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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-007112 | Orphan claim re-pointed Claims processor | CLM-402657 → UHC-09595-21 (Kathleen Hanson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007113 | Orphan claim re-pointed Claims processor | CLM-408174 → UHC-11325-94 (Kenneth Kelly) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007114 | Orphan claim re-pointed Claims processor | CLM-412147 → UHC-48458-09 (Ronald Lopez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007115 | Orphan claim re-pointed Claims processor | CLM-432024 → UHC-86823-72 (Randy Parker) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007116 | Orphan claim re-pointed Claims processor | CLM-405786 → UHC-81514-74 (Amanda Larson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007117 | Orphan claim re-pointed Claims processor | CLM-406905 → UHC-99232-21 (Lawrence Rice) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007118 | Orphan claim re-pointed Claims processor | CLM-420954 → UHC-43105-62 (Denise White) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007119 | Orphan claim re-pointed Claims processor | CLM-417007 → UHC-49436-32 (Madison Taylor) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007120 | Orphan claim re-pointed Claims processor | CLM-417767 → UHC-90635-30 (Justin Johnson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007121 | Orphan claim re-pointed Claims processor | CLM-405144 → UHC-68210-89 (Alexis Ramirez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007122 | Orphan claim re-pointed Claims processor | CLM-425702 → UHC-87716-71 (Betty Willis) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007123 | Orphan claim re-pointed Claims processor | CLM-408457 → UHC-56014-62 (Tony Luna) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007124 | Orphan claim re-pointed Claims processor | CLM-428384 → UHC-44333-96 (Danielle Fox) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007125 | Orphan claim re-pointed Claims processor | CLM-413629 → UHC-64031-66 (Keith Banks) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007126 | Orphan claim re-pointed Claims processor | CLM-403850 → UHC-60731-35 (Larry Arnold) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007127 | Orphan claim re-pointed Claims processor | CLM-425860 → UHC-68692-18 (Donna Reed) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007128 | Orphan claim re-pointed Claims processor | CLM-403248 → UHC-66774-91 (Kenneth Martinez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007129 | Orphan claim re-pointed Claims processor | CLM-428623 → UHC-25585-33 (Martha Washington) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007130 | Orphan claim re-pointed Claims processor | CLM-413571 → UHC-97811-68 (Jonathan Freeman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007131 | Orphan claim re-pointed Claims processor | CLM-405396 → UHC-39143-11 (Rebecca Austin) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007132 | Orphan claim re-pointed Claims processor | CLM-423288 → UHC-25477-10 (Richard Hansen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007133 | Orphan claim re-pointed Claims processor | CLM-404837 → UHC-98156-98 (Terry Watson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007134 | Orphan claim re-pointed Claims processor | CLM-426837 → UHC-26419-88 (Joe Bishop) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007135 | Orphan claim re-pointed Claims processor | CLM-411448 → UHC-73234-71 (Jacob Rios) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007136 | Orphan claim re-pointed Claims processor | CLM-400431 → UHC-60033-71 (Bradley Carroll) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007137 | Orphan claim re-pointed Claims processor | CLM-430441 → UHC-60914-75 (Gerald Anderson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007138 | Orphan claim re-pointed Claims processor | CLM-407700 → UHC-80137-83 (Roger George) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007139 | Orphan claim re-pointed Claims processor | CLM-401817 → UHC-66810-53 (Carlos Wood) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007140 | Orphan claim re-pointed Claims processor | CLM-427826 → UHC-34630-48 (Natalie Morgan) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007141 | Orphan claim re-pointed Claims processor | CLM-404948 → UHC-22461-47 (Nicole Rice) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007142 | Orphan claim re-pointed Claims processor | CLM-416033 → UHC-60936-79 (Marcus Tucker) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007143 | Orphan claim re-pointed Claims processor | CLM-414864 → UHC-21871-27 (Scott Gibson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007144 | Orphan claim re-pointed Claims processor | CLM-429404 → UHC-79908-24 (Edward Edwards) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007145 | Orphan claim re-pointed Claims processor | CLM-431415 → UHC-36403-64 (Carolyn Richards) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007146 | Orphan claim re-pointed Claims processor | CLM-429571 → UHC-15588-86 (Jonathan Bryant) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007147 | Orphan claim re-pointed Claims processor | CLM-411861 → UHC-91260-88 (Nathan Olson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007148 | Orphan claim re-pointed Claims processor | CLM-422238 → UHC-26322-25 (Joseph Daniels) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007149 | Orphan claim re-pointed Claims processor | CLM-409219 → UHC-91184-90 (Vincent Gomez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007150 | Orphan claim re-pointed Claims processor | CLM-400467 → UHC-08752-97 (Wayne Carpenter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007151 | Orphan claim re-pointed Claims processor | CLM-422759 → UHC-13607-07 (Lucia Washington) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007152 | Orphan claim re-pointed Claims processor | CLM-414124 → UHC-62683-57 (Deborah Burke) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007153 | Orphan claim re-pointed Claims processor | CLM-418631 → UHC-31856-02 (Anthony Fields) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007154 | Orphan claim re-pointed Claims processor | CLM-400877 → UHC-77734-83 (Justin Gordon) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007155 | Orphan claim re-pointed Claims processor | CLM-413839 → UHC-21374-40 (Dylan Rivera) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007156 | Orphan claim re-pointed Claims processor | CLM-406757 → UHC-77796-83 (Eugene Elliott) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007157 | Orphan claim re-pointed Claims processor | CLM-423264 → UHC-68621-79 (Raymond Snyder) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007158 | Orphan claim re-pointed Claims processor | CLM-425555 → UHC-98623-51 (Kelly Wallace) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007159 | Orphan claim re-pointed Claims processor | CLM-425310 → UHC-46569-38 (Arthur Carter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007160 | Orphan claim re-pointed Claims processor | CLM-421385 → UHC-60404-50 (Diae Nguyen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-007161 | Orphan claim re-pointed Claims processor | CLM-406490 → UHC-95967-21 (Ralph Nguyen) |
| Executed | resolution_agent 2026-10-22 12:47:23 |
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.