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-014045 | Outreach suppressed pending steward Outreach | ENR-121561 (Theresa Gutierrez) held until CASE-000601 is decided |
| Held | — | ||
| ACT-014046 | Outreach suppressed pending steward Outreach | CLM-427126 (Eugene Phillips) held until CASE-000602 is decided |
| Held | — | ||
| ACT-014047 | Outreach suppressed pending steward Outreach | CLM-427127 (Eugene Phillips) held until CASE-000603 is decided |
| Held | — | ||
| ACT-014048 | Outreach suppressed pending steward Outreach | TPA-53500 (Julia Soto) held until CASE-000604 is decided |
| Held | — | ||
| ACT-014049 | Outreach suppressed pending steward Outreach | TPA-55613 (Logan Adams) held until CASE-000605 is decided |
| Held | — | ||
| ACT-014050 | Outreach suppressed pending steward Outreach | CLM-412773 (Logan Adams) held until CASE-000606 is decided |
| Held | — | ||
| ACT-014051 | Outreach suppressed pending steward Outreach | CLM-415859 (Janet Vega) held until CASE-000607 is decided |
| Held | — | ||
| ACT-014052 | Outreach suppressed pending steward Outreach | CLM-403200 (Samantha Watson) held until CASE-000608 is decided |
| Held | — | ||
| ACT-014053 | Outreach suppressed pending steward Outreach | TPA-51375 (Sam Watson) held until CASE-000609 is decided |
| Held | — | ||
| ACT-014054 | Outreach suppressed pending steward Outreach | ENR-115970 (Jona Watson) held until CASE-000610 is decided |
| Held | — | ||
| ACT-014055 | Outreach suppressed pending steward Outreach | CLM-431873 (Diana Chavez) held until CASE-000611 is decided |
| Held | — | ||
| ACT-014056 | Outreach suppressed pending steward Outreach | CLM-411380 (Judy Miller) held until CASE-000612 is decided |
| Held | — | ||
| ACT-014057 | Outreach suppressed pending steward Outreach | TPA-57350 (Albert Stephens) held until CASE-000613 is decided |
| Held | — | ||
| ACT-014058 | Outreach suppressed pending steward Outreach | TPA-63496 (Albert Stephens) held until CASE-000614 is decided |
| Held | — | ||
| ACT-014059 | Outreach suppressed pending steward Outreach | ENR-140136 (Albert Stephens) held until CASE-000615 is decided |
| Held | — | ||
| ACT-014060 | Outreach suppressed pending steward Outreach | ENR-110731 (Kelly Park) held until CASE-000616 is decided |
| Held | — | ||
| ACT-014061 | Outreach suppressed pending steward Outreach | CLM-408147 (Kelly Park) held until CASE-000617 is decided |
| Held | — | ||
| ACT-014062 | Outreach suppressed pending steward Outreach | ENR-139906 (John Vasquez) held until CASE-000618 is decided |
| Held | — | ||
| ACT-014063 | Outreach suppressed pending steward Outreach | TPA-63417 (Jack Vasquez) held until CASE-000619 is decided |
| Held | — | ||
| ACT-014064 | Outreach suppressed pending steward Outreach | TPA-58172 (Mark Lynch) held until CASE-000620 is decided |
| Held | — | ||
| ACT-014065 | Outreach suppressed pending steward Outreach | TPA-50182 (Barbara Lynch) held until CASE-000621 is decided |
| Held | — | ||
| ACT-014066 | Outreach suppressed pending steward Outreach | ENR-100588 (Barb Lynch) held until CASE-000622 is decided |
| Held | — | ||
| ACT-014067 | Outreach suppressed pending steward Outreach | CLM-404546 (Katherine Wang) held until CASE-000623 is decided |
| Held | — | ||
| ACT-014068 | Outreach suppressed pending steward Outreach | CLM-426457 (Roy Lawrence) held until CASE-000624 is decided |
| Held | — | ||
| ACT-014069 | Outreach suppressed pending steward Outreach | TPA-61690 (Roy Lawrence) held until CASE-000625 is decided |
