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

TypeAllEligibility conflict resolved1,339Orphan claim re-pointed9,112Outreach address corrected2,993Outreach suppressed pending steward4,326Care coordination outreach1,815New member onboarding2,081Duplicate member record retired4,974
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-002090
Orphan claim re-pointed
Claims processor
CLM-422601 → UHC-15087-09 (Laura Morgan)
Member id
UHC-15087-09
Confidence
1
Method
probabilistic
MBR-043967CLM-422601
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002091
Orphan claim re-pointed
Claims processor
CLM-420192 → UHC-77831-87 (Wei Miller)
Member id
UHC-77831-87
Confidence
1
Method
probabilistic
MBR-013785CLM-420192
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002092
Orphan claim re-pointed
Claims processor
CLM-424587 → UHC-98712-15 (Janice Jordan)
Member id
UHC-98712-15
Confidence
1
Method
probabilistic
MBR-008058CLM-424587
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002093
Orphan claim re-pointed
Claims processor
CLM-425889 → UHC-90277-38 (Randy Edwards)
Member id
UHC-90277-38
Confidence
0.99
Method
probabilistic
MBR-013522CLM-425889
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002094
Orphan claim re-pointed
Claims processor
CLM-423571 → UHC-05661-59 (Megan Perez)
Member id
UHC-05661-59
Confidence
1
Method
probabilistic
MBR-043414CLM-423571
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002095
Orphan claim re-pointed
Claims processor
CLM-408319 → UHC-98853-73 (Ray McDonald)
Member id
UHC-98853-73
Confidence
1
Method
probabilistic
MBR-039325CLM-408319
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002096
Orphan claim re-pointed
Claims processor
CLM-413034 → UHC-41092-13 (Christian Hernanez)
Member id
UHC-41092-13
Confidence
0.99
Method
probabilistic
MBR-014601CLM-413034
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002097
Orphan claim re-pointed
Claims processor
CLM-402801 → UHC-54038-88 (Emily Walker)
Member id
UHC-54038-88
Confidence
1
Method
probabilistic
MBR-019596CLM-402801
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002098
Orphan claim re-pointed
Claims processor
CLM-421006 → UHC-42579-42 (Adam McDonald)
Member id
UHC-42579-42
Confidence
0.97
Method
deterministic
MBR-012494CLM-421006
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002099
Orphan claim re-pointed
Claims processor
CLM-412239 → UHC-04157-39 (Julie Lewis)
Member id
UHC-04157-39
Confidence
1
Method
probabilistic
MBR-011161CLM-412239
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002100
Orphan claim re-pointed
Claims processor
CLM-425870 → UHC-86154-31 (Kathleen Jacobs)
Member id
UHC-86154-31
Confidence
0.97
Method
deterministic
MBR-007114CLM-425870
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002101
Orphan claim re-pointed
Claims processor
CLM-408573 → UHC-47319-74 (Isabella Vargas)
Member id
UHC-47319-74
Confidence
1
Method
probabilistic
MBR-022820CLM-408573
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002102
Orphan claim re-pointed
Claims processor
CLM-412910 → UHC-42487-14 (Virginia Foster)
Member id
UHC-42487-14
Confidence
1
Method
probabilistic
MBR-005878CLM-412910
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002103
Orphan claim re-pointed
Claims processor
CLM-404650 → UHC-26313-34 (Nicole Smis)
Member id
UHC-26313-34
Confidence
0.97
Method
deterministic
MBR-011201CLM-404650
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002104
Orphan claim re-pointed
Claims processor
CLM-415960 → UHC-36287-89 (Marilyn Walker)
Member id
UHC-36287-89
Confidence
1
Method
probabilistic
MBR-027840CLM-415960
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002105
Orphan claim re-pointed
Claims processor
CLM-400976 → UHC-33259-01 (Sean Hunter)
Member id
UHC-33259-01
Confidence
0.94
Method
probabilistic
MBR-041404CLM-400976
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002106
Orphan claim re-pointed
Claims processor
