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-014745 | Outreach suppressed pending steward Outreach | PRV-21862 (Ralph Gutierrez) held until CASE-001301 is decided |
| Held | — | ||
| ACT-014746 | Outreach suppressed pending steward Outreach | ENR-135956 (Jessica Butler) held until CASE-001302 is decided |
| Held | — | ||
| ACT-014747 | Outreach suppressed pending steward Outreach | TPA-62124 (Jessica Butler) held until CASE-001303 is decided |
| Held | — | ||
| ACT-014748 | Outreach suppressed pending steward Outreach | ENR-137768 (Isabella Halll) held until CASE-001304 is decided |
| Held | — | ||
| ACT-014749 | Outreach suppressed pending steward Outreach | TPA-62723 (Isabella Hall) held until CASE-001305 is decided |
| Held | — | ||
| ACT-014750 | Outreach suppressed pending steward Outreach | PRV-20441 (Billy Lopez) held until CASE-001306 is decided |
| Held | — | ||
| ACT-014751 | Outreach suppressed pending steward Outreach | ENR-101825 (Billy Lopez) held until CASE-001307 is decided |
| Held | — | ||
| ACT-014752 | Outreach suppressed pending steward Outreach | TPA-57831 (Theresa Garza) held until CASE-001308 is decided |
| Held | — | ||
| ACT-014753 | Outreach suppressed pending steward Outreach | TPA-62577 (Kyle Brown) held until CASE-001309 is decided |
| Held | — | ||
| ACT-014754 | Outreach suppressed pending steward Outreach | TPA-62578 (Kyle Brown) held until CASE-001310 is decided |
| Held | — | ||
| ACT-014755 | Outreach suppressed pending steward Outreach | CLM-410300 (Joan Brown) held until CASE-001311 is decided |
| Held | — | ||
| ACT-014756 | Outreach suppressed pending steward Outreach | CLM-424669 (Bob Vasquez) held until CASE-001312 is decided |
| Held | — | ||
| ACT-014757 | Outreach suppressed pending steward Outreach | ENR-132225 (Robert Vasquez) held until CASE-001313 is decided |
| Held | — | ||
| ACT-014758 | Outreach suppressed pending steward Outreach | ENR-124941 (Cheryl Bradley) held until CASE-001314 is decided |
| Held | — | ||
| ACT-014759 | Outreach suppressed pending steward Outreach | CLM-418928 (Cheryl Bradley) held until CASE-001315 is decided |
| Held | — | ||
| ACT-014760 | Outreach suppressed pending steward Outreach | ENR-120864 (Douglas Bradley) held until CASE-001316 is decided |
| Held | — | ||
| ACT-014761 | Outreach suppressed pending steward Outreach | TPA-58400 (Emma Mitchell) held until CASE-001317 is decided |
| Held | — | ||
| ACT-014762 | Outreach suppressed pending steward Outreach | CLM-432689 (Susan Hart) held until CASE-001318 is decided |
| Held | — | ||
| ACT-014763 | Outreach suppressed pending steward Outreach | TPA-55363 (Emma Simmons) held until CASE-001319 is decided |
| Held | — | ||
| ACT-014764 | Outreach suppressed pending steward Outreach | ENR-116036 (Emma Simmons) held until CASE-001320 is decided |
| Held | — | ||
| ACT-014765 | Outreach suppressed pending steward Outreach | ENR-124044 (Raymond Ray) held until CASE-001321 is decided |
| Held | — | ||
| ACT-014766 | Outreach suppressed pending steward Outreach | CLM-418285 (Ray Ray) held until CASE-001322 is decided |
| Held | — | ||
| ACT-014767 | Outreach suppressed pending steward Outreach | CLM-431027 (Danel Mejia) held until CASE-001323 is decided |
| Held | — | ||
| ACT-014768 | Outreach suppressed pending steward Outreach | TPA-50741 (Jacqueline Taylor) held until CASE-001324 is decided |
| Held | — | ||
| ACT-014769 | Outreach suppressed pending steward Outreach | TPA-57359 (Kayla Riley) held until CASE-001325 is decided |
