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-013595 | Outreach suppressed pending steward Outreach | CLM-422772 (Gregory Le) held until CASE-000151 is decided |
| Held | — | ||
| ACT-013596 | Outreach suppressed pending steward Outreach | TPA-56340 (Nathan Fowler) held until CASE-000152 is decided |
| Held | — | ||
| ACT-013597 | Outreach suppressed pending steward Outreach | PRV-27994 (Lawrence Fuller) held until CASE-000153 is decided |
| Held | — | ||
| ACT-013598 | Outreach suppressed pending steward Outreach | CLM-415616 (Linda Green) held until CASE-000154 is decided |
| Held | — | ||
| ACT-013599 | Outreach suppressed pending steward Outreach | TPA-58040 (Russell Price) held until CASE-000155 is decided |
| Held | — | ||
| ACT-013600 | Outreach suppressed pending steward Outreach | ENR-131264 (Jack Mendeez) held until CASE-000156 is decided |
| Held | — | ||
| ACT-013601 | Outreach suppressed pending steward Outreach | TPA-60518 (Jack Mendez) held until CASE-000157 is decided |
| Held | — | ||
| ACT-013602 | Outreach suppressed pending steward Outreach | TPA-56125 (Natalie Park) held until CASE-000158 is decided |
| Held | — | ||
| ACT-013603 | Outreach suppressed pending steward Outreach | PRV-23256 (Janice Park) held until CASE-000159 is decided |
| Held | — | ||
| ACT-013604 | Outreach suppressed pending steward Outreach | TPA-54954 (Janice Park) held until CASE-000160 is decided |
| Held | — | ||
| ACT-013605 | Outreach suppressed pending steward Outreach | CLM-429665 (Nicholas Sanchez) held until CASE-000161 is decided |
| Held | — | ||
| ACT-013606 | Outreach suppressed pending steward Outreach | ENR-138922 (Nicholas Sanchez) held until CASE-000162 is decided |
| Held | — | ||
| ACT-013607 | Outreach suppressed pending steward Outreach | TPA-50076 (Mason Williams) held until CASE-000163 is decided |
| Held | — | ||
| ACT-013608 | Outreach suppressed pending steward Outreach | CLM-400189 (Mason Williams) held until CASE-000164 is decided |
| Held | — | ||
| ACT-013609 | Outreach suppressed pending steward Outreach | TPA-61926 (Sarah Carroll) held until CASE-000165 is decided |
| Held | — | ||
| ACT-013610 | Outreach suppressed pending steward Outreach | CLM-426656 (Denise Carroll) held until CASE-000166 is decided |
| Held | — | ||
| ACT-013611 | Outreach suppressed pending steward Outreach | PRV-26719 (Terry West) held until CASE-000167 is decided |
| Held | — | ||
| ACT-013612 | Outreach suppressed pending steward Outreach | CLM-420552 (Joyce Andrews) held until CASE-000168 is decided |
| Held | — | ||
| ACT-013613 | Outreach suppressed pending steward Outreach | PRV-29037 (Diana Cruz) held until CASE-000169 is decided |
| Held | — | ||
| ACT-013614 | Outreach suppressed pending steward Outreach | CLM-426954 (Gerald Dean) held until CASE-000170 is decided |
| Held | — | ||
| ACT-013615 | Outreach suppressed pending steward Outreach | CLM-407755 (Karen Dean) held until CASE-000171 is decided |
| Held | — | ||
| ACT-013616 | Outreach suppressed pending steward Outreach | CLM-407756 (Karen Dean) held until CASE-000172 is decided |
| Held | — | ||
| ACT-013617 | Outreach suppressed pending steward Outreach | CLM-431740 (Lida Wite) held until CASE-000173 is decided |
| Held | — | ||
| ACT-013618 | Outreach suppressed pending steward Outreach | PRV-29276 (Linda White) held until CASE-000174 is decided |
| Held | — | ||
| ACT-013619 | Outreach suppressed pending steward Outreach | CLM-431741 (Linda White) held until CASE-000175 is decided |
