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-015302 | Outreach suppressed pending steward Outreach | TPA-56527 (Kathryn Hall) held until CASE-001858 is decided |
| Held | — | ||
| ACT-015303 | Outreach suppressed pending steward Outreach | CLM-400119 (Kyle Carr) held until CASE-001859 is decided |
| Held | — | ||
| ACT-015304 | Outreach suppressed pending steward Outreach | CLM-409355 (Danielle Andersno) held until CASE-001860 is decided |
| Held | — | ||
| ACT-015305 | Outreach suppressed pending steward Outreach | TPA-60508 (Fatima Carroll) held until CASE-001861 is decided |
| Held | — | ||
| ACT-015306 | Outreach suppressed pending steward Outreach | ENR-131240 (Fatima Carroll) held until CASE-001862 is decided |
| Held | — | ||
| ACT-015307 | Outreach suppressed pending steward Outreach | CLM-414486 (Sandra Guzman) held until CASE-001863 is decided |
| Held | — | ||
| ACT-015308 | Outreach suppressed pending steward Outreach | CLM-409380 (Rachel Wong) held until CASE-001864 is decided |
| Held | — | ||
| ACT-015309 | Outreach suppressed pending steward Outreach | CLM-417481 (Diana Bell) held until CASE-001865 is decided |
| Held | — | ||
| ACT-015310 | Outreach suppressed pending steward Outreach | TPA-63477 (Brenda Little) held until CASE-001866 is decided |
| Held | — | ||
| ACT-015311 | Outreach suppressed pending steward Outreach | ENR-134036 (Gordon Sara) held until CASE-001867 is decided |
| Held | — | ||
| ACT-015312 | Outreach suppressed pending steward Outreach | ENR-109425 (Frank Cartar) held until CASE-001868 is decided |
| Held | — | ||
| ACT-015313 | Outreach suppressed pending steward Outreach | CLM-407220 (Frank Carter) held until CASE-001869 is decided |
| Held | — | ||
| ACT-015314 | Outreach suppressed pending steward Outreach | PRV-24059 (Bradley Freeman) held until CASE-001870 is decided |
| Held | — | ||
| ACT-015315 | Outreach suppressed pending steward Outreach | ENR-118336 (Bradley Freeman) held until CASE-001871 is decided |
| Held | — | ||
| ACT-015316 | Outreach suppressed pending steward Outreach | CLM-426008 (David Jacobs) held until CASE-001872 is decided |
| Held | — | ||
| ACT-015317 | Outreach suppressed pending steward Outreach | ENR-110450 (Tohmas Jenkins) held until CASE-001873 is decided |
| Held | — | ||
| ACT-015318 | Outreach suppressed pending steward Outreach | TPA-53491 (Thomas Jenkins) held until CASE-001874 is decided |
| Held | — | ||
| ACT-015319 | Outreach suppressed pending steward Outreach | CLM-424582 (Amy Collins) held until CASE-001875 is decided |
| Held | — | ||
| ACT-015320 | Outreach suppressed pending steward Outreach | PRV-21696 (Lauren Rivera) held until CASE-001876 is decided |
| Held | — | ||
| ACT-015321 | Outreach suppressed pending steward Outreach | TPA-60552 (Christine Phillips) held until CASE-001877 is decided |
| Held | — | ||
| ACT-015322 | Outreach suppressed pending steward Outreach | TPA-62467 (Jesse Padilla) held until CASE-001878 is decided |
| Held | — | ||
| ACT-015323 | Outreach suppressed pending steward Outreach | ENR-136985 (Jesse Padilla) held until CASE-001879 is decided |
| Held | — | ||
| ACT-015324 | Outreach suppressed pending steward Outreach | TPA-57889 (Nathna Cole) held until CASE-001880 is decided |
| Held | — | ||
| ACT-015325 | Outreach suppressed pending steward Outreach | TPA-59184 (Dennis Rivera) held until CASE-001881 is decided |
| Held | — | ||
| ACT-015326 | Outreach suppressed pending steward Outreach | TPA-59185 (Dennis Rivera) held until CASE-001882 is decided |
| Held | — | ||
