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-018639 | Care coordination outreach Next-best-action | Sean Evans: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018640 | Care coordination outreach Next-best-action | Ashley Perry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018641 | Care coordination outreach Next-best-action | Amber Guerrero: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018642 | Care coordination outreach Next-best-action | Diana Bailey: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018643 | Care coordination outreach Next-best-action | Dennis Bradley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018644 | Care coordination outreach Next-best-action | Abigail Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018645 | Care coordination outreach Next-best-action | Jordan Munoz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018646 | Care coordination outreach Next-best-action | Shirley Mitchell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018647 | Care coordination outreach Next-best-action | Judith Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018648 | Care coordination outreach Next-best-action | Gabriel Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018649 | Care coordination outreach Next-best-action | Carol Kelly: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018650 | Care coordination outreach Next-best-action | Amy Myers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018651 | Care coordination outreach Next-best-action | Mariana Obrien: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018652 | Care coordination outreach Next-best-action | Valentina White: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018653 | Care coordination outreach Next-best-action | Bryan Walsh: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018654 | Care coordination outreach Next-best-action | Judith West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018655 | Care coordination outreach Next-best-action | Lisa Silva: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018656 | Care coordination outreach Next-best-action | Vincent Day: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018657 | Care coordination outreach Next-best-action | Alexis Harper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018658 | Care coordination outreach Next-best-action | Shirley Sanchez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018659 | Care coordination outreach Next-best-action | Lawrence Mitchell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018660 | Care coordination outreach Next-best-action | Timothy Rios: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018661 | Care coordination outreach Next-best-action | Denise Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018662 | Care coordination outreach Next-best-action | Margaret Franklin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018663 | Care coordination outreach Next-best-action | Lori Campbell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018664 | Care coordination outreach Next-best-action | Jordan Wheeler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018665 | Care coordination outreach Next-best-action | Arjun Burton: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018666 | Care coordination outreach Next-best-action | Wei Fields: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018667 | Care coordination outreach Next-best-action | Barbara Cooper: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018668 | Care coordination outreach Next-best-action | Ray Scott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018669 | Care coordination outreach Next-best-action | Judith Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018670 | Care coordination outreach Next-best-action | Ryan Evans: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018671 | Care coordination outreach Next-best-action | Olivia Sanchez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018672 | Care coordination outreach Next-best-action | Jacqueline Hansen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018673 | Care coordination outreach Next-best-action | Emma Ortiz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018674 | Care coordination outreach Next-best-action | William Contreras: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018675 | Care coordination outreach Next-best-action | Carl Cole: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018676 | Care coordination outreach Next-best-action | Olivia Espinoza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018677 | Care coordination outreach Next-best-action | Virginia Hoffman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018678 | Care coordination outreach Next-best-action | Kayla Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018679 | Care coordination outreach Next-best-action | Shirley Alvarez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018680 | Care coordination outreach Next-best-action | Carolyn Jackson: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018681 | Care coordination outreach Next-best-action | Debra Aguilar: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018682 | Care coordination outreach Next-best-action | Walter Flores: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018683 | Care coordination outreach Next-best-action | Joshua Burke: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018684 | Care coordination outreach Next-best-action | Arthur Guzman: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018685 | Care coordination outreach Next-best-action | Jerry Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018686 | Care coordination outreach Next-best-action | Ruth Mills: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018687 | Care coordination outreach Next-best-action | Patrick Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018688 | Care coordination outreach Next-best-action | Evelyn Gray: 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.