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
Eligibility conflict resolved, Eligibility engine, 1,339 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-001301 | Eligibility conflict resolved Eligibility engine | Beverly Hughes: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001302 | Eligibility conflict resolved Eligibility engine | Betty Martinez: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001303 | Eligibility conflict resolved Eligibility engine | Paul Nguyen: 3 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001304 | Eligibility conflict resolved Eligibility engine | Juhn Simpson: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-001305 | Eligibility conflict resolved Eligibility engine | Carl Ruiz: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-001306 | Eligibility conflict resolved Eligibility engine | Kennteh Flores: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-001307 | Eligibility conflict resolved Eligibility engine | Grace Johnston: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001308 | Eligibility conflict resolved Eligibility engine | Marcus Ford: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001309 | Eligibility conflict resolved Eligibility engine | Kyle Silva: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-001310 | Eligibility conflict resolved Eligibility engine | Nicholas Le: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001311 | Eligibility conflict resolved Eligibility engine | Isabella Andrews: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-001312 | Eligibility conflict resolved Eligibility engine | Isabella Carter: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-001313 | Eligibility conflict resolved Eligibility engine | Mei Robertson: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001314 | Eligibility conflict resolved Eligibility engine | Ronald Lawrence: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001315 | Eligibility conflict resolved Eligibility engine | Amanda Daniels: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-001316 | Eligibility conflict resolved Eligibility engine | Jimmy Guzman: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-001317 | Eligibility conflict resolved Eligibility engine | Abby Woods: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-001318 | Eligibility conflict resolved Eligibility engine | Madison Foster: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-001319 | Eligibility conflict resolved Eligibility engine | Nancy Patel: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001320 | Eligibility conflict resolved Eligibility engine | Justin Brooks: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-001321 | Eligibility conflict resolved Eligibility engine | Nancy Wallace: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001322 | Eligibility conflict resolved Eligibility engine | Benjamin Ward: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001323 | Eligibility conflict resolved Eligibility engine | Matthew Chavez: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-001324 | Eligibility conflict resolved Eligibility engine | Janice Rojes: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-001325 | Eligibility conflict resolved Eligibility engine | Betty Fox: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001326 | Eligibility conflict resolved Eligibility engine | Carolyn Wheeler: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-001327 | Eligibility conflict resolved Eligibility engine | Marcus Jimenez: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-001328 | Eligibility conflict resolved Eligibility engine | Henry Chen: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-001329 | Eligibility conflict resolved Eligibility engine | Samantha Fowler: 3 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001330 | Eligibility conflict resolved Eligibility engine | Diana Hernandez: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001331 | Eligibility conflict resolved Eligibility engine | Jesse Berry: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-001332 | Eligibility conflict resolved Eligibility engine | Carolyn Dixon: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-001333 | Eligibility conflict resolved Eligibility engine | Nancy Carr: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001334 | Eligibility conflict resolved Eligibility engine | Lawrence King: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-001335 | Eligibility conflict resolved Eligibility engine | Christopher Harris: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-001336 | Eligibility conflict resolved Eligibility engine | Joshua Hoffman: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-001337 | Eligibility conflict resolved Eligibility engine | Camila Nelson: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-001338 | Eligibility conflict resolved Eligibility engine | Brenda Lee: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-001339 | Eligibility conflict resolved Eligibility engine | Alice Silva: 2 plan codes across sources → canonical NAVIGATE-HMO |
| 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.