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-013895 | Outreach suppressed pending steward Outreach | CLM-402277 (Nicloe Torres) held until CASE-000451 is decided |
| Held | — | ||
| ACT-013896 | Outreach suppressed pending steward Outreach | TPA-57390 (Adam Li) held until CASE-000452 is decided |
| Held | — | ||
| ACT-013897 | Outreach suppressed pending steward Outreach | TPA-57389 (Adam Li) held until CASE-000453 is decided |
| Held | — | ||
| ACT-013898 | Outreach suppressed pending steward Outreach | CLM-415487 (Amy Reinolds) held until CASE-000454 is decided |
| Held | — | ||
| ACT-013899 | Outreach suppressed pending steward Outreach | PRV-24572 (Amy Reynolds) held until CASE-000455 is decided |
| Held | — | ||
| ACT-013900 | Outreach suppressed pending steward Outreach | ENR-136909 (Joseph Jimenez) held until CASE-000456 is decided |
| Held | — | ||
| ACT-013901 | Outreach suppressed pending steward Outreach | CLM-428149 (Joseph Jimenez) held until CASE-000457 is decided |
| Held | — | ||
| ACT-013902 | Outreach suppressed pending steward Outreach | TPA-51722 (Jonathan Bennett) held until CASE-000458 is decided |
| Held | — | ||
| ACT-013903 | Outreach suppressed pending steward Outreach | CLM-407102 (Gabriel Bennett) held until CASE-000459 is decided |
| Held | — | ||
| ACT-013904 | Outreach suppressed pending steward Outreach | CLM-406983 (Jeremy Carlson) held until CASE-000460 is decided |
| Held | — | ||
| ACT-013905 | Outreach suppressed pending steward Outreach | ENR-109126 (Jeremy Carlson) held until CASE-000461 is decided |
| Held | — | ||
| ACT-013906 | Outreach suppressed pending steward Outreach | CLM-415485 (Wei Andrews) held until CASE-000462 is decided |
| Held | — | ||
| ACT-013907 | Outreach suppressed pending steward Outreach | CLM-411870 (Kimberly Parker) held until CASE-000463 is decided |
| Held | — | ||
| ACT-013908 | Outreach suppressed pending steward Outreach | ENR-115631 (Kimberly Parker) held until CASE-000464 is decided |
| Held | — | ||
| ACT-013909 | Outreach suppressed pending steward Outreach | CLM-404158 (Priya Chavez) held until CASE-000465 is decided |
| Held | — | ||
| ACT-013910 | Outreach suppressed pending steward Outreach | TPA-52758 (Pamela Hill) held until CASE-000466 is decided |
| Held | — | ||
| ACT-013911 | Outreach suppressed pending steward Outreach | TPA-60433 (Debra Hall) held until CASE-000467 is decided |
| Held | — | ||
| ACT-013912 | Outreach suppressed pending steward Outreach | ENR-130981 (Debra Hall) held until CASE-000468 is decided |
| Held | — | ||
| ACT-013913 | Outreach suppressed pending steward Outreach | CLM-424769 (Sophia Cole) held until CASE-000469 is decided |
| Held | — | ||
| ACT-013914 | Outreach suppressed pending steward Outreach | CLM-424770 (Sophia Cole) held until CASE-000470 is decided |
| Held | — | ||
| ACT-013915 | Outreach suppressed pending steward Outreach | ENR-101887 (Keith Payne) held until CASE-000471 is decided |
| Held | — | ||
| ACT-013916 | Outreach suppressed pending steward Outreach | TPA-50636 (Keith Payne) held until CASE-000472 is decided |
| Held | — | ||
| ACT-013917 | Outreach suppressed pending steward Outreach | CLM-400930 (Lisa Campbell) held until CASE-000473 is decided |
| Held | — | ||
| ACT-013918 | Outreach suppressed pending steward Outreach | PRV-27594 (Gary Kelly) held until CASE-000474 is decided |
| Held | — | ||
| ACT-013919 | Outreach suppressed pending steward Outreach | ENR-142601 (Gabriel Day) held until CASE-000475 is decided |
| Held | — | ||
