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-014145 | Outreach suppressed pending steward Outreach | CLM-407259 (Lucia Woods) held until CASE-000701 is decided |
| Held | — | ||
| ACT-014146 | Outreach suppressed pending steward Outreach | CLM-401039 (Willie Austin) held until CASE-000702 is decided |
| Held | — | ||
| ACT-014147 | Outreach suppressed pending steward Outreach | CLM-431978 (Jeffrey Grant) held until CASE-000703 is decided |
| Held | — | ||
| ACT-014148 | Outreach suppressed pending steward Outreach | TPA-64104 (Jeffrey Grant) held until CASE-000704 is decided |
| Held | — | ||
| ACT-014149 | Outreach suppressed pending steward Outreach | CLM-430489 (Lucia Welch) held until CASE-000705 is decided |
| Held | — | ||
| ACT-014150 | Outreach suppressed pending steward Outreach | TPA-62048 (Cheryl Pena) held until CASE-000706 is decided |
| Held | — | ||
| ACT-014151 | Outreach suppressed pending steward Outreach | TPA-52991 (Pat Hart) held until CASE-000707 is decided |
| Held | — | ||
| ACT-014152 | Outreach suppressed pending steward Outreach | TPA-53758 (William Hayes) held until CASE-000708 is decided |
| Held | — | ||
| ACT-014153 | Outreach suppressed pending steward Outreach | TPA-60807 (Joseph Owens) held until CASE-000709 is decided |
| Held | — | ||
| ACT-014154 | Outreach suppressed pending steward Outreach | PRV-24962 (Robert Vargas) held until CASE-000710 is decided |
| Held | — | ||
| ACT-014155 | Outreach suppressed pending steward Outreach | TPA-57365 (Robert Vargas) held until CASE-000711 is decided |
| Held | — | ||
| ACT-014156 | Outreach suppressed pending steward Outreach | TPA-59031 (Juan Thompson) held until CASE-000712 is decided |
| Held | — | ||
| ACT-014157 | Outreach suppressed pending steward Outreach | ENR-127030 (Juan Thompson) held until CASE-000713 is decided |
| Held | — | ||
| ACT-014158 | Outreach suppressed pending steward Outreach | CLM-401345 (Vincent Roberts) held until CASE-000714 is decided |
| Held | — | ||
| ACT-014159 | Outreach suppressed pending steward Outreach | TPA-51786 (Fatima Elliott) held until CASE-000715 is decided |
| Held | — | ||
| ACT-014160 | Outreach suppressed pending steward Outreach | CLM-407715 (Amy Elliott) held until CASE-000716 is decided |
| Held | — | ||
| ACT-014161 | Outreach suppressed pending steward Outreach | ENR-127287 (Joe Medina) held until CASE-000717 is decided |
| Held | — | ||
| ACT-014162 | Outreach suppressed pending steward Outreach | CLM-420755 (Joe Medina) held until CASE-000718 is decided |
| Held | — | ||
| ACT-014163 | Outreach suppressed pending steward Outreach | CLM-425424 (Babara Park) held until CASE-000719 is decided |
| Held | — | ||
| ACT-014164 | Outreach suppressed pending steward Outreach | TPA-58027 (Ahmed Adams) held until CASE-000720 is decided |
| Held | — | ||
| ACT-014165 | Outreach suppressed pending steward Outreach | TPA-58026 (Ahmed Adams) held until CASE-000721 is decided |
| Held | — | ||
| ACT-014166 | Outreach suppressed pending steward Outreach | CLM-407239 (Gerald Pierce) held until CASE-000722 is decided |
| Held | — | ||
| ACT-014167 | Outreach suppressed pending steward Outreach | CLM-407238 (Gerald Pierce) held until CASE-000723 is decided |
| Held | — | ||
| ACT-014168 | Outreach suppressed pending steward Outreach | TPA-59472 (Nathan Martinez) held until CASE-000724 is decided |
| Held | — | ||
| ACT-014169 | Outreach suppressed pending steward Outreach | TPA-50665 (Jean Bell) held until CASE-000725 is decided |
| Held | — | ||
