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-015095 | Outreach suppressed pending steward Outreach | PRV-25568 (Alice Herrera) held until CASE-001651 is decided |
| Held | — | ||
| ACT-015096 | Outreach suppressed pending steward Outreach | PRV-25454 (Martha Castro) held until CASE-001652 is decided |
| Held | — | ||
| ACT-015097 | Outreach suppressed pending steward Outreach | TPA-62404 (Kayla Jensen) held until CASE-001653 is decided |
| Held | — | ||
| ACT-015098 | Outreach suppressed pending steward Outreach | TPA-52071 (Anna Mason) held until CASE-001654 is decided |
| Held | — | ||
| ACT-015099 | Outreach suppressed pending steward Outreach | CLM-416611 (Frank Kelley) held until CASE-001655 is decided |
| Held | — | ||
| ACT-015100 | Outreach suppressed pending steward Outreach | CLM-414883 (Dennis Murphy) held until CASE-001656 is decided |
| Held | — | ||
| ACT-015101 | Outreach suppressed pending steward Outreach | CLM-431170 (Paul Valdez) held until CASE-001657 is decided |
| Held | — | ||
| ACT-015102 | Outreach suppressed pending steward Outreach | TPA-61328 (Larry Scott) held until CASE-001658 is decided |
| Held | — | ||
| ACT-015103 | Outreach suppressed pending steward Outreach | TPA-56396 (Aisha Wright) held until CASE-001659 is decided |
| Held | — | ||
| ACT-015104 | Outreach suppressed pending steward Outreach | ENR-129533 (Ruger Watkins) held until CASE-001660 is decided |
| Held | — | ||
| ACT-015105 | Outreach suppressed pending steward Outreach | CLM-422542 (Roger Watkins) held until CASE-001661 is decided |
| Held | — | ||
| ACT-015106 | Outreach suppressed pending steward Outreach | CLM-407982 (Sara Watson) held until CASE-001662 is decided |
| Held | — | ||
| ACT-015107 | Outreach suppressed pending steward Outreach | CLM-412260 (Jsoeph Singh) held until CASE-001663 is decided |
| Held | — | ||
| ACT-015108 | Outreach suppressed pending steward Outreach | TPA-55398 (Joseph Singh) held until CASE-001664 is decided |
| Held | — | ||
| ACT-015109 | Outreach suppressed pending steward Outreach | TPA-62284 (Tony Myers) held until CASE-001665 is decided |
| Held | — | ||
| ACT-015110 | Outreach suppressed pending steward Outreach | ENR-136498 (Anthony Myers) held until CASE-001666 is decided |
| Held | — | ||
| ACT-015111 | Outreach suppressed pending steward Outreach | TPA-62174 (Brian Patel) held until CASE-001667 is decided |
| Held | — | ||
| ACT-015112 | Outreach suppressed pending steward Outreach | TPA-62173 (Brian Patel) held until CASE-001668 is decided |
| Held | — | ||
| ACT-015113 | Outreach suppressed pending steward Outreach | CLM-405713 (Dennis Grnt) held until CASE-001669 is decided |
| Held | — | ||
| ACT-015114 | Outreach suppressed pending steward Outreach | CLM-429433 (Jack Smith) held until CASE-001670 is decided |
| Held | — | ||
| ACT-015115 | Outreach suppressed pending steward Outreach | ENR-115346 (Pamela Jnes) held until CASE-001671 is decided |
| Held | — | ||
| ACT-015116 | Outreach suppressed pending steward Outreach | CLM-411657 (Pamela Jones) held until CASE-001672 is decided |
| Held | — | ||
| ACT-015117 | Outreach suppressed pending steward Outreach | ENR-134939 (Willie Franklin) held until CASE-001673 is decided |
| Held | — | ||
| ACT-015118 | Outreach suppressed pending steward Outreach | CLM-428179 (Bruce Porter) held until CASE-001674 is decided |
| Held | — | ||
| ACT-015119 | Outreach suppressed pending steward Outreach | CLM-432685 (Patrick Jacobs) held until CASE-001675 is decided |
| Held | — | ||
