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-014395 | Outreach suppressed pending steward Outreach | TPA-63584 (Judith Knight) held until CASE-000951 is decided |
| Held | — | ||
| ACT-014396 | Outreach suppressed pending steward Outreach | TPA-63583 (Judith Knight) held until CASE-000952 is decided |
| Held | — | ||
| ACT-014397 | Outreach suppressed pending steward Outreach | CLM-426885 (John Warren) held until CASE-000953 is decided |
| Held | — | ||
| ACT-014398 | Outreach suppressed pending steward Outreach | ENR-135266 (John Warren) held until CASE-000954 is decided |
| Held | — | ||
| ACT-014399 | Outreach suppressed pending steward Outreach | ENR-131076 (Donald Jones) held until CASE-000955 is decided |
| Held | — | ||
| ACT-014400 | Outreach suppressed pending steward Outreach | TPA-60453 (Donald Jones) held until CASE-000956 is decided |
| Held | — | ||
| ACT-014401 | Outreach suppressed pending steward Outreach | TPA-50910 (Grag Knight) held until CASE-000957 is decided |
| Held | — | ||
| ACT-014402 | Outreach suppressed pending steward Outreach | TPA-62354 (Kyle Wilson) held until CASE-000958 is decided |
| Held | — | ||
| ACT-014403 | Outreach suppressed pending steward Outreach | TPA-50598 (Andrea McDonald) held until CASE-000959 is decided |
| Held | — | ||
| ACT-014404 | Outreach suppressed pending steward Outreach | CLM-417175 (Shirley Bennnett) held until CASE-000960 is decided |
| Held | — | ||
| ACT-014405 | Outreach suppressed pending steward Outreach | ENR-122616 (Shirley Bennett) held until CASE-000961 is decided |
| Held | — | ||
| ACT-014406 | Outreach suppressed pending steward Outreach | CLM-405415 (Eric Ortiz) held until CASE-000962 is decided |
| Held | — | ||
| ACT-014407 | Outreach suppressed pending steward Outreach | ENR-107125 (Eric Ortiz) held until CASE-000963 is decided |
| Held | — | ||
| ACT-014408 | Outreach suppressed pending steward Outreach | PRV-22043 (Emma Santiago) held until CASE-000964 is decided |
| Held | — | ||
| ACT-014409 | Outreach suppressed pending steward Outreach | TPA-53046 (Emma Santiago) held until CASE-000965 is decided |
| Held | — | ||
| ACT-014410 | Outreach suppressed pending steward Outreach | CLM-406946 (Emma Santiago) held until CASE-000966 is decided |
| Held | — | ||
| ACT-014411 | Outreach suppressed pending steward Outreach | TPA-57742 (Dennis Parker) held until CASE-000967 is decided |
| Held | — | ||
| ACT-014412 | Outreach suppressed pending steward Outreach | CLM-411151 (Austin Park) held until CASE-000968 is decided |
| Held | — | ||
| ACT-014413 | Outreach suppressed pending steward Outreach | CLM-406683 (John Little) held until CASE-000969 is decided |
| Held | — | ||
| ACT-014414 | Outreach suppressed pending steward Outreach | CLM-406850 (Diego Gonzales) held until CASE-000970 is decided |
| Held | — | ||
| ACT-014415 | Outreach suppressed pending steward Outreach | CLM-431433 (Angela Olson) held until CASE-000971 is decided |
| Held | — | ||
| ACT-014416 | Outreach suppressed pending steward Outreach | ENR-141263 (Angela Olson) held until CASE-000972 is decided |
| Held | — | ||
| ACT-014417 | Outreach suppressed pending steward Outreach | CLM-427513 (Kimberly Gordon) held until CASE-000973 is decided |
| Held | — | ||
| ACT-014418 | Outreach suppressed pending steward Outreach | CLM-415560 (Ryan Pena) held until CASE-000974 is decided |
| Held | — | ||
| ACT-014419 | Outreach suppressed pending steward Outreach | TPA-59510 (Melissa Roberts) held until CASE-000975 is decided |
| Held | — | ||
