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-014252 | Outreach suppressed pending steward Outreach | TPA-52846 (Evelyn Simmons) held until CASE-000808 is decided |
| Held | — | ||
| ACT-014253 | Outreach suppressed pending steward Outreach | CLM-402507 (William Simmons) held until CASE-000809 is decided |
| Held | — | ||
| ACT-014254 | Outreach suppressed pending steward Outreach | CLM-420531 (Luis Patterson) held until CASE-000810 is decided |
| Held | — | ||
| ACT-014255 | Outreach suppressed pending steward Outreach | TPA-59592 (Wei Lawrence) held until CASE-000811 is decided |
| Held | — | ||
| ACT-014256 | Outreach suppressed pending steward Outreach | TPA-50258 (Anthony Nunez) held until CASE-000812 is decided |
| Held | — | ||
| ACT-014257 | Outreach suppressed pending steward Outreach | ENR-100769 (Anthony Nunze) held until CASE-000813 is decided |
| Held | — | ||
| ACT-014258 | Outreach suppressed pending steward Outreach | ENR-108107 (Dylan Williamson) held until CASE-000814 is decided |
| Held | — | ||
| ACT-014259 | Outreach suppressed pending steward Outreach | TPA-64051 (Austin Williamson) held until CASE-000815 is decided |
| Held | — | ||
| ACT-014260 | Outreach suppressed pending steward Outreach | PRV-29313 (Austin Williamson) held until CASE-000816 is decided |
| Held | — | ||
| ACT-014261 | Outreach suppressed pending steward Outreach | TPA-64322 (Valentina Mejia) held until CASE-000817 is decided |
| Held | — | ||
| ACT-014262 | Outreach suppressed pending steward Outreach | TPA-55120 (Lawrencce Mejia) held until CASE-000818 is decided |
| Held | — | ||
| ACT-014263 | Outreach suppressed pending steward Outreach | TPA-54842 (Alice Vasquez) held until CASE-000819 is decided |
| Held | — | ||
| ACT-014264 | Outreach suppressed pending steward Outreach | PRV-23215 (Alice Vasquez) held until CASE-000820 is decided |
| Held | — | ||
| ACT-014265 | Outreach suppressed pending steward Outreach | TPA-63050 (George Park) held until CASE-000821 is decided |
| Held | — | ||
| ACT-014266 | Outreach suppressed pending steward Outreach | CLM-415473 (James Reid) held until CASE-000822 is decided |
| Held | — | ||
| ACT-014267 | Outreach suppressed pending steward Outreach | CLM-419770 (Hannah Schultz) held until CASE-000823 is decided |
| Held | — | ||
| ACT-014268 | Outreach suppressed pending steward Outreach | TPA-52851 (Ralph Schultz) held until CASE-000824 is decided |
| Held | — | ||
| ACT-014269 | Outreach suppressed pending steward Outreach | TPA-53162 (Gloria Rogers) held until CASE-000825 is decided |
| Held | — | ||
| ACT-014270 | Outreach suppressed pending steward Outreach | TPA-63624 (Pamela Wheeler) held until CASE-000826 is decided |
| Held | — | ||
| ACT-014271 | Outreach suppressed pending steward Outreach | CLM-407094 (Joseph Wheeler) held until CASE-000827 is decided |
| Held | — | ||
| ACT-014272 | Outreach suppressed pending steward Outreach | TPA-53938 (Brittany Wheeler) held until CASE-000828 is decided |
| Held | — | ||
| ACT-014273 | Outreach suppressed pending steward Outreach | TPA-53969 (Billy Le) held until CASE-000829 is decided |
| Held | — | ||
| ACT-014274 | Outreach suppressed pending steward Outreach | CLM-423405 (Scott Duncan) held until CASE-000830 is decided |
| Held | — | ||
| ACT-014275 | Outreach suppressed pending steward Outreach | TPA-62328 (Kevin Fernandez) held until CASE-000831 is decided |
| Held | — | ||
| ACT-014276 | Outreach suppressed pending steward Outreach | ENR-120098 (Peter Gray) held until CASE-000832 is decided |
