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-015195 | Outreach suppressed pending steward Outreach | ENR-127034 (Ashley Hart) held until CASE-001751 is decided |
| Held | — | ||
| ACT-015196 | Outreach suppressed pending steward Outreach | TPA-58840 (Olivia Campbell) held until CASE-001752 is decided |
| Held | — | ||
| ACT-015197 | Outreach suppressed pending steward Outreach | TPA-63800 (Steven Jones) held until CASE-001753 is decided |
| Held | — | ||
| ACT-015198 | Outreach suppressed pending steward Outreach | TPA-63799 (Steve Jones) held until CASE-001754 is decided |
| Held | — | ||
| ACT-015199 | Outreach suppressed pending steward Outreach | PRV-28026 (Gregry Sandoval) held until CASE-001755 is decided |
| Held | — | ||
| ACT-015200 | Outreach suppressed pending steward Outreach | TPA-62069 (Gregory Sandoval) held until CASE-001756 is decided |
| Held | — | ||
| ACT-015201 | Outreach suppressed pending steward Outreach | ENR-133695 (George Walker) held until CASE-001757 is decided |
| Held | — | ||
| ACT-015202 | Outreach suppressed pending steward Outreach | TPA-61372 (George Walker) held until CASE-001758 is decided |
| Held | — | ||
| ACT-015203 | Outreach suppressed pending steward Outreach | TPA-52871 (Yuki Santiago) held until CASE-001759 is decided |
| Held | — | ||
| ACT-015204 | Outreach suppressed pending steward Outreach | ENR-130158 (Denise Santos) held until CASE-001760 is decided |
| Held | — | ||
| ACT-015205 | Outreach suppressed pending steward Outreach | TPA-57818 (Brandon Bell) held until CASE-001761 is decided |
| Held | — | ||
| ACT-015206 | Outreach suppressed pending steward Outreach | ENR-123324 (Brandon Bell) held until CASE-001762 is decided |
| Held | — | ||
| ACT-015207 | Outreach suppressed pending steward Outreach | CLM-409108 (Donald Walker) held until CASE-001763 is decided |
| Held | — | ||
| ACT-015208 | Outreach suppressed pending steward Outreach | TPA-62311 (Susan Perez) held until CASE-001764 is decided |
| Held | — | ||
| ACT-015209 | Outreach suppressed pending steward Outreach | TPA-62312 (Susan Perez) held until CASE-001765 is decided |
| Held | — | ||
| ACT-015210 | Outreach suppressed pending steward Outreach | TPA-53867 (Jack Pierce) held until CASE-001766 is decided |
| Held | — | ||
| ACT-015211 | Outreach suppressed pending steward Outreach | CLM-421898 (Alexis Price) held until CASE-001767 is decided |
| Held | — | ||
| ACT-015212 | Outreach suppressed pending steward Outreach | TPA-50655 (Beverly Perez) held until CASE-001768 is decided |
| Held | — | ||
| ACT-015213 | Outreach suppressed pending steward Outreach | TPA-50654 (Beverly Perez) held until CASE-001769 is decided |
| Held | — | ||
| ACT-015214 | Outreach suppressed pending steward Outreach | TPA-55845 (Maria Dean) held until CASE-001770 is decided |
| Held | — | ||
| ACT-015215 | Outreach suppressed pending steward Outreach | CLM-419235 (Elizabeth Dunn) held until CASE-001771 is decided |
| Held | — | ||
| ACT-015216 | Outreach suppressed pending steward Outreach | ENR-125366 (Elizabeth Dunn) held until CASE-001772 is decided |
| Held | — | ||
| ACT-015217 | Outreach suppressed pending steward Outreach | CLM-416740 (Jasse Shaw) held until CASE-001773 is decided |
| Held | — | ||
| ACT-015218 | Outreach suppressed pending steward Outreach | TPA-57371 (Jesse Shaw) held until CASE-001774 is decided |
| Held | — | ||
| ACT-015219 | Outreach suppressed pending steward Outreach | PRV-25358 (Jaack Burns) held until CASE-001775 is decided |
