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

TypeAllEligibility conflict resolved1,339Orphan claim re-pointed9,112Outreach address corrected2,993Outreach suppressed pending steward4,326Care coordination outreach1,815New member onboarding2,081Duplicate member record retired4,974
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-006840
Orphan claim re-pointed
Claims processor
CLM-405666 → UHC-41947-43 (Jacqueline Fowler)
Member id
UHC-41947-43
Confidence
1
Method
probabilistic
MBR-037989CLM-405666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006841
Orphan claim re-pointed
Claims processor
CLM-428515 → UHC-64089-39 (Randy Carpenter)
Member id
UHC-64089-39
Confidence
0.97
Method
deterministic
MBR-024291CLM-428515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006842
Orphan claim re-pointed
Claims processor
CLM-408212 → UHC-87272-66 (Billy Olson)
Member id
UHC-87272-66
Confidence
0.97
Method
deterministic
MBR-030613CLM-408212
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006843
Orphan claim re-pointed
Claims processor
CLM-431542 → UHC-37191-05 (Patricia Parker)
Member id
UHC-37191-05
Confidence
1
Method
probabilistic
MBR-006359CLM-431542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006844
Orphan claim re-pointed
Claims processor
CLM-427017 → UHC-68219-53 (Richard James)
Member id
UHC-68219-53
Confidence
1
Method
probabilistic
MBR-041408CLM-427017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006845
Orphan claim re-pointed
Claims processor
CLM-430506 → UHC-78632-10 (Kevin Andrews)
Member id
UHC-78632-10
Confidence
1
Method
probabilistic
MBR-023694CLM-430506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006846
Orphan claim re-pointed
Claims processor
CLM-416242 → UHC-99638-54 (Mei Espinoza)
Member id
UHC-99638-54
Confidence
1
Method
probabilistic
MBR-022461CLM-416242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006847
Orphan claim re-pointed
Claims processor
CLM-413243 → UHC-86246-70 (Roy Patel)
Member id
UHC-86246-70
Confidence
1
Method
probabilistic
MBR-031127CLM-413243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006848
Orphan claim re-pointed
Claims processor
CLM-400313 → UHC-79984-33 (Cynthia Harris)
Member id
UHC-79984-33
Confidence
0.97
Method
deterministic
MBR-023807CLM-400313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006849
Orphan claim re-pointed
Claims processor
CLM-412420 → UHC-94691-18 (Robetr Perkins)
Member id
UHC-94691-18
Confidence
1.00
Method
probabilistic
MBR-029758CLM-412420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006850
Orphan claim re-pointed
Claims processor
CLM-405528 → UHC-66614-26 (Denise Dunn)
Member id
UHC-66614-26
Confidence
1
Method
probabilistic
MBR-009332CLM-405528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006851
Orphan claim re-pointed
Claims processor
CLM-403849 → UHC-15592-78 (Catherine Richardson)
Member id
UHC-15592-78
Confidence
1
Method
probabilistic
MBR-033724CLM-403849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006852
Orphan claim re-pointed
Claims processor
CLM-423289 → UHC-25477-10 (Richard Hansen)
Member id
UHC-25477-10
Confidence
0.98
Method
probabilistic
MBR-011482CLM-423289
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006853
Orphan claim re-pointed
Claims processor
CLM-409311 → UHC-30817-37 (Cheryl Kelly)
Member id
UHC-30817-37
Confidence
1
Method
probabilistic
MBR-005201CLM-409311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006854
Orphan claim re-pointed
Claims processor
CLM-401398 → UHC-52766-32 (Bryan Cruz)
Member id
UHC-52766-32
Confidence
0.99
Method
probabilistic
MBR-022990CLM-401398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006855
Orphan claim re-pointed
Claims processor
CLM-428111 → UHC-11981-05 (Zachary Scott)
Member id
UHC-11981-05
Confidence
0.97
Method
deterministic
