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-019271 | Care coordination outreach Next-best-action | Megan Mejia: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019272 | Care coordination outreach Next-best-action | Camila Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019273 | Care coordination outreach Next-best-action | Alexander Smith: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019274 | Care coordination outreach Next-best-action | Priya Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019275 | Care coordination outreach Next-best-action | Frances Hansen: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019276 | Care coordination outreach Next-best-action | Jeremy Palmer: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019277 | Care coordination outreach Next-best-action | Andrea Carroll: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019278 | Care coordination outreach Next-best-action | Kevin Lewis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019279 | Care coordination outreach Next-best-action | Ryan Hunter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019280 | Care coordination outreach Next-best-action | Rebecca Adams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019281 | Care coordination outreach Next-best-action | Christine Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019282 | Care coordination outreach Next-best-action | Anthony Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019283 | Care coordination outreach Next-best-action | Alexis Price: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019284 | Care coordination outreach Next-best-action | Victoria Salazar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019285 | Care coordination outreach Next-best-action | Kelly Herrera: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019286 | Care coordination outreach Next-best-action | James Owens: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019287 | Care coordination outreach Next-best-action | Matthew Long: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019288 | Care coordination outreach Next-best-action | Kevin Garcia: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019289 | Care coordination outreach Next-best-action | Jacqueline Willis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019290 | Care coordination outreach Next-best-action | Kenneth Hernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019291 | Care coordination outreach Next-best-action | Sofia Weaver: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019292 | Care coordination outreach Next-best-action | Linda Kelly: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019293 | Care coordination outreach Next-best-action | Dylan Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019294 | Care coordination outreach Next-best-action | Julie Pena: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019295 | Care coordination outreach Next-best-action | Joseph Turner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019296 | Care coordination outreach Next-best-action | Edward Edwards: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019297 | Care coordination outreach Next-best-action | Jean Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019298 | Care coordination outreach Next-best-action | Bruce Alexander: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019299 | Care coordination outreach Next-best-action | Brenda Carpenter: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019300 | Care coordination outreach Next-best-action | Jennfier Carroll: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019301 | Care coordination outreach Next-best-action | Gary Bryant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019302 | Care coordination outreach Next-best-action | Denise Petesr: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019303 | Care coordination outreach Next-best-action | Virginia Bennett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019304 | Care coordination outreach Next-best-action | Abigail McDonald: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019305 | Care coordination outreach Next-best-action | Michelle Perkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019306 | Care coordination outreach Next-best-action | Jack Sims: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019307 | Care coordination outreach Next-best-action | Michael Diaz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019308 | Care coordination outreach Next-best-action | Diane Burke: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019309 | Care coordination outreach Next-best-action | Ethan Miller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019310 | Care coordination outreach Next-best-action | Samuel Mendoza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019311 | Care coordination outreach Next-best-action | Vincent Gomez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019312 | Care coordination outreach Next-best-action | Robert Walker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019313 | Care coordination outreach Next-best-action | Terry Williams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019314 | Care coordination outreach Next-best-action | Laura Alvarado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019315 | Care coordination outreach Next-best-action | William Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019316 | Care coordination outreach Next-best-action | Douglas Schultz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019317 | Care coordination outreach Next-best-action | Dorothy Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019318 | Care coordination outreach Next-best-action | Kenneth Kennedy: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019319 | Care coordination outreach Next-best-action | Gabriel Gray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019320 | Care coordination outreach Next-best-action | Priya Rodriguez: 4 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.