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-013445 | Outreach suppressed pending steward Outreach | CLM-402482 (Jackie Reyes) held until CASE-000001 is decided |
| Held | — | ||
| ACT-013446 | Outreach suppressed pending steward Outreach | TPA-51738 (Ethan Rios) held until CASE-000002 is decided |
| Held | — | ||
| ACT-013447 | Outreach suppressed pending steward Outreach | CLM-430743 (Larry Hansen) held until CASE-000003 is decided |
| Held | — | ||
| ACT-013448 | Outreach suppressed pending steward Outreach | TPA-60827 (Keith Varggas) held until CASE-000004 is decided |
| Held | — | ||
| ACT-013449 | Outreach suppressed pending steward Outreach | TPA-56717 (Kim Marquez) held until CASE-000005 is decided |
| Held | — | ||
| ACT-013450 | Outreach suppressed pending steward Outreach | CLM-406008 (Christine Knight) held until CASE-000006 is decided |
| Held | — | ||
| ACT-013451 | Outreach suppressed pending steward Outreach | ENR-101256 (Cristian Knight) held until CASE-000007 is decided |
| Held | — | ||
| ACT-013452 | Outreach suppressed pending steward Outreach | CLM-418429 (Diego Snyder) held until CASE-000008 is decided |
| Held | — | ||
| ACT-013453 | Outreach suppressed pending steward Outreach | CLM-427068 (Sean Gordon) held until CASE-000009 is decided |
| Held | — | ||
| ACT-013454 | Outreach suppressed pending steward Outreach | CLM-406583 (Nancy Wright) held until CASE-000010 is decided |
| Held | — | ||
| ACT-013455 | Outreach suppressed pending steward Outreach | CLM-403782 (Heather Walsh) held until CASE-000011 is decided |
| Held | — | ||
| ACT-013456 | Outreach suppressed pending steward Outreach | ENR-140230 (Julie Miller) held until CASE-000012 is decided |
| Held | — | ||
| ACT-013457 | Outreach suppressed pending steward Outreach | PRV-28967 (Julie Miller) held until CASE-000013 is decided |
| Held | — | ||
| ACT-013458 | Outreach suppressed pending steward Outreach | PRV-22634 (Kathryn Bailey) held until CASE-000014 is decided |
| Held | — | ||
| ACT-013459 | Outreach suppressed pending steward Outreach | ENR-122342 (Tyler Bell) held until CASE-000015 is decided |
| Held | — | ||
| ACT-013460 | Outreach suppressed pending steward Outreach | TPA-57098 (Jeremy Williamson) held until CASE-000016 is decided |
| Held | — | ||
| ACT-013461 | Outreach suppressed pending steward Outreach | PRV-28485 (Arthur Johnson) held until CASE-000017 is decided |
| Held | — | ||
| ACT-013462 | Outreach suppressed pending steward Outreach | TPA-64406 (Richard Perry) held until CASE-000018 is decided |
| Held | — | ||
| ACT-013463 | Outreach suppressed pending steward Outreach | TPA-64407 (Richard Perry) held until CASE-000019 is decided |
| Held | — | ||
| ACT-013464 | Outreach suppressed pending steward Outreach | ENR-141702 (Brian Rogers) held until CASE-000020 is decided |
| Held | — | ||
| ACT-013465 | Outreach suppressed pending steward Outreach | PRV-29290 (Brian Rogers) held until CASE-000021 is decided |
| Held | — | ||
| ACT-013466 | Outreach suppressed pending steward Outreach | TPA-61792 (Kelly Richardson) held until CASE-000022 is decided |
| Held | — | ||
| ACT-013467 | Outreach suppressed pending steward Outreach | ENR-135020 (Kelly Richardson) held until CASE-000023 is decided |
| Held | — | ||
| ACT-013468 | Outreach suppressed pending steward Outreach | PRV-28673 (Albert Richardson) held until CASE-000024 is decided |
| Held | — | ||
| ACT-013469 | Outreach suppressed pending steward Outreach | TPA-63091 (Albert Richardson) held until CASE-000025 is decided |
| Held | — | ||
