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
Outreach suppressed pending steward, Outreach, 0 proposed
| 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.