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-014395 | Outreach suppressed pending steward Outreach | TPA-63584 (Judith Knight) held until CASE-000951 is decided |
| Held | — | ||
| ACT-014396 | Outreach suppressed pending steward Outreach | TPA-63583 (Judith Knight) held until CASE-000952 is decided |
| Held | — | ||
| ACT-014397 | Outreach suppressed pending steward Outreach | CLM-426885 (John Warren) held until CASE-000953 is decided |
| Held | — | ||
| ACT-014398 | Outreach suppressed pending steward Outreach | ENR-135266 (John Warren) held until CASE-000954 is decided |
| Held | — | ||
| ACT-014399 | Outreach suppressed pending steward Outreach | ENR-131076 (Donald Jones) held until CASE-000955 is decided |
| Held | — | ||
| ACT-014400 | Outreach suppressed pending steward Outreach | TPA-60453 (Donald Jones) held until CASE-000956 is decided |
| Held | — | ||
| ACT-014401 | Outreach suppressed pending steward Outreach | TPA-50910 (Grag Knight) held until CASE-000957 is decided |
| Held | — | ||
| ACT-014402 | Outreach suppressed pending steward Outreach | TPA-62354 (Kyle Wilson) held until CASE-000958 is decided |
| Held | — | ||
| ACT-014403 | Outreach suppressed pending steward Outreach | TPA-50598 (Andrea McDonald) held until CASE-000959 is decided |
| Held | — | ||
| ACT-014404 | Outreach suppressed pending steward Outreach | CLM-417175 (Shirley Bennnett) held until CASE-000960 is decided |
| Held | — | ||
| ACT-014405 | Outreach suppressed pending steward Outreach | ENR-122616 (Shirley Bennett) held until CASE-000961 is decided |
| Held | — | ||
| ACT-014406 | Outreach suppressed pending steward Outreach | CLM-405415 (Eric Ortiz) held until CASE-000962 is decided |
| Held | — | ||
| ACT-014407 | Outreach suppressed pending steward Outreach | ENR-107125 (Eric Ortiz) held until CASE-000963 is decided |
| Held | — | ||
| ACT-014408 | Outreach suppressed pending steward Outreach | PRV-22043 (Emma Santiago) held until CASE-000964 is decided |
| Held | — | ||
| ACT-014409 | Outreach suppressed pending steward Outreach | TPA-53046 (Emma Santiago) held until CASE-000965 is decided |
| Held | — | ||
| ACT-014410 | Outreach suppressed pending steward Outreach | CLM-406946 (Emma Santiago) held until CASE-000966 is decided |
| Held | — | ||
| ACT-014411 | Outreach suppressed pending steward Outreach | TPA-57742 (Dennis Parker) held until CASE-000967 is decided |
| Held | — | ||
| ACT-014412 | Outreach suppressed pending steward Outreach | CLM-411151 (Austin Park) held until CASE-000968 is decided |
| Held | — | ||
| ACT-014413 | Outreach suppressed pending steward Outreach | CLM-406683 (John Little) held until CASE-000969 is decided |
| Held | — | ||
| ACT-014414 | Outreach suppressed pending steward Outreach | CLM-406850 (Diego Gonzales) held until CASE-000970 is decided |
| Held | — | ||
| ACT-014415 | Outreach suppressed pending steward Outreach | CLM-431433 (Angela Olson) held until CASE-000971 is decided |
| Held | — | ||
| ACT-014416 | Outreach suppressed pending steward Outreach | ENR-141263 (Angela Olson) held until CASE-000972 is decided |
| Held | — | ||
| ACT-014417 | Outreach suppressed pending steward Outreach | CLM-427513 (Kimberly Gordon) held until CASE-000973 is decided |
| Held | — | ||
| ACT-014418 | Outreach suppressed pending steward Outreach | CLM-415560 (Ryan Pena) held until CASE-000974 is decided |
| Held | — | ||
| ACT-014419 | Outreach suppressed pending steward Outreach | TPA-59510 (Melissa Roberts) held until CASE-000975 is decided |
| Held | — | ||
