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-010440
Orphan claim re-pointed
Claims processor
CLM-420349 → UHC-70497-07 (Evelyn Ramos)
Member id
UHC-70497-07
Confidence
1
Method
probabilistic
MBR-004230CLM-420349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010441
Orphan claim re-pointed
Claims processor
CLM-414781 → UHC-95355-13 (Scott Bryant)
Member id
UHC-95355-13
Confidence
1
Method
probabilistic
MBR-019178CLM-414781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010442
Orphan claim re-pointed
Claims processor
CLM-407028 → UHC-94935-25 (Christian Yang)
Member id
UHC-94935-25
Confidence
0.97
Method
deterministic
MBR-023104CLM-407028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010443
Orphan claim re-pointed
Claims processor
CLM-425819 → UHC-57021-61 (Christine Wagner)
Member id
UHC-57021-61
Confidence
1
Method
probabilistic
MBR-007869CLM-425819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010444
Orphan claim re-pointed
Claims processor
CLM-428704 → UHC-76593-95 (Kathryn Carlson)
Member id
UHC-76593-95
Confidence
1
Method
probabilistic
MBR-008784CLM-428704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010445
Orphan claim re-pointed
Claims processor
CLM-405310 → UHC-37282-88 (Judith Larson)
Member id
UHC-37282-88
Confidence
0.97
Method
deterministic
MBR-025371CLM-405310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010446
Orphan claim re-pointed
Claims processor
CLM-428159 → UHC-56916-28 (Logan Larson)
Member id
UHC-56916-28
Confidence
0.89
Method
probabilistic
MBR-019372CLM-428159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010447
Orphan claim re-pointed
Claims processor
CLM-401437 → UHC-29726-97 (Victoria Diaz)
Member id
UHC-29726-97
Confidence
1
Method
probabilistic
MBR-039101CLM-401437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010448
Orphan claim re-pointed
Claims processor
CLM-415904 → UHC-11243-09 (Jordan Young)
Member id
UHC-11243-09
Confidence
1
Method
probabilistic
MBR-002842CLM-415904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010449
Orphan claim re-pointed
Claims processor
CLM-427353 → UHC-51600-71 (Christina Olson)
Member id
UHC-51600-71
Confidence
1
Method
probabilistic
MBR-000328CLM-427353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010450
Orphan claim re-pointed
Claims processor
CLM-405181 → UHC-97377-90 (Marilyn Aguilar)
Member id
UHC-97377-90
Confidence
0.97
Method
deterministic
MBR-002876CLM-405181
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010451
Orphan claim re-pointed
Claims processor
CLM-410524 → UHC-45319-60 (Ann Hudson)
Member id
UHC-45319-60
Confidence
1
Method
probabilistic
MBR-016813CLM-410524
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021667
Duplicate member record retired
Member services
Emma Reyes: 2 enrollment records collapsed into UHC-53606-43
Enrollment records
2
Member id
UHC-53606-43
MBR-000002
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021668
Duplicate member record retired
Member services
Lauren Fowler: 2 enrollment records collapsed into UHC-70815-91
Enrollment records
2
Member id
UHC-70815-91
MBR-000003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021669
Duplicate member record retired
Member services
Pat Gomez: 2 enrollment records collapsed into UHC-18451-51
Enrollment records
2
Member id
UHC-18451-51
MBR-000011
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021670
Duplicate member record retired
Member services
Kimberly Marquez: 3 enrollment records collapsed into UHC-94929-40
Enrollment records
3
Member id
UHC-94929-40
MBR-000016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021671
Duplicate member record retired
Member services
Kayla Mills: 2 enrollment records collapsed into UHC-01587-52
Enrollment records
2
Member id
UHC-01587-52
MBR-000018
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021672
Duplicate member record retired
Member services
Danielle Schultz: 3 enrollment records collapsed into UHC-69678-97
Enrollment records
3
Member id
UHC-69678-97
MBR-000043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021673
Duplicate member record retired
Member services
Mason Miller: 2 enrollment records collapsed into UHC-52836-22
Enrollment records
2
Member id
UHC-52836-22
MBR-000045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021674
Duplicate member record retired
Member services
Angela Watkins: 2 enrollment records collapsed into UHC-59656-73
Enrollment records
2
Member id
UHC-59656-73
MBR-000049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021675
Duplicate member record retired
Member services
Carlos Evans: 2 enrollment records collapsed into UHC-89882-16
Enrollment records
2
Member id
UHC-89882-16
MBR-000050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021676
Duplicate member record retired
Member services
Luis Howard: 2 enrollment records collapsed into UHC-63334-20
Enrollment records
2
Member id
UHC-63334-20
MBR-000052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021677
Duplicate member record retired
Member services
Amy Bell: 3 enrollment records collapsed into UHC-13517-15
Enrollment records
3
Member id
UHC-13517-15
MBR-000057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021678
Duplicate member record retired
Member services
Henry Hunter: 2 enrollment records collapsed into UHC-98712-70
Enrollment records
2
Member id
UHC-98712-70
MBR-000066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021679
Duplicate member record retired
Member services
Lori Payne: 2 enrollment records collapsed into UHC-01085-43
Enrollment records
2
Member id
UHC-01085-43
MBR-000068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021680
Duplicate member record retired
