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-014995 | Outreach suppressed pending steward Outreach | TPA-60731 (Julie Alexander) held until CASE-001551 is decided |
| Held | — | ||
| ACT-014996 | Outreach suppressed pending steward Outreach | CLM-424358 (Julie Alexander) held until CASE-001552 is decided |
| Held | — | ||
| ACT-014997 | Outreach suppressed pending steward Outreach | TPA-51593 (Gerald Ford) held until CASE-001553 is decided |
| Held | — | ||
| ACT-014998 | Outreach suppressed pending steward Outreach | TPA-55757 (Sarah Tucker) held until CASE-001554 is decided |
| Held | — | ||
| ACT-014999 | Outreach suppressed pending steward Outreach | TPA-54001 (Bryan Ortiz) held until CASE-001555 is decided |
| Held | — | ||
| ACT-015000 | Outreach suppressed pending steward Outreach | CLM-409184 (Bryan Ortiz) held until CASE-001556 is decided |
| Held | — | ||
| ACT-015001 | Outreach suppressed pending steward Outreach | CLM-409185 (Bryan Ortiz) held until CASE-001557 is decided |
| Held | — | ||
| ACT-015002 | Outreach suppressed pending steward Outreach | CLM-427838 (Patricia Lawson) held until CASE-001558 is decided |
| Held | — | ||
| ACT-015003 | Outreach suppressed pending steward Outreach | CLM-417266 (Andrew Jimenez) held until CASE-001559 is decided |
| Held | — | ||
| ACT-015004 | Outreach suppressed pending steward Outreach | CLM-430175 (John Vazquez) held until CASE-001560 is decided |
| Held | — | ||
| ACT-015005 | Outreach suppressed pending steward Outreach | TPA-63318 (John Vazquez) held until CASE-001561 is decided |
| Held | — | ||
| ACT-015006 | Outreach suppressed pending steward Outreach | TPA-51796 (Zechary Luna) held until CASE-001562 is decided |
| Held | — | ||
| ACT-015007 | Outreach suppressed pending steward Outreach | TPA-58567 (Jerry Lane) held until CASE-001563 is decided |
| Held | — | ||
| ACT-015008 | Outreach suppressed pending steward Outreach | TPA-51283 (Carol Snyder) held until CASE-001564 is decided |
| Held | — | ||
| ACT-015009 | Outreach suppressed pending steward Outreach | TPA-55815 (Luis Snyder) held until CASE-001565 is decided |
| Held | — | ||
| ACT-015010 | Outreach suppressed pending steward Outreach | ENR-117349 (Luis Snydre) held until CASE-001566 is decided |
| Held | — | ||
| ACT-015011 | Outreach suppressed pending steward Outreach | PRV-20417 (Sarra Gomez) held until CASE-001567 is decided |
| Held | — | ||
| ACT-015012 | Outreach suppressed pending steward Outreach | CLM-430601 (Randy Coko) held until CASE-001568 is decided |
| Held | — | ||
| ACT-015013 | Outreach suppressed pending steward Outreach | CLM-430602 (Randy Cok) held until CASE-001569 is decided |
| Held | — | ||
| ACT-015014 | Outreach suppressed pending steward Outreach | CLM-428492 (Arthur Wong) held until CASE-001570 is decided |
| Held | — | ||
| ACT-015015 | Outreach suppressed pending steward Outreach | CLM-428493 (Arthur Wong) held until CASE-001571 is decided |
| Held | — | ||
| ACT-015016 | Outreach suppressed pending steward Outreach | CLM-425037 (Willie Simmons) held until CASE-001572 is decided |
| Held | — | ||
| ACT-015017 | Outreach suppressed pending steward Outreach | TPA-61032 (Willie Simmons) held until CASE-001573 is decided |
| Held | — | ||
| ACT-015018 | Outreach suppressed pending steward Outreach | PRV-24474 (Lisa Carpenter) held until CASE-001574 is decided |
| Held | — | ||
| ACT-015019 | Outreach suppressed pending steward Outreach | TPA-59866 (George Riley) held until CASE-001575 is decided |
| Held | — | ||
