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-019371 | Care coordination outreach Next-best-action | Patricia Wood: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019372 | Care coordination outreach Next-best-action | Angela George: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019373 | Care coordination outreach Next-best-action | Isabella McDonald: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019374 | Care coordination outreach Next-best-action | Margaret Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019375 | Care coordination outreach Next-best-action | Brittany Romero: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019376 | Care coordination outreach Next-best-action | Mariana Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019377 | Care coordination outreach Next-best-action | Nathan Powell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019378 | Care coordination outreach Next-best-action | Jessica Sanchez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019379 | Care coordination outreach Next-best-action | Frances George: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019380 | Care coordination outreach Next-best-action | Michelle Nelson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019381 | Care coordination outreach Next-best-action | Joseph Wheeler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019382 | Care coordination outreach Next-best-action | Rachel Davis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019383 | Care coordination outreach Next-best-action | Omar Boyd: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019384 | Care coordination outreach Next-best-action | Rebecca Kennedy: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019385 | Care coordination outreach Next-best-action | Peter Smith: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019386 | Care coordination outreach Next-best-action | Joseph Henderson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019387 | Care coordination outreach Next-best-action | Albert Lynch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019388 | Care coordination outreach Next-best-action | Elijah Torres: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019389 | Care coordination outreach Next-best-action | Christina Nguyen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019390 | Care coordination outreach Next-best-action | Zachary Hudson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019391 | Care coordination outreach Next-best-action | James Rojas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019392 | Care coordination outreach Next-best-action | Donald Adams: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019393 | Care coordination outreach Next-best-action | Adam Vega: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-019394 | Care coordination outreach Next-best-action | Joan Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019395 | Care coordination outreach Next-best-action | Joyce Duncan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019396 | Care coordination outreach Next-best-action | Cynthia Jenkins: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019397 | Care coordination outreach Next-best-action | Kyle Simpson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019398 | Care coordination outreach Next-best-action | Heather Pierce: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019399 | Care coordination outreach Next-best-action | Betty Pena: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019400 | Care coordination outreach Next-best-action | Sharon Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019401 | Care coordination outreach Next-best-action | Austin Li: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019402 | Care coordination outreach Next-best-action | Daniel Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019403 | Care coordination outreach Next-best-action | Isabella Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019404 | Care coordination outreach Next-best-action | Kathryn Schmidt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019405 | Care coordination outreach Next-best-action | Bruce Garrett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019406 | Care coordination outreach Next-best-action | Mateo Simpson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019407 | Care coordination outreach Next-best-action | Gary Valdez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019408 | Care coordination outreach Next-best-action | Elizabeth Brown: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019409 | Care coordination outreach Next-best-action | Mary Fields: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019410 | Care coordination outreach Next-best-action | Sean Chapman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019411 | Care coordination outreach Next-best-action | Dylan Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019412 | Care coordination outreach Next-best-action | Jean Ward: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019413 | Care coordination outreach Next-best-action | Jennifer Bradley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019414 | Care coordination outreach Next-best-action | Joseph Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019415 | Care coordination outreach Next-best-action | Kevin King: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019416 | Care coordination outreach Next-best-action | Elizabeth Carr: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019417 | Care coordination outreach Next-best-action | Danielle Lee: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019418 | Care coordination outreach Next-best-action | Angela Bailey: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019419 | Care coordination outreach Next-best-action | Thomas Morales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019420 | Care coordination outreach Next-best-action | Christine Phillips: 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.