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-014595 | Outreach suppressed pending steward Outreach | CLM-407499 (Peter Fowler) held until CASE-001151 is decided |
| Held | — | ||
| ACT-014596 | Outreach suppressed pending steward Outreach | CLM-427830 (Wayne Cruz) held until CASE-001152 is decided |
| Held | — | ||
| ACT-014597 | Outreach suppressed pending steward Outreach | CLM-407772 (Brian Wang) held until CASE-001153 is decided |
| Held | — | ||
| ACT-014598 | Outreach suppressed pending steward Outreach | CLM-411948 (Don Paark) held until CASE-001154 is decided |
| Held | — | ||
| ACT-014599 | Outreach suppressed pending steward Outreach | TPA-55264 (Donald Park) held until CASE-001155 is decided |
| Held | — | ||
| ACT-014600 | Outreach suppressed pending steward Outreach | ENR-121154 (Lauren Pena) held until CASE-001156 is decided |
| Held | — | ||
| ACT-014601 | Outreach suppressed pending steward Outreach | TPA-57035 (Lauren Pena) held until CASE-001157 is decided |
| Held | — | ||
| ACT-014602 | Outreach suppressed pending steward Outreach | TPA-60042 (Stephanie Payne) held until CASE-001158 is decided |
| Held | — | ||
| ACT-014603 | Outreach suppressed pending steward Outreach | CLM-409423 (Frances Yang) held until CASE-001159 is decided |
| Held | — | ||
| ACT-014604 | Outreach suppressed pending steward Outreach | TPA-54089 (Frances Yang) held until CASE-001160 is decided |
| Held | — | ||
| ACT-014605 | Outreach suppressed pending steward Outreach | CLM-424059 (Kyle Black) held until CASE-001161 is decided |
| Held | — | ||
| ACT-014606 | Outreach suppressed pending steward Outreach | CLM-427150 (Marilyn Sullivan) held until CASE-001162 is decided |
| Held | — | ||
| ACT-014607 | Outreach suppressed pending steward Outreach | TPA-59926 (Bruce Clark) held until CASE-001163 is decided |
| Held | — | ||
| ACT-014608 | Outreach suppressed pending steward Outreach | CLM-404303 (Jason Delgado) held until CASE-001164 is decided |
| Held | — | ||
| ACT-014609 | Outreach suppressed pending steward Outreach | TPA-51872 (Jason Delgado) held until CASE-001165 is decided |
| Held | — | ||
| ACT-014610 | Outreach suppressed pending steward Outreach | ENR-125903 (Sharon Delgado) held until CASE-001166 is decided |
| Held | — | ||
| ACT-014611 | Outreach suppressed pending steward Outreach | PRV-22326 (Larry Walker) held until CASE-001167 is decided |
| Held | — | ||
| ACT-014612 | Outreach suppressed pending steward Outreach | ENR-125056 (Carol Montgomery) held until CASE-001168 is decided |
| Held | — | ||
| ACT-014613 | Outreach suppressed pending steward Outreach | TPA-61503 (Evelyn Yang) held until CASE-001169 is decided |
| Held | — | ||
| ACT-014614 | Outreach suppressed pending steward Outreach | CLM-426038 (Evelyn Yang) held until CASE-001170 is decided |
| Held | — | ||
| ACT-014615 | Outreach suppressed pending steward Outreach | PRV-27825 (Adam Singh) held until CASE-001171 is decided |
| Held | — | ||
| ACT-014616 | Outreach suppressed pending steward Outreach | TPA-55231 (Amanda Richards) held until CASE-001172 is decided |
| Held | — | ||
| ACT-014617 | Outreach suppressed pending steward Outreach | ENR-136872 (Ryan Richards) held until CASE-001173 is decided |
| Held | — | ||
| ACT-014618 | Outreach suppressed pending steward Outreach | CLM-429204 (Brian Little) held until CASE-001174 is decided |
| Held | — | ||
| ACT-014619 | Outreach suppressed pending steward Outreach | CLM-416479 (Jen Lynch) held until CASE-001175 is decided |
| Held | — | ||
