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-017445 | Outreach suppressed pending steward Outreach | TPA-58092 (Gary Hart) held until CASE-004001 is decided |
| Held | — | ||
| ACT-017446 | Outreach suppressed pending steward Outreach | TPA-58091 (Gary Hart) held until CASE-004002 is decided |
| Held | — | ||
| ACT-017447 | Outreach suppressed pending steward Outreach | ENR-134074 (Elijah Mitchell) held until CASE-004003 is decided |
| Held | — | ||
| ACT-017448 | Outreach suppressed pending steward Outreach | CLM-426031 (Eliijah Mitchell) held until CASE-004004 is decided |
| Held | — | ||
| ACT-017449 | Outreach suppressed pending steward Outreach | TPA-53713 (Roy Mendez) held until CASE-004005 is decided |
| Held | — | ||
| ACT-017450 | Outreach suppressed pending steward Outreach | CLM-430590 (Brittany Holmes) held until CASE-004006 is decided |
| Held | — | ||
| ACT-017451 | Outreach suppressed pending steward Outreach | CLM-423244 (Kyle Harper) held until CASE-004007 is decided |
| Held | — | ||
| ACT-017452 | Outreach suppressed pending steward Outreach | CLM-414276 (Christina Moreno) held until CASE-004008 is decided |
| Held | — | ||
| ACT-017453 | Outreach suppressed pending steward Outreach | ENR-118768 (Christian Morenno) held until CASE-004009 is decided |
| Held | — | ||
| ACT-017454 | Outreach suppressed pending steward Outreach | TPA-63630 (Julia Reyes) held until CASE-004010 is decided |
| Held | — | ||
| ACT-017455 | Outreach suppressed pending steward Outreach | CLM-430837 (Julia Reyes) held until CASE-004011 is decided |
| Held | — | ||
| ACT-017456 | Outreach suppressed pending steward Outreach | ENR-142306 (Jerry Chapman) held until CASE-004012 is decided |
| Held | — | ||
| ACT-017457 | Outreach suppressed pending steward Outreach | CLM-432221 (Jerry Chapman) held until CASE-004013 is decided |
| Held | — | ||
| ACT-017458 | Outreach suppressed pending steward Outreach | TPA-62508 (Isabella Mjia) held until CASE-004014 is decided |
| Held | — | ||
| ACT-017459 | Outreach suppressed pending steward Outreach | ENR-137168 (Isabella Mejia) held until CASE-004015 is decided |
| Held | — | ||
| ACT-017460 | Outreach suppressed pending steward Outreach | TPA-55979 (Steven Carr) held until CASE-004016 is decided |
| Held | — | ||
| ACT-017461 | Outreach suppressed pending steward Outreach | CLM-413599 (Steven Carr) held until CASE-004017 is decided |
| Held | — | ||
| ACT-017462 | Outreach suppressed pending steward Outreach | PRV-25456 (Noah Munoz) held until CASE-004018 is decided |
| Held | — | ||
| ACT-017463 | Outreach suppressed pending steward Outreach | ENR-124232 (Noah Munoz) held until CASE-004019 is decided |
| Held | — | ||
| ACT-017464 | Outreach suppressed pending steward Outreach | ENR-113362 (Kayla Jenkins) held until CASE-004020 is decided |
| Held | — | ||
| ACT-017465 | Outreach suppressed pending steward Outreach | CLM-410141 (Kayla Jenkins) held until CASE-004021 is decided |
| Held | — | ||
| ACT-017466 | Outreach suppressed pending steward Outreach | CLM-412401 (Pamela West) held until CASE-004022 is decided |
| Held | — | ||
| ACT-017467 | Outreach suppressed pending steward Outreach | ENR-116311 (Pamela West) held until CASE-004023 is decided |
| Held | — | ||
| ACT-017468 | Outreach suppressed pending steward Outreach | CLM-401339 (Linda Greene) held until CASE-004024 is decided |
| Held | — | ||
| ACT-017469 | Outreach suppressed pending steward Outreach | ENR-101722 (Linda Geene) held until CASE-004025 is decided |
| Held | — | ||
