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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-015245 | Outreach suppressed pending steward Outreach | CLM-405782 (Matthew Ryan) held until CASE-001801 is decided |
| Held | — | ||
| ACT-015246 | Outreach suppressed pending steward Outreach | CLM-421983 (Albert Diaz) held until CASE-001802 is decided |
| Held | — | ||
| ACT-015247 | Outreach suppressed pending steward Outreach | TPA-50163 (Daniel Howell) held until CASE-001803 is decided |
| Held | — | ||
| ACT-015248 | Outreach suppressed pending steward Outreach | ENR-102465 (Tyler Wilson) held until CASE-001804 is decided |
| Held | — | ||
| ACT-015249 | Outreach suppressed pending steward Outreach | CLM-401911 (Tyler Wilson) held until CASE-001805 is decided |
| Held | — | ||
| ACT-015250 | Outreach suppressed pending steward Outreach | TPA-64394 (Jeremy Gardner) held until CASE-001806 is decided |
| Held | — | ||
| ACT-015251 | Outreach suppressed pending steward Outreach | TPA-64395 (Jeremy Gardner) held until CASE-001807 is decided |
| Held | — | ||
| ACT-015252 | Outreach suppressed pending steward Outreach | CLM-423352 (Martha Elliott) held until CASE-001808 is decided |
| Held | — | ||
| ACT-015253 | Outreach suppressed pending steward Outreach | TPA-61703 (Teresa Elliott) held until CASE-001809 is decided |
| Held | — | ||
| ACT-015254 | Outreach suppressed pending steward Outreach | ENR-136505 (Bryan Mitcchell) held until CASE-001810 is decided |
| Held | — | ||
| ACT-015255 | Outreach suppressed pending steward Outreach | CLM-427845 (Bryan Mitchell) held until CASE-001811 is decided |
| Held | — | ||
| ACT-015256 | Outreach suppressed pending steward Outreach | TPA-58785 (Ralph Fernandez) held until CASE-001812 is decided |
| Held | — | ||
| ACT-015257 | Outreach suppressed pending steward Outreach | TPA-63682 (Julie Fernandez) held until CASE-001813 is decided |
| Held | — | ||
| ACT-015258 | Outreach suppressed pending steward Outreach | CLM-430958 (Julie Fernandez) held until CASE-001814 is decided |
| Held | — | ||
| ACT-015259 | Outreach suppressed pending steward Outreach | TPA-53309 (Evelyn Woods) held until CASE-001815 is decided |
| Held | — | ||
| ACT-015260 | Outreach suppressed pending steward Outreach | TPA-61820 (Angela Martinez) held until CASE-001816 is decided |
| Held | — | ||
| ACT-015261 | Outreach suppressed pending steward Outreach | CLM-411210 (Eric Rios) held until CASE-001817 is decided |
| Held | — | ||
| ACT-015262 | Outreach suppressed pending steward Outreach | TPA-55684 (Nicholas Price) held until CASE-001818 is decided |
| Held | — | ||
| ACT-015263 | Outreach suppressed pending steward Outreach | TPA-56371 (Vincent Holmes) held until CASE-001819 is decided |
| Held | — | ||
| ACT-015264 | Outreach suppressed pending steward Outreach | ENR-119008 (Vincent Holmes) held until CASE-001820 is decided |
| Held | — | ||
| ACT-015265 | Outreach suppressed pending steward Outreach | ENR-119542 (Ken Holmes) held until CASE-001821 is decided |
| Held | — | ||
| ACT-015266 | Outreach suppressed pending steward Outreach | CLM-412077 (Noah Ray) held until CASE-001822 is decided |
| Held | — | ||
| ACT-015267 | Outreach suppressed pending steward Outreach | CLM-412076 (Noah Ray) held until CASE-001823 is decided |
| Held | — | ||
| ACT-015268 | Outreach suppressed pending steward Outreach | TPA-55972 (Kyle Dunn) held until CASE-001824 is decided |
| Held | — | ||
| ACT-015269 | Outreach suppressed pending steward Outreach | ENR-117785 (Kyle Dunn) held until CASE-001825 is decided |