| ACT-015020 | Outreach suppressed pending steward Outreach | CLM-422464 (George Riley) held until CASE-001576 is decided |
| Held | — | ||
| ACT-015021 | Outreach suppressed pending steward Outreach | PRV-22011 (Maria Danniels) held until CASE-001577 is decided |
| Held | — | ||
| ACT-015022 | Outreach suppressed pending steward Outreach | CLM-406843 (Maria Daniels) held until CASE-001578 is decided |
| Held | — | ||
| ACT-015023 | Outreach suppressed pending steward Outreach | ENR-141790 (Lauren Tomas) held until CASE-001579 is decided |
| Held | — | ||
| ACT-015024 | Outreach suppressed pending steward Outreach | TPA-64043 (Lauren Thomas) held until CASE-001580 is decided |
| Held | — | ||
| ACT-015025 | Outreach suppressed pending steward Outreach | ENR-104163 (Henry Bishop) held until CASE-001581 is decided |
| Held | — | ||
| ACT-015026 | Outreach suppressed pending steward Outreach | TPA-51385 (Henry Bishop) held until CASE-001582 is decided |
| Held | — | ||
| ACT-015027 | Outreach suppressed pending steward Outreach | ENR-105741 (Carl Hoffman) held until CASE-001583 is decided |
| Held | — | ||
| ACT-015028 | Outreach suppressed pending steward Outreach | TPA-51984 (Brenda Collins) held until CASE-001584 is decided |
| Held | — | ||
| ACT-015029 | Outreach suppressed pending steward Outreach | ENR-105984 (Brenda Collins) held until CASE-001585 is decided |
| Held | — | ||
| ACT-015030 | Outreach suppressed pending steward Outreach | CLM-412911 (Virginia Foster) held until CASE-001586 is decided |
| Held | — | ||
| ACT-015031 | Outreach suppressed pending steward Outreach | TPA-53624 (Jordan Richards) held until CASE-001587 is decided |
| Held | — | ||
| ACT-015032 | Outreach suppressed pending steward Outreach | CLM-413095 (Joe Rojas) held until CASE-001588 is decided |
| Held | — | ||
| ACT-015033 | Outreach suppressed pending steward Outreach | TPA-59537 (Larry Simpson) held until CASE-001589 is decided |
| Held | — | ||
| ACT-015034 | Outreach suppressed pending steward Outreach | TPA-59538 (Larry Simpson) held until CASE-001590 is decided |
| Held | — | ||
| ACT-015035 | Outreach suppressed pending steward Outreach | ENR-105740 (Bobby Garcia) held until CASE-001591 is decided |
| Held | — | ||
| ACT-015036 | Outreach suppressed pending steward Outreach | CLM-404358 (Bobby Garcia) held until CASE-001592 is decided |
| Held | — | ||
| ACT-015037 | Outreach suppressed pending steward Outreach | PRV-24318 (Mary Young) held until CASE-001593 is decided |
| Held | — | ||
| ACT-015038 | Outreach suppressed pending steward Outreach | CLM-426547 (Doris McDonald) held until CASE-001594 is decided |
| Held | — | ||
| ACT-015039 | Outreach suppressed pending steward Outreach | PRV-24188 (Christopher Boyd) held until CASE-001595 is decided |
| Held | — | ||
| ACT-015040 | Outreach suppressed pending steward Outreach | ENR-118820 (Christopher Boyd) held until CASE-001596 is decided |
| Held | — | ||
| ACT-015041 | Outreach suppressed pending steward Outreach | TPA-56226 (Walter Hunt) held until CASE-001597 is decided |
| Held | — | ||
| ACT-015042 | Outreach suppressed pending steward Outreach | ENR-102883 (Hiroshi Banks) held until CASE-001598 is decided |
| Held | — | ||
| ACT-015043 | Outreach suppressed pending steward Outreach | PRV-20668 (Hiroshi Banks) held until CASE-001599 is decided |
| Held | — | ||
| ACT-015044 | Outreach suppressed pending steward Outreach | TPA-55292 (Lisa Walker) held until CASE-001600 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.