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-014652 | Outreach suppressed pending steward Outreach | PRV-27667 (Albert Larson) held until CASE-001208 is decided |
| Held | — | ||
| ACT-014653 | Outreach suppressed pending steward Outreach | TPA-52736 (Rachel Scott) held until CASE-001209 is decided |
| Held | — | ||
| ACT-014654 | Outreach suppressed pending steward Outreach | CLM-412978 (Ruth Vazquez) held until CASE-001210 is decided |
| Held | — | ||
| ACT-014655 | Outreach suppressed pending steward Outreach | CLM-410090 (Aisha Chen) held until CASE-001211 is decided |
| Held | — | ||
| ACT-014656 | Outreach suppressed pending steward Outreach | TPA-53401 (Betty Boyd) held until CASE-001212 is decided |
| Held | — | ||
| ACT-014657 | Outreach suppressed pending steward Outreach | ENR-108260 (Philip Barry) held until CASE-001213 is decided |
| Held | — | ||
| ACT-014658 | Outreach suppressed pending steward Outreach | TPA-52789 (Philip Berry) held until CASE-001214 is decided |
| Held | — | ||
| ACT-014659 | Outreach suppressed pending steward Outreach | ENR-100123 (George Ellis) held until CASE-001215 is decided |
| Held | — | ||
| ACT-014660 | Outreach suppressed pending steward Outreach | CLM-405517 (Kenneth Gonzalez) held until CASE-001216 is decided |
| Held | — | ||
| ACT-014661 | Outreach suppressed pending steward Outreach | CLM-415944 (Abigail Olson) held until CASE-001217 is decided |
| Held | — | ||
| ACT-014662 | Outreach suppressed pending steward Outreach | TPA-53543 (Scott Pena) held until CASE-001218 is decided |
| Held | — | ||
| ACT-014663 | Outreach suppressed pending steward Outreach | TPA-51705 (Diego Pena) held until CASE-001219 is decided |
| Held | — | ||
| ACT-014664 | Outreach suppressed pending steward Outreach | CLM-432353 (Linda Payne) held until CASE-001220 is decided |
| Held | — | ||
| ACT-014665 | Outreach suppressed pending steward Outreach | TPA-55479 (Ahmed Wright) held until CASE-001221 is decided |
| Held | — | ||
| ACT-014666 | Outreach suppressed pending steward Outreach | CLM-412438 (Ahmed Wright) held until CASE-001222 is decided |
| Held | — | ||
| ACT-014667 | Outreach suppressed pending steward Outreach | TPA-51129 (Aisha Richards) held until CASE-001223 is decided |
| Held | — | ||
| ACT-014668 | Outreach suppressed pending steward Outreach | CLM-402643 (Aisha Richards) held until CASE-001224 is decided |
| Held | — | ||
| ACT-014669 | Outreach suppressed pending steward Outreach | TPA-51618 (Kevin Austin) held until CASE-001225 is decided |
| Held | — | ||
| ACT-014670 | Outreach suppressed pending steward Outreach | CLM-403726 (Kevin Austin) held until CASE-001226 is decided |
| Held | — | ||
| ACT-014671 | Outreach suppressed pending steward Outreach | TPA-56760 (Kathleen Watkins) held until CASE-001227 is decided |
| Held | — | ||
| ACT-014672 | Outreach suppressed pending steward Outreach | CLM-401641 (Juddy Schultz) held until CASE-001228 is decided |
| Held | — | ||
| ACT-014673 | Outreach suppressed pending steward Outreach | CLM-415792 (Michelle Schultz) held until CASE-001229 is decided |
| Held | — | ||
| ACT-014674 | Outreach suppressed pending steward Outreach | TPA-58831 (Alice Willis) held until CASE-001230 is decided |
| Held | — | ||
| ACT-014675 | Outreach suppressed pending steward Outreach | TPA-53213 (Christopher Cooper) held until CASE-001231 is decided |
| Held | — | ||
| ACT-014676 | Outreach suppressed pending steward Outreach | CLM-426441 (Ryan Santos) held until CASE-001232 is decided |
