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-013595 | Outreach suppressed pending steward Outreach | CLM-422772 (Gregory Le) held until CASE-000151 is decided |
| Held | — | ||
| ACT-013596 | Outreach suppressed pending steward Outreach | TPA-56340 (Nathan Fowler) held until CASE-000152 is decided |
| Held | — | ||
| ACT-013597 | Outreach suppressed pending steward Outreach | PRV-27994 (Lawrence Fuller) held until CASE-000153 is decided |
| Held | — | ||
| ACT-013598 | Outreach suppressed pending steward Outreach | CLM-415616 (Linda Green) held until CASE-000154 is decided |
| Held | — | ||
| ACT-013599 | Outreach suppressed pending steward Outreach | TPA-58040 (Russell Price) held until CASE-000155 is decided |
| Held | — | ||
| ACT-013600 | Outreach suppressed pending steward Outreach | ENR-131264 (Jack Mendeez) held until CASE-000156 is decided |
| Held | — | ||
| ACT-013601 | Outreach suppressed pending steward Outreach | TPA-60518 (Jack Mendez) held until CASE-000157 is decided |
| Held | — | ||
| ACT-013602 | Outreach suppressed pending steward Outreach | TPA-56125 (Natalie Park) held until CASE-000158 is decided |
| Held | — | ||
| ACT-013603 | Outreach suppressed pending steward Outreach | PRV-23256 (Janice Park) held until CASE-000159 is decided |
| Held | — | ||
| ACT-013604 | Outreach suppressed pending steward Outreach | TPA-54954 (Janice Park) held until CASE-000160 is decided |
| Held | — | ||
| ACT-013605 | Outreach suppressed pending steward Outreach | CLM-429665 (Nicholas Sanchez) held until CASE-000161 is decided |
| Held | — | ||
| ACT-013606 | Outreach suppressed pending steward Outreach | ENR-138922 (Nicholas Sanchez) held until CASE-000162 is decided |
| Held | — | ||
| ACT-013607 | Outreach suppressed pending steward Outreach | TPA-50076 (Mason Williams) held until CASE-000163 is decided |
| Held | — | ||
| ACT-013608 | Outreach suppressed pending steward Outreach | CLM-400189 (Mason Williams) held until CASE-000164 is decided |
| Held | — | ||
| ACT-013609 | Outreach suppressed pending steward Outreach | TPA-61926 (Sarah Carroll) held until CASE-000165 is decided |
| Held | — | ||
| ACT-013610 | Outreach suppressed pending steward Outreach | CLM-426656 (Denise Carroll) held until CASE-000166 is decided |
| Held | — | ||
| ACT-013611 | Outreach suppressed pending steward Outreach | PRV-26719 (Terry West) held until CASE-000167 is decided |
| Held | — | ||
| ACT-013612 | Outreach suppressed pending steward Outreach | CLM-420552 (Joyce Andrews) held until CASE-000168 is decided |
| Held | — | ||
| ACT-013613 | Outreach suppressed pending steward Outreach | PRV-29037 (Diana Cruz) held until CASE-000169 is decided |
| Held | — | ||
| ACT-013614 | Outreach suppressed pending steward Outreach | CLM-426954 (Gerald Dean) held until CASE-000170 is decided |
| Held | — | ||
| ACT-013615 | Outreach suppressed pending steward Outreach | CLM-407755 (Karen Dean) held until CASE-000171 is decided |
| Held | — | ||
| ACT-013616 | Outreach suppressed pending steward Outreach | CLM-407756 (Karen Dean) held until CASE-000172 is decided |
| Held | — | ||
| ACT-013617 | Outreach suppressed pending steward Outreach | CLM-431740 (Lida Wite) held until CASE-000173 is decided |
| Held | — | ||
| ACT-013618 | Outreach suppressed pending steward Outreach | PRV-29276 (Linda White) held until CASE-000174 is decided |
| Held | — | ||
| ACT-013619 | Outreach suppressed pending steward Outreach | CLM-431741 (Linda White) held until CASE-000175 is decided |
