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-014795 | Outreach suppressed pending steward Outreach | PRV-24355 (Madison Garcia) held until CASE-001351 is decided |
| Held | — | ||
| ACT-014796 | Outreach suppressed pending steward Outreach | CLM-414843 (Madison Garcia) held until CASE-001352 is decided |
| Held | — | ||
| ACT-014797 | Outreach suppressed pending steward Outreach | TPA-58409 (Nicole Carr) held until CASE-001353 is decided |
| Held | — | ||
| ACT-014798 | Outreach suppressed pending steward Outreach | TPA-56696 (Bobby Porter) held until CASE-001354 is decided |
| Held | — | ||
| ACT-014799 | Outreach suppressed pending steward Outreach | TPA-50035 (Christian Contreras) held until CASE-001355 is decided |
| Held | — | ||
| ACT-014800 | Outreach suppressed pending steward Outreach | CLM-404125 (Albert Kim) held until CASE-001356 is decided |
| Held | — | ||
| ACT-014801 | Outreach suppressed pending steward Outreach | TPA-51787 (Alberrt Kim) held until CASE-001357 is decided |
| Held | — | ||
| ACT-014802 | Outreach suppressed pending steward Outreach | TPA-51788 (Albert Kim) held until CASE-001358 is decided |
| Held | — | ||
| ACT-014803 | Outreach suppressed pending steward Outreach | CLM-404124 (Albert Kim) held until CASE-001359 is decided |
| Held | — | ||
| ACT-014804 | Outreach suppressed pending steward Outreach | TPA-58632 (Hannah Morales) held until CASE-001360 is decided |
| Held | — | ||
| ACT-014805 | Outreach suppressed pending steward Outreach | ENR-134736 (Michael Chavez) held until CASE-001361 is decided |
| Held | — | ||
| ACT-014806 | Outreach suppressed pending steward Outreach | CLM-426480 (Mike Chavez) held until CASE-001362 is decided |
| Held | — | ||
| ACT-014807 | Outreach suppressed pending steward Outreach | CLM-419455 (Randy Long) held until CASE-001363 is decided |
| Held | — | ||
| ACT-014808 | Outreach suppressed pending steward Outreach | CLM-410883 (Sandra Dominguez) held until CASE-001364 is decided |
| Held | — | ||
| ACT-014809 | Outreach suppressed pending steward Outreach | CLM-410884 (Sandra Dominguez) held until CASE-001365 is decided |
| Held | — | ||
| ACT-014810 | Outreach suppressed pending steward Outreach | CLM-425948 (Virginia Dominguez) held until CASE-001366 is decided |
| Held | — | ||
| ACT-014811 | Outreach suppressed pending steward Outreach | CLM-424795 (Susan Wang) held until CASE-001367 is decided |
| Held | — | ||
| ACT-014812 | Outreach suppressed pending steward Outreach | CLM-405658 (Kathryn Powell) held until CASE-001368 is decided |
| Held | — | ||
| ACT-014813 | Outreach suppressed pending steward Outreach | ENR-131709 (Matthew Long) held until CASE-001369 is decided |
| Held | — | ||
| ACT-014814 | Outreach suppressed pending steward Outreach | TPA-60686 (Matthew Long) held until CASE-001370 is decided |
| Held | — | ||
| ACT-014815 | Outreach suppressed pending steward Outreach | PRV-22558 (Julia Powell) held until CASE-001371 is decided |
| Held | — | ||
| ACT-014816 | Outreach suppressed pending steward Outreach | CLM-408631 (Julia Powell) held until CASE-001372 is decided |
| Held | — | ||
| ACT-014817 | Outreach suppressed pending steward Outreach | CLM-424475 (Brandon Park) held until CASE-001373 is decided |
| Held | — | ||
| ACT-014818 | Outreach suppressed pending steward Outreach | ENR-131996 (Brandon Park) held until CASE-001374 is decided |
| Held | — | ||
| ACT-014819 | Outreach suppressed pending steward Outreach | ENR-128808 (Alice Fisher) held until CASE-001375 is decided |
| Held | — | ||
