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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-013995 | Outreach suppressed pending steward Outreach | TPA-56902 (Pamela Lucas) held until CASE-000551 is decided |
| Held | — | ||
| ACT-013996 | Outreach suppressed pending steward Outreach | TPA-51124 (Donna Torres) held until CASE-000552 is decided |
| Held | — | ||
| ACT-013997 | Outreach suppressed pending steward Outreach | CLM-401010 (Andrea Meyer) held until CASE-000553 is decided |
| Held | — | ||
| ACT-013998 | Outreach suppressed pending steward Outreach | CLM-401009 (Andrea Meyer) held until CASE-000554 is decided |
| Held | — | ||
| ACT-013999 | Outreach suppressed pending steward Outreach | TPA-59070 (Russell Hart) held until CASE-000555 is decided |
| Held | — | ||
| ACT-014000 | Outreach suppressed pending steward Outreach | TPA-62601 (Victoria Hart) held until CASE-000556 is decided |
| Held | — | ||
| ACT-014001 | Outreach suppressed pending steward Outreach | ENR-103633 (Eugene Espinoza) held until CASE-000557 is decided |
| Held | — | ||
| ACT-014002 | Outreach suppressed pending steward Outreach | CLM-401405 (Fetima Ramos) held until CASE-000558 is decided |
| Held | — | ||
| ACT-014003 | Outreach suppressed pending steward Outreach | ENR-101790 (Fatima Ramos) held until CASE-000559 is decided |
| Held | — | ||
| ACT-014004 | Outreach suppressed pending steward Outreach | PRV-27860 (Sandra Ward) held until CASE-000560 is decided |
| Held | — | ||
| ACT-014005 | Outreach suppressed pending steward Outreach | ENR-134967 (Sandra Ward) held until CASE-000561 is decided |
| Held | — | ||
| ACT-014006 | Outreach suppressed pending steward Outreach | CLM-400295 (Valentina Ausstin) held until CASE-000562 is decided |
| Held | — | ||
| ACT-014007 | Outreach suppressed pending steward Outreach | CLM-420261 (Raymond Austin) held until CASE-000563 is decided |
| Held | — | ||
| ACT-014008 | Outreach suppressed pending steward Outreach | TPA-52079 (Katherine Knight) held until CASE-000564 is decided |
| Held | — | ||
| ACT-014009 | Outreach suppressed pending steward Outreach | CLM-415612 (Beverly Hunter) held until CASE-000565 is decided |
| Held | — | ||
| ACT-014010 | Outreach suppressed pending steward Outreach | TPA-56842 (Beverly Hunter) held until CASE-000566 is decided |
| Held | — | ||
| ACT-014011 | Outreach suppressed pending steward Outreach | TPA-61207 (Jason Hansen) held until CASE-000567 is decided |
| Held | — | ||
| ACT-014012 | Outreach suppressed pending steward Outreach | TPA-61206 (Jason Hansen) held until CASE-000568 is decided |
| Held | — | ||
| ACT-014013 | Outreach suppressed pending steward Outreach | CLM-404719 (Karen Walker) held until CASE-000569 is decided |
| Held | — | ||
| ACT-014014 | Outreach suppressed pending steward Outreach | TPA-53472 (Tyler Long) held until CASE-000570 is decided |
| Held | — | ||
| ACT-014015 | Outreach suppressed pending steward Outreach | CLM-429155 (Anna Wallace) held until CASE-000571 is decided |
| Held | — | ||
| ACT-014016 | Outreach suppressed pending steward Outreach | TPA-50442 (Mary Willis) held until CASE-000572 is decided |
| Held | — | ||
| ACT-014017 | Outreach suppressed pending steward Outreach | TPA-61155 (Bruce Evans) held until CASE-000573 is decided |
| Held | — | ||
| ACT-014018 | Outreach suppressed pending steward Outreach | CLM-424736 (Joe Thomas) held until CASE-000574 is decided |
| Held | — | ||
| ACT-014019 | Outreach suppressed pending steward Outreach | ENR-115183 (Alice Harrison) held until CASE-000575 is decided |