| ACT-014420 | Outreach suppressed pending steward Outreach | ENR-128333 (Melissa Roberts) held until CASE-000976 is decided |
| Held | — | ||
| ACT-014421 | Outreach suppressed pending steward Outreach | CLM-408798 (Carlos Jenkins) held until CASE-000977 is decided |
| Held | — | ||
| ACT-014422 | Outreach suppressed pending steward Outreach | CLM-404884 (Amber Robinson) held until CASE-000978 is decided |
| Held | — | ||
| ACT-014423 | Outreach suppressed pending steward Outreach | TPA-52126 (Michael Chappman) held until CASE-000979 is decided |
| Held | — | ||
| ACT-014424 | Outreach suppressed pending steward Outreach | TPA-52028 (Angela Chapman) held until CASE-000980 is decided |
| Held | — | ||
| ACT-014425 | Outreach suppressed pending steward Outreach | TPA-61825 (Sophia Mitchell) held until CASE-000981 is decided |
| Held | — | ||
| ACT-014426 | Outreach suppressed pending steward Outreach | ENR-135119 (Sophia Mitchell) held until CASE-000982 is decided |
| Held | — | ||
| ACT-014427 | Outreach suppressed pending steward Outreach | CLM-415306 (Brittany Kelley) held until CASE-000983 is decided |
| Held | — | ||
| ACT-014428 | Outreach suppressed pending steward Outreach | TPA-56726 (Brittny Kelley) held until CASE-000984 is decided |
| Held | — | ||
| ACT-014429 | Outreach suppressed pending steward Outreach | ENR-115450 (Virginia Kelley) held until CASE-000985 is decided |
| Held | — | ||
| ACT-014430 | Outreach suppressed pending steward Outreach | CLM-428723 (Christina Harris) held until CASE-000986 is decided |
| Held | — | ||
| ACT-014431 | Outreach suppressed pending steward Outreach | ENR-137678 (Christina Harris) held until CASE-000987 is decided |
| Held | — | ||
| ACT-014432 | Outreach suppressed pending steward Outreach | ENR-129573 (Jon Reyes) held until CASE-000988 is decided |
| Held | — | ||
| ACT-014433 | Outreach suppressed pending steward Outreach | PRV-26663 (John Reeys) held until CASE-000989 is decided |
| Held | — | ||
| ACT-014434 | Outreach suppressed pending steward Outreach | TPA-63255 (Martha Marquez) held until CASE-000990 is decided |
| Held | — | ||
| ACT-014435 | Outreach suppressed pending steward Outreach | CLM-401068 (Nathan Delgado) held until CASE-000991 is decided |
| Held | — | ||
| ACT-014436 | Outreach suppressed pending steward Outreach | TPA-61527 (Natalie Obrien) held until CASE-000992 is decided |
| Held | — | ||
| ACT-014437 | Outreach suppressed pending steward Outreach | CLM-423005 (Julia Schmidt) held until CASE-000993 is decided |
| Held | — | ||
| ACT-014438 | Outreach suppressed pending steward Outreach | PRV-26508 (Kimberly Hoffman) held until CASE-000994 is decided |
| Held | — | ||
| ACT-014439 | Outreach suppressed pending steward Outreach | CLM-419088 (Jdy Hoffman) held until CASE-000995 is decided |
| Held | — | ||
| ACT-014440 | Outreach suppressed pending steward Outreach | TPA-63018 (Jack Hoffman) held until CASE-000996 is decided |
| Held | — | ||
| ACT-014441 | Outreach suppressed pending steward Outreach | TPA-59694 (Kimberly Hoffman) held until CASE-000997 is decided |
| Held | — | ||
| ACT-014442 | Outreach suppressed pending steward Outreach | CLM-418903 (Austin Bryant) held until CASE-000998 is decided |
| Held | — | ||
| ACT-014443 | Outreach suppressed pending steward Outreach | TPA-58385 (Austin Bryant) held until CASE-000999 is decided |
| Held | — | ||
| ACT-014444 | Outreach suppressed pending steward Outreach | CLM-425876 (Maria Green) held until CASE-001000 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.