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-010090
Orphan claim re-pointed
Claims processor
CLM-420221 → UHC-19964-20 (Ruth Pierce)
Member id
UHC-19964-20
Confidence
1
Method
probabilistic
MBR-000562CLM-420221
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010091
Orphan claim re-pointed
Claims processor
CLM-402122 → UHC-55723-65 (Austin Cook)
Member id
UHC-55723-65
Confidence
0.97
Method
deterministic
MBR-027315CLM-402122
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010092
Orphan claim re-pointed
Claims processor
CLM-420568 → UHC-95252-31 (Willie Brooks)
Member id
UHC-95252-31
Confidence
0.97
Method
deterministic
MBR-025122CLM-420568
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010093
Orphan claim re-pointed
Claims processor
CLM-404676 → UHC-87798-97 (Sophia Hill)
Member id
UHC-87798-97
Confidence
1
Method
probabilistic
MBR-002649CLM-404676
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010094
Orphan claim re-pointed
Claims processor
CLM-421781 → UHC-52612-93 (Kyle Burns)
Member id
UHC-52612-93
Confidence
0.97
Method
deterministic
MBR-005752CLM-421781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010095
Orphan claim re-pointed
Claims processor
CLM-422899 → UHC-58787-64 (Joan Hayes)
Member id
UHC-58787-64
Confidence
1
Method
probabilistic
MBR-022506CLM-422899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010096
Orphan claim re-pointed
Claims processor
CLM-427783 → UHC-77814-68 (Shirley Vasquez)
Member id
UHC-77814-68
Confidence
1
Method
probabilistic
MBR-009452CLM-427783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010097
Orphan claim re-pointed
Claims processor
CLM-430386 → UHC-37220-34 (Donna Lawson)
Member id
UHC-37220-34
Confidence
1
Method
probabilistic
MBR-010620CLM-430386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010098
Orphan claim re-pointed
Claims processor
CLM-415185 → UHC-65203-16 (Carter Walter)
Member id
UHC-65203-16
Confidence
0.99
Method
probabilistic
MBR-024792CLM-415185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010099
Orphan claim re-pointed
Claims processor
CLM-421615 → UHC-93789-85 (Brandon Reed)
Member id
UHC-93789-85
Confidence
0.97
Method
deterministic
MBR-009386CLM-421615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010100
Orphan claim re-pointed
Claims processor
CLM-408470 → UHC-78437-15 (Alice Salazar)
Member id
UHC-78437-15
Confidence
0.98
Method
probabilistic
MBR-000314CLM-408470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010101
Orphan claim re-pointed
Claims processor
CLM-421557 → UHC-62097-19 (Donald Stewart)
Member id
UHC-62097-19
Confidence
1
Method
probabilistic
MBR-022474CLM-421557
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010102
Orphan claim re-pointed
Claims processor
CLM-407641 → UHC-00554-30 (Edward Brooks)
Member id
UHC-00554-30
Confidence
1
Method
probabilistic
MBR-010187CLM-407641
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010103
Orphan claim re-pointed
Claims processor
CLM-423008 → UHC-12628-50 (John Vasquez)
Member id
UHC-12628-50
Confidence
1
Method
probabilistic
MBR-015579CLM-423008
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010104
Orphan claim re-pointed
Claims processor
CLM-427524 → UHC-95781-13 (Judy Price)
Member id
UHC-95781-13
Confidence
0.97
Method
deterministic
MBR-014436CLM-427524
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010105
Orphan claim re-pointed
Claims processor
CLM-432612 → UHC-09081-77 (Jacob Espinoza)
Member id
UHC-09081-77
Confidence
0.99
Method
probabilistic
MBR-020844CLM-432612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010106
Orphan claim re-pointed
Claims processor
CLM-403164 → UHC-77752-86 (Diego Daniels)
Member id
UHC-77752-86
Confidence
1
Method
probabilistic
MBR-015065CLM-403164
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010107
Orphan claim re-pointed
Claims processor
CLM-416154 → UHC-03974-15 (Priya Welch)
Member id
UHC-03974-15
Confidence
0.99
Method
probabilistic
MBR-018793CLM-416154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010108
Orphan claim re-pointed
Claims processor
CLM-419798 → UHC-71226-29 (Tyler Rice)
Member id
UHC-71226-29
Confidence
1
Method
probabilistic
MBR-019015CLM-419798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010109
Orphan claim re-pointed
Claims processor
CLM-406221 → UHC-81705-08 (Bowman Emma)
Member id
UHC-81705-08
Confidence
1
Method
probabilistic
MBR-024061CLM-406221
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010110
Orphan claim re-pointed
Claims processor
CLM-404803 → UHC-90669-86 (Kyle Romero)
Member id
UHC-90669-86
Confidence
1
Method
probabilistic
MBR-000730CLM-404803
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010111
Orphan claim re-pointed
Claims processor
CLM-402390 → UHC-16663-51 (Linda Ryan)
Member id
UHC-16663-51
Confidence
1
Method
probabilistic
MBR-033535CLM-402390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010112
Orphan claim re-pointed
Claims processor
CLM-415201 → UHC-92691-05 (Emily Contreras)
Member id
UHC-92691-05
Confidence
1
Method
probabilistic
MBR-025767CLM-415201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010113
Orphan claim re-pointed
Claims processor
CLM-419147 → UHC-60348-01 (Samuel Patterson)
Member id
UHC-60348-01
Confidence
0.97
Method
deterministic
MBR-020807CLM-419147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010114
Orphan claim re-pointed
Claims processor
CLM-430104 → UHC-16792-90 (Carol Warren)
Member id
UHC-16792-90
Confidence
1
Method
probabilistic
MBR-038320CLM-430104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010115
