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-017545 | Outreach suppressed pending steward Outreach | TPA-55667 (Kimberly Mitchell) held until CASE-004101 is decided |
| Held | — | ||
| ACT-017546 | Outreach suppressed pending steward Outreach | TPA-55668 (Kimberly Mitkhell) held until CASE-004102 is decided |
| Held | — | ||
| ACT-017547 | Outreach suppressed pending steward Outreach | CLM-420453 (Yuki Elliott) held until CASE-004103 is decided |
| Held | — | ||
| ACT-017548 | Outreach suppressed pending steward Outreach | TPA-52224 (Sean Soto) held until CASE-004104 is decided |
| Held | — | ||
| ACT-017549 | Outreach suppressed pending steward Outreach | ENR-106683 (Sean Soto) held until CASE-004105 is decided |
| Held | — | ||
| ACT-017550 | Outreach suppressed pending steward Outreach | TPA-62684 (Lauren Reid) held until CASE-004106 is decided |
| Held | — | ||
| ACT-017551 | Outreach suppressed pending steward Outreach | TPA-54589 (Juan Santos) held until CASE-004107 is decided |
| Held | — | ||
| ACT-017552 | Outreach suppressed pending steward Outreach | TPA-54798 (Wilile Dunn) held until CASE-004108 is decided |
| Held | — | ||
| ACT-017553 | Outreach suppressed pending steward Outreach | CLM-406462 (Eric Long) held until CASE-004109 is decided |
| Held | — | ||
| ACT-017554 | Outreach suppressed pending steward Outreach | CLM-412065 (Shirley Lane) held until CASE-004110 is decided |
| Held | — | ||
| ACT-017555 | Outreach suppressed pending steward Outreach | ENR-115892 (Shirley Lane) held until CASE-004111 is decided |
| Held | — | ||
| ACT-017556 | Outreach suppressed pending steward Outreach | CLM-426893 (Amanda Santiiago) held until CASE-004112 is decided |
| Held | — | ||
| ACT-017557 | Outreach suppressed pending steward Outreach | TPA-54166 (Marilyn Tucker) held until CASE-004113 is decided |
| Held | — | ||
| ACT-017558 | Outreach suppressed pending steward Outreach | TPA-54165 (Marilyn Tucker) held until CASE-004114 is decided |
| Held | — | ||
| ACT-017559 | Outreach suppressed pending steward Outreach | PRV-22585 (Susan Chavez) held until CASE-004115 is decided |
| Held | — | ||
| ACT-017560 | Outreach suppressed pending steward Outreach | ENR-117827 (Joshua Bell) held until CASE-004116 is decided |
| Held | — | ||
| ACT-017561 | Outreach suppressed pending steward Outreach | TPA-59287 (Eric Castillo) held until CASE-004117 is decided |
| Held | — | ||
| ACT-017562 | Outreach suppressed pending steward Outreach | CLM-421113 (Eric Castillo) held until CASE-004118 is decided |
| Held | — | ||
| ACT-017563 | Outreach suppressed pending steward Outreach | TPA-53887 (Anthony Vega) held until CASE-004119 is decided |
| Held | — | ||
| ACT-017564 | Outreach suppressed pending steward Outreach | ENR-111708 (Anthony Vaga) held until CASE-004120 is decided |
| Held | — | ||
| ACT-017565 | Outreach suppressed pending steward Outreach | CLM-400863 (Joan Lane) held until CASE-004121 is decided |
| Held | — | ||
| ACT-017566 | Outreach suppressed pending steward Outreach | CLM-407415 (Amanda Walker) held until CASE-004122 is decided |
| Held | — | ||
| ACT-017567 | Outreach suppressed pending steward Outreach | ENR-109721 (Amanda Walker) held until CASE-004123 is decided |
| Held | — | ||
| ACT-017568 | Outreach suppressed pending steward Outreach | CLM-425053 (Mark Hughes) held until CASE-004124 is decided |
| Held | — | ||
| ACT-017569 | Outreach suppressed pending steward Outreach | TPA-61153 (Alan Wheeler) held until CASE-004125 is decided |
| Held | — | ||
