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-014545 | Outreach suppressed pending steward Outreach | CLM-426462 (Martha Soto) held until CASE-001101 is decided |
| Held | — | ||
| ACT-014546 | Outreach suppressed pending steward Outreach | CLM-425185 (Tim Clark) held until CASE-001102 is decided |
| Held | — | ||
| ACT-014547 | Outreach suppressed pending steward Outreach | TPA-59171 (Sandra Carlson) held until CASE-001103 is decided |
| Held | — | ||
| ACT-014548 | Outreach suppressed pending steward Outreach | TPA-56648 (Stephanie Morgan) held until CASE-001104 is decided |
| Held | — | ||
| ACT-014549 | Outreach suppressed pending steward Outreach | TPA-53036 (Luica Welch) held until CASE-001105 is decided |
| Held | — | ||
| ACT-014550 | Outreach suppressed pending steward Outreach | ENR-133551 (Nancy Welch) held until CASE-001106 is decided |
| Held | — | ||
| ACT-014551 | Outreach suppressed pending steward Outreach | CLM-425643 (Nancy Welch) held until CASE-001107 is decided |
| Held | — | ||
| ACT-014552 | Outreach suppressed pending steward Outreach | CLM-425644 (Nancy Welch) held until CASE-001108 is decided |
| Held | — | ||
| ACT-014553 | Outreach suppressed pending steward Outreach | CLM-402542 (James Delgado) held until CASE-001109 is decided |
| Held | — | ||
| ACT-014554 | Outreach suppressed pending steward Outreach | PRV-22587 (Catherine Marquez) held until CASE-001110 is decided |
| Held | — | ||
| ACT-014555 | Outreach suppressed pending steward Outreach | CLM-428827 (Brandon Bryant) held until CASE-001111 is decided |
| Held | — | ||
| ACT-014556 | Outreach suppressed pending steward Outreach | CLM-428826 (Brandon Bryant) held until CASE-001112 is decided |
| Held | — | ||
| ACT-014557 | Outreach suppressed pending steward Outreach | CLM-428825 (Brandon Bryant) held until CASE-001113 is decided |
| Held | — | ||
| ACT-014558 | Outreach suppressed pending steward Outreach | TPA-62366 (Helen Garcia) held until CASE-001114 is decided |
| Held | — | ||
| ACT-014559 | Outreach suppressed pending steward Outreach | CLM-401583 (Wayne Santiago) held until CASE-001115 is decided |
| Held | — | ||
| ACT-014560 | Outreach suppressed pending steward Outreach | TPA-63827 (Douglas Ruiz) held until CASE-001116 is decided |
| Held | — | ||
| ACT-014561 | Outreach suppressed pending steward Outreach | TPA-51369 (Robert Ross) held until CASE-001117 is decided |
| Held | — | ||
| ACT-014562 | Outreach suppressed pending steward Outreach | CLM-403189 (Bobby Ross) held until CASE-001118 is decided |
| Held | — | ||
| ACT-014563 | Outreach suppressed pending steward Outreach | TPA-56015 (Stephanie Castillo) held until CASE-001119 is decided |
| Held | — | ||
| ACT-014564 | Outreach suppressed pending steward Outreach | CLM-423977 (Chuck Couk) held until CASE-001120 is decided |
| Held | — | ||
| ACT-014565 | Outreach suppressed pending steward Outreach | CLM-404630 (Jacqueline Bailey) held until CASE-001121 is decided |
| Held | — | ||
| ACT-014566 | Outreach suppressed pending steward Outreach | CLM-404629 (Jacqueline Bailey) held until CASE-001122 is decided |
| Held | — | ||
| ACT-014567 | Outreach suppressed pending steward Outreach | TPA-62675 (Betty Myers) held until CASE-001123 is decided |
| Held | — | ||
| ACT-014568 | Outreach suppressed pending steward Outreach | CLM-431914 (Juan Myers) held until CASE-001124 is decided |
| Held | — | ||
| ACT-014569 | Outreach suppressed pending steward Outreach | ENR-103365 (Grace Chapman) held until CASE-001125 is decided |
