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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-015495 | Outreach suppressed pending steward Outreach | CLM-421828 (Karen Mills) held until CASE-002051 is decided |
| Held | — | ||
| ACT-015496 | Outreach suppressed pending steward Outreach | TPA-63669 (Doris Carlson) held until CASE-002052 is decided |
| Held | — | ||
| ACT-015497 | Outreach suppressed pending steward Outreach | CLM-409898 (Ethan Maldonado) held until CASE-002053 is decided |
| Held | — | ||
| ACT-015498 | Outreach suppressed pending steward Outreach | ENR-113049 (Ethan Maldonado) held until CASE-002054 is decided |
| Held | — | ||
| ACT-015499 | Outreach suppressed pending steward Outreach | ENR-131622 (Johny Weber) held until CASE-002055 is decided |
| Held | — | ||
| ACT-015500 | Outreach suppressed pending steward Outreach | TPA-57596 (Charlotte Haansen) held until CASE-002056 is decided |
| Held | — | ||
| ACT-015501 | Outreach suppressed pending steward Outreach | CLM-417211 (Charlotte Hansen) held until CASE-002057 is decided |
| Held | — | ||
| ACT-015502 | Outreach suppressed pending steward Outreach | CLM-419518 (Karen Padilla) held until CASE-002058 is decided |
| Held | — | ||
| ACT-015503 | Outreach suppressed pending steward Outreach | CLM-424034 (Megan Kim) held until CASE-002059 is decided |
| Held | — | ||
| ACT-015504 | Outreach suppressed pending steward Outreach | ENR-117422 (Tony Aguilar) held until CASE-002060 is decided |
| Held | — | ||
| ACT-015505 | Outreach suppressed pending steward Outreach | TPA-55840 (Anthony Aguilar) held until CASE-002061 is decided |
| Held | — | ||
| ACT-015506 | Outreach suppressed pending steward Outreach | ENR-107329 (Nicole Duncan) held until CASE-002062 is decided |
| Held | — | ||
| ACT-015507 | Outreach suppressed pending steward Outreach | TPA-52454 (Nicole Duncan) held until CASE-002063 is decided |
| Held | — | ||
| ACT-015508 | Outreach suppressed pending steward Outreach | TPA-51444 (Brruce Schultz) held until CASE-002064 is decided |
| Held | — | ||
| ACT-015509 | Outreach suppressed pending steward Outreach | TPA-54125 (Becky Campbell) held until CASE-002065 is decided |
| Held | — | ||
| ACT-015510 | Outreach suppressed pending steward Outreach | TPA-51953 (Alan Soto) held until CASE-002066 is decided |
| Held | — | ||
| ACT-015511 | Outreach suppressed pending steward Outreach | TPA-59206 (Jason Murray) held until CASE-002067 is decided |
| Held | — | ||
| ACT-015512 | Outreach suppressed pending steward Outreach | CLM-421796 (Katleen Tran) held until CASE-002068 is decided |
| Held | — | ||
| ACT-015513 | Outreach suppressed pending steward Outreach | TPA-61762 (Sofiia Davis) held until CASE-002069 is decided |
| Held | — | ||
| ACT-015514 | Outreach suppressed pending steward Outreach | TPA-60427 (Adam Griffin) held until CASE-002070 is decided |
| Held | — | ||
| ACT-015515 | Outreach suppressed pending steward Outreach | CLM-414014 (Karen Lucas) held until CASE-002071 is decided |
| Held | — | ||
| ACT-015516 | Outreach suppressed pending steward Outreach | CLM-415497 (Stephen Mills) held until CASE-002072 is decided |
| Held | — | ||
| ACT-015517 | Outreach suppressed pending steward Outreach | ENR-120432 (Stephen Mills) held until CASE-002073 is decided |
| Held | — | ||
| ACT-015518 | Outreach suppressed pending steward Outreach | TPA-63391 (Helen Murphy) held until CASE-002074 is decided |
| Held | — | ||
| ACT-015519 | Outreach suppressed pending steward Outreach | TPA-58958 (Kayla Hawkins) held until CASE-002075 is decided |