| ACT-014170 | Outreach suppressed pending steward Outreach | TPA-54643 (Tyler Russsell) held until CASE-000726 is decided |
| Held | — | ||
| ACT-014171 | Outreach suppressed pending steward Outreach | ENR-131826 (Helen Hudson) held until CASE-000727 is decided |
| Held | — | ||
| ACT-014172 | Outreach suppressed pending steward Outreach | PRV-27173 (Helen Hudson) held until CASE-000728 is decided |
| Held | — | ||
| ACT-014173 | Outreach suppressed pending steward Outreach | CLM-414850 (Billy Rose) held until CASE-000729 is decided |
| Held | — | ||
| ACT-014174 | Outreach suppressed pending steward Outreach | ENR-119534 (Billy Rose) held until CASE-000730 is decided |
| Held | — | ||
| ACT-014175 | Outreach suppressed pending steward Outreach | ENR-141893 (Christina Ruiz) held until CASE-000731 is decided |
| Held | — | ||
| ACT-014176 | Outreach suppressed pending steward Outreach | TPA-64082 (Christina Ruiz) held until CASE-000732 is decided |
| Held | — | ||
| ACT-014177 | Outreach suppressed pending steward Outreach | CLM-405890 (Amber Rose) held until CASE-000733 is decided |
| Held | — | ||
| ACT-014178 | Outreach suppressed pending steward Outreach | CLM-405889 (Amber Rose) held until CASE-000734 is decided |
| Held | — | ||
| ACT-014179 | Outreach suppressed pending steward Outreach | TPA-55629 (Matthew Phillips) held until CASE-000735 is decided |
| Held | — | ||
| ACT-014180 | Outreach suppressed pending steward Outreach | ENR-141624 (Donald Willis) held until CASE-000736 is decided |
| Held | — | ||
| ACT-014181 | Outreach suppressed pending steward Outreach | CLM-419644 (Mason Wells) held until CASE-000737 is decided |
| Held | — | ||
| ACT-014182 | Outreach suppressed pending steward Outreach | PRV-25826 (Mason Wells) held until CASE-000738 is decided |
| Held | — | ||
| ACT-014183 | Outreach suppressed pending steward Outreach | TPA-61634 (Eugene Grant) held until CASE-000739 is decided |
| Held | — | ||
| ACT-014184 | Outreach suppressed pending steward Outreach | CLM-411345 (Terry Stephens) held until CASE-000740 is decided |
| Held | — | ||
| ACT-014185 | Outreach suppressed pending steward Outreach | CLM-405329 (Rachel Wong) held until CASE-000741 is decided |
| Held | — | ||
| ACT-014186 | Outreach suppressed pending steward Outreach | TPA-56201 (David Hernandez) held until CASE-000742 is decided |
| Held | — | ||
| ACT-014187 | Outreach suppressed pending steward Outreach | TPA-64267 (Olivia Richards) held until CASE-000743 is decided |
| Held | — | ||
| ACT-014188 | Outreach suppressed pending steward Outreach | ENR-119675 (Jonathan Delgado) held until CASE-000744 is decided |
| Held | — | ||
| ACT-014189 | Outreach suppressed pending steward Outreach | TPA-63340 (Judith Delgado) held until CASE-000745 is decided |
| Held | — | ||
| ACT-014190 | Outreach suppressed pending steward Outreach | CLM-408494 (Donna Allen) held until CASE-000746 is decided |
| Held | — | ||
| ACT-014191 | Outreach suppressed pending steward Outreach | CLM-404271 (Nancy Williams) held until CASE-000747 is decided |
| Held | — | ||
| ACT-014192 | Outreach suppressed pending steward Outreach | ENR-105618 (Nancy Williams) held until CASE-000748 is decided |
| Held | — | ||
| ACT-014193 | Outreach suppressed pending steward Outreach | ENR-108563 (Kevin Rice) held until CASE-000749 is decided |
| Held | — | ||
| ACT-014194 | Outreach suppressed pending steward Outreach | PRV-21918 (Kevvin Rice) held until CASE-000750 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.