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-015395 | Outreach suppressed pending steward Outreach | ENR-140918 (Jose Ellis) held until CASE-001951 is decided |
| Held | — | ||
| ACT-015396 | Outreach suppressed pending steward Outreach | ENR-124128 (Frank Phillpis) held until CASE-001952 is decided |
| Held | — | ||
| ACT-015397 | Outreach suppressed pending steward Outreach | CLM-418348 (Frank Phillips) held until CASE-001953 is decided |
| Held | — | ||
| ACT-015398 | Outreach suppressed pending steward Outreach | CLM-401092 (Don Park) held until CASE-001954 is decided |
| Held | — | ||
| ACT-015399 | Outreach suppressed pending steward Outreach | CLM-403273 (Brandon Pierce) held until CASE-001955 is decided |
| Held | — | ||
| ACT-015400 | Outreach suppressed pending steward Outreach | CLM-403274 (Brandon Pierce) held until CASE-001956 is decided |
| Held | — | ||
| ACT-015401 | Outreach suppressed pending steward Outreach | CLM-424385 (Omar Perez) held until CASE-001957 is decided |
| Held | — | ||
| ACT-015402 | Outreach suppressed pending steward Outreach | CLM-412246 (Doris Mills) held until CASE-001958 is decided |
| Held | — | ||
| ACT-015403 | Outreach suppressed pending steward Outreach | TPA-55393 (Doris Mills) held until CASE-001959 is decided |
| Held | — | ||
| ACT-015404 | Outreach suppressed pending steward Outreach | CLM-429820 (Mateo Chen) held until CASE-001960 is decided |
| Held | — | ||
| ACT-015405 | Outreach suppressed pending steward Outreach | ENR-139105 (Mateo Chen) held until CASE-001961 is decided |
| Held | — | ||
| ACT-015406 | Outreach suppressed pending steward Outreach | CLM-418875 (Sofia Garrett) held until CASE-001962 is decided |
| Held | — | ||
| ACT-015407 | Outreach suppressed pending steward Outreach | TPA-58259 (Cynthia Yang) held until CASE-001963 is decided |
| Held | — | ||
| ACT-015408 | Outreach suppressed pending steward Outreach | CLM-418684 (Cynthia Yang) held until CASE-001964 is decided |
| Held | — | ||
| ACT-015409 | Outreach suppressed pending steward Outreach | PRV-26182 (Elijah Phillpis) held until CASE-001965 is decided |
| Held | — | ||
| ACT-015410 | Outreach suppressed pending steward Outreach | CLM-417696 (Denise Watkins) held until CASE-001966 is decided |
| Held | — | ||
| ACT-015411 | Outreach suppressed pending steward Outreach | TPA-57813 (Denise Watkins) held until CASE-001967 is decided |
| Held | — | ||
| ACT-015412 | Outreach suppressed pending steward Outreach | CLM-407570 (Ahmed Sanders) held until CASE-001968 is decided |
| Held | — | ||
| ACT-015413 | Outreach suppressed pending steward Outreach | CLM-407569 (Ahmed Sanders) held until CASE-001969 is decided |
| Held | — | ||
| ACT-015414 | Outreach suppressed pending steward Outreach | TPA-53319 (Ahmed Sanders) held until CASE-001970 is decided |
| Held | — | ||
| ACT-015415 | Outreach suppressed pending steward Outreach | TPA-53090 (Jennifer Hawkins) held until CASE-001971 is decided |
| Held | — | ||
| ACT-015416 | Outreach suppressed pending steward Outreach | CLM-407809 (Jean Burns) held until CASE-001972 is decided |
| Held | — | ||
| ACT-015417 | Outreach suppressed pending steward Outreach | CLM-409835 (Lucia Santos) held until CASE-001973 is decided |
| Held | — | ||
| ACT-015418 | Outreach suppressed pending steward Outreach | TPA-50685 (Johnny Santiago) held until CASE-001974 is decided |
| Held | — | ||
| ACT-015419 | Outreach suppressed pending steward Outreach | TPA-56812 (Jacob Young) held until CASE-001975 is decided |
