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-007040
Orphan claim re-pointed
Claims processor
CLM-402787 → UHC-03439-03 (Luis Wallace)
Member id
UHC-03439-03
Confidence
1
Method
probabilistic
MBR-010455CLM-402787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007041
Orphan claim re-pointed
Claims processor
CLM-425184 → UHC-46251-68 (Deborah Lynch)
Member id
UHC-46251-68
Confidence
0.97
Method
deterministic
MBR-007083CLM-425184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007042
Orphan claim re-pointed
Claims processor
CLM-419971 → UHC-60192-48 (Emma Gardner)
Member id
UHC-60192-48
Confidence
0.99
Method
probabilistic
MBR-020632CLM-419971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007043
Orphan claim re-pointed
Claims processor
CLM-421263 → UHC-68395-91 (Randy Lawrence)
Member id
UHC-68395-91
Confidence
1
Method
probabilistic
MBR-012482CLM-421263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007044
Orphan claim re-pointed
Claims processor
CLM-416810 → UHC-33256-68 (Peter Gray)
Member id
UHC-33256-68
Confidence
1
Method
probabilistic
MBR-017680CLM-416810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007045
Orphan claim re-pointed
Claims processor
CLM-428799 → UHC-60979-31 (Russell Weaver)
Member id
UHC-60979-31
Confidence
0.98
Method
probabilistic
MBR-007664CLM-428799
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007046
Orphan claim re-pointed
Claims processor
CLM-402549 → UHC-77309-19 (Diana Hernandez)
Member id
UHC-77309-19
Confidence
1
Method
probabilistic
MBR-043348CLM-402549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007047
Orphan claim re-pointed
Claims processor
CLM-415099 → UHC-19125-53 (Emily Lane)
Member id
UHC-19125-53
Confidence
0.94
Method
probabilistic
MBR-033908CLM-415099
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007048
Orphan claim re-pointed
Claims processor
CLM-401986 → UHC-73453-17 (Stephanie Berry)
Member id
UHC-73453-17
Confidence
1
Method
probabilistic
MBR-031903CLM-401986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007049
Orphan claim re-pointed
Claims processor
CLM-406660 → UHC-51288-35 (Joyce Perry)
Member id
UHC-51288-35
Confidence
0.97
Method
deterministic
MBR-029317CLM-406660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007050
Orphan claim re-pointed
Claims processor
CLM-418445 → UHC-87872-07 (Martha Gonzales)
Member id
UHC-87872-07
Confidence
1
Method
probabilistic
MBR-021994CLM-418445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007051
Orphan claim re-pointed
Claims processor
CLM-426642 → UHC-93715-49 (Nancy Richards)
Member id
UHC-93715-49
Confidence
1
Method
probabilistic
MBR-011033CLM-426642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007052
Orphan claim re-pointed
Claims processor
CLM-408588 → UHC-19807-30 (Joshua Gordon)
Member id
UHC-19807-30
Confidence
1
Method
probabilistic
MBR-027087CLM-408588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007053
Orphan claim re-pointed
Claims processor
CLM-409381 → UHC-22854-38 (Anna Carlson)
Member id
UHC-22854-38
Confidence
1
Method
probabilistic
MBR-005477CLM-409381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007054
Orphan claim re-pointed
Claims processor
CLM-409308 → UHC-85666-65 (Wayne Arnold)
Member id
UHC-85666-65
Confidence
1
Method
probabilistic
MBR-023371CLM-409308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007055
Orphan claim re-pointed
Claims processor
CLM-414413 → UHC-35265-34 (Bobby Sandoval)
Member id
UHC-35265-34
Confidence
1
Method
probabilistic
MBR-016676CLM-414413
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007056
Orphan claim re-pointed
Claims processor
CLM-402596 → UHC-52002-05 (Patricia Graham)
Member id
UHC-52002-05
Confidence
0.97
Method
deterministic
MBR-000440CLM-402596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007057
Orphan claim re-pointed
Claims processor
CLM-420318 → UHC-91446-36 (Gary Torres)
Member id
UHC-91446-36
Confidence
0.99
Method
probabilistic
MBR-002784CLM-420318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007058
Orphan claim re-pointed
Claims processor
CLM-415036 → UHC-43336-64 (Keith Fox)
Member id
UHC-43336-64
Confidence
0.97
Method
deterministic
MBR-033747CLM-415036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007059
Orphan claim re-pointed
Claims processor
CLM-432296 → UHC-89122-31 (David Howell)
Member id
UHC-89122-31
Confidence
0.99
Method
probabilistic
MBR-025429CLM-432296
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007060
Orphan claim re-pointed
Claims processor
CLM-419341 → UHC-94105-73 (Richard Boyd)
Member id
UHC-94105-73
Confidence
1
Method
probabilistic
MBR-004511CLM-419341
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007061
Orphan claim re-pointed
Claims processor
CLM-402751 → UHC-75257-74 (George Knight)
Member id
UHC-75257-74
Confidence
1
Method
probabilistic
MBR-001992CLM-402751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007062
Orphan claim re-pointed
Claims processor
CLM-425358 → UHC-45106-07 (Nathan Patterson)
Member id
UHC-45106-07
Confidence
1
Method
probabilistic
MBR-012916CLM-425358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007063
Orphan claim re-pointed
Claims processor
CLM-429485 → UHC-15796-58 (Stephen King)
Member id
UHC-15796-58
Confidence
1
Method
probabilistic
MBR-002628CLM-429485
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007064
Orphan claim re-pointed
Claims processor
CLM-412331 → UHC-02947-44 (Carolyn Garrett)
Member id
UHC-02947-44
Confidence
0.97
Method
deterministic
