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-014095 | Outreach suppressed pending steward Outreach | TPA-58463 (Jacob Espinoza) held until CASE-000651 is decided |
| Held | — | ||
| ACT-014096 | Outreach suppressed pending steward Outreach | ENR-122608 (Joe Graham) held until CASE-000652 is decided |
| Held | — | ||
| ACT-014097 | Outreach suppressed pending steward Outreach | CLM-417171 (Joe Graham) held until CASE-000653 is decided |
| Held | — | ||
| ACT-014098 | Outreach suppressed pending steward Outreach | TPA-57284 (Deborah Price) held until CASE-000654 is decided |
| Held | — | ||
| ACT-014099 | Outreach suppressed pending steward Outreach | ENR-139265 (Ann Davis) held until CASE-000655 is decided |
| Held | — | ||
| ACT-014100 | Outreach suppressed pending steward Outreach | CLM-429956 (Ann Davis) held until CASE-000656 is decided |
| Held | — | ||
| ACT-014101 | Outreach suppressed pending steward Outreach | TPA-57369 (Jsoeph Stephens) held until CASE-000657 is decided |
| Held | — | ||
| ACT-014102 | Outreach suppressed pending steward Outreach | ENR-121978 (Joseph Stephens) held until CASE-000658 is decided |
| Held | — | ||
| ACT-014103 | Outreach suppressed pending steward Outreach | TPA-57338 (Kevin Harvey) held until CASE-000659 is decided |
| Held | — | ||
| ACT-014104 | Outreach suppressed pending steward Outreach | TPA-52423 (Theresa Harvey) held until CASE-000660 is decided |
| Held | — | ||
| ACT-014105 | Outreach suppressed pending steward Outreach | TPA-60417 (Mason Vasquez) held until CASE-000661 is decided |
| Held | — | ||
| ACT-014106 | Outreach suppressed pending steward Outreach | CLM-400439 (Juan Castro) held until CASE-000662 is decided |
| Held | — | ||
| ACT-014107 | Outreach suppressed pending steward Outreach | CLM-430329 (Ashley Hunter) held until CASE-000663 is decided |
| Held | — | ||
| ACT-014108 | Outreach suppressed pending steward Outreach | CLM-415561 (Olivia Perez) held until CASE-000664 is decided |
| Held | — | ||
| ACT-014109 | Outreach suppressed pending steward Outreach | PRV-27753 (Cheryl Perz) held until CASE-000665 is decided |
| Held | — | ||
| ACT-014110 | Outreach suppressed pending steward Outreach | CLM-424067 (Patricia Russ) held until CASE-000666 is decided |
| Held | — | ||
| ACT-014111 | Outreach suppressed pending steward Outreach | CLM-408534 (Billy Rice) held until CASE-000667 is decided |
| Held | — | ||
| ACT-014112 | Outreach suppressed pending steward Outreach | TPA-53751 (Billy Rice) held until CASE-000668 is decided |
| Held | — | ||
| ACT-014113 | Outreach suppressed pending steward Outreach | TPA-60875 (Helen Welch) held until CASE-000669 is decided |
| Held | — | ||
| ACT-014114 | Outreach suppressed pending steward Outreach | TPA-59630 (Sandra Stevens) held until CASE-000670 is decided |
| Held | — | ||
| ACT-014115 | Outreach suppressed pending steward Outreach | CLM-410190 (Gabriel Ward) held until CASE-000671 is decided |
| Held | — | ||
| ACT-014116 | Outreach suppressed pending steward Outreach | PRV-22957 (Gabriel Ward) held until CASE-000672 is decided |
| Held | — | ||
| ACT-014117 | Outreach suppressed pending steward Outreach | CLM-427063 (Angela Ellis) held until CASE-000673 is decided |
| Held | — | ||
| ACT-014118 | Outreach suppressed pending steward Outreach | TPA-50787 (Diane Lopez) held until CASE-000674 is decided |
| Held | — | ||
| ACT-014119 | Outreach suppressed pending steward Outreach | CLM-412231 (Jennifer Le) held until CASE-000675 is decided |
| Held | — | ||
