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-018721 | Care coordination outreach Next-best-action | Benjamin Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018722 | Care coordination outreach Next-best-action | Russell Gibson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018723 | Care coordination outreach Next-best-action | Kathryn Knight: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018724 | Care coordination outreach Next-best-action | Paul Russell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018725 | Care coordination outreach Next-best-action | Vincent Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018726 | Care coordination outreach Next-best-action | Gabriel Sanders: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018727 | Care coordination outreach Next-best-action | Carl Coleman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018728 | Care coordination outreach Next-best-action | Kathleen Andrews: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018729 | Care coordination outreach Next-best-action | Catherine Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018730 | Care coordination outreach Next-best-action | Patricia Adams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018731 | Care coordination outreach Next-best-action | Barbara Edwards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018732 | Care coordination outreach Next-best-action | Hiroshi Rogers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018733 | Care coordination outreach Next-best-action | Debra Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018734 | Care coordination outreach Next-best-action | Hannah Roberts: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018735 | Care coordination outreach Next-best-action | Gerald Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018736 | Care coordination outreach Next-best-action | Billy Fisher: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018737 | Care coordination outreach Next-best-action | Stephanie Hamilton: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018738 | Care coordination outreach Next-best-action | Eric Lane: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018739 | Care coordination outreach Next-best-action | Mark Jimenez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018740 | Care coordination outreach Next-best-action | Sharon Davis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018741 | Care coordination outreach Next-best-action | Stephen Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018742 | Care coordination outreach Next-best-action | Joe Ford: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018743 | Care coordination outreach Next-best-action | Mariana Reid: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018744 | Care coordination outreach Next-best-action | Nancy Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018745 | Care coordination outreach Next-best-action | Cheryl Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018746 | Care coordination outreach Next-best-action | Lauren Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018747 | Care coordination outreach Next-best-action | Randy Edwards: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018748 | Care coordination outreach Next-best-action | Jason Meyer: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018749 | Care coordination outreach Next-best-action | Patricia Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018750 | Care coordination outreach Next-best-action | Kathleen Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018751 | Care coordination outreach Next-best-action | Benjamin Contreras: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018752 | Care coordination outreach Next-best-action | Gary Fields: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018753 | Care coordination outreach Next-best-action | Ronald Guzman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018754 | Care coordination outreach Next-best-action | Victoria Knight: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018755 | Care coordination outreach Next-best-action | Arthur Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018756 | Care coordination outreach Next-best-action | Nathan Tran: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018757 | Care coordination outreach Next-best-action | Walter Harris: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018758 | Care coordination outreach Next-best-action | Judy Martin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018759 | Care coordination outreach Next-best-action | Wei Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018760 | Care coordination outreach Next-best-action | Luis Greene: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018761 | Care coordination outreach Next-best-action | Terry Gomez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018762 | Care coordination outreach Next-best-action | Alan Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018763 | Care coordination outreach Next-best-action | Jerry Hughes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018764 | Care coordination outreach Next-best-action | Sean Watkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018765 | Care coordination outreach Next-best-action | Susan Morris: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018766 | Care coordination outreach Next-best-action | Bryan Scott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018767 | Care coordination outreach Next-best-action | Mason Santiago: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018768 | Care coordination outreach Next-best-action | Willie Medina: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018769 | Care coordination outreach Next-best-action | Kathleen Carter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018770 | Care coordination outreach Next-best-action | Daniel Elliott: 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.