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-014895 | Outreach suppressed pending steward Outreach | ENR-107348 (Helen Snyder) held until CASE-001451 is decided |
| Held | — | ||
| ACT-014896 | Outreach suppressed pending steward Outreach | CLM-405587 (Helen Snyder) held until CASE-001452 is decided |
| Held | — | ||
| ACT-014897 | Outreach suppressed pending steward Outreach | TPA-57954 (Ana Grant) held until CASE-001453 is decided |
| Held | — | ||
| ACT-014898 | Outreach suppressed pending steward Outreach | TPA-63534 (Patricia Mendez) held until CASE-001454 is decided |
| Held | — | ||
| ACT-014899 | Outreach suppressed pending steward Outreach | TPA-63533 (Patricia Mendez) held until CASE-001455 is decided |
| Held | — | ||
| ACT-014900 | Outreach suppressed pending steward Outreach | ENR-111129 (Larry Willis) held until CASE-001456 is decided |
| Held | — | ||
| ACT-014901 | Outreach suppressed pending steward Outreach | CLM-408442 (Larry Willis) held until CASE-001457 is decided |
| Held | — | ||
| ACT-014902 | Outreach suppressed pending steward Outreach | PRV-26384 (Patricia Ramirez) held until CASE-001458 is decided |
| Held | — | ||
| ACT-014903 | Outreach suppressed pending steward Outreach | TPA-52383 (Maria Ramirez) held until CASE-001459 is decided |
| Held | — | ||
| ACT-014904 | Outreach suppressed pending steward Outreach | TPA-54690 (Zachary Franklin) held until CASE-001460 is decided |
| Held | — | ||
| ACT-014905 | Outreach suppressed pending steward Outreach | ENR-114027 (Zachary Franklin) held until CASE-001461 is decided |
| Held | — | ||
| ACT-014906 | Outreach suppressed pending steward Outreach | CLM-427273 (Walter Murray) held until CASE-001462 is decided |
| Held | — | ||
| ACT-014907 | Outreach suppressed pending steward Outreach | ENR-135754 (Walter Murray) held until CASE-001463 is decided |
| Held | — | ||
| ACT-014908 | Outreach suppressed pending steward Outreach | CLM-405767 (Ralph Burns) held until CASE-001464 is decided |
| Held | — | ||
| ACT-014909 | Outreach suppressed pending steward Outreach | ENR-111037 (Aisha Austin) held until CASE-001465 is decided |
| Held | — | ||
| ACT-014910 | Outreach suppressed pending steward Outreach | CLM-408367 (Aisha Austin) held until CASE-001466 is decided |
| Held | — | ||
| ACT-014911 | Outreach suppressed pending steward Outreach | TPA-56187 (Keith Rios) held until CASE-001467 is decided |
| Held | — | ||
| ACT-014912 | Outreach suppressed pending steward Outreach | ENR-118350 (Keiht Rios) held until CASE-001468 is decided |
| Held | — | ||
| ACT-014913 | Outreach suppressed pending steward Outreach | CLM-406029 (Douglas Sandoval) held until CASE-001469 is decided |
| Held | — | ||
| ACT-014914 | Outreach suppressed pending steward Outreach | CLM-415494 (William Wright) held until CASE-001470 is decided |
| Held | — | ||
| ACT-014915 | Outreach suppressed pending steward Outreach | PRV-25574 (Gary Burns) held until CASE-001471 is decided |
| Held | — | ||
| ACT-014916 | Outreach suppressed pending steward Outreach | ENR-129369 (Theresa Cooper) held until CASE-001472 is decided |
| Held | — | ||
| ACT-014917 | Outreach suppressed pending steward Outreach | TPA-59832 (Theresa Cooper) held until CASE-001473 is decided |
| Held | — | ||
| ACT-014918 | Outreach suppressed pending steward Outreach | CLM-422409 (Isabella Lopez) held until CASE-001474 is decided |
| Held | — | ||
| ACT-014919 | Outreach suppressed pending steward Outreach | TPA-59839 (Isabella Lopez) held until CASE-001475 is decided |
