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-003112 | Orphan claim re-pointed Claims processor | CLM-431935 → UHC-66521-88 (Helen Martin) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003113 | Orphan claim re-pointed Claims processor | CLM-412678 → UHC-80929-12 (Lucia Duunn) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003114 | Orphan claim re-pointed Claims processor | CLM-421343 → UHC-72821-85 (Eugene Spencer) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003115 | Orphan claim re-pointed Claims processor | CLM-404353 → UHC-87927-23 (Brenda Singh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003116 | Orphan claim re-pointed Claims processor | CLM-410264 → UHC-09624-69 (Shirley Phillips) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003117 | Orphan claim re-pointed Claims processor | CLM-420386 → UHC-43116-07 (Anthony Henry) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003118 | Orphan claim re-pointed Claims processor | CLM-430165 → UHC-29214-49 (Raymond Castillo) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003119 | Orphan claim re-pointed Claims processor | CLM-412605 → UHC-28401-72 (Lori Campbell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003120 | Orphan claim re-pointed Claims processor | CLM-412347 → UHC-83902-40 (Catherine James) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003121 | Orphan claim re-pointed Claims processor | CLM-402896 → UHC-38901-87 (Bradley Hayes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003122 | Orphan claim re-pointed Claims processor | CLM-428317 → UHC-43500-59 (Vincent West) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003123 | Orphan claim re-pointed Claims processor | CLM-405795 → UHC-34754-10 (Eugene Barnes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003124 | Orphan claim re-pointed Claims processor | CLM-427900 → UHC-83530-31 (Keith Larson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003125 | Orphan claim re-pointed Claims processor | CLM-427612 → UHC-08814-68 (Keith Banks) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003126 | Orphan claim re-pointed Claims processor | CLM-414049 → UHC-15036-66 (Andrew Munoz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003127 | Orphan claim re-pointed Claims processor | CLM-419920 → UHC-65965-34 (Douglas Wang) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003128 | Orphan claim re-pointed Claims processor | CLM-424213 → UHC-44341-02 (Roy Campbell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003129 | Orphan claim re-pointed Claims processor | CLM-406174 → UHC-07294-32 (Jean Kelly) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003130 | Orphan claim re-pointed Claims processor | CLM-413405 → UHC-68004-93 (Lori Singh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003131 | Orphan claim re-pointed Claims processor | CLM-426715 → UHC-21038-92 (Melissa Butler) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003132 | Orphan claim re-pointed Claims processor | CLM-403580 → UHC-92434-45 (Brittany Cruz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003133 | Orphan claim re-pointed Claims processor | CLM-426188 → UHC-00810-97 (Mark Marquez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003134 | Orphan claim re-pointed Claims processor | CLM-430074 → UHC-91339-64 (Arthur Cooper) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003135 | Orphan claim re-pointed Claims processor | CLM-411024 → UHC-52164-96 (Olivia Ramirez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003136 | Orphan claim re-pointed Claims processor | CLM-408481 → UHC-53963-27 (Richard Oliver) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003137 | Orphan claim re-pointed Claims processor | CLM-416280 → UHC-27210-12 (Frank Duncan) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003138 | Orphan claim re-pointed Claims processor | CLM-410463 → UHC-09878-93 (Luis Smith) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003139 | Orphan claim re-pointed Claims processor | CLM-402213 → UHC-27777-76 (Edward Garrett) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003140 | Orphan claim re-pointed Claims processor | CLM-429419 → UHC-97480-71 (Billy Herrera) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003141 | Orphan claim re-pointed Claims processor | CLM-414629 → UHC-86083-39 (Kathryn Gray) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003142 | Orphan claim re-pointed Claims processor | CLM-419130 → UHC-77185-29 (Albert Freeman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003143 | Orphan claim re-pointed Claims processor | CLM-408793 → UHC-55422-71 (Nancy Simpson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003144 | Orphan claim re-pointed Claims processor | CLM-431847 → UHC-07344-39 (Roy James) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003145 | Orphan claim re-pointed Claims processor | CLM-408498 → UHC-35056-20 (Alexander Carter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003146 | Orphan claim re-pointed Claims processor | CLM-420418 → UHC-88855-86 (Samantha Hawkins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003147 | Orphan claim re-pointed Claims processor | CLM-423396 → UHC-08669-16 (Vicky Cook) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003148 | Orphan claim re-pointed Claims processor | CLM-423933 → UHC-78913-28 (Sara Wallace) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003149 | Orphan claim re-pointed Claims processor | CLM-412700 → UHC-12163-61 (Sara Wheeler) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003150 | Orphan claim re-pointed Claims processor | CLM-414239 → UHC-62249-83 (Jeffrey Alvarado) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003151 | Orphan claim re-pointed Claims processor | CLM-414737 → UHC-89406-61 (Yuki Foster) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003152 | Orphan claim re-pointed Claims processor | CLM-421543 → UHC-22001-33 (Megan Medina) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003153 | Orphan claim re-pointed Claims processor | CLM-418833 → UHC-86924-33 (Henry Scott) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003154 | Orphan claim re-pointed Claims processor | CLM-426448 → UHC-48090-22 (Mason Jacobs) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003155 | Orphan claim re-pointed Claims processor | CLM-411658 → UHC-43847-07 (Lisa Sanchez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003156 | Orphan claim re-pointed Claims processor | CLM-421643 → UHC-93863-72 (Brenda Smith) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003157 | Orphan claim re-pointed Claims processor | CLM-430027 → UHC-82268-47 (Carolyn Li) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003158 | Orphan claim re-pointed Claims processor | CLM-432795 → UHC-92761-01 (Stephen Murray) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003159 | Orphan claim re-pointed Claims processor | CLM-407158 → UHC-17496-87 (Dylan Stewart) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003160 | Orphan claim re-pointed Claims processor | CLM-414166 → UHC-04085-61 (Jessica Wang) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003161 | Orphan claim re-pointed Claims processor | CLM-425451 → UHC-33272-26 (Raymond Grant) |
| Executed | resolution_agent 2026-10-22 12:47:23 |
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.