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-014502 | Outreach suppressed pending steward Outreach | PRV-26829 (Alice Marquez) held until CASE-001058 is decided |
| Held | — | ||
| ACT-014503 | Outreach suppressed pending steward Outreach | ENR-130257 (Alice Marquez) held until CASE-001059 is decided |
| Held | — | ||
| ACT-014504 | Outreach suppressed pending steward Outreach | TPA-56126 (Hiroshi Green) held until CASE-001060 is decided |
| Held | — | ||
| ACT-014505 | Outreach suppressed pending steward Outreach | CLM-413906 (Hiroshi Green) held until CASE-001061 is decided |
| Held | — | ||
| ACT-014506 | Outreach suppressed pending steward Outreach | TPA-55630 (Alice Perkins) held until CASE-001062 is decided |
| Held | — | ||
| ACT-014507 | Outreach suppressed pending steward Outreach | CLM-430842 (Katherine Gonzalez) held until CASE-001063 is decided |
| Held | — | ||
| ACT-014508 | Outreach suppressed pending steward Outreach | TPA-54984 (Billy Hansen) held until CASE-001064 is decided |
| Held | — | ||
| ACT-014509 | Outreach suppressed pending steward Outreach | CLM-426731 (Abmer Lopez) held until CASE-001065 is decided |
| Held | — | ||
| ACT-014510 | Outreach suppressed pending steward Outreach | TPA-61898 (Mason Fuller) held until CASE-001066 is decided |
| Held | — | ||
| ACT-014511 | Outreach suppressed pending steward Outreach | TPA-61897 (Mason Fuller) held until CASE-001067 is decided |
| Held | — | ||
| ACT-014512 | Outreach suppressed pending steward Outreach | TPA-61061 (Joseph Day) held until CASE-001068 is decided |
| Held | — | ||
| ACT-014513 | Outreach suppressed pending steward Outreach | CLM-411897 (Nick Morgan) held until CASE-001069 is decided |
| Held | — | ||
| ACT-014514 | Outreach suppressed pending steward Outreach | CLM-430080 (Andrea Lee) held until CASE-001070 is decided |
| Held | — | ||
| ACT-014515 | Outreach suppressed pending steward Outreach | ENR-107325 (Abigail Fowler) held until CASE-001071 is decided |
| Held | — | ||
| ACT-014516 | Outreach suppressed pending steward Outreach | TPA-52453 (Abigail Fowler) held until CASE-001072 is decided |
| Held | — | ||
| ACT-014517 | Outreach suppressed pending steward Outreach | TPA-52452 (Abigail Fowler) held until CASE-001073 is decided |
| Held | — | ||
| ACT-014518 | Outreach suppressed pending steward Outreach | CLM-405804 (Samuel Wilson) held until CASE-001074 is decided |
| Held | — | ||
| ACT-014519 | Outreach suppressed pending steward Outreach | ENR-131117 (Carl Wilson) held until CASE-001075 is decided |
| Held | — | ||
| ACT-014520 | Outreach suppressed pending steward Outreach | TPA-53137 (Jose Fuller) held until CASE-001076 is decided |
| Held | — | ||
| ACT-014521 | Outreach suppressed pending steward Outreach | CLM-407171 (Jose Fuller) held until CASE-001077 is decided |
| Held | — | ||
| ACT-014522 | Outreach suppressed pending steward Outreach | CLM-431529 (Gabriel Simmons) held until CASE-001078 is decided |
| Held | — | ||
| ACT-014523 | Outreach suppressed pending steward Outreach | TPA-63970 (Terry Hansen) held until CASE-001079 is decided |
| Held | — | ||
| ACT-014524 | Outreach suppressed pending steward Outreach | PRV-29247 (Terry Hansen) held until CASE-001080 is decided |
| Held | — | ||
| ACT-014525 | Outreach suppressed pending steward Outreach | ENR-106762 (Marilyn Munoz) held until CASE-001081 is decided |
| Held | — | ||
| ACT-014526 | Outreach suppressed pending steward Outreach | CLM-405150 (Marilyn Munoz) held until CASE-001082 is decided |
