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-015045 | Outreach suppressed pending steward Outreach | CLM-412695 (Isabella Torres) held until CASE-001601 is decided |
| Held | — | ||
| ACT-015046 | Outreach suppressed pending steward Outreach | TPA-50703 (Eric Wood) held until CASE-001602 is decided |
| Held | — | ||
| ACT-015047 | Outreach suppressed pending steward Outreach | PRV-24580 (Maria Vazquez) held until CASE-001603 is decided |
| Held | — | ||
| ACT-015048 | Outreach suppressed pending steward Outreach | CLM-418639 (Natalie Hoffman) held until CASE-001604 is decided |
| Held | — | ||
| ACT-015049 | Outreach suppressed pending steward Outreach | CLM-418640 (Natalie Hoffman) held until CASE-001605 is decided |
| Held | — | ||
| ACT-015050 | Outreach suppressed pending steward Outreach | CLM-420999 (Tyler Reed) held until CASE-001606 is decided |
| Held | — | ||
| ACT-015051 | Outreach suppressed pending steward Outreach | TPA-59237 (Tyler Reed) held until CASE-001607 is decided |
| Held | — | ||
| ACT-015052 | Outreach suppressed pending steward Outreach | TPA-50049 (Dylan Reed) held until CASE-001608 is decided |
| Held | — | ||
| ACT-015053 | Outreach suppressed pending steward Outreach | CLM-409066 (Steve Scott) held until CASE-001609 is decided |
| Held | — | ||
| ACT-015054 | Outreach suppressed pending steward Outreach | CLM-416035 (Mateo Chen) held until CASE-001610 is decided |
| Held | — | ||
| ACT-015055 | Outreach suppressed pending steward Outreach | TPA-61201 (Sandra Knight) held until CASE-001611 is decided |
| Held | — | ||
| ACT-015056 | Outreach suppressed pending steward Outreach | ENR-133202 (Sandra Knight) held until CASE-001612 is decided |
| Held | — | ||
| ACT-015057 | Outreach suppressed pending steward Outreach | TPA-59746 (Janet Knight) held until CASE-001613 is decided |
| Held | — | ||
| ACT-015058 | Outreach suppressed pending steward Outreach | PRV-26573 (Terry Kennedy) held until CASE-001614 is decided |
| Held | — | ||
| ACT-015059 | Outreach suppressed pending steward Outreach | TPA-63457 (Virginia Wheeler) held until CASE-001615 is decided |
| Held | — | ||
| ACT-015060 | Outreach suppressed pending steward Outreach | ENR-140011 (Virginia Wheeler) held until CASE-001616 is decided |
| Held | — | ||
| ACT-015061 | Outreach suppressed pending steward Outreach | TPA-59199 (Nancy Freeeman) held until CASE-001617 is decided |
| Held | — | ||
| ACT-015062 | Outreach suppressed pending steward Outreach | TPA-60803 (Melissa White) held until CASE-001618 is decided |
| Held | — | ||
| ACT-015063 | Outreach suppressed pending steward Outreach | TPA-60804 (Melissa White) held until CASE-001619 is decided |
| Held | — | ||
| ACT-015064 | Outreach suppressed pending steward Outreach | CLM-431613 (Logan Hamilton) held until CASE-001620 is decided |
| Held | — | ||
| ACT-015065 | Outreach suppressed pending steward Outreach | ENR-141509 (Logan Hamilton) held until CASE-001621 is decided |
| Held | — | ||
| ACT-015066 | Outreach suppressed pending steward Outreach | TPA-60429 (Mason Alvarez) held until CASE-001622 is decided |
| Held | — | ||
| ACT-015067 | Outreach suppressed pending steward Outreach | TPA-53989 (Kevin Taylor) held until CASE-001623 is decided |
| Held | — | ||
| ACT-015068 | Outreach suppressed pending steward Outreach | CLM-409153 (Kevin Tailor) held until CASE-001624 is decided |
| Held | — | ||
| ACT-015069 | Outreach suppressed pending steward Outreach | ENR-135620 (Nancy Crawford) held until CASE-001625 is decided |
| Held | — | ||
