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-016695 | Outreach suppressed pending steward Outreach | TPA-62569 (Dennis Parker) held until CASE-003251 is decided |
| Held | — | ||
| ACT-016696 | Outreach suppressed pending steward Outreach | PRV-20760 (Julia Nguyen) held until CASE-003252 is decided |
| Held | — | ||
| ACT-016697 | Outreach suppressed pending steward Outreach | CLM-402637 (Julia Nguyen) held until CASE-003253 is decided |
| Held | — | ||
| ACT-016698 | Outreach suppressed pending steward Outreach | CLM-413050 (Paul Mejia) held until CASE-003254 is decided |
| Held | — | ||
| ACT-016699 | Outreach suppressed pending steward Outreach | ENR-122024 (Julie Nunez) held until CASE-003255 is decided |
| Held | — | ||
| ACT-016700 | Outreach suppressed pending steward Outreach | TPA-57391 (Julie Nunez) held until CASE-003256 is decided |
| Held | — | ||
| ACT-016701 | Outreach suppressed pending steward Outreach | PRV-21371 (Luis Jimenez) held until CASE-003257 is decided |
| Held | — | ||
| ACT-016702 | Outreach suppressed pending steward Outreach | TPA-61195 (Evelyn Medina) held until CASE-003258 is decided |
| Held | — | ||
| ACT-016703 | Outreach suppressed pending steward Outreach | TPA-54008 (Steven Johnson) held until CASE-003259 is decided |
| Held | — | ||
| ACT-016704 | Outreach suppressed pending steward Outreach | CLM-413272 (Joe Peters) held until CASE-003260 is decided |
| Held | — | ||
| ACT-016705 | Outreach suppressed pending steward Outreach | CLM-407675 (Christian Porter) held until CASE-003261 is decided |
| Held | — | ||
| ACT-016706 | Outreach suppressed pending steward Outreach | TPA-53367 (Christian Porter) held until CASE-003262 is decided |
| Held | — | ||
| ACT-016707 | Outreach suppressed pending steward Outreach | CLM-415886 (Judith Sullivan) held until CASE-003263 is decided |
| Held | — | ||
| ACT-016708 | Outreach suppressed pending steward Outreach | PRV-28380 (Madison Butler) held until CASE-003264 is decided |
| Held | — | ||
| ACT-016709 | Outreach suppressed pending steward Outreach | CLM-411365 (Elizabeth Ray) held until CASE-003265 is decided |
| Held | — | ||
| ACT-016710 | Outreach suppressed pending steward Outreach | PRV-26682 (Mateo Mason) held until CASE-003266 is decided |
| Held | — | ||
| ACT-016711 | Outreach suppressed pending steward Outreach | CLM-429009 (Andrea Powell) held until CASE-003267 is decided |
| Held | — | ||
| ACT-016712 | Outreach suppressed pending steward Outreach | CLM-429010 (Andrea Powell) held until CASE-003268 is decided |
| Held | — | ||
| ACT-016713 | Outreach suppressed pending steward Outreach | ENR-110008 (Mei Moreno) held until CASE-003269 is decided |
| Held | — | ||
| ACT-016714 | Outreach suppressed pending steward Outreach | TPA-52717 (Hiroshi Murphy) held until CASE-003270 is decided |
| Held | — | ||
| ACT-016715 | Outreach suppressed pending steward Outreach | ENR-100324 (Wei Murphy) held until CASE-003271 is decided |
| Held | — | ||
| ACT-016716 | Outreach suppressed pending steward Outreach | CLM-400229 (Wei Murphy) held until CASE-003272 is decided |
| Held | — | ||
| ACT-016717 | Outreach suppressed pending steward Outreach | PRV-21383 (Angela Kennedy) held until CASE-003273 is decided |
| Held | — | ||
| ACT-016718 | Outreach suppressed pending steward Outreach | CLM-432083 (Jeffrey Warren) held until CASE-003274 is decided |
| Held | — | ||
| ACT-016719 | Outreach suppressed pending steward Outreach | TPA-64162 (Jeff Warren) held until CASE-003275 is decided |
| Held | — | ||
