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-015795 | Outreach suppressed pending steward Outreach | CLM-412866 (Steven Clark) held until CASE-002351 is decided |
| Held | — | ||
| ACT-015796 | Outreach suppressed pending steward Outreach | TPA-63837 (Rachel Nichols) held until CASE-002352 is decided |
| Held | — | ||
| ACT-015797 | Outreach suppressed pending steward Outreach | CLM-408321 (Gregory Pierce) held until CASE-002353 is decided |
| Held | — | ||
| ACT-015798 | Outreach suppressed pending steward Outreach | CLM-408320 (Gregory Pierce) held until CASE-002354 is decided |
| Held | — | ||
| ACT-015799 | Outreach suppressed pending steward Outreach | CLM-425932 (Theresa Ortiz) held until CASE-002355 is decided |
| Held | — | ||
| ACT-015800 | Outreach suppressed pending steward Outreach | ENR-133938 (Theresa Ortiz) held until CASE-002356 is decided |
| Held | — | ||
| ACT-015801 | Outreach suppressed pending steward Outreach | CLM-408178 (Linda Munoz) held until CASE-002357 is decided |
| Held | — | ||
| ACT-015802 | Outreach suppressed pending steward Outreach | TPA-57240 (Aisha Gibsson) held until CASE-002358 is decided |
| Held | — | ||
| ACT-015803 | Outreach suppressed pending steward Outreach | TPA-53440 (Elizabeth Stevens) held until CASE-002359 is decided |
| Held | — | ||
| ACT-015804 | Outreach suppressed pending steward Outreach | PRV-22311 (Elizabeth Stevens) held until CASE-002360 is decided |
| Held | — | ||
| ACT-015805 | Outreach suppressed pending steward Outreach | PRV-26368 (Santiago Washington) held until CASE-002361 is decided |
| Held | — | ||
| ACT-015806 | Outreach suppressed pending steward Outreach | CLM-421605 (Santiago Washington) held until CASE-002362 is decided |
| Held | — | ||
| ACT-015807 | Outreach suppressed pending steward Outreach | CLM-407954 (Joshua Hayes) held until CASE-002363 is decided |
| Held | — | ||
| ACT-015808 | Outreach suppressed pending steward Outreach | PRV-22879 (Linda Lawrence) held until CASE-002364 is decided |
| Held | — | ||
| ACT-015809 | Outreach suppressed pending steward Outreach | TPA-56907 (Omar Lawrence) held until CASE-002365 is decided |
| Held | — | ||
| ACT-015810 | Outreach suppressed pending steward Outreach | ENR-120768 (Omer Lawrence) held until CASE-002366 is decided |
| Held | — | ||
| ACT-015811 | Outreach suppressed pending steward Outreach | CLM-405856 (Dylan Gibson) held until CASE-002367 is decided |
| Held | — | ||
| ACT-015812 | Outreach suppressed pending steward Outreach | CLM-417259 (Patrick Ellis) held until CASE-002368 is decided |
| Held | — | ||
| ACT-015813 | Outreach suppressed pending steward Outreach | TPA-56504 (Brenda Singh) held until CASE-002369 is decided |
| Held | — | ||
| ACT-015814 | Outreach suppressed pending steward Outreach | ENR-105652 (Patrick Singh) held until CASE-002370 is decided |
| Held | — | ||
| ACT-015815 | Outreach suppressed pending steward Outreach | CLM-404305 (Patrick Singh) held until CASE-002371 is decided |
| Held | — | ||
| ACT-015816 | Outreach suppressed pending steward Outreach | ENR-101613 (Brenda Singh) held until CASE-002372 is decided |
| Held | — | ||
| ACT-015817 | Outreach suppressed pending steward Outreach | PRV-22602 (Bruce Fowler) held until CASE-002373 is decided |
| Held | — | ||
| ACT-015818 | Outreach suppressed pending steward Outreach | TPA-63839 (Tyler Ortiz) held until CASE-002374 is decided |
| Held | — | ||
| ACT-015819 | Outreach suppressed pending steward Outreach | CLM-431346 (Tyelr Ortiz) held until CASE-002375 is decided |