| Held | — | ||
| ACT-014070 | Outreach suppressed pending steward Outreach | TPA-60359 (Ann Lawrence) held until CASE-000626 is decided |
| Held | — | ||
| ACT-014071 | Outreach suppressed pending steward Outreach | CLM-417765 (Mason Rose) held until CASE-000627 is decided |
| Held | — | ||
| ACT-014072 | Outreach suppressed pending steward Outreach | CLM-403410 (Eric Ruiz) held until CASE-000628 is decided |
| Held | — | ||
| ACT-014073 | Outreach suppressed pending steward Outreach | ENR-104440 (Eric Ruiz) held until CASE-000629 is decided |
| Held | — | ||
| ACT-014074 | Outreach suppressed pending steward Outreach | PRV-24673 (Brandon Hicks) held until CASE-000630 is decided |
| Held | — | ||
| ACT-014075 | Outreach suppressed pending steward Outreach | TPA-56920 (Brandon Hicks) held until CASE-000631 is decided |
| Held | — | ||
| ACT-014076 | Outreach suppressed pending steward Outreach | CLM-400455 (Nicole Chen) held until CASE-000632 is decided |
| Held | — | ||
| ACT-014077 | Outreach suppressed pending steward Outreach | TPA-63484 (Justin Fowler) held until CASE-000633 is decided |
| Held | — | ||
| ACT-014078 | Outreach suppressed pending steward Outreach | TPA-50791 (Carlos Wood) held until CASE-000634 is decided |
| Held | — | ||
| ACT-014079 | Outreach suppressed pending steward Outreach | CLM-403121 (Barbara Welhc) held until CASE-000635 is decided |
| Held | — | ||
| ACT-014080 | Outreach suppressed pending steward Outreach | TPA-58559 (Jeffrey Wells) held until CASE-000636 is decided |
| Held | — | ||
| ACT-014081 | Outreach suppressed pending steward Outreach | ENR-141286 (Benjamin Parker) held until CASE-000637 is decided |
| Held | — | ||
| ACT-014082 | Outreach suppressed pending steward Outreach | TPA-63247 (Denise Knight) held until CASE-000638 is decided |
| Held | — | ||
| ACT-014083 | Outreach suppressed pending steward Outreach | CLM-430018 (Denise Knight) held until CASE-000639 is decided |
| Held | — | ||
| ACT-014084 | Outreach suppressed pending steward Outreach | CLM-402526 (Sarah Cruz) held until CASE-000640 is decided |
| Held | — | ||
| ACT-014085 | Outreach suppressed pending steward Outreach | PRV-20736 (Sarah Cruz) held until CASE-000641 is decided |
| Held | — | ||
| ACT-014086 | Outreach suppressed pending steward Outreach | TPA-61753 (Sara Cruz) held until CASE-000642 is decided |
| Held | — | ||
| ACT-014087 | Outreach suppressed pending steward Outreach | TPA-61752 (Sara Cruz) held until CASE-000643 is decided |
| Held | — | ||
| ACT-014088 | Outreach suppressed pending steward Outreach | PRV-29260 (Gloria Hudson) held until CASE-000644 is decided |
| Held | — | ||
| ACT-014089 | Outreach suppressed pending steward Outreach | CLM-431681 (Gloria Hudson) held until CASE-000645 is decided |
| Held | — | ||
| ACT-014090 | Outreach suppressed pending steward Outreach | CLM-420419 (Christian Cruz) held until CASE-000646 is decided |
| Held | — | ||
| ACT-014091 | Outreach suppressed pending steward Outreach | TPA-57248 (Yuki Aguilar) held until CASE-000647 is decided |
| Held | — | ||
| ACT-014092 | Outreach suppressed pending steward Outreach | CLM-426987 (Christine Hunter) held until CASE-000648 is decided |
| Held | — | ||
| ACT-014093 | Outreach suppressed pending steward Outreach | CLM-418741 (Ronald Long) held until CASE-000649 is decided |
| Held | — | ||
| ACT-014094 | Outreach suppressed pending steward Outreach | CLM-412365 (Steven Mason) held until CASE-000650 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.