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
ActionTypeTitleDetailLinked toStatusExecuted
ACT-016495
Outreach suppressed pending steward
Outreach
CLM-420021 (Hiroshi Guerrero) held until CASE-003051 is decided
Case id
CASE-003051
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-420021
Held—
ACT-016496
Outreach suppressed pending steward
Outreach
CLM-426726 (Bobby Ferguson) held until CASE-003052 is decided
Case id
CASE-003052
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-426726
Held—
ACT-016497
Outreach suppressed pending steward
Outreach
TPA-61805 (Bobby Ferguson) held until CASE-003053 is decided
Case id
CASE-003053
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-61805
Held—
ACT-016498
Outreach suppressed pending steward
Outreach
CLM-412286 (Janice Cook) held until CASE-003054 is decided
Case id
CASE-003054
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-412286
Held—
ACT-016499
Outreach suppressed pending steward
Outreach
TPA-55414 (Jnice Cook) held until CASE-003055 is decided
Case id
CASE-003055
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-55414
Held—
ACT-016500
Outreach suppressed pending steward
Outreach
PRV-26647 (Nicole Thomas) held until CASE-003056 is decided
Case id
CASE-003056
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-26647
Held—
ACT-016501
Outreach suppressed pending steward
Outreach
ENR-129530 (Nicole Thomas) held until CASE-003057 is decided
Case id
CASE-003057
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-129530
Held—
ACT-016502
Outreach suppressed pending steward
Outreach
TPA-50861 (Sean Alvarado) held until CASE-003058 is decided
Case id
CASE-003058
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-50861
Held—
ACT-016503
Outreach suppressed pending steward
Outreach
TPA-56988 (Arthur Kim) held until CASE-003059 is decided
Case id
CASE-003059
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-56988
Held—
ACT-016504
Outreach suppressed pending steward
Outreach
TPA-50531 (Yuki Stone) held until CASE-003060 is decided
Case id
CASE-003060
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-50531
Held—
ACT-016505
Outreach suppressed pending steward
Outreach
PRV-27543 (Aaron Nunez) held until CASE-003061 is decided
Case id
CASE-003061
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-27543
Held—
ACT-016506
Outreach suppressed pending steward
Outreach
CLM-425617 (Aaron Nunez) held until CASE-003062 is decided
Case id
CASE-003062
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-425617
Held—
ACT-016507
Outreach suppressed pending steward
Outreach
CLM-403818 (Kelly Carroll) held until CASE-003063 is decided
Case id
CASE-003063
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-403818
Held—
ACT-016508
Outreach suppressed pending steward
Outreach
TPA-51658 (Kelly Carroll) held until CASE-003064 is decided
Case id
CASE-003064
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-51658
Held—
ACT-016509
Outreach suppressed pending steward
Outreach
CLM-403819 (Kelly Carroll) held until CASE-003065 is decided
Case id
CASE-003065
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-403819
Held—
ACT-016510
Outreach suppressed pending steward
Outreach
ENR-108852 (Andrew Crawford) held until CASE-003066 is decided
Case id
CASE-003066
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-108852
Held—
ACT-016511
Outreach suppressed pending steward
Outreach
CLM-406783 (Andrew Crawford) held until CASE-003067 is decided
Case id
CASE-003067
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-406783
Held—
ACT-016512
Outreach suppressed pending steward
Outreach
TPA-63854 (Alice Snyder) held until CASE-003068 is decided
Case id
CASE-003068
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-63854
Held—
ACT-016513
Outreach suppressed pending steward
Outreach
ENR-141197 (Alice Snyder) held until CASE-003069 is decided
Case id
CASE-003069
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-141197
Held—
ACT-016514
Outreach suppressed pending steward
Outreach
TPA-54496 (Martha Price) held until CASE-003070 is decided
Case id
CASE-003070
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-54496
Held—
ACT-016515
Outreach suppressed pending steward
Outreach
ENR-131785 (Heather Medina) held until CASE-003071 is decided
Case id
CASE-003071
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-131785
Held—
ACT-016516
Outreach suppressed pending steward
Outreach
PRV-27162 (Heather Medina) held until CASE-003072 is decided
Case id
CASE-003072
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-27162
Held—
ACT-016517
Outreach suppressed pending steward
Outreach
PRV-27387 (Steven Gibson) held until CASE-003073 is decided
Case id
CASE-003073
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-27387
Held—
ACT-016518
Outreach suppressed pending steward
Outreach
ENR-129546 (Frances Long) held until CASE-003074 is decided
Case id
CASE-003074
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-129546
Held—
ACT-016519
Outreach suppressed pending steward
Outreach
CLM-400198 (Robert Jenkins) held until CASE-003075 is decided
Case id
CASE-003075
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-400198
Held—
ACT-016520
Outreach suppressed pending steward
Outreach