Orphan claim re-pointed
Claims processor
CLM-404137 → UHC-32490-35 (Dylan Webb)
Member id
UHC-32490-35
Confidence
1
Method
probabilistic
MBR-008846CLM-404137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010116
Orphan claim re-pointed
Claims processor
CLM-423342 → UHC-54680-35 (Amy Castro)
Member id
UHC-54680-35
Confidence
1
Method
probabilistic
MBR-019862CLM-423342
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010117
Orphan claim re-pointed
Claims processor
CLM-418401 → UHC-00083-62 (Philip Johnson)
Member id
UHC-00083-62
Confidence
0.99
Method
probabilistic
MBR-027895CLM-418401
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010118
Orphan claim re-pointed
Claims processor
CLM-409963 → UHC-60191-91 (Ethan Hill)
Member id
UHC-60191-91
Confidence
1
Method
probabilistic
MBR-011888CLM-409963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010119
Orphan claim re-pointed
Claims processor
CLM-412594 → UHC-35218-06 (Natalie Nelson)
Member id
UHC-35218-06
Confidence
1
Method
probabilistic
MBR-013986CLM-412594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010120
Orphan claim re-pointed
Claims processor
CLM-405561 → UHC-15971-03 (Catherine Oliver)
Member id
UHC-15971-03
Confidence
0.97
Method
deterministic
MBR-018626CLM-405561
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010121
Orphan claim re-pointed
Claims processor
CLM-418948 → UHC-73374-01 (Sandra White)
Member id
UHC-73374-01
Confidence
1
Method
probabilistic
MBR-000887CLM-418948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010122
Orphan claim re-pointed
Claims processor
CLM-411639 → UHC-48356-13 (Anna Dominguez)
Member id
UHC-48356-13
Confidence
0.94
Method
probabilistic
MBR-038920CLM-411639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010123
Orphan claim re-pointed
Claims processor
CLM-424083 → UHC-88017-51 (Wei Austin)
Member id
UHC-88017-51
Confidence
1
Method
probabilistic
MBR-020256CLM-424083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010124
Orphan claim re-pointed
Claims processor
CLM-431512 → UHC-96067-72 (Lisa Castro)
Member id
UHC-96067-72
Confidence
0.97
Method
deterministic
MBR-010821CLM-431512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010125
Orphan claim re-pointed
Claims processor
CLM-410981 → UHC-25847-76 (Katherine Burns)
Member id
UHC-25847-76
Confidence
0.93
Method
probabilistic
MBR-015259CLM-410981
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010126
Orphan claim re-pointed
Claims processor
CLM-421742 → UHC-43583-77 (Donald Fowler)
Member id
UHC-43583-77
Confidence
0.99
Method
probabilistic
MBR-010634CLM-421742
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010127
Orphan claim re-pointed
Claims processor
CLM-429803 → UHC-92291-18 (Paul Williams)
Member id
UHC-92291-18
Confidence
1
Method
probabilistic
MBR-003468CLM-429803
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010128
Orphan claim re-pointed
Claims processor
CLM-417043 → UHC-10345-15 (Gabriel Perkins)
Member id
UHC-10345-15
Confidence
1
Method
probabilistic
MBR-028926CLM-417043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010129
Orphan claim re-pointed
Claims processor
CLM-410844 → UHC-10621-50 (Albert Santos)
Member id
UHC-10621-50
Confidence
1
Method
probabilistic
MBR-003295CLM-410844
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010130
Orphan claim re-pointed
Claims processor
CLM-421591 → UHC-69553-31 (Natalie Johnson)
Member id
UHC-69553-31
Confidence
1
Method
probabilistic
MBR-039030CLM-421591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010131
Orphan claim re-pointed
Claims processor
CLM-412615 → UHC-74094-52 (Roy Hart)
Member id
UHC-74094-52
Confidence
0.97
Method
deterministic
MBR-012068CLM-412615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010132
Orphan claim re-pointed
Claims processor
CLM-415781 → UHC-28641-73 (Jose James)
Member id
UHC-28641-73
Confidence
0.97
Method
deterministic
MBR-015004CLM-415781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010133
Orphan claim re-pointed
Claims processor
CLM-429973 → UHC-28149-36 (Judy Jensen)
Member id
UHC-28149-36
Confidence
1
Method
probabilistic
MBR-025836CLM-429973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010134
Orphan claim re-pointed
Claims processor
CLM-431429 → UHC-84241-56 (Wei Cooper)
Member id
UHC-84241-56
Confidence
1
Method
probabilistic
MBR-010333CLM-431429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010135
Orphan claim re-pointed
Claims processor
CLM-404681 → UHC-27159-72 (Kathleen Obrien)
Member id
UHC-27159-72
Confidence
1
Method
probabilistic
MBR-007184CLM-404681
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010136
Orphan claim re-pointed
Claims processor
CLM-430698 → UHC-95978-86 (Alan Bradley)
Member id
UHC-95978-86
Confidence
1
Method
probabilistic
MBR-042619CLM-430698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010137
Orphan claim re-pointed
Claims processor
CLM-428677 → UHC-56122-14 (Lauren Reid)
Member id
UHC-56122-14
Confidence
1
Method
probabilistic
MBR-033683CLM-428677
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010138
Orphan claim re-pointed
Claims processor
CLM-407991 → UHC-31120-14 (Samantha Nunez)
Member id
UHC-31120-14
Confidence
1
Method
probabilistic
MBR-008099CLM-407991
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010139
Orphan claim re-pointed
Claims processor
CLM-423676 → UHC-73574-97 (Brenda Allen)
Member id
UHC-73574-97
Confidence
1
Method
probabilistic
MBR-029108CLM-423676
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 176 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.