| ACT-017570 | Outreach suppressed pending steward Outreach | CLM-400097 (Justin Cooper) held until CASE-004126 is decided |
| Held | — | ||
| ACT-017571 | Outreach suppressed pending steward Outreach | ENR-118109 (Cheryl Cruz) held until CASE-004127 is decided |
| Held | — | ||
| ACT-017572 | Outreach suppressed pending steward Outreach | TPA-56083 (Cheryl Cruz) held until CASE-004128 is decided |
| Held | — | ||
| ACT-017573 | Outreach suppressed pending steward Outreach | CLM-406102 (Santiago Crawford) held until CASE-004129 is decided |
| Held | — | ||
| ACT-017574 | Outreach suppressed pending steward Outreach | TPA-61954 (Watson Brittany) held until CASE-004130 is decided |
| Held | — | ||
| ACT-017575 | Outreach suppressed pending steward Outreach | CLM-409406 (Olivia Campbell) held until CASE-004131 is decided |
| Held | — | ||
| ACT-017576 | Outreach suppressed pending steward Outreach | TPA-55408 (Charlotte Obrien) held until CASE-004132 is decided |
| Held | — | ||
| ACT-017577 | Outreach suppressed pending steward Outreach | CLM-429925 (Stephen Freeman) held until CASE-004133 is decided |
| Held | — | ||
| ACT-017578 | Outreach suppressed pending steward Outreach | CLM-423421 (Wei Morales) held until CASE-004134 is decided |
| Held | — | ||
| ACT-017579 | Outreach suppressed pending steward Outreach | ENR-130623 (Wei Morales) held until CASE-004135 is decided |
| Held | — | ||
| ACT-017580 | Outreach suppressed pending steward Outreach | CLM-410690 (Robertson Ahmed) held until CASE-004136 is decided |
| Held | — | ||
| ACT-017581 | Outreach suppressed pending steward Outreach | TPA-53218 (Madison Garrett) held until CASE-004137 is decided |
| Held | — | ||
| ACT-017582 | Outreach suppressed pending steward Outreach | ENR-104308 (Madison Carlson) held until CASE-004138 is decided |
| Held | — | ||
| ACT-017583 | Outreach suppressed pending steward Outreach | CLM-403315 (Madison Carllson) held until CASE-004139 is decided |
| Held | — | ||
| ACT-017584 | Outreach suppressed pending steward Outreach | CLM-414672 (Grace Cole) held until CASE-004140 is decided |
| Held | — | ||
| ACT-017585 | Outreach suppressed pending steward Outreach | CLM-417506 (Austin Green) held until CASE-004141 is decided |
| Held | — | ||
| ACT-017586 | Outreach suppressed pending steward Outreach | TPA-53095 (Benjamin Yang) held until CASE-004142 is decided |
| Held | — | ||
| ACT-017587 | Outreach suppressed pending steward Outreach | TPA-58560 (Jefrfey Wells) held until CASE-004143 is decided |
| Held | — | ||
| ACT-017588 | Outreach suppressed pending steward Outreach | TPA-51962 (Walter Coleman) held until CASE-004144 is decided |
| Held | — | ||
| ACT-017589 | Outreach suppressed pending steward Outreach | ENR-105932 (Welter Coleman) held until CASE-004145 is decided |
| Held | — | ||
| ACT-017590 | Outreach suppressed pending steward Outreach | CLM-427041 (Priya Crapenter) held until CASE-004146 is decided |
| Held | — | ||
| ACT-017591 | Outreach suppressed pending steward Outreach | ENR-135477 (Priya Carpenter) held until CASE-004147 is decided |
| Held | — | ||
| ACT-017592 | Outreach suppressed pending steward Outreach | CLM-415452 (Lawrence Richards) held until CASE-004148 is decided |
| Held | — | ||
| ACT-017593 | Outreach suppressed pending steward Outreach | ENR-107705 (Brittany Johnston) held until CASE-004149 is decided |
| Held | — | ||
| ACT-017594 | Outreach suppressed pending steward Outreach | TPA-52589 (Brittany Johnston) held until CASE-004150 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.