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-014845 | Outreach suppressed pending steward Outreach | ENR-115593 (Bobby Hudson) held until CASE-001401 is decided |
| Held | — | ||
| ACT-014846 | Outreach suppressed pending steward Outreach | CLM-429728 (Marcus Luna) held until CASE-001402 is decided |
| Held | — | ||
| ACT-014847 | Outreach suppressed pending steward Outreach | TPA-53641 (Deborah Alvarado) held until CASE-001403 is decided |
| Held | — | ||
| ACT-014848 | Outreach suppressed pending steward Outreach | TPA-50885 (Austin Cox) held until CASE-001404 is decided |
| Held | — | ||
| ACT-014849 | Outreach suppressed pending steward Outreach | ENR-130370 (Sharon Dean) held until CASE-001405 is decided |
| Held | — | ||
| ACT-014850 | Outreach suppressed pending steward Outreach | CLM-423224 (Sharon Dean) held until CASE-001406 is decided |
| Held | — | ||
| ACT-014851 | Outreach suppressed pending steward Outreach | TPA-59700 (Keith Hudson) held until CASE-001407 is decided |
| Held | — | ||
| ACT-014852 | Outreach suppressed pending steward Outreach | PRV-27022 (Justin Ryan) held until CASE-001408 is decided |
| Held | — | ||
| ACT-014853 | Outreach suppressed pending steward Outreach | TPA-58211 (Debra Ortega) held until CASE-001409 is decided |
| Held | — | ||
| ACT-014854 | Outreach suppressed pending steward Outreach | TPA-64413 (Benjamin Olson) held until CASE-001410 is decided |
| Held | — | ||
| ACT-014855 | Outreach suppressed pending steward Outreach | ENR-137873 (Gary Santiago) held until CASE-001411 is decided |
| Held | — | ||
| ACT-014856 | Outreach suppressed pending steward Outreach | CLM-426992 (Martha Jenkins) held until CASE-001412 is decided |
| Held | — | ||
| ACT-014857 | Outreach suppressed pending steward Outreach | CLM-407443 (Elijah Aguilar) held until CASE-001413 is decided |
| Held | — | ||
| ACT-014858 | Outreach suppressed pending steward Outreach | PRV-22201 (Elijah Aguilar) held until CASE-001414 is decided |
| Held | — | ||
| ACT-014859 | Outreach suppressed pending steward Outreach | TPA-60969 (Zachary Gibson) held until CASE-001415 is decided |
| Held | — | ||
| ACT-014860 | Outreach suppressed pending steward Outreach | CLM-421691 (Willima Olson) held until CASE-001416 is decided |
| Held | — | ||
| ACT-014861 | Outreach suppressed pending steward Outreach | TPA-59526 (William Olson) held until CASE-001417 is decided |
| Held | — | ||
| ACT-014862 | Outreach suppressed pending steward Outreach | CLM-432575 (Melissa Allen) held until CASE-001418 is decided |
| Held | — | ||
| ACT-014863 | Outreach suppressed pending steward Outreach | TPA-51674 (Emma Cooleman) held until CASE-001419 is decided |
| Held | — | ||
| ACT-014864 | Outreach suppressed pending steward Outreach | TPA-58521 (Sara Gibson) held until CASE-001420 is decided |
| Held | — | ||
| ACT-014865 | Outreach suppressed pending steward Outreach | ENR-125428 (Sara Gibson) held until CASE-001421 is decided |
| Held | — | ||
| ACT-014866 | Outreach suppressed pending steward Outreach | TPA-64161 (Isabella Dominguez) held until CASE-001422 is decided |
| Held | — | ||
| ACT-014867 | Outreach suppressed pending steward Outreach | TPA-64160 (Isabella Dominguez) held until CASE-001423 is decided |
| Held | — | ||
| ACT-014868 | Outreach suppressed pending steward Outreach | TPA-55737 (Walter Carr) held until CASE-001424 is decided |
| Held | — | ||
| ACT-014869 | Outreach suppressed pending steward Outreach | CLM-428562 (Janet Howell) held until CASE-001425 is decided |
