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-013545 | Outreach suppressed pending steward Outreach | TPA-54793 (Sarah Fernandez) held until CASE-000101 is decided |
| Held | — | ||
| ACT-013546 | Outreach suppressed pending steward Outreach | TPA-62804 (Cynthia Weber) held until CASE-000102 is decided |
| Held | — | ||
| ACT-013547 | Outreach suppressed pending steward Outreach | PRV-24344 (Badley Weber) held until CASE-000103 is decided |
| Held | — | ||
| ACT-013548 | Outreach suppressed pending steward Outreach | ENR-107310 (Christine Ward) held until CASE-000104 is decided |
| Held | — | ||
| ACT-013549 | Outreach suppressed pending steward Outreach | TPA-52447 (Christine Ward) held until CASE-000105 is decided |
| Held | — | ||
| ACT-013550 | Outreach suppressed pending steward Outreach | ENR-106371 (Willie Greene) held until CASE-000106 is decided |
| Held | — | ||
| ACT-013551 | Outreach suppressed pending steward Outreach | CLM-404832 (Willie Greene) held until CASE-000107 is decided |
| Held | — | ||
| ACT-013552 | Outreach suppressed pending steward Outreach | TPA-50264 (Daniel Burton) held until CASE-000108 is decided |
| Held | — | ||
| ACT-013553 | Outreach suppressed pending steward Outreach | TPA-50169 (Mark Stevens) held until CASE-000109 is decided |
| Held | — | ||
| ACT-013554 | Outreach suppressed pending steward Outreach | ENR-114825 (Daniel Austin) held until CASE-000110 is decided |
| Held | — | ||
| ACT-013555 | Outreach suppressed pending steward Outreach | CLM-411268 (Daniel Austin) held until CASE-000111 is decided |
| Held | — | ||
| ACT-013556 | Outreach suppressed pending steward Outreach | PRV-23517 (Hiroshi Martinez) held until CASE-000112 is decided |
| Held | — | ||
| ACT-013557 | Outreach suppressed pending steward Outreach | CLM-420111 (Daniel Greene) held until CASE-000113 is decided |
| Held | — | ||
| ACT-013558 | Outreach suppressed pending steward Outreach | CLM-420112 (Daniel Grreene) held until CASE-000114 is decided |
| Held | — | ||
| ACT-013559 | Outreach suppressed pending steward Outreach | TPA-58865 (Daniel Greene) held until CASE-000115 is decided |
| Held | — | ||
| ACT-013560 | Outreach suppressed pending steward Outreach | CLM-418118 (Aisha Padilla) held until CASE-000116 is decided |
| Held | — | ||
| ACT-013561 | Outreach suppressed pending steward Outreach | PRV-22244 (Albbert Murray) held until CASE-000117 is decided |
| Held | — | ||
| ACT-013562 | Outreach suppressed pending steward Outreach | PRV-20457 (Mateo Shaw) held until CASE-000118 is decided |
| Held | — | ||
| ACT-013563 | Outreach suppressed pending steward Outreach | CLM-401473 (Mateo Shaw) held until CASE-000119 is decided |
| Held | — | ||
| ACT-013564 | Outreach suppressed pending steward Outreach | CLM-401956 (Ashley Murphy) held until CASE-000120 is decided |
| Held | — | ||
| ACT-013565 | Outreach suppressed pending steward Outreach | CLM-401957 (Ashley Murphy) held until CASE-000121 is decided |
| Held | — | ||
| ACT-013566 | Outreach suppressed pending steward Outreach | ENR-137269 (Emma Lewis) held until CASE-000122 is decided |
| Held | — | ||
| ACT-013567 | Outreach suppressed pending steward Outreach | TPA-62554 (Emma Leis) held until CASE-000123 is decided |
| Held | — | ||
| ACT-013568 | Outreach suppressed pending steward Outreach | TPA-51853 (Santiago Hrrera) held until CASE-000124 is decided |
| Held | — | ||
| ACT-013569 | Outreach suppressed pending steward Outreach | ENR-105592 (Santiago Herrera) held until CASE-000125 is decided |
| Held | — | ||
