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