| Held | — | ||
| ACT-014770 | Outreach suppressed pending steward Outreach | TPA-56346 (Larry Banks) held until CASE-001326 is decided |
| Held | — | ||
| ACT-014771 | Outreach suppressed pending steward Outreach | PRV-24210 (Larry Banks) held until CASE-001327 is decided |
| Held | — | ||
| ACT-014772 | Outreach suppressed pending steward Outreach | CLM-422726 (Gerald Arnold) held until CASE-001328 is decided |
| Held | — | ||
| ACT-014773 | Outreach suppressed pending steward Outreach | CLM-422461 (Charles Medina) held until CASE-001329 is decided |
| Held | — | ||
| ACT-014774 | Outreach suppressed pending steward Outreach | TPA-51957 (Mason Duncan) held until CASE-001330 is decided |
| Held | — | ||
| ACT-014775 | Outreach suppressed pending steward Outreach | PRV-29529 (Laura Fox) held until CASE-001331 is decided |
| Held | — | ||
| ACT-014776 | Outreach suppressed pending steward Outreach | ENR-142805 (Laura Fox) held until CASE-001332 is decided |
| Held | — | ||
| ACT-014777 | Outreach suppressed pending steward Outreach | TPA-62259 (Vasquez Shirley) held until CASE-001333 is decided |
| Held | — | ||
| ACT-014778 | Outreach suppressed pending steward Outreach | TPA-54581 (Catherine Washington) held until CASE-001334 is decided |
| Held | — | ||
| ACT-014779 | Outreach suppressed pending steward Outreach | CLM-425016 (Juliia Wright) held until CASE-001335 is decided |
| Held | — | ||
| ACT-014780 | Outreach suppressed pending steward Outreach | TPA-54314 (Bruce Alvarez) held until CASE-001336 is decided |
| Held | — | ||
| ACT-014781 | Outreach suppressed pending steward Outreach | CLM-409880 (Bruce Alvarez) held until CASE-001337 is decided |
| Held | — | ||
| ACT-014782 | Outreach suppressed pending steward Outreach | TPA-52286 (Dorothy Gry) held until CASE-001338 is decided |
| Held | — | ||
| ACT-014783 | Outreach suppressed pending steward Outreach | CLM-410080 (Bobby Walsh) held until CASE-001339 is decided |
| Held | — | ||
| ACT-014784 | Outreach suppressed pending steward Outreach | CLM-416807 (Janet Cruz) held until CASE-001340 is decided |
| Held | — | ||
| ACT-014785 | Outreach suppressed pending steward Outreach | TPA-59762 (Jacob Wallace) held until CASE-001341 is decided |
| Held | — | ||
| ACT-014786 | Outreach suppressed pending steward Outreach | TPA-58770 (Brian Walsh) held until CASE-001342 is decided |
| Held | — | ||
| ACT-014787 | Outreach suppressed pending steward Outreach | TPA-55976 (Arjun Reid) held until CASE-001343 is decided |
| Held | — | ||
| ACT-014788 | Outreach suppressed pending steward Outreach | CLM-413597 (Arjun Reid) held until CASE-001344 is decided |
| Held | — | ||
| ACT-014789 | Outreach suppressed pending steward Outreach | TPA-58963 (Lauren Martin) held until CASE-001345 is decided |
| Held | — | ||
| ACT-014790 | Outreach suppressed pending steward Outreach | CLM-426128 (Joseph Hayes) held until CASE-001346 is decided |
| Held | — | ||
| ACT-014791 | Outreach suppressed pending steward Outreach | CLM-422773 (Jesse Cunningham) held until CASE-001347 is decided |
| Held | — | ||
| ACT-014792 | Outreach suppressed pending steward Outreach | TPA-51355 (Carolyn Hawkins) held until CASE-001348 is decided |
| Held | — | ||
| ACT-014793 | Outreach suppressed pending steward Outreach | ENR-104096 (Carolyn Hawkins) held until CASE-001349 is decided |
| Held | — | ||
| ACT-014794 | Outreach suppressed pending steward Outreach | CLM-431635 (Andrea Grean) held until CASE-001350 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.