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-019471 | Care coordination outreach Next-best-action | Bradley Armstrong: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019472 | Care coordination outreach Next-best-action | Amber Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019473 | Care coordination outreach Next-best-action | Grace Burton: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019474 | Care coordination outreach Next-best-action | Chris Baker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019475 | Care coordination outreach Next-best-action | Lori Fowler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019476 | Care coordination outreach Next-best-action | Philip Willis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019477 | Care coordination outreach Next-best-action | Mariana Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019478 | Care coordination outreach Next-best-action | Patrick Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019479 | Care coordination outreach Next-best-action | Patrick Spencer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019480 | Care coordination outreach Next-best-action | Kelly Tucker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019481 | Care coordination outreach Next-best-action | Adam Young: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019482 | Care coordination outreach Next-best-action | Arjun Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019483 | Care coordination outreach Next-best-action | Yuki Ortega: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019484 | Care coordination outreach Next-best-action | Denise Davis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019485 | Care coordination outreach Next-best-action | Wayne Castillo: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019486 | Care coordination outreach Next-best-action | Barbara Burton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019487 | Care coordination outreach Next-best-action | Mateo Jackson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019488 | Care coordination outreach Next-best-action | Mary Mason: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019489 | Care coordination outreach Next-best-action | Katherine Ross: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019490 | Care coordination outreach Next-best-action | Gabriel Burns: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019491 | Care coordination outreach Next-best-action | Eric Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019492 | Care coordination outreach Next-best-action | Amanda Li: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019493 | Care coordination outreach Next-best-action | Charles Gonzalez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019494 | Care coordination outreach Next-best-action | George Jensen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019495 | Care coordination outreach Next-best-action | Diana Mills: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019496 | Care coordination outreach Next-best-action | Andrew Fernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019497 | Care coordination outreach Next-best-action | Teresa Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019498 | Care coordination outreach Next-best-action | Grace Alexander: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019499 | Care coordination outreach Next-best-action | Linda Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019500 | Care coordination outreach Next-best-action | Heather Lopez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019501 | Care coordination outreach Next-best-action | Diane Mendez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019502 | Care coordination outreach Next-best-action | Nicole Evans: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019503 | Care coordination outreach Next-best-action | Priya Williams: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019504 | Care coordination outreach Next-best-action | Ahmed Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019505 | Care coordination outreach Next-best-action | Jack Fowler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019506 | Care coordination outreach Next-best-action | Angela Nelson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019507 | Care coordination outreach Next-best-action | Bradley Lane: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019508 | Care coordination outreach Next-best-action | Robert Perkins: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019509 | Care coordination outreach Next-best-action | Dennis Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019510 | Care coordination outreach Next-best-action | Teresa Sims: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019511 | Care coordination outreach Next-best-action | Doris Armstrong: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019512 | Care coordination outreach Next-best-action | Sara Andrews: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019513 | Care coordination outreach Next-best-action | Linda Reid: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019514 | Care coordination outreach Next-best-action | Richard Washington: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-019515 | Care coordination outreach Next-best-action | Betsy Perez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019516 | Care coordination outreach Next-best-action | Shirley Rojas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019517 | Care coordination outreach Next-best-action | Mark Arnold: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019518 | Care coordination outreach Next-best-action | Ashley Pena: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019519 | Care coordination outreach Next-best-action | Daniel Holmes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-019520 | Care coordination outreach Next-best-action | James Ortiz: 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.