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-014195 | Outreach suppressed pending steward Outreach | TPA-54459 (Charles Rice) held until CASE-000751 is decided |
| Held | — | ||
| ACT-014196 | Outreach suppressed pending steward Outreach | PRV-21623 (Omar Richardson) held until CASE-000752 is decided |
| Held | — | ||
| ACT-014197 | Outreach suppressed pending steward Outreach | CLM-424242 (Lawrence Richards) held until CASE-000753 is decided |
| Held | — | ||
| ACT-014198 | Outreach suppressed pending steward Outreach | CLM-432474 (Juan Snyder) held until CASE-000754 is decided |
| Held | — | ||
| ACT-014199 | Outreach suppressed pending steward Outreach | ENR-123868 (Sarah Knight) held until CASE-000755 is decided |
| Held | — | ||
| ACT-014200 | Outreach suppressed pending steward Outreach | TPA-58020 (Sarah Knight) held until CASE-000756 is decided |
| Held | — | ||
| ACT-014201 | Outreach suppressed pending steward Outreach | CLM-404282 (Aisha Fowler) held until CASE-000757 is decided |
| Held | — | ||
| ACT-014202 | Outreach suppressed pending steward Outreach | CLM-404281 (Aisha Fowler) held until CASE-000758 is decided |
| Held | — | ||
| ACT-014203 | Outreach suppressed pending steward Outreach | CLM-403630 (Harold Ward) held until CASE-000759 is decided |
| Held | — | ||
| ACT-014204 | Outreach suppressed pending steward Outreach | TPA-51571 (Harold Ward) held until CASE-000760 is decided |
| Held | — | ||
| ACT-014205 | Outreach suppressed pending steward Outreach | PRV-24476 (Steven Banks) held until CASE-000761 is decided |
| Held | — | ||
| ACT-014206 | Outreach suppressed pending steward Outreach | ENR-120030 (Steven Banks) held until CASE-000762 is decided |
| Held | — | ||
| ACT-014207 | Outreach suppressed pending steward Outreach | TPA-62423 (Christopher Wells) held until CASE-000763 is decided |
| Held | — | ||
| ACT-014208 | Outreach suppressed pending steward Outreach | CLM-427621 (Jose Bradley) held until CASE-000764 is decided |
| Held | — | ||
| ACT-014209 | Outreach suppressed pending steward Outreach | ENR-121138 (Linda Robinson) held until CASE-000765 is decided |
| Held | — | ||
| ACT-014210 | Outreach suppressed pending steward Outreach | TPA-57031 (Linda Robinson) held until CASE-000766 is decided |
| Held | — | ||
| ACT-014211 | Outreach suppressed pending steward Outreach | CLM-430187 (Ronald Thomas) held until CASE-000767 is decided |
| Held | — | ||
| ACT-014212 | Outreach suppressed pending steward Outreach | ENR-129552 (Susan Gray) held until CASE-000768 is decided |
| Held | — | ||
| ACT-014213 | Outreach suppressed pending steward Outreach | TPA-59910 (Susan Gray) held until CASE-000769 is decided |
| Held | — | ||
| ACT-014214 | Outreach suppressed pending steward Outreach | CLM-403128 (Charlotte Gray) held until CASE-000770 is decided |
| Held | — | ||
| ACT-014215 | Outreach suppressed pending steward Outreach | ENR-104050 (Charlotte Gray) held until CASE-000771 is decided |
| Held | — | ||
| ACT-014216 | Outreach suppressed pending steward Outreach | TPA-51224 (Olivia Chpman) held until CASE-000772 is decided |
| Held | — | ||
| ACT-014217 | Outreach suppressed pending steward Outreach | CLM-425762 (Gerald Cook) held until CASE-000773 is decided |
| Held | — | ||
| ACT-014218 | Outreach suppressed pending steward Outreach | ENR-133689 (Gerald Cook) held until CASE-000774 is decided |
| Held | — | ||
| ACT-014219 | Outreach suppressed pending steward Outreach | CLM-405061 (Michelle Smith) held until CASE-000775 is decided |
