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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-019221 | Care coordination outreach Next-best-action | Kayla Greene: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019222 | Care coordination outreach Next-best-action | Priya Ortega: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019223 | Care coordination outreach Next-best-action | Walter Duncan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019224 | Care coordination outreach Next-best-action | Stephen Mills: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019225 | Care coordination outreach Next-best-action | Marcus Carpenter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019226 | Care coordination outreach Next-best-action | Joseph Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019227 | Care coordination outreach Next-best-action | Debra Mendez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019228 | Care coordination outreach Next-best-action | Lauren Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019229 | Care coordination outreach Next-best-action | Peter Cunningham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019230 | Care coordination outreach Next-best-action | Samuel Ray: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019231 | Care coordination outreach Next-best-action | Jack Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019232 | Care coordination outreach Next-best-action | Luis Park: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019233 | Care coordination outreach Next-best-action | Arjun Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019234 | Care coordination outreach Next-best-action | Jordan Gardner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019235 | Care coordination outreach Next-best-action | James Gardner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019236 | Care coordination outreach Next-best-action | Albert Marshall: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019237 | Care coordination outreach Next-best-action | Samuel Rodriguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019238 | Care coordination outreach Next-best-action | Brittany Griffin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019239 | Care coordination outreach Next-best-action | Bryan Ferguson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019240 | Care coordination outreach Next-best-action | Madison Guzman: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019241 | Care coordination outreach Next-best-action | Bruce Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019242 | Care coordination outreach Next-best-action | Lucia Washington: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019243 | Care coordination outreach Next-best-action | Nathan Sanchez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019244 | Care coordination outreach Next-best-action | Brittany Kim: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019245 | Care coordination outreach Next-best-action | Joe Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019246 | Care coordination outreach Next-best-action | David Henry: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019247 | Care coordination outreach Next-best-action | Kevin Andrews: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019248 | Care coordination outreach Next-best-action | Zachary Greene: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019249 | Care coordination outreach Next-best-action | Andrea Ortiz: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019250 | Care coordination outreach Next-best-action | Kathryn Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019251 | Care coordination outreach Next-best-action | Gary Matthews: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019252 | Care coordination outreach Next-best-action | Julia Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019253 | Care coordination outreach Next-best-action | Ann Gonzalez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019254 | Care coordination outreach Next-best-action | Joyce Griffin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019255 | Care coordination outreach Next-best-action | Karen Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019256 | Care coordination outreach Next-best-action | Samantha Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019257 | Care coordination outreach Next-best-action | Judith Simpson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019258 | Care coordination outreach Next-best-action | Brittany Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019259 | Care coordination outreach Next-best-action | Edward Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019260 | Care coordination outreach Next-best-action | Bobby Carroll: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019261 | Care coordination outreach Next-best-action | Julie Singh: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019262 | Care coordination outreach Next-best-action | Karen Wong: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019263 | Care coordination outreach Next-best-action | Jesse Fields: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019264 | Care coordination outreach Next-best-action | Bryan Simmons: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019265 | Care coordination outreach Next-best-action | Russell Stewart: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019266 | Care coordination outreach Next-best-action | Joseph King: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019267 | Care coordination outreach Next-best-action | Aisha Larson: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019268 | Care coordination outreach Next-best-action | James Burke: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019269 | Care coordination outreach Next-best-action | Virginia Fernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019270 | Care coordination outreach Next-best-action | Julie Fields: 3 claims, no attributed provider |
| 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.