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-014895 | Outreach suppressed pending steward Outreach | ENR-107348 (Helen Snyder) held until CASE-001451 is decided |
| Held | — | ||
| ACT-014896 | Outreach suppressed pending steward Outreach | CLM-405587 (Helen Snyder) held until CASE-001452 is decided |
| Held | — | ||
| ACT-014897 | Outreach suppressed pending steward Outreach | TPA-57954 (Ana Grant) held until CASE-001453 is decided |
| Held | — | ||
| ACT-014898 | Outreach suppressed pending steward Outreach | TPA-63534 (Patricia Mendez) held until CASE-001454 is decided |
| Held | — | ||
| ACT-014899 | Outreach suppressed pending steward Outreach | TPA-63533 (Patricia Mendez) held until CASE-001455 is decided |
| Held | — | ||
| ACT-014900 | Outreach suppressed pending steward Outreach | ENR-111129 (Larry Willis) held until CASE-001456 is decided |
| Held | — | ||
| ACT-014901 | Outreach suppressed pending steward Outreach | CLM-408442 (Larry Willis) held until CASE-001457 is decided |
| Held | — | ||
| ACT-014902 | Outreach suppressed pending steward Outreach | PRV-26384 (Patricia Ramirez) held until CASE-001458 is decided |
| Held | — | ||
| ACT-014903 | Outreach suppressed pending steward Outreach | TPA-52383 (Maria Ramirez) held until CASE-001459 is decided |
| Held | — | ||
| ACT-014904 | Outreach suppressed pending steward Outreach | TPA-54690 (Zachary Franklin) held until CASE-001460 is decided |
| Held | — | ||
| ACT-014905 | Outreach suppressed pending steward Outreach | ENR-114027 (Zachary Franklin) held until CASE-001461 is decided |
| Held | — | ||
| ACT-014906 | Outreach suppressed pending steward Outreach | CLM-427273 (Walter Murray) held until CASE-001462 is decided |
| Held | — | ||
| ACT-014907 | Outreach suppressed pending steward Outreach | ENR-135754 (Walter Murray) held until CASE-001463 is decided |
| Held | — | ||
| ACT-014908 | Outreach suppressed pending steward Outreach | CLM-405767 (Ralph Burns) held until CASE-001464 is decided |
| Held | — | ||
| ACT-014909 | Outreach suppressed pending steward Outreach | ENR-111037 (Aisha Austin) held until CASE-001465 is decided |
| Held | — | ||
| ACT-014910 | Outreach suppressed pending steward Outreach | CLM-408367 (Aisha Austin) held until CASE-001466 is decided |
| Held | — | ||
| ACT-014911 | Outreach suppressed pending steward Outreach | TPA-56187 (Keith Rios) held until CASE-001467 is decided |
| Held | — | ||
| ACT-014912 | Outreach suppressed pending steward Outreach | ENR-118350 (Keiht Rios) held until CASE-001468 is decided |
| Held | — | ||
| ACT-014913 | Outreach suppressed pending steward Outreach | CLM-406029 (Douglas Sandoval) held until CASE-001469 is decided |
| Held | — | ||
| ACT-014914 | Outreach suppressed pending steward Outreach | CLM-415494 (William Wright) held until CASE-001470 is decided |
| Held | — | ||
| ACT-014915 | Outreach suppressed pending steward Outreach | PRV-25574 (Gary Burns) held until CASE-001471 is decided |
| Held | — | ||
| ACT-014916 | Outreach suppressed pending steward Outreach | ENR-129369 (Theresa Cooper) held until CASE-001472 is decided |
| Held | — | ||
| ACT-014917 | Outreach suppressed pending steward Outreach | TPA-59832 (Theresa Cooper) held until CASE-001473 is decided |
| Held | — | ||
| ACT-014918 | Outreach suppressed pending steward Outreach | CLM-422409 (Isabella Lopez) held until CASE-001474 is decided |
| Held | — | ||
| ACT-014919 | Outreach suppressed pending steward Outreach | TPA-59839 (Isabella Lopez) held until CASE-001475 is decided |
