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-018921 | Care coordination outreach Next-best-action | Brittany Banks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018922 | Care coordination outreach Next-best-action | Helen Ellis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018923 | Care coordination outreach Next-best-action | Carlos Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018924 | Care coordination outreach Next-best-action | Janice Kelley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018925 | Care coordination outreach Next-best-action | Jack Marshall: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018926 | Care coordination outreach Next-best-action | Juan Murphy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018927 | Care coordination outreach Next-best-action | Ann Hudson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018928 | Care coordination outreach Next-best-action | Michelle Jensen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018929 | Care coordination outreach Next-best-action | Lisa Foster: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018930 | Care coordination outreach Next-best-action | Dennis Brown: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018931 | Care coordination outreach Next-best-action | Keith Brooks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018932 | Care coordination outreach Next-best-action | Sean Alvarado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018933 | Care coordination outreach Next-best-action | Jackie Watson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018934 | Care coordination outreach Next-best-action | Bradley Carroll: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018935 | Care coordination outreach Next-best-action | Brandon Armstrong: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018936 | Care coordination outreach Next-best-action | Sofia Andrews: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018937 | Care coordination outreach Next-best-action | Sean Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018938 | Care coordination outreach Next-best-action | Ruth White: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018939 | Care coordination outreach Next-best-action | Victoria Herrera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018940 | Care coordination outreach Next-best-action | Logan Salazar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018941 | Care coordination outreach Next-best-action | Ralph Cole: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018942 | Care coordination outreach Next-best-action | Alexis Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018943 | Care coordination outreach Next-best-action | Hiroshi Montgomery: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018944 | Care coordination outreach Next-best-action | Diana Thomas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018945 | Care coordination outreach Next-best-action | Logan Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018946 | Care coordination outreach Next-best-action | Joe Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018947 | Care coordination outreach Next-best-action | Evelyn Fisher: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018948 | Care coordination outreach Next-best-action | Luis Butler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018949 | Care coordination outreach Next-best-action | Ruth Harper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018950 | Care coordination outreach Next-best-action | Brandon Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018951 | Care coordination outreach Next-best-action | Karen Stewart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018952 | Care coordination outreach Next-best-action | Judith Larson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018953 | Care coordination outreach Next-best-action | Yuki Boyd: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018954 | Care coordination outreach Next-best-action | Melissa Cruz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018955 | Care coordination outreach Next-best-action | Julia Castro: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018956 | Care coordination outreach Next-best-action | Margaret Bryant: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018957 | Care coordination outreach Next-best-action | Ashley Cox: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018958 | Care coordination outreach Next-best-action | Billy Weaver: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018959 | Care coordination outreach Next-best-action | Alexis Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018960 | Care coordination outreach Next-best-action | Shirley Simpson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018961 | Care coordination outreach Next-best-action | Sharon Mendoza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018962 | Care coordination outreach Next-best-action | Terry Russell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018963 | Care coordination outreach Next-best-action | Sarah Sanchez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018964 | Care coordination outreach Next-best-action | Keith Hernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018965 | Care coordination outreach Next-best-action | Angela Garrett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018966 | Care coordination outreach Next-best-action | Cheryl Simmons: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018967 | Care coordination outreach Next-best-action | Christian Ferguson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018968 | Care coordination outreach Next-best-action | Hannah Mendoza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018969 | Care coordination outreach Next-best-action | Catherine Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018970 | Care coordination outreach Next-best-action | Kathryn Chapman: 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.