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

TypeAllOutreach address corrected2,993Outreach suppressed pending steward4,326
StatusAllProposed8,228Executed14,086Held4,326Released0
Outreach suppressed pending steward, Outreach, 0 proposed
ActionTypeTitleDetailLinked toStatusExecuted
ACT-015545
Outreach suppressed pending steward
Outreach
CLM-418265 (Kathleen Owens) held until CASE-002101 is decided
Case id
CASE-002101
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-418265
Held—
ACT-015546
Outreach suppressed pending steward
Outreach
PRV-25415 (Kathleen Owens) held until CASE-002102 is decided
Case id
CASE-002102
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-25415
Held—
ACT-015547
Outreach suppressed pending steward
Outreach
CLM-428194 (Adam Obrien) held until CASE-002103 is decided
Case id
CASE-002103
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-428194
Held—
ACT-015548
Outreach suppressed pending steward
Outreach
CLM-402377 (Deb Obrien) held until CASE-002104 is decided
Case id
CASE-002104
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-402377
Held—
ACT-015549
Outreach suppressed pending steward
Outreach
ENR-103051 (Deborah Obrien) held until CASE-002105 is decided
Case id
CASE-002105
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-103051
Held—
ACT-015550
Outreach suppressed pending steward
Outreach
TPA-59790 (Heather Waston) held until CASE-002106 is decided
Case id
CASE-002106
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-59790
Held—
ACT-015551
Outreach suppressed pending steward
Outreach
TPA-59286 (Mateo Hughes) held until CASE-002107 is decided
Case id
CASE-002107
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-59286
Held—
ACT-015552
Outreach suppressed pending steward
Outreach
PRV-25394 (Ronald Price) held until CASE-002108 is decided
Case id
CASE-002108
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-25394
Held—
ACT-015553
Outreach suppressed pending steward
Outreach
TPA-58037 (Ronald Price) held until CASE-002109 is decided
Case id
CASE-002109
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-58037
Held—
ACT-015554
Outreach suppressed pending steward
Outreach
CLM-403206 (Jakob Wong) held until CASE-002110 is decided
Case id
CASE-002110
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-403206
Held—
ACT-015555
Outreach suppressed pending steward
Outreach
TPA-51379 (Jacob Wong) held until CASE-002111 is decided
Case id
CASE-002111
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-51379
Held—
ACT-015556
Outreach suppressed pending steward
Outreach
ENR-130012 (Doris Mejia) held until CASE-002112 is decided
Case id
CASE-002112
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-130012
Held—
ACT-015557
Outreach suppressed pending steward
Outreach
ENR-109848 (Jack Sanchez) held until CASE-002113 is decided
Case id
CASE-002113
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-109848
Held—
ACT-015558
Outreach suppressed pending steward
Outreach
CLM-407511 (Jack Sanchez) held until CASE-002114 is decided
Case id
CASE-002114
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-407511
Held—
ACT-015559
Outreach suppressed pending steward
Outreach
PRV-20731 (Austin Holmes) held until CASE-002115 is decided
Case id
CASE-002115
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-20731
Held—
ACT-015560
Outreach suppressed pending steward
Outreach
ENR-103217 (Austin Holmes) held until CASE-002116 is decided
Case id
CASE-002116
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-103217
Held—
ACT-015561
Outreach suppressed pending steward
Outreach
PRV-28366 (Julie Stephens) held until CASE-002117 is decided
Case id
CASE-002117
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-28366
Held—
ACT-015562
Outreach suppressed pending steward
Outreach
CLM-428504 (Julie Stephens) held until CASE-002118 is decided
Case id
CASE-002118
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-428504
Held—
ACT-015563
Outreach suppressed pending steward
Outreach
TPA-57632 (Marilyn Holms) held until CASE-002119 is decided
Case id
CASE-002119
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-57632
Held—
ACT-015564
Outreach suppressed pending steward
Outreach
TPA-57633 (Marilyn Holmes) held until CASE-002120 is decided
Case id
CASE-002120
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-57633
Held—
ACT-015565
Outreach suppressed pending steward
Outreach
ENR-101638 (Luccia Peters) held until CASE-002121 is decided
Case id
CASE-002121
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-101638
Held—
ACT-015566
Outreach suppressed pending steward
Outreach
TPA-50543 (Lucia Peters) held until CASE-002122 is decided
Case id
CASE-002122
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-50543
Held—
ACT-015567
Outreach suppressed pending steward
Outreach
CLM-432051 (Timothy Delgado) held until CASE-002123 is decided
Case id
CASE-002123
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-432051
Held—
ACT-015568
Outreach suppressed pending steward
Outreach
CLM-432050 (Timothy Delgado) held until CASE-002124 is decided
Case id
CASE-002124
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-432050
Held—
ACT-015569
Outreach suppressed pending steward
Outreach
TPA-52095 (Roy Bennett) held until CASE-002125 is decided
Case id
CASE-002125
