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-014645 | Outreach suppressed pending steward Outreach | CLM-424314 (Michele Luna) held until CASE-001201 is decided |
| Held | — | ||
| ACT-014646 | Outreach suppressed pending steward Outreach | ENR-113320 (Sara Padilla) held until CASE-001202 is decided |
| Held | — | ||
| ACT-014647 | Outreach suppressed pending steward Outreach | CLM-410107 (Sara Padilla) held until CASE-001203 is decided |
| Held | — | ||
| ACT-014648 | Outreach suppressed pending steward Outreach | CLM-404422 (Gloria Ortega) held until CASE-001204 is decided |
| Held | — | ||
| ACT-014649 | Outreach suppressed pending steward Outreach | ENR-131665 (Ashley Ortega) held until CASE-001205 is decided |
| Held | — | ||
| ACT-014650 | Outreach suppressed pending steward Outreach | CLM-431827 (Jordan Vasquez) held until CASE-001206 is decided |
| Held | — | ||
| ACT-014651 | Outreach suppressed pending steward Outreach | TPA-64035 (Jordan Vasquez) held until CASE-001207 is decided |
| Held | — | ||
| ACT-014652 | Outreach suppressed pending steward Outreach | PRV-27667 (Albert Larson) held until CASE-001208 is decided |
| Held | — | ||
| ACT-014653 | Outreach suppressed pending steward Outreach | TPA-52736 (Rachel Scott) held until CASE-001209 is decided |
| Held | — | ||
| ACT-014654 | Outreach suppressed pending steward Outreach | CLM-412978 (Ruth Vazquez) held until CASE-001210 is decided |
| Held | — | ||
| ACT-014655 | Outreach suppressed pending steward Outreach | CLM-410090 (Aisha Chen) held until CASE-001211 is decided |
| Held | — | ||
| ACT-014656 | Outreach suppressed pending steward Outreach | TPA-53401 (Betty Boyd) held until CASE-001212 is decided |
| Held | — | ||
| ACT-014657 | Outreach suppressed pending steward Outreach | ENR-108260 (Philip Barry) held until CASE-001213 is decided |
| Held | — | ||
| ACT-014658 | Outreach suppressed pending steward Outreach | TPA-52789 (Philip Berry) held until CASE-001214 is decided |
| Held | — | ||
| ACT-014659 | Outreach suppressed pending steward Outreach | ENR-100123 (George Ellis) held until CASE-001215 is decided |
| Held | — | ||
| ACT-014660 | Outreach suppressed pending steward Outreach | CLM-405517 (Kenneth Gonzalez) held until CASE-001216 is decided |
| Held | — | ||
| ACT-014661 | Outreach suppressed pending steward Outreach | CLM-415944 (Abigail Olson) held until CASE-001217 is decided |
| Held | — | ||
| ACT-014662 | Outreach suppressed pending steward Outreach | TPA-53543 (Scott Pena) held until CASE-001218 is decided |
| Held | — | ||
| ACT-014663 | Outreach suppressed pending steward Outreach | TPA-51705 (Diego Pena) held until CASE-001219 is decided |
| Held | — | ||
| ACT-014664 | Outreach suppressed pending steward Outreach | CLM-432353 (Linda Payne) held until CASE-001220 is decided |
| Held | — | ||
| ACT-014665 | Outreach suppressed pending steward Outreach | TPA-55479 (Ahmed Wright) held until CASE-001221 is decided |
| Held | — | ||
| ACT-014666 | Outreach suppressed pending steward Outreach | CLM-412438 (Ahmed Wright) held until CASE-001222 is decided |
| Held | — | ||
| ACT-014667 | Outreach suppressed pending steward Outreach | TPA-51129 (Aisha Richards) held until CASE-001223 is decided |
| Held | — | ||
| ACT-014668 | Outreach suppressed pending steward Outreach | CLM-402643 (Aisha Richards) held until CASE-001224 is decided |
| Held | — | ||
| ACT-014669 | Outreach suppressed pending steward Outreach | TPA-51618 (Kevin Austin) held until CASE-001225 is decided |
| Held | — | ||
