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-014545 | Outreach suppressed pending steward Outreach | CLM-426462 (Martha Soto) held until CASE-001101 is decided |
| Held | — | ||
| ACT-014546 | Outreach suppressed pending steward Outreach | CLM-425185 (Tim Clark) held until CASE-001102 is decided |
| Held | — | ||
| ACT-014547 | Outreach suppressed pending steward Outreach | TPA-59171 (Sandra Carlson) held until CASE-001103 is decided |
| Held | — | ||
| ACT-014548 | Outreach suppressed pending steward Outreach | TPA-56648 (Stephanie Morgan) held until CASE-001104 is decided |
| Held | — | ||
| ACT-014549 | Outreach suppressed pending steward Outreach | TPA-53036 (Luica Welch) held until CASE-001105 is decided |
| Held | — | ||
| ACT-014550 | Outreach suppressed pending steward Outreach | ENR-133551 (Nancy Welch) held until CASE-001106 is decided |
| Held | — | ||
| ACT-014551 | Outreach suppressed pending steward Outreach | CLM-425643 (Nancy Welch) held until CASE-001107 is decided |
| Held | — | ||
| ACT-014552 | Outreach suppressed pending steward Outreach | CLM-425644 (Nancy Welch) held until CASE-001108 is decided |
| Held | — | ||
| ACT-014553 | Outreach suppressed pending steward Outreach | CLM-402542 (James Delgado) held until CASE-001109 is decided |
| Held | — | ||
| ACT-014554 | Outreach suppressed pending steward Outreach | PRV-22587 (Catherine Marquez) held until CASE-001110 is decided |
| Held | — | ||
| ACT-014555 | Outreach suppressed pending steward Outreach | CLM-428827 (Brandon Bryant) held until CASE-001111 is decided |
| Held | — | ||
| ACT-014556 | Outreach suppressed pending steward Outreach | CLM-428826 (Brandon Bryant) held until CASE-001112 is decided |
| Held | — | ||
| ACT-014557 | Outreach suppressed pending steward Outreach | CLM-428825 (Brandon Bryant) held until CASE-001113 is decided |
| Held | — | ||
| ACT-014558 | Outreach suppressed pending steward Outreach | TPA-62366 (Helen Garcia) held until CASE-001114 is decided |
| Held | — | ||
| ACT-014559 | Outreach suppressed pending steward Outreach | CLM-401583 (Wayne Santiago) held until CASE-001115 is decided |
| Held | — | ||
| ACT-014560 | Outreach suppressed pending steward Outreach | TPA-63827 (Douglas Ruiz) held until CASE-001116 is decided |
| Held | — | ||
| ACT-014561 | Outreach suppressed pending steward Outreach | TPA-51369 (Robert Ross) held until CASE-001117 is decided |
| Held | — | ||
| ACT-014562 | Outreach suppressed pending steward Outreach | CLM-403189 (Bobby Ross) held until CASE-001118 is decided |
| Held | — | ||
| ACT-014563 | Outreach suppressed pending steward Outreach | TPA-56015 (Stephanie Castillo) held until CASE-001119 is decided |
| Held | — | ||
| ACT-014564 | Outreach suppressed pending steward Outreach | CLM-423977 (Chuck Couk) held until CASE-001120 is decided |
| Held | — | ||
| ACT-014565 | Outreach suppressed pending steward Outreach | CLM-404630 (Jacqueline Bailey) held until CASE-001121 is decided |
| Held | — | ||
| ACT-014566 | Outreach suppressed pending steward Outreach | CLM-404629 (Jacqueline Bailey) held until CASE-001122 is decided |
| Held | — | ||
| ACT-014567 | Outreach suppressed pending steward Outreach | TPA-62675 (Betty Myers) held until CASE-001123 is decided |
| Held | — | ||
| ACT-014568 | Outreach suppressed pending steward Outreach | CLM-431914 (Juan Myers) held until CASE-001124 is decided |
| Held | — | ||
| ACT-014569 | Outreach suppressed pending steward Outreach | ENR-103365 (Grace Chapman) held until CASE-001125 is decided |
