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-016595 | Outreach suppressed pending steward Outreach | CLM-421530 (Omar Webb) held until CASE-003151 is decided |
| Held | — | ||
| ACT-016596 | Outreach suppressed pending steward Outreach | CLM-421529 (Omar Webb) held until CASE-003152 is decided |
| Held | — | ||
| ACT-016597 | Outreach suppressed pending steward Outreach | TPA-56434 (Jonathan Carter) held until CASE-003153 is decided |
| Held | — | ||
| ACT-016598 | Outreach suppressed pending steward Outreach | TPA-56435 (Jonathan Carter) held until CASE-003154 is decided |
| Held | — | ||
| ACT-016599 | Outreach suppressed pending steward Outreach | CLM-419813 (Jordan Sims) held until CASE-003155 is decided |
| Held | — | ||
| ACT-016600 | Outreach suppressed pending steward Outreach | TPA-58741 (Jordan Siims) held until CASE-003156 is decided |
| Held | — | ||
| ACT-016601 | Outreach suppressed pending steward Outreach | ENR-117556 (Mills Ana) held until CASE-003157 is decided |
| Held | — | ||
| ACT-016602 | Outreach suppressed pending steward Outreach | TPA-57897 (Keith Myers) held until CASE-003158 is decided |
| Held | — | ||
| ACT-016603 | Outreach suppressed pending steward Outreach | CLM-431989 (Austin Hansen) held until CASE-003159 is decided |
| Held | — | ||
| ACT-016604 | Outreach suppressed pending steward Outreach | CLM-431988 (Austin Hansen) held until CASE-003160 is decided |
| Held | — | ||
| ACT-016605 | Outreach suppressed pending steward Outreach | TPA-51641 (Mariana Bradley) held until CASE-003161 is decided |
| Held | — | ||
| ACT-016606 | Outreach suppressed pending steward Outreach | ENR-123814 (Jason Bryant) held until CASE-003162 is decided |
| Held | — | ||
| ACT-016607 | Outreach suppressed pending steward Outreach | CLM-426027 (John Hayes) held until CASE-003163 is decided |
| Held | — | ||
| ACT-016608 | Outreach suppressed pending steward Outreach | TPA-62142 (Julia Walsh) held until CASE-003164 is decided |
| Held | — | ||
| ACT-016609 | Outreach suppressed pending steward Outreach | TPA-62184 (Marcus Richardson) held until CASE-003165 is decided |
| Held | — | ||
| ACT-016610 | Outreach suppressed pending steward Outreach | TPA-51779 (Beverly Fuller) held until CASE-003166 is decided |
| Held | — | ||
| ACT-016611 | Outreach suppressed pending steward Outreach | PRV-24529 (George Hall) held until CASE-003167 is decided |
| Held | — | ||
| ACT-016612 | Outreach suppressed pending steward Outreach | ENR-135648 (Isabella Shaw) held until CASE-003168 is decided |
| Held | — | ||
| ACT-016613 | Outreach suppressed pending steward Outreach | TPA-62013 (Isabella Shaw) held until CASE-003169 is decided |
| Held | — | ||
| ACT-016614 | Outreach suppressed pending steward Outreach | CLM-422008 (Ruth Sandoval) held until CASE-003170 is decided |
| Held | — | ||
| ACT-016615 | Outreach suppressed pending steward Outreach | CLM-427313 (Brenda Stewart) held until CASE-003171 is decided |
| Held | — | ||
| ACT-016616 | Outreach suppressed pending steward Outreach | ENR-102241 (Joe Stewart) held until CASE-003172 is decided |
| Held | — | ||
| ACT-016617 | Outreach suppressed pending steward Outreach | TPA-54220 (Samantha Patterson) held until CASE-003173 is decided |
| Held | — | ||
| ACT-016618 | Outreach suppressed pending steward Outreach | TPA-57646 (Lori Obrien) held until CASE-003174 is decided |
| Held | — | ||
| ACT-016619 | Outreach suppressed pending steward Outreach | CLM-417315 (Lori Obrien) held until CASE-003175 is decided |
| Held | — | ||
