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-014852 | Outreach suppressed pending steward Outreach | PRV-27022 (Justin Ryan) held until CASE-001408 is decided |
| Held | — | ||
| ACT-014853 | Outreach suppressed pending steward Outreach | TPA-58211 (Debra Ortega) held until CASE-001409 is decided |
| Held | — | ||
| ACT-014854 | Outreach suppressed pending steward Outreach | TPA-64413 (Benjamin Olson) held until CASE-001410 is decided |
| Held | — | ||
| ACT-014855 | Outreach suppressed pending steward Outreach | ENR-137873 (Gary Santiago) held until CASE-001411 is decided |
| Held | — | ||
| ACT-014856 | Outreach suppressed pending steward Outreach | CLM-426992 (Martha Jenkins) held until CASE-001412 is decided |
| Held | — | ||
| ACT-014857 | Outreach suppressed pending steward Outreach | CLM-407443 (Elijah Aguilar) held until CASE-001413 is decided |
| Held | — | ||
| ACT-014858 | Outreach suppressed pending steward Outreach | PRV-22201 (Elijah Aguilar) held until CASE-001414 is decided |
| Held | — | ||
| ACT-014859 | Outreach suppressed pending steward Outreach | TPA-60969 (Zachary Gibson) held until CASE-001415 is decided |
| Held | — | ||
| ACT-014860 | Outreach suppressed pending steward Outreach | CLM-421691 (Willima Olson) held until CASE-001416 is decided |
| Held | — | ||
| ACT-014861 | Outreach suppressed pending steward Outreach | TPA-59526 (William Olson) held until CASE-001417 is decided |
| Held | — | ||
| ACT-014862 | Outreach suppressed pending steward Outreach | CLM-432575 (Melissa Allen) held until CASE-001418 is decided |
| Held | — | ||
| ACT-014863 | Outreach suppressed pending steward Outreach | TPA-51674 (Emma Cooleman) held until CASE-001419 is decided |
| Held | — | ||
| ACT-014864 | Outreach suppressed pending steward Outreach | TPA-58521 (Sara Gibson) held until CASE-001420 is decided |
| Held | — | ||
| ACT-014865 | Outreach suppressed pending steward Outreach | ENR-125428 (Sara Gibson) held until CASE-001421 is decided |
| Held | — | ||
| ACT-014866 | Outreach suppressed pending steward Outreach | TPA-64161 (Isabella Dominguez) held until CASE-001422 is decided |
| Held | — | ||
| ACT-014867 | Outreach suppressed pending steward Outreach | TPA-64160 (Isabella Dominguez) held until CASE-001423 is decided |
| Held | — | ||
| ACT-014868 | Outreach suppressed pending steward Outreach | TPA-55737 (Walter Carr) held until CASE-001424 is decided |
| Held | — | ||
| ACT-014869 | Outreach suppressed pending steward Outreach | CLM-428562 (Janet Howell) held until CASE-001425 is decided |
| Held | — | ||
| ACT-014870 | Outreach suppressed pending steward Outreach | PRV-28390 (Jnet Howell) held until CASE-001426 is decided |
| Held | — | ||
| ACT-014871 | Outreach suppressed pending steward Outreach | CLM-402039 (Tyler Matthews) held until CASE-001427 is decided |
| Held | — | ||
| ACT-014872 | Outreach suppressed pending steward Outreach | ENR-102608 (Tyler Matthews) held until CASE-001428 is decided |
| Held | — | ||
| ACT-014873 | Outreach suppressed pending steward Outreach | TPA-58601 (Angela Flores) held until CASE-001429 is decided |
| Held | — | ||
| ACT-014874 | Outreach suppressed pending steward Outreach | CLM-432134 (Maria Welch) held until CASE-001430 is decided |
| Held | — | ||
| ACT-014875 | Outreach suppressed pending steward Outreach | CLM-424970 (Jacob Kelly) held until CASE-001431 is decided |
| Held | — | ||
| ACT-014876 | Outreach suppressed pending steward Outreach | TPA-54507 (Jessica Soto) held until CASE-001432 is decided |