CLM-416466 → UHC-05477-22 (Joyce Hunt)
Member id
UHC-05477-22
Confidence
0.99
Method
probabilistic
MBR-015471CLM-416466
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002107
Orphan claim re-pointed
Claims processor
CLM-417055 → UHC-69187-33 (Timothy Nichols)
Member id
UHC-69187-33
Confidence
1
Method
probabilistic
MBR-037786CLM-417055
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002108
Orphan claim re-pointed
Claims processor
CLM-426565 → UHC-32035-80 (Alan Holmes)
Member id
UHC-32035-80
Confidence
0.99
Method
probabilistic
MBR-043746CLM-426565
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002109
Orphan claim re-pointed
Claims processor
CLM-407754 → UHC-43635-68 (Albert Ortiz)
Member id
UHC-43635-68
Confidence
0.97
Method
deterministic
MBR-020088CLM-407754
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002110
Orphan claim re-pointed
Claims processor
CLM-401977 → UHC-14808-33 (Charles Jackson)
Member id
UHC-14808-33
Confidence
1
Method
probabilistic
MBR-020126CLM-401977
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002111
Orphan claim re-pointed
Claims processor
CLM-420007 → UHC-19955-99 (Patricia Dixon)
Member id
UHC-19955-99
Confidence
1
Method
probabilistic
MBR-002689CLM-420007
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002112
Orphan claim re-pointed
Claims processor
CLM-415045 → UHC-05367-86 (Carolyn Bennett)
Member id
UHC-05367-86
Confidence
1
Method
probabilistic
MBR-003500CLM-415045
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002113
Orphan claim re-pointed
Claims processor
CLM-408242 → UHC-40407-79 (Doris Dunn)
Member id
UHC-40407-79
Confidence
1
Method
probabilistic
MBR-020260CLM-408242
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002114
Orphan claim re-pointed
Claims processor
CLM-429747 → UHC-18434-28 (Lauren Franklin)
Member id
UHC-18434-28
Confidence
0.97
Method
deterministic
MBR-022382CLM-429747
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002115
Orphan claim re-pointed
Claims processor
CLM-423424 → UHC-98614-28 (Elijah Shaw)
Member id
UHC-98614-28
Confidence
1
Method
probabilistic
MBR-005135CLM-423424
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002116
Orphan claim re-pointed
Claims processor
CLM-406239 → UHC-47679-95 (Sharon Kelly)
Member id
UHC-47679-95
Confidence
0.97
Method
deterministic
MBR-014170CLM-406239
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002117
Orphan claim re-pointed
Claims processor
CLM-401148 → UHC-11161-09 (Victoria Wilson)
Member id
UHC-11161-09
Confidence
1
Method
probabilistic
MBR-012110CLM-401148
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002118
Orphan claim re-pointed
Claims processor
CLM-428747 → UHC-37323-32 (Peter Perry)
Member id
UHC-37323-32
Confidence
1
Method
probabilistic
MBR-000300CLM-428747
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002119
Orphan claim re-pointed
Claims processor
CLM-431705 → UHC-56875-41 (Christine Wallace)
Member id
UHC-56875-41
Confidence
1
Method
probabilistic
MBR-000404CLM-431705
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002120
Orphan claim re-pointed
Claims processor
CLM-422215 → UHC-02831-95 (Yuki Smith)
Member id
UHC-02831-95
Confidence
0.97
Method
deterministic
MBR-001267CLM-422215
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002121
Orphan claim re-pointed
Claims processor
CLM-411349 → UHC-31410-22 (Alexander Ray)
Member id
UHC-31410-22
Confidence
1
Method
probabilistic
MBR-003327CLM-411349
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002122
Orphan claim re-pointed
Claims processor
CLM-428028 → UHC-86087-23 (Benjamin Simmons)
Member id
UHC-86087-23
Confidence
1
Method
probabilistic
MBR-003452CLM-428028
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002123
Orphan claim re-pointed
Claims processor
CLM-429598 → UHC-20820-88 (Mary Taylor)
Member id
UHC-20820-88
Confidence
1
Method
probabilistic
MBR-003894CLM-429598
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002124
Orphan claim re-pointed
