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-013645 | Outreach suppressed pending steward Outreach | ENR-104457 (Bruce Cooper) held until CASE-000201 is decided |
| Held | — | ||
| ACT-013646 | Outreach suppressed pending steward Outreach | CLM-429039 (Aaron Howell) held until CASE-000202 is decided |
| Held | — | ||
| ACT-013647 | Outreach suppressed pending steward Outreach | ENR-117841 (Janet Dunn) held until CASE-000203 is decided |
| Held | — | ||
| ACT-013648 | Outreach suppressed pending steward Outreach | CLM-428530 (Emma Le) held until CASE-000204 is decided |
| Held | — | ||
| ACT-013649 | Outreach suppressed pending steward Outreach | ENR-137433 (Emma Le) held until CASE-000205 is decided |
| Held | — | ||
| ACT-013650 | Outreach suppressed pending steward Outreach | PRV-22307 (Keith Wallace) held until CASE-000206 is decided |
| Held | — | ||
| ACT-013651 | Outreach suppressed pending steward Outreach | ENR-110226 (Keith Wallace) held until CASE-000207 is decided |
| Held | — | ||
| ACT-013652 | Outreach suppressed pending steward Outreach | CLM-431522 (Christina Rios) held until CASE-000208 is decided |
| Held | — | ||
| ACT-013653 | Outreach suppressed pending steward Outreach | CLM-414196 (Santiago Aguilar) held until CASE-000209 is decided |
| Held | — | ||
| ACT-013654 | Outreach suppressed pending steward Outreach | CLM-431269 (Alice Ortiz) held until CASE-000210 is decided |
| Held | — | ||
| ACT-013655 | Outreach suppressed pending steward Outreach | ENR-120818 (Megan Ortiz) held until CASE-000211 is decided |
| Held | — | ||
| ACT-013656 | Outreach suppressed pending steward Outreach | TPA-51551 (Donald Hill) held until CASE-000212 is decided |
| Held | — | ||
| ACT-013657 | Outreach suppressed pending steward Outreach | ENR-104639 (Donald Hill) held until CASE-000213 is decided |
| Held | — | ||
| ACT-013658 | Outreach suppressed pending steward Outreach | CLM-403230 (Rachel Washington) held until CASE-000214 is decided |
| Held | — | ||
| ACT-013659 | Outreach suppressed pending steward Outreach | ENR-116882 (Alexander Washington) held until CASE-000215 is decided |
| Held | — | ||
| ACT-013660 | Outreach suppressed pending steward Outreach | TPA-52872 (Carl Pnea) held until CASE-000216 is decided |
| Held | — | ||
| ACT-013661 | Outreach suppressed pending steward Outreach | TPA-52873 (Carl Pena) held until CASE-000217 is decided |
| Held | — | ||
| ACT-013662 | Outreach suppressed pending steward Outreach | TPA-54535 (Matthew Perrez) held until CASE-000218 is decided |
| Held | — | ||
| ACT-013663 | Outreach suppressed pending steward Outreach | ENR-113642 (Matthew Perez) held until CASE-000219 is decided |
| Held | — | ||
| ACT-013664 | Outreach suppressed pending steward Outreach | CLM-423743 (Gloria Pierce) held until CASE-000220 is decided |
| Held | — | ||
| ACT-013665 | Outreach suppressed pending steward Outreach | ENR-131053 (Gloria Pierce) held until CASE-000221 is decided |
| Held | — | ||
| ACT-013666 | Outreach suppressed pending steward Outreach | PRV-21532 (Kathryn Garcia) held until CASE-000222 is decided |
| Held | — | ||
| ACT-013667 | Outreach suppressed pending steward Outreach | ENR-135430 (Arthur Davis) held until CASE-000223 is decided |
| Held | — | ||
| ACT-013668 | Outreach suppressed pending steward Outreach | TPA-61927 (Arthur Davis) held until CASE-000224 is decided |
| Held | — | ||
| ACT-013669 | Outreach suppressed pending steward Outreach | TPA-56433 (Tyler Lawson) held until CASE-000225 is decided |