MBR-026946CLM-428111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006856
Orphan claim re-pointed
Claims processor
CLM-425306 → UHC-91873-66 (Rebecca Burke)
Member id
UHC-91873-66
Confidence
1
Method
probabilistic
MBR-025473CLM-425306
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006857
Orphan claim re-pointed
Claims processor
CLM-404758 → UHC-74232-48 (Nancy Elliott)
Member id
UHC-74232-48
Confidence
1
Method
probabilistic
MBR-021019CLM-404758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006858
Orphan claim re-pointed
Claims processor
CLM-414336 → UHC-74680-11 (Lucia Welch)
Member id
UHC-74680-11
Confidence
1
Method
probabilistic
MBR-015037CLM-414336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006859
Orphan claim re-pointed
Claims processor
CLM-414071 → UHC-72265-16 (Michael Lucas)
Member id
UHC-72265-16
Confidence
1
Method
probabilistic
MBR-020647CLM-414071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006860
Orphan claim re-pointed
Claims processor
CLM-418634 → UHC-44752-52 (Abigail Harrison)
Member id
UHC-44752-52
Confidence
1
Method
probabilistic
MBR-037426CLM-418634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006861
Orphan claim re-pointed
Claims processor
CLM-414751 → UHC-13601-93 (Juan Lopez)
Member id
UHC-13601-93
Confidence
1
Method
probabilistic
MBR-012669CLM-414751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006862
Orphan claim re-pointed
Claims processor
CLM-403394 → UHC-81347-87 (Jason Stone)
Member id
UHC-81347-87
Confidence
1
Method
probabilistic
MBR-014332CLM-403394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006863
Orphan claim re-pointed
Claims processor
CLM-400640 → UHC-33970-88 (Billy Jacobs)
Member id
UHC-33970-88
Confidence
1
Method
probabilistic
MBR-012421CLM-400640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006864
Orphan claim re-pointed
Claims processor
CLM-422207 → UHC-02360-93 (Sara Carpenter)
Member id
UHC-02360-93
Confidence
1
Method
probabilistic
MBR-012492CLM-422207
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006865
Orphan claim re-pointed
Claims processor
CLM-407928 → UHC-87372-54 (Jeremy Reyes)
Member id
UHC-87372-54
Confidence
1
Method
probabilistic
MBR-003804CLM-407928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006866
Orphan claim re-pointed
Claims processor
CLM-426332 → UHC-70642-29 (Nancy Fields)
Member id
UHC-70642-29
Confidence
1
Method
probabilistic
MBR-024707CLM-426332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006867
Orphan claim re-pointed
Claims processor
CLM-404211 → UHC-66823-60 (Jeremy Campbell)
Member id
UHC-66823-60
Confidence
1
Method
probabilistic
MBR-038245CLM-404211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006868
Orphan claim re-pointed
Claims processor
CLM-409608 → UHC-52959-32 (Paul Webb)
Member id
UHC-52959-32
Confidence
0.97
Method
deterministic
MBR-029167CLM-409608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006869
Orphan claim re-pointed
Claims processor
CLM-409565 → UHC-76252-18 (Linda Parker)
Member id
UHC-76252-18
Confidence
1
Method
probabilistic
MBR-002338CLM-409565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006870
Orphan claim re-pointed
Claims processor
CLM-416390 → UHC-94650-89 (Eric Schmidt)
Member id
UHC-94650-89
Confidence
1
Method
probabilistic
MBR-005264CLM-416390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006871
Orphan claim re-pointed
Claims processor
CLM-415484 → UHC-67722-09 (Gabriel Davis)
Member id
UHC-67722-09
Confidence
1
Method
probabilistic
MBR-017679CLM-415484
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006872
Orphan claim re-pointed
Claims processor
CLM-405409 → UHC-63626-44 (Diego Bradley)
Member id
UHC-63626-44
Confidence
0.99
Method
probabilistic
MBR-017284CLM-405409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006873
Orphan claim re-pointed
Claims processor
CLM-429739 → UHC-66691-05 (Austin Nguyen)
