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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-018471 | Care coordination outreach Next-best-action | Melissa Garratt: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018472 | Care coordination outreach Next-best-action | Brandon Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018473 | Care coordination outreach Next-best-action | Willie Munoz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018474 | Care coordination outreach Next-best-action | Marilyn King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018475 | Care coordination outreach Next-best-action | Henry Foster: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018476 | Care coordination outreach Next-best-action | Keith Larson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018477 | Care coordination outreach Next-best-action | Scott Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018478 | Care coordination outreach Next-best-action | Mason Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018479 | Care coordination outreach Next-best-action | Emily Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018480 | Care coordination outreach Next-best-action | Jessica Adams: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018481 | Care coordination outreach Next-best-action | Samuel Montgomery: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018482 | Care coordination outreach Next-best-action | Kyle Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018483 | Care coordination outreach Next-best-action | Daniel Jordan: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018484 | Care coordination outreach Next-best-action | Ronald Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018485 | Care coordination outreach Next-best-action | Donald Sullivan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018486 | Care coordination outreach Next-best-action | Elizabeth Myers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018487 | Care coordination outreach Next-best-action | Danielle Peterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018488 | Care coordination outreach Next-best-action | Scott Boyd: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018489 | Care coordination outreach Next-best-action | Juan Guerrero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018490 | Care coordination outreach Next-best-action | Hannah Ramos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018491 | Care coordination outreach Next-best-action | Noah Burns: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018492 | Care coordination outreach Next-best-action | Kayla Thompson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018493 | Care coordination outreach Next-best-action | Madison Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018494 | Care coordination outreach Next-best-action | Tyler Adams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018495 | Care coordination outreach Next-best-action | Raymond Wood: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018496 | Care coordination outreach Next-best-action | Natalie Wagner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018497 | Care coordination outreach Next-best-action | Charles Hoffman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018498 | Care coordination outreach Next-best-action | Jacob Schmidt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018499 | Care coordination outreach Next-best-action | Yuki Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018500 | Care coordination outreach Next-best-action | Kathleen Butler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018501 | Care coordination outreach Next-best-action | Evelyn Knight: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018502 | Care coordination outreach Next-best-action | Carolyn Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018503 | Care coordination outreach Next-best-action | Natalie Wallace: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018504 | Care coordination outreach Next-best-action | Samantha Olson: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018505 | Care coordination outreach Next-best-action | Elizabeth Freeman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018506 | Care coordination outreach Next-best-action | Jordan Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018507 | Care coordination outreach Next-best-action | Peter Mendoza: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018508 | Care coordination outreach Next-best-action | Mary Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018509 | Care coordination outreach Next-best-action | Harold Patterson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018510 | Care coordination outreach Next-best-action | Larry Singh: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018511 | Care coordination outreach Next-best-action | Jerry Rojas: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018512 | Care coordination outreach Next-best-action | Teresa Fisher: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018513 | Care coordination outreach Next-best-action | Theresa Gray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018514 | Care coordination outreach Next-best-action | Arjun Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018515 | Care coordination outreach Next-best-action | Charlotte Turner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018516 | Care coordination outreach Next-best-action | Barbara Hanson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018517 | Care coordination outreach Next-best-action | Susan Padilla: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018518 | Care coordination outreach Next-best-action | Omar Richardson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018519 | Care coordination outreach Next-best-action | Terry Butler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018520 | Care coordination outreach Next-best-action | Jordan Carr: 3 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.