| Held | — | ||
| ACT-014870 | Outreach suppressed pending steward Outreach | PRV-28390 (Jnet Howell) held until CASE-001426 is decided |
| Held | — | ||
| ACT-014871 | Outreach suppressed pending steward Outreach | CLM-402039 (Tyler Matthews) held until CASE-001427 is decided |
| Held | — | ||
| ACT-014872 | Outreach suppressed pending steward Outreach | ENR-102608 (Tyler Matthews) held until CASE-001428 is decided |
| Held | — | ||
| ACT-014873 | Outreach suppressed pending steward Outreach | TPA-58601 (Angela Flores) held until CASE-001429 is decided |
| Held | — | ||
| ACT-014874 | Outreach suppressed pending steward Outreach | CLM-432134 (Maria Welch) held until CASE-001430 is decided |
| Held | — | ||
| ACT-014875 | Outreach suppressed pending steward Outreach | CLM-424970 (Jacob Kelly) held until CASE-001431 is decided |
| Held | — | ||
| ACT-014876 | Outreach suppressed pending steward Outreach | TPA-54507 (Jessica Soto) held until CASE-001432 is decided |
| Held | — | ||
| ACT-014877 | Outreach suppressed pending steward Outreach | ENR-113576 (Jessica Soto) held until CASE-001433 is decided |
| Held | — | ||
| ACT-014878 | Outreach suppressed pending steward Outreach | TPA-50073 (Sean Cook) held until CASE-001434 is decided |
| Held | — | ||
| ACT-014879 | Outreach suppressed pending steward Outreach | PRV-27589 (Mariana Hansen) held until CASE-001435 is decided |
| Held | — | ||
| ACT-014880 | Outreach suppressed pending steward Outreach | CLM-425785 (Mariana Hansen) held until CASE-001436 is decided |
| Held | — | ||
| ACT-014881 | Outreach suppressed pending steward Outreach | CLM-424722 (Daniel Garcia) held until CASE-001437 is decided |
| Held | — | ||
| ACT-014882 | Outreach suppressed pending steward Outreach | CLM-418306 (Janet Sullivan) held until CASE-001438 is decided |
| Held | — | ||
| ACT-014883 | Outreach suppressed pending steward Outreach | TPA-63136 (Karen Nichols) held until CASE-001439 is decided |
| Held | — | ||
| ACT-014884 | Outreach suppressed pending steward Outreach | ENR-122620 (Mei Lynch) held until CASE-001440 is decided |
| Held | — | ||
| ACT-014885 | Outreach suppressed pending steward Outreach | CLM-414105 (Isabella Lynch) held until CASE-001441 is decided |
| Held | — | ||
| ACT-014886 | Outreach suppressed pending steward Outreach | ENR-102457 (Peter Sullivan) held until CASE-001442 is decided |
| Held | — | ||
| ACT-014887 | Outreach suppressed pending steward Outreach | PRV-25127 (Dorothy Diaz) held until CASE-001443 is decided |
| Held | — | ||
| ACT-014888 | Outreach suppressed pending steward Outreach | CLM-417311 (Dot Diaz) held until CASE-001444 is decided |
| Held | — | ||
| ACT-014889 | Outreach suppressed pending steward Outreach | TPA-62153 (Emma Diaz) held until CASE-001445 is decided |
| Held | — | ||
| ACT-014890 | Outreach suppressed pending steward Outreach | TPA-57542 (Nicole Owens) held until CASE-001446 is decided |
| Held | — | ||
| ACT-014891 | Outreach suppressed pending steward Outreach | TPA-57543 (Nicole Owens) held until CASE-001447 is decided |
| Held | — | ||
| ACT-014892 | Outreach suppressed pending steward Outreach | TPA-59104 (Jacob Maldonado) held until CASE-001448 is decided |
| Held | — | ||
| ACT-014893 | Outreach suppressed pending steward Outreach | TPA-63783 (Jason Kelley) held until CASE-001449 is decided |
| Held | — | ||
| ACT-014894 | Outreach suppressed pending steward Outreach | CLM-431187 (Jason Kelley) held until CASE-001450 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.