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
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-017695 | Outreach suppressed pending steward Outreach | TPA-53626 (Patrick Gibson) held until CASE-004251 is decided |
| Held | — | ||
| ACT-017696 | Outreach suppressed pending steward Outreach | CLM-408269 (Patrick Gibson) held until CASE-004252 is decided |
| Held | — | ||
| ACT-017697 | Outreach suppressed pending steward Outreach | TPA-64334 (Isabella Gordon) held until CASE-004253 is decided |
| Held | — | ||
| ACT-017698 | Outreach suppressed pending steward Outreach | TPA-56144 (Joseph Meyer) held until CASE-004254 is decided |
| Held | — | ||
| ACT-017699 | Outreach suppressed pending steward Outreach | ENR-118228 (Joseph Meyer) held until CASE-004255 is decided |
| Held | — | ||
| ACT-017700 | Outreach suppressed pending steward Outreach | PRV-26351 (Marcus Nichols) held until CASE-004256 is decided |
| Held | — | ||
| ACT-017701 | Outreach suppressed pending steward Outreach | PRV-26352 (Marcus Nichols) held until CASE-004257 is decided |
| Held | — | ||
| ACT-017702 | Outreach suppressed pending steward Outreach | CLM-432382 (Kelly King) held until CASE-004258 is decided |
| Held | — | ||
| ACT-017703 | Outreach suppressed pending steward Outreach | ENR-142510 (Kelly King) held until CASE-004259 is decided |
| Held | — | ||
| ACT-017704 | Outreach suppressed pending steward Outreach | ENR-115315 (Bruce Gordon) held until CASE-004260 is decided |
| Held | — | ||
| ACT-017705 | Outreach suppressed pending steward Outreach | TPA-55133 (Bruce Gordon) held until CASE-004261 is decided |
| Held | — | ||
| ACT-017706 | Outreach suppressed pending steward Outreach | CLM-420578 (Juan Lewis) held until CASE-004262 is decided |
| Held | — | ||
| ACT-017707 | Outreach suppressed pending steward Outreach | ENR-134696 (Matthew Jones) held until CASE-004263 is decided |
| Held | — | ||
| ACT-017708 | Outreach suppressed pending steward Outreach | CLM-426459 (Matthew Jones) held until CASE-004264 is decided |
| Held | — | ||
| ACT-017709 | Outreach suppressed pending steward Outreach | CLM-400485 (Andrea Jordan) held until CASE-004265 is decided |
| Held | — | ||
| ACT-017710 | Outreach suppressed pending steward Outreach | TPA-50207 (Andrea Jordan) held until CASE-004266 is decided |
| Held | — | ||
| ACT-017711 | Outreach suppressed pending steward Outreach | ENR-108661 (James Butler) held until CASE-004267 is decided |
| Held | — | ||
| ACT-017712 | Outreach suppressed pending steward Outreach | TPA-52911 (Jimmy Butler) held until CASE-004268 is decided |
| Held | — | ||
| ACT-017713 | Outreach suppressed pending steward Outreach | CLM-414907 (Emma Weaver) held until CASE-004269 is decided |
| Held | — | ||
| ACT-017714 | Outreach suppressed pending steward Outreach | TPA-56572 (Emma Weaver) held until CASE-004270 is decided |
| Held | — | ||
| ACT-017715 | Outreach suppressed pending steward Outreach | TPA-53649 (Debra Guerrero) held until CASE-004271 is decided |
| Held | — | ||
| ACT-017716 | Outreach suppressed pending steward Outreach | ENR-110969 (Debra Guerrero) held until CASE-004272 is decided |
| Held | — | ||
| ACT-017717 | Outreach suppressed pending steward Outreach | TPA-63133 (Timothy Simmons) held until CASE-004273 is decided |
| Held | — | ||
| ACT-017718 | Outreach suppressed pending steward Outreach | TPA-52217 (Mark Palmer) held until CASE-004274 is decided |
| Held | — | ||
| ACT-017719 | Outreach suppressed pending steward Outreach | TPA-52216 (Mark Palmer) held until CASE-004275 is decided |