| ACT-014620 | Outreach suppressed pending steward Outreach | CLM-416480 (Jen Lynch) held until CASE-001176 is decided |
| Held | — | ||
| ACT-014621 | Outreach suppressed pending steward Outreach | CLM-402809 (Adam Lynch) held until CASE-001177 is decided |
| Held | — | ||
| ACT-014622 | Outreach suppressed pending steward Outreach | ENR-103617 (Adam Lynch) held until CASE-001178 is decided |
| Held | — | ||
| ACT-014623 | Outreach suppressed pending steward Outreach | TPA-50823 (Dick Medina) held until CASE-001179 is decided |
| Held | — | ||
| ACT-014624 | Outreach suppressed pending steward Outreach | TPA-57894 (Ryan Wright) held until CASE-001180 is decided |
| Held | — | ||
| ACT-014625 | Outreach suppressed pending steward Outreach | PRV-24789 (Harold Greane) held until CASE-001181 is decided |
| Held | — | ||
| ACT-014626 | Outreach suppressed pending steward Outreach | TPA-51560 (Carolyn Green) held until CASE-001182 is decided |
| Held | — | ||
| ACT-014627 | Outreach suppressed pending steward Outreach | CLM-421059 (Deborah Sandoval) held until CASE-001183 is decided |
| Held | — | ||
| ACT-014628 | Outreach suppressed pending steward Outreach | CLM-411282 (Melissa Hudson) held until CASE-001184 is decided |
| Held | — | ||
| ACT-014629 | Outreach suppressed pending steward Outreach | CLM-411283 (Melissa Hudson) held until CASE-001185 is decided |
| Held | — | ||
| ACT-014630 | Outreach suppressed pending steward Outreach | CLM-402961 (Rebecca Warren) held until CASE-001186 is decided |
| Held | — | ||
| ACT-014631 | Outreach suppressed pending steward Outreach | TPA-50305 (Mariana Berry) held until CASE-001187 is decided |
| Held | — | ||
| ACT-014632 | Outreach suppressed pending steward Outreach | CLM-410458 (Rachle Scott) held until CASE-001188 is decided |
| Held | — | ||
| ACT-014633 | Outreach suppressed pending steward Outreach | CLM-408129 (Christian Romero) held until CASE-001189 is decided |
| Held | — | ||
| ACT-014634 | Outreach suppressed pending steward Outreach | TPA-60294 (Emma Garrtt) held until CASE-001190 is decided |
| Held | — | ||
| ACT-014635 | Outreach suppressed pending steward Outreach | TPA-62289 (Mari Wells) held until CASE-001191 is decided |
| Held | — | ||
| ACT-014636 | Outreach suppressed pending steward Outreach | ENR-136506 (Maria Wells) held until CASE-001192 is decided |
| Held | — | ||
| ACT-014637 | Outreach suppressed pending steward Outreach | CLM-425302 (Karan Berry) held until CASE-001193 is decided |
| Held | — | ||
| ACT-014638 | Outreach suppressed pending steward Outreach | CLM-416912 (Jesse Mendez) held until CASE-001194 is decided |
| Held | — | ||
| ACT-014639 | Outreach suppressed pending steward Outreach | CLM-416911 (Jesse Mendez) held until CASE-001195 is decided |
| Held | — | ||
| ACT-014640 | Outreach suppressed pending steward Outreach | TPA-51929 (Carol Rodriguez) held until CASE-001196 is decided |
| Held | — | ||
| ACT-014641 | Outreach suppressed pending steward Outreach | CLM-404432 (Carol Rodriguez) held until CASE-001197 is decided |
| Held | — | ||
| ACT-014642 | Outreach suppressed pending steward Outreach | CLM-427401 (Amy Gonzalez) held until CASE-001198 is decided |
| Held | — | ||
| ACT-014643 | Outreach suppressed pending steward Outreach | ENR-135989 (William Rodriguez) held until CASE-001199 is decided |
| Held | — | ||
| ACT-014644 | Outreach suppressed pending steward Outreach | CLM-423067 (Philyp Fox) held until CASE-001200 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.