| ACT-013570 | Outreach suppressed pending steward Outreach | CLM-430925 (Kimberly Richardson) held until CASE-000126 is decided |
| Held | — | ||
| ACT-013571 | Outreach suppressed pending steward Outreach | TPA-52231 (Valentina Alvarado) held until CASE-000127 is decided |
| Held | — | ||
| ACT-013572 | Outreach suppressed pending steward Outreach | CLM-405093 (Valentina Alvarado) held until CASE-000128 is decided |
| Held | — | ||
| ACT-013573 | Outreach suppressed pending steward Outreach | CLM-426003 (Zachary Hunt) held until CASE-000129 is decided |
| Held | — | ||
| ACT-013574 | Outreach suppressed pending steward Outreach | CLM-425024 (Joseph Reid) held until CASE-000130 is decided |
| Held | — | ||
| ACT-013575 | Outreach suppressed pending steward Outreach | TPA-61026 (Joseph Reid) held until CASE-000131 is decided |
| Held | — | ||
| ACT-013576 | Outreach suppressed pending steward Outreach | CLM-402842 (Mason Welch) held until CASE-000132 is decided |
| Held | — | ||
| ACT-013577 | Outreach suppressed pending steward Outreach | TPA-51223 (Mason Welch) held until CASE-000133 is decided |
| Held | — | ||
| ACT-013578 | Outreach suppressed pending steward Outreach | CLM-416088 (Matthew Stevens) held until CASE-000134 is decided |
| Held | — | ||
| ACT-013579 | Outreach suppressed pending steward Outreach | ENR-121163 (Matthew Stevens) held until CASE-000135 is decided |
| Held | — | ||
| ACT-013580 | Outreach suppressed pending steward Outreach | CLM-429030 (Sharon Ruiz) held until CASE-000136 is decided |
| Held | — | ||
| ACT-013581 | Outreach suppressed pending steward Outreach | CLM-402167 (Benjamin Cruz) held until CASE-000137 is decided |
| Held | — | ||
| ACT-013582 | Outreach suppressed pending steward Outreach | TPA-62428 (Yuki Richardson) held until CASE-000138 is decided |
| Held | — | ||
| ACT-013583 | Outreach suppressed pending steward Outreach | CLM-413183 (Lori Butler) held until CASE-000139 is decided |
| Held | — | ||
| ACT-013584 | Outreach suppressed pending steward Outreach | TPA-55802 (Lori Butler) held until CASE-000140 is decided |
| Held | — | ||
| ACT-013585 | Outreach suppressed pending steward Outreach | CLM-405606 (Adam Vasquez) held until CASE-000141 is decided |
| Held | — | ||
| ACT-013586 | Outreach suppressed pending steward Outreach | TPA-59563 (Charlotte Hayes) held until CASE-000142 is decided |
| Held | — | ||
| ACT-013587 | Outreach suppressed pending steward Outreach | CLM-401066 (Logan Andrews) held until CASE-000143 is decided |
| Held | — | ||
| ACT-013588 | Outreach suppressed pending steward Outreach | PRV-20335 (Logan Andrews) held until CASE-000144 is decided |
| Held | — | ||
| ACT-013589 | Outreach suppressed pending steward Outreach | ENR-117492 (Michael Anderson) held until CASE-000145 is decided |
| Held | — | ||
| ACT-013590 | Outreach suppressed pending steward Outreach | TPA-57455 (Michelle Anderws) held until CASE-000146 is decided |
| Held | — | ||
| ACT-013591 | Outreach suppressed pending steward Outreach | CLM-419108 (Gregory Ried) held until CASE-000147 is decided |
| Held | — | ||
| ACT-013592 | Outreach suppressed pending steward Outreach | CLM-431863 (James Holmes) held until CASE-000148 is decided |
| Held | — | ||
| ACT-013593 | Outreach suppressed pending steward Outreach | ENR-141820 (James Holmes) held until CASE-000149 is decided |
| Held | — | ||
| ACT-013594 | Outreach suppressed pending steward Outreach | PRV-22182 (Bobby Lee) held until CASE-000150 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.