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-015495 | Outreach suppressed pending steward Outreach | CLM-421828 (Karen Mills) held until CASE-002051 is decided |
| Held | — | ||
| ACT-015496 | Outreach suppressed pending steward Outreach | TPA-63669 (Doris Carlson) held until CASE-002052 is decided |
| Held | — | ||
| ACT-015497 | Outreach suppressed pending steward Outreach | CLM-409898 (Ethan Maldonado) held until CASE-002053 is decided |
| Held | — | ||
| ACT-015498 | Outreach suppressed pending steward Outreach | ENR-113049 (Ethan Maldonado) held until CASE-002054 is decided |
| Held | — | ||
| ACT-015499 | Outreach suppressed pending steward Outreach | ENR-131622 (Johny Weber) held until CASE-002055 is decided |
| Held | — | ||
| ACT-015500 | Outreach suppressed pending steward Outreach | TPA-57596 (Charlotte Haansen) held until CASE-002056 is decided |
| Held | — | ||
| ACT-015501 | Outreach suppressed pending steward Outreach | CLM-417211 (Charlotte Hansen) held until CASE-002057 is decided |
| Held | — | ||
| ACT-015502 | Outreach suppressed pending steward Outreach | CLM-419518 (Karen Padilla) held until CASE-002058 is decided |
| Held | — | ||
| ACT-015503 | Outreach suppressed pending steward Outreach | CLM-424034 (Megan Kim) held until CASE-002059 is decided |
| Held | — | ||
| ACT-015504 | Outreach suppressed pending steward Outreach | ENR-117422 (Tony Aguilar) held until CASE-002060 is decided |
| Held | — | ||
| ACT-015505 | Outreach suppressed pending steward Outreach | TPA-55840 (Anthony Aguilar) held until CASE-002061 is decided |
| Held | — | ||
| ACT-015506 | Outreach suppressed pending steward Outreach | ENR-107329 (Nicole Duncan) held until CASE-002062 is decided |
| Held | — | ||
| ACT-015507 | Outreach suppressed pending steward Outreach | TPA-52454 (Nicole Duncan) held until CASE-002063 is decided |
| Held | — | ||
| ACT-015508 | Outreach suppressed pending steward Outreach | TPA-51444 (Brruce Schultz) held until CASE-002064 is decided |
| Held | — | ||
| ACT-015509 | Outreach suppressed pending steward Outreach | TPA-54125 (Becky Campbell) held until CASE-002065 is decided |
| Held | — | ||
| ACT-015510 | Outreach suppressed pending steward Outreach | TPA-51953 (Alan Soto) held until CASE-002066 is decided |
| Held | — | ||
| ACT-015511 | Outreach suppressed pending steward Outreach | TPA-59206 (Jason Murray) held until CASE-002067 is decided |
| Held | — | ||
| ACT-015512 | Outreach suppressed pending steward Outreach | CLM-421796 (Katleen Tran) held until CASE-002068 is decided |
| Held | — | ||
| ACT-015513 | Outreach suppressed pending steward Outreach | TPA-61762 (Sofiia Davis) held until CASE-002069 is decided |
| Held | — | ||
| ACT-015514 | Outreach suppressed pending steward Outreach | TPA-60427 (Adam Griffin) held until CASE-002070 is decided |
| Held | — | ||
| ACT-015515 | Outreach suppressed pending steward Outreach | CLM-414014 (Karen Lucas) held until CASE-002071 is decided |
| Held | — | ||
| ACT-015516 | Outreach suppressed pending steward Outreach | CLM-415497 (Stephen Mills) held until CASE-002072 is decided |
| Held | — | ||
| ACT-015517 | Outreach suppressed pending steward Outreach | ENR-120432 (Stephen Mills) held until CASE-002073 is decided |
| Held | — | ||
| ACT-015518 | Outreach suppressed pending steward Outreach | TPA-63391 (Helen Murphy) held until CASE-002074 is decided |
| Held | — | ||
| ACT-015519 | Outreach suppressed pending steward Outreach | TPA-58958 (Kayla Hawkins) held until CASE-002075 is decided |