Member id
UHC-66691-05
Confidence
1
Method
probabilistic
MBR-013844CLM-429739
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006874
Orphan claim re-pointed
Claims processor
CLM-412795 → UHC-33252-10 (Juan Carpenter)
Member id
UHC-33252-10
Confidence
1
Method
probabilistic
MBR-019209CLM-412795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006875
Orphan claim re-pointed
Claims processor
CLM-418423 → UHC-24398-42 (Camila Sanders)
Member id
UHC-24398-42
Confidence
1
Method
probabilistic
MBR-008496CLM-418423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006876
Orphan claim re-pointed
Claims processor
CLM-405987 → UHC-04821-42 (Deborah Vasquez)
Member id
UHC-04821-42
Confidence
1
Method
probabilistic
MBR-023279CLM-405987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006877
Orphan claim re-pointed
Claims processor
CLM-402540 → UHC-33344-70 (James Delgado)
Member id
UHC-33344-70
Confidence
1
Method
probabilistic
MBR-018511CLM-402540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006878
Orphan claim re-pointed
Claims processor
CLM-422269 → UHC-90693-56 (Roger Peters)
Member id
UHC-90693-56
Confidence
1
Method
probabilistic
MBR-027123CLM-422269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006879
Orphan claim re-pointed
Claims processor
CLM-427824 → UHC-64152-85 (Donna Ramos)
Member id
UHC-64152-85
Confidence
1
Method
probabilistic
MBR-027937CLM-427824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006880
Orphan claim re-pointed
Claims processor
CLM-428921 → UHC-70467-12 (Andrea Griffin)
Member id
UHC-70467-12
Confidence
1
Method
probabilistic
MBR-017785CLM-428921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006881
Orphan claim re-pointed
Claims processor
CLM-414117 → UHC-48894-38 (Dennis Spencer)
Member id
UHC-48894-38
Confidence
0.97
Method
deterministic
MBR-000087CLM-414117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006882
Orphan claim re-pointed
Claims processor
CLM-430411 → UHC-37517-47 (Bradley Larson)
Member id
UHC-37517-47
Confidence
1
Method
probabilistic
MBR-013945CLM-430411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006883
Orphan claim re-pointed
Claims processor
CLM-421405 → UHC-02720-67 (Santiago Fields)
Member id
UHC-02720-67
Confidence
1
Method
probabilistic
MBR-018872CLM-421405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006884
Orphan claim re-pointed
Claims processor
CLM-416919 → UHC-12402-61 (Thomas Chapman)
Member id
UHC-12402-61
Confidence
1
Method
probabilistic
MBR-008014CLM-416919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006885
Orphan claim re-pointed
Claims processor
CLM-429877 → UHC-41015-83 (Luis Stevens)
Member id
UHC-41015-83
Confidence
1
Method
probabilistic
MBR-024946CLM-429877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006886
Orphan claim re-pointed
Claims processor
CLM-415644 → UHC-23041-70 (Austin Johnson)
Member id
UHC-23041-70
Confidence
1
Method
probabilistic
MBR-004367CLM-415644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006887
Orphan claim re-pointed
Claims processor
CLM-403738 → UHC-15167-50 (Gerald Cunningham)
Member id
UHC-15167-50
Confidence
1
Method
probabilistic
MBR-002081CLM-403738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006888
Orphan claim re-pointed
Claims processor
CLM-431072 → UHC-00720-73 (Brenda Carpenter)
Member id
UHC-00720-73
Confidence
1
Method
probabilistic
MBR-025314CLM-431072
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006889
Orphan claim re-pointed
Claims processor
CLM-413354 → UHC-95825-79 (Bruce Murray)
Member id
UHC-95825-79
Confidence
1
Method
probabilistic
MBR-001690CLM-413354
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 111 of 282PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A 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.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.