Member services
Sara Baker: 3 enrollment records collapsed into UHC-35017-70
Enrollment records
3
Member id
UHC-35017-70
MBR-000072
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021681
Duplicate member record retired
Member services
Diane Reed: 2 enrollment records collapsed into UHC-16399-94
Enrollment records
2
Member id
UHC-16399-94
MBR-000082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021682
Duplicate member record retired
Member services
Teresa Allen: 2 enrollment records collapsed into UHC-50538-21
Enrollment records
2
Member id
UHC-50538-21
MBR-000083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021683
Duplicate member record retired
Member services
Jack Kelly: 3 enrollment records collapsed into UHC-23475-39
Enrollment records
3
Member id
UHC-23475-39
MBR-000084
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021684
Duplicate member record retired
Member services
Camila Coleman: 4 enrollment records collapsed into UHC-30287-02
Enrollment records
4
Member id
UHC-30287-02
MBR-000095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021685
Duplicate member record retired
Member services
Ethan Jackson: 2 enrollment records collapsed into UHC-62313-89
Enrollment records
2
Member id
UHC-62313-89
MBR-000104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021686
Duplicate member record retired
Member services
Jessica Butler: 2 enrollment records collapsed into UHC-65037-61
Enrollment records
2
Member id
UHC-65037-61
MBR-000105
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021687
Duplicate member record retired
Member services
Jordan Armstrong: 2 enrollment records collapsed into UHC-21547-04
Enrollment records
2
Member id
UHC-21547-04
MBR-000112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021688
Duplicate member record retired
Member services
Janet Olson: 2 enrollment records collapsed into UHC-94774-60
Enrollment records
2
Member id
UHC-94774-60
MBR-000116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021689
Duplicate member record retired
Member services
Richard Santiago: 2 enrollment records collapsed into UHC-26774-18
Enrollment records
2
Member id
UHC-26774-18
MBR-000123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021690
Duplicate member record retired
Member services
Freeman Diana: 2 enrollment records collapsed into UHC-59043-73
Enrollment records
2
Member id
UHC-59043-73
MBR-000124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021691
Duplicate member record retired
Member services
Aaron Gilbert: 2 enrollment records collapsed into UHC-80916-38
Enrollment records
2
Member id
UHC-80916-38
MBR-000127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021692
Duplicate member record retired
Member services
Doris Meyer: 2 enrollment records collapsed into UHC-49829-23
Enrollment records
2
Member id
UHC-49829-23
MBR-000130
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021693
Duplicate member record retired
Member services
Michael Chapman: 2 enrollment records collapsed into UHC-78960-31
Enrollment records
2
Member id
UHC-78960-31
MBR-000134
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021694
Duplicate member record retired
Member services
Sarah Henderson: 3 enrollment records collapsed into UHC-24133-93
Enrollment records
3
Member id
UHC-24133-93
MBR-000139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021695
Duplicate member record retired
Member services
Dorothy Green: 2 enrollment records collapsed into UHC-13074-61
Enrollment records
2
Member id
UHC-13074-61
MBR-000142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021696
Duplicate member record retired
Member services
Kathyrn Carpenter: 2 enrollment records collapsed into UHC-20471-72
Enrollment records
2
Member id
UHC-20471-72
MBR-000159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021697
Duplicate member record retired
Member services
Bruce Garrett: 3 enrollment records collapsed into UHC-64079-01
Enrollment records
3
Member id
UHC-64079-01
MBR-000167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021698
Duplicate member record retired
Member services
Cynthia Sanders: 2 enrollment records collapsed into UHC-98112-58
Enrollment records
2
Member id
UHC-98112-58
MBR-000191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021699
Duplicate member record retired
Member services
Jean Gonzales: 2 enrollment records collapsed into UHC-38360-46
Enrollment records
2
Member id
UHC-38360-46
MBR-000195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021700
Duplicate member record retired
Member services
Sean Day: 2 enrollment records collapsed into UHC-42310-30
Enrollment records
2
Member id
UHC-42310-30
MBR-000197
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021701
Duplicate member record retired
Member services
Rebecca Castillo: 2 enrollment records collapsed into UHC-84696-29
Enrollment records
2
Member id
UHC-84696-29
MBR-000199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021702
Duplicate member record retired
Member services
Patrick James: 2 enrollment records collapsed into UHC-29865-88
Enrollment records
2
Member id
UHC-29865-88
MBR-000205
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021703
Duplicate member record retired
Member services
Judy Soto: 2 enrollment records collapsed into UHC-64354-17
Enrollment records
2
Member id
UHC-64354-17
MBR-000209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-021704
Duplicate member record retired
Member services
Hiroshi Armstrong: 2 enrollment records collapsed into UHC-54673-76
Enrollment records
2
Member id
UHC-54673-76
MBR-000212
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 183 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.