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
Eligibility conflict resolved, Eligibility engine, 1,339 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-000501 | Eligibility conflict resolved Eligibility engine | Roger Nguyen: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000502 | Eligibility conflict resolved Eligibility engine | Roger Lewis: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000503 | Eligibility conflict resolved Eligibility engine | Jason Jacobs: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000504 | Eligibility conflict resolved Eligibility engine | George Lawrence: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000505 | Eligibility conflict resolved Eligibility engine | Sean Allen: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000506 | Eligibility conflict resolved Eligibility engine | Shirley Hall: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000507 | Eligibility conflict resolved Eligibility engine | Samuel Medina: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000508 | Eligibility conflict resolved Eligibility engine | David Ferguson: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000509 | Eligibility conflict resolved Eligibility engine | Eugene Myers: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000510 | Eligibility conflict resolved Eligibility engine | David Simmons: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000511 | Eligibility conflict resolved Eligibility engine | Diane Flores: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000512 | Eligibility conflict resolved Eligibility engine | Rebecca Jones: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000513 | Eligibility conflict resolved Eligibility engine | Ann Rose: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000514 | Eligibility conflict resolved Eligibility engine | Lucia Vega: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000515 | Eligibility conflict resolved Eligibility engine | Angela Sanchez: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000516 | Eligibility conflict resolved Eligibility engine | Roy Mills: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000517 | Eligibility conflict resolved Eligibility engine | James Garrett: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000518 | Eligibility conflict resolved Eligibility engine | Dylan Ross: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000519 | Eligibility conflict resolved Eligibility engine | Emma Simpson: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000520 | Eligibility conflict resolved Eligibility engine | Elizabeth Morris: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000521 | Eligibility conflict resolved Eligibility engine | Lisa Hicks: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000522 | Eligibility conflict resolved Eligibility engine | Tyler Wagner: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000523 | Eligibility conflict resolved Eligibility engine | Mark Valdez: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000524 | Eligibility conflict resolved Eligibility engine | Valentina Owens: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000525 | Eligibility conflict resolved Eligibility engine | Vicky Cook: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000526 | Eligibility conflict resolved Eligibility engine | Dylan Wagner: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000527 | Eligibility conflict resolved Eligibility engine | Frank Carter: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000528 | Eligibility conflict resolved Eligibility engine | Joan Hunt: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000529 | Eligibility conflict resolved Eligibility engine | Rebecca Pierce: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000530 | Eligibility conflict resolved Eligibility engine | Gregory Ward: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000531 | Eligibility conflict resolved Eligibility engine | Sophia Lee: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000532 | Eligibility conflict resolved Eligibility engine | Jerry Hoffman: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000533 | Eligibility conflict resolved Eligibility engine | Jack Campbell: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000534 | Eligibility conflict resolved Eligibility engine | Sofia Matthews: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000535 | Eligibility conflict resolved Eligibility engine | Hiroshi Dean: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000536 | Eligibility conflict resolved Eligibility engine | Laura Fowler: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000537 | Eligibility conflict resolved Eligibility engine | Larry Grant: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000538 | Eligibility conflict resolved Eligibility engine | Ethan Hill: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000539 | Eligibility conflict resolved Eligibility engine | Kathryn Warren: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000540 | Eligibility conflict resolved Eligibility engine | Julie Ross: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000541 | Eligibility conflict resolved Eligibility engine | Abigail Gutierez: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000542 | Eligibility conflict resolved Eligibility engine | Shirley Mitchell: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000543 | Eligibility conflict resolved Eligibility engine | Philip Woods: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000544 | Eligibility conflict resolved Eligibility engine | Katherine Turner: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000545 | Eligibility conflict resolved Eligibility engine | Carol Bishop: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000546 | Eligibility conflict resolved Eligibility engine | William Weaver: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000547 | Eligibility conflict resolved Eligibility engine | Jesse Flores: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000548 | Eligibility conflict resolved Eligibility engine | Diego Holmes: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000549 | Eligibility conflict resolved Eligibility engine | Mary Fields: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000550 | Eligibility conflict resolved Eligibility engine | Lawrence Mitchell: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| 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.