| ACT-014420 | Outreach suppressed pending steward Outreach | ENR-128333 (Melissa Roberts) held until CASE-000976 is decided |
| Held | — | ||
| ACT-014421 | Outreach suppressed pending steward Outreach | CLM-408798 (Carlos Jenkins) held until CASE-000977 is decided |
| Held | — | ||
| ACT-014422 | Outreach suppressed pending steward Outreach | CLM-404884 (Amber Robinson) held until CASE-000978 is decided |
| Held | — | ||
| ACT-014423 | Outreach suppressed pending steward Outreach | TPA-52126 (Michael Chappman) held until CASE-000979 is decided |
| Held | — | ||
| ACT-014424 | Outreach suppressed pending steward Outreach | TPA-52028 (Angela Chapman) held until CASE-000980 is decided |
| Held | — | ||
| ACT-014425 | Outreach suppressed pending steward Outreach | TPA-61825 (Sophia Mitchell) held until CASE-000981 is decided |
| Held | — | ||
| ACT-014426 | Outreach suppressed pending steward Outreach | ENR-135119 (Sophia Mitchell) held until CASE-000982 is decided |
| Held | — | ||
| ACT-014427 | Outreach suppressed pending steward Outreach | CLM-415306 (Brittany Kelley) held until CASE-000983 is decided |
| Held | — | ||
| ACT-014428 | Outreach suppressed pending steward Outreach | TPA-56726 (Brittny Kelley) held until CASE-000984 is decided |
| Held | — | ||
| ACT-014429 | Outreach suppressed pending steward Outreach | ENR-115450 (Virginia Kelley) held until CASE-000985 is decided |
| Held | — | ||
| ACT-014430 | Outreach suppressed pending steward Outreach | CLM-428723 (Christina Harris) held until CASE-000986 is decided |
| Held | — | ||
| ACT-014431 | Outreach suppressed pending steward Outreach | ENR-137678 (Christina Harris) held until CASE-000987 is decided |
| Held | — | ||
| ACT-014432 | Outreach suppressed pending steward Outreach | ENR-129573 (Jon Reyes) held until CASE-000988 is decided |
| Held | — | ||
| ACT-014433 | Outreach suppressed pending steward Outreach | PRV-26663 (John Reeys) held until CASE-000989 is decided |
| Held | — | ||
| ACT-014434 | Outreach suppressed pending steward Outreach | TPA-63255 (Martha Marquez) held until CASE-000990 is decided |
| Held | — | ||
| ACT-014435 | Outreach suppressed pending steward Outreach | CLM-401068 (Nathan Delgado) held until CASE-000991 is decided |
| Held | — | ||
| ACT-014436 | Outreach suppressed pending steward Outreach | TPA-61527 (Natalie Obrien) held until CASE-000992 is decided |
| Held | — | ||
| ACT-014437 | Outreach suppressed pending steward Outreach | CLM-423005 (Julia Schmidt) held until CASE-000993 is decided |
| Held | — | ||
| ACT-014438 | Outreach suppressed pending steward Outreach | PRV-26508 (Kimberly Hoffman) held until CASE-000994 is decided |
| Held | — | ||
| ACT-014439 | Outreach suppressed pending steward Outreach | CLM-419088 (Jdy Hoffman) held until CASE-000995 is decided |
| Held | — | ||
| ACT-014440 | Outreach suppressed pending steward Outreach | TPA-63018 (Jack Hoffman) held until CASE-000996 is decided |
| Held | — | ||
| ACT-014441 | Outreach suppressed pending steward Outreach | TPA-59694 (Kimberly Hoffman) held until CASE-000997 is decided |
| Held | — | ||
| ACT-014442 | Outreach suppressed pending steward Outreach | CLM-418903 (Austin Bryant) held until CASE-000998 is decided |
| Held | — | ||
| ACT-014443 | Outreach suppressed pending steward Outreach | TPA-58385 (Austin Bryant) held until CASE-000999 is decided |
| Held | — | ||
| ACT-014444 | Outreach suppressed pending steward Outreach | CLM-425876 (Maria Green) held until CASE-001000 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.