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-018871 | Care coordination outreach Next-best-action | Betty Daniels: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018872 | Care coordination outreach Next-best-action | Elizabeth Reyes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018873 | Care coordination outreach Next-best-action | Samantha Romero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018874 | Care coordination outreach Next-best-action | Julia McDonald: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018875 | Care coordination outreach Next-best-action | Bruce Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018876 | Care coordination outreach Next-best-action | Christian Woods: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018877 | Care coordination outreach Next-best-action | Jordan Evans: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018878 | Care coordination outreach Next-best-action | Gregory Roberts: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018879 | Care coordination outreach Next-best-action | Ethan Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018880 | Care coordination outreach Next-best-action | Charlotte Wheeler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018881 | Care coordination outreach Next-best-action | Jeffrey Singh: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018882 | Care coordination outreach Next-best-action | Sharon Stone: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018883 | Care coordination outreach Next-best-action | Ryan Howard: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018884 | Care coordination outreach Next-best-action | Judith Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018885 | Care coordination outreach Next-best-action | Dylan King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018886 | Care coordination outreach Next-best-action | Maria Fields: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018887 | Care coordination outreach Next-best-action | Nathan Olson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018888 | Care coordination outreach Next-best-action | Bradley Jones: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018889 | Care coordination outreach Next-best-action | Stephen Watkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018890 | Care coordination outreach Next-best-action | Douglas Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018891 | Care coordination outreach Next-best-action | Kenneth Martinez: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018892 | Care coordination outreach Next-best-action | Omar Stone: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018893 | Care coordination outreach Next-best-action | Cynthia Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018894 | Care coordination outreach Next-best-action | Donna Morris: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018895 | Care coordination outreach Next-best-action | Katherine Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018896 | Care coordination outreach Next-best-action | Santiago Thompson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018897 | Care coordination outreach Next-best-action | Jdy Wells: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018898 | Care coordination outreach Next-best-action | Karen Wagner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018899 | Care coordination outreach Next-best-action | Kimberly Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018900 | Care coordination outreach Next-best-action | Donna Jenkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018901 | Care coordination outreach Next-best-action | Amber Greene: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018902 | Care coordination outreach Next-best-action | Dylan Rivera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018903 | Care coordination outreach Next-best-action | Lawrence Chapman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018904 | Care coordination outreach Next-best-action | Dennis Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018905 | Care coordination outreach Next-best-action | Joyce Reid: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018906 | Care coordination outreach Next-best-action | Amanda Hill: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018907 | Care coordination outreach Next-best-action | Jacqueline Webb: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018908 | Care coordination outreach Next-best-action | Nicholas Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018909 | Care coordination outreach Next-best-action | Steve Guerrero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018910 | Care coordination outreach Next-best-action | Helen Washington: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018911 | Care coordination outreach Next-best-action | Grace Hawkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018912 | Care coordination outreach Next-best-action | Shirley Lopez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018913 | Care coordination outreach Next-best-action | Theresa Henry: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018914 | Care coordination outreach Next-best-action | Luis Dominguez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018915 | Care coordination outreach Next-best-action | Natalie Ferguson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018916 | Care coordination outreach Next-best-action | Joe Green: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018917 | Care coordination outreach Next-best-action | Bryan Grant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018918 | Care coordination outreach Next-best-action | Judith Castillo: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018919 | Care coordination outreach Next-best-action | Julia Alexander: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018920 | Care coordination outreach Next-best-action | Karen Welch: 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.