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-015345 | Outreach suppressed pending steward Outreach | TPA-55980 (Terry Schmidt) held until CASE-001901 is decided |
| Held | — | ||
| ACT-015346 | Outreach suppressed pending steward Outreach | ENR-140156 (Theresa Johnson) held until CASE-001902 is decided |
| Held | — | ||
| ACT-015347 | Outreach suppressed pending steward Outreach | CLM-430584 (Theresa Johnson) held until CASE-001903 is decided |
| Held | — | ||
| ACT-015348 | Outreach suppressed pending steward Outreach | TPA-60013 (Carlos Daniels) held until CASE-001904 is decided |
| Held | — | ||
| ACT-015349 | Outreach suppressed pending steward Outreach | CLM-422809 (Carlos Daniels) held until CASE-001905 is decided |
| Held | — | ||
| ACT-015350 | Outreach suppressed pending steward Outreach | PRV-28398 (Mariana Henry) held until CASE-001906 is decided |
| Held | — | ||
| ACT-015351 | Outreach suppressed pending steward Outreach | TPA-50269 (Katherine Spencer) held until CASE-001907 is decided |
| Held | — | ||
| ACT-015352 | Outreach suppressed pending steward Outreach | CLM-400602 (Katherine Spencer) held until CASE-001908 is decided |
| Held | — | ||
| ACT-015353 | Outreach suppressed pending steward Outreach | ENR-111441 (Sophia Allen) held until CASE-001909 is decided |
| Held | — | ||
| ACT-015354 | Outreach suppressed pending steward Outreach | TPA-58034 (Brandon Reid) held until CASE-001910 is decided |
| Held | — | ||
| ACT-015355 | Outreach suppressed pending steward Outreach | PRV-24466 (Peterson Terry) held until CASE-001911 is decided |
| Held | — | ||
| ACT-015356 | Outreach suppressed pending steward Outreach | CLM-424900 (Scott Lee) held until CASE-001912 is decided |
| Held | — | ||
| ACT-015357 | Outreach suppressed pending steward Outreach | TPA-50235 (Carl Jacobs) held until CASE-001913 is decided |
| Held | — | ||
| ACT-015358 | Outreach suppressed pending steward Outreach | TPA-57672 (Emily Harris) held until CASE-001914 is decided |
| Held | — | ||
| ACT-015359 | Outreach suppressed pending steward Outreach | TPA-63321 (Samuel Oliver) held until CASE-001915 is decided |
| Held | — | ||
| ACT-015360 | Outreach suppressed pending steward Outreach | CLM-408082 (Ranyd Wood) held until CASE-001916 is decided |
| Held | — | ||
| ACT-015361 | Outreach suppressed pending steward Outreach | TPA-59757 (Jon Alvarado) held until CASE-001917 is decided |
| Held | — | ||
| ACT-015362 | Outreach suppressed pending steward Outreach | CLM-422206 (Jonathan Alvarado) held until CASE-001918 is decided |
| Held | — | ||
| ACT-015363 | Outreach suppressed pending steward Outreach | PRV-26558 (Jonathan Alvarado) held until CASE-001919 is decided |
| Held | — | ||
| ACT-015364 | Outreach suppressed pending steward Outreach | CLM-418565 (Lawrence Alvarado) held until CASE-001920 is decided |
| Held | — | ||
| ACT-015365 | Outreach suppressed pending steward Outreach | TPA-61822 (Andrew Johnson) held until CASE-001921 is decided |
| Held | — | ||
| ACT-015366 | Outreach suppressed pending steward Outreach | CLM-426761 (Andrew Johnson) held until CASE-001922 is decided |
| Held | — | ||
| ACT-015367 | Outreach suppressed pending steward Outreach | CLM-423694 (Fatima Bell) held until CASE-001923 is decided |
| Held | — | ||
| ACT-015368 | Outreach suppressed pending steward Outreach | TPA-61853 (Sarrah Patterson) held until CASE-001924 is decided |
| Held | — | ||
| ACT-015369 | Outreach suppressed pending steward Outreach | TPA-52632 (Emily Peters) held until CASE-001925 is decided |