| ACT-014670 | Outreach suppressed pending steward Outreach | CLM-403726 (Kevin Austin) held until CASE-001226 is decided |
| Held | — | ||
| ACT-014671 | Outreach suppressed pending steward Outreach | TPA-56760 (Kathleen Watkins) held until CASE-001227 is decided |
| Held | — | ||
| ACT-014672 | Outreach suppressed pending steward Outreach | CLM-401641 (Juddy Schultz) held until CASE-001228 is decided |
| Held | — | ||
| ACT-014673 | Outreach suppressed pending steward Outreach | CLM-415792 (Michelle Schultz) held until CASE-001229 is decided |
| Held | — | ||
| ACT-014674 | Outreach suppressed pending steward Outreach | TPA-58831 (Alice Willis) held until CASE-001230 is decided |
| Held | — | ||
| ACT-014675 | Outreach suppressed pending steward Outreach | TPA-53213 (Christopher Cooper) held until CASE-001231 is decided |
| Held | — | ||
| ACT-014676 | Outreach suppressed pending steward Outreach | CLM-426441 (Ryan Santos) held until CASE-001232 is decided |
| Held | — | ||
| ACT-014677 | Outreach suppressed pending steward Outreach | CLM-409228 (Katherine Freeman) held until CASE-001233 is decided |
| Held | — | ||
| ACT-014678 | Outreach suppressed pending steward Outreach | CLM-402227 (Alice Singh) held until CASE-001234 is decided |
| Held | — | ||
| ACT-014679 | Outreach suppressed pending steward Outreach | TPA-53545 (Megan Henry) held until CASE-001235 is decided |
| Held | — | ||
| ACT-014680 | Outreach suppressed pending steward Outreach | CLM-423194 (Bety Watson) held until CASE-001236 is decided |
| Held | — | ||
| ACT-014681 | Outreach suppressed pending steward Outreach | TPA-60504 (Ashley Nunez) held until CASE-001237 is decided |
| Held | — | ||
| ACT-014682 | Outreach suppressed pending steward Outreach | CLM-423878 (Ashley Nunez) held until CASE-001238 is decided |
| Held | — | ||
| ACT-014683 | Outreach suppressed pending steward Outreach | TPA-61118 (Cheryl Munoz) held until CASE-001239 is decided |
| Held | — | ||
| ACT-014684 | Outreach suppressed pending steward Outreach | TPA-54381 (Debra Rojas) held until CASE-001240 is decided |
| Held | — | ||
| ACT-014685 | Outreach suppressed pending steward Outreach | TPA-51598 (Valentina Gonzalez) held until CASE-001241 is decided |
| Held | — | ||
| ACT-014686 | Outreach suppressed pending steward Outreach | CLM-428210 (Beverrly Gonzalez) held until CASE-001242 is decided |
| Held | — | ||
| ACT-014687 | Outreach suppressed pending steward Outreach | TPA-63980 (Roger Luna) held until CASE-001243 is decided |
| Held | — | ||
| ACT-014688 | Outreach suppressed pending steward Outreach | PRV-20330 (Jesse Hunt) held until CASE-001244 is decided |
| Held | — | ||
| ACT-014689 | Outreach suppressed pending steward Outreach | CLM-405867 (Karen Elliott) held until CASE-001245 is decided |
| Held | — | ||
| ACT-014690 | Outreach suppressed pending steward Outreach | ENR-133676 (Sara Webar) held until CASE-001246 is decided |
| Held | — | ||
| ACT-014691 | Outreach suppressed pending steward Outreach | TPA-61367 (Sara Webar) held until CASE-001247 is decided |
| Held | — | ||
| ACT-014692 | Outreach suppressed pending steward Outreach | TPA-60744 (Jacqueline Lewis) held until CASE-001248 is decided |
| Held | — | ||
| ACT-014693 | Outreach suppressed pending steward Outreach | PRV-23505 (Ana Bradley) held until CASE-001249 is decided |
| Held | — | ||
| ACT-014694 | Outreach suppressed pending steward Outreach | TPA-59380 (Judy Hansen) held until CASE-001250 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.