| ACT-015327 | Outreach suppressed pending steward Outreach | CLM-422513 (Brandon Payne) held until CASE-001883 is decided |
| Held | — | ||
| ACT-015328 | Outreach suppressed pending steward Outreach | ENR-129498 (Brandon Payne) held until CASE-001884 is decided |
| Held | — | ||
| ACT-015329 | Outreach suppressed pending steward Outreach | TPA-63366 (Sara Hudson) held until CASE-001885 is decided |
| Held | — | ||
| ACT-015330 | Outreach suppressed pending steward Outreach | TPA-58588 (Rachel Freeman) held until CASE-001886 is decided |
| Held | — | ||
| ACT-015331 | Outreach suppressed pending steward Outreach | PRV-25777 (Rachel Freeman) held until CASE-001887 is decided |
| Held | — | ||
| ACT-015332 | Outreach suppressed pending steward Outreach | ENR-105328 (Lori Contreras) held until CASE-001888 is decided |
| Held | — | ||
| ACT-015333 | Outreach suppressed pending steward Outreach | CLM-404075 (Lori Contreras) held until CASE-001889 is decided |
| Held | — | ||
| ACT-015334 | Outreach suppressed pending steward Outreach | CLM-409891 (Joseph Lawson) held until CASE-001890 is decided |
| Held | — | ||
| ACT-015335 | Outreach suppressed pending steward Outreach | TPA-56068 (Valentina Bishop) held until CASE-001891 is decided |
| Held | — | ||
| ACT-015336 | Outreach suppressed pending steward Outreach | TPA-62663 (Austin Allen) held until CASE-001892 is decided |
| Held | — | ||
| ACT-015337 | Outreach suppressed pending steward Outreach | CLM-401925 (Emma Soto) held until CASE-001893 is decided |
| Held | — | ||
| ACT-015338 | Outreach suppressed pending steward Outreach | ENR-102483 (Emma Soto) held until CASE-001894 is decided |
| Held | — | ||
| ACT-015339 | Outreach suppressed pending steward Outreach | CLM-426974 (Kevin Griffin) held until CASE-001895 is decided |
| Held | — | ||
| ACT-015340 | Outreach suppressed pending steward Outreach | TPA-54302 (Abigail Vargas) held until CASE-001896 is decided |
| Held | — | ||
| ACT-015341 | Outreach suppressed pending steward Outreach | CLM-409862 (Abigail Vargas) held until CASE-001897 is decided |
| Held | — | ||
| ACT-015342 | Outreach suppressed pending steward Outreach | CLM-412079 (Gregory Moreno) held until CASE-001898 is decided |
| Held | — | ||
| ACT-015343 | Outreach suppressed pending steward Outreach | CLM-416292 (Diana Owens) held until CASE-001899 is decided |
| Held | — | ||
| ACT-015344 | Outreach suppressed pending steward Outreach | CLM-413604 (Terry Schmidt) held until CASE-001900 is decided |
| Held | — | ||
| ACT-015345 | Outreach suppressed pending steward Outreach | TPA-55980 (Terry Schmidt) held until CASE-001901 is decided |
| Held | — | ||
| ACT-015346 | Outreach suppressed pending steward Outreach | ENR-140156 (Theresa Johnson) held until CASE-001902 is decided |
| Held | — | ||
| ACT-015347 | Outreach suppressed pending steward Outreach | CLM-430584 (Theresa Johnson) held until CASE-001903 is decided |
| Held | — | ||
| ACT-015348 | Outreach suppressed pending steward Outreach | TPA-60013 (Carlos Daniels) held until CASE-001904 is decided |
| Held | — | ||
| ACT-015349 | Outreach suppressed pending steward Outreach | CLM-422809 (Carlos Daniels) held until CASE-001905 is decided |
| Held | — | ||
| ACT-015350 | Outreach suppressed pending steward Outreach | PRV-28398 (Mariana Henry) held until CASE-001906 is decided |
| Held | — | ||
| ACT-015351 | Outreach suppressed pending steward Outreach | TPA-50269 (Katherine Spencer) held until CASE-001907 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.