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-014345 | Outreach suppressed pending steward Outreach | TPA-59518 (Richard Hamilton) held until CASE-000901 is decided |
| Held | — | ||
| ACT-014346 | Outreach suppressed pending steward Outreach | TPA-61227 (Logan Hoffman) held until CASE-000902 is decided |
| Held | — | ||
| ACT-014347 | Outreach suppressed pending steward Outreach | ENR-106036 (Megan Hoffman) held until CASE-000903 is decided |
| Held | — | ||
| ACT-014348 | Outreach suppressed pending steward Outreach | CLM-413786 (Alice Baker) held until CASE-000904 is decided |
| Held | — | ||
| ACT-014349 | Outreach suppressed pending steward Outreach | TPA-51264 (Anthoony Gilbert) held until CASE-000905 is decided |
| Held | — | ||
| ACT-014350 | Outreach suppressed pending steward Outreach | ENR-103805 (Tony Gilbert) held until CASE-000906 is decided |
| Held | — | ||
| ACT-014351 | Outreach suppressed pending steward Outreach | TPA-53239 (Arthhur Gilbert) held until CASE-000907 is decided |
| Held | — | ||
| ACT-014352 | Outreach suppressed pending steward Outreach | CLM-400700 (Marcus Collins) held until CASE-000908 is decided |
| Held | — | ||
| ACT-014353 | Outreach suppressed pending steward Outreach | CLM-405293 (Albert Hall) held until CASE-000909 is decided |
| Held | — | ||
| ACT-014354 | Outreach suppressed pending steward Outreach | TPA-55057 (Luis Ortiz) held until CASE-000910 is decided |
| Held | — | ||
| ACT-014355 | Outreach suppressed pending steward Outreach | ENR-115101 (Luis Ortyz) held until CASE-000911 is decided |
| Held | — | ||
| ACT-014356 | Outreach suppressed pending steward Outreach | ENR-111924 (Bobby Ortiz) held until CASE-000912 is decided |
| Held | — | ||
| ACT-014357 | Outreach suppressed pending steward Outreach | TPA-60285 (Charles Li) held until CASE-000913 is decided |
| Held | — | ||
| ACT-014358 | Outreach suppressed pending steward Outreach | CLM-426044 (Russell Mendoza) held until CASE-000914 is decided |
| Held | — | ||
| ACT-014359 | Outreach suppressed pending steward Outreach | PRV-25759 (Carl Castro) held until CASE-000915 is decided |
| Held | — | ||
| ACT-014360 | Outreach suppressed pending steward Outreach | CLM-419394 (Carl Castro) held until CASE-000916 is decided |
| Held | — | ||
| ACT-014361 | Outreach suppressed pending steward Outreach | TPA-61787 (Tyler Wag) held until CASE-000917 is decided |
| Held | — | ||
| ACT-014362 | Outreach suppressed pending steward Outreach | TPA-50357 (Wei Patterson) held until CASE-000918 is decided |
| Held | — | ||
| ACT-014363 | Outreach suppressed pending steward Outreach | TPA-58169 (Bruce Jones) held until CASE-000919 is decided |
| Held | — | ||
| ACT-014364 | Outreach suppressed pending steward Outreach | ENR-111246 (Victoria Hunnt) held until CASE-000920 is decided |
| Held | — | ||
| ACT-014365 | Outreach suppressed pending steward Outreach | PRV-28261 (Joshua Hicks) held until CASE-000921 is decided |
| Held | — | ||
| ACT-014366 | Outreach suppressed pending steward Outreach | TPA-54352 (Teresa Hayes) held until CASE-000922 is decided |
| Held | — | ||
| ACT-014367 | Outreach suppressed pending steward Outreach | TPA-54351 (Teresa Hayes) held until CASE-000923 is decided |
| Held | — | ||
| ACT-014368 | Outreach suppressed pending steward Outreach | CLM-401215 (Carl Morrison) held until CASE-000924 is decided |
| Held | — | ||
| ACT-014369 | Outreach suppressed pending steward Outreach | CLM-425973 (Dorothy Salazar) held until CASE-000925 is decided |
