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-016445 | Outreach suppressed pending steward Outreach | ENR-131364 (Margaret Roberts) held until CASE-003001 is decided |
| Held | — | ||
| ACT-016446 | Outreach suppressed pending steward Outreach | TPA-63757 (Kenneth Ryan) held until CASE-003002 is decided |
| Held | — | ||
| ACT-016447 | Outreach suppressed pending steward Outreach | CLM-431137 (Kenneth Ryan) held until CASE-003003 is decided |
| Held | — | ||
| ACT-016448 | Outreach suppressed pending steward Outreach | PRV-25004 (Adam Jimenez) held until CASE-003004 is decided |
| Held | — | ||
| ACT-016449 | Outreach suppressed pending steward Outreach | ENR-122205 (Adam Jimenez) held until CASE-003005 is decided |
| Held | — | ||
| ACT-016450 | Outreach suppressed pending steward Outreach | TPA-57576 (William Jimenez) held until CASE-003006 is decided |
| Held | — | ||
| ACT-016451 | Outreach suppressed pending steward Outreach | TPA-52698 (Mraiana Peters) held until CASE-003007 is decided |
| Held | — | ||
| ACT-016452 | Outreach suppressed pending steward Outreach | TPA-52697 (Mariana Peters) held until CASE-003008 is decided |
| Held | — | ||
| ACT-016453 | Outreach suppressed pending steward Outreach | CLM-406609 (Sophia Carroll) held until CASE-003009 is decided |
| Held | — | ||
| ACT-016454 | Outreach suppressed pending steward Outreach | CLM-407364 (Arthur Gilbert) held until CASE-003010 is decided |
| Held | — | ||
| ACT-016455 | Outreach suppressed pending steward Outreach | TPA-60105 (Diana Mills) held until CASE-003011 is decided |
| Held | — | ||
| ACT-016456 | Outreach suppressed pending steward Outreach | TPA-60106 (Diana Mills) held until CASE-003012 is decided |
| Held | — | ||
| ACT-016457 | Outreach suppressed pending steward Outreach | PRV-26830 (Henry Weaver) held until CASE-003013 is decided |
| Held | — | ||
| ACT-016458 | Outreach suppressed pending steward Outreach | TPA-60164 (Henry Weaver) held until CASE-003014 is decided |
| Held | — | ||
| ACT-016459 | Outreach suppressed pending steward Outreach | TPA-59115 (Gary Jenkins) held until CASE-003015 is decided |
| Held | — | ||
| ACT-016460 | Outreach suppressed pending steward Outreach | TPA-59114 (Gary Jenkins) held until CASE-003016 is decided |
| Held | — | ||
| ACT-016461 | Outreach suppressed pending steward Outreach | PRV-26599 (Dorothy Richards) held until CASE-003017 is decided |
| Held | — | ||
| ACT-016462 | Outreach suppressed pending steward Outreach | TPA-59820 (Dorothy Richards) held until CASE-003018 is decided |
| Held | — | ||
| ACT-016463 | Outreach suppressed pending steward Outreach | CLM-422342 (Dorothy Richards) held until CASE-003019 is decided |
| Held | — | ||
| ACT-016464 | Outreach suppressed pending steward Outreach | PRV-23333 (Santiago Miller) held until CASE-003020 is decided |
| Held | — | ||
| ACT-016465 | Outreach suppressed pending steward Outreach | TPA-58861 (Lauren Diza) held until CASE-003021 is decided |
| Held | — | ||
| ACT-016466 | Outreach suppressed pending steward Outreach | ENR-126470 (Lauren Diaz) held until CASE-003022 is decided |
| Held | — | ||
| ACT-016467 | Outreach suppressed pending steward Outreach | CLM-404203 (George Lewis) held until CASE-003023 is decided |
| Held | — | ||
| ACT-016468 | Outreach suppressed pending steward Outreach | TPA-51191 (Gary Martin) held until CASE-003024 is decided |
| Held | — | ||
| ACT-016469 | Outreach suppressed pending steward Outreach | CLM-403213 (Carolyn Knig) held until CASE-003025 is decided |
