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
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-013495 | Outreach suppressed pending steward Outreach | CLM-409790 (Russell Price) held until CASE-000051 is decided |
| Held | — | ||
| ACT-013496 | Outreach suppressed pending steward Outreach | CLM-424584 (Alexander Moore) held until CASE-000052 is decided |
| Held | — | ||
| ACT-013497 | Outreach suppressed pending steward Outreach | TPA-61064 (Martha Dixno) held until CASE-000053 is decided |
| Held | — | ||
| ACT-013498 | Outreach suppressed pending steward Outreach | ENR-100007 (Evelyn Watkins) held until CASE-000054 is decided |
| Held | — | ||
| ACT-013499 | Outreach suppressed pending steward Outreach | CLM-401470 (Jerry Pierce) held until CASE-000055 is decided |
| Held | — | ||
| ACT-013500 | Outreach suppressed pending steward Outreach | TPA-61309 (Ahmed Li) held until CASE-000056 is decided |
| Held | — | ||
| ACT-013501 | Outreach suppressed pending steward Outreach | TPA-61310 (Ahmed Li) held until CASE-000057 is decided |
| Held | — | ||
| ACT-013502 | Outreach suppressed pending steward Outreach | TPA-59799 (Noah Woods) held until CASE-000058 is decided |
| Held | — | ||
| ACT-013503 | Outreach suppressed pending steward Outreach | ENR-122365 (Vincent Rose) held until CASE-000059 is decided |
| Held | — | ||
| ACT-013504 | Outreach suppressed pending steward Outreach | ENR-112102 (Santiago Ris) held until CASE-000060 is decided |
| Held | — | ||
| ACT-013505 | Outreach suppressed pending steward Outreach | TPA-54243 (Brenda Ross) held until CASE-000061 is decided |
| Held | — | ||
| ACT-013506 | Outreach suppressed pending steward Outreach | ENR-112855 (Brenda Ross) held until CASE-000062 is decided |
| Held | — | ||
| ACT-013507 | Outreach suppressed pending steward Outreach | PRV-24103 (Walter Florse) held until CASE-000063 is decided |
| Held | — | ||
| ACT-013508 | Outreach suppressed pending steward Outreach | CLM-402989 (Gary Cook) held until CASE-000064 is decided |
| Held | — | ||
| ACT-013509 | Outreach suppressed pending steward Outreach | TPA-56751 (Bobby Gilbert) held until CASE-000065 is decided |
| Held | — | ||
| ACT-013510 | Outreach suppressed pending steward Outreach | TPA-56699 (Lawrence Rice) held until CASE-000066 is decided |
| Held | — | ||
| ACT-013511 | Outreach suppressed pending steward Outreach | ENR-143040 (Ryan Stephens) held until CASE-000067 is decided |
| Held | — | ||
| ACT-013512 | Outreach suppressed pending steward Outreach | TPA-64453 (Ryan Stephens) held until CASE-000068 is decided |
| Held | — | ||
| ACT-013513 | Outreach suppressed pending steward Outreach | CLM-418607 (Ruth Weber) held until CASE-000069 is decided |
| Held | — | ||
| ACT-013514 | Outreach suppressed pending steward Outreach | CLM-431350 (Richard Medina) held until CASE-000070 is decided |
| Held | — | ||
| ACT-013515 | Outreach suppressed pending steward Outreach | CLM-415381 (Elizabeth Patterson) held until CASE-000071 is decided |
| Held | — | ||
| ACT-013516 | Outreach suppressed pending steward Outreach | ENR-120256 (Elizabeth Patterson) held until CASE-000072 is decided |
| Held | — | ||
| ACT-013517 | Outreach suppressed pending steward Outreach | TPA-56071 (Betyt Kelly) held until CASE-000073 is decided |
| Held | — | ||
| ACT-013518 | Outreach suppressed pending steward Outreach | TPA-58004 (Gloria Wells) held until CASE-000074 is decided |
| Held | — | ||
| ACT-013519 | Outreach suppressed pending steward Outreach | ENR-123827 (Gloria Wells) held until CASE-000075 is decided |
