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-014695 | Outreach suppressed pending steward Outreach | PRV-26281 (Judy Hansen) held until CASE-001251 is decided |
| Held | — | ||
| ACT-014696 | Outreach suppressed pending steward Outreach | TPA-59381 (Judy Hansen) held until CASE-001252 is decided |
| Held | — | ||
| ACT-014697 | Outreach suppressed pending steward Outreach | CLM-430116 (Juan Alexander) held until CASE-001253 is decided |
| Held | — | ||
| ACT-014698 | Outreach suppressed pending steward Outreach | PRV-20690 (Ann Alexander) held until CASE-001254 is decided |
| Held | — | ||
| ACT-014699 | Outreach suppressed pending steward Outreach | PRV-27564 (Cynthia Porter) held until CASE-001255 is decided |
| Held | — | ||
| ACT-014700 | Outreach suppressed pending steward Outreach | CLM-431118 (Sandra Patel) held until CASE-001256 is decided |
| Held | — | ||
| ACT-014701 | Outreach suppressed pending steward Outreach | TPA-54632 (Harold Rojas) held until CASE-001257 is decided |
| Held | — | ||
| ACT-014702 | Outreach suppressed pending steward Outreach | CLM-405039 (Isabella Lawrence) held until CASE-001258 is decided |
| Held | — | ||
| ACT-014703 | Outreach suppressed pending steward Outreach | TPA-52199 (Isabella Lawrence) held until CASE-001259 is decided |
| Held | — | ||
| ACT-014704 | Outreach suppressed pending steward Outreach | TPA-63143 (Ahmed Campbell) held until CASE-001260 is decided |
| Held | — | ||
| ACT-014705 | Outreach suppressed pending steward Outreach | PRV-20542 (Theresa Fowler) held until CASE-001261 is decided |
| Held | — | ||
| ACT-014706 | Outreach suppressed pending steward Outreach | TPA-54056 (Teresa Williamson) held until CASE-001262 is decided |
| Held | — | ||
| ACT-014707 | Outreach suppressed pending steward Outreach | ENR-101143 (Yuki Knight) held until CASE-001263 is decided |
| Held | — | ||
| ACT-014708 | Outreach suppressed pending steward Outreach | CLM-400865 (Yuki Knight) held until CASE-001264 is decided |
| Held | — | ||
| ACT-014709 | Outreach suppressed pending steward Outreach | PRV-24266 (Diana Mendez) held until CASE-001265 is decided |
| Held | — | ||
| ACT-014710 | Outreach suppressed pending steward Outreach | CLM-411020 (Amanda Allen) held until CASE-001266 is decided |
| Held | — | ||
| ACT-014711 | Outreach suppressed pending steward Outreach | ENR-114457 (Amanda Allen) held until CASE-001267 is decided |
| Held | — | ||
| ACT-014712 | Outreach suppressed pending steward Outreach | CLM-408359 (Ana Allen) held until CASE-001268 is decided |
| Held | — | ||
| ACT-014713 | Outreach suppressed pending steward Outreach | TPA-61759 (Lori Allen) held until CASE-001269 is decided |
| Held | — | ||
| ACT-014714 | Outreach suppressed pending steward Outreach | TPA-63398 (Omar Hamilton) held until CASE-001270 is decided |
| Held | — | ||
| ACT-014715 | Outreach suppressed pending steward Outreach | TPA-61364 (James Li) held until CASE-001271 is decided |
| Held | — | ||
| ACT-014716 | Outreach suppressed pending steward Outreach | CLM-415684 (Sophia Lee) held until CASE-001272 is decided |
| Held | — | ||
| ACT-014717 | Outreach suppressed pending steward Outreach | CLM-417046 (Lori Nunez) held until CASE-001273 is decided |
| Held | — | ||
| ACT-014718 | Outreach suppressed pending steward Outreach | TPA-56828 (Harold Murray) held until CASE-001274 is decided |
| Held | — | ||
| ACT-014719 | Outreach suppressed pending steward Outreach | CLM-415577 (Harold Murray) held until CASE-001275 is decided |
