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-014802 | Outreach suppressed pending steward Outreach | TPA-51788 (Albert Kim) held until CASE-001358 is decided |
| Held | — | ||
| ACT-014803 | Outreach suppressed pending steward Outreach | CLM-404124 (Albert Kim) held until CASE-001359 is decided |
| Held | — | ||
| ACT-014804 | Outreach suppressed pending steward Outreach | TPA-58632 (Hannah Morales) held until CASE-001360 is decided |
| Held | — | ||
| ACT-014805 | Outreach suppressed pending steward Outreach | ENR-134736 (Michael Chavez) held until CASE-001361 is decided |
| Held | — | ||
| ACT-014806 | Outreach suppressed pending steward Outreach | CLM-426480 (Mike Chavez) held until CASE-001362 is decided |
| Held | — | ||
| ACT-014807 | Outreach suppressed pending steward Outreach | CLM-419455 (Randy Long) held until CASE-001363 is decided |
| Held | — | ||
| ACT-014808 | Outreach suppressed pending steward Outreach | CLM-410883 (Sandra Dominguez) held until CASE-001364 is decided |
| Held | — | ||
| ACT-014809 | Outreach suppressed pending steward Outreach | CLM-410884 (Sandra Dominguez) held until CASE-001365 is decided |
| Held | — | ||
| ACT-014810 | Outreach suppressed pending steward Outreach | CLM-425948 (Virginia Dominguez) held until CASE-001366 is decided |
| Held | — | ||
| ACT-014811 | Outreach suppressed pending steward Outreach | CLM-424795 (Susan Wang) held until CASE-001367 is decided |
| Held | — | ||
| ACT-014812 | Outreach suppressed pending steward Outreach | CLM-405658 (Kathryn Powell) held until CASE-001368 is decided |
| Held | — | ||
| ACT-014813 | Outreach suppressed pending steward Outreach | ENR-131709 (Matthew Long) held until CASE-001369 is decided |
| Held | — | ||
| ACT-014814 | Outreach suppressed pending steward Outreach | TPA-60686 (Matthew Long) held until CASE-001370 is decided |
| Held | — | ||
| ACT-014815 | Outreach suppressed pending steward Outreach | PRV-22558 (Julia Powell) held until CASE-001371 is decided |
| Held | — | ||
| ACT-014816 | Outreach suppressed pending steward Outreach | CLM-408631 (Julia Powell) held until CASE-001372 is decided |
| Held | — | ||
| ACT-014817 | Outreach suppressed pending steward Outreach | CLM-424475 (Brandon Park) held until CASE-001373 is decided |
| Held | — | ||
| ACT-014818 | Outreach suppressed pending steward Outreach | ENR-131996 (Brandon Park) held until CASE-001374 is decided |
| Held | — | ||
| ACT-014819 | Outreach suppressed pending steward Outreach | ENR-128808 (Alice Fisher) held until CASE-001375 is decided |
| Held | — | ||
| ACT-014820 | Outreach suppressed pending steward Outreach | TPA-59662 (Alice Fisher) held until CASE-001376 is decided |
| Held | — | ||
| ACT-014821 | Outreach suppressed pending steward Outreach | TPA-50370 (Brittany Estrada) held until CASE-001377 is decided |
| Held | — | ||
| ACT-014822 | Outreach suppressed pending steward Outreach | CLM-400797 (Brittany Estrada) held until CASE-001378 is decided |
| Held | — | ||
| ACT-014823 | Outreach suppressed pending steward Outreach | CLM-400798 (Brittany Estrada) held until CASE-001379 is decided |
| Held | — | ||
| ACT-014824 | Outreach suppressed pending steward Outreach | CLM-400794 (Brittany Estrada) held until CASE-001380 is decided |
| Held | — | ||
| ACT-014825 | Outreach suppressed pending steward Outreach | CLM-408933 (Justin Bradley) held until CASE-001381 is decided |
| Held | — | ||
| ACT-014826 | Outreach suppressed pending steward Outreach | CLM-426808 (Alexis Howard) held until CASE-001382 is decided |
