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-015145 | Outreach suppressed pending steward Outreach | ENR-108830 (Kimberly Salazar) held until CASE-001701 is decided |
| Held | — | ||
| ACT-015146 | Outreach suppressed pending steward Outreach | TPA-59999 (Joe Obrrien) held until CASE-001702 is decided |
| Held | — | ||
| ACT-015147 | Outreach suppressed pending steward Outreach | ENR-140951 (Lucia Armstrong) held until CASE-001703 is decided |
| Held | — | ||
| ACT-015148 | Outreach suppressed pending steward Outreach | CLM-431183 (Lucia Armstrong) held until CASE-001704 is decided |
| Held | — | ||
| ACT-015149 | Outreach suppressed pending steward Outreach | ENR-107228 (Sophia Green) held until CASE-001705 is decided |
| Held | — | ||
| ACT-015150 | Outreach suppressed pending steward Outreach | PRV-25188 (Michelle Green) held until CASE-001706 is decided |
| Held | — | ||
| ACT-015151 | Outreach suppressed pending steward Outreach | ENR-123000 (Heather Lawrence) held until CASE-001707 is decided |
| Held | — | ||
| ACT-015152 | Outreach suppressed pending steward Outreach | TPA-57722 (Heather Lawrence) held until CASE-001708 is decided |
| Held | — | ||
| ACT-015153 | Outreach suppressed pending steward Outreach | CLM-407984 (Jacqueline Riice) held until CASE-001709 is decided |
| Held | — | ||
| ACT-015154 | Outreach suppressed pending steward Outreach | CLM-419750 (Gerald Maldonado) held until CASE-001710 is decided |
| Held | — | ||
| ACT-015155 | Outreach suppressed pending steward Outreach | ENR-125999 (Gerald Maldonado) held until CASE-001711 is decided |
| Held | — | ||
| ACT-015156 | Outreach suppressed pending steward Outreach | TPA-62336 (Stephanie Snyder) held until CASE-001712 is decided |
| Held | — | ||
| ACT-015157 | Outreach suppressed pending steward Outreach | CLM-427923 (Stephanie Snyder) held until CASE-001713 is decided |
| Held | — | ||
| ACT-015158 | Outreach suppressed pending steward Outreach | TPA-57886 (Hirohsi Wheeler) held until CASE-001714 is decided |
| Held | — | ||
| ACT-015159 | Outreach suppressed pending steward Outreach | TPA-61137 (Matthew Johnston) held until CASE-001715 is decided |
| Held | — | ||
| ACT-015160 | Outreach suppressed pending steward Outreach | TPA-61138 (Matthew Johnston) held until CASE-001716 is decided |
| Held | — | ||
| ACT-015161 | Outreach suppressed pending steward Outreach | ENR-133018 (Matthew Johnston) held until CASE-001717 is decided |
| Held | — | ||
| ACT-015162 | Outreach suppressed pending steward Outreach | TPA-59111 (Jonathan Marquez) held until CASE-001718 is decided |
| Held | — | ||
| ACT-015163 | Outreach suppressed pending steward Outreach | TPA-51599 (Fatima Graham) held until CASE-001719 is decided |
| Held | — | ||
| ACT-015164 | Outreach suppressed pending steward Outreach | ENR-104798 (Fatima Graham) held until CASE-001720 is decided |
| Held | — | ||
| ACT-015165 | Outreach suppressed pending steward Outreach | ENR-100608 (Donald Johnston) held until CASE-001721 is decided |
| Held | — | ||
| ACT-015166 | Outreach suppressed pending steward Outreach | ENR-117252 (Christopher Hamilton) held until CASE-001722 is decided |
| Held | — | ||
| ACT-015167 | Outreach suppressed pending steward Outreach | TPA-52514 (Santiago Mendoza) held until CASE-001723 is decided |
| Held | — | ||
| ACT-015168 | Outreach suppressed pending steward Outreach | TPA-57899 (Thomas Hamilton) held until CASE-001724 is decided |
| Held | — | ||
| ACT-015169 | Outreach suppressed pending steward Outreach | CLM-422166 (Harold Castillo) held until CASE-001725 is decided |