| Held | — | ||
| ACT-014720 | Outreach suppressed pending steward Outreach | ENR-121991 (Amber Hudson) held until CASE-001276 is decided |
| Held | — | ||
| ACT-014721 | Outreach suppressed pending steward Outreach | TPA-57376 (Amber Hudson) held until CASE-001277 is decided |
| Held | — | ||
| ACT-014722 | Outreach suppressed pending steward Outreach | CLM-410822 (Teresa Hudson) held until CASE-001278 is decided |
| Held | — | ||
| ACT-014723 | Outreach suppressed pending steward Outreach | TPA-56156 (Mary Ruiz) held until CASE-001279 is decided |
| Held | — | ||
| ACT-014724 | Outreach suppressed pending steward Outreach | ENR-118257 (Mary Ruiz) held until CASE-001280 is decided |
| Held | — | ||
| ACT-014725 | Outreach suppressed pending steward Outreach | CLM-420244 (Ethan Boyd) held until CASE-001281 is decided |
| Held | — | ||
| ACT-014726 | Outreach suppressed pending steward Outreach | TPA-59591 (Olivia Howard) held until CASE-001282 is decided |
| Held | — | ||
| ACT-014727 | Outreach suppressed pending steward Outreach | CLM-419578 (Ashley Obrien) held until CASE-001283 is decided |
| Held | — | ||
| ACT-014728 | Outreach suppressed pending steward Outreach | TPA-51566 (Emma Watson) held until CASE-001284 is decided |
| Held | — | ||
| ACT-014729 | Outreach suppressed pending steward Outreach | CLM-414070 (Jordan Jenkins) held until CASE-001285 is decided |
| Held | — | ||
| ACT-014730 | Outreach suppressed pending steward Outreach | TPA-62837 (Walter Henry) held until CASE-001286 is decided |
| Held | — | ||
| ACT-014731 | Outreach suppressed pending steward Outreach | CLM-429054 (Walter Henry) held until CASE-001287 is decided |
| Held | — | ||
| ACT-014732 | Outreach suppressed pending steward Outreach | TPA-52392 (Jesse Hughes) held until CASE-001288 is decided |
| Held | — | ||
| ACT-014733 | Outreach suppressed pending steward Outreach | CLM-402728 (Ana Coleman) held until CASE-001289 is decided |
| Held | — | ||
| ACT-014734 | Outreach suppressed pending steward Outreach | PRV-28872 (Ana Kelly) held until CASE-001290 is decided |
| Held | — | ||
| ACT-014735 | Outreach suppressed pending steward Outreach | ENR-139770 (Ana Kelly) held until CASE-001291 is decided |
| Held | — | ||
| ACT-014736 | Outreach suppressed pending steward Outreach | TPA-59067 (Julie Kelly) held until CASE-001292 is decided |
| Held | — | ||
| ACT-014737 | Outreach suppressed pending steward Outreach | CLM-414683 (Edward Chapman) held until CASE-001293 is decided |
| Held | — | ||
| ACT-014738 | Outreach suppressed pending steward Outreach | TPA-53669 (Mason Maldonado) held until CASE-001294 is decided |
| Held | — | ||
| ACT-014739 | Outreach suppressed pending steward Outreach | TPA-59234 (Linda Hart) held until CASE-001295 is decided |
| Held | — | ||
| ACT-014740 | Outreach suppressed pending steward Outreach | ENR-127578 (Linda Hart) held until CASE-001296 is decided |
| Held | — | ||
| ACT-014741 | Outreach suppressed pending steward Outreach | CLM-421514 (Joe Stewart) held until CASE-001297 is decided |
| Held | — | ||
| ACT-014742 | Outreach suppressed pending steward Outreach | PRV-22736 (Scott Jacobs) held until CASE-001298 is decided |
| Held | — | ||
| ACT-014743 | Outreach suppressed pending steward Outreach | CLM-409334 (Scott Jacobs) held until CASE-001299 is decided |
| Held | — | ||
| ACT-014744 | Outreach suppressed pending steward Outreach | ENR-113236 (Isabella Chen) held until CASE-001300 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.