| Held | — | ||
| ACT-014920 | Outreach suppressed pending steward Outreach | CLM-418148 (Nancy Larson) held until CASE-001476 is decided |
| Held | — | ||
| ACT-014921 | Outreach suppressed pending steward Outreach | CLM-430492 (Jordan Kelley) held until CASE-001477 is decided |
| Held | — | ||
| ACT-014922 | Outreach suppressed pending steward Outreach | ENR-124259 (Evelyn Rodriguaz) held until CASE-001478 is decided |
| Held | — | ||
| ACT-014923 | Outreach suppressed pending steward Outreach | TPA-62157 (Linda Smith) held until CASE-001479 is decided |
| Held | — | ||
| ACT-014924 | Outreach suppressed pending steward Outreach | ENR-118761 (Ftaima Armstrong) held until CASE-001480 is decided |
| Held | — | ||
| ACT-014925 | Outreach suppressed pending steward Outreach | CLM-414273 (Fatima Armstrong) held until CASE-001481 is decided |
| Held | — | ||
| ACT-014926 | Outreach suppressed pending steward Outreach | CLM-409843 (Ahmed Ortega) held until CASE-001482 is decided |
| Held | — | ||
| ACT-014927 | Outreach suppressed pending steward Outreach | CLM-409845 (Ahmed Ortega) held until CASE-001483 is decided |
| Held | — | ||
| ACT-014928 | Outreach suppressed pending steward Outreach | TPA-51572 (Anna Ford) held until CASE-001484 is decided |
| Held | — | ||
| ACT-014929 | Outreach suppressed pending steward Outreach | CLM-403633 (Anna Ford) held until CASE-001485 is decided |
| Held | — | ||
| ACT-014930 | Outreach suppressed pending steward Outreach | TPA-63218 (Terry Cunningham) held until CASE-001486 is decided |
| Held | — | ||
| ACT-014931 | Outreach suppressed pending steward Outreach | TPA-63219 (Terry Cunningham) held until CASE-001487 is decided |
| Held | — | ||
| ACT-014932 | Outreach suppressed pending steward Outreach | TPA-61200 (Andrew Berry) held until CASE-001488 is decided |
| Held | — | ||
| ACT-014933 | Outreach suppressed pending steward Outreach | CLM-426252 (Thomas Anderson) held until CASE-001489 is decided |
| Held | — | ||
| ACT-014934 | Outreach suppressed pending steward Outreach | TPA-58943 (Rachel Palmer) held until CASE-001490 is decided |
| Held | — | ||
| ACT-014935 | Outreach suppressed pending steward Outreach | ENR-126746 (Rachel Palmer) held until CASE-001491 is decided |
| Held | — | ||
| ACT-014936 | Outreach suppressed pending steward Outreach | PRV-24767 (Jordan Romero) held until CASE-001492 is decided |
| Held | — | ||
| ACT-014937 | Outreach suppressed pending steward Outreach | TPA-57927 (Joseph Romero) held until CASE-001493 is decided |
| Held | — | ||
| ACT-014938 | Outreach suppressed pending steward Outreach | TPA-53590 (Austin Tucker) held until CASE-001494 is decided |
| Held | — | ||
| ACT-014939 | Outreach suppressed pending steward Outreach | PRV-22406 (Austin Tucker) held until CASE-001495 is decided |
| Held | — | ||
| ACT-014940 | Outreach suppressed pending steward Outreach | CLM-414405 (Christian Ortega) held until CASE-001496 is decided |
| Held | — | ||
| ACT-014941 | Outreach suppressed pending steward Outreach | CLM-400344 (Priya Alexander) held until CASE-001497 is decided |
| Held | — | ||
| ACT-014942 | Outreach suppressed pending steward Outreach | ENR-138193 (Jose Jensen) held until CASE-001498 is decided |
| Held | — | ||
| ACT-014943 | Outreach suppressed pending steward Outreach | TPA-60935 (Amy Mendoza) held until CASE-001499 is decided |
| Held | — | ||
| ACT-014944 | Outreach suppressed pending steward Outreach | ENR-141259 (Frances Bowman) held until CASE-001500 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.