ENR-101633 (Wayne James) held until CASE-003076 is decided
Case id
CASE-003076
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-101633
Held—
ACT-016521
Outreach suppressed pending steward
Outreach
CLM-401262 (Wayne James) held until CASE-003077 is decided
Case id
CASE-003077
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-401262
Held—
ACT-016522
Outreach suppressed pending steward
Outreach
ENR-106215 (Harold Ortega) held until CASE-003078 is decided
Case id
CASE-003078
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-106215
Held—
ACT-016523
Outreach suppressed pending steward
Outreach
TPA-52063 (Harold Ortega) held until CASE-003079 is decided
Case id
CASE-003079
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-52063
Held—
ACT-016524
Outreach suppressed pending steward
Outreach
CLM-409975 (Emma Ortiz) held until CASE-003080 is decided
Case id
CASE-003080
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-409975
Held—
ACT-016525
Outreach suppressed pending steward
Outreach
CLM-409976 (Emma Ortiz) held until CASE-003081 is decided
Case id
CASE-003081
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-409976
Held—
ACT-016526
Outreach suppressed pending steward
Outreach
TPA-50642 (Roger Ortiz) held until CASE-003082 is decided
Case id
CASE-003082
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-50642
Held—
ACT-016527
Outreach suppressed pending steward
Outreach
TPA-63495 (Liz Riley) held until CASE-003083 is decided
Case id
CASE-003083
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-63495
Held—
ACT-016528
Outreach suppressed pending steward
Outreach
CLM-430562 (Elizabeth Riley) held until CASE-003084 is decided
Case id
CASE-003084
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-430562
Held—
ACT-016529
Outreach suppressed pending steward
Outreach
CLM-403707 (Andrea Riley) held until CASE-003085 is decided
Case id
CASE-003085
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-403707
Held—
ACT-016530
Outreach suppressed pending steward
Outreach
CLM-403706 (Andrea Riley) held until CASE-003086 is decided
Case id
CASE-003086
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-403706
Held—
ACT-016531
Outreach suppressed pending steward
Outreach
CLM-413105 (Henry Hanson) held until CASE-003087 is decided
Case id
CASE-003087
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-413105
Held—
ACT-016532
Outreach suppressed pending steward
Outreach
CLM-411983 (Fuller Christian) held until CASE-003088 is decided
Case id
CASE-003088
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-411983
Held—
ACT-016533
Outreach suppressed pending steward
Outreach
TPA-54681 (Lawrence Cunningham) held until CASE-003089 is decided
Case id
CASE-003089
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-54681
Held—
ACT-016534
Outreach suppressed pending steward
Outreach
TPA-51422 (Omar Rios) held until CASE-003090 is decided
Case id
CASE-003090
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-51422
Held—
ACT-016535
Outreach suppressed pending steward
Outreach
ENR-106049 (Donna Austin) held until CASE-003091 is decided
Case id
CASE-003091
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-106049
Held—
ACT-016536
Outreach suppressed pending steward
Outreach
CLM-404583 (Donna Austin) held until CASE-003092 is decided
Case id
CASE-003092
Source
CLM
Reason
identity below confidence threshold; sensitive communication withheld
CLM-404583
Held—
ACT-016537
Outreach suppressed pending steward
Outreach
PRV-21943 (Priya Adams) held until CASE-003093 is decided
Case id
CASE-003093
Source
PRV
Reason
identity below confidence threshold; sensitive communication withheld
PRV-21943
Held—
ACT-016538
Outreach suppressed pending steward
Outreach
ENR-108678 (Priya Adams) held until CASE-003094 is decided
Case id
CASE-003094
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-108678
Held—
ACT-016539
Outreach suppressed pending steward
Outreach
ENR-123792 (Mark Miller) held until CASE-003095 is decided
Case id
CASE-003095
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-123792
Held—
ACT-016540
Outreach suppressed pending steward
Outreach
TPA-57996 (Mark Miller) held until CASE-003096 is decided
Case id
CASE-003096
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-57996
Held—
ACT-016541
Outreach suppressed pending steward
Outreach
TPA-60043 (Eugene Anderson) held until CASE-003097 is decided
Case id
CASE-003097
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-60043
Held—
ACT-016542
Outreach suppressed pending steward
Outreach
TPA-51941 (Obrien Joyce) held until CASE-003098 is decided
Case id
CASE-003098
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-51941
Held—
ACT-016543
Outreach suppressed pending steward
Outreach
ENR-122807 (Ryan Washington) held until CASE-003099 is decided
Case id
CASE-003099
Source
ENR
Reason
identity below confidence threshold; sensitive communication withheld
ENR-122807
Held—
ACT-016544
Outreach suppressed pending steward
Outreach
TPA-57644 (Ryan Washington) held until CASE-003100 is decided
Case id
CASE-003100
Source
TPA
Reason
identity below confidence threshold; sensitive communication withheld
TPA-57644
Held—
4,326 rows, page 62 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.