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-014702 | Outreach suppressed pending steward Outreach | CLM-405039 (Isabella Lawrence) held until CASE-001258 is decided |
| Held | — | ||
| ACT-014703 | Outreach suppressed pending steward Outreach | TPA-52199 (Isabella Lawrence) held until CASE-001259 is decided |
| Held | — | ||
| ACT-014704 | Outreach suppressed pending steward Outreach | TPA-63143 (Ahmed Campbell) held until CASE-001260 is decided |
| Held | — | ||
| ACT-014705 | Outreach suppressed pending steward Outreach | PRV-20542 (Theresa Fowler) held until CASE-001261 is decided |
| Held | — | ||
| ACT-014706 | Outreach suppressed pending steward Outreach | TPA-54056 (Teresa Williamson) held until CASE-001262 is decided |
| Held | — | ||
| ACT-014707 | Outreach suppressed pending steward Outreach | ENR-101143 (Yuki Knight) held until CASE-001263 is decided |
| Held | — | ||
| ACT-014708 | Outreach suppressed pending steward Outreach | CLM-400865 (Yuki Knight) held until CASE-001264 is decided |
| Held | — | ||
| ACT-014709 | Outreach suppressed pending steward Outreach | PRV-24266 (Diana Mendez) held until CASE-001265 is decided |
| Held | — | ||
| ACT-014710 | Outreach suppressed pending steward Outreach | CLM-411020 (Amanda Allen) held until CASE-001266 is decided |
| Held | — | ||
| ACT-014711 | Outreach suppressed pending steward Outreach | ENR-114457 (Amanda Allen) held until CASE-001267 is decided |
| Held | — | ||
| ACT-014712 | Outreach suppressed pending steward Outreach | CLM-408359 (Ana Allen) held until CASE-001268 is decided |
| Held | — | ||
| ACT-014713 | Outreach suppressed pending steward Outreach | TPA-61759 (Lori Allen) held until CASE-001269 is decided |
| Held | — | ||
| ACT-014714 | Outreach suppressed pending steward Outreach | TPA-63398 (Omar Hamilton) held until CASE-001270 is decided |
| Held | — | ||
| ACT-014715 | Outreach suppressed pending steward Outreach | TPA-61364 (James Li) held until CASE-001271 is decided |
| Held | — | ||
| ACT-014716 | Outreach suppressed pending steward Outreach | CLM-415684 (Sophia Lee) held until CASE-001272 is decided |
| Held | — | ||
| ACT-014717 | Outreach suppressed pending steward Outreach | CLM-417046 (Lori Nunez) held until CASE-001273 is decided |
| Held | — | ||
| ACT-014718 | Outreach suppressed pending steward Outreach | TPA-56828 (Harold Murray) held until CASE-001274 is decided |
| Held | — | ||
| ACT-014719 | Outreach suppressed pending steward Outreach | CLM-415577 (Harold Murray) held until CASE-001275 is decided |
| Held | — | ||
| ACT-014720 | Outreach suppressed pending steward Outreach | ENR-121991 (Amber Hudson) held until CASE-001276 is decided |
| Held | — | ||
| ACT-014721 | Outreach suppressed pending steward Outreach | TPA-57376 (Amber Hudson) held until CASE-001277 is decided |
| Held | — | ||
| ACT-014722 | Outreach suppressed pending steward Outreach | CLM-410822 (Teresa Hudson) held until CASE-001278 is decided |
| Held | — | ||
| ACT-014723 | Outreach suppressed pending steward Outreach | TPA-56156 (Mary Ruiz) held until CASE-001279 is decided |
| Held | — | ||
| ACT-014724 | Outreach suppressed pending steward Outreach | ENR-118257 (Mary Ruiz) held until CASE-001280 is decided |
| Held | — | ||
| ACT-014725 | Outreach suppressed pending steward Outreach | CLM-420244 (Ethan Boyd) held until CASE-001281 is decided |
| Held | — | ||
| ACT-014726 | Outreach suppressed pending steward Outreach | TPA-59591 (Olivia Howard) held until CASE-001282 is decided |
