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-017595 | Outreach suppressed pending steward Outreach | CLM-431979 (Ralph Rodriguez) held until CASE-004151 is decided |
| Held | — | ||
| ACT-017596 | Outreach suppressed pending steward Outreach | CLM-420543 (Kevin Chen) held until CASE-004152 is decided |
| Held | — | ||
| ACT-017597 | Outreach suppressed pending steward Outreach | ENR-127029 (Kevin Chen) held until CASE-004153 is decided |
| Held | — | ||
| ACT-017598 | Outreach suppressed pending steward Outreach | TPA-50451 (Garrett Jason) held until CASE-004154 is decided |
| Held | — | ||
| ACT-017599 | Outreach suppressed pending steward Outreach | CLM-403451 (Ken Kim) held until CASE-004155 is decided |
| Held | — | ||
| ACT-017600 | Outreach suppressed pending steward Outreach | ENR-104481 (Kenneth Kim) held until CASE-004156 is decided |
| Held | — | ||
| ACT-017601 | Outreach suppressed pending steward Outreach | PRV-20948 (Keith Bennett) held until CASE-004157 is decided |
| Held | — | ||
| ACT-017602 | Outreach suppressed pending steward Outreach | TPA-51439 (Keith Bennett) held until CASE-004158 is decided |
| Held | — | ||
| ACT-017603 | Outreach suppressed pending steward Outreach | ENR-104307 (Keith Bennett) held until CASE-004159 is decided |
| Held | — | ||
| ACT-017604 | Outreach suppressed pending steward Outreach | ENR-142522 (Alan Etrada) held until CASE-004160 is decided |
| Held | — | ||
| ACT-017605 | Outreach suppressed pending steward Outreach | TPA-57608 (Barbara Garza) held until CASE-004161 is decided |
| Held | — | ||
| ACT-017606 | Outreach suppressed pending steward Outreach | ENR-131676 (Yuki Ramos) held until CASE-004162 is decided |
| Held | — | ||
| ACT-017607 | Outreach suppressed pending steward Outreach | CLM-424223 (Yuki Ramos) held until CASE-004163 is decided |
| Held | — | ||
| ACT-017608 | Outreach suppressed pending steward Outreach | CLM-416165 (Ralph Simmons) held until CASE-004164 is decided |
| Held | — | ||
| ACT-017609 | Outreach suppressed pending steward Outreach | ENR-121276 (Ralph Simmons) held until CASE-004165 is decided |
| Held | — | ||
| ACT-017610 | Outreach suppressed pending steward Outreach | TPA-56471 (Mariana Luna) held until CASE-004166 is decided |
| Held | — | ||
| ACT-017611 | Outreach suppressed pending steward Outreach | TPA-56470 (Mariana Luna) held until CASE-004167 is decided |
| Held | — | ||
| ACT-017612 | Outreach suppressed pending steward Outreach | TPA-64470 (Wayne Simmons) held until CASE-004168 is decided |
| Held | — | ||
| ACT-017613 | Outreach suppressed pending steward Outreach | ENR-143088 (Wayne Simmons) held until CASE-004169 is decided |
| Held | — | ||
| ACT-017614 | Outreach suppressed pending steward Outreach | CLM-415903 (Judith Lucas) held until CASE-004170 is decided |
| Held | — | ||
| ACT-017615 | Outreach suppressed pending steward Outreach | ENR-120956 (Judith Lucas) held until CASE-004171 is decided |
| Held | — | ||
| ACT-017616 | Outreach suppressed pending steward Outreach | ENR-129288 (Jessica Duncan) held until CASE-004172 is decided |
| Held | — | ||
| ACT-017617 | Outreach suppressed pending steward Outreach | TPA-51188 (Linda Oliver) held until CASE-004173 is decided |
| Held | — | ||
| ACT-017618 | Outreach suppressed pending steward Outreach | TPA-56914 (Noah Black) held until CASE-004174 is decided |
| Held | — | ||
| ACT-017619 | Outreach suppressed pending steward Outreach | TPA-56913 (Noah Black) held until CASE-004175 is decided |
| Held | — | ||
