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-014945 | Outreach suppressed pending steward Outreach | PRV-29189 (Frances Bowman) held until CASE-001501 is decided |
| Held | — | ||
| ACT-014946 | Outreach suppressed pending steward Outreach | ENR-138308 (Betty Ray) held until CASE-001502 is decided |
| Held | — | ||
| ACT-014947 | Outreach suppressed pending steward Outreach | CLM-429202 (Betty Ray) held until CASE-001503 is decided |
| Held | — | ||
| ACT-014948 | Outreach suppressed pending steward Outreach | ENR-105280 (Virginia Watkins) held until CASE-001504 is decided |
| Held | — | ||
| ACT-014949 | Outreach suppressed pending steward Outreach | TPA-51747 (Virginia Watkins) held until CASE-001505 is decided |
| Held | — | ||
| ACT-014950 | Outreach suppressed pending steward Outreach | CLM-419263 (Vincent Dixon) held until CASE-001506 is decided |
| Held | — | ||
| ACT-014951 | Outreach suppressed pending steward Outreach | CLM-411480 (Margaret Cruz) held until CASE-001507 is decided |
| Held | — | ||
| ACT-014952 | Outreach suppressed pending steward Outreach | CLM-423685 (Randy Morris) held until CASE-001508 is decided |
| Held | — | ||
| ACT-014953 | Outreach suppressed pending steward Outreach | CLM-423686 (Randy Morris) held until CASE-001509 is decided |
| Held | — | ||
| ACT-014954 | Outreach suppressed pending steward Outreach | PRV-27471 (Lucia Guerrero) held until CASE-001510 is decided |
| Held | — | ||
| ACT-014955 | Outreach suppressed pending steward Outreach | CLM-425355 (Lucia Guerrero) held until CASE-001511 is decided |
| Held | — | ||
| ACT-014956 | Outreach suppressed pending steward Outreach | TPA-56754 (Daniel Warren) held until CASE-001512 is decided |
| Held | — | ||
| ACT-014957 | Outreach suppressed pending steward Outreach | PRV-27593 (Jesse Fields) held until CASE-001513 is decided |
| Held | — | ||
| ACT-014958 | Outreach suppressed pending steward Outreach | ENR-108782 (Katherine Jimenez) held until CASE-001514 is decided |
| Held | — | ||
| ACT-014959 | Outreach suppressed pending steward Outreach | CLM-406734 (Kathy Jimenez) held until CASE-001515 is decided |
| Held | — | ||
| ACT-014960 | Outreach suppressed pending steward Outreach | TPA-61628 (Jmaes Williams) held until CASE-001516 is decided |
| Held | — | ||
| ACT-014961 | Outreach suppressed pending steward Outreach | ENR-142346 (Olivia Williams) held until CASE-001517 is decided |
| Held | — | ||
| ACT-014962 | Outreach suppressed pending steward Outreach | CLM-432253 (Olivia Williams) held until CASE-001518 is decided |
| Held | — | ||
| ACT-014963 | Outreach suppressed pending steward Outreach | TPA-58882 (Jose Griffin) held until CASE-001519 is decided |
| Held | — | ||
| ACT-014964 | Outreach suppressed pending steward Outreach | CLM-420176 (Jose Griffin) held until CASE-001520 is decided |
| Held | — | ||
| ACT-014965 | Outreach suppressed pending steward Outreach | TPA-64137 (Joshua Griffin) held until CASE-001521 is decided |
| Held | — | ||
| ACT-014966 | Outreach suppressed pending steward Outreach | ENR-128700 (Anthony Bennett) held until CASE-001522 is decided |
| Held | — | ||
| ACT-014967 | Outreach suppressed pending steward Outreach | ENR-123381 (Susan Burns) held until CASE-001523 is decided |
| Held | — | ||
| ACT-014968 | Outreach suppressed pending steward Outreach | CLM-417770 (Susan Burns) held until CASE-001524 is decided |
| Held | — | ||
| ACT-014969 | Outreach suppressed pending steward Outreach | TPA-55490 (Alexis Watkins) held until CASE-001525 is decided |