| ACT-015070 | Outreach suppressed pending steward Outreach | CLM-427163 (Nancy Crawford) held until CASE-001626 is decided |
| Held | — | ||
| ACT-015071 | Outreach suppressed pending steward Outreach | CLM-408977 (Bobby Gray) held until CASE-001627 is decided |
| Held | — | ||
| ACT-015072 | Outreach suppressed pending steward Outreach | CLM-410881 (Abigail Gray) held until CASE-001628 is decided |
| Held | — | ||
| ACT-015073 | Outreach suppressed pending steward Outreach | CLM-410880 (Abigail Gray) held until CASE-001629 is decided |
| Held | — | ||
| ACT-015074 | Outreach suppressed pending steward Outreach | ENR-115973 (Lawrence Garza) held until CASE-001630 is decided |
| Held | — | ||
| ACT-015075 | Outreach suppressed pending steward Outreach | CLM-409655 (Dilan Berry) held until CASE-001631 is decided |
| Held | — | ||
| ACT-015076 | Outreach suppressed pending steward Outreach | CLM-418247 (Juan Estrada) held until CASE-001632 is decided |
| Held | — | ||
| ACT-015077 | Outreach suppressed pending steward Outreach | TPA-54073 (Walter Morrison) held until CASE-001633 is decided |
| Held | — | ||
| ACT-015078 | Outreach suppressed pending steward Outreach | TPA-54074 (Walter Morrison) held until CASE-001634 is decided |
| Held | — | ||
| ACT-015079 | Outreach suppressed pending steward Outreach | CLM-409404 (Walter Mrrison) held until CASE-001635 is decided |
| Held | — | ||
| ACT-015080 | Outreach suppressed pending steward Outreach | CLM-413973 (Kennteh Gibson) held until CASE-001636 is decided |
| Held | — | ||
| ACT-015081 | Outreach suppressed pending steward Outreach | CLM-405586 (Marcus Bryant) held until CASE-001637 is decided |
| Held | — | ||
| ACT-015082 | Outreach suppressed pending steward Outreach | ENR-107343 (Marcus Bryant) held until CASE-001638 is decided |
| Held | — | ||
| ACT-015083 | Outreach suppressed pending steward Outreach | ENR-118362 (Victoria Reyes) held until CASE-001639 is decided |
| Held | — | ||
| ACT-015084 | Outreach suppressed pending steward Outreach | TPA-56192 (Victoria Reyes) held until CASE-001640 is decided |
| Held | — | ||
| ACT-015085 | Outreach suppressed pending steward Outreach | CLM-400115 (Samuel Reyes) held until CASE-001641 is decided |
| Held | — | ||
| ACT-015086 | Outreach suppressed pending steward Outreach | ENR-100165 (Samuel Reyes) held until CASE-001642 is decided |
| Held | — | ||
| ACT-015087 | Outreach suppressed pending steward Outreach | TPA-53324 (Judith Boyd) held until CASE-001643 is decided |
| Held | — | ||
| ACT-015088 | Outreach suppressed pending steward Outreach | TPA-55728 (Julia Jackson) held until CASE-001644 is decided |
| Held | — | ||
| ACT-015089 | Outreach suppressed pending steward Outreach | PRV-28400 (Maria Jackson) held until CASE-001645 is decided |
| Held | — | ||
| ACT-015090 | Outreach suppressed pending steward Outreach | TPA-62633 (Maria Jackson) held until CASE-001646 is decided |
| Held | — | ||
| ACT-015091 | Outreach suppressed pending steward Outreach | TPA-51997 (Sofia Luna) held until CASE-001647 is decided |
| Held | — | ||
| ACT-015092 | Outreach suppressed pending steward Outreach | TPA-61394 (Stephanie Chapman) held until CASE-001648 is decided |
| Held | — | ||
| ACT-015093 | Outreach suppressed pending steward Outreach | TPA-61553 (Kelly Carlson) held until CASE-001649 is decided |
| Held | — | ||
| ACT-015094 | Outreach suppressed pending steward Outreach | CLM-412939 (Mariana Sullivan) held until CASE-001650 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.