| Held | — | ||
| ACT-014570 | Outreach suppressed pending steward Outreach | TPA-51121 (Grace Chapman) held until CASE-001126 is decided |
| Held | — | ||
| ACT-014571 | Outreach suppressed pending steward Outreach | TPA-63678 (Kelly Chapman) held until CASE-001127 is decided |
| Held | — | ||
| ACT-014572 | Outreach suppressed pending steward Outreach | CLM-430956 (Kelly Chapman) held until CASE-001128 is decided |
| Held | — | ||
| ACT-014573 | Outreach suppressed pending steward Outreach | CLM-408298 (Jean White) held until CASE-001129 is decided |
| Held | — | ||
| ACT-014574 | Outreach suppressed pending steward Outreach | CLM-410396 (Philip Wood) held until CASE-001130 is decided |
| Held | — | ||
| ACT-014575 | Outreach suppressed pending steward Outreach | CLM-412831 (Wayne Roberts) held until CASE-001131 is decided |
| Held | — | ||
| ACT-014576 | Outreach suppressed pending steward Outreach | TPA-53138 (Stephanie Roberts) held until CASE-001132 is decided |
| Held | — | ||
| ACT-014577 | Outreach suppressed pending steward Outreach | ENR-109376 (Stephanie Roberts) held until CASE-001133 is decided |
| Held | — | ||
| ACT-014578 | Outreach suppressed pending steward Outreach | TPA-55641 (Wayne Roberts) held until CASE-001134 is decided |
| Held | — | ||
| ACT-014579 | Outreach suppressed pending steward Outreach | PRV-28396 (Jack Warren) held until CASE-001135 is decided |
| Held | — | ||
| ACT-014580 | Outreach suppressed pending steward Outreach | CLM-421189 (Brian Fuller) held until CASE-001136 is decided |
| Held | — | ||
| ACT-014581 | Outreach suppressed pending steward Outreach | TPA-60149 (Karen Green) held until CASE-001137 is decided |
| Held | — | ||
| ACT-014582 | Outreach suppressed pending steward Outreach | PRV-22686 (Cheryl Stephens) held until CASE-001138 is decided |
| Held | — | ||
| ACT-014583 | Outreach suppressed pending steward Outreach | TPA-53990 (Cheryl Stepehns) held until CASE-001139 is decided |
| Held | — | ||
| ACT-014584 | Outreach suppressed pending steward Outreach | ENR-141244 (Russell Park) held until CASE-001140 is decided |
| Held | — | ||
| ACT-014585 | Outreach suppressed pending steward Outreach | CLM-431420 (Russell Park) held until CASE-001141 is decided |
| Held | — | ||
| ACT-014586 | Outreach suppressed pending steward Outreach | ENR-123771 (Eric Hayees) held until CASE-001142 is decided |
| Held | — | ||
| ACT-014587 | Outreach suppressed pending steward Outreach | PRV-25364 (Eric Hayes) held until CASE-001143 is decided |
| Held | — | ||
| ACT-014588 | Outreach suppressed pending steward Outreach | CLM-423973 (Isabella Edwards) held until CASE-001144 is decided |
| Held | — | ||
| ACT-014589 | Outreach suppressed pending steward Outreach | CLM-417778 (Fatima Jordan) held until CASE-001145 is decided |
| Held | — | ||
| ACT-014590 | Outreach suppressed pending steward Outreach | CLM-417779 (Fatima Jordan) held until CASE-001146 is decided |
| Held | — | ||
| ACT-014591 | Outreach suppressed pending steward Outreach | ENR-127601 (Russell Espinoza) held until CASE-001147 is decided |
| Held | — | ||
| ACT-014592 | Outreach suppressed pending steward Outreach | CLM-421016 (Russell Espinoza) held until CASE-001148 is decided |
| Held | — | ||
| ACT-014593 | Outreach suppressed pending steward Outreach | CLM-414789 (Olivia Ruiz) held until CASE-001149 is decided |
| Held | — | ||
| ACT-014594 | Outreach suppressed pending steward Outreach | CLM-404100 (Gary Rice) held until CASE-001150 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.