| Held | — | ||
| ACT-014827 | Outreach suppressed pending steward Outreach | ENR-135163 (Alexis Howard) held until CASE-001383 is decided |
| Held | — | ||
| ACT-014828 | Outreach suppressed pending steward Outreach | TPA-55853 (Doris White) held until CASE-001384 is decided |
| Held | — | ||
| ACT-014829 | Outreach suppressed pending steward Outreach | ENR-117473 (Doris White) held until CASE-001385 is decided |
| Held | — | ||
| ACT-014830 | Outreach suppressed pending steward Outreach | TPA-52138 (Jacqueline Simmons) held until CASE-001386 is decided |
| Held | — | ||
| ACT-014831 | Outreach suppressed pending steward Outreach | ENR-106459 (Jaccqueline Simmons) held until CASE-001387 is decided |
| Held | — | ||
| ACT-014832 | Outreach suppressed pending steward Outreach | TPA-62350 (Christine Young) held until CASE-001388 is decided |
| Held | — | ||
| ACT-014833 | Outreach suppressed pending steward Outreach | CLM-420305 (Sandra Jackson) held until CASE-001389 is decided |
| Held | — | ||
| ACT-014834 | Outreach suppressed pending steward Outreach | ENR-130161 (Melissa Gerdner) held until CASE-001390 is decided |
| Held | — | ||
| ACT-014835 | Outreach suppressed pending steward Outreach | TPA-60126 (Melissa Gardner) held until CASE-001391 is decided |
| Held | — | ||
| ACT-014836 | Outreach suppressed pending steward Outreach | TPA-51744 (Samuel Estrada) held until CASE-001392 is decided |
| Held | — | ||
| ACT-014837 | Outreach suppressed pending steward Outreach | TPA-51973 (Olivia Walker) held until CASE-001393 is decided |
| Held | — | ||
| ACT-014838 | Outreach suppressed pending steward Outreach | ENR-105971 (Olivia Walker) held until CASE-001394 is decided |
| Held | — | ||
| ACT-014839 | Outreach suppressed pending steward Outreach | CLM-404534 (Olivia Walker) held until CASE-001395 is decided |
| Held | — | ||
| ACT-014840 | Outreach suppressed pending steward Outreach | CLM-427396 (Justin Ruiz) held until CASE-001396 is decided |
| Held | — | ||
| ACT-014841 | Outreach suppressed pending steward Outreach | CLM-427395 (Justin Ruiz) held until CASE-001397 is decided |
| Held | — | ||
| ACT-014842 | Outreach suppressed pending steward Outreach | CLM-414656 (Ralph Hudson) held until CASE-001398 is decided |
| Held | — | ||
| ACT-014843 | Outreach suppressed pending steward Outreach | ENR-119293 (Ralph Hudson) held until CASE-001399 is decided |
| Held | — | ||
| ACT-014844 | Outreach suppressed pending steward Outreach | TPA-55211 (Bobby Hudson) held until CASE-001400 is decided |
| Held | — | ||
| ACT-014845 | Outreach suppressed pending steward Outreach | ENR-115593 (Bobby Hudson) held until CASE-001401 is decided |
| Held | — | ||
| ACT-014846 | Outreach suppressed pending steward Outreach | CLM-429728 (Marcus Luna) held until CASE-001402 is decided |
| Held | — | ||
| ACT-014847 | Outreach suppressed pending steward Outreach | TPA-53641 (Deborah Alvarado) held until CASE-001403 is decided |
| Held | — | ||
| ACT-014848 | Outreach suppressed pending steward Outreach | TPA-50885 (Austin Cox) held until CASE-001404 is decided |
| Held | — | ||
| ACT-014849 | Outreach suppressed pending steward Outreach | ENR-130370 (Sharon Dean) held until CASE-001405 is decided |
| Held | — | ||
| ACT-014850 | Outreach suppressed pending steward Outreach | CLM-423224 (Sharon Dean) held until CASE-001406 is decided |
| Held | — | ||
| ACT-014851 | Outreach suppressed pending steward Outreach | TPA-59700 (Keith Hudson) held until CASE-001407 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.