| Held | — | ||
| ACT-015820 | Outreach suppressed pending steward Outreach | TPA-57604 (Edward Gomez) held until CASE-002376 is decided |
| Held | — | ||
| ACT-015821 | Outreach suppressed pending steward Outreach | PRV-22659 (Raymond Pierce) held until CASE-002377 is decided |
| Held | — | ||
| ACT-015822 | Outreach suppressed pending steward Outreach | ENR-129854 (Bruce Wells) held until CASE-002378 is decided |
| Held | — | ||
| ACT-015823 | Outreach suppressed pending steward Outreach | CLM-427862 (Keith Simmons) held until CASE-002379 is decided |
| Held | — | ||
| ACT-015824 | Outreach suppressed pending steward Outreach | ENR-136525 (Keith Simmons) held until CASE-002380 is decided |
| Held | — | ||
| ACT-015825 | Outreach suppressed pending steward Outreach | CLM-426216 (Nancy Peters) held until CASE-002381 is decided |
| Held | — | ||
| ACT-015826 | Outreach suppressed pending steward Outreach | CLM-432394 (Justin Crawford) held until CASE-002382 is decided |
| Held | — | ||
| ACT-015827 | Outreach suppressed pending steward Outreach | TPA-64199 (Kenneth Gilbert) held until CASE-002383 is decided |
| Held | — | ||
| ACT-015828 | Outreach suppressed pending steward Outreach | ENR-142229 (Kenneth Gilbert) held until CASE-002384 is decided |
| Held | — | ||
| ACT-015829 | Outreach suppressed pending steward Outreach | CLM-412992 (Justin Walker) held until CASE-002385 is decided |
| Held | — | ||
| ACT-015830 | Outreach suppressed pending steward Outreach | CLM-412993 (Justin Walker) held until CASE-002386 is decided |
| Held | — | ||
| ACT-015831 | Outreach suppressed pending steward Outreach | CLM-417739 (Jacob Ferguson) held until CASE-002387 is decided |
| Held | — | ||
| ACT-015832 | Outreach suppressed pending steward Outreach | TPA-57834 (Jacob Ferguson) held until CASE-002388 is decided |
| Held | — | ||
| ACT-015833 | Outreach suppressed pending steward Outreach | PRV-28729 (Samuel Daniels) held until CASE-002389 is decided |
| Held | — | ||
| ACT-015834 | Outreach suppressed pending steward Outreach | ENR-104504 (Joyce Freeman) held until CASE-002390 is decided |
| Held | — | ||
| ACT-015835 | Outreach suppressed pending steward Outreach | CLM-403683 (Rachel Fernandez) held until CASE-002391 is decided |
| Held | — | ||
| ACT-015836 | Outreach suppressed pending steward Outreach | CLM-429233 (Natalie Bennett) held until CASE-002392 is decided |
| Held | — | ||
| ACT-015837 | Outreach suppressed pending steward Outreach | ENR-129909 (Joyce Porter) held until CASE-002393 is decided |
| Held | — | ||
| ACT-015838 | Outreach suppressed pending steward Outreach | PRV-26763 (Joyce Porter) held until CASE-002394 is decided |
| Held | — | ||
| ACT-015839 | Outreach suppressed pending steward Outreach | CLM-410691 (Lori Webb) held until CASE-002395 is decided |
| Held | — | ||
| ACT-015840 | Outreach suppressed pending steward Outreach | ENR-114504 (David Knight) held until CASE-002396 is decided |
| Held | — | ||
| ACT-015841 | Outreach suppressed pending steward Outreach | TPA-54828 (Daivd Knight) held until CASE-002397 is decided |
| Held | — | ||
| ACT-015842 | Outreach suppressed pending steward Outreach | CLM-427137 (Judith Jenkins) held until CASE-002398 is decided |
| Held | — | ||
| ACT-015843 | Outreach suppressed pending steward Outreach | CLM-405209 (Beverly Mntgomery) held until CASE-002399 is decided |
| Held | — | ||
| ACT-015844 | Outreach suppressed pending steward Outreach | CLM-426398 (Juan Santos) held until CASE-002400 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.