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-015545 | Outreach suppressed pending steward Outreach | CLM-418265 (Kathleen Owens) held until CASE-002101 is decided |
| Held | — | ||
| ACT-015546 | Outreach suppressed pending steward Outreach | PRV-25415 (Kathleen Owens) held until CASE-002102 is decided |
| Held | — | ||
| ACT-015547 | Outreach suppressed pending steward Outreach | CLM-428194 (Adam Obrien) held until CASE-002103 is decided |
| Held | — | ||
| ACT-015548 | Outreach suppressed pending steward Outreach | CLM-402377 (Deb Obrien) held until CASE-002104 is decided |
| Held | — | ||
| ACT-015549 | Outreach suppressed pending steward Outreach | ENR-103051 (Deborah Obrien) held until CASE-002105 is decided |
| Held | — | ||
| ACT-015550 | Outreach suppressed pending steward Outreach | TPA-59790 (Heather Waston) held until CASE-002106 is decided |
| Held | — | ||
| ACT-015551 | Outreach suppressed pending steward Outreach | TPA-59286 (Mateo Hughes) held until CASE-002107 is decided |
| Held | — | ||
| ACT-015552 | Outreach suppressed pending steward Outreach | PRV-25394 (Ronald Price) held until CASE-002108 is decided |
| Held | — | ||
| ACT-015553 | Outreach suppressed pending steward Outreach | TPA-58037 (Ronald Price) held until CASE-002109 is decided |
| Held | — | ||
| ACT-015554 | Outreach suppressed pending steward Outreach | CLM-403206 (Jakob Wong) held until CASE-002110 is decided |
| Held | — | ||
| ACT-015555 | Outreach suppressed pending steward Outreach | TPA-51379 (Jacob Wong) held until CASE-002111 is decided |
| Held | — | ||
| ACT-015556 | Outreach suppressed pending steward Outreach | ENR-130012 (Doris Mejia) held until CASE-002112 is decided |
| Held | — | ||
| ACT-015557 | Outreach suppressed pending steward Outreach | ENR-109848 (Jack Sanchez) held until CASE-002113 is decided |
| Held | — | ||
| ACT-015558 | Outreach suppressed pending steward Outreach | CLM-407511 (Jack Sanchez) held until CASE-002114 is decided |
| Held | — | ||
| ACT-015559 | Outreach suppressed pending steward Outreach | PRV-20731 (Austin Holmes) held until CASE-002115 is decided |
| Held | — | ||
| ACT-015560 | Outreach suppressed pending steward Outreach | ENR-103217 (Austin Holmes) held until CASE-002116 is decided |
| Held | — | ||
| ACT-015561 | Outreach suppressed pending steward Outreach | PRV-28366 (Julie Stephens) held until CASE-002117 is decided |
| Held | — | ||
| ACT-015562 | Outreach suppressed pending steward Outreach | CLM-428504 (Julie Stephens) held until CASE-002118 is decided |
| Held | — | ||
| ACT-015563 | Outreach suppressed pending steward Outreach | TPA-57632 (Marilyn Holms) held until CASE-002119 is decided |
| Held | — | ||
| ACT-015564 | Outreach suppressed pending steward Outreach | TPA-57633 (Marilyn Holmes) held until CASE-002120 is decided |
| Held | — | ||
| ACT-015565 | Outreach suppressed pending steward Outreach | ENR-101638 (Luccia Peters) held until CASE-002121 is decided |
| Held | — | ||
| ACT-015566 | Outreach suppressed pending steward Outreach | TPA-50543 (Lucia Peters) held until CASE-002122 is decided |
| Held | — | ||
| ACT-015567 | Outreach suppressed pending steward Outreach | CLM-432051 (Timothy Delgado) held until CASE-002123 is decided |
| Held | — | ||
| ACT-015568 | Outreach suppressed pending steward Outreach | CLM-432050 (Timothy Delgado) held until CASE-002124 is decided |
| Held | — | ||
| ACT-015569 | Outreach suppressed pending steward Outreach | TPA-52095 (Roy Bennett) held until CASE-002125 is decided |
