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-015202 | Outreach suppressed pending steward Outreach | TPA-61372 (George Walker) held until CASE-001758 is decided |
| Held | — | ||
| ACT-015203 | Outreach suppressed pending steward Outreach | TPA-52871 (Yuki Santiago) held until CASE-001759 is decided |
| Held | — | ||
| ACT-015204 | Outreach suppressed pending steward Outreach | ENR-130158 (Denise Santos) held until CASE-001760 is decided |
| Held | — | ||
| ACT-015205 | Outreach suppressed pending steward Outreach | TPA-57818 (Brandon Bell) held until CASE-001761 is decided |
| Held | — | ||
| ACT-015206 | Outreach suppressed pending steward Outreach | ENR-123324 (Brandon Bell) held until CASE-001762 is decided |
| Held | — | ||
| ACT-015207 | Outreach suppressed pending steward Outreach | CLM-409108 (Donald Walker) held until CASE-001763 is decided |
| Held | — | ||
| ACT-015208 | Outreach suppressed pending steward Outreach | TPA-62311 (Susan Perez) held until CASE-001764 is decided |
| Held | — | ||
| ACT-015209 | Outreach suppressed pending steward Outreach | TPA-62312 (Susan Perez) held until CASE-001765 is decided |
| Held | — | ||
| ACT-015210 | Outreach suppressed pending steward Outreach | TPA-53867 (Jack Pierce) held until CASE-001766 is decided |
| Held | — | ||
| ACT-015211 | Outreach suppressed pending steward Outreach | CLM-421898 (Alexis Price) held until CASE-001767 is decided |
| Held | — | ||
| ACT-015212 | Outreach suppressed pending steward Outreach | TPA-50655 (Beverly Perez) held until CASE-001768 is decided |
| Held | — | ||
| ACT-015213 | Outreach suppressed pending steward Outreach | TPA-50654 (Beverly Perez) held until CASE-001769 is decided |
| Held | — | ||
| ACT-015214 | Outreach suppressed pending steward Outreach | TPA-55845 (Maria Dean) held until CASE-001770 is decided |
| Held | — | ||
| ACT-015215 | Outreach suppressed pending steward Outreach | CLM-419235 (Elizabeth Dunn) held until CASE-001771 is decided |
| Held | — | ||
| ACT-015216 | Outreach suppressed pending steward Outreach | ENR-125366 (Elizabeth Dunn) held until CASE-001772 is decided |
| Held | — | ||
| ACT-015217 | Outreach suppressed pending steward Outreach | CLM-416740 (Jasse Shaw) held until CASE-001773 is decided |
| Held | — | ||
| ACT-015218 | Outreach suppressed pending steward Outreach | TPA-57371 (Jesse Shaw) held until CASE-001774 is decided |
| Held | — | ||
| ACT-015219 | Outreach suppressed pending steward Outreach | PRV-25358 (Jaack Burns) held until CASE-001775 is decided |
| Held | — | ||
| ACT-015220 | Outreach suppressed pending steward Outreach | CLM-423038 (Kelly Silva) held until CASE-001776 is decided |
| Held | — | ||
| ACT-015221 | Outreach suppressed pending steward Outreach | CLM-422371 (Jess Sanchez) held until CASE-001777 is decided |
| Held | — | ||
| ACT-015222 | Outreach suppressed pending steward Outreach | TPA-51023 (Edward Espinoza) held until CASE-001778 is decided |
| Held | — | ||
| ACT-015223 | Outreach suppressed pending steward Outreach | CLM-420963 (Gerald Tran) held until CASE-001779 is decided |
| Held | — | ||
| ACT-015224 | Outreach suppressed pending steward Outreach | TPA-59219 (Gerald Tran) held until CASE-001780 is decided |
| Held | — | ||
| ACT-015225 | Outreach suppressed pending steward Outreach | PRV-25215 (Jason Garrett) held until CASE-001781 is decided |
| Held | — | ||
| ACT-015226 | Outreach suppressed pending steward Outreach | ENR-121388 (Keith Henry) held until CASE-001782 is decided |
