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-015095 | Outreach suppressed pending steward Outreach | PRV-25568 (Alice Herrera) held until CASE-001651 is decided |
| Held | — | ||
| ACT-015096 | Outreach suppressed pending steward Outreach | PRV-25454 (Martha Castro) held until CASE-001652 is decided |
| Held | — | ||
| ACT-015097 | Outreach suppressed pending steward Outreach | TPA-62404 (Kayla Jensen) held until CASE-001653 is decided |
| Held | — | ||
| ACT-015098 | Outreach suppressed pending steward Outreach | TPA-52071 (Anna Mason) held until CASE-001654 is decided |
| Held | — | ||
| ACT-015099 | Outreach suppressed pending steward Outreach | CLM-416611 (Frank Kelley) held until CASE-001655 is decided |
| Held | — | ||
| ACT-015100 | Outreach suppressed pending steward Outreach | CLM-414883 (Dennis Murphy) held until CASE-001656 is decided |
| Held | — | ||
| ACT-015101 | Outreach suppressed pending steward Outreach | CLM-431170 (Paul Valdez) held until CASE-001657 is decided |
| Held | — | ||
| ACT-015102 | Outreach suppressed pending steward Outreach | TPA-61328 (Larry Scott) held until CASE-001658 is decided |
| Held | — | ||
| ACT-015103 | Outreach suppressed pending steward Outreach | TPA-56396 (Aisha Wright) held until CASE-001659 is decided |
| Held | — | ||
| ACT-015104 | Outreach suppressed pending steward Outreach | ENR-129533 (Ruger Watkins) held until CASE-001660 is decided |
| Held | — | ||
| ACT-015105 | Outreach suppressed pending steward Outreach | CLM-422542 (Roger Watkins) held until CASE-001661 is decided |
| Held | — | ||
| ACT-015106 | Outreach suppressed pending steward Outreach | CLM-407982 (Sara Watson) held until CASE-001662 is decided |
| Held | — | ||
| ACT-015107 | Outreach suppressed pending steward Outreach | CLM-412260 (Jsoeph Singh) held until CASE-001663 is decided |
| Held | — | ||
| ACT-015108 | Outreach suppressed pending steward Outreach | TPA-55398 (Joseph Singh) held until CASE-001664 is decided |
| Held | — | ||
| ACT-015109 | Outreach suppressed pending steward Outreach | TPA-62284 (Tony Myers) held until CASE-001665 is decided |
| Held | — | ||
| ACT-015110 | Outreach suppressed pending steward Outreach | ENR-136498 (Anthony Myers) held until CASE-001666 is decided |
| Held | — | ||
| ACT-015111 | Outreach suppressed pending steward Outreach | TPA-62174 (Brian Patel) held until CASE-001667 is decided |
| Held | — | ||
| ACT-015112 | Outreach suppressed pending steward Outreach | TPA-62173 (Brian Patel) held until CASE-001668 is decided |
| Held | — | ||
| ACT-015113 | Outreach suppressed pending steward Outreach | CLM-405713 (Dennis Grnt) held until CASE-001669 is decided |
| Held | — | ||
| ACT-015114 | Outreach suppressed pending steward Outreach | CLM-429433 (Jack Smith) held until CASE-001670 is decided |
| Held | — | ||
| ACT-015115 | Outreach suppressed pending steward Outreach | ENR-115346 (Pamela Jnes) held until CASE-001671 is decided |
| Held | — | ||
| ACT-015116 | Outreach suppressed pending steward Outreach | CLM-411657 (Pamela Jones) held until CASE-001672 is decided |
| Held | — | ||
| ACT-015117 | Outreach suppressed pending steward Outreach | ENR-134939 (Willie Franklin) held until CASE-001673 is decided |
| Held | — | ||
| ACT-015118 | Outreach suppressed pending steward Outreach | CLM-428179 (Bruce Porter) held until CASE-001674 is decided |
| Held | — | ||
| ACT-015119 | Outreach suppressed pending steward Outreach | CLM-432685 (Patrick Jacobs) held until CASE-001675 is decided |
| Held | — | ||