| ACT-017620 | Outreach suppressed pending steward Outreach | ENR-133438 (Evelyn Nelson) held until CASE-004176 is decided |
| Held | — | ||
| ACT-017621 | Outreach suppressed pending steward Outreach | TPA-61273 (Evelyn Nelson) held until CASE-004177 is decided |
| Held | — | ||
| ACT-017622 | Outreach suppressed pending steward Outreach | TPA-63794 (Zachary Armmstrong) held until CASE-004178 is decided |
| Held | — | ||
| ACT-017623 | Outreach suppressed pending steward Outreach | TPA-63795 (Zachary Armstrong) held until CASE-004179 is decided |
| Held | — | ||
| ACT-017624 | Outreach suppressed pending steward Outreach | CLM-407190 (Kimberly Robinson) held until CASE-004180 is decided |
| Held | — | ||
| ACT-017625 | Outreach suppressed pending steward Outreach | ENR-123286 (Carol Jones) held until CASE-004181 is decided |
| Held | — | ||
| ACT-017626 | Outreach suppressed pending steward Outreach | PRV-25236 (Carol Jones) held until CASE-004182 is decided |
| Held | — | ||
| ACT-017627 | Outreach suppressed pending steward Outreach | ENR-133831 (Bruce Bradley) held until CASE-004183 is decided |
| Held | — | ||
| ACT-017628 | Outreach suppressed pending steward Outreach | PRV-27619 (Bruce Bradley) held until CASE-004184 is decided |
| Held | — | ||
| ACT-017629 | Outreach suppressed pending steward Outreach | ENR-129516 (Kevin Marshall) held until CASE-004185 is decided |
| Held | — | ||
| ACT-017630 | Outreach suppressed pending steward Outreach | PRV-26645 (Kevin Marshall) held until CASE-004186 is decided |
| Held | — | ||
| ACT-017631 | Outreach suppressed pending steward Outreach | CLM-420927 (Tyler Perry) held until CASE-004187 is decided |
| Held | — | ||
| ACT-017632 | Outreach suppressed pending steward Outreach | ENR-127517 (Tyler Perry) held until CASE-004188 is decided |
| Held | — | ||
| ACT-017633 | Outreach suppressed pending steward Outreach | CLM-402471 (Janice Rodriguez) held until CASE-004189 is decided |
| Held | — | ||
| ACT-017634 | Outreach suppressed pending steward Outreach | CLM-402472 (Janice Rodriguez) held until CASE-004190 is decided |
| Held | — | ||
| ACT-017635 | Outreach suppressed pending steward Outreach | CLM-431937 (Natalie Nguyen) held until CASE-004191 is decided |
| Held | — | ||
| ACT-017636 | Outreach suppressed pending steward Outreach | TPA-55005 (Pamela Burns) held until CASE-004192 is decided |
| Held | — | ||
| ACT-017637 | Outreach suppressed pending steward Outreach | TPA-55006 (Pamela Burns) held until CASE-004193 is decided |
| Held | — | ||
| ACT-017638 | Outreach suppressed pending steward Outreach | ENR-130620 (Ralph Montgomery) held until CASE-004194 is decided |
| Held | — | ||
| ACT-017639 | Outreach suppressed pending steward Outreach | CLM-414020 (Fatima Boyd) held until CASE-004195 is decided |
| Held | — | ||
| ACT-017640 | Outreach suppressed pending steward Outreach | TPA-56189 (Fatima Boyd) held until CASE-004196 is decided |
| Held | — | ||
| ACT-017641 | Outreach suppressed pending steward Outreach | TPA-60948 (Christopher Contreras) held until CASE-004197 is decided |
| Held | — | ||
| ACT-017642 | Outreach suppressed pending steward Outreach | TPA-50869 (Arthur Grant) held until CASE-004198 is decided |
| Held | — | ||
| ACT-017643 | Outreach suppressed pending steward Outreach | CLM-402008 (Arthur Grant) held until CASE-004199 is decided |
| Held | — | ||
| ACT-017644 | Outreach suppressed pending steward Outreach | CLM-405516 (Joe Duncan) held until CASE-004200 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.