| Held | — | ||
| ACT-015220 | Outreach suppressed pending steward Outreach | CLM-423038 (Kelly Silva) held until CASE-001776 is decided |
| Held | — | ||
| ACT-015221 | Outreach suppressed pending steward Outreach | CLM-422371 (Jess Sanchez) held until CASE-001777 is decided |
| Held | — | ||
| ACT-015222 | Outreach suppressed pending steward Outreach | TPA-51023 (Edward Espinoza) held until CASE-001778 is decided |
| Held | — | ||
| ACT-015223 | Outreach suppressed pending steward Outreach | CLM-420963 (Gerald Tran) held until CASE-001779 is decided |
| Held | — | ||
| ACT-015224 | Outreach suppressed pending steward Outreach | TPA-59219 (Gerald Tran) held until CASE-001780 is decided |
| Held | — | ||
| ACT-015225 | Outreach suppressed pending steward Outreach | PRV-25215 (Jason Garrett) held until CASE-001781 is decided |
| Held | — | ||
| ACT-015226 | Outreach suppressed pending steward Outreach | ENR-121388 (Keith Henry) held until CASE-001782 is decided |
| Held | — | ||
| ACT-015227 | Outreach suppressed pending steward Outreach | TPA-57124 (Keith Henry) held until CASE-001783 is decided |
| Held | — | ||
| ACT-015228 | Outreach suppressed pending steward Outreach | TPA-52282 (Kathy Lucas) held until CASE-001784 is decided |
| Held | — | ||
| ACT-015229 | Outreach suppressed pending steward Outreach | CLM-405212 (Katherine Lucas) held until CASE-001785 is decided |
| Held | — | ||
| ACT-015230 | Outreach suppressed pending steward Outreach | TPA-52283 (Katherine Lucas) held until CASE-001786 is decided |
| Held | — | ||
| ACT-015231 | Outreach suppressed pending steward Outreach | CLM-411450 (Olivia Coleman) held until CASE-001787 is decided |
| Held | — | ||
| ACT-015232 | Outreach suppressed pending steward Outreach | PRV-20062 (John Cunningham) held until CASE-001788 is decided |
| Held | — | ||
| ACT-015233 | Outreach suppressed pending steward Outreach | CLM-400218 (John Cunningham) held until CASE-001789 is decided |
| Held | — | ||
| ACT-015234 | Outreach suppressed pending steward Outreach | PRV-28453 (Joan Coleman) held until CASE-001790 is decided |
| Held | — | ||
| ACT-015235 | Outreach suppressed pending steward Outreach | ENR-136070 (Larry Lee) held until CASE-001791 is decided |
| Held | — | ||
| ACT-015236 | Outreach suppressed pending steward Outreach | ENR-138962 (Kareen Li) held until CASE-001792 is decided |
| Held | — | ||
| ACT-015237 | Outreach suppressed pending steward Outreach | CLM-429701 (Karen Li) held until CASE-001793 is decided |
| Held | — | ||
| ACT-015238 | Outreach suppressed pending steward Outreach | PRV-27236 (Judy Lee) held until CASE-001794 is decided |
| Held | — | ||
| ACT-015239 | Outreach suppressed pending steward Outreach | ENR-132117 (Judy Lee) held until CASE-001795 is decided |
| Held | — | ||
| ACT-015240 | Outreach suppressed pending steward Outreach | CLM-409702 (Shirley Aguilar) held until CASE-001796 is decided |
| Held | — | ||
| ACT-015241 | Outreach suppressed pending steward Outreach | PRV-22810 (Shirley Aguilar) held until CASE-001797 is decided |
| Held | — | ||
| ACT-015242 | Outreach suppressed pending steward Outreach | CLM-423380 (Laura Alvarado) held until CASE-001798 is decided |
| Held | — | ||
| ACT-015243 | Outreach suppressed pending steward Outreach | CLM-422907 (Laura Weber) held until CASE-001799 is decided |
| Held | — | ||
| ACT-015244 | Outreach suppressed pending steward Outreach | TPA-60063 (Laura Weber) held until CASE-001800 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.