| Held | — | ||
| ACT-014920 | Outreach suppressed pending steward Outreach | CLM-418148 (Nancy Larson) held until CASE-001476 is decided |
| Held | — | ||
| ACT-014921 | Outreach suppressed pending steward Outreach | CLM-430492 (Jordan Kelley) held until CASE-001477 is decided |
| Held | — | ||
| ACT-014922 | Outreach suppressed pending steward Outreach | ENR-124259 (Evelyn Rodriguaz) held until CASE-001478 is decided |
| Held | — | ||
| ACT-014923 | Outreach suppressed pending steward Outreach | TPA-62157 (Linda Smith) held until CASE-001479 is decided |
| Held | — | ||
| ACT-014924 | Outreach suppressed pending steward Outreach | ENR-118761 (Ftaima Armstrong) held until CASE-001480 is decided |
| Held | — | ||
| ACT-014925 | Outreach suppressed pending steward Outreach | CLM-414273 (Fatima Armstrong) held until CASE-001481 is decided |
| Held | — | ||
| ACT-014926 | Outreach suppressed pending steward Outreach | CLM-409843 (Ahmed Ortega) held until CASE-001482 is decided |
| Held | — | ||
| ACT-014927 | Outreach suppressed pending steward Outreach | CLM-409845 (Ahmed Ortega) held until CASE-001483 is decided |
| Held | — | ||
| ACT-014928 | Outreach suppressed pending steward Outreach | TPA-51572 (Anna Ford) held until CASE-001484 is decided |
| Held | — | ||
| ACT-014929 | Outreach suppressed pending steward Outreach | CLM-403633 (Anna Ford) held until CASE-001485 is decided |
| Held | — | ||
| ACT-014930 | Outreach suppressed pending steward Outreach | TPA-63218 (Terry Cunningham) held until CASE-001486 is decided |
| Held | — | ||
| ACT-014931 | Outreach suppressed pending steward Outreach | TPA-63219 (Terry Cunningham) held until CASE-001487 is decided |
| Held | — | ||
| ACT-014932 | Outreach suppressed pending steward Outreach | TPA-61200 (Andrew Berry) held until CASE-001488 is decided |
| Held | — | ||
| ACT-014933 | Outreach suppressed pending steward Outreach | CLM-426252 (Thomas Anderson) held until CASE-001489 is decided |
| Held | — | ||
| ACT-014934 | Outreach suppressed pending steward Outreach | TPA-58943 (Rachel Palmer) held until CASE-001490 is decided |
| Held | — | ||
| ACT-014935 | Outreach suppressed pending steward Outreach | ENR-126746 (Rachel Palmer) held until CASE-001491 is decided |
| Held | — | ||
| ACT-014936 | Outreach suppressed pending steward Outreach | PRV-24767 (Jordan Romero) held until CASE-001492 is decided |
| Held | — | ||
| ACT-014937 | Outreach suppressed pending steward Outreach | TPA-57927 (Joseph Romero) held until CASE-001493 is decided |
| Held | — | ||
| ACT-014938 | Outreach suppressed pending steward Outreach | TPA-53590 (Austin Tucker) held until CASE-001494 is decided |
| Held | — | ||
| ACT-014939 | Outreach suppressed pending steward Outreach | PRV-22406 (Austin Tucker) held until CASE-001495 is decided |
| Held | — | ||
| ACT-014940 | Outreach suppressed pending steward Outreach | CLM-414405 (Christian Ortega) held until CASE-001496 is decided |
| Held | — | ||
| ACT-014941 | Outreach suppressed pending steward Outreach | CLM-400344 (Priya Alexander) held until CASE-001497 is decided |
| Held | — | ||
| ACT-014942 | Outreach suppressed pending steward Outreach | ENR-138193 (Jose Jensen) held until CASE-001498 is decided |
| Held | — | ||
| ACT-014943 | Outreach suppressed pending steward Outreach | TPA-60935 (Amy Mendoza) held until CASE-001499 is decided |
| Held | — | ||
| ACT-014944 | Outreach suppressed pending steward Outreach | ENR-141259 (Frances Bowman) held until CASE-001500 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.