Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Actions

26,640 derived from the last resolution run

Care coordination outreach, Next-best-action, 1,815 proposed
ActionTypeTitleDetailLinked toStatusExecuted
ACT-019071
Care coordination outreach
Next-best-action
Amy Butler: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019072
Care coordination outreach
Next-best-action
Joyce Williams: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019073
Care coordination outreach
Next-best-action
Luis Cruz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019074
Care coordination outreach
Next-best-action
Debra Cox: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019075
Care coordination outreach
Next-best-action
Frank Padilla: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019076
Care coordination outreach
Next-best-action
Priya Chen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019077
Care coordination outreach
Next-best-action
Paul Bryant: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019078
Care coordination outreach
Next-best-action
Andrew Hicks: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019079
Care coordination outreach
Next-best-action
Mateo Chapman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019080
Care coordination outreach
Next-best-action
Amy Castro: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019081
Care coordination outreach
Next-best-action
Hiroshi Ortega: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019082
Care coordination outreach
Next-best-action
Jessica Gordon: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019083
Care coordination outreach
Next-best-action
Diego Johnston: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019084
Care coordination outreach
Next-best-action
Denise King: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019085
Care coordination outreach
Next-best-action
Douglas Edwards: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019086
Care coordination outreach
Next-best-action
Jessica Wang: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019087
Care coordination outreach
Next-best-action
Anthony Rios: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019088
Care coordination outreach
Next-best-action
Mariana Gardner: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019089
Care coordination outreach
Next-best-action
Megan Richardson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019090
Care coordination outreach
Next-best-action
Nicole Le: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019091
Care coordination outreach
Next-best-action
Elijah Owens: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019092
Care coordination outreach
Next-best-action
Beverly Padilla: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019093
Care coordination outreach
Next-best-action
Wayne Harper: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019094
Care coordination outreach
Next-best-action
David Ryan: 6 claims, no attributed provider
Claims
6
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019095
Care coordination outreach
Next-best-action
Eric Watson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019096
Care coordination outreach
Next-best-action
Doris Dunn: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019097
Care coordination outreach
Next-best-action
Ethan Wood: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019098
Care coordination outreach
Next-best-action
Marilyn George: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019099
Care coordination outreach
Next-best-action
Robert Nichols: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019100
Care coordination outreach
Next-best-action
Rachel Richardson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019101
Care coordination outreach
Next-best-action
David Mason: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019102
Care coordination outreach
Next-best-action
Scott Clark: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019103
Care coordination outreach
Next-best-action
Patrick Le: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019104
Care coordination outreach
Next-best-action
Noah Ortiz: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019105
Care coordination outreach
Next-best-action
Rebecca Hamilton: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019106
Care coordination outreach
Next-best-action
Joyce Carlson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019107
Care coordination outreach
Next-best-action
Ralph Sullivan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019108
Care coordination outreach
Next-best-action
Frank Weber: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019109
Care coordination outreach
Next-best-action
Stephen Lawson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019110
Care coordination outreach
Next-best-action
Steven Brooks: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019111
Care coordination outreach
Next-best-action
Gerald Jordan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019112
Care coordination outreach
Next-best-action
Marcus Lewis: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019113
Care coordination outreach
Next-best-action
Judy Powell: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019114
Care coordination outreach
Next-best-action
Carlos Wood: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019115
Care coordination outreach
Next-best-action
Jacob Grant: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019116
Care coordination outreach
Next-best-action
Sara Reyes: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019117
Care coordination outreach
Next-best-action
Virginia Ross: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019118
Care coordination outreach
Next-best-action
Dylan Bowman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019119
Care coordination outreach
Next-best-action
Jacob Holmes: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-019120
Care coordination outreach
Next-best-action
Amanda McDonald: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
1,815 rows, page 27 of 37PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A 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.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.