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-014295 | Outreach suppressed pending steward Outreach | TPA-58529 (Billy Hayes) held until CASE-000851 is decided |
| Held | — | ||
| ACT-014296 | Outreach suppressed pending steward Outreach | ENR-125445 (Billy Hayes) held until CASE-000852 is decided |
| Held | — | ||
| ACT-014297 | Outreach suppressed pending steward Outreach | ENR-110294 (John Schmidt) held until CASE-000853 is decided |
| Held | — | ||
| ACT-014298 | Outreach suppressed pending steward Outreach | CLM-407824 (John Schmidt) held until CASE-000854 is decided |
| Held | — | ||
| ACT-014299 | Outreach suppressed pending steward Outreach | ENR-115860 (Nathan Black) held until CASE-000855 is decided |
| Held | — | ||
| ACT-014300 | Outreach suppressed pending steward Outreach | TPA-55311 (Nathan Black) held until CASE-000856 is decided |
| Held | — | ||
| ACT-014301 | Outreach suppressed pending steward Outreach | ENR-111009 (Stephen Reyes) held until CASE-000857 is decided |
| Held | — | ||
| ACT-014302 | Outreach suppressed pending steward Outreach | ENR-103263 (Isabella Rice) held until CASE-000858 is decided |
| Held | — | ||
| ACT-014303 | Outreach suppressed pending steward Outreach | CLM-412426 (Brian Brooks) held until CASE-000859 is decided |
| Held | — | ||
| ACT-014304 | Outreach suppressed pending steward Outreach | ENR-123609 (Sophia Robertson) held until CASE-000860 is decided |
| Held | — | ||
| ACT-014305 | Outreach suppressed pending steward Outreach | TPA-57920 (Sophia Robertson) held until CASE-000861 is decided |
| Held | — | ||
| ACT-014306 | Outreach suppressed pending steward Outreach | TPA-60663 (Alexys Washington) held until CASE-000862 is decided |
| Held | — | ||
| ACT-014307 | Outreach suppressed pending steward Outreach | TPA-60662 (Alexys Washington) held until CASE-000863 is decided |
| Held | — | ||
| ACT-014308 | Outreach suppressed pending steward Outreach | TPA-50722 (Martha Harrison) held until CASE-000864 is decided |
| Held | — | ||
| ACT-014309 | Outreach suppressed pending steward Outreach | CLM-429174 (Kayla Harrison) held until CASE-000865 is decided |
| Held | — | ||
| ACT-014310 | Outreach suppressed pending steward Outreach | ENR-138259 (Kalya Harrison) held until CASE-000866 is decided |
| Held | — | ||
| ACT-014311 | Outreach suppressed pending steward Outreach | CLM-410860 (Susan Burke) held until CASE-000867 is decided |
| Held | — | ||
| ACT-014312 | Outreach suppressed pending steward Outreach | CLM-421920 (Kevin Burke) held until CASE-000868 is decided |
| Held | — | ||
| ACT-014313 | Outreach suppressed pending steward Outreach | CLM-406355 (Alexis Robinson) held until CASE-000869 is decided |
| Held | — | ||
| ACT-014314 | Outreach suppressed pending steward Outreach | CLM-406674 (Martha Young) held until CASE-000870 is decided |
| Held | — | ||
| ACT-014315 | Outreach suppressed pending steward Outreach | TPA-58076 (Teresa Yang) held until CASE-000871 is decided |
| Held | — | ||
| ACT-014316 | Outreach suppressed pending steward Outreach | PRV-25428 (Teressa Yang) held until CASE-000872 is decided |
| Held | — | ||
| ACT-014317 | Outreach suppressed pending steward Outreach | PRV-21726 (Noah Pena) held until CASE-000873 is decided |
| Held | — | ||
| ACT-014318 | Outreach suppressed pending steward Outreach | CLM-410842 (Ann Rios) held until CASE-000874 is decided |
| Held | — | ||
| ACT-014319 | Outreach suppressed pending steward Outreach | PRV-23135 (Ann Ryos) held until CASE-000875 is decided |
| Held | — | ||