| Held | — | ||
| ACT-014727 | Outreach suppressed pending steward Outreach | CLM-419578 (Ashley Obrien) held until CASE-001283 is decided |
| Held | — | ||
| ACT-014728 | Outreach suppressed pending steward Outreach | TPA-51566 (Emma Watson) held until CASE-001284 is decided |
| Held | — | ||
| ACT-014729 | Outreach suppressed pending steward Outreach | CLM-414070 (Jordan Jenkins) held until CASE-001285 is decided |
| Held | — | ||
| ACT-014730 | Outreach suppressed pending steward Outreach | TPA-62837 (Walter Henry) held until CASE-001286 is decided |
| Held | — | ||
| ACT-014731 | Outreach suppressed pending steward Outreach | CLM-429054 (Walter Henry) held until CASE-001287 is decided |
| Held | — | ||
| ACT-014732 | Outreach suppressed pending steward Outreach | TPA-52392 (Jesse Hughes) held until CASE-001288 is decided |
| Held | — | ||
| ACT-014733 | Outreach suppressed pending steward Outreach | CLM-402728 (Ana Coleman) held until CASE-001289 is decided |
| Held | — | ||
| ACT-014734 | Outreach suppressed pending steward Outreach | PRV-28872 (Ana Kelly) held until CASE-001290 is decided |
| Held | — | ||
| ACT-014735 | Outreach suppressed pending steward Outreach | ENR-139770 (Ana Kelly) held until CASE-001291 is decided |
| Held | — | ||
| ACT-014736 | Outreach suppressed pending steward Outreach | TPA-59067 (Julie Kelly) held until CASE-001292 is decided |
| Held | — | ||
| ACT-014737 | Outreach suppressed pending steward Outreach | CLM-414683 (Edward Chapman) held until CASE-001293 is decided |
| Held | — | ||
| ACT-014738 | Outreach suppressed pending steward Outreach | TPA-53669 (Mason Maldonado) held until CASE-001294 is decided |
| Held | — | ||
| ACT-014739 | Outreach suppressed pending steward Outreach | TPA-59234 (Linda Hart) held until CASE-001295 is decided |
| Held | — | ||
| ACT-014740 | Outreach suppressed pending steward Outreach | ENR-127578 (Linda Hart) held until CASE-001296 is decided |
| Held | — | ||
| ACT-014741 | Outreach suppressed pending steward Outreach | CLM-421514 (Joe Stewart) held until CASE-001297 is decided |
| Held | — | ||
| ACT-014742 | Outreach suppressed pending steward Outreach | PRV-22736 (Scott Jacobs) held until CASE-001298 is decided |
| Held | — | ||
| ACT-014743 | Outreach suppressed pending steward Outreach | CLM-409334 (Scott Jacobs) held until CASE-001299 is decided |
| Held | — | ||
| ACT-014744 | Outreach suppressed pending steward Outreach | ENR-113236 (Isabella Chen) held until CASE-001300 is decided |
| Held | — | ||
| ACT-014745 | Outreach suppressed pending steward Outreach | PRV-21862 (Ralph Gutierrez) held until CASE-001301 is decided |
| Held | — | ||
| ACT-014746 | Outreach suppressed pending steward Outreach | ENR-135956 (Jessica Butler) held until CASE-001302 is decided |
| Held | — | ||
| ACT-014747 | Outreach suppressed pending steward Outreach | TPA-62124 (Jessica Butler) held until CASE-001303 is decided |
| Held | — | ||
| ACT-014748 | Outreach suppressed pending steward Outreach | ENR-137768 (Isabella Halll) held until CASE-001304 is decided |
| Held | — | ||
| ACT-014749 | Outreach suppressed pending steward Outreach | TPA-62723 (Isabella Hall) held until CASE-001305 is decided |
| Held | — | ||
| ACT-014750 | Outreach suppressed pending steward Outreach | PRV-20441 (Billy Lopez) held until CASE-001306 is decided |
| Held | — | ||
| ACT-014751 | Outreach suppressed pending steward Outreach | ENR-101825 (Billy Lopez) held until CASE-001307 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.