| Held | — | ||
| ACT-015420 | Outreach suppressed pending steward Outreach | TPA-51054 (Karen Simpson) held until CASE-001976 is decided |
| Held | — | ||
| ACT-015421 | Outreach suppressed pending steward Outreach | ENR-134220 (Helen Lane) held until CASE-001977 is decided |
| Held | — | ||
| ACT-015422 | Outreach suppressed pending steward Outreach | PRV-27698 (Helen Lane) held until CASE-001978 is decided |
| Held | — | ||
| ACT-015423 | Outreach suppressed pending steward Outreach | CLM-413686 (Yuki Moreno) held until CASE-001979 is decided |
| Held | — | ||
| ACT-015424 | Outreach suppressed pending steward Outreach | ENR-117901 (Yuki Moreon) held until CASE-001980 is decided |
| Held | — | ||
| ACT-015425 | Outreach suppressed pending steward Outreach | TPA-53406 (Rachel Hart) held until CASE-001981 is decided |
| Held | — | ||
| ACT-015426 | Outreach suppressed pending steward Outreach | ENR-110166 (Rachel Hart) held until CASE-001982 is decided |
| Held | — | ||
| ACT-015427 | Outreach suppressed pending steward Outreach | TPA-51364 (Timothy Arnold) held until CASE-001983 is decided |
| Held | — | ||
| ACT-015428 | Outreach suppressed pending steward Outreach | CLM-406451 (Sophia Marquez) held until CASE-001984 is decided |
| Held | — | ||
| ACT-015429 | Outreach suppressed pending steward Outreach | ENR-131682 (Sandra Harrison) held until CASE-001985 is decided |
| Held | — | ||
| ACT-015430 | Outreach suppressed pending steward Outreach | PRV-27134 (Sandra Harrison) held until CASE-001986 is decided |
| Held | — | ||
| ACT-015431 | Outreach suppressed pending steward Outreach | CLM-404588 (Anna Sanchez) held until CASE-001987 is decided |
| Held | — | ||
| ACT-015432 | Outreach suppressed pending steward Outreach | ENR-106056 (Anna Sanchez) held until CASE-001988 is decided |
| Held | — | ||
| ACT-015433 | Outreach suppressed pending steward Outreach | TPA-64126 (Jose Carpenter) held until CASE-001989 is decided |
| Held | — | ||
| ACT-015434 | Outreach suppressed pending steward Outreach | TPA-58935 (Nathan Bell) held until CASE-001990 is decided |
| Held | — | ||
| ACT-015435 | Outreach suppressed pending steward Outreach | TPA-61078 (Madison Black) held until CASE-001991 is decided |
| Held | — | ||
| ACT-015436 | Outreach suppressed pending steward Outreach | ENR-132837 (Madison Black) held until CASE-001992 is decided |
| Held | — | ||
| ACT-015437 | Outreach suppressed pending steward Outreach | TPA-58708 (Camila Maldonado) held until CASE-001993 is decided |
| Held | — | ||
| ACT-015438 | Outreach suppressed pending steward Outreach | TPA-58417 (Gary Jordan) held until CASE-001994 is decided |
| Held | — | ||
| ACT-015439 | Outreach suppressed pending steward Outreach | CLM-422967 (Barbara Brooks) held until CASE-001995 is decided |
| Held | — | ||
| ACT-015440 | Outreach suppressed pending steward Outreach | TPA-52750 (Janice Gonzales) held until CASE-001996 is decided |
| Held | — | ||
| ACT-015441 | Outreach suppressed pending steward Outreach | TPA-57552 (Danny Cooper) held until CASE-001997 is decided |
| Held | — | ||
| ACT-015442 | Outreach suppressed pending steward Outreach | CLM-425361 (Steven Park) held until CASE-001998 is decided |
| Held | — | ||
| ACT-015443 | Outreach suppressed pending steward Outreach | CLM-419659 (Jenkins Bryan) held until CASE-001999 is decided |
| Held | — | ||
| ACT-015444 | Outreach suppressed pending steward Outreach | TPA-55573 (Kimberly Rooberts) held until CASE-002000 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.