| ACT-015120 | Outreach suppressed pending steward Outreach | CLM-419961 (Teresa Stephens) held until CASE-001676 is decided |
| Held | — | ||
| ACT-015121 | Outreach suppressed pending steward Outreach | PRV-26758 (Rachel Daniels) held until CASE-001677 is decided |
| Held | — | ||
| ACT-015122 | Outreach suppressed pending steward Outreach | CLM-431469 (Kim Heather) held until CASE-001678 is decided |
| Held | — | ||
| ACT-015123 | Outreach suppressed pending steward Outreach | CLM-412435 (Maria McDonald) held until CASE-001679 is decided |
| Held | — | ||
| ACT-015124 | Outreach suppressed pending steward Outreach | PRV-27690 (Pat Hansen) held until CASE-001680 is decided |
| Held | — | ||
| ACT-015125 | Outreach suppressed pending steward Outreach | TPA-52007 (Gary Hansen) held until CASE-001681 is decided |
| Held | — | ||
| ACT-015126 | Outreach suppressed pending steward Outreach | ENR-136675 (Melissa Crter) held until CASE-001682 is decided |
| Held | — | ||
| ACT-015127 | Outreach suppressed pending steward Outreach | CLM-418139 (Daniel Carter) held until CASE-001683 is decided |
| Held | — | ||
| ACT-015128 | Outreach suppressed pending steward Outreach | TPA-58335 (Mariana Ferguson) held until CASE-001684 is decided |
| Held | — | ||
| ACT-015129 | Outreach suppressed pending steward Outreach | CLM-412458 (Cynthia Dunn) held until CASE-001685 is decided |
| Held | — | ||
| ACT-015130 | Outreach suppressed pending steward Outreach | CLM-422286 (Dorothy Knnedy) held until CASE-001686 is decided |
| Held | — | ||
| ACT-015131 | Outreach suppressed pending steward Outreach | ENR-129211 (Dorothy Kennedy) held until CASE-001687 is decided |
| Held | — | ||
| ACT-015132 | Outreach suppressed pending steward Outreach | CLM-420535 (Sean Howell) held until CASE-001688 is decided |
| Held | — | ||
| ACT-015133 | Outreach suppressed pending steward Outreach | ENR-132647 (Helen Howell) held until CASE-001689 is decided |
| Held | — | ||
| ACT-015134 | Outreach suppressed pending steward Outreach | ENR-127015 (Sean Howell) held until CASE-001690 is decided |
| Held | — | ||
| ACT-015135 | Outreach suppressed pending steward Outreach | ENR-116846 (Jason Bailey) held until CASE-001691 is decided |
| Held | — | ||
| ACT-015136 | Outreach suppressed pending steward Outreach | CLM-401782 (Jeremy Bailey) held until CASE-001692 is decided |
| Held | — | ||
| ACT-015137 | Outreach suppressed pending steward Outreach | PRV-22650 (Debra Bailey) held until CASE-001693 is decided |
| Held | — | ||
| ACT-015138 | Outreach suppressed pending steward Outreach | ENR-132485 (Valentina Roberts) held until CASE-001694 is decided |
| Held | — | ||
| ACT-015139 | Outreach suppressed pending steward Outreach | CLM-424857 (Valentina Roberts) held until CASE-001695 is decided |
| Held | — | ||
| ACT-015140 | Outreach suppressed pending steward Outreach | CLM-419808 (Aaron Ortiz) held until CASE-001696 is decided |
| Held | — | ||
| ACT-015141 | Outreach suppressed pending steward Outreach | CLM-425622 (Edward Alvarado) held until CASE-001697 is decided |
| Held | — | ||
| ACT-015142 | Outreach suppressed pending steward Outreach | TPA-61305 (George Warren) held until CASE-001698 is decided |
| Held | — | ||
| ACT-015143 | Outreach suppressed pending steward Outreach | ENR-133530 (George Warren) held until CASE-001699 is decided |
| Held | — | ||
| ACT-015144 | Outreach suppressed pending steward Outreach | TPA-52970 (Kimberly Salazar) held until CASE-001700 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.