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-015595 | Outreach suppressed pending steward Outreach | CLM-424379 (Nicole Bryant) held until CASE-002151 is decided |
| Held | — | ||
| ACT-015596 | Outreach suppressed pending steward Outreach | CLM-421863 (Walter Brooks) held until CASE-002152 is decided |
| Held | — | ||
| ACT-015597 | Outreach suppressed pending steward Outreach | TPA-59044 (Gregory Hudson) held until CASE-002153 is decided |
| Held | — | ||
| ACT-015598 | Outreach suppressed pending steward Outreach | TPA-59043 (Gregory Hudson) held until CASE-002154 is decided |
| Held | — | ||
| ACT-015599 | Outreach suppressed pending steward Outreach | TPA-61863 (Hannah Martin) held until CASE-002155 is decided |
| Held | — | ||
| ACT-015600 | Outreach suppressed pending steward Outreach | CLM-426848 (Hannah Martin) held until CASE-002156 is decided |
| Held | — | ||
| ACT-015601 | Outreach suppressed pending steward Outreach | CLM-404249 (Joan Robertson) held until CASE-002157 is decided |
| Held | — | ||
| ACT-015602 | Outreach suppressed pending steward Outreach | CLM-410726 (Jose Weber) held until CASE-002158 is decided |
| Held | — | ||
| ACT-015603 | Outreach suppressed pending steward Outreach | TPA-56446 (Kevin Morris) held until CASE-002159 is decided |
| Held | — | ||
| ACT-015604 | Outreach suppressed pending steward Outreach | PRV-24288 (Kevin Morris) held until CASE-002160 is decided |
| Held | — | ||
| ACT-015605 | Outreach suppressed pending steward Outreach | TPA-57004 (Alexander Johnston) held until CASE-002161 is decided |
| Held | — | ||
| ACT-015606 | Outreach suppressed pending steward Outreach | TPA-59410 (Santiago Green) held until CASE-002162 is decided |
| Held | — | ||
| ACT-015607 | Outreach suppressed pending steward Outreach | PRV-22809 (Jooyce Graham) held until CASE-002163 is decided |
| Held | — | ||
| ACT-015608 | Outreach suppressed pending steward Outreach | ENR-112758 (Joyce Graham) held until CASE-002164 is decided |
| Held | — | ||
| ACT-015609 | Outreach suppressed pending steward Outreach | CLM-419112 (Jacqueline Nelson) held until CASE-002165 is decided |
| Held | — | ||
| ACT-015610 | Outreach suppressed pending steward Outreach | TPA-63105 (Jose Long) held until CASE-002166 is decided |
| Held | — | ||
| ACT-015611 | Outreach suppressed pending steward Outreach | TPA-63106 (Jose Long) held until CASE-002167 is decided |
| Held | — | ||
| ACT-015612 | Outreach suppressed pending steward Outreach | TPA-54464 (Mateo Austin) held until CASE-002168 is decided |
| Held | — | ||
| ACT-015613 | Outreach suppressed pending steward Outreach | TPA-54465 (Mateo Austin) held until CASE-002169 is decided |
| Held | — | ||
| ACT-015614 | Outreach suppressed pending steward Outreach | CLM-421754 (Linda Johnson) held until CASE-002170 is decided |
| Held | — | ||
| ACT-015615 | Outreach suppressed pending steward Outreach | TPA-55663 (Judy Ortega) held until CASE-002171 is decided |
| Held | — | ||
| ACT-015616 | Outreach suppressed pending steward Outreach | TPA-54232 (Yuki Lynch) held until CASE-002172 is decided |
| Held | — | ||
| ACT-015617 | Outreach suppressed pending steward Outreach | TPA-50065 (Jennifer Cole) held until CASE-002173 is decided |
| Held | — | ||
| ACT-015618 | Outreach suppressed pending steward Outreach | PRV-22469 (Pamela Gardner) held until CASE-002174 is decided |
| Held | — | ||
| ACT-015619 | Outreach suppressed pending steward Outreach | CLM-408365 (Pamela Gardner) held until CASE-002175 is decided |
| Held | — | ||
