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-006990
Orphan claim re-pointed
Claims processor
CLM-412710 → UHC-17679-69 (Randy Dixon)
Member id
UHC-17679-69
Confidence
0.99
Method
probabilistic
MBR-019683CLM-412710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006991
Orphan claim re-pointed
Claims processor
CLM-408484 → UHC-71172-51 (Ralph Johnston)
Member id
UHC-71172-51
Confidence
1
Method
probabilistic
MBR-011558CLM-408484
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006992
Orphan claim re-pointed
Claims processor
CLM-427642 → UHC-57924-01 (Shirley Simpson)
Member id
UHC-57924-01
Confidence
0.93
Method
probabilistic
MBR-017444CLM-427642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006993
Orphan claim re-pointed
Claims processor
CLM-413166 → UHC-58593-18 (Logan Phillips)
Member id
UHC-58593-18
Confidence
1
Method
probabilistic
MBR-010813CLM-413166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006994
Orphan claim re-pointed
Claims processor
CLM-413264 → UHC-95705-04 (Willie Hicks)
Member id
UHC-95705-04
Confidence
0.97
Method
deterministic
MBR-013351CLM-413264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006995
Orphan claim re-pointed
Claims processor
CLM-417943 → UHC-87700-61 (Ryan Rogers)
Member id
UHC-87700-61
Confidence
1
Method
probabilistic
MBR-002075CLM-417943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006996
Orphan claim re-pointed
Claims processor
CLM-418823 → UHC-20624-46 (Bruce Nichols)
Member id
UHC-20624-46
Confidence
1
Method
probabilistic
MBR-017833CLM-418823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006997
Orphan claim re-pointed
Claims processor
CLM-404491 → UHC-32520-91 (Jonathan Cunningham)
Member id
UHC-32520-91
Confidence
1
Method
probabilistic
MBR-005389CLM-404491
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006998
Orphan claim re-pointed
Claims processor
CLM-428516 → UHC-40621-41 (Scott Chapman)
Member id
UHC-40621-41
Confidence
0.97
Method
deterministic
MBR-036737CLM-428516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006999
Orphan claim re-pointed
Claims processor
CLM-400763 → UHC-23266-84 (Billy Thomas)
Member id
UHC-23266-84
Confidence
1
Method
probabilistic
MBR-021224CLM-400763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007000
Orphan claim re-pointed
Claims processor
CLM-428466 → UHC-22551-06 (Laura Hill)
Member id
UHC-22551-06
Confidence
0.87
Method
probabilistic
MBR-003322CLM-428466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007001
Orphan claim re-pointed
Claims processor
CLM-421466 → UHC-09837-69 (Karen Foster)
Member id
UHC-09837-69
Confidence
1
Method
probabilistic
MBR-000741CLM-421466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007002
Orphan claim re-pointed
Claims processor
CLM-411577 → UHC-86063-13 (Ahmed Patel)
Member id
UHC-86063-13
Confidence
1
Method
probabilistic
MBR-024580CLM-411577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007003
Orphan claim re-pointed
Claims processor
CLM-422494 → UHC-43524-49 (Rachel Lopez)
Member id
UHC-43524-49
Confidence
1
Method
probabilistic
MBR-005146CLM-422494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007004
Orphan claim re-pointed
Claims processor
CLM-426052 → UHC-95033-99 (Carlos Estrada)
Member id
UHC-95033-99
Confidence
1
Method
probabilistic
MBR-024709CLM-426052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007005
Orphan claim re-pointed
Claims processor
CLM-431195 → UHC-46380-98 (Timothy Long)
Member id
UHC-46380-98
Confidence
1
Method
probabilistic
MBR-024837CLM-431195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007006
Orphan claim re-pointed
Claims processor
CLM-419900 → UHC-69124-67 (Kathryn Robinson)
Member id
UHC-69124-67
Confidence
1
Method
probabilistic
MBR-003509CLM-419900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007007
Orphan claim re-pointed
Claims processor
CLM-427994 → UHC-68499-83 (Jose Williams)
Member id
UHC-68499-83
Confidence
1
Method
probabilistic
MBR-012275CLM-427994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007008
Orphan claim re-pointed
Claims processor
CLM-427157 → UHC-26241-69 (Donald Henry)
Member id
UHC-26241-69
Confidence
1
Method
probabilistic
MBR-026779CLM-427157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007009
Orphan claim re-pointed
Claims processor
CLM-412042 → UHC-26200-71 (Jonathan McDonald)
Member id
UHC-26200-71
Confidence
1
Method
probabilistic
MBR-020275CLM-412042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007010
Orphan claim re-pointed
Claims processor
CLM-424416 → UHC-85600-23 (Noah Cooper)
Member id
UHC-85600-23
Confidence
1
Method
probabilistic
MBR-019191CLM-424416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007011
Orphan claim re-pointed
Claims processor
CLM-400211 → UHC-96143-73 (Brandon Bennett)
Member id
UHC-96143-73
Confidence
1
Method
probabilistic
MBR-012428CLM-400211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007012
Orphan claim re-pointed
Claims processor
CLM-422151 → UHC-85301-17 (Jason Espinoza)
Member id
UHC-85301-17
Confidence
1
Method
probabilistic
MBR-006148CLM-422151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007013
Orphan claim re-pointed
Claims processor
CLM-410870 → UHC-84632-41 (Gerald Bennett)
Member id
UHC-84632-41
Confidence
1
Method
probabilistic
MBR-041848CLM-410870
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007014
Orphan claim re-pointed
Claims processor
CLM-400362 → UHC-69655-07 (Eric Sims)
Member id
UHC-69655-07
Confidence
1
Method
probabilistic
MBR-019406CLM-400362
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007015