| Held | — | ||
| ACT-014277 | Outreach suppressed pending steward Outreach | CLM-406167 (Helen Graay) held until CASE-000833 is decided |
| Held | — | ||
| ACT-014278 | Outreach suppressed pending steward Outreach | CLM-405901 (Jacob Fulleer) held until CASE-000834 is decided |
| Held | — | ||
| ACT-014279 | Outreach suppressed pending steward Outreach | ENR-107770 (Jacob Fuller) held until CASE-000835 is decided |
| Held | — | ||
| ACT-014280 | Outreach suppressed pending steward Outreach | TPA-63383 (Ethan Weber) held until CASE-000836 is decided |
| Held | — | ||
| ACT-014281 | Outreach suppressed pending steward Outreach | TPA-58994 (Jennifer Watkins) held until CASE-000837 is decided |
| Held | — | ||
| ACT-014282 | Outreach suppressed pending steward Outreach | TPA-59197 (Denise Lucas) held until CASE-000838 is decided |
| Held | — | ||
| ACT-014283 | Outreach suppressed pending steward Outreach | PRV-21947 (Joyce Perry) held until CASE-000839 is decided |
| Held | — | ||
| ACT-014284 | Outreach suppressed pending steward Outreach | TPA-53106 (Maria Collins) held until CASE-000840 is decided |
| Held | — | ||
| ACT-014285 | Outreach suppressed pending steward Outreach | TPA-50682 (Megan Peters) held until CASE-000841 is decided |
| Held | — | ||
| ACT-014286 | Outreach suppressed pending steward Outreach | ENR-102040 (Megan Peters) held until CASE-000842 is decided |
| Held | — | ||
| ACT-014287 | Outreach suppressed pending steward Outreach | TPA-53683 (Alyce Butler) held until CASE-000843 is decided |
| Held | — | ||
| ACT-014288 | Outreach suppressed pending steward Outreach | CLM-408395 (Alice Butler) held until CASE-000844 is decided |
| Held | — | ||
| ACT-014289 | Outreach suppressed pending steward Outreach | TPA-54391 (Amber Hamilton) held until CASE-000845 is decided |
| Held | — | ||
| ACT-014290 | Outreach suppressed pending steward Outreach | PRV-29465 (Lucia Jimenez) held until CASE-000846 is decided |
| Held | — | ||
| ACT-014291 | Outreach suppressed pending steward Outreach | TPA-59384 (Ben Dean) held until CASE-000847 is decided |
| Held | — | ||
| ACT-014292 | Outreach suppressed pending steward Outreach | CLM-421347 (Benjamin Dean) held until CASE-000848 is decided |
| Held | — | ||
| ACT-014293 | Outreach suppressed pending steward Outreach | CLM-415509 (Carolin Fields) held until CASE-000849 is decided |
| Held | — | ||
| ACT-014294 | Outreach suppressed pending steward Outreach | CLM-432331 (Brittany Torres) held until CASE-000850 is decided |
| Held | — | ||
| ACT-014295 | Outreach suppressed pending steward Outreach | TPA-58529 (Billy Hayes) held until CASE-000851 is decided |
| Held | — | ||
| ACT-014296 | Outreach suppressed pending steward Outreach | ENR-125445 (Billy Hayes) held until CASE-000852 is decided |
| Held | — | ||
| ACT-014297 | Outreach suppressed pending steward Outreach | ENR-110294 (John Schmidt) held until CASE-000853 is decided |
| Held | — | ||
| ACT-014298 | Outreach suppressed pending steward Outreach | CLM-407824 (John Schmidt) held until CASE-000854 is decided |
| Held | — | ||
| ACT-014299 | Outreach suppressed pending steward Outreach | ENR-115860 (Nathan Black) held until CASE-000855 is decided |
| Held | — | ||
| ACT-014300 | Outreach suppressed pending steward Outreach | TPA-55311 (Nathan Black) held until CASE-000856 is decided |
| Held | — | ||
| ACT-014301 | Outreach suppressed pending steward Outreach | ENR-111009 (Stephen Reyes) held until CASE-000857 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.