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-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.