held | — | ||
| ACT-013502 | Outreach suppressed pending steward Outreach | TPA-59799 (Noah Woods) held until CASE-000058 is decided |
| Held | — | ||
| ACT-013503 | Outreach suppressed pending steward Outreach | ENR-122365 (Vincent Rose) held until CASE-000059 is decided |
| Held | — | ||
| ACT-013504 | Outreach suppressed pending steward Outreach | ENR-112102 (Santiago Ris) held until CASE-000060 is decided |
| Held | — | ||
| ACT-013505 | Outreach suppressed pending steward Outreach | TPA-54243 (Brenda Ross) held until CASE-000061 is decided |
| Held | — | ||
| ACT-013506 | Outreach suppressed pending steward Outreach | ENR-112855 (Brenda Ross) held until CASE-000062 is decided |
| Held | — | ||
| ACT-013507 | Outreach suppressed pending steward Outreach | PRV-24103 (Walter Florse) held until CASE-000063 is decided |
| Held | — | ||
| ACT-013508 | Outreach suppressed pending steward Outreach | CLM-402989 (Gary Cook) held until CASE-000064 is decided |
| Held | — | ||
| ACT-013509 | Outreach suppressed pending steward Outreach | TPA-56751 (Bobby Gilbert) held until CASE-000065 is decided |
| Held | — | ||
| ACT-013510 | Outreach suppressed pending steward Outreach | TPA-56699 (Lawrence Rice) held until CASE-000066 is decided |
| Held | — | ||
| ACT-013511 | Outreach suppressed pending steward Outreach | ENR-143040 (Ryan Stephens) held until CASE-000067 is decided |
| Held | — | ||
| ACT-013512 | Outreach suppressed pending steward Outreach | TPA-64453 (Ryan Stephens) held until CASE-000068 is decided |
| Held | — | ||
| ACT-013513 | Outreach suppressed pending steward Outreach | CLM-418607 (Ruth Weber) held until CASE-000069 is decided |
| Held | — | ||
| ACT-013514 | Outreach suppressed pending steward Outreach | CLM-431350 (Richard Medina) held until CASE-000070 is decided |
| Held | — | ||
| ACT-013515 | Outreach suppressed pending steward Outreach | CLM-415381 (Elizabeth Patterson) held until CASE-000071 is decided |
| Held | — | ||
| ACT-013516 | Outreach suppressed pending steward Outreach | ENR-120256 (Elizabeth Patterson) held until CASE-000072 is decided |
| Held | — | ||
| ACT-013517 | Outreach suppressed pending steward Outreach | TPA-56071 (Betyt Kelly) held until CASE-000073 is decided |
| Held | — | ||
| ACT-013518 | Outreach suppressed pending steward Outreach | TPA-58004 (Gloria Wells) held until CASE-000074 is decided |
| Held | — | ||
| ACT-013519 | Outreach suppressed pending steward Outreach | ENR-123827 (Gloria Wells) held until CASE-000075 is decided |
| Held | — | ||
| ACT-013520 | Outreach suppressed pending steward Outreach | TPA-51696 (Wayne Marshall) held until CASE-000076 is decided |
| Held | — | ||
| ACT-013521 | Outreach suppressed pending steward Outreach | TPA-54069 (Zachary Perkins) held until CASE-000077 is decided |
| Held | — | ||
| ACT-013522 | Outreach suppressed pending steward Outreach | CLM-409387 (Zachary Perkins) held until CASE-000078 is decided |
| Held | — | ||
| ACT-013523 | Outreach suppressed pending steward Outreach | TPA-57081 (Kimberly Knight) held until CASE-000079 is decided |
| Held | — | ||
| ACT-013524 | Outreach suppressed pending steward Outreach | CLM-418275 (Jacob Vazquez) held until CASE-000080 is decided |
| Held | — | ||
| ACT-013525 | Outreach suppressed pending steward Outreach | CLM-416300 (Carol Vazquez) held until CASE-000081 is decided |
| Held | — | ||
| ACT-013526 | Outreach suppressed pending steward Outreach | ENR-121456 (Carol Vazquez) held until CASE-000082 is decided |
| Held | — | ||
| ACT-013527 | Outreach suppressed pending steward Outreach | CLM-418274 (Jacob Vazquez) held until CASE-000083 is decided |
| Held | — | ||
| ACT-013528 | Outreach suppressed pending steward Outreach | TPA-52092 (Bradley Schmidt) held until CASE-000084 is decided |
| Held | — | ||
| ACT-013529 | Outreach suppressed pending steward Outreach | CLM-400014 (Raymond Walsh) held until CASE-000085 is decided |
| Held | — | ||
| ACT-013530 | Outreach suppressed pending steward Outreach | TPA-51855 (Melissa Thompson) held until CASE-000086 is decided |
| Held | — | ||
| ACT-013531 | Outreach suppressed pending steward Outreach | CLM-426611 (Barbara Johnston) held until CASE-000087 is decided |
| Held | — | ||
| ACT-013532 | Outreach suppressed pending steward Outreach | CLM-425516 (Grace Garza) held until CASE-000088 is decided |
| Held | — | ||
| ACT-013533 | Outreach suppressed pending steward Outreach | CLM-425517 (Grace Garza) held until CASE-000089 is decided |
| Held | — | ||
| ACT-013534 | Outreach suppressed pending steward Outreach | TPA-60330 (Kevin Guerrero) held until CASE-000090 is decided |
| Held | — | ||
| ACT-013535 | Outreach suppressed pending steward Outreach | ENR-130684 (Kevin Guerrero) held until CASE-000091 is decided |
| Held | — | ||
| ACT-013536 | Outreach suppressed pending steward Outreach | TPA-54936 (Lawrence Ray) held until CASE-000092 is decided |
| Held | — | ||
| ACT-013537 | Outreach suppressed pending steward Outreach | TPA-54937 (Lawrence Ray) held until CASE-000093 is decided |
| Held | — | ||
| ACT-013538 | Outreach suppressed pending steward Outreach | CLM-413722 (Alan Bennett) held until CASE-000094 is decided |
| Held | — | ||
| ACT-013539 | Outreach suppressed pending steward Outreach | CLM-425348 (Dot Patterson) held until CASE-000095 is decided |
| Held | — | ||
| ACT-013540 | Outreach suppressed pending steward Outreach | CLM-419705 (Roy Marshall) held until CASE-000096 is decided |
| Held | — | ||
| ACT-013541 | Outreach suppressed pending steward Outreach | TPA-58142 (Sara Sanders) held until CASE-000097 is decided |
| Held | — | ||
| ACT-013542 | Outreach suppressed pending steward Outreach | PRV-25482 (Sara Sanders) held until CASE-000098 is decided |
| Held | — | ||
| ACT-013543 | Outreach suppressed pending steward Outreach | PRV-24901 (Yuki Chapman) held until CASE-000099 is decided |
| Held | — | ||
| ACT-013544 | Outreach suppressed pending steward Outreach | CLM-420575 (Theresa Green) held until CASE-000100 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.