MBR-013924CLM-412331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007065
Orphan claim re-pointed
Claims processor
CLM-418154 → UHC-63645-91 (Harold Mejia)
Member id
UHC-63645-91
Confidence
1
Method
probabilistic
MBR-009130CLM-418154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007066
Orphan claim re-pointed
Claims processor
CLM-407420 → UHC-15937-04 (Rachel Munoz)
Member id
UHC-15937-04
Confidence
1
Method
probabilistic
MBR-009939CLM-407420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007067
Orphan claim re-pointed
Claims processor
CLM-409307 → UHC-30271-36 (Emma Estrada)
Member id
UHC-30271-36
Confidence
1
Method
probabilistic
MBR-006207CLM-409307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007068
Orphan claim re-pointed
Claims processor
CLM-421358 → UHC-19063-42 (Larry Bradley)
Member id
UHC-19063-42
Confidence
0.99
Method
probabilistic
MBR-038211CLM-421358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007069
Orphan claim re-pointed
Claims processor
CLM-412428 → UHC-62361-29 (Jason Wang)
Member id
UHC-62361-29
Confidence
1
Method
probabilistic
MBR-025813CLM-412428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007070
Orphan claim re-pointed
Claims processor
CLM-421703 → UHC-25714-67 (Paul Bryant)
Member id
UHC-25714-67
Confidence
0.93
Method
probabilistic
MBR-019832CLM-421703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007071
Orphan claim re-pointed
Claims processor
CLM-425859 → UHC-68692-18 (Donna Reed)
Member id
UHC-68692-18
Confidence
1
Method
probabilistic
MBR-001647CLM-425859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007072
Orphan claim re-pointed
Claims processor
CLM-428032 → UHC-28017-01 (Lawrence Johnston)
Member id
UHC-28017-01
Confidence
1
Method
probabilistic
MBR-022857CLM-428032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007073
Orphan claim re-pointed
Claims processor
CLM-411399 → UHC-75380-43 (Julie Ortega)
Member id
UHC-75380-43
Confidence
0.93
Method
probabilistic
MBR-019990CLM-411399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007074
Orphan claim re-pointed
Claims processor
CLM-414702 → UHC-66762-67 (Cynthia Green)
Member id
UHC-66762-67
Confidence
1.00
Method
probabilistic
MBR-011352CLM-414702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007075
Orphan claim re-pointed
Claims processor
CLM-406650 → UHC-76743-89 (Walter Patel)
Member id
UHC-76743-89
Confidence
1
Method
probabilistic
MBR-026737CLM-406650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007076
Orphan claim re-pointed
Claims processor
CLM-405020 → UHC-26434-29 (Abigail George)
Member id
UHC-26434-29
Confidence
1
Method
probabilistic
MBR-007370CLM-405020
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007077
Orphan claim re-pointed
Claims processor
CLM-401399 → UHC-65311-64 (Gabriel Robertson)
Member id
UHC-65311-64
Confidence
1
Method
probabilistic
MBR-001760CLM-401399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007078
Orphan claim re-pointed
Claims processor
CLM-427932 → UHC-47608-49 (Jack Taylor)
Member id
UHC-47608-49
Confidence
0.97
Method
deterministic
MBR-025980CLM-427932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007079
Orphan claim re-pointed
Claims processor
CLM-408629 → UHC-11208-80 (Theresa Munoz)
Member id
UHC-11208-80
Confidence
1
Method
probabilistic
MBR-004379CLM-408629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007080
Orphan claim re-pointed
Claims processor
CLM-405392 → UHC-81436-54 (Wei Martinez)
Member id
UHC-81436-54
Confidence
0.97
Method
deterministic
MBR-006095CLM-405392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007081
Orphan claim re-pointed
Claims processor
CLM-420510 → UHC-80101-02 (Arjun White)
Member id
UHC-80101-02
Confidence
0.98
Method
probabilistic
MBR-008780CLM-420510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007082
Orphan claim re-pointed
Claims processor
CLM-410241 → UHC-81933-20 (Scott Lynch)
Member id
UHC-81933-20
Confidence
1
Method
probabilistic
MBR-032627CLM-410241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007083
Orphan claim re-pointed
Claims processor
CLM-420576 → UHC-73258-28 (Willie Daniels)
Member id
UHC-73258-28
Confidence
1
Method
probabilistic
MBR-008733CLM-420576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007084
Orphan claim re-pointed
Claims processor
CLM-432321 → UHC-58364-11 (Cheryl Obrien)
Member id
UHC-58364-11
Confidence
0.99
Method
probabilistic
MBR-002556CLM-432321
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007085
Orphan claim re-pointed
Claims processor
CLM-417848 → UHC-78224-40 (Sean Castro)
Member id
UHC-78224-40
Confidence
0.94
Method
probabilistic
MBR-001542CLM-417848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007086
Orphan claim re-pointed
Claims processor
CLM-418734 → UHC-20070-18 (Justin Martinez)
Member id
UHC-20070-18
Confidence
1
Method
probabilistic
MBR-010191CLM-418734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007087
Orphan claim re-pointed
Claims processor
CLM-408973 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007088
Orphan claim re-pointed
Claims processor
CLM-409737 → UHC-80139-48 (Scott Howell)
Member id
UHC-80139-48
Confidence
1
Method
probabilistic
MBR-019713CLM-409737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007089
Orphan claim re-pointed
Claims processor
CLM-408767 → UHC-60553-01 (Amy Young)
Member id
UHC-60553-01
Confidence
1
Method
probabilistic
MBR-008531CLM-408767
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 115 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.