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-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.