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-015745 | Outreach suppressed pending steward Outreach | CLM-415911 (Janice Owens) held until CASE-002301 is decided |
| Held | — | ||
| ACT-015746 | Outreach suppressed pending steward Outreach | ENR-132334 (Daniel Harper) held until CASE-002302 is decided |
| Held | — | ||
| ACT-015747 | Outreach suppressed pending steward Outreach | TPA-59858 (Amanda Alexander) held until CASE-002303 is decided |
| Held | — | ||
| ACT-015748 | Outreach suppressed pending steward Outreach | ENR-132742 (Joe Cox) held until CASE-002304 is decided |
| Held | — | ||
| ACT-015749 | Outreach suppressed pending steward Outreach | TPA-61039 (Joe Cox) held until CASE-002305 is decided |
| Held | — | ||
| ACT-015750 | Outreach suppressed pending steward Outreach | CLM-405660 (Brenda Harris) held until CASE-002306 is decided |
| Held | — | ||
| ACT-015751 | Outreach suppressed pending steward Outreach | ENR-128429 (Jeffrey Bradley) held until CASE-002307 is decided |
| Held | — | ||
| ACT-015752 | Outreach suppressed pending steward Outreach | TPA-59535 (Jeffrey Bradley) held until CASE-002308 is decided |
| Held | — | ||
| ACT-015753 | Outreach suppressed pending steward Outreach | PRV-25330 (Jean Bell) held until CASE-002309 is decided |
| Held | — | ||
| ACT-015754 | Outreach suppressed pending steward Outreach | CLM-417961 (Jean Bell) held until CASE-002310 is decided |
| Held | — | ||
| ACT-015755 | Outreach suppressed pending steward Outreach | ENR-104173 (Alice Black) held until CASE-002311 is decided |
| Held | — | ||
| ACT-015756 | Outreach suppressed pending steward Outreach | TPA-51388 (Alice Black) held until CASE-002312 is decided |
| Held | — | ||
| ACT-015757 | Outreach suppressed pending steward Outreach | CLM-427153 (Heather Austin) held until CASE-002313 is decided |
| Held | — | ||
| ACT-015758 | Outreach suppressed pending steward Outreach | PRV-25429 (Joan Anderson) held until CASE-002314 is decided |
| Held | — | ||
| ACT-015759 | Outreach suppressed pending steward Outreach | CLM-425343 (Lawrence Gutierrez) held until CASE-002315 is decided |
| Held | — | ||
| ACT-015760 | Outreach suppressed pending steward Outreach | CLM-425344 (Lawrence Gutierrez) held until CASE-002316 is decided |
| Held | — | ||
| ACT-015761 | Outreach suppressed pending steward Outreach | TPA-59085 (Stephanie Armstrong) held until CASE-002317 is decided |
| Held | — | ||
| ACT-015762 | Outreach suppressed pending steward Outreach | TPA-59086 (Stephanie Armstrong) held until CASE-002318 is decided |
| Held | — | ||
| ACT-015763 | Outreach suppressed pending steward Outreach | ENR-140644 (Joan Santiago) held until CASE-002319 is decided |
| Held | — | ||
| ACT-015764 | Outreach suppressed pending steward Outreach | CLM-430944 (Joan Santiago) held until CASE-002320 is decided |
| Held | — | ||
| ACT-015765 | Outreach suppressed pending steward Outreach | ENR-101651 (Sharon Owens) held until CASE-002321 is decided |
| Held | — | ||
| ACT-015766 | Outreach suppressed pending steward Outreach | TPA-50550 (Sharon Owens) held until CASE-002322 is decided |
| Held | — | ||
| ACT-015767 | Outreach suppressed pending steward Outreach | CLM-414842 (Sara Jimenez) held until CASE-002323 is decided |
| Held | — | ||
| ACT-015768 | Outreach suppressed pending steward Outreach | TPA-55856 (Lisa Chapman) held until CASE-002324 is decided |
| Held | — | ||
| ACT-015769 | Outreach suppressed pending steward Outreach | ENR-117481 (Lisa Chapman) held until CASE-002325 is decided |
