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-010140
Orphan claim re-pointed
Claims processor
CLM-412532 → UHC-77548-67 (Karen Wagner)
Member id
UHC-77548-67
Confidence
1
Method
probabilistic
MBR-016170CLM-412532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010141
Orphan claim re-pointed
Claims processor
CLM-414774 → UHC-12054-22 (Frances White)
Member id
UHC-12054-22
Confidence
1
Method
probabilistic
MBR-025739CLM-414774
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010142
Orphan claim re-pointed
Claims processor
CLM-417127 → UHC-85213-42 (Jordan Carr)
Member id
UHC-85213-42
Confidence
1
Method
probabilistic
MBR-009693CLM-417127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010143
Orphan claim re-pointed
Claims processor
CLM-405610 → UHC-86916-41 (Larry Jackson)
Member id
UHC-86916-41
Confidence
1
Method
probabilistic
MBR-014093CLM-405610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010144
Orphan claim re-pointed
Claims processor
CLM-420627 → UHC-53668-61 (Aisha Nichols)
Member id
UHC-53668-61
Confidence
0.97
Method
deterministic
MBR-011184CLM-420627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010145
Orphan claim re-pointed
Claims processor
CLM-420436 → UHC-68921-36 (Brenda Adams)
Member id
UHC-68921-36
Confidence
1
Method
probabilistic
MBR-014397CLM-420436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010146
Orphan claim re-pointed
Claims processor
CLM-410412 → UHC-67569-91 (Teresa Myers)
Member id
UHC-67569-91
Confidence
1
Method
probabilistic
MBR-015023CLM-410412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010147
Orphan claim re-pointed
Claims processor
CLM-404496 → UHC-92949-91 (Heather Soto)
Member id
UHC-92949-91
Confidence
1
Method
probabilistic
MBR-020945CLM-404496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010148
Orphan claim re-pointed
Claims processor
CLM-415379 → UHC-54040-20 (Kyle Kennedy)
Member id
UHC-54040-20
Confidence
1
Method
probabilistic
MBR-000132CLM-415379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010149
Orphan claim re-pointed
Claims processor
CLM-400051 → UHC-53605-63 (Brenda Phillips)
Member id
UHC-53605-63
Confidence
1
Method
probabilistic
MBR-045060CLM-400051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010150
Orphan claim re-pointed
Claims processor
CLM-431300 → UHC-99875-36 (Danielle Boyd)
Member id
UHC-99875-36
Confidence
0.99
Method
probabilistic
MBR-022575CLM-431300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010151
Orphan claim re-pointed
Claims processor
CLM-430533 → UHC-52177-38 (Philip Stephens)
Member id
UHC-52177-38
Confidence
0.98
Method
probabilistic
MBR-012682CLM-430533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010152
Orphan claim re-pointed
Claims processor
CLM-430785 → UHC-50010-56 (Roger Marshall)
Member id
UHC-50010-56
Confidence
0.97
Method
deterministic
MBR-019661CLM-430785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010153
Orphan claim re-pointed
Claims processor
CLM-411666 → UHC-35708-48 (Heather Rodriguez)
Member id
UHC-35708-48
Confidence
1
Method
probabilistic
MBR-004986CLM-411666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010154
Orphan claim re-pointed
Claims processor
CLM-403861 → UHC-55706-27 (Lauren Taylor)
Member id
UHC-55706-27
Confidence
1
Method
probabilistic
MBR-018485CLM-403861
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010155
Orphan claim re-pointed
Claims processor
CLM-421214 → UHC-05678-36 (Alexis Payne)
Member id
UHC-05678-36
Confidence
0.99
Method
probabilistic
MBR-018595CLM-421214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010156
Orphan claim re-pointed
Claims processor
CLM-427531 → UHC-79816-41 (Virginia Wheeler)
Member id
UHC-79816-41
Confidence
1
Method
probabilistic
MBR-008856CLM-427531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010157
Orphan claim re-pointed
Claims processor
CLM-403222 → UHC-58145-97 (Heather Crawford)
Member id
UHC-58145-97
Confidence
1
Method
probabilistic
MBR-023378CLM-403222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010158
Orphan claim re-pointed
Claims processor
CLM-405811 → UHC-60245-45 (Nancy Delgado)
Member id
UHC-60245-45
Confidence
0.99
Method
probabilistic
MBR-018973CLM-405811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010159
Orphan claim re-pointed
Claims processor
CLM-400196 → UHC-31553-52 (Andrea Mendoza)
Member id
UHC-31553-52
Confidence
0.91
Method
probabilistic
MBR-027157CLM-400196
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010160
Orphan claim re-pointed
Claims processor
CLM-412616 → UHC-32520-63 (Donald Dunn)
Member id
UHC-32520-63
Confidence
1
Method
probabilistic
MBR-012591CLM-412616
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010161
Orphan claim re-pointed
Claims processor
CLM-406589 → UHC-93344-27 (Mateo Castro)
Member id
UHC-93344-27
Confidence
1
Method
probabilistic
MBR-015230CLM-406589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010162
Orphan claim re-pointed
Claims processor
CLM-402817 → UHC-47186-94 (Victoria Weber)
Member id
UHC-47186-94
Confidence
1
Method
probabilistic
MBR-021358CLM-402817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010163
Orphan claim re-pointed
Claims processor
CLM-406398 → UHC-53305-41 (Gloria Elliott)
Member id
UHC-53305-41
Confidence
0.89
Method
probabilistic
MBR-036859CLM-406398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010164
Orphan claim re-pointed
Claims processor
CLM-410218 → UHC-06564-81 (David Yang)
Member id
UHC-06564-81
Confidence
0.97
Method
deterministic
MBR-018330CLM-410218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010165