Orphan claim re-pointed
Claims processor
CLM-429931 → UHC-43150-75 (Amy Carr)
Member id
UHC-43150-75
Confidence
1
Method
probabilistic
MBR-015811CLM-429931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007016
Orphan claim re-pointed
Claims processor
CLM-406496 → UHC-54871-91 (Omar Torres)
Member id
UHC-54871-91
Confidence
0.97
Method
deterministic
MBR-024385CLM-406496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007017
Orphan claim re-pointed
Claims processor
CLM-429483 → UHC-15796-58 (Stephen King)
Member id
UHC-15796-58
Confidence
0.88
Method
probabilistic
MBR-002628CLM-429483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007018
Orphan claim re-pointed
Claims processor
CLM-420116 → UHC-36493-03 (Jose Mejia)
Member id
UHC-36493-03
Confidence
1
Method
probabilistic
MBR-001214CLM-420116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007019
Orphan claim re-pointed
Claims processor
CLM-420487 → UHC-68721-38 (Jose Kennedy)
Member id
UHC-68721-38
Confidence
1
Method
probabilistic
MBR-003034CLM-420487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007020
Orphan claim re-pointed
Claims processor
CLM-423708 → UHC-22282-57 (Joyce Montgomery)
Member id
UHC-22282-57
Confidence
1
Method
probabilistic
MBR-019420CLM-423708
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007021
Orphan claim re-pointed
Claims processor
CLM-432161 → UHC-59494-89 (Linda Reid)
Member id
UHC-59494-89
Confidence
0.99
Method
probabilistic
MBR-034318CLM-432161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007022
Orphan claim re-pointed
Claims processor
CLM-424666 → UHC-60560-81 (Alice Mejia)
Member id
UHC-60560-81
Confidence
1
Method
probabilistic
MBR-030620CLM-424666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007023
Orphan claim re-pointed
Claims processor
CLM-409977 → UHC-24326-31 (Priya Dixon)
Member id
UHC-24326-31
Confidence
1
Method
probabilistic
MBR-016593CLM-409977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007024
Orphan claim re-pointed
Claims processor
CLM-405234 → UHC-52836-55 (Victoria Hawkins)
Member id
UHC-52836-55
Confidence
0.97
Method
deterministic
MBR-018388CLM-405234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007025
Orphan claim re-pointed
Claims processor
CLM-406464 → UHC-73695-03 (Kathleen Moore)
Member id
UHC-73695-03
Confidence
1
Method
probabilistic
MBR-039191CLM-406464
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007026
Orphan claim re-pointed
Claims processor
CLM-413126 → UHC-33748-51 (Frank Howard)
Member id
UHC-33748-51
Confidence
1
Method
probabilistic
MBR-019927CLM-413126
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007027
Orphan claim re-pointed
Claims processor
CLM-404649 → UHC-13806-99 (Mary Wilson)
Member id
UHC-13806-99
Confidence
1
Method
probabilistic
MBR-029755CLM-404649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007028
Orphan claim re-pointed
Claims processor
CLM-422135 → UHC-73040-31 (Kevin Reynolds)
Member id
UHC-73040-31
Confidence
1
Method
probabilistic
MBR-022639CLM-422135
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007029
Orphan claim re-pointed
Claims processor
CLM-421764 → UHC-69098-58 (Laura Bennett)
Member id
UHC-69098-58
Confidence
1
Method
probabilistic
MBR-016031CLM-421764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007030
Orphan claim re-pointed
Claims processor
CLM-421966 → UHC-17502-07 (Jeffrey Harrison)
Member id
UHC-17502-07
Confidence
1
Method
probabilistic
MBR-003965CLM-421966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007031
Orphan claim re-pointed
Claims processor
CLM-409139 → UHC-74963-28 (Bruce Adams)
Member id
UHC-74963-28
Confidence
0.97
Method
deterministic
MBR-016420CLM-409139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007032
Orphan claim re-pointed
Claims processor
CLM-413910 → UHC-66169-12 (Paul Knight)
Member id
UHC-66169-12
Confidence
0.97
Method
deterministic
MBR-029438CLM-413910
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007033
Orphan claim re-pointed
Claims processor
CLM-420616 → UHC-01722-15 (Jonathan Snyder)
Member id
UHC-01722-15
Confidence
1
Method
probabilistic
MBR-011576CLM-420616
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007034
Orphan claim re-pointed
Claims processor
CLM-418915 → UHC-07852-29 (Stephanie Lee)
Member id
UHC-07852-29
Confidence
0.97
Method
deterministic
MBR-030726CLM-418915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007035
Orphan claim re-pointed
Claims processor
CLM-420108 → UHC-36357-55 (Nicholas Hughes)
Member id
UHC-36357-55
Confidence
1
Method
probabilistic
MBR-015127CLM-420108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007036
Orphan claim re-pointed
Claims processor
CLM-406741 → UHC-82015-88 (Ana Rojas)
Member id
UHC-82015-88
Confidence
1
Method
probabilistic
MBR-043730CLM-406741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007037
Orphan claim re-pointed
Claims processor
CLM-413260 → UHC-23765-47 (Karen Morrison)
Member id
UHC-23765-47
Confidence
0.98
Method
probabilistic
MBR-034256CLM-413260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007038
Orphan claim re-pointed
Claims processor
CLM-419707 → UHC-34608-53 (Marilyn James)
Member id
UHC-34608-53
Confidence
1
Method
probabilistic
MBR-002431CLM-419707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007039
Orphan claim re-pointed
Claims processor
CLM-422054 → UHC-47146-64 (Sara Williams)
Member id
UHC-47146-64
Confidence
0.99
Method
probabilistic
MBR-034801CLM-422054
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 114 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.