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-013945 | Outreach suppressed pending steward Outreach | CLM-401509 (Mary Murray) held until CASE-000501 is decided |
| Held | — | ||
| ACT-013946 | Outreach suppressed pending steward Outreach | TPA-62338 (Chriistian Bradley) held until CASE-000502 is decided |
| Held | — | ||
| ACT-013947 | Outreach suppressed pending steward Outreach | CLM-430402 (Ruth Rice) held until CASE-000503 is decided |
| Held | — | ||
| ACT-013948 | Outreach suppressed pending steward Outreach | CLM-430401 (Ruth Rice) held until CASE-000504 is decided |
| Held | — | ||
| ACT-013949 | Outreach suppressed pending steward Outreach | CLM-429631 (Janice Willis) held until CASE-000505 is decided |
| Held | — | ||
| ACT-013950 | Outreach suppressed pending steward Outreach | TPA-63094 (Janice Willis) held until CASE-000506 is decided |
| Held | — | ||
| ACT-013951 | Outreach suppressed pending steward Outreach | PRV-28676 (Janice Willis) held until CASE-000507 is decided |
| Held | — | ||
| ACT-013952 | Outreach suppressed pending steward Outreach | TPA-55460 (Brandon Munoz) held until CASE-000508 is decided |
| Held | — | ||
| ACT-013953 | Outreach suppressed pending steward Outreach | TPA-54257 (Charoltte Parker) held until CASE-000509 is decided |
| Held | — | ||
| ACT-013954 | Outreach suppressed pending steward Outreach | CLM-417024 (Jeremy Singh) held until CASE-000510 is decided |
| Held | — | ||
| ACT-013955 | Outreach suppressed pending steward Outreach | CLM-417023 (Jeremy Singh) held until CASE-000511 is decided |
| Held | — | ||
| ACT-013956 | Outreach suppressed pending steward Outreach | ENR-104236 (Sandra Sims) held until CASE-000512 is decided |
| Held | — | ||
| ACT-013957 | Outreach suppressed pending steward Outreach | TPA-62204 (Madison Taylor) held until CASE-000513 is decided |
| Held | — | ||
| ACT-013958 | Outreach suppressed pending steward Outreach | CLM-429903 (Tony Taylor) held until CASE-000514 is decided |
| Held | — | ||
| ACT-013959 | Outreach suppressed pending steward Outreach | CLM-427617 (Madison Taylor) held until CASE-000515 is decided |
| Held | — | ||
| ACT-013960 | Outreach suppressed pending steward Outreach | CLM-415249 (Janice Griffin) held until CASE-000516 is decided |
| Held | — | ||
| ACT-013961 | Outreach suppressed pending steward Outreach | ENR-120097 (Janice Griffin) held until CASE-000517 is decided |
| Held | — | ||
| ACT-013962 | Outreach suppressed pending steward Outreach | TPA-53901 (Kevin Rice) held until CASE-000518 is decided |
| Held | — | ||
| ACT-013963 | Outreach suppressed pending steward Outreach | CLM-408906 (Kevin Rice) held until CASE-000519 is decided |
| Held | — | ||
| ACT-013964 | Outreach suppressed pending steward Outreach | TPA-62062 (Joan Santos) held until CASE-000520 is decided |
| Held | — | ||
| ACT-013965 | Outreach suppressed pending steward Outreach | PRV-26047 (Ahmed Muurray) held until CASE-000521 is decided |
| Held | — | ||
| ACT-013966 | Outreach suppressed pending steward Outreach | TPA-58954 (Ahmd Murray) held until CASE-000522 is decided |
| Held | — | ||
| ACT-013967 | Outreach suppressed pending steward Outreach | TPA-51605 (Victoria Moore) held until CASE-000523 is decided |
| Held | — | ||
| ACT-013968 | Outreach suppressed pending steward Outreach | ENR-104807 (Victoria Moore) held until CASE-000524 is decided |
| Held | — | ||
| ACT-013969 | Outreach suppressed pending steward Outreach | TPA-50096 (Deborah Murray) held until CASE-000525 is decided |
| Held | — | ||