| Held | — | ||
| ACT-014877 | Outreach suppressed pending steward Outreach | ENR-113576 (Jessica Soto) held until CASE-001433 is decided |
| Held | — | ||
| ACT-014878 | Outreach suppressed pending steward Outreach | TPA-50073 (Sean Cook) held until CASE-001434 is decided |
| Held | — | ||
| ACT-014879 | Outreach suppressed pending steward Outreach | PRV-27589 (Mariana Hansen) held until CASE-001435 is decided |
| Held | — | ||
| ACT-014880 | Outreach suppressed pending steward Outreach | CLM-425785 (Mariana Hansen) held until CASE-001436 is decided |
| Held | — | ||
| ACT-014881 | Outreach suppressed pending steward Outreach | CLM-424722 (Daniel Garcia) held until CASE-001437 is decided |
| Held | — | ||
| ACT-014882 | Outreach suppressed pending steward Outreach | CLM-418306 (Janet Sullivan) held until CASE-001438 is decided |
| Held | — | ||
| ACT-014883 | Outreach suppressed pending steward Outreach | TPA-63136 (Karen Nichols) held until CASE-001439 is decided |
| Held | — | ||
| ACT-014884 | Outreach suppressed pending steward Outreach | ENR-122620 (Mei Lynch) held until CASE-001440 is decided |
| Held | — | ||
| ACT-014885 | Outreach suppressed pending steward Outreach | CLM-414105 (Isabella Lynch) held until CASE-001441 is decided |
| Held | — | ||
| ACT-014886 | Outreach suppressed pending steward Outreach | ENR-102457 (Peter Sullivan) held until CASE-001442 is decided |
| Held | — | ||
| ACT-014887 | Outreach suppressed pending steward Outreach | PRV-25127 (Dorothy Diaz) held until CASE-001443 is decided |
| Held | — | ||
| ACT-014888 | Outreach suppressed pending steward Outreach | CLM-417311 (Dot Diaz) held until CASE-001444 is decided |
| Held | — | ||
| ACT-014889 | Outreach suppressed pending steward Outreach | TPA-62153 (Emma Diaz) held until CASE-001445 is decided |
| Held | — | ||
| ACT-014890 | Outreach suppressed pending steward Outreach | TPA-57542 (Nicole Owens) held until CASE-001446 is decided |
| Held | — | ||
| ACT-014891 | Outreach suppressed pending steward Outreach | TPA-57543 (Nicole Owens) held until CASE-001447 is decided |
| Held | — | ||
| ACT-014892 | Outreach suppressed pending steward Outreach | TPA-59104 (Jacob Maldonado) held until CASE-001448 is decided |
| Held | — | ||
| ACT-014893 | Outreach suppressed pending steward Outreach | TPA-63783 (Jason Kelley) held until CASE-001449 is decided |
| Held | — | ||
| ACT-014894 | Outreach suppressed pending steward Outreach | CLM-431187 (Jason Kelley) held until CASE-001450 is decided |
| Held | — | ||
| ACT-014895 | Outreach suppressed pending steward Outreach | ENR-107348 (Helen Snyder) held until CASE-001451 is decided |
| Held | — | ||
| ACT-014896 | Outreach suppressed pending steward Outreach | CLM-405587 (Helen Snyder) held until CASE-001452 is decided |
| Held | — | ||
| ACT-014897 | Outreach suppressed pending steward Outreach | TPA-57954 (Ana Grant) held until CASE-001453 is decided |
| Held | — | ||
| ACT-014898 | Outreach suppressed pending steward Outreach | TPA-63534 (Patricia Mendez) held until CASE-001454 is decided |
| Held | — | ||
| ACT-014899 | Outreach suppressed pending steward Outreach | TPA-63533 (Patricia Mendez) held until CASE-001455 is decided |
| Held | — | ||
| ACT-014900 | Outreach suppressed pending steward Outreach | ENR-111129 (Larry Willis) held until CASE-001456 is decided |
| Held | — | ||
| ACT-014901 | Outreach suppressed pending steward Outreach | CLM-408442 (Larry Willis) held until CASE-001457 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.