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-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.