| ACT-014320 | Outreach suppressed pending steward Outreach | PRV-23136 (Ann Rios) held until CASE-000876 is decided |
| Held | — | ||
| ACT-014321 | Outreach suppressed pending steward Outreach | CLM-419445 (Patricia Flores) held until CASE-000877 is decided |
| Held | — | ||
| ACT-014322 | Outreach suppressed pending steward Outreach | CLM-407173 (Christina Garza) held until CASE-000878 is decided |
| Held | — | ||
| ACT-014323 | Outreach suppressed pending steward Outreach | CLM-405047 (Paul Garza) held until CASE-000879 is decided |
| Held | — | ||
| ACT-014324 | Outreach suppressed pending steward Outreach | CLM-430760 (Paul Aguilar) held until CASE-000880 is decided |
| Held | — | ||
| ACT-014325 | Outreach suppressed pending steward Outreach | CLM-415339 (Margaret Foster) held until CASE-000881 is decided |
| Held | — | ||
| ACT-014326 | Outreach suppressed pending steward Outreach | CLM-405651 (Maria Griffin) held until CASE-000882 is decided |
| Held | — | ||
| ACT-014327 | Outreach suppressed pending steward Outreach | ENR-107428 (Maria Griffin) held until CASE-000883 is decided |
| Held | — | ||
| ACT-014328 | Outreach suppressed pending steward Outreach | TPA-54344 (Stephen Harrison) held until CASE-000884 is decided |
| Held | — | ||
| ACT-014329 | Outreach suppressed pending steward Outreach | TPA-52785 (Janice Ellis) held until CASE-000885 is decided |
| Held | — | ||
| ACT-014330 | Outreach suppressed pending steward Outreach | ENR-135187 (Janice Ellis) held until CASE-000886 is decided |
| Held | — | ||
| ACT-014331 | Outreach suppressed pending steward Outreach | CLM-417418 (Sean Carpenter) held until CASE-000887 is decided |
| Held | — | ||
| ACT-014332 | Outreach suppressed pending steward Outreach | PRV-25167 (Seen Carpenter) held until CASE-000888 is decided |
| Held | — | ||
| ACT-014333 | Outreach suppressed pending steward Outreach | CLM-417417 (Sean Carpenter) held until CASE-000889 is decided |
| Held | — | ||
| ACT-014334 | Outreach suppressed pending steward Outreach | PRV-26257 (Nathan Carpenter) held until CASE-000890 is decided |
| Held | — | ||
| ACT-014335 | Outreach suppressed pending steward Outreach | TPA-62858 (Benjamin Thompson) held until CASE-000891 is decided |
| Held | — | ||
| ACT-014336 | Outreach suppressed pending steward Outreach | ENR-137391 (Heather Evans) held until CASE-000892 is decided |
| Held | — | ||
| ACT-014337 | Outreach suppressed pending steward Outreach | CLM-423870 (Mariana Peterson) held until CASE-000893 is decided |
| Held | — | ||
| ACT-014338 | Outreach suppressed pending steward Outreach | ENR-120948 (Brenda Nichols) held until CASE-000894 is decided |
| Held | — | ||
| ACT-014339 | Outreach suppressed pending steward Outreach | TPA-56972 (Brenda Nichols) held until CASE-000895 is decided |
| Held | — | ||
| ACT-014340 | Outreach suppressed pending steward Outreach | CLM-406286 (Janice Ellis) held until CASE-000896 is decided |
| Held | — | ||
| ACT-014341 | Outreach suppressed pending steward Outreach | TPA-61124 (Martha Hernandez) held until CASE-000897 is decided |
| Held | — | ||
| ACT-014342 | Outreach suppressed pending steward Outreach | CLM-409888 (Peter Vazquez) held until CASE-000898 is decided |
| Held | — | ||
| ACT-014343 | Outreach suppressed pending steward Outreach | ENR-113033 (Peter Vazquez) held until CASE-000899 is decided |
| Held | — | ||
| ACT-014344 | Outreach suppressed pending steward Outreach | CLM-413588 (Melissa White) held until CASE-000900 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.