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-018521 | Care coordination outreach Next-best-action | Raymond Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018522 | Care coordination outreach Next-best-action | Diane Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018523 | Care coordination outreach Next-best-action | Donna Perez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018524 | Care coordination outreach Next-best-action | Daniel Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018525 | Care coordination outreach Next-best-action | Brandon Torres: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018526 | Care coordination outreach Next-best-action | Larry Arnold: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018527 | Care coordination outreach Next-best-action | Sandra Hansen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018528 | Care coordination outreach Next-best-action | Keneth Schultz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018529 | Care coordination outreach Next-best-action | Kayla Lee: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018530 | Care coordination outreach Next-best-action | Danielle Martinez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018531 | Care coordination outreach Next-best-action | Sofia Kelley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018532 | Care coordination outreach Next-best-action | Julia Jackson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018533 | Care coordination outreach Next-best-action | Rachel Munoz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018534 | Care coordination outreach Next-best-action | Charles Hunter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018535 | Care coordination outreach Next-best-action | Rebecca Mitchell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018536 | Care coordination outreach Next-best-action | Michael Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018537 | Care coordination outreach Next-best-action | Linda Wood: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018538 | Care coordination outreach Next-best-action | Raymond Kim: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018539 | Care coordination outreach Next-best-action | Austin Franklin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018540 | Care coordination outreach Next-best-action | Eugene Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018541 | Care coordination outreach Next-best-action | Jacob Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018542 | Care coordination outreach Next-best-action | Tyler Weber: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018543 | Care coordination outreach Next-best-action | Christopher Young: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018544 | Care coordination outreach Next-best-action | Peter Walker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018545 | Care coordination outreach Next-best-action | Eric Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018546 | Care coordination outreach Next-best-action | Barbara Cox: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018547 | Care coordination outreach Next-best-action | Camila Hart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018548 | Care coordination outreach Next-best-action | Yuki Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018549 | Care coordination outreach Next-best-action | Joan Bennett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018550 | Care coordination outreach Next-best-action | Emma Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018551 | Care coordination outreach Next-best-action | Jonathan Brooks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018552 | Care coordination outreach Next-best-action | Nancy Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018553 | Care coordination outreach Next-best-action | Omar Ferguson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018554 | Care coordination outreach Next-best-action | Margaret Stone: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018555 | Care coordination outreach Next-best-action | Ronald Alvarado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018556 | Care coordination outreach Next-best-action | Jonathan Carlson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018557 | Care coordination outreach Next-best-action | John Hughes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018558 | Care coordination outreach Next-best-action | Dylan Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018559 | Care coordination outreach Next-best-action | Samuel Russell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018560 | Care coordination outreach Next-best-action | Victoria Schmidt: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018561 | Care coordination outreach Next-best-action | Deborah Henderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018562 | Care coordination outreach Next-best-action | Arthur Myers: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018563 | Care coordination outreach Next-best-action | Evelyn Williams: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018564 | Care coordination outreach Next-best-action | Donald Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018565 | Care coordination outreach Next-best-action | Nancy Munoz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018566 | Care coordination outreach Next-best-action | Frances Grant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018567 | Care coordination outreach Next-best-action | Douglas Nunez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018568 | Care coordination outreach Next-best-action | Michael Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018569 | Care coordination outreach Next-best-action | Maria Carlson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018570 | Care coordination outreach Next-best-action | Susan Alvarez: 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.