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-018771 | Care coordination outreach Next-best-action | Bradley Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018772 | Care coordination outreach Next-best-action | Vincent Hart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018773 | Care coordination outreach Next-best-action | Walter Hudson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018774 | Care coordination outreach Next-best-action | Michael Campbell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018775 | Care coordination outreach Next-best-action | Benjamin Montgomery: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018776 | Care coordination outreach Next-best-action | Roy Howell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018777 | Care coordination outreach Next-best-action | Grace Hayes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018778 | Care coordination outreach Next-best-action | Willie Price: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018779 | Care coordination outreach Next-best-action | Willie Wang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018780 | Care coordination outreach Next-best-action | Dennis Hamilton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018781 | Care coordination outreach Next-best-action | Scott Henderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018782 | Care coordination outreach Next-best-action | Lori Hawkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018783 | Care coordination outreach Next-best-action | Mary Fuller: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018784 | Care coordination outreach Next-best-action | Joyce Hanson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018785 | Care coordination outreach Next-best-action | Samantha Palmer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018786 | Care coordination outreach Next-best-action | Philip Black: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018787 | Care coordination outreach Next-best-action | Nicholas Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018788 | Care coordination outreach Next-best-action | Kelly Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018789 | Care coordination outreach Next-best-action | Carolyn Smith: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018790 | Care coordination outreach Next-best-action | Terry Snyder: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018791 | Care coordination outreach Next-best-action | Anna Knight: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018792 | Care coordination outreach Next-best-action | Philip Garrett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018793 | Care coordination outreach Next-best-action | Beverly Schultz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018794 | Care coordination outreach Next-best-action | James Kim: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018795 | Care coordination outreach Next-best-action | Keith Collins: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018796 | Care coordination outreach Next-best-action | Ralph Campbell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018797 | Care coordination outreach Next-best-action | Nicole Kelley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018798 | Care coordination outreach Next-best-action | Teresa Washington: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018799 | Care coordination outreach Next-best-action | Christian King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018800 | Care coordination outreach Next-best-action | Emily Thompson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018801 | Care coordination outreach Next-best-action | Lauren Freeman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018802 | Care coordination outreach Next-best-action | Aaron Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018803 | Care coordination outreach Next-best-action | John Estrada: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018804 | Care coordination outreach Next-best-action | Jose Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018805 | Care coordination outreach Next-best-action | Wei Harrison: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018806 | Care coordination outreach Next-best-action | Mary Howard: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018807 | Care coordination outreach Next-best-action | Catherine Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018808 | Care coordination outreach Next-best-action | Betty Williamson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018809 | Care coordination outreach Next-best-action | Michael Kim: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018810 | Care coordination outreach Next-best-action | Eugene Sanchez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018811 | Care coordination outreach Next-best-action | Thomas Walker: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018812 | Care coordination outreach Next-best-action | Mei Tran: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018813 | Care coordination outreach Next-best-action | Grace James: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018814 | Care coordination outreach Next-best-action | Bruce Jensen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018815 | Care coordination outreach Next-best-action | Amber Mills: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018816 | Care coordination outreach Next-best-action | Ralph Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018817 | Care coordination outreach Next-best-action | Emily Young: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018818 | Care coordination outreach Next-best-action | Patrick Schmidt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018819 | Care coordination outreach Next-best-action | Michael Vargas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018820 | Care coordination outreach Next-best-action | Alan Lane: 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.