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-015645 | Outreach suppressed pending steward Outreach | PRV-22599 (Jack Mitchell) held until CASE-002201 is decided |
| Held | — | ||
| ACT-015646 | Outreach suppressed pending steward Outreach | CLM-427162 (Alexander Hudson) held until CASE-002202 is decided |
| Held | — | ||
| ACT-015647 | Outreach suppressed pending steward Outreach | ENR-103845 (Amanda Herrera) held until CASE-002203 is decided |
| Held | — | ||
| ACT-015648 | Outreach suppressed pending steward Outreach | PRV-20843 (Amanda Herrera) held until CASE-002204 is decided |
| Held | — | ||
| ACT-015649 | Outreach suppressed pending steward Outreach | CLM-403034 (Noah Morales) held until CASE-002205 is decided |
| Held | — | ||
| ACT-015650 | Outreach suppressed pending steward Outreach | TPA-51720 (Bryan Moreno) held until CASE-002206 is decided |
| Held | — | ||
| ACT-015651 | Outreach suppressed pending steward Outreach | TPA-60141 (Kenneth Nguyeen) held until CASE-002207 is decided |
| Held | — | ||
| ACT-015652 | Outreach suppressed pending steward Outreach | CLM-410919 (Ashleey Espinoza) held until CASE-002208 is decided |
| Held | — | ||
| ACT-015653 | Outreach suppressed pending steward Outreach | CLM-406620 (Brenda Porter) held until CASE-002209 is decided |
| Held | — | ||
| ACT-015654 | Outreach suppressed pending steward Outreach | TPA-58962 (Carol Ortega) held until CASE-002210 is decided |
| Held | — | ||
| ACT-015655 | Outreach suppressed pending steward Outreach | PRV-29233 (Wayne Rios) held until CASE-002211 is decided |
| Held | — | ||
| ACT-015656 | Outreach suppressed pending steward Outreach | TPA-55330 (Mike Mills) held until CASE-002212 is decided |
| Held | — | ||
| ACT-015657 | Outreach suppressed pending steward Outreach | TPA-64376 (Evelyn Hughes) held until CASE-002213 is decided |
| Held | — | ||
| ACT-015658 | Outreach suppressed pending steward Outreach | TPA-62377 (Drew James) held until CASE-002214 is decided |
| Held | — | ||
| ACT-015659 | Outreach suppressed pending steward Outreach | TPA-54307 (Santiago Garza) held until CASE-002215 is decided |
| Held | — | ||
| ACT-015660 | Outreach suppressed pending steward Outreach | CLM-422355 (Marcus Yang) held until CASE-002216 is decided |
| Held | — | ||
| ACT-015661 | Outreach suppressed pending steward Outreach | TPA-52788 (Ryan Rios) held until CASE-002217 is decided |
| Held | — | ||
| ACT-015662 | Outreach suppressed pending steward Outreach | TPA-52787 (Ryan Rioos) held until CASE-002218 is decided |
| Held | — | ||
| ACT-015663 | Outreach suppressed pending steward Outreach | ENR-109277 (Henry Rodriguez) held until CASE-002219 is decided |
| Held | — | ||
| ACT-015664 | Outreach suppressed pending steward Outreach | TPA-53107 (Henry Rodriguez) held until CASE-002220 is decided |
| Held | — | ||
| ACT-015665 | Outreach suppressed pending steward Outreach | CLM-425415 (Willie Roberts) held until CASE-002221 is decided |
| Held | — | ||
| ACT-015666 | Outreach suppressed pending steward Outreach | CLM-405527 (Denise Dunn) held until CASE-002222 is decided |
| Held | — | ||
| ACT-015667 | Outreach suppressed pending steward Outreach | CLM-414229 (Jesse Reyes) held until CASE-002223 is decided |
| Held | — | ||
| ACT-015668 | Outreach suppressed pending steward Outreach | CLM-431392 (Jerry Roberts) held until CASE-002224 is decided |
| Held | — | ||
| ACT-015669 | Outreach suppressed pending steward Outreach | TPA-51824 (Jonathan Richards) held until CASE-002225 is decided |
| Held | — | ||