Claims processor
CLM-412229 → UHC-91956-26 (Yuki King)
Member id
UHC-91956-26
Confidence
1
Method
probabilistic
MBR-002132CLM-412229
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002125
Orphan claim re-pointed
Claims processor
CLM-431927 → UHC-04180-39 (Isabella White)
Member id
UHC-04180-39
Confidence
1
Method
probabilistic
MBR-015535CLM-431927
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002126
Orphan claim re-pointed
Claims processor
CLM-408083 → UHC-10379-19 (Randy Wood)
Member id
UHC-10379-19
Confidence
0.94
Method
probabilistic
MBR-044747CLM-408083
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002127
Orphan claim re-pointed
Claims processor
CLM-415821 → UHC-64116-48 (Jeremy Duncan)
Member id
UHC-64116-48
Confidence
1
Method
probabilistic
MBR-007080CLM-415821
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002128
Orphan claim re-pointed
Claims processor
CLM-419972 → UHC-47074-60 (Bobby Murphy)
Member id
UHC-47074-60
Confidence
1
Method
probabilistic
MBR-017715CLM-419972
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002129
Orphan claim re-pointed
Claims processor
CLM-410254 → UHC-10287-51 (Frank Carter)
Member id
UHC-10287-51
Confidence
0.98
Method
probabilistic
MBR-011751CLM-410254
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002130
Orphan claim re-pointed
Claims processor
CLM-403534 → UHC-30904-19 (Kevin Turner)
Member id
UHC-30904-19
Confidence
1
Method
probabilistic
MBR-033571CLM-403534
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002131
Orphan claim re-pointed
Claims processor
CLM-413447 → UHC-15252-88 (Emily Sanders)
Member id
UHC-15252-88
Confidence
0.99
Method
probabilistic
MBR-017977CLM-413447
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002132
Orphan claim re-pointed
Claims processor
CLM-422898 → UHC-30425-67 (Betty Gardner)
Member id
UHC-30425-67
Confidence
1
Method
probabilistic
MBR-014784CLM-422898
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002133
Orphan claim re-pointed
Claims processor
CLM-410337 → UHC-62319-26 (Evelyn McDonald)
Member id
UHC-62319-26
Confidence
1
Method
probabilistic
MBR-015345CLM-410337
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002134
Orphan claim re-pointed
Claims processor
CLM-401594 → UHC-17637-46 (Timothy Arnold)
Member id
UHC-17637-46
Confidence
0.97
Method
deterministic
MBR-017903CLM-401594
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002135
Orphan claim re-pointed
Claims processor
CLM-405284 → UHC-05707-46 (Laura Davis)
Member id
UHC-05707-46
Confidence
1
Method
probabilistic
MBR-029366CLM-405284
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002136
Orphan claim re-pointed
Claims processor
CLM-418683 → UHC-35354-11 (William Reid)
Member id
UHC-35354-11
Confidence
0.97
Method
deterministic
MBR-002171CLM-418683
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002137
Orphan claim re-pointed
Claims processor
CLM-429426 → UHC-77088-92 (Gregory Roberts)
Member id
UHC-77088-92
Confidence
1
Method
probabilistic
MBR-015834CLM-429426
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002138
Orphan claim re-pointed
Claims processor
CLM-426237 → UHC-28109-74 (Burce Moore)
Member id
UHC-28109-74
Confidence
0.99
Method
probabilistic
MBR-031631CLM-426237
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002139
Orphan claim re-pointed
Claims processor
CLM-431180 → UHC-58544-19 (Carolyn George)
Member id
UHC-58544-19
Confidence
1
Method
probabilistic
MBR-015520CLM-431180
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 16 of 282PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 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. 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. 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. 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. 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. 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. 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.