| ACT-016720 | Outreach suppressed pending steward Outreach | TPA-62036 (Juan Richardson) held until CASE-003276 is decided |
| Held | — | ||
| ACT-016721 | Outreach suppressed pending steward Outreach | PRV-27125 (Timothhy Alexander) held until CASE-003277 is decided |
| Held | — | ||
| ACT-016722 | Outreach suppressed pending steward Outreach | CLM-424191 (Timothy Alexander) held until CASE-003278 is decided |
| Held | — | ||
| ACT-016723 | Outreach suppressed pending steward Outreach | PRV-28747 (Kevin Guzman) held until CASE-003279 is decided |
| Held | — | ||
| ACT-016724 | Outreach suppressed pending steward Outreach | PRV-28748 (Kevin Guzman) held until CASE-003280 is decided |
| Held | — | ||
| ACT-016725 | Outreach suppressed pending steward Outreach | CLM-428555 (Robert Gilbert) held until CASE-003281 is decided |
| Held | — | ||
| ACT-016726 | Outreach suppressed pending steward Outreach | PRV-28388 (Robert Gilbert) held until CASE-003282 is decided |
| Held | — | ||
| ACT-016727 | Outreach suppressed pending steward Outreach | ENR-129986 (Kelly Lawrence) held until CASE-003283 is decided |
| Held | — | ||
| ACT-016728 | Outreach suppressed pending steward Outreach | TPA-60069 (Kelly Lawrence) held until CASE-003284 is decided |
| Held | — | ||
| ACT-016729 | Outreach suppressed pending steward Outreach | ENR-109510 (Stephen Carr) held until CASE-003285 is decided |
| Held | — | ||
| ACT-016730 | Outreach suppressed pending steward Outreach | PRV-22155 (Stephen Carr) held until CASE-003286 is decided |
| Held | — | ||
| ACT-016731 | Outreach suppressed pending steward Outreach | CLM-406275 (Frances Mason) held until CASE-003287 is decided |
| Held | — | ||
| ACT-016732 | Outreach suppressed pending steward Outreach | TPA-52780 (Frances Mason) held until CASE-003288 is decided |
| Held | — | ||
| ACT-016733 | Outreach suppressed pending steward Outreach | TPA-61279 (Angela Vargas) held until CASE-003289 is decided |
| Held | — | ||
| ACT-016734 | Outreach suppressed pending steward Outreach | TPA-61254 (Roger Hawkins) held until CASE-003290 is decided |
| Held | — | ||
| ACT-016735 | Outreach suppressed pending steward Outreach | CLM-425506 (Roger Hawkins) held until CASE-003291 is decided |
| Held | — | ||
| ACT-016736 | Outreach suppressed pending steward Outreach | CLM-417198 (Mrk Hawkins) held until CASE-003292 is decided |
| Held | — | ||
| ACT-016737 | Outreach suppressed pending steward Outreach | TPA-52975 (Michael Olson) held until CASE-003293 is decided |
| Held | — | ||
| ACT-016738 | Outreach suppressed pending steward Outreach | TPA-52974 (Michael Olson) held until CASE-003294 is decided |
| Held | — | ||
| ACT-016739 | Outreach suppressed pending steward Outreach | TPA-51662 (Mason Marquez) held until CASE-003295 is decided |
| Held | — | ||
| ACT-016740 | Outreach suppressed pending steward Outreach | TPA-52774 (Nancy Hoffman) held until CASE-003296 is decided |
| Held | — | ||
| ACT-016741 | Outreach suppressed pending steward Outreach | CLM-406269 (Nancy Hoffman) held until CASE-003297 is decided |
| Held | — | ||
| ACT-016742 | Outreach suppressed pending steward Outreach | PRV-26270 (Victoria Estrada) held until CASE-003298 is decided |
| Held | — | ||
| ACT-016743 | Outreach suppressed pending steward Outreach | TPA-56663 (Madison Cole) held until CASE-003299 is decided |
| Held | — | ||
| ACT-016744 | Outreach suppressed pending steward Outreach | TPA-52595 (Benjamin Brown) held until CASE-003300 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.