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-015445 | Outreach suppressed pending steward Outreach | CLM-425369 (Juan Graham) held until CASE-002001 is decided |
| Held | — | ||
| ACT-015446 | Outreach suppressed pending steward Outreach | CLM-417511 (Debra Obrien) held until CASE-002002 is decided |
| Held | — | ||
| ACT-015447 | Outreach suppressed pending steward Outreach | PRV-26935 (Laura Tran) held until CASE-002003 is decided |
| Held | — | ||
| ACT-015448 | Outreach suppressed pending steward Outreach | ENR-130785 (Laura Tran) held until CASE-002004 is decided |
| Held | — | ||
| ACT-015449 | Outreach suppressed pending steward Outreach | CLM-411707 (Adnrea Guerrero) held until CASE-002005 is decided |
| Held | — | ||
| ACT-015450 | Outreach suppressed pending steward Outreach | ENR-115427 (Andrea Guerrero) held until CASE-002006 is decided |
| Held | — | ||
| ACT-015451 | Outreach suppressed pending steward Outreach | TPA-50120 (Lauren Castro) held until CASE-002007 is decided |
| Held | — | ||
| ACT-015452 | Outreach suppressed pending steward Outreach | TPA-50830 (Santiago Carter) held until CASE-002008 is decided |
| Held | — | ||
| ACT-015453 | Outreach suppressed pending steward Outreach | CLM-401922 (Santiago Carter) held until CASE-002009 is decided |
| Held | — | ||
| ACT-015454 | Outreach suppressed pending steward Outreach | CLM-407421 (Gloria Fowler) held until CASE-002010 is decided |
| Held | — | ||
| ACT-015455 | Outreach suppressed pending steward Outreach | CLM-422728 (Benjamin Fuller) held until CASE-002011 is decided |
| Held | — | ||
| ACT-015456 | Outreach suppressed pending steward Outreach | TPA-56654 (Fatima Ford) held until CASE-002012 is decided |
| Held | — | ||
| ACT-015457 | Outreach suppressed pending steward Outreach | CLM-415105 (Fatima Ford) held until CASE-002013 is decided |
| Held | — | ||
| ACT-015458 | Outreach suppressed pending steward Outreach | PRV-27240 (Jose Ford) held until CASE-002014 is decided |
| Held | — | ||
| ACT-015459 | Outreach suppressed pending steward Outreach | CLM-430280 (Ruth Baker) held until CASE-002015 is decided |
| Held | — | ||
| ACT-015460 | Outreach suppressed pending steward Outreach | PRV-28441 (Heather Gardner) held until CASE-002016 is decided |
| Held | — | ||
| ACT-015461 | Outreach suppressed pending steward Outreach | PRV-20849 (David Turner) held until CASE-002017 is decided |
| Held | — | ||
| ACT-015462 | Outreach suppressed pending steward Outreach | CLM-411368 (Jonathan Wheeler) held until CASE-002018 is decided |
| Held | — | ||
| ACT-015463 | Outreach suppressed pending steward Outreach | TPA-59173 (Vincent Castro) held until CASE-002019 is decided |
| Held | — | ||
| ACT-015464 | Outreach suppressed pending steward Outreach | PRV-20158 (Harold Carter) held until CASE-002020 is decided |
| Held | — | ||
| ACT-015465 | Outreach suppressed pending steward Outreach | PRV-23828 (Christine Carter) held until CASE-002021 is decided |
| Held | — | ||
| ACT-015466 | Outreach suppressed pending steward Outreach | CLM-416244 (Joyce Hanson) held until CASE-002022 is decided |
| Held | — | ||
| ACT-015467 | Outreach suppressed pending steward Outreach | CLM-407674 (Birttany Knight) held until CASE-002023 is decided |
| Held | — | ||
| ACT-015468 | Outreach suppressed pending steward Outreach | CLM-404524 (Rachel Pierce) held until CASE-002024 is decided |
| Held | — | ||
| ACT-015469 | Outreach suppressed pending steward Outreach | CLM-404525 (Rachel Pirce) held until CASE-002025 is decided |
