Action	Type	Title	Detail	Linked to	Status	Executed
ACT-000751	Eligibility conflict resolved Eligibility engine	Valentina Ramos: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-017696	Proposed	—
ACT-000752	Eligibility conflict resolved Eligibility engine	Angela Woods: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed MEDICARE-ADV-A, SELECT-EPO Rule survivorship: ENR plan wins	MBR-017728	Proposed	—
ACT-000753	Eligibility conflict resolved Eligibility engine	Jeremy Fernandez: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed OPTIONS-PPO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-017749	Proposed	—
ACT-000754	Eligibility conflict resolved Eligibility engine	George Brown: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-017757	Proposed	—
ACT-000755	Eligibility conflict resolved Eligibility engine	Kimberly Burns: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed NAVIGATE-HMO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-017792	Proposed	—
ACT-000756	Eligibility conflict resolved Eligibility engine	Alice Graham: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed NAVIGATE-HMO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-017821	Proposed	—
ACT-000757	Eligibility conflict resolved Eligibility engine	Logan Payne: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed NAVIGATE-HMO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-017837	Proposed	—
ACT-000758	Eligibility conflict resolved Eligibility engine	Megan Brown: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed MEDICARE-ADV-B, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-017912	Proposed	—
ACT-000759	Eligibility conflict resolved Eligibility engine	Betty Henderson: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed CORE-HMO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-017920	Proposed	—
ACT-000760	Eligibility conflict resolved Eligibility engine	Mark Perez: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-017921	Proposed	—
ACT-000761	Eligibility conflict resolved Eligibility engine	Carlos Scott: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018012	Proposed	—
ACT-000762	Eligibility conflict resolved Eligibility engine	Ralph Burns: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed CHOICE-PLUS-PPO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-018018	Proposed	—
ACT-000763	Eligibility conflict resolved Eligibility engine	Debra Mills: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed MEDICARE-ADV-A, CORE-HMO Rule survivorship: ENR plan wins	MBR-018029	Proposed	—
ACT-000764	Eligibility conflict resolved Eligibility engine	Lori Gibson: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed CHOICE-PLUS-PPO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-018071	Proposed	—
ACT-000765	Eligibility conflict resolved Eligibility engine	Elizabeth Ray: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed NAVIGATE-HMO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018083	Proposed	—
ACT-000766	Eligibility conflict resolved Eligibility engine	Jeffrey Griffin: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed NAVIGATE-HMO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018110	Proposed	—
ACT-000767	Eligibility conflict resolved Eligibility engine	Russell Powell: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed CHOICE-PLUS-PPO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018124	Proposed	—
ACT-000768	Eligibility conflict resolved Eligibility engine	Anthony Taylor: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed NAVIGATE-HMO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-018146	Proposed	—
ACT-000769	Eligibility conflict resolved Eligibility engine	Mark Johnson: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed OPTIONS-PPO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-018221	Proposed	—
ACT-000770	Eligibility conflict resolved Eligibility engine	Gabriel Reynolds: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-018259	Proposed	—
ACT-000771	Eligibility conflict resolved Eligibility engine	Sara Gordon: 2 plan codes across sources → canonical OPTIONS-PPO	Canonical plan OPTIONS-PPO Observed OPTIONS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-018284	Proposed	—
ACT-000772	Eligibility conflict resolved Eligibility engine	Ann Harris: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed MEDICARE-ADV-B, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018289	Proposed	—
ACT-000773	Eligibility conflict resolved Eligibility engine	David Yang: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed MEDICARE-ADV-B, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-018330	Proposed	—
ACT-000774	Eligibility conflict resolved Eligibility engine	Mason Munoz: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed OPTIONS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-018332	Proposed	—
ACT-000775	Eligibility conflict resolved Eligibility engine	James Crawford: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018336	Proposed	—
ACT-000776	Eligibility conflict resolved Eligibility engine	Kim Lee: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018341	Proposed	—
ACT-000777	Eligibility conflict resolved Eligibility engine	Ruth Jordan: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed SELECT-EPO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018347	Proposed	—
