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-016645 | Outreach suppressed pending steward Outreach | PRV-25516 (Jesse Cunningham) held until CASE-003201 is decided |
| Held | — | ||
| ACT-016646 | Outreach suppressed pending steward Outreach | ENR-124479 (Jesse Cunningham) held until CASE-003202 is decided |
| Held | — | ||
| ACT-016647 | Outreach suppressed pending steward Outreach | CLM-413828 (Karen Gibson) held until CASE-003203 is decided |
| Held | — | ||
| ACT-016648 | Outreach suppressed pending steward Outreach | TPA-60987 (Henry Fisher) held until CASE-003204 is decided |
| Held | — | ||
| ACT-016649 | Outreach suppressed pending steward Outreach | CLM-405373 (Robert Hoffman) held until CASE-003205 is decided |
| Held | — | ||
| ACT-016650 | Outreach suppressed pending steward Outreach | TPA-59106 (Nicole Larson) held until CASE-003206 is decided |
| Held | — | ||
| ACT-016651 | Outreach suppressed pending steward Outreach | TPA-55969 (Mary Cox) held until CASE-003207 is decided |
| Held | — | ||
| ACT-016652 | Outreach suppressed pending steward Outreach | TPA-55968 (Mary Cox) held until CASE-003208 is decided |
| Held | — | ||
| ACT-016653 | Outreach suppressed pending steward Outreach | ENR-103710 (Catherine Cook) held until CASE-003209 is decided |
| Held | — | ||
| ACT-016654 | Outreach suppressed pending steward Outreach | ENR-123339 (Sophia Kelley) held until CASE-003210 is decided |
| Held | — | ||
| ACT-016655 | Outreach suppressed pending steward Outreach | CLM-417724 (Sophia Kelley) held until CASE-003211 is decided |
| Held | — | ||
| ACT-016656 | Outreach suppressed pending steward Outreach | ENR-115565 (Cynthiia Matthews) held until CASE-003212 is decided |
| Held | — | ||
| ACT-016657 | Outreach suppressed pending steward Outreach | TPA-55195 (Cynthia Maatthews) held until CASE-003213 is decided |
| Held | — | ||
| ACT-016658 | Outreach suppressed pending steward Outreach | TPA-62679 (Russell Bell) held until CASE-003214 is decided |
| Held | — | ||
| ACT-016659 | Outreach suppressed pending steward Outreach | ENR-128519 (Betty Jimenez) held until CASE-003215 is decided |
| Held | — | ||
| ACT-016660 | Outreach suppressed pending steward Outreach | TPA-59572 (Betty Jimenez) held until CASE-003216 is decided |
| Held | — | ||
| ACT-016661 | Outreach suppressed pending steward Outreach | ENR-111747 (Mracus Olson) held until CASE-003217 is decided |
| Held | — | ||
| ACT-016662 | Outreach suppressed pending steward Outreach | PRV-28611 (Harold Green) held until CASE-003218 is decided |
| Held | — | ||
| ACT-016663 | Outreach suppressed pending steward Outreach | PRV-26857 (Camila Kelly) held until CASE-003219 is decided |
| Held | — | ||
| ACT-016664 | Outreach suppressed pending steward Outreach | CLM-423212 (Camila Kelly) held until CASE-003220 is decided |
| Held | — | ||
| ACT-016665 | Outreach suppressed pending steward Outreach | ENR-104879 (Cheryl Scott) held until CASE-003221 is decided |
| Held | — | ||
| ACT-016666 | Outreach suppressed pending steward Outreach | ENR-136270 (Ann Salazar) held until CASE-003222 is decided |
| Held | — | ||
| ACT-016667 | Outreach suppressed pending steward Outreach | CLM-427678 (Ann Salazar) held until CASE-003223 is decided |
| Held | — | ||
| ACT-016668 | Outreach suppressed pending steward Outreach | CLM-417687 (Rebecca Salazar) held until CASE-003224 is decided |
| Held | — | ||
| ACT-016669 | Outreach suppressed pending steward Outreach | ENR-123301 (Rebecca Salazer) held until CASE-003225 is decided |
| Held | — | ||
