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-015345 | Outreach suppressed pending steward Outreach | TPA-55980 (Terry Schmidt) held until CASE-001901 is decided |
| Held | — | ||
| ACT-015346 | Outreach suppressed pending steward Outreach | ENR-140156 (Theresa Johnson) held until CASE-001902 is decided |
| Held | — | ||
| ACT-015347 | Outreach suppressed pending steward Outreach | CLM-430584 (Theresa Johnson) held until CASE-001903 is decided |
| Held | — | ||
| ACT-015348 | Outreach suppressed pending steward Outreach | TPA-60013 (Carlos Daniels) held until CASE-001904 is decided |
| Held | — | ||
| ACT-015349 | Outreach suppressed pending steward Outreach | CLM-422809 (Carlos Daniels) held until CASE-001905 is decided |
| Held | — | ||
| ACT-015350 | Outreach suppressed pending steward Outreach | PRV-28398 (Mariana Henry) held until CASE-001906 is decided |
| Held | — | ||
| ACT-015351 | Outreach suppressed pending steward Outreach | TPA-50269 (Katherine Spencer) held until CASE-001907 is decided |
| Held | — | ||
| ACT-015352 | Outreach suppressed pending steward Outreach | CLM-400602 (Katherine Spencer) held until CASE-001908 is decided |
| Held | — | ||
| ACT-015353 | Outreach suppressed pending steward Outreach | ENR-111441 (Sophia Allen) held until CASE-001909 is decided |
| Held | — | ||
| ACT-015354 | Outreach suppressed pending steward Outreach | TPA-58034 (Brandon Reid) held until CASE-001910 is decided |
| Held | — | ||
| ACT-015355 | Outreach suppressed pending steward Outreach | PRV-24466 (Peterson Terry) held until CASE-001911 is decided |
| Held | — | ||
| ACT-015356 | Outreach suppressed pending steward Outreach | CLM-424900 (Scott Lee) held until CASE-001912 is decided |
| Held | — | ||
| ACT-015357 | Outreach suppressed pending steward Outreach | TPA-50235 (Carl Jacobs) held until CASE-001913 is decided |
| Held | — | ||
| ACT-015358 | Outreach suppressed pending steward Outreach | TPA-57672 (Emily Harris) held until CASE-001914 is decided |
| Held | — | ||
| ACT-015359 | Outreach suppressed pending steward Outreach | TPA-63321 (Samuel Oliver) held until CASE-001915 is decided |
| Held | — | ||
| ACT-015360 | Outreach suppressed pending steward Outreach | CLM-408082 (Ranyd Wood) held until CASE-001916 is decided |
| Held | — | ||
| ACT-015361 | Outreach suppressed pending steward Outreach | TPA-59757 (Jon Alvarado) held until CASE-001917 is decided |
| Held | — | ||
| ACT-015362 | Outreach suppressed pending steward Outreach | CLM-422206 (Jonathan Alvarado) held until CASE-001918 is decided |
| Held | — | ||
| ACT-015363 | Outreach suppressed pending steward Outreach | PRV-26558 (Jonathan Alvarado) held until CASE-001919 is decided |
| Held | — | ||
| ACT-015364 | Outreach suppressed pending steward Outreach | CLM-418565 (Lawrence Alvarado) held until CASE-001920 is decided |
| Held | — | ||
| ACT-015365 | Outreach suppressed pending steward Outreach | TPA-61822 (Andrew Johnson) held until CASE-001921 is decided |
| Held | — | ||
| ACT-015366 | Outreach suppressed pending steward Outreach | CLM-426761 (Andrew Johnson) held until CASE-001922 is decided |
| Held | — | ||
| ACT-015367 | Outreach suppressed pending steward Outreach | CLM-423694 (Fatima Bell) held until CASE-001923 is decided |
| Held | — | ||
| ACT-015368 | Outreach suppressed pending steward Outreach | TPA-61853 (Sarrah Patterson) held until CASE-001924 is decided |
| Held | — | ||
| ACT-015369 | Outreach suppressed pending steward Outreach | TPA-52632 (Emily Peters) held until CASE-001925 is decided |
