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-014752 | Outreach suppressed pending steward Outreach | TPA-57831 (Theresa Garza) held until CASE-001308 is decided |
| Held | — | ||
| ACT-014753 | Outreach suppressed pending steward Outreach | TPA-62577 (Kyle Brown) held until CASE-001309 is decided |
| Held | — | ||
| ACT-014754 | Outreach suppressed pending steward Outreach | TPA-62578 (Kyle Brown) held until CASE-001310 is decided |
| Held | — | ||
| ACT-014755 | Outreach suppressed pending steward Outreach | CLM-410300 (Joan Brown) held until CASE-001311 is decided |
| Held | — | ||
| ACT-014756 | Outreach suppressed pending steward Outreach | CLM-424669 (Bob Vasquez) held until CASE-001312 is decided |
| Held | — | ||
| ACT-014757 | Outreach suppressed pending steward Outreach | ENR-132225 (Robert Vasquez) held until CASE-001313 is decided |
| Held | — | ||
| ACT-014758 | Outreach suppressed pending steward Outreach | ENR-124941 (Cheryl Bradley) held until CASE-001314 is decided |
| Held | — | ||
| ACT-014759 | Outreach suppressed pending steward Outreach | CLM-418928 (Cheryl Bradley) held until CASE-001315 is decided |
| Held | — | ||
| ACT-014760 | Outreach suppressed pending steward Outreach | ENR-120864 (Douglas Bradley) held until CASE-001316 is decided |
| Held | — | ||
| ACT-014761 | Outreach suppressed pending steward Outreach | TPA-58400 (Emma Mitchell) held until CASE-001317 is decided |
| Held | — | ||
| ACT-014762 | Outreach suppressed pending steward Outreach | CLM-432689 (Susan Hart) held until CASE-001318 is decided |
| Held | — | ||
| ACT-014763 | Outreach suppressed pending steward Outreach | TPA-55363 (Emma Simmons) held until CASE-001319 is decided |
| Held | — | ||
| ACT-014764 | Outreach suppressed pending steward Outreach | ENR-116036 (Emma Simmons) held until CASE-001320 is decided |
| Held | — | ||
| ACT-014765 | Outreach suppressed pending steward Outreach | ENR-124044 (Raymond Ray) held until CASE-001321 is decided |
| Held | — | ||
| ACT-014766 | Outreach suppressed pending steward Outreach | CLM-418285 (Ray Ray) held until CASE-001322 is decided |
| Held | — | ||
| ACT-014767 | Outreach suppressed pending steward Outreach | CLM-431027 (Danel Mejia) held until CASE-001323 is decided |
| Held | — | ||
| ACT-014768 | Outreach suppressed pending steward Outreach | TPA-50741 (Jacqueline Taylor) held until CASE-001324 is decided |
| Held | — | ||
| ACT-014769 | Outreach suppressed pending steward Outreach | TPA-57359 (Kayla Riley) held until CASE-001325 is decided |
| Held | — | ||
| ACT-014770 | Outreach suppressed pending steward Outreach | TPA-56346 (Larry Banks) held until CASE-001326 is decided |
| Held | — | ||
| ACT-014771 | Outreach suppressed pending steward Outreach | PRV-24210 (Larry Banks) held until CASE-001327 is decided |
| Held | — | ||
| ACT-014772 | Outreach suppressed pending steward Outreach | CLM-422726 (Gerald Arnold) held until CASE-001328 is decided |
| Held | — | ||
| ACT-014773 | Outreach suppressed pending steward Outreach | CLM-422461 (Charles Medina) held until CASE-001329 is decided |
| Held | — | ||
| ACT-014774 | Outreach suppressed pending steward Outreach | TPA-51957 (Mason Duncan) held until CASE-001330 is decided |
| Held | — | ||
| ACT-014775 | Outreach suppressed pending steward Outreach | PRV-29529 (Laura Fox) held until CASE-001331 is decided |
| Held | — | ||
| ACT-014776 | Outreach suppressed pending steward Outreach | ENR-142805 (Laura Fox) held until CASE-001332 is decided |
| Held | — | ||
