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-015145 | Outreach suppressed pending steward Outreach | ENR-108830 (Kimberly Salazar) held until CASE-001701 is decided |
| Held | — | ||
| ACT-015146 | Outreach suppressed pending steward Outreach | TPA-59999 (Joe Obrrien) held until CASE-001702 is decided |
| Held | — | ||
| ACT-015147 | Outreach suppressed pending steward Outreach | ENR-140951 (Lucia Armstrong) held until CASE-001703 is decided |
| Held | — | ||
| ACT-015148 | Outreach suppressed pending steward Outreach | CLM-431183 (Lucia Armstrong) held until CASE-001704 is decided |
| Held | — | ||
| ACT-015149 | Outreach suppressed pending steward Outreach | ENR-107228 (Sophia Green) held until CASE-001705 is decided |
| Held | — | ||
| ACT-015150 | Outreach suppressed pending steward Outreach | PRV-25188 (Michelle Green) held until CASE-001706 is decided |
| Held | — | ||
| ACT-015151 | Outreach suppressed pending steward Outreach | ENR-123000 (Heather Lawrence) held until CASE-001707 is decided |
| Held | — | ||
| ACT-015152 | Outreach suppressed pending steward Outreach | TPA-57722 (Heather Lawrence) held until CASE-001708 is decided |
| Held | — | ||
| ACT-015153 | Outreach suppressed pending steward Outreach | CLM-407984 (Jacqueline Riice) held until CASE-001709 is decided |
| Held | — | ||
| ACT-015154 | Outreach suppressed pending steward Outreach | CLM-419750 (Gerald Maldonado) held until CASE-001710 is decided |
| Held | — | ||
| ACT-015155 | Outreach suppressed pending steward Outreach | ENR-125999 (Gerald Maldonado) held until CASE-001711 is decided |
| Held | — | ||
| ACT-015156 | Outreach suppressed pending steward Outreach | TPA-62336 (Stephanie Snyder) held until CASE-001712 is decided |
| Held | — | ||
| ACT-015157 | Outreach suppressed pending steward Outreach | CLM-427923 (Stephanie Snyder) held until CASE-001713 is decided |
| Held | — | ||
| ACT-015158 | Outreach suppressed pending steward Outreach | TPA-57886 (Hirohsi Wheeler) held until CASE-001714 is decided |
| Held | — | ||
| ACT-015159 | Outreach suppressed pending steward Outreach | TPA-61137 (Matthew Johnston) held until CASE-001715 is decided |
| Held | — | ||
| ACT-015160 | Outreach suppressed pending steward Outreach | TPA-61138 (Matthew Johnston) held until CASE-001716 is decided |
| Held | — | ||
| ACT-015161 | Outreach suppressed pending steward Outreach | ENR-133018 (Matthew Johnston) held until CASE-001717 is decided |
| Held | — | ||
| ACT-015162 | Outreach suppressed pending steward Outreach | TPA-59111 (Jonathan Marquez) held until CASE-001718 is decided |
| Held | — | ||
| ACT-015163 | Outreach suppressed pending steward Outreach | TPA-51599 (Fatima Graham) held until CASE-001719 is decided |
| Held | — | ||
| ACT-015164 | Outreach suppressed pending steward Outreach | ENR-104798 (Fatima Graham) held until CASE-001720 is decided |
| Held | — | ||
| ACT-015165 | Outreach suppressed pending steward Outreach | ENR-100608 (Donald Johnston) held until CASE-001721 is decided |
| Held | — | ||
| ACT-015166 | Outreach suppressed pending steward Outreach | ENR-117252 (Christopher Hamilton) held until CASE-001722 is decided |
| Held | — | ||
| ACT-015167 | Outreach suppressed pending steward Outreach | TPA-52514 (Santiago Mendoza) held until CASE-001723 is decided |
| Held | — | ||
| ACT-015168 | Outreach suppressed pending steward Outreach | TPA-57899 (Thomas Hamilton) held until CASE-001724 is decided |
| Held | — | ||
| ACT-015169 | Outreach suppressed pending steward Outreach | CLM-422166 (Harold Castillo) held until CASE-001725 is decided |
