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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-018221 | Care coordination outreach Next-best-action | Albert Ellis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018222 | Care coordination outreach Next-best-action | Vincent Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018223 | Care coordination outreach Next-best-action | Anna Baker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018224 | Care coordination outreach Next-best-action | Timothy Rios: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018225 | Care coordination outreach Next-best-action | Patricia Lawson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018226 | Care coordination outreach Next-best-action | Stephen McCoy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018227 | Care coordination outreach Next-best-action | Kyle Burns: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018228 | Care coordination outreach Next-best-action | Gloria Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018229 | Care coordination outreach Next-best-action | Marilyn West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018230 | Care coordination outreach Next-best-action | Evelyn Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018231 | Care coordination outreach Next-best-action | Gregory Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018232 | Care coordination outreach Next-best-action | Julia Cook: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018233 | Care coordination outreach Next-best-action | Lawrence Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018234 | Care coordination outreach Next-best-action | Donald Murray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018235 | Care coordination outreach Next-best-action | Priya Santos: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018236 | Care coordination outreach Next-best-action | Jack Barnes: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018237 | Care coordination outreach Next-best-action | Carolyn Ward: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018238 | Care coordination outreach Next-best-action | George Patterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018239 | Care coordination outreach Next-best-action | Gabriel Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018240 | Care coordination outreach Next-best-action | Gregory Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018241 | Care coordination outreach Next-best-action | Walter Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018242 | Care coordination outreach Next-best-action | Nicole Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018243 | Care coordination outreach Next-best-action | Emily Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018244 | Care coordination outreach Next-best-action | Benjamin Gibson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018245 | Care coordination outreach Next-best-action | Dylan Alexander: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018246 | Care coordination outreach Next-best-action | Samantha Reid: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018247 | Care coordination outreach Next-best-action | Bobby Chapman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018248 | Care coordination outreach Next-best-action | Jacqueline Ryan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018249 | Care coordination outreach Next-best-action | Scott Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018250 | Care coordination outreach Next-best-action | Mary Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018251 | Care coordination outreach Next-best-action | Sharon Bell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018252 | Care coordination outreach Next-best-action | Priya Spencer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018253 | Care coordination outreach Next-best-action | Brittany Hudson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018254 | Care coordination outreach Next-best-action | Ronald Herrera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018255 | Care coordination outreach Next-best-action | Jordan Duncan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018256 | Care coordination outreach Next-best-action | Ana Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018257 | Care coordination outreach Next-best-action | Ryan Edwards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018258 | Care coordination outreach Next-best-action | Ralph Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018259 | Care coordination outreach Next-best-action | Tyler Gomez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018260 | Care coordination outreach Next-best-action | Jessica Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018261 | Care coordination outreach Next-best-action | Ana Banks: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018262 | Care coordination outreach Next-best-action | Pamela Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018263 | Care coordination outreach Next-best-action | Scott Johnston: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018264 | Care coordination outreach Next-best-action | Sam Miller: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018265 | Care coordination outreach Next-best-action | Debra Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018266 | Care coordination outreach Next-best-action | Brandon Sandoval: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018267 | Care coordination outreach Next-best-action | Gregory Delgado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018268 | Care coordination outreach Next-best-action | Jonathan Davis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018269 | Care coordination outreach Next-best-action | Ruth Fisher: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018270 | Care coordination outreach Next-best-action | Doris Nunez: 3 claims, no attributed provider |
| Proposed | — |
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.