Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Actions

26,640 derived from the last resolution run

ActionTypeTitleDetailLinked toStatusExecuted
ACT-019389
Care coordination outreach
Next-best-action
Christina Nguyen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019390
Care coordination outreach
Next-best-action
Zachary Hudson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019391
Care coordination outreach
Next-best-action
James Rojas: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019392
Care coordination outreach
Next-best-action
Donald Adams: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019393
Care coordination outreach
Next-best-action
Adam Vega: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019394
Care coordination outreach
Next-best-action
Joan Meyer: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019395
Care coordination outreach
Next-best-action
Joyce Duncan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019396
Care coordination outreach
Next-best-action
Cynthia Jenkins: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019397
Care coordination outreach
Next-best-action
Kyle Simpson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019398
Care coordination outreach
Next-best-action
Heather Pierce: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019399
Care coordination outreach
Next-best-action
Betty Pena: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019400
Care coordination outreach
Next-best-action
Sharon Gilbert: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019401
Care coordination outreach
Next-best-action
Austin Li: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019402
Care coordination outreach
Next-best-action
Daniel Lawrence: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019403
Care coordination outreach
Next-best-action
Isabella Santos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019404
Care coordination outreach
Next-best-action
Kathryn Schmidt: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019405
Care coordination outreach
Next-best-action
Bruce Garrett: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019406
Care coordination outreach
Next-best-action
Mateo Simpson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019407
Care coordination outreach
Next-best-action
Gary Valdez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019408
Care coordination outreach
Next-best-action
Elizabeth Brown: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019409
Care coordination outreach
Next-best-action
Mary Fields: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019410
Care coordination outreach
Next-best-action
Sean Chapman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019411
Care coordination outreach
Next-best-action
Dylan Parker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019412
Care coordination outreach
Next-best-action
Jean Ward: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019413
Care coordination outreach
Next-best-action
Jennifer Bradley: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019414
Care coordination outreach
Next-best-action
Joseph Olson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019415
Care coordination outreach
Next-best-action
Kevin King: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019416
Care coordination outreach
Next-best-action
Elizabeth Carr: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019417
Care coordination outreach
Next-best-action
Danielle Lee: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019418
Care coordination outreach
Next-best-action
Angela Bailey: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019419
Care coordination outreach
Next-best-action
Thomas Morales: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019420
Care coordination outreach
Next-best-action
Christine Phillips: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019421
Care coordination outreach
Next-best-action
Mark Edwards: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019422
Care coordination outreach
Next-best-action
Kathryn Payne: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019423
Care coordination outreach
Next-best-action
Frances Ruiz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019424
Care coordination outreach
Next-best-action
Priya Henry: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019425
Care coordination outreach
Next-best-action
Heather Willis: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019426
Care coordination outreach
Next-best-action
Jason Perez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019427
Care coordination outreach
Next-best-action
Denise Stephens: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019428
Care coordination outreach
Next-best-action
Bobby Santos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019429
Care coordination outreach
Next-best-action
Brandon Vazquez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019430
Care coordination outreach
Next-best-action
Charlotte Coleman: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019431
Care coordination outreach
Next-best-action
Anna Clark: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019432
Care coordination outreach
Next-best-action
Mary Wilson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019433
Care coordination outreach
Next-best-action
Frank Guzman: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019434
Care coordination outreach
Next-best-action
Sean Howell: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019435
Care coordination outreach
Next-best-action
Nicole Sullivan: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019436
Care coordination outreach
Next-best-action
Sandra Simmons: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019437
Care coordination outreach
Next-best-action
Elizabeth Tucker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019438
Care coordination outreach
Next-best-action
Edward Dunn: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
26,640 rows, page 120 of 533PreviousNext

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.