| ACT-015620 | Outreach suppressed pending steward Outreach | CLM-401461 (Pat Bishop) held until CASE-002176 is decided |
| Held | — | ||
| ACT-015621 | Outreach suppressed pending steward Outreach | CLM-405424 (Maria Johnston) held until CASE-002177 is decided |
| Held | — | ||
| ACT-015622 | Outreach suppressed pending steward Outreach | TPA-52386 (Maria Johnston) held until CASE-002178 is decided |
| Held | — | ||
| ACT-015623 | Outreach suppressed pending steward Outreach | TPA-57163 (Kathleen Johnston) held until CASE-002179 is decided |
| Held | — | ||
| ACT-015624 | Outreach suppressed pending steward Outreach | TPA-56680 (Denise Gibson) held until CASE-002180 is decided |
| Held | — | ||
| ACT-015625 | Outreach suppressed pending steward Outreach | ENR-119990 (Denise Gibson) held until CASE-002181 is decided |
| Held | — | ||
| ACT-015626 | Outreach suppressed pending steward Outreach | TPA-62703 (Patricia Colleman) held until CASE-002182 is decided |
| Held | — | ||
| ACT-015627 | Outreach suppressed pending steward Outreach | CLM-415898 (Brenda Nichools) held until CASE-002183 is decided |
| Held | — | ||
| ACT-015628 | Outreach suppressed pending steward Outreach | CLM-403512 (Ronald Alvarado) held until CASE-002184 is decided |
| Held | — | ||
| ACT-015629 | Outreach suppressed pending steward Outreach | CLM-406721 (Kathleen Bailey) held until CASE-002185 is decided |
| Held | — | ||
| ACT-015630 | Outreach suppressed pending steward Outreach | CLM-416651 (Emily Diaz) held until CASE-002186 is decided |
| Held | — | ||
| ACT-015631 | Outreach suppressed pending steward Outreach | PRV-24933 (Emily Diaz) held until CASE-002187 is decided |
| Held | — | ||
| ACT-015632 | Outreach suppressed pending steward Outreach | TPA-50099 (Evelyn Knight) held until CASE-002188 is decided |
| Held | — | ||
| ACT-015633 | Outreach suppressed pending steward Outreach | CLM-418124 (Donald Sullivan) held until CASE-002189 is decided |
| Held | — | ||
| ACT-015634 | Outreach suppressed pending steward Outreach | TPA-51446 (Evelyn Delgado) held until CASE-002190 is decided |
| Held | — | ||
| ACT-015635 | Outreach suppressed pending steward Outreach | ENR-104325 (Evelyn Delgado) held until CASE-002191 is decided |
| Held | — | ||
| ACT-015636 | Outreach suppressed pending steward Outreach | CLM-416969 (Sara Burton) held until CASE-002192 is decided |
| Held | — | ||
| ACT-015637 | Outreach suppressed pending steward Outreach | TPA-62105 (Jason Scott) held until CASE-002193 is decided |
| Held | — | ||
| ACT-015638 | Outreach suppressed pending steward Outreach | ENR-135906 (Jason Scott) held until CASE-002194 is decided |
| Held | — | ||
| ACT-015639 | Outreach suppressed pending steward Outreach | ENR-113104 (Beverly Crawwford) held until CASE-002195 is decided |
| Held | — | ||
| ACT-015640 | Outreach suppressed pending steward Outreach | PRV-22894 (Beverly Crawford) held until CASE-002196 is decided |
| Held | — | ||
| ACT-015641 | Outreach suppressed pending steward Outreach | ENR-139244 (Jose Boyd) held until CASE-002197 is decided |
| Held | — | ||
| ACT-015642 | Outreach suppressed pending steward Outreach | CLM-420333 (Samuel Green) held until CASE-002198 is decided |
| Held | — | ||
| ACT-015643 | Outreach suppressed pending steward Outreach | CLM-418552 (Luis Adams) held until CASE-002199 is decided |
| Held | — | ||
| ACT-015644 | Outreach suppressed pending steward Outreach | CLM-408761 (Jack Mitchell) held until CASE-002200 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.