| Held | — | ||
| ACT-015470 | Outreach suppressed pending steward Outreach | CLM-404183 (Sofia Carr) held until CASE-002026 is decided |
| Held | — | ||
| ACT-015471 | Outreach suppressed pending steward Outreach | ENR-119999 (Martha Kim) held until CASE-002027 is decided |
| Held | — | ||
| ACT-015472 | Outreach suppressed pending steward Outreach | CLM-415179 (Martha Kim) held until CASE-002028 is decided |
| Held | — | ||
| ACT-015473 | Outreach suppressed pending steward Outreach | CLM-406912 (Priya Barnes) held until CASE-002029 is decided |
| Held | — | ||
| ACT-015474 | Outreach suppressed pending steward Outreach | CLM-432760 (Jesse Hunter) held until CASE-002030 is decided |
| Held | — | ||
| ACT-015475 | Outreach suppressed pending steward Outreach | TPA-53457 (Kevin Chapman) held until CASE-002031 is decided |
| Held | — | ||
| ACT-015476 | Outreach suppressed pending steward Outreach | ENR-107142 (Willie Chapman) held until CASE-002032 is decided |
| Held | — | ||
| ACT-015477 | Outreach suppressed pending steward Outreach | TPA-52822 (Logan Nychols) held until CASE-002033 is decided |
| Held | — | ||
| ACT-015478 | Outreach suppressed pending steward Outreach | CLM-406430 (Logan Nichols) held until CASE-002034 is decided |
| Held | — | ||
| ACT-015479 | Outreach suppressed pending steward Outreach | TPA-57907 (Carlos Gordon) held until CASE-002035 is decided |
| Held | — | ||
| ACT-015480 | Outreach suppressed pending steward Outreach | TPA-51059 (Deborah Lopez) held until CASE-002036 is decided |
| Held | — | ||
| ACT-015481 | Outreach suppressed pending steward Outreach | ENR-103192 (Deborah Lopez) held until CASE-002037 is decided |
| Held | — | ||
| ACT-015482 | Outreach suppressed pending steward Outreach | CLM-431061 (Jonathan Hunt) held until CASE-002038 is decided |
| Held | — | ||
| ACT-015483 | Outreach suppressed pending steward Outreach | ENR-100651 (Samuel Allen) held until CASE-002039 is decided |
| Held | — | ||
| ACT-015484 | Outreach suppressed pending steward Outreach | PRV-20142 (Samuel Allen) held until CASE-002040 is decided |
| Held | — | ||
| ACT-015485 | Outreach suppressed pending steward Outreach | TPA-62983 (Jordan Payne) held until CASE-002041 is decided |
| Held | — | ||
| ACT-015486 | Outreach suppressed pending steward Outreach | ENR-138569 (Jordan Paayne) held until CASE-002042 is decided |
| Held | — | ||
| ACT-015487 | Outreach suppressed pending steward Outreach | CLM-416083 (Lori George) held until CASE-002043 is decided |
| Held | — | ||
| ACT-015488 | Outreach suppressed pending steward Outreach | TPA-61978 (Lias Graham) held until CASE-002044 is decided |
| Held | — | ||
| ACT-015489 | Outreach suppressed pending steward Outreach | CLM-428929 (Hannah Valdez) held until CASE-002045 is decided |
| Held | — | ||
| ACT-015490 | Outreach suppressed pending steward Outreach | ENR-123651 (Pual Herrera) held until CASE-002046 is decided |
| Held | — | ||
| ACT-015491 | Outreach suppressed pending steward Outreach | CLM-417975 (Paul Herrera) held until CASE-002047 is decided |
| Held | — | ||
| ACT-015492 | Outreach suppressed pending steward Outreach | ENR-108476 (Paul Herrera) held until CASE-002048 is decided |
| Held | — | ||
| ACT-015493 | Outreach suppressed pending steward Outreach | CLM-430838 (Scott Fowler) held until CASE-002049 is decided |
| Held | — | ||
| ACT-015494 | Outreach suppressed pending steward Outreach | TPA-63631 (Scott Fowler) held until CASE-002050 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.