| Held | — | ||
| ACT-014527 | Outreach suppressed pending steward Outreach | TPA-50736 (Stephen Jensen) held until CASE-001083 is decided |
| Held | — | ||
| ACT-014528 | Outreach suppressed pending steward Outreach | TPA-51802 (Ryan Walsh) held until CASE-001084 is decided |
| Held | — | ||
| ACT-014529 | Outreach suppressed pending steward Outreach | TPA-58583 (Kevin Welch) held until CASE-001085 is decided |
| Held | — | ||
| ACT-014530 | Outreach suppressed pending steward Outreach | ENR-125599 (Kevin Welch) held until CASE-001086 is decided |
| Held | — | ||
| ACT-014531 | Outreach suppressed pending steward Outreach | CLM-415444 (Tyler Rojas) held until CASE-001087 is decided |
| Held | — | ||
| ACT-014532 | Outreach suppressed pending steward Outreach | TPA-51633 (Lawrence Reyes) held until CASE-001088 is decided |
| Held | — | ||
| ACT-014533 | Outreach suppressed pending steward Outreach | ENR-104876 (Lawrence Reyes) held until CASE-001089 is decided |
| Held | — | ||
| ACT-014534 | Outreach suppressed pending steward Outreach | TPA-54731 (Marilyn Reyes) held until CASE-001090 is decided |
| Held | — | ||
| ACT-014535 | Outreach suppressed pending steward Outreach | CLM-410787 (Marilyn Reyes) held until CASE-001091 is decided |
| Held | — | ||
| ACT-014536 | Outreach suppressed pending steward Outreach | TPA-51640 (Ryan Rose) held until CASE-001092 is decided |
| Held | — | ||
| ACT-014537 | Outreach suppressed pending steward Outreach | ENR-104900 (Ryan Rose) held until CASE-001093 is decided |
| Held | — | ||
| ACT-014538 | Outreach suppressed pending steward Outreach | PRV-24522 (Wayne Jackson) held until CASE-001094 is decided |
| Held | — | ||
| ACT-014539 | Outreach suppressed pending steward Outreach | ENR-129116 (Kelly Richardson) held until CASE-001095 is decided |
| Held | — | ||
| ACT-014540 | Outreach suppressed pending steward Outreach | TPA-54355 (Virginia Hayes) held until CASE-001096 is decided |
| Held | — | ||
| ACT-014541 | Outreach suppressed pending steward Outreach | TPA-59004 (Janet Hicks) held until CASE-001097 is decided |
| Held | — | ||
| ACT-014542 | Outreach suppressed pending steward Outreach | CLM-423353 (Cynthia Luna) held until CASE-001098 is decided |
| Held | — | ||
| ACT-014543 | Outreach suppressed pending steward Outreach | CLM-416633 (Beverly Simmons) held until CASE-001099 is decided |
| Held | — | ||
| ACT-014544 | Outreach suppressed pending steward Outreach | ENR-121850 (Beverly Simmons) held until CASE-001100 is decided |
| Held | — | ||
| ACT-014545 | Outreach suppressed pending steward Outreach | CLM-426462 (Martha Soto) held until CASE-001101 is decided |
| Held | — | ||
| ACT-014546 | Outreach suppressed pending steward Outreach | CLM-425185 (Tim Clark) held until CASE-001102 is decided |
| Held | — | ||
| ACT-014547 | Outreach suppressed pending steward Outreach | TPA-59171 (Sandra Carlson) held until CASE-001103 is decided |
| Held | — | ||
| ACT-014548 | Outreach suppressed pending steward Outreach | TPA-56648 (Stephanie Morgan) held until CASE-001104 is decided |
| Held | — | ||
| ACT-014549 | Outreach suppressed pending steward Outreach | TPA-53036 (Luica Welch) held until CASE-001105 is decided |
| Held | — | ||
| ACT-014550 | Outreach suppressed pending steward Outreach | ENR-133551 (Nancy Welch) held until CASE-001106 is decided |
| Held | — | ||
| ACT-014551 | Outreach suppressed pending steward Outreach | CLM-425643 (Nancy Welch) held until CASE-001107 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.