| Held | — | ||
| ACT-014370 | Outreach suppressed pending steward Outreach | ENR-133999 (Dorothy Salazar) held until CASE-000926 is decided |
| Held | — | ||
| ACT-014371 | Outreach suppressed pending steward Outreach | CLM-401071 (Eric Jimenez) held until CASE-000927 is decided |
| Held | — | ||
| ACT-014372 | Outreach suppressed pending steward Outreach | ENR-138523 (Sanndra Howell) held until CASE-000928 is decided |
| Held | — | ||
| ACT-014373 | Outreach suppressed pending steward Outreach | PRV-28614 (Sandra Howell) held until CASE-000929 is decided |
| Held | — | ||
| ACT-014374 | Outreach suppressed pending steward Outreach | CLM-425486 (Priya Smith) held until CASE-000930 is decided |
| Held | — | ||
| ACT-014375 | Outreach suppressed pending steward Outreach | TPA-55222 (Patrick Le) held until CASE-000931 is decided |
| Held | — | ||
| ACT-014376 | Outreach suppressed pending steward Outreach | ENR-122428 (Jonathan Ford) held until CASE-000932 is decided |
| Held | — | ||
| ACT-014377 | Outreach suppressed pending steward Outreach | ENR-118630 (Priya Ford) held until CASE-000933 is decided |
| Held | — | ||
| ACT-014378 | Outreach suppressed pending steward Outreach | CLM-414207 (Priya Ford) held until CASE-000934 is decided |
| Held | — | ||
| ACT-014379 | Outreach suppressed pending steward Outreach | CLM-414313 (Carolyn Harrison) held until CASE-000935 is decided |
| Held | — | ||
| ACT-014380 | Outreach suppressed pending steward Outreach | ENR-137472 (Olivia Jenkins) held until CASE-000936 is decided |
| Held | — | ||
| ACT-014381 | Outreach suppressed pending steward Outreach | TPA-62612 (Olivia Jenkins) held until CASE-000937 is decided |
| Held | — | ||
| ACT-014382 | Outreach suppressed pending steward Outreach | TPA-63749 (Joe Vargas) held until CASE-000938 is decided |
| Held | — | ||
| ACT-014383 | Outreach suppressed pending steward Outreach | PRV-27644 (Brittany Wang) held until CASE-000939 is decided |
| Held | — | ||
| ACT-014384 | Outreach suppressed pending steward Outreach | TPA-61520 (Samantha Wang) held until CASE-000940 is decided |
| Held | — | ||
| ACT-014385 | Outreach suppressed pending steward Outreach | CLM-425107 (Kayla Padilla) held until CASE-000941 is decided |
| Held | — | ||
| ACT-014386 | Outreach suppressed pending steward Outreach | ENR-132806 (Kayla Padilla) held until CASE-000942 is decided |
| Held | — | ||
| ACT-014387 | Outreach suppressed pending steward Outreach | TPA-51526 (Danielle Bradley) held until CASE-000943 is decided |
| Held | — | ||
| ACT-014388 | Outreach suppressed pending steward Outreach | TPA-57765 (Henry Graham) held until CASE-000944 is decided |
| Held | — | ||
| ACT-014389 | Outreach suppressed pending steward Outreach | TPA-57764 (Henry Graham) held until CASE-000945 is decided |
| Held | — | ||
| ACT-014390 | Outreach suppressed pending steward Outreach | PRV-25786 (Jose Yang) held until CASE-000946 is decided |
| Held | — | ||
| ACT-014391 | Outreach suppressed pending steward Outreach | TPA-51079 (Lucia Hansen) held until CASE-000947 is decided |
| Held | — | ||
| ACT-014392 | Outreach suppressed pending steward Outreach | CLM-429286 (Bobby Wilson) held until CASE-000948 is decided |
| Held | — | ||
| ACT-014393 | Outreach suppressed pending steward Outreach | PRV-23164 (Mari Vazquez) held until CASE-000949 is decided |
| Held | — | ||
| ACT-014394 | Outreach suppressed pending steward Outreach | TPA-53463 (Alexander Perry) held until CASE-000950 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.