| ACT-014777 | Outreach suppressed pending steward Outreach | TPA-62259 (Vasquez Shirley) held until CASE-001333 is decided |
| Held | — | ||
| ACT-014778 | Outreach suppressed pending steward Outreach | TPA-54581 (Catherine Washington) held until CASE-001334 is decided |
| Held | — | ||
| ACT-014779 | Outreach suppressed pending steward Outreach | CLM-425016 (Juliia Wright) held until CASE-001335 is decided |
| Held | — | ||
| ACT-014780 | Outreach suppressed pending steward Outreach | TPA-54314 (Bruce Alvarez) held until CASE-001336 is decided |
| Held | — | ||
| ACT-014781 | Outreach suppressed pending steward Outreach | CLM-409880 (Bruce Alvarez) held until CASE-001337 is decided |
| Held | — | ||
| ACT-014782 | Outreach suppressed pending steward Outreach | TPA-52286 (Dorothy Gry) held until CASE-001338 is decided |
| Held | — | ||
| ACT-014783 | Outreach suppressed pending steward Outreach | CLM-410080 (Bobby Walsh) held until CASE-001339 is decided |
| Held | — | ||
| ACT-014784 | Outreach suppressed pending steward Outreach | CLM-416807 (Janet Cruz) held until CASE-001340 is decided |
| Held | — | ||
| ACT-014785 | Outreach suppressed pending steward Outreach | TPA-59762 (Jacob Wallace) held until CASE-001341 is decided |
| Held | — | ||
| ACT-014786 | Outreach suppressed pending steward Outreach | TPA-58770 (Brian Walsh) held until CASE-001342 is decided |
| Held | — | ||
| ACT-014787 | Outreach suppressed pending steward Outreach | TPA-55976 (Arjun Reid) held until CASE-001343 is decided |
| Held | — | ||
| ACT-014788 | Outreach suppressed pending steward Outreach | CLM-413597 (Arjun Reid) held until CASE-001344 is decided |
| Held | — | ||
| ACT-014789 | Outreach suppressed pending steward Outreach | TPA-58963 (Lauren Martin) held until CASE-001345 is decided |
| Held | — | ||
| ACT-014790 | Outreach suppressed pending steward Outreach | CLM-426128 (Joseph Hayes) held until CASE-001346 is decided |
| Held | — | ||
| ACT-014791 | Outreach suppressed pending steward Outreach | CLM-422773 (Jesse Cunningham) held until CASE-001347 is decided |
| Held | — | ||
| ACT-014792 | Outreach suppressed pending steward Outreach | TPA-51355 (Carolyn Hawkins) held until CASE-001348 is decided |
| Held | — | ||
| ACT-014793 | Outreach suppressed pending steward Outreach | ENR-104096 (Carolyn Hawkins) held until CASE-001349 is decided |
| Held | — | ||
| ACT-014794 | Outreach suppressed pending steward Outreach | CLM-431635 (Andrea Grean) held until CASE-001350 is decided |
| Held | — | ||
| ACT-014795 | Outreach suppressed pending steward Outreach | PRV-24355 (Madison Garcia) held until CASE-001351 is decided |
| Held | — | ||
| ACT-014796 | Outreach suppressed pending steward Outreach | CLM-414843 (Madison Garcia) held until CASE-001352 is decided |
| Held | — | ||
| ACT-014797 | Outreach suppressed pending steward Outreach | TPA-58409 (Nicole Carr) held until CASE-001353 is decided |
| Held | — | ||
| ACT-014798 | Outreach suppressed pending steward Outreach | TPA-56696 (Bobby Porter) held until CASE-001354 is decided |
| Held | — | ||
| ACT-014799 | Outreach suppressed pending steward Outreach | TPA-50035 (Christian Contreras) held until CASE-001355 is decided |
| Held | — | ||
| ACT-014800 | Outreach suppressed pending steward Outreach | CLM-404125 (Albert Kim) held until CASE-001356 is decided |
| Held | — | ||
| ACT-014801 | Outreach suppressed pending steward Outreach | TPA-51787 (Alberrt Kim) held until CASE-001357 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.