| Held | — | ||
| ACT-013670 | Outreach suppressed pending steward Outreach | CLM-427271 (Kyle Myers) held until CASE-000226 is decided |
| Held | — | ||
| ACT-013671 | Outreach suppressed pending steward Outreach | TPA-59802 (Omaar Myres) held until CASE-000227 is decided |
| Held | — | ||
| ACT-013672 | Outreach suppressed pending steward Outreach | TPA-62715 (Jacqueline Schultz) held until CASE-000228 is decided |
| Held | — | ||
| ACT-013673 | Outreach suppressed pending steward Outreach | ENR-137747 (Jacqueline Schultz) held until CASE-000229 is decided |
| Held | — | ||
| ACT-013674 | Outreach suppressed pending steward Outreach | CLM-428068 (Stephen Rios) held until CASE-000230 is decided |
| Held | — | ||
| ACT-013675 | Outreach suppressed pending steward Outreach | ENR-136800 (Stephen Rios) held until CASE-000231 is decided |
| Held | — | ||
| ACT-013676 | Outreach suppressed pending steward Outreach | CLM-418198 (Larry Burke) held until CASE-000232 is decided |
| Held | — | ||
| ACT-013677 | Outreach suppressed pending steward Outreach | PRV-25392 (Larry Burke) held until CASE-000233 is decided |
| Held | — | ||
| ACT-013678 | Outreach suppressed pending steward Outreach | TPA-62246 (Noah Brooks) held until CASE-000234 is decided |
| Held | — | ||
| ACT-013679 | Outreach suppressed pending steward Outreach | ENR-136370 (Noah Brooks) held until CASE-000235 is decided |
| Held | — | ||
| ACT-013680 | Outreach suppressed pending steward Outreach | CLM-429767 (Eric Burke) held until CASE-000236 is decided |
| Held | — | ||
| ACT-013681 | Outreach suppressed pending steward Outreach | CLM-405275 (Roy Hansen) held until CASE-000237 is decided |
| Held | — | ||
| ACT-013682 | Outreach suppressed pending steward Outreach | ENR-106906 (Roy Hansen) held until CASE-000238 is decided |
| Held | — | ||
| ACT-013683 | Outreach suppressed pending steward Outreach | CLM-418116 (Kimberly Burns) held until CASE-000239 is decided |
| Held | — | ||
| ACT-013684 | Outreach suppressed pending steward Outreach | ENR-117235 (Patricia Williams) held until CASE-000240 is decided |
| Held | — | ||
| ACT-013685 | Outreach suppressed pending steward Outreach | PRV-23800 (Patricia Williams) held until CASE-000241 is decided |
| Held | — | ||
| ACT-013686 | Outreach suppressed pending steward Outreach | TPA-54185 (Albert Hayes) held until CASE-000242 is decided |
| Held | — | ||
| ACT-013687 | Outreach suppressed pending steward Outreach | CLM-423220 (Rachel Coleman) held until CASE-000243 is decided |
| Held | — | ||
| ACT-013688 | Outreach suppressed pending steward Outreach | PRV-20090 (Philip Le) held until CASE-000244 is decided |
| Held | — | ||
| ACT-013689 | Outreach suppressed pending steward Outreach | CLM-420872 (Donna Cook) held until CASE-000245 is decided |
| Held | — | ||
| ACT-013690 | Outreach suppressed pending steward Outreach | TPA-59912 (Keith Foster) held until CASE-000246 is decided |
| Held | — | ||
| ACT-013691 | Outreach suppressed pending steward Outreach | CLM-411164 (Gabriel Ortega) held until CASE-000247 is decided |
| Held | — | ||
| ACT-013692 | Outreach suppressed pending steward Outreach | ENR-114678 (Gabriel Ortega) held until CASE-000248 is decided |
| Held | — | ||
| ACT-013693 | Outreach suppressed pending steward Outreach | TPA-50439 (Justin Ortiz) held until CASE-000249 is decided |
| Held | — | ||
| ACT-013694 | Outreach suppressed pending steward Outreach | CLM-431076 (Robert Mason) held until CASE-000250 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.