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-014602 | Outreach suppressed pending steward Outreach | TPA-60042 (Stephanie Payne) held until CASE-001158 is decided |
| Held | — | ||
| ACT-014603 | Outreach suppressed pending steward Outreach | CLM-409423 (Frances Yang) held until CASE-001159 is decided |
| Held | — | ||
| ACT-014604 | Outreach suppressed pending steward Outreach | TPA-54089 (Frances Yang) held until CASE-001160 is decided |
| Held | — | ||
| ACT-014605 | Outreach suppressed pending steward Outreach | CLM-424059 (Kyle Black) held until CASE-001161 is decided |
| Held | — | ||
| ACT-014606 | Outreach suppressed pending steward Outreach | CLM-427150 (Marilyn Sullivan) held until CASE-001162 is decided |
| Held | — | ||
| ACT-014607 | Outreach suppressed pending steward Outreach | TPA-59926 (Bruce Clark) held until CASE-001163 is decided |
| Held | — | ||
| ACT-014608 | Outreach suppressed pending steward Outreach | CLM-404303 (Jason Delgado) held until CASE-001164 is decided |
| Held | — | ||
| ACT-014609 | Outreach suppressed pending steward Outreach | TPA-51872 (Jason Delgado) held until CASE-001165 is decided |
| Held | — | ||
| ACT-014610 | Outreach suppressed pending steward Outreach | ENR-125903 (Sharon Delgado) held until CASE-001166 is decided |
| Held | — | ||
| ACT-014611 | Outreach suppressed pending steward Outreach | PRV-22326 (Larry Walker) held until CASE-001167 is decided |
| Held | — | ||
| ACT-014612 | Outreach suppressed pending steward Outreach | ENR-125056 (Carol Montgomery) held until CASE-001168 is decided |
| Held | — | ||
| ACT-014613 | Outreach suppressed pending steward Outreach | TPA-61503 (Evelyn Yang) held until CASE-001169 is decided |
| Held | — | ||
| ACT-014614 | Outreach suppressed pending steward Outreach | CLM-426038 (Evelyn Yang) held until CASE-001170 is decided |
| Held | — | ||
| ACT-014615 | Outreach suppressed pending steward Outreach | PRV-27825 (Adam Singh) held until CASE-001171 is decided |
| Held | — | ||
| ACT-014616 | Outreach suppressed pending steward Outreach | TPA-55231 (Amanda Richards) held until CASE-001172 is decided |
| Held | — | ||
| ACT-014617 | Outreach suppressed pending steward Outreach | ENR-136872 (Ryan Richards) held until CASE-001173 is decided |
| Held | — | ||
| ACT-014618 | Outreach suppressed pending steward Outreach | CLM-429204 (Brian Little) held until CASE-001174 is decided |
| Held | — | ||
| ACT-014619 | Outreach suppressed pending steward Outreach | CLM-416479 (Jen Lynch) held until CASE-001175 is decided |
| Held | — | ||
| ACT-014620 | Outreach suppressed pending steward Outreach | CLM-416480 (Jen Lynch) held until CASE-001176 is decided |
| Held | — | ||
| ACT-014621 | Outreach suppressed pending steward Outreach | CLM-402809 (Adam Lynch) held until CASE-001177 is decided |
| Held | — | ||
| ACT-014622 | Outreach suppressed pending steward Outreach | ENR-103617 (Adam Lynch) held until CASE-001178 is decided |
| Held | — | ||
| ACT-014623 | Outreach suppressed pending steward Outreach | TPA-50823 (Dick Medina) held until CASE-001179 is decided |
| Held | — | ||
| ACT-014624 | Outreach suppressed pending steward Outreach | TPA-57894 (Ryan Wright) held until CASE-001180 is decided |
| Held | — | ||
| ACT-014625 | Outreach suppressed pending steward Outreach | PRV-24789 (Harold Greane) held until CASE-001181 is decided |
| Held | — | ||
| ACT-014626 | Outreach suppressed pending steward Outreach | TPA-51560 (Carolyn Green) held until CASE-001182 is decided |
| Held | — | ||
