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-014952 | Outreach suppressed pending steward Outreach | CLM-423685 (Randy Morris) held until CASE-001508 is decided |
| Held | — | ||
| ACT-014953 | Outreach suppressed pending steward Outreach | CLM-423686 (Randy Morris) held until CASE-001509 is decided |
| Held | — | ||
| ACT-014954 | Outreach suppressed pending steward Outreach | PRV-27471 (Lucia Guerrero) held until CASE-001510 is decided |
| Held | — | ||
| ACT-014955 | Outreach suppressed pending steward Outreach | CLM-425355 (Lucia Guerrero) held until CASE-001511 is decided |
| Held | — | ||
| ACT-014956 | Outreach suppressed pending steward Outreach | TPA-56754 (Daniel Warren) held until CASE-001512 is decided |
| Held | — | ||
| ACT-014957 | Outreach suppressed pending steward Outreach | PRV-27593 (Jesse Fields) held until CASE-001513 is decided |
| Held | — | ||
| ACT-014958 | Outreach suppressed pending steward Outreach | ENR-108782 (Katherine Jimenez) held until CASE-001514 is decided |
| Held | — | ||
| ACT-014959 | Outreach suppressed pending steward Outreach | CLM-406734 (Kathy Jimenez) held until CASE-001515 is decided |
| Held | — | ||
| ACT-014960 | Outreach suppressed pending steward Outreach | TPA-61628 (Jmaes Williams) held until CASE-001516 is decided |
| Held | — | ||
| ACT-014961 | Outreach suppressed pending steward Outreach | ENR-142346 (Olivia Williams) held until CASE-001517 is decided |
| Held | — | ||
| ACT-014962 | Outreach suppressed pending steward Outreach | CLM-432253 (Olivia Williams) held until CASE-001518 is decided |
| Held | — | ||
| ACT-014963 | Outreach suppressed pending steward Outreach | TPA-58882 (Jose Griffin) held until CASE-001519 is decided |
| Held | — | ||
| ACT-014964 | Outreach suppressed pending steward Outreach | CLM-420176 (Jose Griffin) held until CASE-001520 is decided |
| Held | — | ||
| ACT-014965 | Outreach suppressed pending steward Outreach | TPA-64137 (Joshua Griffin) held until CASE-001521 is decided |
| Held | — | ||
| ACT-014966 | Outreach suppressed pending steward Outreach | ENR-128700 (Anthony Bennett) held until CASE-001522 is decided |
| Held | — | ||
| ACT-014967 | Outreach suppressed pending steward Outreach | ENR-123381 (Susan Burns) held until CASE-001523 is decided |
| Held | — | ||
| ACT-014968 | Outreach suppressed pending steward Outreach | CLM-417770 (Susan Burns) held until CASE-001524 is decided |
| Held | — | ||
| ACT-014969 | Outreach suppressed pending steward Outreach | TPA-55490 (Alexis Watkins) held until CASE-001525 is decided |
| Held | — | ||
| ACT-014970 | Outreach suppressed pending steward Outreach | TPA-63438 (Kelly Watson) held until CASE-001526 is decided |
| Held | — | ||
| ACT-014971 | Outreach suppressed pending steward Outreach | CLM-430429 (Kelly Watson) held until CASE-001527 is decided |
| Held | — | ||
| ACT-014972 | Outreach suppressed pending steward Outreach | TPA-53484 (Alexis Burton) held until CASE-001528 is decided |
| Held | — | ||
| ACT-014973 | Outreach suppressed pending steward Outreach | CLM-422592 (Karne Palmeer) held until CASE-001529 is decided |
| Held | — | ||
| ACT-014974 | Outreach suppressed pending steward Outreach | CLM-404318 (Angela Wagner) held until CASE-001530 is decided |
| Held | — | ||
| ACT-014975 | Outreach suppressed pending steward Outreach | CLM-404317 (Angela Wagner) held until CASE-001531 is decided |
| Held | — | ||
| ACT-014976 | Outreach suppressed pending steward Outreach | CLM-404315 (Angela Wagner) held until CASE-001532 is decided |
