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
Eligibility conflict resolved, Eligibility engine, 1,339 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-000101 | Eligibility conflict resolved Eligibility engine | Frank Lawrence: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000102 | Eligibility conflict resolved Eligibility engine | Larry Perez: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000103 | Eligibility conflict resolved Eligibility engine | George Austin: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000104 | Eligibility conflict resolved Eligibility engine | Diane Carter: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000105 | Eligibility conflict resolved Eligibility engine | Jeffrey Cox: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000106 | Eligibility conflict resolved Eligibility engine | Nicholas Coleman: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000107 | Eligibility conflict resolved Eligibility engine | Ryan Rogers: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000108 | Eligibility conflict resolved Eligibility engine | Heather Fuller: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000109 | Eligibility conflict resolved Eligibility engine | James Long: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000110 | Eligibility conflict resolved Eligibility engine | Billy Barnes: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000111 | Eligibility conflict resolved Eligibility engine | Christian Marshall: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000112 | Eligibility conflict resolved Eligibility engine | Denise Roberts: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000113 | Eligibility conflict resolved Eligibility engine | Russell Gordon: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000114 | Eligibility conflict resolved Eligibility engine | Joyce Carter: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000115 | Eligibility conflict resolved Eligibility engine | Henry Lane: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000116 | Eligibility conflict resolved Eligibility engine | Zachary Maldonado: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000117 | Eligibility conflict resolved Eligibility engine | Barbara Park: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000118 | Eligibility conflict resolved Eligibility engine | Jeffrey Martin: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000119 | Eligibility conflict resolved Eligibility engine | Jonathan Rivera: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000120 | Eligibility conflict resolved Eligibility engine | Diego Montgomery: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000121 | Eligibility conflict resolved Eligibility engine | Chris Meyer: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000122 | Eligibility conflict resolved Eligibility engine | Hannah Simpson: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000123 | Eligibility conflict resolved Eligibility engine | Jack Hall: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000124 | Eligibility conflict resolved Eligibility engine | Bryan Jenkins: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000125 | Eligibility conflict resolved Eligibility engine | Yuki Richardson: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000126 | Eligibility conflict resolved Eligibility engine | Jacqueline Evans: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000127 | Eligibility conflict resolved Eligibility engine | Evelyn Coleman: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000128 | Eligibility conflict resolved Eligibility engine | Doris Guzman: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000129 | Eligibility conflict resolved Eligibility engine | Scott Thomas: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000130 | Eligibility conflict resolved Eligibility engine | Karen Fowler: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000131 | Eligibility conflict resolved Eligibility engine | Mark Crawford: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000132 | Eligibility conflict resolved Eligibility engine | Jacqueline Chen: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000133 | Eligibility conflict resolved Eligibility engine | Tyler Snyder: 2 plan codes across sources → canonical OPTIONS-PPO |
| Proposed | — | ||
| ACT-000134 | Eligibility conflict resolved Eligibility engine | Yuki Maldonado: 3 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000135 | Eligibility conflict resolved Eligibility engine | Keith Lopez: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000136 | Eligibility conflict resolved Eligibility engine | Diego Guerrero: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000137 | Eligibility conflict resolved Eligibility engine | Patrick Jenkins: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000138 | Eligibility conflict resolved Eligibility engine | Michelle Carpenter: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000139 | Eligibility conflict resolved Eligibility engine | Margaret Roberts: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000140 | Eligibility conflict resolved Eligibility engine | Olivia Fox: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000141 | Eligibility conflict resolved Eligibility engine | Peter Tucker: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000142 | Eligibility conflict resolved Eligibility engine | Patricia Flores: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — | ||
| ACT-000143 | Eligibility conflict resolved Eligibility engine | Cynthia Ortega: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000144 | Eligibility conflict resolved Eligibility engine | Billy Henderson: 2 plan codes across sources → canonical MEDICARE-ADV-A |
| Proposed | — | ||
| ACT-000145 | Eligibility conflict resolved Eligibility engine | Alice Baker: 2 plan codes across sources → canonical SELECT-EPO |
| Proposed | — | ||
| ACT-000146 | Eligibility conflict resolved Eligibility engine | Laura Obrien: 2 plan codes across sources → canonical CORE-HMO |
| Proposed | — | ||
| ACT-000147 | Eligibility conflict resolved Eligibility engine | Olivia Padilla: 2 plan codes across sources → canonical MEDICARE-ADV-B |
| Proposed | — | ||
| ACT-000148 | Eligibility conflict resolved Eligibility engine | Ana Ortega: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000149 | Eligibility conflict resolved Eligibility engine | Heather Walsh: 2 plan codes across sources → canonical CHOICE-PLUS-PPO |
| Proposed | — | ||
| ACT-000150 | Eligibility conflict resolved Eligibility engine | Sandra Obrien: 2 plan codes across sources → canonical NAVIGATE-HMO |
| Proposed | — |
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.