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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-006112 | Orphan claim re-pointed Claims processor | CLM-423682 → UHC-62687-13 (Jerry White) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006113 | Orphan claim re-pointed Claims processor | CLM-413079 → UHC-94649-01 (Kathryn Moreno) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006114 | Orphan claim re-pointed Claims processor | CLM-424305 → UHC-81484-49 (Teresa Yang) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006115 | Orphan claim re-pointed Claims processor | CLM-409667 → UHC-50547-71 (Barb Hansen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006116 | Orphan claim re-pointed Claims processor | CLM-424570 → UHC-77317-26 (Eugene Nichols) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006117 | Orphan claim re-pointed Claims processor | CLM-401252 → UHC-29310-13 (Carlos Scott) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006118 | Orphan claim re-pointed Claims processor | CLM-416132 → UHC-02598-90 (Michelle Taylor) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006119 | Orphan claim re-pointed Claims processor | CLM-427595 → UHC-21440-42 (Nathan Wong) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006120 | Orphan claim re-pointed Claims processor | CLM-432663 → UHC-19912-27 (Emily Stephens) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006121 | Orphan claim re-pointed Claims processor | CLM-410268 → UHC-53781-65 (Michael Evans) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006122 | Orphan claim re-pointed Claims processor | CLM-404711 → UHC-28560-68 (Charles Rice) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006123 | Orphan claim re-pointed Claims processor | CLM-422159 → UHC-65660-37 (Santiago Johnston) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006124 | Orphan claim re-pointed Claims processor | CLM-412915 → UHC-63686-35 (Robert Bradley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006125 | Orphan claim re-pointed Claims processor | CLM-421567 → UHC-47477-34 (Julie Singh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006126 | Orphan claim re-pointed Claims processor | CLM-411887 → UHC-85455-92 (Pamela Lucas) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006127 | Orphan claim re-pointed Claims processor | CLM-413803 → UHC-39549-73 (Henry Johnson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006128 | Orphan claim re-pointed Claims processor | CLM-428750 → UHC-81652-63 (Danielle Chen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006129 | Orphan claim re-pointed Claims processor | CLM-406795 → UHC-90670-68 (Gloria Estrada) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006130 | Orphan claim re-pointed Claims processor | CLM-402411 → UHC-12831-60 (Debra Romero) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006131 | Orphan claim re-pointed Claims processor | CLM-421988 → UHC-13352-81 (Janice Riley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006132 | Orphan claim re-pointed Claims processor | CLM-419671 → UHC-07485-72 (William Singh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006133 | Orphan claim re-pointed Claims processor | CLM-424702 → UHC-58169-52 (Diane Morales) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006134 | Orphan claim re-pointed Claims processor | CLM-411958 → UHC-63413-52 (Abigail Taylor) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006135 | Orphan claim re-pointed Claims processor | CLM-431968 → UHC-46657-20 (Randy Foster) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006136 | Orphan claim re-pointed Claims processor | CLM-403806 → UHC-24980-13 (Austin Mendoza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006137 | Orphan claim re-pointed Claims processor | CLM-404322 → UHC-01641-97 (John Hayes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006138 | Orphan claim re-pointed Claims processor | CLM-403159 → UHC-48058-63 (Diana Reid) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006139 | Orphan claim re-pointed Claims processor | CLM-408419 → UHC-61312-95 (Zachary Weber) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006140 | Orphan claim re-pointed Claims processor | CLM-408791 → UHC-43424-68 (Susan Torres) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006141 | Orphan claim re-pointed Claims processor | CLM-426930 → UHC-66065-50 (Sean Howell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006142 | Orphan claim re-pointed Claims processor | CLM-413505 → UHC-44097-04 (Julie Parker) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006143 | Orphan claim re-pointed Claims processor | CLM-429940 → UHC-39409-51 (Lauren Johnson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006144 | Orphan claim re-pointed Claims processor | CLM-400514 → UHC-27977-55 (Kimberly Henry) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006145 | Orphan claim re-pointed Claims processor | CLM-432097 → UHC-31595-46 (Terry Spencer) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006146 | Orphan claim re-pointed Claims processor | CLM-429871 → UHC-84706-98 (Ronald Mejia) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006147 | Orphan claim re-pointed Claims processor | CLM-428479 → UHC-33993-62 (Linda Boyd) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006148 | Orphan claim re-pointed Claims processor | CLM-423246 → UHC-54923-39 (Sophia Lawrence) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006149 | Orphan claim re-pointed Claims processor | CLM-402117 → UHC-66088-38 (Mary Pena) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006150 | Orphan claim re-pointed Claims processor | CLM-421652 → UHC-53180-18 (Mark Washington) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006151 | Orphan claim re-pointed Claims processor | CLM-410518 → UHC-39798-52 (Diego Martin) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006152 | Orphan claim re-pointed Claims processor | CLM-414612 → UHC-67775-91 (Mark Johnston) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006153 | Orphan claim re-pointed Claims processor | CLM-431206 → UHC-72195-70 (Gary Montgomery) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006154 | Orphan claim re-pointed Claims processor | CLM-413695 → UHC-43246-74 (David Luna) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006155 | Orphan claim re-pointed Claims processor | CLM-422116 → UHC-87446-72 (Samantha Kelly) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006156 | Orphan claim re-pointed Claims processor | CLM-422775 → UHC-69449-60 (Brenda Simmons) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006157 | Orphan claim re-pointed Claims processor | CLM-431439 → UHC-86939-73 (Ann Hoffman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006158 | Orphan claim re-pointed Claims processor | CLM-419938 → UHC-92907-25 (Mateo Diaz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006159 | Orphan claim re-pointed Claims processor | CLM-424757 → UHC-54543-72 (Thomas Matthews) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006160 | Orphan claim re-pointed Claims processor | CLM-417404 → UHC-42860-23 (Jeremy Palmer) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006161 | Orphan claim re-pointed Claims processor | CLM-424270 → UHC-58851-08 (Jack Barnes) |
| Executed | resolution_agent 2026-10-22 12:47:23 |
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.