| ACT-014627 | Outreach suppressed pending steward Outreach | CLM-421059 (Deborah Sandoval) held until CASE-001183 is decided |
| Held | — | ||
| ACT-014628 | Outreach suppressed pending steward Outreach | CLM-411282 (Melissa Hudson) held until CASE-001184 is decided |
| Held | — | ||
| ACT-014629 | Outreach suppressed pending steward Outreach | CLM-411283 (Melissa Hudson) held until CASE-001185 is decided |
| Held | — | ||
| ACT-014630 | Outreach suppressed pending steward Outreach | CLM-402961 (Rebecca Warren) held until CASE-001186 is decided |
| Held | — | ||
| ACT-014631 | Outreach suppressed pending steward Outreach | TPA-50305 (Mariana Berry) held until CASE-001187 is decided |
| Held | — | ||
| ACT-014632 | Outreach suppressed pending steward Outreach | CLM-410458 (Rachle Scott) held until CASE-001188 is decided |
| Held | — | ||
| ACT-014633 | Outreach suppressed pending steward Outreach | CLM-408129 (Christian Romero) held until CASE-001189 is decided |
| Held | — | ||
| ACT-014634 | Outreach suppressed pending steward Outreach | TPA-60294 (Emma Garrtt) held until CASE-001190 is decided |
| Held | — | ||
| ACT-014635 | Outreach suppressed pending steward Outreach | TPA-62289 (Mari Wells) held until CASE-001191 is decided |
| Held | — | ||
| ACT-014636 | Outreach suppressed pending steward Outreach | ENR-136506 (Maria Wells) held until CASE-001192 is decided |
| Held | — | ||
| ACT-014637 | Outreach suppressed pending steward Outreach | CLM-425302 (Karan Berry) held until CASE-001193 is decided |
| Held | — | ||
| ACT-014638 | Outreach suppressed pending steward Outreach | CLM-416912 (Jesse Mendez) held until CASE-001194 is decided |
| Held | — | ||
| ACT-014639 | Outreach suppressed pending steward Outreach | CLM-416911 (Jesse Mendez) held until CASE-001195 is decided |
| Held | — | ||
| ACT-014640 | Outreach suppressed pending steward Outreach | TPA-51929 (Carol Rodriguez) held until CASE-001196 is decided |
| Held | — | ||
| ACT-014641 | Outreach suppressed pending steward Outreach | CLM-404432 (Carol Rodriguez) held until CASE-001197 is decided |
| Held | — | ||
| ACT-014642 | Outreach suppressed pending steward Outreach | CLM-427401 (Amy Gonzalez) held until CASE-001198 is decided |
| Held | — | ||
| ACT-014643 | Outreach suppressed pending steward Outreach | ENR-135989 (William Rodriguez) held until CASE-001199 is decided |
| Held | — | ||
| ACT-014644 | Outreach suppressed pending steward Outreach | CLM-423067 (Philyp Fox) held until CASE-001200 is decided |
| Held | — | ||
| ACT-014645 | Outreach suppressed pending steward Outreach | CLM-424314 (Michele Luna) held until CASE-001201 is decided |
| Held | — | ||
| ACT-014646 | Outreach suppressed pending steward Outreach | ENR-113320 (Sara Padilla) held until CASE-001202 is decided |
| Held | — | ||
| ACT-014647 | Outreach suppressed pending steward Outreach | CLM-410107 (Sara Padilla) held until CASE-001203 is decided |
| Held | — | ||
| ACT-014648 | Outreach suppressed pending steward Outreach | CLM-404422 (Gloria Ortega) held until CASE-001204 is decided |
| Held | — | ||
| ACT-014649 | Outreach suppressed pending steward Outreach | ENR-131665 (Ashley Ortega) held until CASE-001205 is decided |
| Held | — | ||
| ACT-014650 | Outreach suppressed pending steward Outreach | CLM-431827 (Jordan Vasquez) held until CASE-001206 is decided |
| Held | — | ||
| ACT-014651 | Outreach suppressed pending steward Outreach | TPA-64035 (Jordan Vasquez) held until CASE-001207 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.