| Held | — | ||
| ACT-014977 | Outreach suppressed pending steward Outreach | CLM-400363 (Grace Soto) held until CASE-001533 is decided |
| Held | — | ||
| ACT-014978 | Outreach suppressed pending steward Outreach | ENR-110343 (Yuki Luna) held until CASE-001534 is decided |
| Held | — | ||
| ACT-014979 | Outreach suppressed pending steward Outreach | TPA-53465 (Yuki Luna) held until CASE-001535 is decided |
| Held | — | ||
| ACT-014980 | Outreach suppressed pending steward Outreach | TPA-61248 (Gregory Tuckr) held until CASE-001536 is decided |
| Held | — | ||
| ACT-014981 | Outreach suppressed pending steward Outreach | ENR-133349 (Gregory Tucker) held until CASE-001537 is decided |
| Held | — | ||
| ACT-014982 | Outreach suppressed pending steward Outreach | TPA-61916 (Frank Taylor) held until CASE-001538 is decided |
| Held | — | ||
| ACT-014983 | Outreach suppressed pending steward Outreach | TPA-59056 (Natthan Tran) held until CASE-001539 is decided |
| Held | — | ||
| ACT-014984 | Outreach suppressed pending steward Outreach | TPA-53717 (Ronald Weaver) held until CASE-001540 is decided |
| Held | — | ||
| ACT-014985 | Outreach suppressed pending steward Outreach | CLM-429209 (Sara Williams) held until CASE-001541 is decided |
| Held | — | ||
| ACT-014986 | Outreach suppressed pending steward Outreach | CLM-403954 (Cheryl Montgomery) held until CASE-001542 is decided |
| Held | — | ||
| ACT-014987 | Outreach suppressed pending steward Outreach | CLM-421248 (Amanda Phillips) held until CASE-001543 is decided |
| Held | — | ||
| ACT-014988 | Outreach suppressed pending steward Outreach | TPA-59346 (Amanda Phillips) held until CASE-001544 is decided |
| Held | — | ||
| ACT-014989 | Outreach suppressed pending steward Outreach | CLM-400518 (Evelyn Rodriguez) held until CASE-001545 is decided |
| Held | — | ||
| ACT-014990 | Outreach suppressed pending steward Outreach | TPA-50224 (Evelyn Rodriguez) held until CASE-001546 is decided |
| Held | — | ||
| ACT-014991 | Outreach suppressed pending steward Outreach | TPA-54063 (Elizabeth Diaz) held until CASE-001547 is decided |
| Held | — | ||
| ACT-014992 | Outreach suppressed pending steward Outreach | CLM-409368 (Elizabeth Diaz) held until CASE-001548 is decided |
| Held | — | ||
| ACT-014993 | Outreach suppressed pending steward Outreach | ENR-142259 (Valentina Diaz) held until CASE-001549 is decided |
| Held | — | ||
| ACT-014994 | Outreach suppressed pending steward Outreach | TPA-64208 (Valentina Diaz) held until CASE-001550 is decided |
| Held | — | ||
| ACT-014995 | Outreach suppressed pending steward Outreach | TPA-60731 (Julie Alexander) held until CASE-001551 is decided |
| Held | — | ||
| ACT-014996 | Outreach suppressed pending steward Outreach | CLM-424358 (Julie Alexander) held until CASE-001552 is decided |
| Held | — | ||
| ACT-014997 | Outreach suppressed pending steward Outreach | TPA-51593 (Gerald Ford) held until CASE-001553 is decided |
| Held | — | ||
| ACT-014998 | Outreach suppressed pending steward Outreach | TPA-55757 (Sarah Tucker) held until CASE-001554 is decided |
| Held | — | ||
| ACT-014999 | Outreach suppressed pending steward Outreach | TPA-54001 (Bryan Ortiz) held until CASE-001555 is decided |
| Held | — | ||
| ACT-015000 | Outreach suppressed pending steward Outreach | CLM-409184 (Bryan Ortiz) held until CASE-001556 is decided |
| Held | — | ||
| ACT-015001 | Outreach suppressed pending steward Outreach | CLM-409185 (Bryan Ortiz) held until CASE-001557 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.