| Held | — | ||
| ACT-014677 | Outreach suppressed pending steward Outreach | CLM-409228 (Katherine Freeman) held until CASE-001233 is decided |
| Held | — | ||
| ACT-014678 | Outreach suppressed pending steward Outreach | CLM-402227 (Alice Singh) held until CASE-001234 is decided |
| Held | — | ||
| ACT-014679 | Outreach suppressed pending steward Outreach | TPA-53545 (Megan Henry) held until CASE-001235 is decided |
| Held | — | ||
| ACT-014680 | Outreach suppressed pending steward Outreach | CLM-423194 (Bety Watson) held until CASE-001236 is decided |
| Held | — | ||
| ACT-014681 | Outreach suppressed pending steward Outreach | TPA-60504 (Ashley Nunez) held until CASE-001237 is decided |
| Held | — | ||
| ACT-014682 | Outreach suppressed pending steward Outreach | CLM-423878 (Ashley Nunez) held until CASE-001238 is decided |
| Held | — | ||
| ACT-014683 | Outreach suppressed pending steward Outreach | TPA-61118 (Cheryl Munoz) held until CASE-001239 is decided |
| Held | — | ||
| ACT-014684 | Outreach suppressed pending steward Outreach | TPA-54381 (Debra Rojas) held until CASE-001240 is decided |
| Held | — | ||
| ACT-014685 | Outreach suppressed pending steward Outreach | TPA-51598 (Valentina Gonzalez) held until CASE-001241 is decided |
| Held | — | ||
| ACT-014686 | Outreach suppressed pending steward Outreach | CLM-428210 (Beverrly Gonzalez) held until CASE-001242 is decided |
| Held | — | ||
| ACT-014687 | Outreach suppressed pending steward Outreach | TPA-63980 (Roger Luna) held until CASE-001243 is decided |
| Held | — | ||
| ACT-014688 | Outreach suppressed pending steward Outreach | PRV-20330 (Jesse Hunt) held until CASE-001244 is decided |
| Held | — | ||
| ACT-014689 | Outreach suppressed pending steward Outreach | CLM-405867 (Karen Elliott) held until CASE-001245 is decided |
| Held | — | ||
| ACT-014690 | Outreach suppressed pending steward Outreach | ENR-133676 (Sara Webar) held until CASE-001246 is decided |
| Held | — | ||
| ACT-014691 | Outreach suppressed pending steward Outreach | TPA-61367 (Sara Webar) held until CASE-001247 is decided |
| Held | — | ||
| ACT-014692 | Outreach suppressed pending steward Outreach | TPA-60744 (Jacqueline Lewis) held until CASE-001248 is decided |
| Held | — | ||
| ACT-014693 | Outreach suppressed pending steward Outreach | PRV-23505 (Ana Bradley) held until CASE-001249 is decided |
| Held | — | ||
| ACT-014694 | Outreach suppressed pending steward Outreach | TPA-59380 (Judy Hansen) held until CASE-001250 is decided |
| Held | — | ||
| ACT-014695 | Outreach suppressed pending steward Outreach | PRV-26281 (Judy Hansen) held until CASE-001251 is decided |
| Held | — | ||
| ACT-014696 | Outreach suppressed pending steward Outreach | TPA-59381 (Judy Hansen) held until CASE-001252 is decided |
| Held | — | ||
| ACT-014697 | Outreach suppressed pending steward Outreach | CLM-430116 (Juan Alexander) held until CASE-001253 is decided |
| Held | — | ||
| ACT-014698 | Outreach suppressed pending steward Outreach | PRV-20690 (Ann Alexander) held until CASE-001254 is decided |
| Held | — | ||
| ACT-014699 | Outreach suppressed pending steward Outreach | PRV-27564 (Cynthia Porter) held until CASE-001255 is decided |
| Held | — | ||
| ACT-014700 | Outreach suppressed pending steward Outreach | CLM-431118 (Sandra Patel) held until CASE-001256 is decided |
| Held | — | ||
| ACT-014701 | Outreach suppressed pending steward Outreach | TPA-54632 (Harold Rojas) held until CASE-001257 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.