| Held | — | ||
| ACT-013620 | Outreach suppressed pending steward Outreach | TPA-64002 (Linda White) held until CASE-000176 is decided |
| Held | — | ||
| ACT-013621 | Outreach suppressed pending steward Outreach | CLM-420194 (Benjamin Wood) held until CASE-000177 is decided |
| Held | — | ||
| ACT-013622 | Outreach suppressed pending steward Outreach | ENR-126567 (Ben Wood) held until CASE-000178 is decided |
| Held | — | ||
| ACT-013623 | Outreach suppressed pending steward Outreach | TPA-59546 (Sue Mason) held until CASE-000179 is decided |
| Held | — | ||
| ACT-013624 | Outreach suppressed pending steward Outreach | CLM-429916 (Melissa Soto) held until CASE-000180 is decided |
| Held | — | ||
| ACT-013625 | Outreach suppressed pending steward Outreach | CLM-429915 (Melissa Soto) held until CASE-000181 is decided |
| Held | — | ||
| ACT-013626 | Outreach suppressed pending steward Outreach | CLM-413805 (Henry Johnson) held until CASE-000182 is decided |
| Held | — | ||
| ACT-013627 | Outreach suppressed pending steward Outreach | CLM-405693 (Bradley Vazquez) held until CASE-000183 is decided |
| Held | — | ||
| ACT-013628 | Outreach suppressed pending steward Outreach | PRV-21653 (Bradley Vazquez) held until CASE-000184 is decided |
| Held | — | ||
| ACT-013629 | Outreach suppressed pending steward Outreach | TPA-57347 (Matthew Munoz) held until CASE-000185 is decided |
| Held | — | ||
| ACT-013630 | Outreach suppressed pending steward Outreach | TPA-53872 (Vincent Riz) held until CASE-000186 is decided |
| Held | — | ||
| ACT-013631 | Outreach suppressed pending steward Outreach | CLM-408811 (Vincent Ruiz) held until CASE-000187 is decided |
| Held | — | ||
| ACT-013632 | Outreach suppressed pending steward Outreach | TPA-50461 (Henry Gray) held until CASE-000188 is decided |
| Held | — | ||
| ACT-013633 | Outreach suppressed pending steward Outreach | ENR-111084 (Emily Gray) held until CASE-000189 is decided |
| Held | — | ||
| ACT-013634 | Outreach suppressed pending steward Outreach | CLM-427583 (William Mitchell) held until CASE-000190 is decided |
| Held | — | ||
| ACT-013635 | Outreach suppressed pending steward Outreach | CLM-408355 (Camila Lucas) held until CASE-000191 is decided |
| Held | — | ||
| ACT-013636 | Outreach suppressed pending steward Outreach | CLM-422949 (Betty Evans) held until CASE-000192 is decided |
| Held | — | ||
| ACT-013637 | Outreach suppressed pending steward Outreach | CLM-432178 (Keith Rice) held until CASE-000193 is decided |
| Held | — | ||
| ACT-013638 | Outreach suppressed pending steward Outreach | TPA-50780 (Amy Rice) held until CASE-000194 is decided |
| Held | — | ||
| ACT-013639 | Outreach suppressed pending steward Outreach | ENR-119677 (Billy Holmes) held until CASE-000195 is decided |
| Held | — | ||
| ACT-013640 | Outreach suppressed pending steward Outreach | CLM-414958 (Billy Holmes) held until CASE-000196 is decided |
| Held | — | ||
| ACT-013641 | Outreach suppressed pending steward Outreach | CLM-432022 (Ashley Gordon) held until CASE-000197 is decided |
| Held | — | ||
| ACT-013642 | Outreach suppressed pending steward Outreach | TPA-54686 (Ahmed Garza) held until CASE-000198 is decided |
| Held | — | ||
| ACT-013643 | Outreach suppressed pending steward Outreach | CLM-426824 (Priya Garcia) held until CASE-000199 is decided |
| Held | — | ||
| ACT-013644 | Outreach suppressed pending steward Outreach | CLM-403430 (Bruce Coopr) held until CASE-000200 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.