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-52095
Held—
ACT-015570
Outreach suppressed pending steward
Outreach
ENR-135444 (Teresa Porter) held until CASE-002126 is decided
Case id
CASE-002126
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-135444
Held—
ACT-015571
Outreach suppressed pending steward
Outreach
PRV-27937 (Teresa Porter) held until CASE-002127 is decided
Case id
CASE-002127
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-27937
Held—
ACT-015572
Outreach suppressed pending steward
Outreach
ENR-134553 (Mary Ford) held until CASE-002128 is decided
Case id
CASE-002128
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-134553
Held—
ACT-015573
Outreach suppressed pending steward
Outreach
ENR-107251 (Michael Pena) held until CASE-002129 is decided
Case id
CASE-002129
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-107251
Held—
ACT-015574
Outreach suppressed pending steward
Outreach
CLM-405504 (Michael Pena) held until CASE-002130 is decided
Case id
CASE-002130
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-405504
Held—
ACT-015575
Outreach suppressed pending steward
Outreach
TPA-51833 (Daniel Matthews) held until CASE-002131 is decided
Case id
CASE-002131
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-51833
Held—
ACT-015576
Outreach suppressed pending steward
Outreach
TPA-63701 (Fatima Price) held until CASE-002132 is decided
Case id
CASE-002132
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-63701
Held—
ACT-015577
Outreach suppressed pending steward
Outreach
PRV-27643 (Brittany Wang) held until CASE-002133 is decided
Case id
CASE-002133
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-27643
Held—
ACT-015578
Outreach suppressed pending steward
Outreach
TPA-62159 (Elizabeth Taylor) held until CASE-002134 is decided
Case id
CASE-002134
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-62159
Held—
ACT-015579
Outreach suppressed pending steward
Outreach
CLM-413021 (Kathleen Brooks) held until CASE-002135 is decided
Case id
CASE-002135
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-413021
Held—
ACT-015580
Outreach suppressed pending steward
Outreach
TPA-55726 (Kathleen Brooks) held until CASE-002136 is decided
Case id
CASE-002136
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-55726
Held—
ACT-015581
Outreach suppressed pending steward
Outreach
ENR-135014 (Mason McDonald) held until CASE-002137 is decided
Case id
CASE-002137
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-135014
Held—
ACT-015582
Outreach suppressed pending steward
Outreach
CLM-426700 (Mason McDonald) held until CASE-002138 is decided
Case id
CASE-002138
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-426700
Held—
ACT-015583
Outreach suppressed pending steward
Outreach
CLM-406546 (Brian Nunez) held until CASE-002139 is decided
Case id
CASE-002139
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-406546
Held—
ACT-015584
Outreach suppressed pending steward
Outreach
TPA-52881 (Brian Nunez) held until CASE-002140 is decided
Case id
CASE-002140
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-52881
Held—
ACT-015585
Outreach suppressed pending steward
Outreach
CLM-412465 (Angela Kennedy) held until CASE-002141 is decided
Case id
CASE-002141
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-412465
Held—
ACT-015586
Outreach suppressed pending steward
Outreach
CLM-408119 (Jessica Patel) held until CASE-002142 is decided
Case id
CASE-002142
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-408119
Held—
ACT-015587
Outreach suppressed pending steward
Outreach
TPA-53570 (Jessica Patel) held until CASE-002143 is decided
Case id
CASE-002143
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-53570
Held—
ACT-015588
Outreach suppressed pending steward
Outreach
CLM-401472 (Willie Chen) held until CASE-002144 is decided
Case id
CASE-002144
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-401472
Held—
ACT-015589
Outreach suppressed pending steward
Outreach
ENR-101914 (Willie Chen) held until CASE-002145 is decided
Case id
CASE-002145
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-101914
Held—
ACT-015590
Outreach suppressed pending steward
Outreach
PRV-27648 (Gracce Wong) held until CASE-002146 is decided
Case id
CASE-002146
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-27648
Held—
ACT-015591
Outreach suppressed pending steward
Outreach
CLM-420390 (Laura Smith) held until CASE-002147 is decided
Case id
CASE-002147
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-420390
Held—
ACT-015592
Outreach suppressed pending steward
Outreach
PRV-20095 (Kyle Mason) held until CASE-002148 is decided
Case id
CASE-002148
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-20095
Held—
ACT-015593
Outreach suppressed pending steward
Outreach
ENR-127830 (Amy Bennett) held until CASE-002149 is decided
Case id
CASE-002149
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-127830
Held—
ACT-015594
Outreach suppressed pending steward
Outreach
PRV-26245 (Amy Bennett) held until CASE-002150 is decided
Case id
CASE-002150
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-26245
Held—
4,326 rows, page 43 of 87PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A 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.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.