| Held | — | ||
| ACT-013520 | Outreach suppressed pending steward Outreach | TPA-51696 (Wayne Marshall) held until CASE-000076 is decided |
| Held | — | ||
| ACT-013521 | Outreach suppressed pending steward Outreach | TPA-54069 (Zachary Perkins) held until CASE-000077 is decided |
| Held | — | ||
| ACT-013522 | Outreach suppressed pending steward Outreach | CLM-409387 (Zachary Perkins) held until CASE-000078 is decided |
| Held | — | ||
| ACT-013523 | Outreach suppressed pending steward Outreach | TPA-57081 (Kimberly Knight) held until CASE-000079 is decided |
| Held | — | ||
| ACT-013524 | Outreach suppressed pending steward Outreach | CLM-418275 (Jacob Vazquez) held until CASE-000080 is decided |
| Held | — | ||
| ACT-013525 | Outreach suppressed pending steward Outreach | CLM-416300 (Carol Vazquez) held until CASE-000081 is decided |
| Held | — | ||
| ACT-013526 | Outreach suppressed pending steward Outreach | ENR-121456 (Carol Vazquez) held until CASE-000082 is decided |
| Held | — | ||
| ACT-013527 | Outreach suppressed pending steward Outreach | CLM-418274 (Jacob Vazquez) held until CASE-000083 is decided |
| Held | — | ||
| ACT-013528 | Outreach suppressed pending steward Outreach | TPA-52092 (Bradley Schmidt) held until CASE-000084 is decided |
| Held | — | ||
| ACT-013529 | Outreach suppressed pending steward Outreach | CLM-400014 (Raymond Walsh) held until CASE-000085 is decided |
| Held | — | ||
| ACT-013530 | Outreach suppressed pending steward Outreach | TPA-51855 (Melissa Thompson) held until CASE-000086 is decided |
| Held | — | ||
| ACT-013531 | Outreach suppressed pending steward Outreach | CLM-426611 (Barbara Johnston) held until CASE-000087 is decided |
| Held | — | ||
| ACT-013532 | Outreach suppressed pending steward Outreach | CLM-425516 (Grace Garza) held until CASE-000088 is decided |
| Held | — | ||
| ACT-013533 | Outreach suppressed pending steward Outreach | CLM-425517 (Grace Garza) held until CASE-000089 is decided |
| Held | — | ||
| ACT-013534 | Outreach suppressed pending steward Outreach | TPA-60330 (Kevin Guerrero) held until CASE-000090 is decided |
| Held | — | ||
| ACT-013535 | Outreach suppressed pending steward Outreach | ENR-130684 (Kevin Guerrero) held until CASE-000091 is decided |
| Held | — | ||
| ACT-013536 | Outreach suppressed pending steward Outreach | TPA-54936 (Lawrence Ray) held until CASE-000092 is decided |
| Held | — | ||
| ACT-013537 | Outreach suppressed pending steward Outreach | TPA-54937 (Lawrence Ray) held until CASE-000093 is decided |
| Held | — | ||
| ACT-013538 | Outreach suppressed pending steward Outreach | CLM-413722 (Alan Bennett) held until CASE-000094 is decided |
| Held | — | ||
| ACT-013539 | Outreach suppressed pending steward Outreach | CLM-425348 (Dot Patterson) held until CASE-000095 is decided |
| Held | — | ||
| ACT-013540 | Outreach suppressed pending steward Outreach | CLM-419705 (Roy Marshall) held until CASE-000096 is decided |
| Held | — | ||
| ACT-013541 | Outreach suppressed pending steward Outreach | TPA-58142 (Sara Sanders) held until CASE-000097 is decided |
| Held | — | ||
| ACT-013542 | Outreach suppressed pending steward Outreach | PRV-25482 (Sara Sanders) held until CASE-000098 is decided |
| Held | — | ||
| ACT-013543 | Outreach suppressed pending steward Outreach | PRV-24901 (Yuki Chapman) held until CASE-000099 is decided |
| Held | — | ||
| ACT-013544 | Outreach suppressed pending steward Outreach | CLM-420575 (Theresa Green) held until CASE-000100 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.