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