| Held | — | ||
| ACT-013620 | Outreach suppressed pending steward Outreach | TPA-64002 (Linda White) held until CASE-000176 is decided |
| Held | — | ||
| ACT-013621 | Outreach suppressed pending steward Outreach | CLM-420194 (Benjamin Wood) held until CASE-000177 is decided |
| Held | — | ||
| ACT-013622 | Outreach suppressed pending steward Outreach | ENR-126567 (Ben Wood) held until CASE-000178 is decided |
| Held | — | ||
| ACT-013623 | Outreach suppressed pending steward Outreach | TPA-59546 (Sue Mason) held until CASE-000179 is decided |
| Held | — | ||
| ACT-013624 | Outreach suppressed pending steward Outreach | CLM-429916 (Melissa Soto) held until CASE-000180 is decided |
| Held | — | ||
| ACT-013625 | Outreach suppressed pending steward Outreach | CLM-429915 (Melissa Soto) held until CASE-000181 is decided |
| Held | — | ||
| ACT-013626 | Outreach suppressed pending steward Outreach | CLM-413805 (Henry Johnson) held until CASE-000182 is decided |
| Held | — | ||
| ACT-013627 | Outreach suppressed pending steward Outreach | CLM-405693 (Bradley Vazquez) held until CASE-000183 is decided |
| Held | — | ||
| ACT-013628 | Outreach suppressed pending steward Outreach | PRV-21653 (Bradley Vazquez) held until CASE-000184 is decided |
| Held | — | ||
| ACT-013629 | Outreach suppressed pending steward Outreach | TPA-57347 (Matthew Munoz) held until CASE-000185 is decided |
| Held | — | ||
| ACT-013630 | Outreach suppressed pending steward Outreach | TPA-53872 (Vincent Riz) held until CASE-000186 is decided |
| Held | — | ||
| ACT-013631 | Outreach suppressed pending steward Outreach | CLM-408811 (Vincent Ruiz) held until CASE-000187 is decided |
| Held | — | ||
| ACT-013632 | Outreach suppressed pending steward Outreach | TPA-50461 (Henry Gray) held until CASE-000188 is decided |
| Held | — | ||
| ACT-013633 | Outreach suppressed pending steward Outreach | ENR-111084 (Emily Gray) held until CASE-000189 is decided |
| Held | — | ||
| ACT-013634 | Outreach suppressed pending steward Outreach | CLM-427583 (William Mitchell) held until CASE-000190 is decided |
| Held | — | ||
| ACT-013635 | Outreach suppressed pending steward Outreach | CLM-408355 (Camila Lucas) held until CASE-000191 is decided |
| Held | — | ||
| ACT-013636 | Outreach suppressed pending steward Outreach | CLM-422949 (Betty Evans) held until CASE-000192 is decided |
| Held | — | ||
| ACT-013637 | Outreach suppressed pending steward Outreach | CLM-432178 (Keith Rice) held until CASE-000193 is decided |
| Held | — | ||
| ACT-013638 | Outreach suppressed pending steward Outreach | TPA-50780 (Amy Rice) held until CASE-000194 is decided |
| Held | — | ||
| ACT-013639 | Outreach suppressed pending steward Outreach | ENR-119677 (Billy Holmes) held until CASE-000195 is decided |
| Held | — | ||
| ACT-013640 | Outreach suppressed pending steward Outreach | CLM-414958 (Billy Holmes) held until CASE-000196 is decided |
| Held | — | ||
| ACT-013641 | Outreach suppressed pending steward Outreach | CLM-432022 (Ashley Gordon) held until CASE-000197 is decided |
| Held | — | ||
| ACT-013642 | Outreach suppressed pending steward Outreach | TPA-54686 (Ahmed Garza) held until CASE-000198 is decided |
| Held | — | ||
| ACT-013643 | Outreach suppressed pending steward Outreach | CLM-426824 (Priya Garcia) held until CASE-000199 is decided |
| Held | — | ||
| ACT-013644 | Outreach suppressed pending steward Outreach | CLM-403430 (Bruce Coopr) held until CASE-000200 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.