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
Outreach suppressed pending steward, Outreach, 0 proposed
| 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.