| ACT-017470 | Outreach suppressed pending steward Outreach | CLM-430302 (Debbie Perez) held until CASE-004026 is decided |
| Held | — | ||
| ACT-017471 | Outreach suppressed pending steward Outreach | TPA-61881 (Gregory Lawson) held until CASE-004027 is decided |
| Held | — | ||
| ACT-017472 | Outreach suppressed pending steward Outreach | TPA-61882 (Grgeory Lawson) held until CASE-004028 is decided |
| Held | — | ||
| ACT-017473 | Outreach suppressed pending steward Outreach | CLM-418562 (Vincent Laawson) held until CASE-004029 is decided |
| Held | — | ||
| ACT-017474 | Outreach suppressed pending steward Outreach | ENR-124438 (Vincent Lawson) held until CASE-004030 is decided |
| Held | — | ||
| ACT-017475 | Outreach suppressed pending steward Outreach | TPA-58766 (Ronald Burton) held until CASE-004031 is decided |
| Held | — | ||
| ACT-017476 | Outreach suppressed pending steward Outreach | TPA-64095 (Jacqueline Sandoval) held until CASE-004032 is decided |
| Held | — | ||
| ACT-017477 | Outreach suppressed pending steward Outreach | TPA-52240 (Sophia Wilson) held until CASE-004033 is decided |
| Held | — | ||
| ACT-017478 | Outreach suppressed pending steward Outreach | CLM-405466 (Gabriel Lawson) held until CASE-004034 is decided |
| Held | — | ||
| ACT-017479 | Outreach suppressed pending steward Outreach | TPA-52406 (Gabriel Lawson) held until CASE-004035 is decided |
| Held | — | ||
| ACT-017480 | Outreach suppressed pending steward Outreach | CLM-430122 (Noah Bowman) held until CASE-004036 is decided |
| Held | — | ||
| ACT-017481 | Outreach suppressed pending steward Outreach | ENR-139518 (Noah Bowman) held until CASE-004037 is decided |
| Held | — | ||
| ACT-017482 | Outreach suppressed pending steward Outreach | TPA-60066 (Joe Rivera) held until CASE-004038 is decided |
| Held | — | ||
| ACT-017483 | Outreach suppressed pending steward Outreach | ENR-129968 (Joe Rivera) held until CASE-004039 is decided |
| Held | — | ||
| ACT-017484 | Outreach suppressed pending steward Outreach | CLM-404925 (Keith Baker) held until CASE-004040 is decided |
| Held | — | ||
| ACT-017485 | Outreach suppressed pending steward Outreach | TPA-52149 (Keith Baker) held until CASE-004041 is decided |
| Held | — | ||
| ACT-017486 | Outreach suppressed pending steward Outreach | TPA-55341 (Danielle Diaz) held until CASE-004042 is decided |
| Held | — | ||
| ACT-017487 | Outreach suppressed pending steward Outreach | ENR-115960 (Danielle Diaz) held until CASE-004043 is decided |
| Held | — | ||
| ACT-017488 | Outreach suppressed pending steward Outreach | CLM-420912 (Megan Young) held until CASE-004044 is decided |
| Held | — | ||
| ACT-017489 | Outreach suppressed pending steward Outreach | CLM-420802 (Angela Cole) held until CASE-004045 is decided |
| Held | — | ||
| ACT-017490 | Outreach suppressed pending steward Outreach | TPA-59919 (Sara Garrett) held until CASE-004046 is decided |
| Held | — | ||
| ACT-017491 | Outreach suppressed pending steward Outreach | ENR-129586 (Sara Garrett) held until CASE-004047 is decided |
| Held | — | ||
| ACT-017492 | Outreach suppressed pending steward Outreach | CLM-406113 (Juan Banks) held until CASE-004048 is decided |
| Held | — | ||
| ACT-017493 | Outreach suppressed pending steward Outreach | CLM-416445 (Beverly Aguilar) held until CASE-004049 is decided |
| Held | — | ||
| ACT-017494 | Outreach suppressed pending steward Outreach | TPA-50835 (Christopher Thompson) held until CASE-004050 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.