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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-017921 | Care coordination outreach Next-best-action | Frank Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017922 | Care coordination outreach Next-best-action | Nicholas Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017923 | Care coordination outreach Next-best-action | Mason Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017924 | Care coordination outreach Next-best-action | Jesse Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017925 | Care coordination outreach Next-best-action | Julie Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017926 | Care coordination outreach Next-best-action | William Allen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017927 | Care coordination outreach Next-best-action | Catherine Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017928 | Care coordination outreach Next-best-action | Katherine James: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017929 | Care coordination outreach Next-best-action | Hannah Nguyen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017930 | Care coordination outreach Next-best-action | Gerald Cunningham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017931 | Care coordination outreach Next-best-action | Heather Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017932 | Care coordination outreach Next-best-action | Ahmed Wallace: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017933 | Care coordination outreach Next-best-action | Albert Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017934 | Care coordination outreach Next-best-action | Hannah Nelson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017935 | Care coordination outreach Next-best-action | Billy Barnes: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017936 | Care coordination outreach Next-best-action | Austin Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017937 | Care coordination outreach Next-best-action | Mason Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017938 | Care coordination outreach Next-best-action | Emma Harrison: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017939 | Care coordination outreach Next-best-action | Hiroshi Meyer: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017940 | Care coordination outreach Next-best-action | Dylan Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017941 | Care coordination outreach Next-best-action | Ethan Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017942 | Care coordination outreach Next-best-action | Peter Kelly: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017943 | Care coordination outreach Next-best-action | Kyle Myers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017944 | Care coordination outreach Next-best-action | Henry Lane: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017945 | Care coordination outreach Next-best-action | Andrea Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017946 | Care coordination outreach Next-best-action | Samantha Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017947 | Care coordination outreach Next-best-action | Fatima Perkins: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017948 | Care coordination outreach Next-best-action | Isabella Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017949 | Care coordination outreach Next-best-action | Barbara Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017950 | Care coordination outreach Next-best-action | Brandon Bryant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017951 | Care coordination outreach Next-best-action | Ruth Stephens: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017952 | Care coordination outreach Next-best-action | Chris Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017953 | Care coordination outreach Next-best-action | Camila Green: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017954 | Care coordination outreach Next-best-action | Marilyn James: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017955 | Care coordination outreach Next-best-action | Joyce Evans: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017956 | Care coordination outreach Next-best-action | Larry Martin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017957 | Care coordination outreach Next-best-action | Andrea Gray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017958 | Care coordination outreach Next-best-action | Gloria Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017959 | Care coordination outreach Next-best-action | Gerald Cox: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017960 | Care coordination outreach Next-best-action | Patricia Le: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017961 | Care coordination outreach Next-best-action | Deborah Ramos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017962 | Care coordination outreach Next-best-action | Hiroshi Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017963 | Care coordination outreach Next-best-action | Grace Stephens: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017964 | Care coordination outreach Next-best-action | Eugene Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017965 | Care coordination outreach Next-best-action | Sharon Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017966 | Care coordination outreach Next-best-action | Linda Watson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017967 | Care coordination outreach Next-best-action | Scott Thomas: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017968 | Care coordination outreach Next-best-action | Karen Fowler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017969 | Care coordination outreach Next-best-action | Aaron Johnson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017970 | Care coordination outreach Next-best-action | Jose Gordon: 3 claims, no attributed provider |
| Proposed | — |
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.