| Held | — | ||
| ACT-015227 | Outreach suppressed pending steward Outreach | TPA-57124 (Keith Henry) held until CASE-001783 is decided |
| Held | — | ||
| ACT-015228 | Outreach suppressed pending steward Outreach | TPA-52282 (Kathy Lucas) held until CASE-001784 is decided |
| Held | — | ||
| ACT-015229 | Outreach suppressed pending steward Outreach | CLM-405212 (Katherine Lucas) held until CASE-001785 is decided |
| Held | — | ||
| ACT-015230 | Outreach suppressed pending steward Outreach | TPA-52283 (Katherine Lucas) held until CASE-001786 is decided |
| Held | — | ||
| ACT-015231 | Outreach suppressed pending steward Outreach | CLM-411450 (Olivia Coleman) held until CASE-001787 is decided |
| Held | — | ||
| ACT-015232 | Outreach suppressed pending steward Outreach | PRV-20062 (John Cunningham) held until CASE-001788 is decided |
| Held | — | ||
| ACT-015233 | Outreach suppressed pending steward Outreach | CLM-400218 (John Cunningham) held until CASE-001789 is decided |
| Held | — | ||
| ACT-015234 | Outreach suppressed pending steward Outreach | PRV-28453 (Joan Coleman) held until CASE-001790 is decided |
| Held | — | ||
| ACT-015235 | Outreach suppressed pending steward Outreach | ENR-136070 (Larry Lee) held until CASE-001791 is decided |
| Held | — | ||
| ACT-015236 | Outreach suppressed pending steward Outreach | ENR-138962 (Kareen Li) held until CASE-001792 is decided |
| Held | — | ||
| ACT-015237 | Outreach suppressed pending steward Outreach | CLM-429701 (Karen Li) held until CASE-001793 is decided |
| Held | — | ||
| ACT-015238 | Outreach suppressed pending steward Outreach | PRV-27236 (Judy Lee) held until CASE-001794 is decided |
| Held | — | ||
| ACT-015239 | Outreach suppressed pending steward Outreach | ENR-132117 (Judy Lee) held until CASE-001795 is decided |
| Held | — | ||
| ACT-015240 | Outreach suppressed pending steward Outreach | CLM-409702 (Shirley Aguilar) held until CASE-001796 is decided |
| Held | — | ||
| ACT-015241 | Outreach suppressed pending steward Outreach | PRV-22810 (Shirley Aguilar) held until CASE-001797 is decided |
| Held | — | ||
| ACT-015242 | Outreach suppressed pending steward Outreach | CLM-423380 (Laura Alvarado) held until CASE-001798 is decided |
| Held | — | ||
| ACT-015243 | Outreach suppressed pending steward Outreach | CLM-422907 (Laura Weber) held until CASE-001799 is decided |
| Held | — | ||
| ACT-015244 | Outreach suppressed pending steward Outreach | TPA-60063 (Laura Weber) held until CASE-001800 is decided |
| Held | — | ||
| ACT-015245 | Outreach suppressed pending steward Outreach | CLM-405782 (Matthew Ryan) held until CASE-001801 is decided |
| Held | — | ||
| ACT-015246 | Outreach suppressed pending steward Outreach | CLM-421983 (Albert Diaz) held until CASE-001802 is decided |
| Held | — | ||
| ACT-015247 | Outreach suppressed pending steward Outreach | TPA-50163 (Daniel Howell) held until CASE-001803 is decided |
| Held | — | ||
| ACT-015248 | Outreach suppressed pending steward Outreach | ENR-102465 (Tyler Wilson) held until CASE-001804 is decided |
| Held | — | ||
| ACT-015249 | Outreach suppressed pending steward Outreach | CLM-401911 (Tyler Wilson) held until CASE-001805 is decided |
| Held | — | ||
| ACT-015250 | Outreach suppressed pending steward Outreach | TPA-64394 (Jeremy Gardner) held until CASE-001806 is decided |
| Held | — | ||
| ACT-015251 | Outreach suppressed pending steward Outreach | TPA-64395 (Jeremy Gardner) held until CASE-001807 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.