| Held | — | ||
| ACT-015520 | Outreach suppressed pending steward Outreach | TPA-64165 (Brittany Garrett) held until CASE-002076 is decided |
| Held | — | ||
| ACT-015521 | Outreach suppressed pending steward Outreach | TPA-56745 (Priya Berry) held until CASE-002077 is decided |
| Held | — | ||
| ACT-015522 | Outreach suppressed pending steward Outreach | ENR-120230 (Priya Berry) held until CASE-002078 is decided |
| Held | — | ||
| ACT-015523 | Outreach suppressed pending steward Outreach | PRV-23812 (Aaron Rojas) held until CASE-002079 is decided |
| Held | — | ||
| ACT-015524 | Outreach suppressed pending steward Outreach | TPA-53946 (Alan Ortiz) held until CASE-002080 is decided |
| Held | — | ||
| ACT-015525 | Outreach suppressed pending steward Outreach | TPA-54524 (Brandon Ortega) held until CASE-002081 is decided |
| Held | — | ||
| ACT-015526 | Outreach suppressed pending steward Outreach | TPA-52844 (Lara Ryan) held until CASE-002082 is decided |
| Held | — | ||
| ACT-015527 | Outreach suppressed pending steward Outreach | CLM-429587 (Laura Ford) held until CASE-002083 is decided |
| Held | — | ||
| ACT-015528 | Outreach suppressed pending steward Outreach | TPA-59778 (Mark Payne) held until CASE-002084 is decided |
| Held | — | ||
| ACT-015529 | Outreach suppressed pending steward Outreach | ENR-126743 (Alexander Oliver) held until CASE-002085 is decided |
| Held | — | ||
| ACT-015530 | Outreach suppressed pending steward Outreach | TPA-52472 (Alexander Oliver) held until CASE-002086 is decided |
| Held | — | ||
| ACT-015531 | Outreach suppressed pending steward Outreach | TPA-62634 (Ana Carr) held until CASE-002087 is decided |
| Held | — | ||
| ACT-015532 | Outreach suppressed pending steward Outreach | CLM-428589 (Ana Carr) held until CASE-002088 is decided |
| Held | — | ||
| ACT-015533 | Outreach suppressed pending steward Outreach | TPA-64368 (Cheryl Carr) held until CASE-002089 is decided |
| Held | — | ||
| ACT-015534 | Outreach suppressed pending steward Outreach | PRV-22371 (Alan Daniels) held until CASE-002090 is decided |
| Held | — | ||
| ACT-015535 | Outreach suppressed pending steward Outreach | ENR-110589 (Alan Daniels) held until CASE-002091 is decided |
| Held | — | ||
| ACT-015536 | Outreach suppressed pending steward Outreach | TPA-61579 (Samantha Morris) held until CASE-002092 is decided |
| Held | — | ||
| ACT-015537 | Outreach suppressed pending steward Outreach | TPA-53560 (Nancy Morales) held until CASE-002093 is decided |
| Held | — | ||
| ACT-015538 | Outreach suppressed pending steward Outreach | TPA-53561 (Nancy Morales) held until CASE-002094 is decided |
| Held | — | ||
| ACT-015539 | Outreach suppressed pending steward Outreach | CLM-414876 (Heather Burton) held until CASE-002095 is decided |
| Held | — | ||
| ACT-015540 | Outreach suppressed pending steward Outreach | TPA-50171 (Ralph Ellioott) held until CASE-002096 is decided |
| Held | — | ||
| ACT-015541 | Outreach suppressed pending steward Outreach | CLM-404622 (Scott Singh) held until CASE-002097 is decided |
| Held | — | ||
| ACT-015542 | Outreach suppressed pending steward Outreach | CLM-423671 (Donna Owens) held until CASE-002098 is decided |
| Held | — | ||
| ACT-015543 | Outreach suppressed pending steward Outreach | TPA-60424 (Donna Owens) held until CASE-002099 is decided |
| Held | — | ||
| ACT-015544 | Outreach suppressed pending steward Outreach | ENR-134418 (Noah Owens) held until CASE-002100 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.