| ACT-015670 | Outreach suppressed pending steward Outreach | CLM-422126 (Donald Patel) held until CASE-002226 is decided |
| Held | — | ||
| ACT-015671 | Outreach suppressed pending steward Outreach | CLM-425815 (Thomas Jordan) held until CASE-002227 is decided |
| Held | — | ||
| ACT-015672 | Outreach suppressed pending steward Outreach | CLM-406383 (Vincent Jenkins) held until CASE-002228 is decided |
| Held | — | ||
| ACT-015673 | Outreach suppressed pending steward Outreach | ENR-120000 (Terry Diaz) held until CASE-002229 is decided |
| Held | — | ||
| ACT-015674 | Outreach suppressed pending steward Outreach | TPA-56684 (Terry Diaz) held until CASE-002230 is decided |
| Held | — | ||
| ACT-015675 | Outreach suppressed pending steward Outreach | TPA-50380 (Brandon Russell) held until CASE-002231 is decided |
| Held | — | ||
| ACT-015676 | Outreach suppressed pending steward Outreach | CLM-422811 (Christina Burke) held until CASE-002232 is decided |
| Held | — | ||
| ACT-015677 | Outreach suppressed pending steward Outreach | CLM-422812 (Christina Burke) held until CASE-002233 is decided |
| Held | — | ||
| ACT-015678 | Outreach suppressed pending steward Outreach | CLM-419371 (Mateo Nichols) held until CASE-002234 is decided |
| Held | — | ||
| ACT-015679 | Outreach suppressed pending steward Outreach | ENR-125523 (Mateo Nichols) held until CASE-002235 is decided |
| Held | — | ||
| ACT-015680 | Outreach suppressed pending steward Outreach | CLM-422588 (Bobby Freeman) held until CASE-002236 is decided |
| Held | — | ||
| ACT-015681 | Outreach suppressed pending steward Outreach | PRV-29061 (Natalie Medina) held until CASE-002237 is decided |
| Held | — | ||
| ACT-015682 | Outreach suppressed pending steward Outreach | ENR-140699 (Natalie Medina) held until CASE-002238 is decided |
| Held | — | ||
| ACT-015683 | Outreach suppressed pending steward Outreach | ENR-111295 (Nathan Guerrero) held until CASE-002239 is decided |
| Held | — | ||
| ACT-015684 | Outreach suppressed pending steward Outreach | CLM-408558 (Nathan Guerrero) held until CASE-002240 is decided |
| Held | — | ||
| ACT-015685 | Outreach suppressed pending steward Outreach | CLM-415738 (Brian Wells) held until CASE-002241 is decided |
| Held | — | ||
| ACT-015686 | Outreach suppressed pending steward Outreach | CLM-415737 (Brian Wells) held until CASE-002242 is decided |
| Held | — | ||
| ACT-015687 | Outreach suppressed pending steward Outreach | TPA-58857 (Kimberly Reynolds) held until CASE-002243 is decided |
| Held | — | ||
| ACT-015688 | Outreach suppressed pending steward Outreach | CLM-405007 (Billy Mendez) held until CASE-002244 is decided |
| Held | — | ||
| ACT-015689 | Outreach suppressed pending steward Outreach | PRV-26205 (Sara Powell) held until CASE-002245 is decided |
| Held | — | ||
| ACT-015690 | Outreach suppressed pending steward Outreach | TPA-56769 (Cheryl Walker) held until CASE-002246 is decided |
| Held | — | ||
| ACT-015691 | Outreach suppressed pending steward Outreach | TPA-57598 (George Porter) held until CASE-002247 is decided |
| Held | — | ||
| ACT-015692 | Outreach suppressed pending steward Outreach | ENR-122676 (George Porter) held until CASE-002248 is decided |
| Held | — | ||
| ACT-015693 | Outreach suppressed pending steward Outreach | ENR-139483 (Dylan Munoz) held until CASE-002249 is decided |
| Held | — | ||
| ACT-015694 | Outreach suppressed pending steward Outreach | CLM-430102 (Dylan Munoz) held until CASE-002250 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.