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-015295 | Outreach suppressed pending steward Outreach | TPA-64349 (Joe Martin) held until CASE-001851 is decided |
| Held | — | ||
| ACT-015296 | Outreach suppressed pending steward Outreach | CLM-408329 (Carol Vazquez) held until CASE-001852 is decided |
| Held | — | ||
| ACT-015297 | Outreach suppressed pending steward Outreach | TPA-51068 (Ethan Estrada) held until CASE-001853 is decided |
| Held | — | ||
| ACT-015298 | Outreach suppressed pending steward Outreach | CLM-417136 (Anthony Ryan) held until CASE-001854 is decided |
| Held | — | ||
| ACT-015299 | Outreach suppressed pending steward Outreach | ENR-122557 (Anthony Ryan) held until CASE-001855 is decided |
| Held | — | ||
| ACT-015300 | Outreach suppressed pending steward Outreach | CLM-419906 (Lisa Harrison) held until CASE-001856 is decided |
| Held | — | ||
| ACT-015301 | Outreach suppressed pending steward Outreach | TPA-58776 (Lisa Harrison) held until CASE-001857 is decided |
| Held | — | ||
| ACT-015302 | Outreach suppressed pending steward Outreach | TPA-56527 (Kathryn Hall) held until CASE-001858 is decided |
| Held | — | ||
| ACT-015303 | Outreach suppressed pending steward Outreach | CLM-400119 (Kyle Carr) held until CASE-001859 is decided |
| Held | — | ||
| ACT-015304 | Outreach suppressed pending steward Outreach | CLM-409355 (Danielle Andersno) held until CASE-001860 is decided |
| Held | — | ||
| ACT-015305 | Outreach suppressed pending steward Outreach | TPA-60508 (Fatima Carroll) held until CASE-001861 is decided |
| Held | — | ||
| ACT-015306 | Outreach suppressed pending steward Outreach | ENR-131240 (Fatima Carroll) held until CASE-001862 is decided |
| Held | — | ||
| ACT-015307 | Outreach suppressed pending steward Outreach | CLM-414486 (Sandra Guzman) held until CASE-001863 is decided |
| Held | — | ||
| ACT-015308 | Outreach suppressed pending steward Outreach | CLM-409380 (Rachel Wong) held until CASE-001864 is decided |
| Held | — | ||
| ACT-015309 | Outreach suppressed pending steward Outreach | CLM-417481 (Diana Bell) held until CASE-001865 is decided |
| Held | — | ||
| ACT-015310 | Outreach suppressed pending steward Outreach | TPA-63477 (Brenda Little) held until CASE-001866 is decided |
| Held | — | ||
| ACT-015311 | Outreach suppressed pending steward Outreach | ENR-134036 (Gordon Sara) held until CASE-001867 is decided |
| Held | — | ||
| ACT-015312 | Outreach suppressed pending steward Outreach | ENR-109425 (Frank Cartar) held until CASE-001868 is decided |
| Held | — | ||
| ACT-015313 | Outreach suppressed pending steward Outreach | CLM-407220 (Frank Carter) held until CASE-001869 is decided |
| Held | — | ||
| ACT-015314 | Outreach suppressed pending steward Outreach | PRV-24059 (Bradley Freeman) held until CASE-001870 is decided |
| Held | — | ||
| ACT-015315 | Outreach suppressed pending steward Outreach | ENR-118336 (Bradley Freeman) held until CASE-001871 is decided |
| Held | — | ||
| ACT-015316 | Outreach suppressed pending steward Outreach | CLM-426008 (David Jacobs) held until CASE-001872 is decided |
| Held | — | ||
| ACT-015317 | Outreach suppressed pending steward Outreach | ENR-110450 (Tohmas Jenkins) held until CASE-001873 is decided |
| Held | — | ||
| ACT-015318 | Outreach suppressed pending steward Outreach | TPA-53491 (Thomas Jenkins) held until CASE-001874 is decided |
| Held | — | ||
| ACT-015319 | Outreach suppressed pending steward Outreach | CLM-424582 (Amy Collins) held until CASE-001875 is decided |
