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-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.