| Held | — | ||
| ACT-014220 | Outreach suppressed pending steward Outreach | CLM-421101 (Ryan Li) held until CASE-000776 is decided |
| Held | — | ||
| ACT-014221 | Outreach suppressed pending steward Outreach | TPA-62449 (Kevin Matthews) held until CASE-000777 is decided |
| Held | — | ||
| ACT-014222 | Outreach suppressed pending steward Outreach | TPA-58435 (Jack Jenkins) held until CASE-000778 is decided |
| Held | — | ||
| ACT-014223 | Outreach suppressed pending steward Outreach | CLM-419026 (Jack Jenkins) held until CASE-000779 is decided |
| Held | — | ||
| ACT-014224 | Outreach suppressed pending steward Outreach | CLM-406421 (Christine Reid) held until CASE-000780 is decided |
| Held | — | ||
| ACT-014225 | Outreach suppressed pending steward Outreach | ENR-108431 (Christine Reid) held until CASE-000781 is decided |
| Held | — | ||
| ACT-014226 | Outreach suppressed pending steward Outreach | ENR-108670 (Pamela Lawrence) held until CASE-000782 is decided |
| Held | — | ||
| ACT-014227 | Outreach suppressed pending steward Outreach | TPA-52917 (Pamela Lawrence) held until CASE-000783 is decided |
| Held | — | ||
| ACT-014228 | Outreach suppressed pending steward Outreach | TPA-57866 (Aisha Nguyen) held until CASE-000784 is decided |
| Held | — | ||
| ACT-014229 | Outreach suppressed pending steward Outreach | CLM-408568 (Vincent Pena) held until CASE-000785 is decided |
| Held | — | ||
| ACT-014230 | Outreach suppressed pending steward Outreach | CLM-406711 (Jess Johnson) held until CASE-000786 is decided |
| Held | — | ||
| ACT-014231 | Outreach suppressed pending steward Outreach | CLM-411535 (Kenneth Santos) held until CASE-000787 is decided |
| Held | — | ||
| ACT-014232 | Outreach suppressed pending steward Outreach | PRV-26998 (Jacqueline Wang) held until CASE-000788 is decided |
| Held | — | ||
| ACT-014233 | Outreach suppressed pending steward Outreach | ENR-131058 (Jacqueline Wang) held until CASE-000789 is decided |
| Held | — | ||
| ACT-014234 | Outreach suppressed pending steward Outreach | TPA-59300 (Scott Rogers) held until CASE-000790 is decided |
| Held | — | ||
| ACT-014235 | Outreach suppressed pending steward Outreach | TPA-56752 (Sophia Williamson) held until CASE-000791 is decided |
| Held | — | ||
| ACT-014236 | Outreach suppressed pending steward Outreach | CLM-430880 (Sophia Williamson) held until CASE-000792 is decided |
| Held | — | ||
| ACT-014237 | Outreach suppressed pending steward Outreach | PRV-23839 (Jordan Elliott) held until CASE-000793 is decided |
| Held | — | ||
| ACT-014238 | Outreach suppressed pending steward Outreach | CLM-413220 (Jordan Elliott) held until CASE-000794 is decided |
| Held | — | ||
| ACT-014239 | Outreach suppressed pending steward Outreach | TPA-53361 (Jose Munoz) held until CASE-000795 is decided |
| Held | — | ||
| ACT-014240 | Outreach suppressed pending steward Outreach | TPA-53360 (Jose Munoz) held until CASE-000796 is decided |
| Held | — | ||
| ACT-014241 | Outreach suppressed pending steward Outreach | ENR-110066 (Jose Munoz) held until CASE-000797 is decided |
| Held | — | ||
| ACT-014242 | Outreach suppressed pending steward Outreach | TPA-64172 (Jesse Coleman) held until CASE-000798 is decided |
| Held | — | ||
| ACT-014243 | Outreach suppressed pending steward Outreach | TPA-54252 (Mei Johnson) held until CASE-000799 is decided |
| Held | — | ||
| ACT-014244 | Outreach suppressed pending steward Outreach | TPA-64229 (Danielle Herrera) held until CASE-000800 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.