| Held | — | ||
| ACT-017720 | Outreach suppressed pending steward Outreach | ENR-120679 (Wong Maason) held until CASE-004276 is decided |
| Held | — | ||
| ACT-017721 | Outreach suppressed pending steward Outreach | TPA-55604 (Christian West) held until CASE-004277 is decided |
| Held | — | ||
| ACT-017722 | Outreach suppressed pending steward Outreach | ENR-116747 (Christian West) held until CASE-004278 is decided |
| Held | — | ||
| ACT-017723 | Outreach suppressed pending steward Outreach | TPA-50335 (Ana Ward) held until CASE-004279 is decided |
| Held | — | ||
| ACT-017724 | Outreach suppressed pending steward Outreach | ENR-100009 (Shirley Hernandez) held until CASE-004280 is decided |
| Held | — | ||
| ACT-017725 | Outreach suppressed pending steward Outreach | PRV-20003 (Shirley Hernandez) held until CASE-004281 is decided |
| Held | — | ||
| ACT-017726 | Outreach suppressed pending steward Outreach | ENR-140463 (Camila Russell) held until CASE-004282 is decided |
| Held | — | ||
| ACT-017727 | Outreach suppressed pending steward Outreach | CLM-430790 (Camila Russell) held until CASE-004283 is decided |
| Held | — | ||
| ACT-017728 | Outreach suppressed pending steward Outreach | CLM-404639 (Douglas Salazar) held until CASE-004284 is decided |
| Held | — | ||
| ACT-017729 | Outreach suppressed pending steward Outreach | CLM-418574 (Terry Tran) held until CASE-004285 is decided |
| Held | — | ||
| ACT-017730 | Outreach suppressed pending steward Outreach | ENR-124447 (Terry Tran) held until CASE-004286 is decided |
| Held | — | ||
| ACT-017731 | Outreach suppressed pending steward Outreach | ENR-136168 (Barbara Hill) held until CASE-004287 is decided |
| Held | — | ||
| ACT-017732 | Outreach suppressed pending steward Outreach | CLM-427589 (Barbara Hill) held until CASE-004288 is decided |
| Held | — | ||
| ACT-017733 | Outreach suppressed pending steward Outreach | ENR-106992 (Frances Jensen) held until CASE-004289 is decided |
| Held | — | ||
| ACT-017734 | Outreach suppressed pending steward Outreach | CLM-405338 (Frances Jensen) held until CASE-004290 is decided |
| Held | — | ||
| ACT-017735 | Outreach suppressed pending steward Outreach | PRV-24093 (Christian Hghes) held until CASE-004291 is decided |
| Held | — | ||
| ACT-017736 | Outreach suppressed pending steward Outreach | TPA-56220 (Christian Hughes) held until CASE-004292 is decided |
| Held | — | ||
| ACT-017737 | Outreach suppressed pending steward Outreach | PRV-20602 (Natalie Palmer) held until CASE-004293 is decided |
| Held | — | ||
| ACT-017738 | Outreach suppressed pending steward Outreach | CLM-402050 (Natalie Palmer) held until CASE-004294 is decided |
| Held | — | ||
| ACT-017739 | Outreach suppressed pending steward Outreach | CLM-431631 (Kayla Roojas) held until CASE-004295 is decided |
| Held | — | ||
| ACT-017740 | Outreach suppressed pending steward Outreach | ENR-141531 (Kayla Rojas) held until CASE-004296 is decided |
| Held | — | ||
| ACT-017741 | Outreach suppressed pending steward Outreach | ENR-126352 (Ryan Parker) held until CASE-004297 is decided |
| Held | — | ||
| ACT-017742 | Outreach suppressed pending steward Outreach | TPA-59251 (Gabriel Ford) held until CASE-004298 is decided |
| Held | — | ||
| ACT-017743 | Outreach suppressed pending steward Outreach | ENR-127630 (Gabriel Ford) held until CASE-004299 is decided |
| Held | — | ||
| ACT-017744 | Outreach suppressed pending steward Outreach | CLM-429540 (Ahmed Senders) held until CASE-004300 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.