ACT-000778	Eligibility conflict resolved Eligibility engine	Bryan Burke: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-018355	Proposed	—
ACT-000779	Eligibility conflict resolved Eligibility engine	Victoria Hawkins: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed SELECT-EPO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018388	Proposed	—
ACT-000780	Eligibility conflict resolved Eligibility engine	Mason Marquez: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-018400	Proposed	—
ACT-000781	Eligibility conflict resolved Eligibility engine	Cynthia Kelley: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed MEDICARE-ADV-A, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-018413	Proposed	—
ACT-000782	Eligibility conflict resolved Eligibility engine	Beverly Schultz: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, MEDICARE-ADV-A Rule survivorship: ENR plan wins	MBR-018459	Proposed	—
ACT-000783	Eligibility conflict resolved Eligibility engine	Sandra Barnes: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed OPTIONS-PPO, CORE-HMO Rule survivorship: ENR plan wins	MBR-018491	Proposed	—
ACT-000784	Eligibility conflict resolved Eligibility engine	Katherine Walker: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, SELECT-EPO Rule survivorship: ENR plan wins	MBR-018498	Proposed	—
ACT-000785	Eligibility conflict resolved Eligibility engine	Dennis Moore: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-018500	Proposed	—
ACT-000786	Eligibility conflict resolved Eligibility engine	Sarah Bailey: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018504	Proposed	—
ACT-000787	Eligibility conflict resolved Eligibility engine	Eugene Henderson: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed SELECT-EPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-018526	Proposed	—
ACT-000788	Eligibility conflict resolved Eligibility engine	David Coleman: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, CORE-HMO Rule survivorship: ENR plan wins	MBR-018534	Proposed	—
ACT-000789	Eligibility conflict resolved Eligibility engine	Megan Gomez: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-018546	Proposed	—
ACT-000790	Eligibility conflict resolved Eligibility engine	Cheryl Vazquez: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed NAVIGATE-HMO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018548	Proposed	—
ACT-000791	Eligibility conflict resolved Eligibility engine	Daniel Marshall: 2 plan codes across sources → canonical NAVIGATE-HMO	Canonical plan NAVIGATE-HMO Observed SELECT-EPO, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-018603	Proposed	—
ACT-000792	Eligibility conflict resolved Eligibility engine	Rebecca Hart: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed CORE-HMO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018635	Proposed	—
ACT-000793	Eligibility conflict resolved Eligibility engine	Austin Palmer: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed SELECT-EPO, CHOICE-PLUS-PPO Rule survivorship: ENR plan wins	MBR-018640	Proposed	—
ACT-000794	Eligibility conflict resolved Eligibility engine	Martha Warren: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed SELECT-EPO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018669	Proposed	—
ACT-000795	Eligibility conflict resolved Eligibility engine	Joseph Day: 2 plan codes across sources → canonical SELECT-EPO	Canonical plan SELECT-EPO Observed SELECT-EPO, OPTIONS-PPO Rule survivorship: ENR plan wins	MBR-018685	Proposed	—
ACT-000796	Eligibility conflict resolved Eligibility engine	Cynthia Lucas: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, CORE-HMO Rule survivorship: ENR plan wins	MBR-018739	Proposed	—
ACT-000797	Eligibility conflict resolved Eligibility engine	Andrew Little: 2 plan codes across sources → canonical MEDICARE-ADV-A	Canonical plan MEDICARE-ADV-A Observed MEDICARE-ADV-A, CORE-HMO Rule survivorship: ENR plan wins	MBR-018752	Proposed	—
ACT-000798	Eligibility conflict resolved Eligibility engine	Joe Salazar: 2 plan codes across sources → canonical MEDICARE-ADV-B	Canonical plan MEDICARE-ADV-B Observed MEDICARE-ADV-B, NAVIGATE-HMO Rule survivorship: ENR plan wins	MBR-018795	Proposed	—
ACT-000799	Eligibility conflict resolved Eligibility engine	Jacqueline Garza: 2 plan codes across sources → canonical CORE-HMO	Canonical plan CORE-HMO Observed NAVIGATE-HMO, CORE-HMO Rule survivorship: ENR plan wins	MBR-018817	Proposed	—
ACT-000800	Eligibility conflict resolved Eligibility engine	Cheryl Padilla: 2 plan codes across sources → canonical CHOICE-PLUS-PPO	Canonical plan CHOICE-PLUS-PPO Observed CHOICE-PLUS-PPO, MEDICARE-ADV-B Rule survivorship: ENR plan wins	MBR-018839	Proposed	—

26,640 rows, page 16 of 533Previous Next

Derivation rules

Evaluated after every gold rebuild

1
Eligibility conflict resolved
The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
2
Orphan claim re-pointed
A 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.
3
Outreach address corrected
The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
4
Outreach suppressed pending steward
The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
5
Care coordination outreach
Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
6
New member onboarding
A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
7
Duplicate member record retired
Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.