| Held | — | ||
| ACT-015370 | Outreach suppressed pending steward Outreach | CLM-427885 (Diane Jimenez) held until CASE-001926 is decided |
| Held | — | ||
| ACT-015371 | Outreach suppressed pending steward Outreach | ENR-112381 (Olivia Gibson) held until CASE-001927 is decided |
| Held | — | ||
| ACT-015372 | Outreach suppressed pending steward Outreach | TPA-54078 (Olivia Gibson) held until CASE-001928 is decided |
| Held | — | ||
| ACT-015373 | Outreach suppressed pending steward Outreach | ENR-103371 (Amy Montgomery) held until CASE-001929 is decided |
| Held | — | ||
| ACT-015374 | Outreach suppressed pending steward Outreach | PRV-20759 (Amy Montgomery) held until CASE-001930 is decided |
| Held | — | ||
| ACT-015375 | Outreach suppressed pending steward Outreach | TPA-61329 (Zachary Dixon) held until CASE-001931 is decided |
| Held | — | ||
| ACT-015376 | Outreach suppressed pending steward Outreach | CLM-417399 (Aaron Johnston) held until CASE-001932 is decided |
| Held | — | ||
| ACT-015377 | Outreach suppressed pending steward Outreach | ENR-122929 (Aaron Johnston) held until CASE-001933 is decided |
| Held | — | ||
| ACT-015378 | Outreach suppressed pending steward Outreach | TPA-53477 (Maria Arnold) held until CASE-001934 is decided |
| Held | — | ||
| ACT-015379 | Outreach suppressed pending steward Outreach | CLM-405303 (Jluia Simmons) held until CASE-001935 is decided |
| Held | — | ||
| ACT-015380 | Outreach suppressed pending steward Outreach | PRV-27894 (Elijah Weaver) held until CASE-001936 is decided |
| Held | — | ||
| ACT-015381 | Outreach suppressed pending steward Outreach | TPA-51480 (Vicky Hughes) held until CASE-001937 is decided |
| Held | — | ||
| ACT-015382 | Outreach suppressed pending steward Outreach | CLM-403405 (Victoria Hughes) held until CASE-001938 is decided |
| Held | — | ||
| ACT-015383 | Outreach suppressed pending steward Outreach | CLM-427860 (Gloria Hall) held until CASE-001939 is decided |
| Held | — | ||
| ACT-015384 | Outreach suppressed pending steward Outreach | ENR-136521 (Gloria Hall) held until CASE-001940 is decided |
| Held | — | ||
| ACT-015385 | Outreach suppressed pending steward Outreach | CLM-430988 (Adam Sandoval) held until CASE-001941 is decided |
| Held | — | ||
| ACT-015386 | Outreach suppressed pending steward Outreach | ENR-140697 (Adam Sanduval) held until CASE-001942 is decided |
| Held | — | ||
| ACT-015387 | Outreach suppressed pending steward Outreach | CLM-412045 (Lorri Perkins) held until CASE-001943 is decided |
| Held | — | ||
| ACT-015388 | Outreach suppressed pending steward Outreach | ENR-115856 (Lori Perkins) held until CASE-001944 is decided |
| Held | — | ||
| ACT-015389 | Outreach suppressed pending steward Outreach | TPA-62981 (Beverly Howell) held until CASE-001945 is decided |
| Held | — | ||
| ACT-015390 | Outreach suppressed pending steward Outreach | CLM-402433 (Lori King) held until CASE-001946 is decided |
| Held | — | ||
| ACT-015391 | Outreach suppressed pending steward Outreach | ENR-103126 (Lori King) held until CASE-001947 is decided |
| Held | — | ||
| ACT-015392 | Outreach suppressed pending steward Outreach | CLM-410057 (Randy Mason) held until CASE-001948 is decided |
| Held | — | ||
| ACT-015393 | Outreach suppressed pending steward Outreach | CLM-424860 (Stephanie Bell) held until CASE-001949 is decided |
| Held | — | ||
| ACT-015394 | Outreach suppressed pending steward Outreach | TPA-63763 (Jose Ellis) held until CASE-001950 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.