| Held | — | ||
| ACT-016470 | Outreach suppressed pending steward Outreach | TPA-51386 (Carolyn King) held until CASE-003026 is decided |
| Held | — | ||
| ACT-016471 | Outreach suppressed pending steward Outreach | CLM-405971 (Sophia Graham) held until CASE-003027 is decided |
| Held | — | ||
| ACT-016472 | Outreach suppressed pending steward Outreach | TPA-52655 (Sophia Graham) held until CASE-003028 is decided |
| Held | — | ||
| ACT-016473 | Outreach suppressed pending steward Outreach | TPA-50095 (Alice Le) held until CASE-003029 is decided |
| Held | — | ||
| ACT-016474 | Outreach suppressed pending steward Outreach | PRV-23671 (Melissa Dixon) held until CASE-003030 is decided |
| Held | — | ||
| ACT-016475 | Outreach suppressed pending steward Outreach | CLM-412705 (Melissa Dixon) held until CASE-003031 is decided |
| Held | — | ||
| ACT-016476 | Outreach suppressed pending steward Outreach | PRV-22578 (Nathan Bennett) held until CASE-003032 is decided |
| Held | — | ||
| ACT-016477 | Outreach suppressed pending steward Outreach | CLM-416671 (Pamela Sanders) held until CASE-003033 is decided |
| Held | — | ||
| ACT-016478 | Outreach suppressed pending steward Outreach | TPA-57333 (Pamela Sanders) held until CASE-003034 is decided |
| Held | — | ||
| ACT-016479 | Outreach suppressed pending steward Outreach | TPA-50677 (Sam Mejia) held until CASE-003035 is decided |
| Held | — | ||
| ACT-016480 | Outreach suppressed pending steward Outreach | CLM-426431 (Abigail Banks) held until CASE-003036 is decided |
| Held | — | ||
| ACT-016481 | Outreach suppressed pending steward Outreach | TPA-56164 (Luis Walker) held until CASE-003037 is decided |
| Held | — | ||
| ACT-016482 | Outreach suppressed pending steward Outreach | TPA-52990 (Martha Walker) held until CASE-003038 is decided |
| Held | — | ||
| ACT-016483 | Outreach suppressed pending steward Outreach | TPA-61854 (Charlotte Kennedy) held until CASE-003039 is decided |
| Held | — | ||
| ACT-016484 | Outreach suppressed pending steward Outreach | PRV-22976 (Shirley James) held until CASE-003040 is decided |
| Held | — | ||
| ACT-016485 | Outreach suppressed pending steward Outreach | TPA-55212 (Juan Singh) held until CASE-003041 is decided |
| Held | — | ||
| ACT-016486 | Outreach suppressed pending steward Outreach | TPA-53630 (Alan Wilson) held until CASE-003042 is decided |
| Held | — | ||
| ACT-016487 | Outreach suppressed pending steward Outreach | CLM-411514 (Michael Rivera) held until CASE-003043 is decided |
| Held | — | ||
| ACT-016488 | Outreach suppressed pending steward Outreach | ENR-115144 (Michael Rivera) held until CASE-003044 is decided |
| Held | — | ||
| ACT-016489 | Outreach suppressed pending steward Outreach | CLM-410110 (Judy Alvarez) held until CASE-003045 is decided |
| Held | — | ||
| ACT-016490 | Outreach suppressed pending steward Outreach | CLM-410109 (Judy Alvarez) held until CASE-003046 is decided |
| Held | — | ||
| ACT-016491 | Outreach suppressed pending steward Outreach | PRV-22051 (Danielle Knight) held until CASE-003047 is decided |
| Held | — | ||
| ACT-016492 | Outreach suppressed pending steward Outreach | PRV-23120 (Billy Morris) held until CASE-003048 is decided |
| Held | — | ||
| ACT-016493 | Outreach suppressed pending steward Outreach | CLM-401723 (Juan Mills) held until CASE-003049 is decided |
| Held | — | ||
| ACT-016494 | Outreach suppressed pending steward Outreach | TPA-62316 (Steven Guerrero) held until CASE-003050 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.