| ACT-013470 | Outreach suppressed pending steward Outreach | ENR-107861 (Adam Riley) held until CASE-000026 is decided |
| Held | — | ||
| ACT-013471 | Outreach suppressed pending steward Outreach | CLM-405967 (Adam Riley) held until CASE-000027 is decided |
| Held | — | ||
| ACT-013472 | Outreach suppressed pending steward Outreach | CLM-430009 (Tyler Moreno) held until CASE-000028 is decided |
| Held | — | ||
| ACT-013473 | Outreach suppressed pending steward Outreach | CLM-428337 (Frances Hunter) held until CASE-000029 is decided |
| Held | — | ||
| ACT-013474 | Outreach suppressed pending steward Outreach | TPA-62514 (Frances Hunter) held until CASE-000030 is decided |
| Held | — | ||
| ACT-013475 | Outreach suppressed pending steward Outreach | CLM-429375 (Mason Walsh) held until CASE-000031 is decided |
| Held | — | ||
| ACT-013476 | Outreach suppressed pending steward Outreach | CLM-430591 (Frank Willis) held until CASE-000032 is decided |
| Held | — | ||
| ACT-013477 | Outreach suppressed pending steward Outreach | TPA-63509 (Frank Willis) held until CASE-000033 is decided |
| Held | — | ||
| ACT-013478 | Outreach suppressed pending steward Outreach | CLM-413208 (Matthew Burke) held until CASE-000034 is decided |
| Held | — | ||
| ACT-013479 | Outreach suppressed pending steward Outreach | ENR-115466 (William Brooks) held until CASE-000035 is decided |
| Held | — | ||
| ACT-013480 | Outreach suppressed pending steward Outreach | ENR-112951 (Jose Jackson) held until CASE-000036 is decided |
| Held | — | ||
| ACT-013481 | Outreach suppressed pending steward Outreach | ENR-126848 (Alexander Jackson) held until CASE-000037 is decided |
| Held | — | ||
| ACT-013482 | Outreach suppressed pending steward Outreach | CLM-422333 (Andrew Jackson) held until CASE-000038 is decided |
| Held | — | ||
| ACT-013483 | Outreach suppressed pending steward Outreach | PRV-25896 (Sandra Lawis) held until CASE-000039 is decided |
| Held | — | ||
| ACT-013484 | Outreach suppressed pending steward Outreach | TPA-59395 (Cynthia Baker) held until CASE-000040 is decided |
| Held | — | ||
| ACT-013485 | Outreach suppressed pending steward Outreach | TPA-59396 (Cyntiha Baker) held until CASE-000041 is decided |
| Held | — | ||
| ACT-013486 | Outreach suppressed pending steward Outreach | ENR-128007 (Cynthia Baker) held until CASE-000042 is decided |
| Held | — | ||
| ACT-013487 | Outreach suppressed pending steward Outreach | ENR-130444 (Christine Robinnson) held until CASE-000043 is decided |
| Held | — | ||
| ACT-013488 | Outreach suppressed pending steward Outreach | PRV-26873 (Christine Robinson) held until CASE-000044 is decided |
| Held | — | ||
| ACT-013489 | Outreach suppressed pending steward Outreach | TPA-57030 (Nancy Freeman) held until CASE-000045 is decided |
| Held | — | ||
| ACT-013490 | Outreach suppressed pending steward Outreach | TPA-51230 (Michael Fernandez) held until CASE-000046 is decided |
| Held | — | ||
| ACT-013491 | Outreach suppressed pending steward Outreach | ENR-103705 (Michael Fernandez) held until CASE-000047 is decided |
| Held | — | ||
| ACT-013492 | Outreach suppressed pending steward Outreach | ENR-100604 (Austin Fernandez) held until CASE-000048 is decided |
| Held | — | ||
| ACT-013493 | Outreach suppressed pending steward Outreach | TPA-56952 (Doris Meyer) held until CASE-000049 is decided |
| Held | — | ||
| ACT-013494 | Outreach suppressed pending steward Outreach | ENR-112895 (Russell Price) held until CASE-000050 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.