| Held | — | ||
| ACT-015770 | Outreach suppressed pending steward Outreach | CLM-413326 (Lisa Chapman) held until CASE-002326 is decided |
| Held | — | ||
| ACT-015771 | Outreach suppressed pending steward Outreach | CLM-413325 (Lisa Chapmman) held until CASE-002327 is decided |
| Held | — | ||
| ACT-015772 | Outreach suppressed pending steward Outreach | CLM-416638 (Cerlos Ford) held until CASE-002328 is decided |
| Held | — | ||
| ACT-015773 | Outreach suppressed pending steward Outreach | TPA-51466 (Dorothy Rogers) held until CASE-002329 is decided |
| Held | — | ||
| ACT-015774 | Outreach suppressed pending steward Outreach | PRV-23950 (Pamela Santiago) held until CASE-002330 is decided |
| Held | — | ||
| ACT-015775 | Outreach suppressed pending steward Outreach | CLM-413632 (Pamela Santiago) held until CASE-002331 is decided |
| Held | — | ||
| ACT-015776 | Outreach suppressed pending steward Outreach | PRV-26101 (Carl Santos) held until CASE-002332 is decided |
| Held | — | ||
| ACT-015777 | Outreach suppressed pending steward Outreach | CLM-429648 (Kenneth Cox) held until CASE-002333 is decided |
| Held | — | ||
| ACT-015778 | Outreach suppressed pending steward Outreach | TPA-59298 (Amy Palmer) held until CASE-002334 is decided |
| Held | — | ||
| ACT-015779 | Outreach suppressed pending steward Outreach | ENR-123493 (Raymond Palmer) held until CASE-002335 is decided |
| Held | — | ||
| ACT-015780 | Outreach suppressed pending steward Outreach | TPA-57884 (Raymond Palmer) held until CASE-002336 is decided |
| Held | — | ||
| ACT-015781 | Outreach suppressed pending steward Outreach | TPA-54788 (Adam Lnua) held until CASE-002337 is decided |
| Held | — | ||
| ACT-015782 | Outreach suppressed pending steward Outreach | CLM-410935 (Adam Luna) held until CASE-002338 is decided |
| Held | — | ||
| ACT-015783 | Outreach suppressed pending steward Outreach | CLM-415084 (Joseph Vasquez) held until CASE-002339 is decided |
| Held | — | ||
| ACT-015784 | Outreach suppressed pending steward Outreach | ENR-119868 (Joseph Vasquez) held until CASE-002340 is decided |
| Held | — | ||
| ACT-015785 | Outreach suppressed pending steward Outreach | CLM-410167 (Gabriel Evans) held until CASE-002341 is decided |
| Held | — | ||
| ACT-015786 | Outreach suppressed pending steward Outreach | TPA-54455 (Gabriel Evaans) held until CASE-002342 is decided |
| Held | — | ||
| ACT-015787 | Outreach suppressed pending steward Outreach | CLM-400017 (Nancy Campbell) held until CASE-002343 is decided |
| Held | — | ||
| ACT-015788 | Outreach suppressed pending steward Outreach | ENR-116139 (Ralph Guerrero) held until CASE-002344 is decided |
| Held | — | ||
| ACT-015789 | Outreach suppressed pending steward Outreach | PRV-23539 (Ralph Guerrero) held until CASE-002345 is decided |
| Held | — | ||
| ACT-015790 | Outreach suppressed pending steward Outreach | TPA-57252 (Janet Dean) held until CASE-002346 is decided |
| Held | — | ||
| ACT-015791 | Outreach suppressed pending steward Outreach | PRV-24269 (Mateo Elliott) held until CASE-002347 is decided |
| Held | — | ||
| ACT-015792 | Outreach suppressed pending steward Outreach | TPA-62163 (Dougls Ortega) held until CASE-002348 is decided |
| Held | — | ||
| ACT-015793 | Outreach suppressed pending steward Outreach | TPA-63064 (Ahmde Sanders) held until CASE-002349 is decided |
| Held | — | ||
| ACT-015794 | Outreach suppressed pending steward Outreach | ENR-116911 (Steven Clark) held until CASE-002350 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.