| Held | — | ||
| ACT-014970 | Outreach suppressed pending steward Outreach | TPA-63438 (Kelly Watson) held until CASE-001526 is decided |
| Held | — | ||
| ACT-014971 | Outreach suppressed pending steward Outreach | CLM-430429 (Kelly Watson) held until CASE-001527 is decided |
| Held | — | ||
| ACT-014972 | Outreach suppressed pending steward Outreach | TPA-53484 (Alexis Burton) held until CASE-001528 is decided |
| Held | — | ||
| ACT-014973 | Outreach suppressed pending steward Outreach | CLM-422592 (Karne Palmeer) held until CASE-001529 is decided |
| Held | — | ||
| ACT-014974 | Outreach suppressed pending steward Outreach | CLM-404318 (Angela Wagner) held until CASE-001530 is decided |
| Held | — | ||
| ACT-014975 | Outreach suppressed pending steward Outreach | CLM-404317 (Angela Wagner) held until CASE-001531 is decided |
| Held | — | ||
| ACT-014976 | Outreach suppressed pending steward Outreach | CLM-404315 (Angela Wagner) held until CASE-001532 is decided |
| Held | — | ||
| ACT-014977 | Outreach suppressed pending steward Outreach | CLM-400363 (Grace Soto) held until CASE-001533 is decided |
| Held | — | ||
| ACT-014978 | Outreach suppressed pending steward Outreach | ENR-110343 (Yuki Luna) held until CASE-001534 is decided |
| Held | — | ||
| ACT-014979 | Outreach suppressed pending steward Outreach | TPA-53465 (Yuki Luna) held until CASE-001535 is decided |
| Held | — | ||
| ACT-014980 | Outreach suppressed pending steward Outreach | TPA-61248 (Gregory Tuckr) held until CASE-001536 is decided |
| Held | — | ||
| ACT-014981 | Outreach suppressed pending steward Outreach | ENR-133349 (Gregory Tucker) held until CASE-001537 is decided |
| Held | — | ||
| ACT-014982 | Outreach suppressed pending steward Outreach | TPA-61916 (Frank Taylor) held until CASE-001538 is decided |
| Held | — | ||
| ACT-014983 | Outreach suppressed pending steward Outreach | TPA-59056 (Natthan Tran) held until CASE-001539 is decided |
| Held | — | ||
| ACT-014984 | Outreach suppressed pending steward Outreach | TPA-53717 (Ronald Weaver) held until CASE-001540 is decided |
| Held | — | ||
| ACT-014985 | Outreach suppressed pending steward Outreach | CLM-429209 (Sara Williams) held until CASE-001541 is decided |
| Held | — | ||
| ACT-014986 | Outreach suppressed pending steward Outreach | CLM-403954 (Cheryl Montgomery) held until CASE-001542 is decided |
| Held | — | ||
| ACT-014987 | Outreach suppressed pending steward Outreach | CLM-421248 (Amanda Phillips) held until CASE-001543 is decided |
| Held | — | ||
| ACT-014988 | Outreach suppressed pending steward Outreach | TPA-59346 (Amanda Phillips) held until CASE-001544 is decided |
| Held | — | ||
| ACT-014989 | Outreach suppressed pending steward Outreach | CLM-400518 (Evelyn Rodriguez) held until CASE-001545 is decided |
| Held | — | ||
| ACT-014990 | Outreach suppressed pending steward Outreach | TPA-50224 (Evelyn Rodriguez) held until CASE-001546 is decided |
| Held | — | ||
| ACT-014991 | Outreach suppressed pending steward Outreach | TPA-54063 (Elizabeth Diaz) held until CASE-001547 is decided |
| Held | — | ||
| ACT-014992 | Outreach suppressed pending steward Outreach | CLM-409368 (Elizabeth Diaz) held until CASE-001548 is decided |
| Held | — | ||
| ACT-014993 | Outreach suppressed pending steward Outreach | ENR-142259 (Valentina Diaz) held until CASE-001549 is decided |
| Held | — | ||
| ACT-014994 | Outreach suppressed pending steward Outreach | TPA-64208 (Valentina Diaz) held until CASE-001550 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.