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-014495 | Outreach suppressed pending steward Outreach | ENR-130622 (Joyce Jnesen) held until CASE-001051 is decided |
| Held | — | ||
| ACT-014496 | Outreach suppressed pending steward Outreach | ENR-100518 (Debra Jensen) held until CASE-001052 is decided |
| Held | — | ||
| ACT-014497 | Outreach suppressed pending steward Outreach | CLM-400377 (Debra Jensen) held until CASE-001053 is decided |
| Held | — | ||
| ACT-014498 | Outreach suppressed pending steward Outreach | ENR-128307 (Mary Cox) held until CASE-001054 is decided |
| Held | — | ||
| ACT-014499 | Outreach suppressed pending steward Outreach | PRV-28318 (Dennis Sims) held until CASE-001055 is decided |
| Held | — | ||
| ACT-014500 | Outreach suppressed pending steward Outreach | TPA-58620 (Nick Bailey) held until CASE-001056 is decided |
| Held | — | ||
| ACT-014501 | Outreach suppressed pending steward Outreach | CLM-419556 (Nicholas Bailey) held until CASE-001057 is decided |
| Held | — | ||
| ACT-014502 | Outreach suppressed pending steward Outreach | PRV-26829 (Alice Marquez) held until CASE-001058 is decided |
| Held | — | ||
| ACT-014503 | Outreach suppressed pending steward Outreach | ENR-130257 (Alice Marquez) held until CASE-001059 is decided |
| Held | — | ||
| ACT-014504 | Outreach suppressed pending steward Outreach | TPA-56126 (Hiroshi Green) held until CASE-001060 is decided |
| Held | — | ||
| ACT-014505 | Outreach suppressed pending steward Outreach | CLM-413906 (Hiroshi Green) held until CASE-001061 is decided |
| Held | — | ||
| ACT-014506 | Outreach suppressed pending steward Outreach | TPA-55630 (Alice Perkins) held until CASE-001062 is decided |
| Held | — | ||
| ACT-014507 | Outreach suppressed pending steward Outreach | CLM-430842 (Katherine Gonzalez) held until CASE-001063 is decided |
| Held | — | ||
| ACT-014508 | Outreach suppressed pending steward Outreach | TPA-54984 (Billy Hansen) held until CASE-001064 is decided |
| Held | — | ||
| ACT-014509 | Outreach suppressed pending steward Outreach | CLM-426731 (Abmer Lopez) held until CASE-001065 is decided |
| Held | — | ||
| ACT-014510 | Outreach suppressed pending steward Outreach | TPA-61898 (Mason Fuller) held until CASE-001066 is decided |
| Held | — | ||
| ACT-014511 | Outreach suppressed pending steward Outreach | TPA-61897 (Mason Fuller) held until CASE-001067 is decided |
| Held | — | ||
| ACT-014512 | Outreach suppressed pending steward Outreach | TPA-61061 (Joseph Day) held until CASE-001068 is decided |
| Held | — | ||
| ACT-014513 | Outreach suppressed pending steward Outreach | CLM-411897 (Nick Morgan) held until CASE-001069 is decided |
| Held | — | ||
| ACT-014514 | Outreach suppressed pending steward Outreach | CLM-430080 (Andrea Lee) held until CASE-001070 is decided |
| Held | — | ||
| ACT-014515 | Outreach suppressed pending steward Outreach | ENR-107325 (Abigail Fowler) held until CASE-001071 is decided |
| Held | — | ||
| ACT-014516 | Outreach suppressed pending steward Outreach | TPA-52453 (Abigail Fowler) held until CASE-001072 is decided |
| Held | — | ||
| ACT-014517 | Outreach suppressed pending steward Outreach | TPA-52452 (Abigail Fowler) held until CASE-001073 is decided |
| Held | — | ||
| ACT-014518 | Outreach suppressed pending steward Outreach | CLM-405804 (Samuel Wilson) held until CASE-001074 is decided |
| Held | — | ||
| ACT-014519 | Outreach suppressed pending steward Outreach | ENR-131117 (Carl Wilson) held until CASE-001075 is decided |