| Held | — | ||
| ACT-015320 | Outreach suppressed pending steward Outreach | PRV-21696 (Lauren Rivera) held until CASE-001876 is decided |
| Held | — | ||
| ACT-015321 | Outreach suppressed pending steward Outreach | TPA-60552 (Christine Phillips) held until CASE-001877 is decided |
| Held | — | ||
| ACT-015322 | Outreach suppressed pending steward Outreach | TPA-62467 (Jesse Padilla) held until CASE-001878 is decided |
| Held | — | ||
| ACT-015323 | Outreach suppressed pending steward Outreach | ENR-136985 (Jesse Padilla) held until CASE-001879 is decided |
| Held | — | ||
| ACT-015324 | Outreach suppressed pending steward Outreach | TPA-57889 (Nathna Cole) held until CASE-001880 is decided |
| Held | — | ||
| ACT-015325 | Outreach suppressed pending steward Outreach | TPA-59184 (Dennis Rivera) held until CASE-001881 is decided |
| Held | — | ||
| ACT-015326 | Outreach suppressed pending steward Outreach | TPA-59185 (Dennis Rivera) held until CASE-001882 is decided |
| Held | — | ||
| ACT-015327 | Outreach suppressed pending steward Outreach | CLM-422513 (Brandon Payne) held until CASE-001883 is decided |
| Held | — | ||
| ACT-015328 | Outreach suppressed pending steward Outreach | ENR-129498 (Brandon Payne) held until CASE-001884 is decided |
| Held | — | ||
| ACT-015329 | Outreach suppressed pending steward Outreach | TPA-63366 (Sara Hudson) held until CASE-001885 is decided |
| Held | — | ||
| ACT-015330 | Outreach suppressed pending steward Outreach | TPA-58588 (Rachel Freeman) held until CASE-001886 is decided |
| Held | — | ||
| ACT-015331 | Outreach suppressed pending steward Outreach | PRV-25777 (Rachel Freeman) held until CASE-001887 is decided |
| Held | — | ||
| ACT-015332 | Outreach suppressed pending steward Outreach | ENR-105328 (Lori Contreras) held until CASE-001888 is decided |
| Held | — | ||
| ACT-015333 | Outreach suppressed pending steward Outreach | CLM-404075 (Lori Contreras) held until CASE-001889 is decided |
| Held | — | ||
| ACT-015334 | Outreach suppressed pending steward Outreach | CLM-409891 (Joseph Lawson) held until CASE-001890 is decided |
| Held | — | ||
| ACT-015335 | Outreach suppressed pending steward Outreach | TPA-56068 (Valentina Bishop) held until CASE-001891 is decided |
| Held | — | ||
| ACT-015336 | Outreach suppressed pending steward Outreach | TPA-62663 (Austin Allen) held until CASE-001892 is decided |
| Held | — | ||
| ACT-015337 | Outreach suppressed pending steward Outreach | CLM-401925 (Emma Soto) held until CASE-001893 is decided |
| Held | — | ||
| ACT-015338 | Outreach suppressed pending steward Outreach | ENR-102483 (Emma Soto) held until CASE-001894 is decided |
| Held | — | ||
| ACT-015339 | Outreach suppressed pending steward Outreach | CLM-426974 (Kevin Griffin) held until CASE-001895 is decided |
| Held | — | ||
| ACT-015340 | Outreach suppressed pending steward Outreach | TPA-54302 (Abigail Vargas) held until CASE-001896 is decided |
| Held | — | ||
| ACT-015341 | Outreach suppressed pending steward Outreach | CLM-409862 (Abigail Vargas) held until CASE-001897 is decided |
| Held | — | ||
| ACT-015342 | Outreach suppressed pending steward Outreach | CLM-412079 (Gregory Moreno) held until CASE-001898 is decided |
| Held | — | ||
| ACT-015343 | Outreach suppressed pending steward Outreach | CLM-416292 (Diana Owens) held until CASE-001899 is decided |
| Held | — | ||
| ACT-015344 | Outreach suppressed pending steward Outreach | CLM-413604 (Terry Schmidt) held until CASE-001900 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.