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-016845 | Outreach suppressed pending steward Outreach | PRV-28939 (Kathryn Ray) held until CASE-003401 is decided |
| Held | — | ||
| ACT-016846 | Outreach suppressed pending steward Outreach | CLM-403358 (Jose Dixon) held until CASE-003402 is decided |
| Held | — | ||
| ACT-016847 | Outreach suppressed pending steward Outreach | TPA-60341 (Vincent Perry) held until CASE-003403 is decided |
| Held | — | ||
| ACT-016848 | Outreach suppressed pending steward Outreach | ENR-113386 (Katherine Romero) held until CASE-003404 is decided |
| Held | — | ||
| ACT-016849 | Outreach suppressed pending steward Outreach | CLM-410172 (Romero Katherine) held until CASE-003405 is decided |
| Held | — | ||
| ACT-016850 | Outreach suppressed pending steward Outreach | ENR-137879 (Madison Flores) held until CASE-003406 is decided |
| Held | — | ||
| ACT-016851 | Outreach suppressed pending steward Outreach | CLM-428889 (Madison Flores) held until CASE-003407 is decided |
| Held | — | ||
| ACT-016852 | Outreach suppressed pending steward Outreach | TPA-57965 (Kayla Turner) held until CASE-003408 is decided |
| Held | — | ||
| ACT-016853 | Outreach suppressed pending steward Outreach | ENR-111221 (Stephanie Turner) held until CASE-003409 is decided |
| Held | — | ||
| ACT-016854 | Outreach suppressed pending steward Outreach | TPA-51232 (Stephen Ray) held until CASE-003410 is decided |
| Held | — | ||
| ACT-016855 | Outreach suppressed pending steward Outreach | ENR-140853 (Laura Cruz) held until CASE-003411 is decided |
| Held | — | ||
| ACT-016856 | Outreach suppressed pending steward Outreach | ENR-136110 (Donald Mendez) held until CASE-003412 is decided |
| Held | — | ||
| ACT-016857 | Outreach suppressed pending steward Outreach | PRV-28070 (Donald Mendez) held until CASE-003413 is decided |
| Held | — | ||
| ACT-016858 | Outreach suppressed pending steward Outreach | CLM-407119 (Frank Bowman) held until CASE-003414 is decided |
| Held | — | ||
| ACT-016859 | Outreach suppressed pending steward Outreach | CLM-410355 (Pamela Richards) held until CASE-003415 is decided |
| Held | — | ||
| ACT-016860 | Outreach suppressed pending steward Outreach | TPA-53288 (Teresa Hansen) held until CASE-003416 is decided |
| Held | — | ||
| ACT-016861 | Outreach suppressed pending steward Outreach | TPA-53287 (Teresa Hansen) held until CASE-003417 is decided |
| Held | — | ||
| ACT-016862 | Outreach suppressed pending steward Outreach | TPA-54301 (Charlotte Greene) held until CASE-003418 is decided |
| Held | — | ||
| ACT-016863 | Outreach suppressed pending steward Outreach | ENR-112994 (Charlotte Greene) held until CASE-003419 is decided |
| Held | — | ||
| ACT-016864 | Outreach suppressed pending steward Outreach | CLM-416650 (Christine Smipson) held until CASE-003420 is decided |
| Held | — | ||
| ACT-016865 | Outreach suppressed pending steward Outreach | ENR-141667 (Diego Larsun) held until CASE-003421 is decided |
| Held | — | ||
| ACT-016866 | Outreach suppressed pending steward Outreach | CLM-431767 (Diego Larson) held until CASE-003422 is decided |
| Held | — | ||
| ACT-016867 | Outreach suppressed pending steward Outreach | CLM-424879 (Masno Price) held until CASE-003423 is decided |
| Held | — | ||
| ACT-016868 | Outreach suppressed pending steward Outreach | TPA-63404 (Arthur Burns) held until CASE-003424 is decided |
| Held | — | ||
| ACT-016869 | Outreach suppressed pending steward Outreach | CLM-400037 (Donna Hunter) held until CASE-003425 is decided |
