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-014445 | Outreach suppressed pending steward Outreach | CLM-425877 (Mari Green) held until CASE-001001 is decided |
| Held | — | ||
| ACT-014446 | Outreach suppressed pending steward Outreach | PRV-21549 (Scott Garrett) held until CASE-001002 is decided |
| Held | — | ||
| ACT-014447 | Outreach suppressed pending steward Outreach | ENR-107049 (Scott Garrett) held until CASE-001003 is decided |
| Held | — | ||
| ACT-014448 | Outreach suppressed pending steward Outreach | TPA-58822 (Marcus Salazar) held until CASE-001004 is decided |
| Held | — | ||
| ACT-014449 | Outreach suppressed pending steward Outreach | PRV-22661 (David Cole) held until CASE-001005 is decided |
| Held | — | ||
| ACT-014450 | Outreach suppressed pending steward Outreach | TPA-63111 (Christine Moore) held until CASE-001006 is decided |
| Held | — | ||
| ACT-014451 | Outreach suppressed pending steward Outreach | CLM-432590 (Chrystina Martinez) held until CASE-001007 is decided |
| Held | — | ||
| ACT-014452 | Outreach suppressed pending steward Outreach | PRV-29522 (Christina Martinez) held until CASE-001008 is decided |
| Held | — | ||
| ACT-014453 | Outreach suppressed pending steward Outreach | CLM-424178 (Joe Reyes) held until CASE-001009 is decided |
| Held | — | ||
| ACT-014454 | Outreach suppressed pending steward Outreach | ENR-125512 (Ahmed Mendez) held until CASE-001010 is decided |
| Held | — | ||
| ACT-014455 | Outreach suppressed pending steward Outreach | CLM-419360 (Ahmed Mendez) held until CASE-001011 is decided |
| Held | — | ||
| ACT-014456 | Outreach suppressed pending steward Outreach | TPA-53714 (Roy Mendez) held until CASE-001012 is decided |
| Held | — | ||
| ACT-014457 | Outreach suppressed pending steward Outreach | ENR-111148 (Roy Mendez) held until CASE-001013 is decided |
| Held | — | ||
| ACT-014458 | Outreach suppressed pending steward Outreach | CLM-407879 (Scott Santos) held until CASE-001014 is decided |
| Held | — | ||
| ACT-014459 | Outreach suppressed pending steward Outreach | TPA-53479 (Scott Santos) held until CASE-001015 is decided |
| Held | — | ||
| ACT-014460 | Outreach suppressed pending steward Outreach | PRV-21759 (Scott Santos) held until CASE-001016 is decided |
| Held | — | ||
| ACT-014461 | Outreach suppressed pending steward Outreach | ENR-107917 (Scott Santos) held until CASE-001017 is decided |
| Held | — | ||
| ACT-014462 | Outreach suppressed pending steward Outreach | CLM-430351 (Aaron Shaw) held until CASE-001018 is decided |
| Held | — | ||
| ACT-014463 | Outreach suppressed pending steward Outreach | CLM-415308 (Christine Pierce) held until CASE-001019 is decided |
| Held | — | ||
| ACT-014464 | Outreach suppressed pending steward Outreach | CLM-425539 (Megan Carlson) held until CASE-001020 is decided |
| Held | — | ||
| ACT-014465 | Outreach suppressed pending steward Outreach | CLM-423019 (Bradley Carlson) held until CASE-001021 is decided |
| Held | — | ||
| ACT-014466 | Outreach suppressed pending steward Outreach | TPA-57949 (Jordan Mitchell) held until CASE-001022 is decided |
| Held | — | ||
| ACT-014467 | Outreach suppressed pending steward Outreach | TPA-50337 (Kathryn King) held until CASE-001023 is decided |
| Held | — | ||
| ACT-014468 | Outreach suppressed pending steward Outreach | ENR-100974 (Kathryn King) held until CASE-001024 is decided |
| Held | — | ||
| ACT-014469 | Outreach suppressed pending steward Outreach | ENR-140038 (Christina Hughes) held until CASE-001025 is decided |
| Held | — | ||
