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-015002 | Outreach suppressed pending steward Outreach | CLM-427838 (Patricia Lawson) held until CASE-001558 is decided |
| Held | — | ||
| ACT-015003 | Outreach suppressed pending steward Outreach | CLM-417266 (Andrew Jimenez) held until CASE-001559 is decided |
| Held | — | ||
| ACT-015004 | Outreach suppressed pending steward Outreach | CLM-430175 (John Vazquez) held until CASE-001560 is decided |
| Held | — | ||
| ACT-015005 | Outreach suppressed pending steward Outreach | TPA-63318 (John Vazquez) held until CASE-001561 is decided |
| Held | — | ||
| ACT-015006 | Outreach suppressed pending steward Outreach | TPA-51796 (Zechary Luna) held until CASE-001562 is decided |
| Held | — | ||
| ACT-015007 | Outreach suppressed pending steward Outreach | TPA-58567 (Jerry Lane) held until CASE-001563 is decided |
| Held | — | ||
| ACT-015008 | Outreach suppressed pending steward Outreach | TPA-51283 (Carol Snyder) held until CASE-001564 is decided |
| Held | — | ||
| ACT-015009 | Outreach suppressed pending steward Outreach | TPA-55815 (Luis Snyder) held until CASE-001565 is decided |
| Held | — | ||
| ACT-015010 | Outreach suppressed pending steward Outreach | ENR-117349 (Luis Snydre) held until CASE-001566 is decided |
| Held | — | ||
| ACT-015011 | Outreach suppressed pending steward Outreach | PRV-20417 (Sarra Gomez) held until CASE-001567 is decided |
| Held | — | ||
| ACT-015012 | Outreach suppressed pending steward Outreach | CLM-430601 (Randy Coko) held until CASE-001568 is decided |
| Held | — | ||
| ACT-015013 | Outreach suppressed pending steward Outreach | CLM-430602 (Randy Cok) held until CASE-001569 is decided |
| Held | — | ||
| ACT-015014 | Outreach suppressed pending steward Outreach | CLM-428492 (Arthur Wong) held until CASE-001570 is decided |
| Held | — | ||
| ACT-015015 | Outreach suppressed pending steward Outreach | CLM-428493 (Arthur Wong) held until CASE-001571 is decided |
| Held | — | ||
| ACT-015016 | Outreach suppressed pending steward Outreach | CLM-425037 (Willie Simmons) held until CASE-001572 is decided |
| Held | — | ||
| ACT-015017 | Outreach suppressed pending steward Outreach | TPA-61032 (Willie Simmons) held until CASE-001573 is decided |
| Held | — | ||
| ACT-015018 | Outreach suppressed pending steward Outreach | PRV-24474 (Lisa Carpenter) held until CASE-001574 is decided |
| Held | — | ||
| ACT-015019 | Outreach suppressed pending steward Outreach | TPA-59866 (George Riley) held until CASE-001575 is decided |
| Held | — | ||
| ACT-015020 | Outreach suppressed pending steward Outreach | CLM-422464 (George Riley) held until CASE-001576 is decided |
| Held | — | ||
| ACT-015021 | Outreach suppressed pending steward Outreach | PRV-22011 (Maria Danniels) held until CASE-001577 is decided |
| Held | — | ||
| ACT-015022 | Outreach suppressed pending steward Outreach | CLM-406843 (Maria Daniels) held until CASE-001578 is decided |
| Held | — | ||
| ACT-015023 | Outreach suppressed pending steward Outreach | ENR-141790 (Lauren Tomas) held until CASE-001579 is decided |
| Held | — | ||
| ACT-015024 | Outreach suppressed pending steward Outreach | TPA-64043 (Lauren Thomas) held until CASE-001580 is decided |
| Held | — | ||
| ACT-015025 | Outreach suppressed pending steward Outreach | ENR-104163 (Henry Bishop) held until CASE-001581 is decided |
| Held | — | ||
| ACT-015026 | Outreach suppressed pending steward Outreach | TPA-51385 (Henry Bishop) held until CASE-001582 is decided |
| Held | — | ||
