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-018271 | Care coordination outreach Next-best-action | Ashley Bowman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018272 | Care coordination outreach Next-best-action | Don Richardson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018273 | Care coordination outreach Next-best-action | Patricia Marshall: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018274 | Care coordination outreach Next-best-action | Helen Wright: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018275 | Care coordination outreach Next-best-action | Bryan Carter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018276 | Care coordination outreach Next-best-action | Nathan Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018277 | Care coordination outreach Next-best-action | Keith Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018278 | Care coordination outreach Next-best-action | Brenda Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018279 | Care coordination outreach Next-best-action | Patricia Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018280 | Care coordination outreach Next-best-action | Logan Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018281 | Care coordination outreach Next-best-action | Lauren Hill: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018282 | Care coordination outreach Next-best-action | Gabriel Gonzalez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018283 | Care coordination outreach Next-best-action | Sophia Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018284 | Care coordination outreach Next-best-action | Nicole Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018285 | Care coordination outreach Next-best-action | Judith Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018286 | Care coordination outreach Next-best-action | Dorothy Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018287 | Care coordination outreach Next-best-action | Jesse Armstrong: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018288 | Care coordination outreach Next-best-action | Ashley Bowman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018289 | Care coordination outreach Next-best-action | Jennifer Powell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018290 | Care coordination outreach Next-best-action | Mateo Estrada: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018291 | Care coordination outreach Next-best-action | Roger Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018292 | Care coordination outreach Next-best-action | Keith Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018293 | Care coordination outreach Next-best-action | Julie Rios: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018294 | Care coordination outreach Next-best-action | Madison Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018295 | Care coordination outreach Next-best-action | Richard Luna: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018296 | Care coordination outreach Next-best-action | Fatima Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018297 | Care coordination outreach Next-best-action | Natalie Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018298 | Care coordination outreach Next-best-action | Isabella Wood: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018299 | Care coordination outreach Next-best-action | Wei Morrison: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018300 | Care coordination outreach Next-best-action | Kathryn Pierce: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018301 | Care coordination outreach Next-best-action | Lucia Rios: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018302 | Care coordination outreach Next-best-action | Ray Garza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018303 | Care coordination outreach Next-best-action | Jacob Hall: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018304 | Care coordination outreach Next-best-action | Danielle Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018305 | Care coordination outreach Next-best-action | Judith Rivera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018306 | Care coordination outreach Next-best-action | Pamela Hayes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018307 | Care coordination outreach Next-best-action | Aisha Hughes: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018308 | Care coordination outreach Next-best-action | Emma Fields: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018309 | Care coordination outreach Next-best-action | Bruce Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018310 | Care coordination outreach Next-best-action | Anna Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018311 | Care coordination outreach Next-best-action | Judith Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018312 | Care coordination outreach Next-best-action | Angela Sanders: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018313 | Care coordination outreach Next-best-action | Shirley Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018314 | Care coordination outreach Next-best-action | Brittany Lucas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018315 | Care coordination outreach Next-best-action | Christian Hayes: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018316 | Care coordination outreach Next-best-action | Amber Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018317 | Care coordination outreach Next-best-action | Nathan Hall: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018318 | Care coordination outreach Next-best-action | Gregory Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018319 | Care coordination outreach Next-best-action | Jacqueline Soto: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018320 | Care coordination outreach Next-best-action | Isabella Gutierrez: 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.