| ACT-014470 | Outreach suppressed pending steward Outreach | TPA-63472 (Christina Hughes) held until CASE-001026 is decided |
| Held | — | ||
| ACT-014471 | Outreach suppressed pending steward Outreach | TPA-55080 (Doris Cox) held until CASE-001027 is decided |
| Held | — | ||
| ACT-014472 | Outreach suppressed pending steward Outreach | ENR-139392 (Christine Marquez) held until CASE-001028 is decided |
| Held | — | ||
| ACT-014473 | Outreach suppressed pending steward Outreach | TPA-63263 (Christine Marquez) held until CASE-001029 is decided |
| Held | — | ||
| ACT-014474 | Outreach suppressed pending steward Outreach | ENR-133096 (Sarah Parker) held until CASE-001030 is decided |
| Held | — | ||
| ACT-014475 | Outreach suppressed pending steward Outreach | CLM-430921 (Betty Perez) held until CASE-001031 is decided |
| Held | — | ||
| ACT-014476 | Outreach suppressed pending steward Outreach | CLM-431630 (Samantha Meyer) held until CASE-001032 is decided |
| Held | — | ||
| ACT-014477 | Outreach suppressed pending steward Outreach | PRV-28063 (Brittany Murray) held until CASE-001033 is decided |
| Held | — | ||
| ACT-014478 | Outreach suppressed pending steward Outreach | TPA-62146 (Brittany Murray) held until CASE-001034 is decided |
| Held | — | ||
| ACT-014479 | Outreach suppressed pending steward Outreach | TPA-50595 (Cynthia Hensen) held until CASE-001035 is decided |
| Held | — | ||
| ACT-014480 | Outreach suppressed pending steward Outreach | TPA-58448 (Donna Stone) held until CASE-001036 is decided |
| Held | — | ||
| ACT-014481 | Outreach suppressed pending steward Outreach | PRV-25677 (Donna Stone) held until CASE-001037 is decided |
| Held | — | ||
| ACT-014482 | Outreach suppressed pending steward Outreach | ENR-131105 (Aisha Carlson) held until CASE-001038 is decided |
| Held | — | ||
| ACT-014483 | Outreach suppressed pending steward Outreach | TPA-60458 (Aisha Carlson) held until CASE-001039 is decided |
| Held | — | ||
| ACT-014484 | Outreach suppressed pending steward Outreach | ENR-126611 (Jesse Carlson) held until CASE-001040 is decided |
| Held | — | ||
| ACT-014485 | Outreach suppressed pending steward Outreach | TPA-58908 (Jesse Carlson) held until CASE-001041 is decided |
| Held | — | ||
| ACT-014486 | Outreach suppressed pending steward Outreach | CLM-432808 (Carlos Payne) held until CASE-001042 is decided |
| Held | — | ||
| ACT-014487 | Outreach suppressed pending steward Outreach | TPA-53658 (Shirley Hamilton) held until CASE-001043 is decided |
| Held | — | ||
| ACT-014488 | Outreach suppressed pending steward Outreach | CLM-417814 (Karen Bishop) held until CASE-001044 is decided |
| Held | — | ||
| ACT-014489 | Outreach suppressed pending steward Outreach | CLM-429147 (Nancy Morales) held until CASE-001045 is decided |
| Held | — | ||
| ACT-014490 | Outreach suppressed pending steward Outreach | PRV-24691 (Randy Robertson) held until CASE-001046 is decided |
| Held | — | ||
| ACT-014491 | Outreach suppressed pending steward Outreach | TPA-63273 (Christine Phillips) held until CASE-001047 is decided |
| Held | — | ||
| ACT-014492 | Outreach suppressed pending steward Outreach | PRV-23863 (Priya Rogers) held until CASE-001048 is decided |
| Held | — | ||
| ACT-014493 | Outreach suppressed pending steward Outreach | PRV-25085 (Matt Williamson) held until CASE-001049 is decided |
| Held | — | ||
| ACT-014494 | Outreach suppressed pending steward Outreach | CLM-423420 (Joyce Jensen) held until CASE-001050 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.