| ACT-016620 | Outreach suppressed pending steward Outreach | ENR-114031 (Ashley Ford) held until CASE-003176 is decided |
| Held | — | ||
| ACT-016621 | Outreach suppressed pending steward Outreach | TPA-54691 (Ashley Ford) held until CASE-003177 is decided |
| Held | — | ||
| ACT-016622 | Outreach suppressed pending steward Outreach | CLM-404114 (Marcus Espinoza) held until CASE-003178 is decided |
| Held | — | ||
| ACT-016623 | Outreach suppressed pending steward Outreach | ENR-105385 (Marcus Espinoza) held until CASE-003179 is decided |
| Held | — | ||
| ACT-016624 | Outreach suppressed pending steward Outreach | TPA-59493 (Austin Bishop) held until CASE-003180 is decided |
| Held | — | ||
| ACT-016625 | Outreach suppressed pending steward Outreach | ENR-128283 (Austin Bishop) held until CASE-003181 is decided |
| Held | — | ||
| ACT-016626 | Outreach suppressed pending steward Outreach | ENR-103225 (Olivia Hunt) held until CASE-003182 is decided |
| Held | — | ||
| ACT-016627 | Outreach suppressed pending steward Outreach | CLM-408862 (Logan Santos) held until CASE-003183 is decided |
| Held | — | ||
| ACT-016628 | Outreach suppressed pending steward Outreach | ENR-111705 (Logan Santos) held until CASE-003184 is decided |
| Held | — | ||
| ACT-016629 | Outreach suppressed pending steward Outreach | TPA-51784 (Ahmed Robertson) held until CASE-003185 is decided |
| Held | — | ||
| ACT-016630 | Outreach suppressed pending steward Outreach | ENR-103970 (Phlip Reynolds) held until CASE-003186 is decided |
| Held | — | ||
| ACT-016631 | Outreach suppressed pending steward Outreach | CLM-403069 (Philip Reynolds) held until CASE-003187 is decided |
| Held | — | ||
| ACT-016632 | Outreach suppressed pending steward Outreach | ENR-120446 (Raymond Johnston) held until CASE-003188 is decided |
| Held | — | ||
| ACT-016633 | Outreach suppressed pending steward Outreach | CLM-429983 (Julie Romero) held until CASE-003189 is decided |
| Held | — | ||
| ACT-016634 | Outreach suppressed pending steward Outreach | CLM-427537 (Mei Lane) held until CASE-003190 is decided |
| Held | — | ||
| ACT-016635 | Outreach suppressed pending steward Outreach | CLM-427539 (Mei Lane) held until CASE-003191 is decided |
| Held | — | ||
| ACT-016636 | Outreach suppressed pending steward Outreach | CLM-426886 (Martha McDonald) held until CASE-003192 is decided |
| Held | — | ||
| ACT-016637 | Outreach suppressed pending steward Outreach | TPA-51513 (Hiroshi Wood) held until CASE-003193 is decided |
| Held | — | ||
| ACT-016638 | Outreach suppressed pending steward Outreach | TPA-60052 (Scott Maldonado) held until CASE-003194 is decided |
| Held | — | ||
| ACT-016639 | Outreach suppressed pending steward Outreach | CLM-423249 (Daniel Crawford) held until CASE-003195 is decided |
| Held | — | ||
| ACT-016640 | Outreach suppressed pending steward Outreach | TPA-60219 (Daniel Crawford) held until CASE-003196 is decided |
| Held | — | ||
| ACT-016641 | Outreach suppressed pending steward Outreach | CLM-431211 (Arjun Crawford) held until CASE-003197 is decided |
| Held | — | ||
| ACT-016642 | Outreach suppressed pending steward Outreach | TPA-52261 (Gregory Hunt) held until CASE-003198 is decided |
| Held | — | ||
| ACT-016643 | Outreach suppressed pending steward Outreach | CLM-418467 (Brittany Rios) held until CASE-003199 is decided |
| Held | — | ||
| ACT-016644 | Outreach suppressed pending steward Outreach | PRV-20910 (Christian Lawson) held until CASE-003200 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.