| Held | — | ||
| ACT-015270 | Outreach suppressed pending steward Outreach | CLM-432762 (Tyler Anderson) held until CASE-001826 is decided |
| Held | — | ||
| ACT-015271 | Outreach suppressed pending steward Outreach | TPA-51072 (Jerry Johnson) held until CASE-001827 is decided |
| Held | — | ||
| ACT-015272 | Outreach suppressed pending steward Outreach | CLM-413513 (Sara Matthews) held until CASE-001828 is decided |
| Held | — | ||
| ACT-015273 | Outreach suppressed pending steward Outreach | TPA-55945 (Sara Matthews) held until CASE-001829 is decided |
| Held | — | ||
| ACT-015274 | Outreach suppressed pending steward Outreach | TPA-58337 (Sophia Hill) held until CASE-001830 is decided |
| Held | — | ||
| ACT-015275 | Outreach suppressed pending steward Outreach | CLM-431611 (Gabriel Hall) held until CASE-001831 is decided |
| Held | — | ||
| ACT-015276 | Outreach suppressed pending steward Outreach | ENR-133453 (Gabriel Howell) held until CASE-001832 is decided |
| Held | — | ||
| ACT-015277 | Outreach suppressed pending steward Outreach | CLM-407646 (Diana Ryan) held until CASE-001833 is decided |
| Held | — | ||
| ACT-015278 | Outreach suppressed pending steward Outreach | ENR-116756 (Jack Ryan) held until CASE-001834 is decided |
| Held | — | ||
| ACT-015279 | Outreach suppressed pending steward Outreach | PRV-23684 (Jack Ryan) held until CASE-001835 is decided |
| Held | — | ||
| ACT-015280 | Outreach suppressed pending steward Outreach | CLM-406321 (Stephanie Vrgas) held until CASE-001836 is decided |
| Held | — | ||
| ACT-015281 | Outreach suppressed pending steward Outreach | CLM-406320 (Stephanie Vargas) held until CASE-001837 is decided |
| Held | — | ||
| ACT-015282 | Outreach suppressed pending steward Outreach | TPA-63663 (Jean Scott) held until CASE-001838 is decided |
| Held | — | ||
| ACT-015283 | Outreach suppressed pending steward Outreach | TPA-63662 (Jean Scott) held until CASE-001839 is decided |
| Held | — | ||
| ACT-015284 | Outreach suppressed pending steward Outreach | TPA-52619 (Ahmed Soto) held until CASE-001840 is decided |
| Held | — | ||
| ACT-015285 | Outreach suppressed pending steward Outreach | TPA-63949 (Sean Cunningham) held until CASE-001841 is decided |
| Held | — | ||
| ACT-015286 | Outreach suppressed pending steward Outreach | CLM-403952 (Bobby Cooper) held until CASE-001842 is decided |
| Held | — | ||
| ACT-015287 | Outreach suppressed pending steward Outreach | CLM-417123 (Wayne Morris) held until CASE-001843 is decided |
| Held | — | ||
| ACT-015288 | Outreach suppressed pending steward Outreach | TPA-63463 (Wayne Morris) held until CASE-001844 is decided |
| Held | — | ||
| ACT-015289 | Outreach suppressed pending steward Outreach | TPA-54400 (Marcus Tucker) held until CASE-001845 is decided |
| Held | — | ||
| ACT-015290 | Outreach suppressed pending steward Outreach | ENR-113253 (Marcus Tuckeer) held until CASE-001846 is decided |
| Held | — | ||
| ACT-015291 | Outreach suppressed pending steward Outreach | TPA-51424 (Omar Rios) held until CASE-001847 is decided |
| Held | — | ||
| ACT-015292 | Outreach suppressed pending steward Outreach | CLM-402566 (Janice Rose) held until CASE-001848 is decided |
| Held | — | ||
| ACT-015293 | Outreach suppressed pending steward Outreach | CLM-402565 (Janice Rose) held until CASE-001849 is decided |
| Held | — | ||
| ACT-015294 | Outreach suppressed pending steward Outreach | TPA-60593 (Henry Ross) held until CASE-001850 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.