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-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.