| Held | — | ||
| ACT-014570 | Outreach suppressed pending steward Outreach | TPA-51121 (Grace Chapman) held until CASE-001126 is decided |
| Held | — | ||
| ACT-014571 | Outreach suppressed pending steward Outreach | TPA-63678 (Kelly Chapman) held until CASE-001127 is decided |
| Held | — | ||
| ACT-014572 | Outreach suppressed pending steward Outreach | CLM-430956 (Kelly Chapman) held until CASE-001128 is decided |
| Held | — | ||
| ACT-014573 | Outreach suppressed pending steward Outreach | CLM-408298 (Jean White) held until CASE-001129 is decided |
| Held | — | ||
| ACT-014574 | Outreach suppressed pending steward Outreach | CLM-410396 (Philip Wood) held until CASE-001130 is decided |
| Held | — | ||
| ACT-014575 | Outreach suppressed pending steward Outreach | CLM-412831 (Wayne Roberts) held until CASE-001131 is decided |
| Held | — | ||
| ACT-014576 | Outreach suppressed pending steward Outreach | TPA-53138 (Stephanie Roberts) held until CASE-001132 is decided |
| Held | — | ||
| ACT-014577 | Outreach suppressed pending steward Outreach | ENR-109376 (Stephanie Roberts) held until CASE-001133 is decided |
| Held | — | ||
| ACT-014578 | Outreach suppressed pending steward Outreach | TPA-55641 (Wayne Roberts) held until CASE-001134 is decided |
| Held | — | ||
| ACT-014579 | Outreach suppressed pending steward Outreach | PRV-28396 (Jack Warren) held until CASE-001135 is decided |
| Held | — | ||
| ACT-014580 | Outreach suppressed pending steward Outreach | CLM-421189 (Brian Fuller) held until CASE-001136 is decided |
| Held | — | ||
| ACT-014581 | Outreach suppressed pending steward Outreach | TPA-60149 (Karen Green) held until CASE-001137 is decided |
| Held | — | ||
| ACT-014582 | Outreach suppressed pending steward Outreach | PRV-22686 (Cheryl Stephens) held until CASE-001138 is decided |
| Held | — | ||
| ACT-014583 | Outreach suppressed pending steward Outreach | TPA-53990 (Cheryl Stepehns) held until CASE-001139 is decided |
| Held | — | ||
| ACT-014584 | Outreach suppressed pending steward Outreach | ENR-141244 (Russell Park) held until CASE-001140 is decided |
| Held | — | ||
| ACT-014585 | Outreach suppressed pending steward Outreach | CLM-431420 (Russell Park) held until CASE-001141 is decided |
| Held | — | ||
| ACT-014586 | Outreach suppressed pending steward Outreach | ENR-123771 (Eric Hayees) held until CASE-001142 is decided |
| Held | — | ||
| ACT-014587 | Outreach suppressed pending steward Outreach | PRV-25364 (Eric Hayes) held until CASE-001143 is decided |
| Held | — | ||
| ACT-014588 | Outreach suppressed pending steward Outreach | CLM-423973 (Isabella Edwards) held until CASE-001144 is decided |
| Held | — | ||
| ACT-014589 | Outreach suppressed pending steward Outreach | CLM-417778 (Fatima Jordan) held until CASE-001145 is decided |
| Held | — | ||
| ACT-014590 | Outreach suppressed pending steward Outreach | CLM-417779 (Fatima Jordan) held until CASE-001146 is decided |
| Held | — | ||
| ACT-014591 | Outreach suppressed pending steward Outreach | ENR-127601 (Russell Espinoza) held until CASE-001147 is decided |
| Held | — | ||
| ACT-014592 | Outreach suppressed pending steward Outreach | CLM-421016 (Russell Espinoza) held until CASE-001148 is decided |
| Held | — | ||
| ACT-014593 | Outreach suppressed pending steward Outreach | CLM-414789 (Olivia Ruiz) held until CASE-001149 is decided |
| Held | — | ||
| ACT-014594 | Outreach suppressed pending steward Outreach | CLM-404100 (Gary Rice) held until CASE-001150 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.