| Held | — | ||
| ACT-015520 | Outreach suppressed pending steward Outreach | TPA-64165 (Brittany Garrett) held until CASE-002076 is decided |
| Held | — | ||
| ACT-015521 | Outreach suppressed pending steward Outreach | TPA-56745 (Priya Berry) held until CASE-002077 is decided |
| Held | — | ||
| ACT-015522 | Outreach suppressed pending steward Outreach | ENR-120230 (Priya Berry) held until CASE-002078 is decided |
| Held | — | ||
| ACT-015523 | Outreach suppressed pending steward Outreach | PRV-23812 (Aaron Rojas) held until CASE-002079 is decided |
| Held | — | ||
| ACT-015524 | Outreach suppressed pending steward Outreach | TPA-53946 (Alan Ortiz) held until CASE-002080 is decided |
| Held | — | ||
| ACT-015525 | Outreach suppressed pending steward Outreach | TPA-54524 (Brandon Ortega) held until CASE-002081 is decided |
| Held | — | ||
| ACT-015526 | Outreach suppressed pending steward Outreach | TPA-52844 (Lara Ryan) held until CASE-002082 is decided |
| Held | — | ||
| ACT-015527 | Outreach suppressed pending steward Outreach | CLM-429587 (Laura Ford) held until CASE-002083 is decided |
| Held | — | ||
| ACT-015528 | Outreach suppressed pending steward Outreach | TPA-59778 (Mark Payne) held until CASE-002084 is decided |
| Held | — | ||
| ACT-015529 | Outreach suppressed pending steward Outreach | ENR-126743 (Alexander Oliver) held until CASE-002085 is decided |
| Held | — | ||
| ACT-015530 | Outreach suppressed pending steward Outreach | TPA-52472 (Alexander Oliver) held until CASE-002086 is decided |
| Held | — | ||
| ACT-015531 | Outreach suppressed pending steward Outreach | TPA-62634 (Ana Carr) held until CASE-002087 is decided |
| Held | — | ||
| ACT-015532 | Outreach suppressed pending steward Outreach | CLM-428589 (Ana Carr) held until CASE-002088 is decided |
| Held | — | ||
| ACT-015533 | Outreach suppressed pending steward Outreach | TPA-64368 (Cheryl Carr) held until CASE-002089 is decided |
| Held | — | ||
| ACT-015534 | Outreach suppressed pending steward Outreach | PRV-22371 (Alan Daniels) held until CASE-002090 is decided |
| Held | — | ||
| ACT-015535 | Outreach suppressed pending steward Outreach | ENR-110589 (Alan Daniels) held until CASE-002091 is decided |
| Held | — | ||
| ACT-015536 | Outreach suppressed pending steward Outreach | TPA-61579 (Samantha Morris) held until CASE-002092 is decided |
| Held | — | ||
| ACT-015537 | Outreach suppressed pending steward Outreach | TPA-53560 (Nancy Morales) held until CASE-002093 is decided |
| Held | — | ||
| ACT-015538 | Outreach suppressed pending steward Outreach | TPA-53561 (Nancy Morales) held until CASE-002094 is decided |
| Held | — | ||
| ACT-015539 | Outreach suppressed pending steward Outreach | CLM-414876 (Heather Burton) held until CASE-002095 is decided |
| Held | — | ||
| ACT-015540 | Outreach suppressed pending steward Outreach | TPA-50171 (Ralph Ellioott) held until CASE-002096 is decided |
| Held | — | ||
| ACT-015541 | Outreach suppressed pending steward Outreach | CLM-404622 (Scott Singh) held until CASE-002097 is decided |
| Held | — | ||
| ACT-015542 | Outreach suppressed pending steward Outreach | CLM-423671 (Donna Owens) held until CASE-002098 is decided |
| Held | — | ||
| ACT-015543 | Outreach suppressed pending steward Outreach | TPA-60424 (Donna Owens) held until CASE-002099 is decided |
| Held | — | ||
| ACT-015544 | Outreach suppressed pending steward Outreach | ENR-134418 (Noah Owens) held until CASE-002100 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.