| ACT-014820 | Outreach suppressed pending steward Outreach | TPA-59662 (Alice Fisher) held until CASE-001376 is decided |
| Held | — | ||
| ACT-014821 | Outreach suppressed pending steward Outreach | TPA-50370 (Brittany Estrada) held until CASE-001377 is decided |
| Held | — | ||
| ACT-014822 | Outreach suppressed pending steward Outreach | CLM-400797 (Brittany Estrada) held until CASE-001378 is decided |
| Held | — | ||
| ACT-014823 | Outreach suppressed pending steward Outreach | CLM-400798 (Brittany Estrada) held until CASE-001379 is decided |
| Held | — | ||
| ACT-014824 | Outreach suppressed pending steward Outreach | CLM-400794 (Brittany Estrada) held until CASE-001380 is decided |
| Held | — | ||
| ACT-014825 | Outreach suppressed pending steward Outreach | CLM-408933 (Justin Bradley) held until CASE-001381 is decided |
| Held | — | ||
| ACT-014826 | Outreach suppressed pending steward Outreach | CLM-426808 (Alexis Howard) held until CASE-001382 is decided |
| Held | — | ||
| ACT-014827 | Outreach suppressed pending steward Outreach | ENR-135163 (Alexis Howard) held until CASE-001383 is decided |
| Held | — | ||
| ACT-014828 | Outreach suppressed pending steward Outreach | TPA-55853 (Doris White) held until CASE-001384 is decided |
| Held | — | ||
| ACT-014829 | Outreach suppressed pending steward Outreach | ENR-117473 (Doris White) held until CASE-001385 is decided |
| Held | — | ||
| ACT-014830 | Outreach suppressed pending steward Outreach | TPA-52138 (Jacqueline Simmons) held until CASE-001386 is decided |
| Held | — | ||
| ACT-014831 | Outreach suppressed pending steward Outreach | ENR-106459 (Jaccqueline Simmons) held until CASE-001387 is decided |
| Held | — | ||
| ACT-014832 | Outreach suppressed pending steward Outreach | TPA-62350 (Christine Young) held until CASE-001388 is decided |
| Held | — | ||
| ACT-014833 | Outreach suppressed pending steward Outreach | CLM-420305 (Sandra Jackson) held until CASE-001389 is decided |
| Held | — | ||
| ACT-014834 | Outreach suppressed pending steward Outreach | ENR-130161 (Melissa Gerdner) held until CASE-001390 is decided |
| Held | — | ||
| ACT-014835 | Outreach suppressed pending steward Outreach | TPA-60126 (Melissa Gardner) held until CASE-001391 is decided |
| Held | — | ||
| ACT-014836 | Outreach suppressed pending steward Outreach | TPA-51744 (Samuel Estrada) held until CASE-001392 is decided |
| Held | — | ||
| ACT-014837 | Outreach suppressed pending steward Outreach | TPA-51973 (Olivia Walker) held until CASE-001393 is decided |
| Held | — | ||
| ACT-014838 | Outreach suppressed pending steward Outreach | ENR-105971 (Olivia Walker) held until CASE-001394 is decided |
| Held | — | ||
| ACT-014839 | Outreach suppressed pending steward Outreach | CLM-404534 (Olivia Walker) held until CASE-001395 is decided |
| Held | — | ||
| ACT-014840 | Outreach suppressed pending steward Outreach | CLM-427396 (Justin Ruiz) held until CASE-001396 is decided |
| Held | — | ||
| ACT-014841 | Outreach suppressed pending steward Outreach | CLM-427395 (Justin Ruiz) held until CASE-001397 is decided |
| Held | — | ||
| ACT-014842 | Outreach suppressed pending steward Outreach | CLM-414656 (Ralph Hudson) held until CASE-001398 is decided |
| Held | — | ||
| ACT-014843 | Outreach suppressed pending steward Outreach | ENR-119293 (Ralph Hudson) held until CASE-001399 is decided |
| Held | — | ||
| ACT-014844 | Outreach suppressed pending steward Outreach | TPA-55211 (Bobby Hudson) held until CASE-001400 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.