| Held | — | ||
| ACT-014020 | Outreach suppressed pending steward Outreach | CLM-401022 (Margaret Powell) held until CASE-000576 is decided |
| Held | — | ||
| ACT-014021 | Outreach suppressed pending steward Outreach | ENR-101335 (Margaret Powell) held until CASE-000577 is decided |
| Held | — | ||
| ACT-014022 | Outreach suppressed pending steward Outreach | CLM-412418 (Priya Wilson) held until CASE-000578 is decided |
| Held | — | ||
| ACT-014023 | Outreach suppressed pending steward Outreach | ENR-116337 (Priya Wilson) held until CASE-000579 is decided |
| Held | — | ||
| ACT-014024 | Outreach suppressed pending steward Outreach | ENR-102892 (Samantha Padilla) held until CASE-000580 is decided |
| Held | — | ||
| ACT-014025 | Outreach suppressed pending steward Outreach | CLM-402268 (Samantha Padilla) held until CASE-000581 is decided |
| Held | — | ||
| ACT-014026 | Outreach suppressed pending steward Outreach | TPA-61112 (Bryan Morgan) held until CASE-000582 is decided |
| Held | — | ||
| ACT-014027 | Outreach suppressed pending steward Outreach | ENR-102025 (Jordan Rice) held until CASE-000583 is decided |
| Held | — | ||
| ACT-014028 | Outreach suppressed pending steward Outreach | TPA-50678 (Jordan Rice) held until CASE-000584 is decided |
| Held | — | ||
| ACT-014029 | Outreach suppressed pending steward Outreach | CLM-406714 (Kelly Richardson) held until CASE-000585 is decided |
| Held | — | ||
| ACT-014030 | Outreach suppressed pending steward Outreach | ENR-108751 (Kelly Richardson) held until CASE-000586 is decided |
| Held | — | ||
| ACT-014031 | Outreach suppressed pending steward Outreach | CLM-419765 (Chris Schmidt) held until CASE-000587 is decided |
| Held | — | ||
| ACT-014032 | Outreach suppressed pending steward Outreach | ENR-126022 (Christine Schmidt) held until CASE-000588 is decided |
| Held | — | ||
| ACT-014033 | Outreach suppressed pending steward Outreach | CLM-402358 (Philip Morgan) held until CASE-000589 is decided |
| Held | — | ||
| ACT-014034 | Outreach suppressed pending steward Outreach | PRV-27604 (Donna Silva) held until CASE-000590 is decided |
| Held | — | ||
| ACT-014035 | Outreach suppressed pending steward Outreach | PRV-21864 (Judith Collins) held until CASE-000591 is decided |
| Held | — | ||
| ACT-014036 | Outreach suppressed pending steward Outreach | TPA-62272 (Austin Gibson) held until CASE-000592 is decided |
| Held | — | ||
| ACT-014037 | Outreach suppressed pending steward Outreach | TPA-58525 (Madisn Rodriguez) held until CASE-000593 is decided |
| Held | — | ||
| ACT-014038 | Outreach suppressed pending steward Outreach | TPA-59487 (Natalie Johnson) held until CASE-000594 is decided |
| Held | — | ||
| ACT-014039 | Outreach suppressed pending steward Outreach | TPA-54940 (Kayla Wheeler) held until CASE-000595 is decided |
| Held | — | ||
| ACT-014040 | Outreach suppressed pending steward Outreach | ENR-114798 (Kayla Wheeler) held until CASE-000596 is decided |
| Held | — | ||
| ACT-014041 | Outreach suppressed pending steward Outreach | CLM-430266 (Anna Knight) held until CASE-000597 is decided |
| Held | — | ||
| ACT-014042 | Outreach suppressed pending steward Outreach | ENR-122155 (Samantha Tran) held until CASE-000598 is decided |
| Held | — | ||
| ACT-014043 | Outreach suppressed pending steward Outreach | CLM-416867 (Samantha Tran) held until CASE-000599 is decided |
| Held | — | ||
| ACT-014044 | Outreach suppressed pending steward Outreach | PRV-24863 (Theresa Gutierrez) held until CASE-000600 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.