| ACT-016670 | Outreach suppressed pending steward Outreach | ENR-125041 (Hannah Hoffman) held until CASE-003226 is decided |
| Held | — | ||
| ACT-016671 | Outreach suppressed pending steward Outreach | CLM-419006 (Hannaah Hoffman) held until CASE-003227 is decided |
| Held | — | ||
| ACT-016672 | Outreach suppressed pending steward Outreach | CLM-418332 (Tyler Hoffman) held until CASE-003228 is decided |
| Held | — | ||
| ACT-016673 | Outreach suppressed pending steward Outreach | CLM-425685 (Alexander Mason) held until CASE-003229 is decided |
| Held | — | ||
| ACT-016674 | Outreach suppressed pending steward Outreach | TPA-61338 (Alexander Mason) held until CASE-003230 is decided |
| Held | — | ||
| ACT-016675 | Outreach suppressed pending steward Outreach | CLM-418518 (Virginia Hudson) held until CASE-003231 is decided |
| Held | — | ||
| ACT-016676 | Outreach suppressed pending steward Outreach | TPA-52711 (Linda Gomez) held until CASE-003232 is decided |
| Held | — | ||
| ACT-016677 | Outreach suppressed pending steward Outreach | ENR-135542 (Albert Davis) held until CASE-003233 is decided |
| Held | — | ||
| ACT-016678 | Outreach suppressed pending steward Outreach | CLM-427107 (Albert Davis) held until CASE-003234 is decided |
| Held | — | ||
| ACT-016679 | Outreach suppressed pending steward Outreach | TPA-56739 (Jacike McCoy) held until CASE-003235 is decided |
| Held | — | ||
| ACT-016680 | Outreach suppressed pending steward Outreach | TPA-56740 (Jacqueline McCoy) held until CASE-003236 is decided |
| Held | — | ||
| ACT-016681 | Outreach suppressed pending steward Outreach | TPA-53237 (Brian Vazquez) held until CASE-003237 is decided |
| Held | — | ||
| ACT-016682 | Outreach suppressed pending steward Outreach | ENR-117343 (Noah Hawkins) held until CASE-003238 is decided |
| Held | — | ||
| ACT-016683 | Outreach suppressed pending steward Outreach | TPA-55813 (Noah Hawkins) held until CASE-003239 is decided |
| Held | — | ||
| ACT-016684 | Outreach suppressed pending steward Outreach | TPA-50889 (Thomas Harvey) held until CASE-003240 is decided |
| Held | — | ||
| ACT-016685 | Outreach suppressed pending steward Outreach | CLM-410929 (Alice Armstrong) held until CASE-003241 is decided |
| Held | — | ||
| ACT-016686 | Outreach suppressed pending steward Outreach | CLM-422733 (Heather Hart) held until CASE-003242 is decided |
| Held | — | ||
| ACT-016687 | Outreach suppressed pending steward Outreach | CLM-421024 (Justin Griffin) held until CASE-003243 is decided |
| Held | — | ||
| ACT-016688 | Outreach suppressed pending steward Outreach | TPA-62171 (Eric Simmons) held until CASE-003244 is decided |
| Held | — | ||
| ACT-016689 | Outreach suppressed pending steward Outreach | CLM-424897 (Frank Roberts) held until CASE-003245 is decided |
| Held | — | ||
| ACT-016690 | Outreach suppressed pending steward Outreach | CLM-427299 (Richard Graham) held until CASE-003246 is decided |
| Held | — | ||
| ACT-016691 | Outreach suppressed pending steward Outreach | ENR-118682 (Jason Greene) held until CASE-003247 is decided |
| Held | — | ||
| ACT-016692 | Outreach suppressed pending steward Outreach | CLM-414231 (Jason Greene) held until CASE-003248 is decided |
| Held | — | ||
| ACT-016693 | Outreach suppressed pending steward Outreach | ENR-121934 (Stephanie Arnold) held until CASE-003249 is decided |
| Held | — | ||
| ACT-016694 | Outreach suppressed pending steward Outreach | CLM-416701 (Stephanie Arnold) held until CASE-003250 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.