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-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.