| Held | — | ||
| ACT-015570 | Outreach suppressed pending steward Outreach | ENR-135444 (Teresa Porter) held until CASE-002126 is decided |
| Held | — | ||
| ACT-015571 | Outreach suppressed pending steward Outreach | PRV-27937 (Teresa Porter) held until CASE-002127 is decided |
| Held | — | ||
| ACT-015572 | Outreach suppressed pending steward Outreach | ENR-134553 (Mary Ford) held until CASE-002128 is decided |
| Held | — | ||
| ACT-015573 | Outreach suppressed pending steward Outreach | ENR-107251 (Michael Pena) held until CASE-002129 is decided |
| Held | — | ||
| ACT-015574 | Outreach suppressed pending steward Outreach | CLM-405504 (Michael Pena) held until CASE-002130 is decided |
| Held | — | ||
| ACT-015575 | Outreach suppressed pending steward Outreach | TPA-51833 (Daniel Matthews) held until CASE-002131 is decided |
| Held | — | ||
| ACT-015576 | Outreach suppressed pending steward Outreach | TPA-63701 (Fatima Price) held until CASE-002132 is decided |
| Held | — | ||
| ACT-015577 | Outreach suppressed pending steward Outreach | PRV-27643 (Brittany Wang) held until CASE-002133 is decided |
| Held | — | ||
| ACT-015578 | Outreach suppressed pending steward Outreach | TPA-62159 (Elizabeth Taylor) held until CASE-002134 is decided |
| Held | — | ||
| ACT-015579 | Outreach suppressed pending steward Outreach | CLM-413021 (Kathleen Brooks) held until CASE-002135 is decided |
| Held | — | ||
| ACT-015580 | Outreach suppressed pending steward Outreach | TPA-55726 (Kathleen Brooks) held until CASE-002136 is decided |
| Held | — | ||
| ACT-015581 | Outreach suppressed pending steward Outreach | ENR-135014 (Mason McDonald) held until CASE-002137 is decided |
| Held | — | ||
| ACT-015582 | Outreach suppressed pending steward Outreach | CLM-426700 (Mason McDonald) held until CASE-002138 is decided |
| Held | — | ||
| ACT-015583 | Outreach suppressed pending steward Outreach | CLM-406546 (Brian Nunez) held until CASE-002139 is decided |
| Held | — | ||
| ACT-015584 | Outreach suppressed pending steward Outreach | TPA-52881 (Brian Nunez) held until CASE-002140 is decided |
| Held | — | ||
| ACT-015585 | Outreach suppressed pending steward Outreach | CLM-412465 (Angela Kennedy) held until CASE-002141 is decided |
| Held | — | ||
| ACT-015586 | Outreach suppressed pending steward Outreach | CLM-408119 (Jessica Patel) held until CASE-002142 is decided |
| Held | — | ||
| ACT-015587 | Outreach suppressed pending steward Outreach | TPA-53570 (Jessica Patel) held until CASE-002143 is decided |
| Held | — | ||
| ACT-015588 | Outreach suppressed pending steward Outreach | CLM-401472 (Willie Chen) held until CASE-002144 is decided |
| Held | — | ||
| ACT-015589 | Outreach suppressed pending steward Outreach | ENR-101914 (Willie Chen) held until CASE-002145 is decided |
| Held | — | ||
| ACT-015590 | Outreach suppressed pending steward Outreach | PRV-27648 (Gracce Wong) held until CASE-002146 is decided |
| Held | — | ||
| ACT-015591 | Outreach suppressed pending steward Outreach | CLM-420390 (Laura Smith) held until CASE-002147 is decided |
| Held | — | ||
| ACT-015592 | Outreach suppressed pending steward Outreach | PRV-20095 (Kyle Mason) held until CASE-002148 is decided |
| Held | — | ||
| ACT-015593 | Outreach suppressed pending steward Outreach | ENR-127830 (Amy Bennett) held until CASE-002149 is decided |
| Held | — | ||
| ACT-015594 | Outreach suppressed pending steward Outreach | PRV-26245 (Amy Bennett) held until CASE-002150 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.