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-015695 | Outreach suppressed pending steward Outreach | CLM-418477 (Theresa Grray) held until CASE-002251 is decided |
| Held | — | ||
| ACT-015696 | Outreach suppressed pending steward Outreach | TPA-61583 (Wei James) held until CASE-002252 is decided |
| Held | — | ||
| ACT-015697 | Outreach suppressed pending steward Outreach | CLM-414556 (Brandon Warren) held until CASE-002253 is decided |
| Held | — | ||
| ACT-015698 | Outreach suppressed pending steward Outreach | CLM-414555 (Brandon Warren) held until CASE-002254 is decided |
| Held | — | ||
| ACT-015699 | Outreach suppressed pending steward Outreach | CLM-404136 (Emiyl Valdez) held until CASE-002255 is decided |
| Held | — | ||
| ACT-015700 | Outreach suppressed pending steward Outreach | PRV-21165 (Emily Valdez) held until CASE-002256 is decided |
| Held | — | ||
| ACT-015701 | Outreach suppressed pending steward Outreach | CLM-400432 (Bradley Caarroll) held until CASE-002257 is decided |
| Held | — | ||
| ACT-015702 | Outreach suppressed pending steward Outreach | TPA-57197 (Lori Walsh) held until CASE-002258 is decided |
| Held | — | ||
| ACT-015703 | Outreach suppressed pending steward Outreach | PRV-24862 (Lori Walsh) held until CASE-002259 is decided |
| Held | — | ||
| ACT-015704 | Outreach suppressed pending steward Outreach | TPA-63331 (Christian Simmons) held until CASE-002260 is decided |
| Held | — | ||
| ACT-015705 | Outreach suppressed pending steward Outreach | TPA-60298 (Kathy Edwards) held until CASE-002261 is decided |
| Held | — | ||
| ACT-015706 | Outreach suppressed pending steward Outreach | PRV-26903 (Kathleen Edwards) held until CASE-002262 is decided |
| Held | — | ||
| ACT-015707 | Outreach suppressed pending steward Outreach | CLM-412469 (Matt Arnold) held until CASE-002263 is decided |
| Held | — | ||
| ACT-015708 | Outreach suppressed pending steward Outreach | ENR-141676 (Brenda Gilbert) held until CASE-002264 is decided |
| Held | — | ||
| ACT-015709 | Outreach suppressed pending steward Outreach | CLM-431774 (Brenda Glbert) held until CASE-002265 is decided |
| Held | — | ||
| ACT-015710 | Outreach suppressed pending steward Outreach | TPA-58787 (Kimberly Morrison) held until CASE-002266 is decided |
| Held | — | ||
| ACT-015711 | Outreach suppressed pending steward Outreach | TPA-62222 (Margaret Jensen) held until CASE-002267 is decided |
| Held | — | ||
| ACT-015712 | Outreach suppressed pending steward Outreach | TPA-52393 (Cynthia Tucker) held until CASE-002268 is decided |
| Held | — | ||
| ACT-015713 | Outreach suppressed pending steward Outreach | ENR-101810 (Joyce Oliver) held until CASE-002269 is decided |
| Held | — | ||
| ACT-015714 | Outreach suppressed pending steward Outreach | PRV-20437 (Joyce Oliver) held until CASE-002270 is decided |
| Held | — | ||
| ACT-015715 | Outreach suppressed pending steward Outreach | CLM-406883 (Keith Dixon) held until CASE-002271 is decided |
| Held | — | ||
| ACT-015716 | Outreach suppressed pending steward Outreach | TPA-53021 (Keith Dixon) held until CASE-002272 is decided |
| Held | — | ||
| ACT-015717 | Outreach suppressed pending steward Outreach | TPA-50336 (Carlos Perkins) held until CASE-002273 is decided |
| Held | — | ||
| ACT-015718 | Outreach suppressed pending steward Outreach | CLM-400728 (Carlos Perkins) held until CASE-002274 is decided |
| Held | — | ||
| ACT-015719 | Outreach suppressed pending steward Outreach | CLM-421991 (Gerald Wagner) held until CASE-002275 is decided |