| ACT-013970 | Outreach suppressed pending steward Outreach | TPA-60770 (Ralph Ruiz) held until CASE-000526 is decided |
| Held | — | ||
| ACT-013971 | Outreach suppressed pending steward Outreach | CLM-420219 (Logan Park) held until CASE-000527 is decided |
| Held | — | ||
| ACT-013972 | Outreach suppressed pending steward Outreach | ENR-106733 (Jean Shaw) held until CASE-000528 is decided |
| Held | — | ||
| ACT-013973 | Outreach suppressed pending steward Outreach | CLM-431866 (Ronald Meyer) held until CASE-000529 is decided |
| Held | — | ||
| ACT-013974 | Outreach suppressed pending steward Outreach | ENR-112727 (Chhris Alexander) held until CASE-000530 is decided |
| Held | — | ||
| ACT-013975 | Outreach suppressed pending steward Outreach | CLM-409678 (Chhristine Alexander) held until CASE-000531 is decided |
| Held | — | ||
| ACT-013976 | Outreach suppressed pending steward Outreach | TPA-51559 (Debra Pierce) held until CASE-000532 is decided |
| Held | — | ||
| ACT-013977 | Outreach suppressed pending steward Outreach | TPA-56909 (Christina Pierce) held until CASE-000533 is decided |
| Held | — | ||
| ACT-013978 | Outreach suppressed pending steward Outreach | TPA-56908 (Christina Pierce) held until CASE-000534 is decided |
| Held | — | ||
| ACT-013979 | Outreach suppressed pending steward Outreach | TPA-57856 (Alan Bradley) held until CASE-000535 is decided |
| Held | — | ||
| ACT-013980 | Outreach suppressed pending steward Outreach | CLM-417798 (Alan Bradley) held until CASE-000536 is decided |
| Held | — | ||
| ACT-013981 | Outreach suppressed pending steward Outreach | CLM-425462 (Harold Maldonado) held until CASE-000537 is decided |
| Held | — | ||
| ACT-013982 | Outreach suppressed pending steward Outreach | ENR-133302 (Hrold Maldonado) held until CASE-000538 is decided |
| Held | — | ||
| ACT-013983 | Outreach suppressed pending steward Outreach | TPA-63475 (Sara Hicks) held until CASE-000539 is decided |
| Held | — | ||
| ACT-013984 | Outreach suppressed pending steward Outreach | ENR-126597 (Susen Ross) held until CASE-000540 is decided |
| Held | — | ||
| ACT-013985 | Outreach suppressed pending steward Outreach | TPA-58903 (Susan Ross) held until CASE-000541 is decided |
| Held | — | ||
| ACT-013986 | Outreach suppressed pending steward Outreach | PRV-21188 (Christine Coleman) held until CASE-000542 is decided |
| Held | — | ||
| ACT-013987 | Outreach suppressed pending steward Outreach | TPA-51839 (Christine Coleman) held until CASE-000543 is decided |
| Held | — | ||
| ACT-013988 | Outreach suppressed pending steward Outreach | PRV-27611 (Donna Reed) held until CASE-000544 is decided |
| Held | — | ||
| ACT-013989 | Outreach suppressed pending steward Outreach | CLM-419297 (Isabella Walsh) held until CASE-000545 is decided |
| Held | — | ||
| ACT-013990 | Outreach suppressed pending steward Outreach | TPA-51149 (Alan Jacbs) held until CASE-000546 is decided |
| Held | — | ||
| ACT-013991 | Outreach suppressed pending steward Outreach | ENR-101767 (Edward Perez) held until CASE-000547 is decided |
| Held | — | ||
| ACT-013992 | Outreach suppressed pending steward Outreach | TPA-50603 (Edward Perez) held until CASE-000548 is decided |
| Held | — | ||
| ACT-013993 | Outreach suppressed pending steward Outreach | TPA-51680 (Bobby Moreno) held until CASE-000549 is decided |
| Held | — | ||
| ACT-013994 | Outreach suppressed pending steward Outreach | TPA-53251 (Madison Moreno) held until CASE-000550 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.