| ACT-015120 | Outreach suppressed pending steward Outreach | CLM-419961 (Teresa Stephens) held until CASE-001676 is decided |
| Held | — | ||
| ACT-015121 | Outreach suppressed pending steward Outreach | PRV-26758 (Rachel Daniels) held until CASE-001677 is decided |
| Held | — | ||
| ACT-015122 | Outreach suppressed pending steward Outreach | CLM-431469 (Kim Heather) held until CASE-001678 is decided |
| Held | — | ||
| ACT-015123 | Outreach suppressed pending steward Outreach | CLM-412435 (Maria McDonald) held until CASE-001679 is decided |
| Held | — | ||
| ACT-015124 | Outreach suppressed pending steward Outreach | PRV-27690 (Pat Hansen) held until CASE-001680 is decided |
| Held | — | ||
| ACT-015125 | Outreach suppressed pending steward Outreach | TPA-52007 (Gary Hansen) held until CASE-001681 is decided |
| Held | — | ||
| ACT-015126 | Outreach suppressed pending steward Outreach | ENR-136675 (Melissa Crter) held until CASE-001682 is decided |
| Held | — | ||
| ACT-015127 | Outreach suppressed pending steward Outreach | CLM-418139 (Daniel Carter) held until CASE-001683 is decided |
| Held | — | ||
| ACT-015128 | Outreach suppressed pending steward Outreach | TPA-58335 (Mariana Ferguson) held until CASE-001684 is decided |
| Held | — | ||
| ACT-015129 | Outreach suppressed pending steward Outreach | CLM-412458 (Cynthia Dunn) held until CASE-001685 is decided |
| Held | — | ||
| ACT-015130 | Outreach suppressed pending steward Outreach | CLM-422286 (Dorothy Knnedy) held until CASE-001686 is decided |
| Held | — | ||
| ACT-015131 | Outreach suppressed pending steward Outreach | ENR-129211 (Dorothy Kennedy) held until CASE-001687 is decided |
| Held | — | ||
| ACT-015132 | Outreach suppressed pending steward Outreach | CLM-420535 (Sean Howell) held until CASE-001688 is decided |
| Held | — | ||
| ACT-015133 | Outreach suppressed pending steward Outreach | ENR-132647 (Helen Howell) held until CASE-001689 is decided |
| Held | — | ||
| ACT-015134 | Outreach suppressed pending steward Outreach | ENR-127015 (Sean Howell) held until CASE-001690 is decided |
| Held | — | ||
| ACT-015135 | Outreach suppressed pending steward Outreach | ENR-116846 (Jason Bailey) held until CASE-001691 is decided |
| Held | — | ||
| ACT-015136 | Outreach suppressed pending steward Outreach | CLM-401782 (Jeremy Bailey) held until CASE-001692 is decided |
| Held | — | ||
| ACT-015137 | Outreach suppressed pending steward Outreach | PRV-22650 (Debra Bailey) held until CASE-001693 is decided |
| Held | — | ||
| ACT-015138 | Outreach suppressed pending steward Outreach | ENR-132485 (Valentina Roberts) held until CASE-001694 is decided |
| Held | — | ||
| ACT-015139 | Outreach suppressed pending steward Outreach | CLM-424857 (Valentina Roberts) held until CASE-001695 is decided |
| Held | — | ||
| ACT-015140 | Outreach suppressed pending steward Outreach | CLM-419808 (Aaron Ortiz) held until CASE-001696 is decided |
| Held | — | ||
| ACT-015141 | Outreach suppressed pending steward Outreach | CLM-425622 (Edward Alvarado) held until CASE-001697 is decided |
| Held | — | ||
| ACT-015142 | Outreach suppressed pending steward Outreach | TPA-61305 (George Warren) held until CASE-001698 is decided |
| Held | — | ||
| ACT-015143 | Outreach suppressed pending steward Outreach | ENR-133530 (George Warren) held until CASE-001699 is decided |
| Held | — | ||
| ACT-015144 | Outreach suppressed pending steward Outreach | TPA-52970 (Kimberly Salazar) held until CASE-001700 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.