| Held | — | ||
| ACT-015720 | Outreach suppressed pending steward Outreach | PRV-26482 (Gerald Wagner) held until CASE-002276 is decided |
| Held | — | ||
| ACT-015721 | Outreach suppressed pending steward Outreach | CLM-413448 (Emily Sanders) held until CASE-002277 is decided |
| Held | — | ||
| ACT-015722 | Outreach suppressed pending steward Outreach | CLM-413449 (Emily Sanders) held until CASE-002278 is decided |
| Held | — | ||
| ACT-015723 | Outreach suppressed pending steward Outreach | TPA-53315 (Scott Snyder) held until CASE-002279 is decided |
| Held | — | ||
| ACT-015724 | Outreach suppressed pending steward Outreach | ENR-109913 (Scott Snyder) held until CASE-002280 is decided |
| Held | — | ||
| ACT-015725 | Outreach suppressed pending steward Outreach | CLM-411650 (Alice Red) held until CASE-002281 is decided |
| Held | — | ||
| ACT-015726 | Outreach suppressed pending steward Outreach | CLM-425392 (Isabella Reed) held until CASE-002282 is decided |
| Held | — | ||
| ACT-015727 | Outreach suppressed pending steward Outreach | TPA-51061 (Mei Torrs) held until CASE-002283 is decided |
| Held | — | ||
| ACT-015728 | Outreach suppressed pending steward Outreach | CLM-402493 (Mei Torres) held until CASE-002284 is decided |
| Held | — | ||
| ACT-015729 | Outreach suppressed pending steward Outreach | PRV-20725 (Mei Torres) held until CASE-002285 is decided |
| Held | — | ||
| ACT-015730 | Outreach suppressed pending steward Outreach | TPA-57830 (Ann Wagner) held until CASE-002286 is decided |
| Held | — | ||
| ACT-015731 | Outreach suppressed pending steward Outreach | ENR-123355 (Ann Wagner) held until CASE-002287 is decided |
| Held | — | ||
| ACT-015732 | Outreach suppressed pending steward Outreach | ENR-125993 (Teresa Alvarado) held until CASE-002288 is decided |
| Held | — | ||
| ACT-015733 | Outreach suppressed pending steward Outreach | ENR-135454 (Benjamin Jones) held until CASE-002289 is decided |
| Held | — | ||
| ACT-015734 | Outreach suppressed pending steward Outreach | PRV-27939 (Benjamin Jones) held until CASE-002290 is decided |
| Held | — | ||
| ACT-015735 | Outreach suppressed pending steward Outreach | CLM-405169 (Terry Williams) held until CASE-002291 is decided |
| Held | — | ||
| ACT-015736 | Outreach suppressed pending steward Outreach | TPA-52266 (Terry Williams) held until CASE-002292 is decided |
| Held | — | ||
| ACT-015737 | Outreach suppressed pending steward Outreach | CLM-405170 (Terry Williams) held until CASE-002293 is decided |
| Held | — | ||
| ACT-015738 | Outreach suppressed pending steward Outreach | PRV-20569 (Kayla Berry) held until CASE-002294 is decided |
| Held | — | ||
| ACT-015739 | Outreach suppressed pending steward Outreach | TPA-50836 (Kayla Berry) held until CASE-002295 is decided |
| Held | — | ||
| ACT-015740 | Outreach suppressed pending steward Outreach | ENR-139421 (Mason Berry) held until CASE-002296 is decided |
| Held | — | ||
| ACT-015741 | Outreach suppressed pending steward Outreach | CLM-430061 (Mason Bery) held until CASE-002297 is decided |
| Held | — | ||
| ACT-015742 | Outreach suppressed pending steward Outreach | ENR-117625 (Stephen Dixon) held until CASE-002298 is decided |
| Held | — | ||
| ACT-015743 | Outreach suppressed pending steward Outreach | CLM-415247 (Jeremy Vega) held until CASE-002299 is decided |
| Held | — | ||
| ACT-015744 | Outreach suppressed pending steward Outreach | CLM-415910 (Janice Owens) held until CASE-002300 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.