Orphan claim re-pointed
Claims processor
CLM-411877 → UHC-36360-26 (Theresa Cruz)
Member id
UHC-36360-26
Confidence
1
Method
probabilistic
MBR-007332CLM-411877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010166
Orphan claim re-pointed
Claims processor
CLM-415267 → UHC-91600-43 (Albert Richards)
Member id
UHC-91600-43
Confidence
0.97
Method
deterministic
MBR-000416CLM-415267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010167
Orphan claim re-pointed
Claims processor
CLM-409475 → UHC-13577-79 (Emily Little)
Member id
UHC-13577-79
Confidence
1
Method
probabilistic
MBR-002389CLM-409475
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010168
Orphan claim re-pointed
Claims processor
CLM-410248 → UHC-21468-84 (Lisa Morales)
Member id
UHC-21468-84
Confidence
1
Method
probabilistic
MBR-000605CLM-410248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010169
Orphan claim re-pointed
Claims processor
CLM-408857 → UHC-35394-38 (Angela Guzman)
Member id
UHC-35394-38
Confidence
1
Method
probabilistic
MBR-029676CLM-408857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010170
Orphan claim re-pointed
Claims processor
CLM-432176 → UHC-76242-39 (Anthony Park)
Member id
UHC-76242-39
Confidence
1
Method
probabilistic
MBR-026113CLM-432176
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010171
Orphan claim re-pointed
Claims processor
CLM-432009 → UHC-55792-79 (Lisa Knight)
Member id
UHC-55792-79
Confidence
1
Method
probabilistic
MBR-026574CLM-432009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010172
Orphan claim re-pointed
Claims processor
CLM-429792 → UHC-26263-45 (Jeremy Moore)
Member id
UHC-26263-45
Confidence
1
Method
probabilistic
MBR-000239CLM-429792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010173
Orphan claim re-pointed
Claims processor
CLM-418940 → UHC-28850-11 (Helen Johnson)
Member id
UHC-28850-11
Confidence
1
Method
probabilistic
MBR-008140CLM-418940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010174
Orphan claim re-pointed
Claims processor
CLM-406919 → UHC-68201-47 (Melissa Ortiz)
Member id
UHC-68201-47
Confidence
1
Method
probabilistic
MBR-015025CLM-406919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010175
Orphan claim re-pointed
Claims processor
CLM-424429 → UHC-58097-77 (Daniel Den)
Member id
UHC-58097-77
Confidence
0.97
Method
deterministic
MBR-034534CLM-424429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010176
Orphan claim re-pointed
Claims processor
CLM-411761 → UHC-54139-37 (Aaron Freeman)
Member id
UHC-54139-37
Confidence
1
Method
probabilistic
MBR-002697CLM-411761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010177
Orphan claim re-pointed
Claims processor
CLM-403660 → UHC-32458-35 (Nathan Morrison)
Member id
UHC-32458-35
Confidence
0.92
Method
probabilistic
MBR-000450CLM-403660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010178
Orphan claim re-pointed
Claims processor
CLM-402740 → UHC-37593-70 (Emily Roberts)
Member id
UHC-37593-70
Confidence
1
Method
probabilistic
MBR-011793CLM-402740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010179
Orphan claim re-pointed
Claims processor
CLM-415769 → UHC-71756-75 (Tyler Moore)
Member id
UHC-71756-75
Confidence
1
Method
probabilistic
MBR-011325CLM-415769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010180
Orphan claim re-pointed
Claims processor
CLM-422643 → UHC-68272-84 (Timothy Rios)
Member id
UHC-68272-84
Confidence
1
Method
probabilistic
MBR-012153CLM-422643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010181
Orphan claim re-pointed
Claims processor
CLM-401446 → UHC-05668-40 (Andrea Soto)
Member id
UHC-05668-40
Confidence
1
Method
probabilistic
MBR-028362CLM-401446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010182
Orphan claim re-pointed
Claims processor
CLM-429685 → UHC-61234-06 (Donald Carr)
Member id
UHC-61234-06
Confidence
1
Method
probabilistic
MBR-015250CLM-429685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010183
Orphan claim re-pointed
Claims processor
CLM-429852 → UHC-10556-56 (Sara Simpson)
Member id
UHC-10556-56
Confidence
0.97
Method
deterministic
MBR-020330CLM-429852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010184
Orphan claim re-pointed
Claims processor
CLM-411013 → UHC-34684-56 (Gloria Gordon)
Member id
UHC-34684-56
Confidence
1
Method
probabilistic
MBR-023936CLM-411013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010185
Orphan claim re-pointed
Claims processor
CLM-426070 → UHC-98310-32 (Ann Banks)
Member id
UHC-98310-32
Confidence
0.97
Method
deterministic
MBR-015843CLM-426070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010186
Orphan claim re-pointed
Claims processor
CLM-406917 → UHC-68736-64 (Gerald Davis)
Member id
UHC-68736-64
Confidence
1
Method
probabilistic
MBR-000776CLM-406917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010187
Orphan claim re-pointed
Claims processor
CLM-419051 → UHC-53279-40 (Jesse Wood)
Member id
UHC-53279-40
Confidence
1
Method
probabilistic
MBR-023756CLM-419051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010188
Orphan claim re-pointed
Claims processor
CLM-419029 → UHC-54434-24 (Natalie Ramos)
Member id
UHC-54434-24
Confidence
1
Method
probabilistic
MBR-001151CLM-419029
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010189
Orphan claim re-pointed
Claims processor
CLM-408051 → UHC-56097-83 (Thomas Kelly)
Member id
UHC-56097-83
Confidence
1
Method
probabilistic
MBR-027083CLM-408051
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 177 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.