| ACT-013920 | Outreach suppressed pending steward Outreach | TPA-64316 (Gabriel Day) held until CASE-000476 is decided |
| Held | — | ||
| ACT-013921 | Outreach suppressed pending steward Outreach | TPA-58501 (Gabriel Espinoza) held until CASE-000477 is decided |
| Held | — | ||
| ACT-013922 | Outreach suppressed pending steward Outreach | ENR-128381 (Patrcik Mendez) held until CASE-000478 is decided |
| Held | — | ||
| ACT-013923 | Outreach suppressed pending steward Outreach | PRV-26387 (Patrick Mendez) held until CASE-000479 is decided |
| Held | — | ||
| ACT-013924 | Outreach suppressed pending steward Outreach | CLM-425709 (Gerald Mendez) held until CASE-000480 is decided |
| Held | — | ||
| ACT-013925 | Outreach suppressed pending steward Outreach | TPA-60732 (Gloria Howard) held until CASE-000481 is decided |
| Held | — | ||
| ACT-013926 | Outreach suppressed pending steward Outreach | CLM-424359 (Gloia Howard) held until CASE-000482 is decided |
| Held | — | ||
| ACT-013927 | Outreach suppressed pending steward Outreach | TPA-59316 (Terry Lane) held until CASE-000483 is decided |
| Held | — | ||
| ACT-013928 | Outreach suppressed pending steward Outreach | CLM-421179 (Terry Laane) held until CASE-000484 is decided |
| Held | — | ||
| ACT-013929 | Outreach suppressed pending steward Outreach | TPA-60612 (Sofia Barnes) held until CASE-000485 is decided |
| Held | — | ||
| ACT-013930 | Outreach suppressed pending steward Outreach | ENR-131498 (Sofia Barnes) held until CASE-000486 is decided |
| Held | — | ||
| ACT-013931 | Outreach suppressed pending steward Outreach | CLM-424779 (Raymond Valdez) held until CASE-000487 is decided |
| Held | — | ||
| ACT-013932 | Outreach suppressed pending steward Outreach | CLM-409488 (Brina Hawkins) held until CASE-000488 is decided |
| Held | — | ||
| ACT-013933 | Outreach suppressed pending steward Outreach | CLM-411089 (Lori Hawkins) held until CASE-000489 is decided |
| Held | — | ||
| ACT-013934 | Outreach suppressed pending steward Outreach | TPA-54116 (Brian Hawkins) held until CASE-000490 is decided |
| Held | — | ||
| ACT-013935 | Outreach suppressed pending steward Outreach | CLM-420381 (George Weaver) held until CASE-000491 is decided |
| Held | — | ||
| ACT-013936 | Outreach suppressed pending steward Outreach | CLM-414617 (Alexander Vasquez) held until CASE-000492 is decided |
| Held | — | ||
| ACT-013937 | Outreach suppressed pending steward Outreach | CLM-404745 (Camila Perez) held until CASE-000493 is decided |
| Held | — | ||
| ACT-013938 | Outreach suppressed pending steward Outreach | TPA-52075 (Camila Perez) held until CASE-000494 is decided |
| Held | — | ||
| ACT-013939 | Outreach suppressed pending steward Outreach | CLM-411771 (Natalie Fernandez) held until CASE-000495 is decided |
| Held | — | ||
| ACT-013940 | Outreach suppressed pending steward Outreach | ENR-112793 (Rachhel Brooks) held until CASE-000496 is decided |
| Held | — | ||
| ACT-013941 | Outreach suppressed pending steward Outreach | CLM-409732 (Rachel Brooks) held until CASE-000497 is decided |
| Held | — | ||
| ACT-013942 | Outreach suppressed pending steward Outreach | ENR-126894 (Christine Jackson) held until CASE-000498 is decided |
| Held | — | ||
| ACT-013943 | Outreach suppressed pending steward Outreach | TPA-58424 (Nicole Peterson) held until CASE-000499 is decided |
| Held | — | ||
| ACT-013944 | Outreach suppressed pending steward Outreach | TPA-58423 (Nicole Peterson) held until CASE-000500 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.