| Held | — | ||
| ACT-015170 | Outreach suppressed pending steward Outreach | ENR-126487 (Vicoria Stevens) held until CASE-001726 is decided |
| Held | — | ||
| ACT-015171 | Outreach suppressed pending steward Outreach | CLM-420122 (Victoria Stevens) held until CASE-001727 is decided |
| Held | — | ||
| ACT-015172 | Outreach suppressed pending steward Outreach | TPA-63898 (Megan Graham) held until CASE-001728 is decided |
| Held | — | ||
| ACT-015173 | Outreach suppressed pending steward Outreach | CLM-431387 (Philip Greene) held until CASE-001729 is decided |
| Held | — | ||
| ACT-015174 | Outreach suppressed pending steward Outreach | ENR-141211 (Philip Greene) held until CASE-001730 is decided |
| Held | — | ||
| ACT-015175 | Outreach suppressed pending steward Outreach | TPA-61659 (Paul Estrada) held until CASE-001731 is decided |
| Held | — | ||
| ACT-015176 | Outreach suppressed pending steward Outreach | CLM-432392 (Alan Estrada) held until CASE-001732 is decided |
| Held | — | ||
| ACT-015177 | Outreach suppressed pending steward Outreach | TPA-64294 (Alan Estrada) held until CASE-001733 is decided |
| Held | — | ||
| ACT-015178 | Outreach suppressed pending steward Outreach | CLM-417658 (Carlos McCoy) held until CASE-001734 is decided |
| Held | — | ||
| ACT-015179 | Outreach suppressed pending steward Outreach | TPA-51950 (Willie Boyd) held until CASE-001735 is decided |
| Held | — | ||
| ACT-015180 | Outreach suppressed pending steward Outreach | TPA-51628 (Wiillie Phillips) held until CASE-001736 is decided |
| Held | — | ||
| ACT-015181 | Outreach suppressed pending steward Outreach | ENR-104860 (Willie Phillips) held until CASE-001737 is decided |
| Held | — | ||
| ACT-015182 | Outreach suppressed pending steward Outreach | PRV-24214 (Carl Vasquez) held until CASE-001738 is decided |
| Held | — | ||
| ACT-015183 | Outreach suppressed pending steward Outreach | CLM-418157 (Christopher Cunningham) held until CASE-001739 is decided |
| Held | — | ||
| ACT-015184 | Outreach suppressed pending steward Outreach | CLM-422452 (Diaen Luna) held until CASE-001740 is decided |
| Held | — | ||
| ACT-015185 | Outreach suppressed pending steward Outreach | ENR-129423 (Diane Luna) held until CASE-001741 is decided |
| Held | — | ||
| ACT-015186 | Outreach suppressed pending steward Outreach | CLM-401199 (Katherine Fields) held until CASE-001742 is decided |
| Held | — | ||
| ACT-015187 | Outreach suppressed pending steward Outreach | PRV-22679 (Gregory Wheeler) held until CASE-001743 is decided |
| Held | — | ||
| ACT-015188 | Outreach suppressed pending steward Outreach | CLM-432812 (Valentina Jacobs) held until CASE-001744 is decided |
| Held | — | ||
| ACT-015189 | Outreach suppressed pending steward Outreach | PRV-23961 (Frances Jacobs) held until CASE-001745 is decided |
| Held | — | ||
| ACT-015190 | Outreach suppressed pending steward Outreach | TPA-63454 (Stephan Herrera) held until CASE-001746 is decided |
| Held | — | ||
| ACT-015191 | Outreach suppressed pending steward Outreach | CLM-402134 (Lori Mejia) held until CASE-001747 is decided |
| Held | — | ||
| ACT-015192 | Outreach suppressed pending steward Outreach | CLM-402133 (Lori Mejia) held until CASE-001748 is decided |
| Held | — | ||
| ACT-015193 | Outreach suppressed pending steward Outreach | PRV-20623 (Lori Mejia) held until CASE-001749 is decided |
| Held | — | ||
| ACT-015194 | Outreach suppressed pending steward Outreach | CLM-420546 (Ashley Hart) held until CASE-001750 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.