| Held | — | ||
| ACT-014520 | Outreach suppressed pending steward Outreach | TPA-53137 (Jose Fuller) held until CASE-001076 is decided |
| Held | — | ||
| ACT-014521 | Outreach suppressed pending steward Outreach | CLM-407171 (Jose Fuller) held until CASE-001077 is decided |
| Held | — | ||
| ACT-014522 | Outreach suppressed pending steward Outreach | CLM-431529 (Gabriel Simmons) held until CASE-001078 is decided |
| Held | — | ||
| ACT-014523 | Outreach suppressed pending steward Outreach | TPA-63970 (Terry Hansen) held until CASE-001079 is decided |
| Held | — | ||
| ACT-014524 | Outreach suppressed pending steward Outreach | PRV-29247 (Terry Hansen) held until CASE-001080 is decided |
| Held | — | ||
| ACT-014525 | Outreach suppressed pending steward Outreach | ENR-106762 (Marilyn Munoz) held until CASE-001081 is decided |
| Held | — | ||
| ACT-014526 | Outreach suppressed pending steward Outreach | CLM-405150 (Marilyn Munoz) held until CASE-001082 is decided |
| Held | — | ||
| ACT-014527 | Outreach suppressed pending steward Outreach | TPA-50736 (Stephen Jensen) held until CASE-001083 is decided |
| Held | — | ||
| ACT-014528 | Outreach suppressed pending steward Outreach | TPA-51802 (Ryan Walsh) held until CASE-001084 is decided |
| Held | — | ||
| ACT-014529 | Outreach suppressed pending steward Outreach | TPA-58583 (Kevin Welch) held until CASE-001085 is decided |
| Held | — | ||
| ACT-014530 | Outreach suppressed pending steward Outreach | ENR-125599 (Kevin Welch) held until CASE-001086 is decided |
| Held | — | ||
| ACT-014531 | Outreach suppressed pending steward Outreach | CLM-415444 (Tyler Rojas) held until CASE-001087 is decided |
| Held | — | ||
| ACT-014532 | Outreach suppressed pending steward Outreach | TPA-51633 (Lawrence Reyes) held until CASE-001088 is decided |
| Held | — | ||
| ACT-014533 | Outreach suppressed pending steward Outreach | ENR-104876 (Lawrence Reyes) held until CASE-001089 is decided |
| Held | — | ||
| ACT-014534 | Outreach suppressed pending steward Outreach | TPA-54731 (Marilyn Reyes) held until CASE-001090 is decided |
| Held | — | ||
| ACT-014535 | Outreach suppressed pending steward Outreach | CLM-410787 (Marilyn Reyes) held until CASE-001091 is decided |
| Held | — | ||
| ACT-014536 | Outreach suppressed pending steward Outreach | TPA-51640 (Ryan Rose) held until CASE-001092 is decided |
| Held | — | ||
| ACT-014537 | Outreach suppressed pending steward Outreach | ENR-104900 (Ryan Rose) held until CASE-001093 is decided |
| Held | — | ||
| ACT-014538 | Outreach suppressed pending steward Outreach | PRV-24522 (Wayne Jackson) held until CASE-001094 is decided |
| Held | — | ||
| ACT-014539 | Outreach suppressed pending steward Outreach | ENR-129116 (Kelly Richardson) held until CASE-001095 is decided |
| Held | — | ||
| ACT-014540 | Outreach suppressed pending steward Outreach | TPA-54355 (Virginia Hayes) held until CASE-001096 is decided |
| Held | — | ||
| ACT-014541 | Outreach suppressed pending steward Outreach | TPA-59004 (Janet Hicks) held until CASE-001097 is decided |
| Held | — | ||
| ACT-014542 | Outreach suppressed pending steward Outreach | CLM-423353 (Cynthia Luna) held until CASE-001098 is decided |
| Held | — | ||
| ACT-014543 | Outreach suppressed pending steward Outreach | CLM-416633 (Beverly Simmons) held until CASE-001099 is decided |
| Held | — | ||
| ACT-014544 | Outreach suppressed pending steward Outreach | ENR-121850 (Beverly Simmons) held until CASE-001100 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.