| ACT-015027 | Outreach suppressed pending steward Outreach | ENR-105741 (Carl Hoffman) held until CASE-001583 is decided |
| Held | — | ||
| ACT-015028 | Outreach suppressed pending steward Outreach | TPA-51984 (Brenda Collins) held until CASE-001584 is decided |
| Held | — | ||
| ACT-015029 | Outreach suppressed pending steward Outreach | ENR-105984 (Brenda Collins) held until CASE-001585 is decided |
| Held | — | ||
| ACT-015030 | Outreach suppressed pending steward Outreach | CLM-412911 (Virginia Foster) held until CASE-001586 is decided |
| Held | — | ||
| ACT-015031 | Outreach suppressed pending steward Outreach | TPA-53624 (Jordan Richards) held until CASE-001587 is decided |
| Held | — | ||
| ACT-015032 | Outreach suppressed pending steward Outreach | CLM-413095 (Joe Rojas) held until CASE-001588 is decided |
| Held | — | ||
| ACT-015033 | Outreach suppressed pending steward Outreach | TPA-59537 (Larry Simpson) held until CASE-001589 is decided |
| Held | — | ||
| ACT-015034 | Outreach suppressed pending steward Outreach | TPA-59538 (Larry Simpson) held until CASE-001590 is decided |
| Held | — | ||
| ACT-015035 | Outreach suppressed pending steward Outreach | ENR-105740 (Bobby Garcia) held until CASE-001591 is decided |
| Held | — | ||
| ACT-015036 | Outreach suppressed pending steward Outreach | CLM-404358 (Bobby Garcia) held until CASE-001592 is decided |
| Held | — | ||
| ACT-015037 | Outreach suppressed pending steward Outreach | PRV-24318 (Mary Young) held until CASE-001593 is decided |
| Held | — | ||
| ACT-015038 | Outreach suppressed pending steward Outreach | CLM-426547 (Doris McDonald) held until CASE-001594 is decided |
| Held | — | ||
| ACT-015039 | Outreach suppressed pending steward Outreach | PRV-24188 (Christopher Boyd) held until CASE-001595 is decided |
| Held | — | ||
| ACT-015040 | Outreach suppressed pending steward Outreach | ENR-118820 (Christopher Boyd) held until CASE-001596 is decided |
| Held | — | ||
| ACT-015041 | Outreach suppressed pending steward Outreach | TPA-56226 (Walter Hunt) held until CASE-001597 is decided |
| Held | — | ||
| ACT-015042 | Outreach suppressed pending steward Outreach | ENR-102883 (Hiroshi Banks) held until CASE-001598 is decided |
| Held | — | ||
| ACT-015043 | Outreach suppressed pending steward Outreach | PRV-20668 (Hiroshi Banks) held until CASE-001599 is decided |
| Held | — | ||
| ACT-015044 | Outreach suppressed pending steward Outreach | TPA-55292 (Lisa Walker) held until CASE-001600 is decided |
| Held | — | ||
| ACT-015045 | Outreach suppressed pending steward Outreach | CLM-412695 (Isabella Torres) held until CASE-001601 is decided |
| Held | — | ||
| ACT-015046 | Outreach suppressed pending steward Outreach | TPA-50703 (Eric Wood) held until CASE-001602 is decided |
| Held | — | ||
| ACT-015047 | Outreach suppressed pending steward Outreach | PRV-24580 (Maria Vazquez) held until CASE-001603 is decided |
| Held | — | ||
| ACT-015048 | Outreach suppressed pending steward Outreach | CLM-418639 (Natalie Hoffman) held until CASE-001604 is decided |
| Held | — | ||
| ACT-015049 | Outreach suppressed pending steward Outreach | CLM-418640 (Natalie Hoffman) held until CASE-001605 is decided |
| Held | — | ||
| ACT-015050 | Outreach suppressed pending steward Outreach | CLM-420999 (Tyler Reed) held until CASE-001606 is decided |
| Held | — | ||
| ACT-015051 | Outreach suppressed pending steward Outreach | TPA-59237 (Tyler Reed) held until CASE-001607 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.