| Held | — | ||
| ACT-016870 | Outreach suppressed pending steward Outreach | TPA-59309 (Gabriel Castro) held until CASE-003426 is decided |
| Held | — | ||
| ACT-016871 | Outreach suppressed pending steward Outreach | CLM-413971 (Kelly Duncan) held until CASE-003427 is decided |
| Held | — | ||
| ACT-016872 | Outreach suppressed pending steward Outreach | TPA-56364 (Linda Patterson) held until CASE-003428 is decided |
| Held | — | ||
| ACT-016873 | Outreach suppressed pending steward Outreach | CLM-414433 (Donna Jacobs) held until CASE-003429 is decided |
| Held | — | ||
| ACT-016874 | Outreach suppressed pending steward Outreach | ENR-132437 (Alan Dean) held until CASE-003430 is decided |
| Held | — | ||
| ACT-016875 | Outreach suppressed pending steward Outreach | CLM-424840 (Alan Dean) held until CASE-003431 is decided |
| Held | — | ||
| ACT-016876 | Outreach suppressed pending steward Outreach | ENR-115782 (Julie Bowman) held until CASE-003432 is decided |
| Held | — | ||
| ACT-016877 | Outreach suppressed pending steward Outreach | TPA-62510 (Jerry Snyder) held until CASE-003433 is decided |
| Held | — | ||
| ACT-016878 | Outreach suppressed pending steward Outreach | CLM-428328 (Jerry Snyder) held until CASE-003434 is decided |
| Held | — | ||
| ACT-016879 | Outreach suppressed pending steward Outreach | CLM-425226 (Jose Matthews) held until CASE-003435 is decided |
| Held | — | ||
| ACT-016880 | Outreach suppressed pending steward Outreach | PRV-27411 (Jose Matthews) held until CASE-003436 is decided |
| Held | — | ||
| ACT-016881 | Outreach suppressed pending steward Outreach | TPA-54893 (Patrick Alexander) held until CASE-003437 is decided |
| Held | — | ||
| ACT-016882 | Outreach suppressed pending steward Outreach | ENR-130816 (Ryan Cox) held until CASE-003438 is decided |
| Held | — | ||
| ACT-016883 | Outreach suppressed pending steward Outreach | TPA-60365 (Ryan Cox) held until CASE-003439 is decided |
| Held | — | ||
| ACT-016884 | Outreach suppressed pending steward Outreach | PRV-26297 (Dyln Bowman) held until CASE-003440 is decided |
| Held | — | ||
| ACT-016885 | Outreach suppressed pending steward Outreach | TPA-57538 (Russell Matthews) held until CASE-003441 is decided |
| Held | — | ||
| ACT-016886 | Outreach suppressed pending steward Outreach | CLM-409800 (Santiago Munoz) held until CASE-003442 is decided |
| Held | — | ||
| ACT-016887 | Outreach suppressed pending steward Outreach | PRV-28853 (Austin Miller) held until CASE-003443 is decided |
| Held | — | ||
| ACT-016888 | Outreach suppressed pending steward Outreach | CLM-405038 (Carlos Young) held until CASE-003444 is decided |
| Held | — | ||
| ACT-016889 | Outreach suppressed pending steward Outreach | ENR-125231 (Eugene Bell) held until CASE-003445 is decided |
| Held | — | ||
| ACT-016890 | Outreach suppressed pending steward Outreach | CLM-419150 (Eugene Bell) held until CASE-003446 is decided |
| Held | — | ||
| ACT-016891 | Outreach suppressed pending steward Outreach | TPA-56035 (Christian Burton) held until CASE-003447 is decided |
| Held | — | ||
| ACT-016892 | Outreach suppressed pending steward Outreach | PRV-20491 (Gloria Chapman) held until CASE-003448 is decided |
| Held | — | ||
| ACT-016893 | Outreach suppressed pending steward Outreach | CLM-425551 (Nancy Vaga) held until CASE-003449 is decided |
| Held | — | ||
| ACT-016894 | Outreach suppressed pending steward Outreach | CLM-401064 (Danielle Harper) held until CASE-003450 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.