| Held | — | ||
| ACT-015370 | Outreach suppressed pending steward Outreach | CLM-427885 (Diane Jimenez) held until CASE-001926 is decided |
| Held | — | ||
| ACT-015371 | Outreach suppressed pending steward Outreach | ENR-112381 (Olivia Gibson) held until CASE-001927 is decided |
| Held | — | ||
| ACT-015372 | Outreach suppressed pending steward Outreach | TPA-54078 (Olivia Gibson) held until CASE-001928 is decided |
| Held | — | ||
| ACT-015373 | Outreach suppressed pending steward Outreach | ENR-103371 (Amy Montgomery) held until CASE-001929 is decided |
| Held | — | ||
| ACT-015374 | Outreach suppressed pending steward Outreach | PRV-20759 (Amy Montgomery) held until CASE-001930 is decided |
| Held | — | ||
| ACT-015375 | Outreach suppressed pending steward Outreach | TPA-61329 (Zachary Dixon) held until CASE-001931 is decided |
| Held | — | ||
| ACT-015376 | Outreach suppressed pending steward Outreach | CLM-417399 (Aaron Johnston) held until CASE-001932 is decided |
| Held | — | ||
| ACT-015377 | Outreach suppressed pending steward Outreach | ENR-122929 (Aaron Johnston) held until CASE-001933 is decided |
| Held | — | ||
| ACT-015378 | Outreach suppressed pending steward Outreach | TPA-53477 (Maria Arnold) held until CASE-001934 is decided |
| Held | — | ||
| ACT-015379 | Outreach suppressed pending steward Outreach | CLM-405303 (Jluia Simmons) held until CASE-001935 is decided |
| Held | — | ||
| ACT-015380 | Outreach suppressed pending steward Outreach | PRV-27894 (Elijah Weaver) held until CASE-001936 is decided |
| Held | — | ||
| ACT-015381 | Outreach suppressed pending steward Outreach | TPA-51480 (Vicky Hughes) held until CASE-001937 is decided |
| Held | — | ||
| ACT-015382 | Outreach suppressed pending steward Outreach | CLM-403405 (Victoria Hughes) held until CASE-001938 is decided |
| Held | — | ||
| ACT-015383 | Outreach suppressed pending steward Outreach | CLM-427860 (Gloria Hall) held until CASE-001939 is decided |
| Held | — | ||
| ACT-015384 | Outreach suppressed pending steward Outreach | ENR-136521 (Gloria Hall) held until CASE-001940 is decided |
| Held | — | ||
| ACT-015385 | Outreach suppressed pending steward Outreach | CLM-430988 (Adam Sandoval) held until CASE-001941 is decided |
| Held | — | ||
| ACT-015386 | Outreach suppressed pending steward Outreach | ENR-140697 (Adam Sanduval) held until CASE-001942 is decided |
| Held | — | ||
| ACT-015387 | Outreach suppressed pending steward Outreach | CLM-412045 (Lorri Perkins) held until CASE-001943 is decided |
| Held | — | ||
| ACT-015388 | Outreach suppressed pending steward Outreach | ENR-115856 (Lori Perkins) held until CASE-001944 is decided |
| Held | — | ||
| ACT-015389 | Outreach suppressed pending steward Outreach | TPA-62981 (Beverly Howell) held until CASE-001945 is decided |
| Held | — | ||
| ACT-015390 | Outreach suppressed pending steward Outreach | CLM-402433 (Lori King) held until CASE-001946 is decided |
| Held | — | ||
| ACT-015391 | Outreach suppressed pending steward Outreach | ENR-103126 (Lori King) held until CASE-001947 is decided |
| Held | — | ||
| ACT-015392 | Outreach suppressed pending steward Outreach | CLM-410057 (Randy Mason) held until CASE-001948 is decided |
| Held | — | ||
| ACT-015393 | Outreach suppressed pending steward Outreach | CLM-424860 (Stephanie Bell) held until CASE-001949 is decided |
| Held | — | ||
| ACT-015394 | Outreach suppressed pending steward Outreach | TPA-63763 (Jose Ellis) held until CASE-001950 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.