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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-017821 | Care coordination outreach Next-best-action | Shirley Soto: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017822 | Care coordination outreach Next-best-action | Kyle Romero: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017823 | Care coordination outreach Next-best-action | Jack Clark: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017824 | Care coordination outreach Next-best-action | Karen Foster: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017825 | Care coordination outreach Next-best-action | Yuki Herrera: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017826 | Care coordination outreach Next-best-action | Diego Contreras: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017827 | Care coordination outreach Next-best-action | Billy Robinson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017828 | Care coordination outreach Next-best-action | Willie Sanchez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017829 | Care coordination outreach Next-best-action | Amanda Watkins: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017830 | Care coordination outreach Next-best-action | Ralph Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017831 | Care coordination outreach Next-best-action | Ann Sullivan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017832 | Care coordination outreach Next-best-action | Valentina Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017833 | Care coordination outreach Next-best-action | Mary George: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017834 | Care coordination outreach Next-best-action | Zachary Watkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017835 | Care coordination outreach Next-best-action | Diego Richardson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017836 | Care coordination outreach Next-best-action | Andrea Cook: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017837 | Care coordination outreach Next-best-action | Carlos Henderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017838 | Care coordination outreach Next-best-action | Marilyn Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017839 | Care coordination outreach Next-best-action | Amanda Shaw: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017840 | Care coordination outreach Next-best-action | Jon Parker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017841 | Care coordination outreach Next-best-action | Kevin Johnston: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017842 | Care coordination outreach Next-best-action | Kenneth Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017843 | Care coordination outreach Next-best-action | Christian Butler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017844 | Care coordination outreach Next-best-action | Donald Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017845 | Care coordination outreach Next-best-action | Lucia Vargas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017846 | Care coordination outreach Next-best-action | Abigail Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017847 | Care coordination outreach Next-best-action | Ryan Lee: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017848 | Care coordination outreach Next-best-action | Sophia Walker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017849 | Care coordination outreach Next-best-action | Roger Hamilton: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017850 | Care coordination outreach Next-best-action | Emily White: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017851 | Care coordination outreach Next-best-action | Donald Russell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017852 | Care coordination outreach Next-best-action | Carl Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017853 | Care coordination outreach Next-best-action | Julia Rice: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017854 | Care coordination outreach Next-best-action | Emily Henderson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017855 | Care coordination outreach Next-best-action | Jacob King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017856 | Care coordination outreach Next-best-action | Jesse Morrison: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017857 | Care coordination outreach Next-best-action | Austin Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017858 | Care coordination outreach Next-best-action | Frances Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017859 | Care coordination outreach Next-best-action | Rebecca Chavez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017860 | Care coordination outreach Next-best-action | Gerald Miller: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017861 | Care coordination outreach Next-best-action | Natalie Ramos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017862 | Care coordination outreach Next-best-action | Timothy Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017863 | Care coordination outreach Next-best-action | Roy Tucker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017864 | Care coordination outreach Next-best-action | Jack Espinoza: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017865 | Care coordination outreach Next-best-action | Natalie Tran: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017866 | Care coordination outreach Next-best-action | Jose Mejia: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017867 | Care coordination outreach Next-best-action | Sara Franklin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017868 | Care coordination outreach Next-best-action | Samuel Guerrero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017869 | Care coordination outreach Next-best-action | Brian Fox: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017870 | Care coordination outreach Next-best-action | Joseph Flores: 3 claims, no attributed provider |
| Proposed | — |
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.