| Held | — | ||
| ACT-015170 | Outreach suppressed pending steward Outreach | ENR-126487 (Vicoria Stevens) held until CASE-001726 is decided |
| Held | — | ||
| ACT-015171 | Outreach suppressed pending steward Outreach | CLM-420122 (Victoria Stevens) held until CASE-001727 is decided |
| Held | — | ||
| ACT-015172 | Outreach suppressed pending steward Outreach | TPA-63898 (Megan Graham) held until CASE-001728 is decided |
| Held | — | ||
| ACT-015173 | Outreach suppressed pending steward Outreach | CLM-431387 (Philip Greene) held until CASE-001729 is decided |
| Held | — | ||
| ACT-015174 | Outreach suppressed pending steward Outreach | ENR-141211 (Philip Greene) held until CASE-001730 is decided |
| Held | — | ||
| ACT-015175 | Outreach suppressed pending steward Outreach | TPA-61659 (Paul Estrada) held until CASE-001731 is decided |
| Held | — | ||
| ACT-015176 | Outreach suppressed pending steward Outreach | CLM-432392 (Alan Estrada) held until CASE-001732 is decided |
| Held | — | ||
| ACT-015177 | Outreach suppressed pending steward Outreach | TPA-64294 (Alan Estrada) held until CASE-001733 is decided |
| Held | — | ||
| ACT-015178 | Outreach suppressed pending steward Outreach | CLM-417658 (Carlos McCoy) held until CASE-001734 is decided |
| Held | — | ||
| ACT-015179 | Outreach suppressed pending steward Outreach | TPA-51950 (Willie Boyd) held until CASE-001735 is decided |
| Held | — | ||
| ACT-015180 | Outreach suppressed pending steward Outreach | TPA-51628 (Wiillie Phillips) held until CASE-001736 is decided |
| Held | — | ||
| ACT-015181 | Outreach suppressed pending steward Outreach | ENR-104860 (Willie Phillips) held until CASE-001737 is decided |
| Held | — | ||
| ACT-015182 | Outreach suppressed pending steward Outreach | PRV-24214 (Carl Vasquez) held until CASE-001738 is decided |
| Held | — | ||
| ACT-015183 | Outreach suppressed pending steward Outreach | CLM-418157 (Christopher Cunningham) held until CASE-001739 is decided |
| Held | — | ||
| ACT-015184 | Outreach suppressed pending steward Outreach | CLM-422452 (Diaen Luna) held until CASE-001740 is decided |
| Held | — | ||
| ACT-015185 | Outreach suppressed pending steward Outreach | ENR-129423 (Diane Luna) held until CASE-001741 is decided |
| Held | — | ||
| ACT-015186 | Outreach suppressed pending steward Outreach | CLM-401199 (Katherine Fields) held until CASE-001742 is decided |
| Held | — | ||
| ACT-015187 | Outreach suppressed pending steward Outreach | PRV-22679 (Gregory Wheeler) held until CASE-001743 is decided |
| Held | — | ||
| ACT-015188 | Outreach suppressed pending steward Outreach | CLM-432812 (Valentina Jacobs) held until CASE-001744 is decided |
| Held | — | ||
| ACT-015189 | Outreach suppressed pending steward Outreach | PRV-23961 (Frances Jacobs) held until CASE-001745 is decided |
| Held | — | ||
| ACT-015190 | Outreach suppressed pending steward Outreach | TPA-63454 (Stephan Herrera) held until CASE-001746 is decided |
| Held | — | ||
| ACT-015191 | Outreach suppressed pending steward Outreach | CLM-402134 (Lori Mejia) held until CASE-001747 is decided |
| Held | — | ||
| ACT-015192 | Outreach suppressed pending steward Outreach | CLM-402133 (Lori Mejia) held until CASE-001748 is decided |
| Held | — | ||
| ACT-015193 | Outreach suppressed pending steward Outreach | PRV-20623 (Lori Mejia) held until CASE-001749 is decided |
| Held | — | ||
| ACT-015194 | Outreach suppressed pending steward Outreach | CLM-420546 (Ashley Hart) held until CASE-001750 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.