| ACT-014120 | Outreach suppressed pending steward Outreach | TPA-55388 (Jennifer Le) held until CASE-000676 is decided |
| Held | — | ||
| ACT-014121 | Outreach suppressed pending steward Outreach | CLM-419599 (Carolyn Gordon) held until CASE-000677 is decided |
| Held | — | ||
| ACT-014122 | Outreach suppressed pending steward Outreach | CLM-410862 (Rachel Porter) held until CASE-000678 is decided |
| Held | — | ||
| ACT-014123 | Outreach suppressed pending steward Outreach | TPA-56091 (Katherine Porter) held until CASE-000679 is decided |
| Held | — | ||
| ACT-014124 | Outreach suppressed pending steward Outreach | CLM-428591 (Kayla Vazquez) held until CASE-000680 is decided |
| Held | — | ||
| ACT-014125 | Outreach suppressed pending steward Outreach | PRV-28311 (Deborah Bishop) held until CASE-000681 is decided |
| Held | — | ||
| ACT-014126 | Outreach suppressed pending steward Outreach | ENR-137167 (Deborah Bisshop) held until CASE-000682 is decided |
| Held | — | ||
| ACT-014127 | Outreach suppressed pending steward Outreach | CLM-412237 (Yuki Boyd) held until CASE-000683 is decided |
| Held | — | ||
| ACT-014128 | Outreach suppressed pending steward Outreach | CLM-418766 (Tyler Vargas) held until CASE-000684 is decided |
| Held | — | ||
| ACT-014129 | Outreach suppressed pending steward Outreach | CLM-432821 (Margaret Patel) held until CASE-000685 is decided |
| Held | — | ||
| ACT-014130 | Outreach suppressed pending steward Outreach | TPA-51942 (Sandra Porter) held until CASE-000686 is decided |
| Held | — | ||
| ACT-014131 | Outreach suppressed pending steward Outreach | TPA-53792 (Lori Dominguez) held until CASE-000687 is decided |
| Held | — | ||
| ACT-014132 | Outreach suppressed pending steward Outreach | ENR-100679 (Judith Ortiz) held until CASE-000688 is decided |
| Held | — | ||
| ACT-014133 | Outreach suppressed pending steward Outreach | CLM-410712 (Mason Carter) held until CASE-000689 is decided |
| Held | — | ||
| ACT-014134 | Outreach suppressed pending steward Outreach | CLM-415176 (Andrew Snyder) held until CASE-000690 is decided |
| Held | — | ||
| ACT-014135 | Outreach suppressed pending steward Outreach | ENR-119996 (Andy Snyder) held until CASE-000691 is decided |
| Held | — | ||
| ACT-014136 | Outreach suppressed pending steward Outreach | PRV-28096 (Tyler Sanders) held until CASE-000692 is decided |
| Held | — | ||
| ACT-014137 | Outreach suppressed pending steward Outreach | CLM-431383 (Stephen Mason) held until CASE-000693 is decided |
| Held | — | ||
| ACT-014138 | Outreach suppressed pending steward Outreach | ENR-131444 (Niccole Mason) held until CASE-000694 is decided |
| Held | — | ||
| ACT-014139 | Outreach suppressed pending steward Outreach | CLM-424051 (Nicole Mason) held until CASE-000695 is decided |
| Held | — | ||
| ACT-014140 | Outreach suppressed pending steward Outreach | ENR-115067 (Marcus Armstrong) held until CASE-000696 is decided |
| Held | — | ||
| ACT-014141 | Outreach suppressed pending steward Outreach | CLM-411451 (Marcus Armstrong) held until CASE-000697 is decided |
| Held | — | ||
| ACT-014142 | Outreach suppressed pending steward Outreach | TPA-56573 (Omar Obrien) held until CASE-000698 is decided |
| Held | — | ||
| ACT-014143 | Outreach suppressed pending steward Outreach | ENR-119611 (Omar Obrien) held until CASE-000699 is decided |
| Held | — | ||
| ACT-014144 | Outreach suppressed pending steward Outreach | CLM-401562 (Omar Obrien) held until CASE-000700 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.