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-015845 | Outreach suppressed pending steward Outreach | CLM-426397 (Juan Santos) held until CASE-002401 is decided |
| Held | — | ||
| ACT-015846 | Outreach suppressed pending steward Outreach | CLM-426396 (Jan Santos) held until CASE-002402 is decided |
| Held | — | ||
| ACT-015847 | Outreach suppressed pending steward Outreach | TPA-62886 (Bobby Ramos) held until CASE-002403 is decided |
| Held | — | ||
| ACT-015848 | Outreach suppressed pending steward Outreach | CLM-429148 (Bobby Ramos) held until CASE-002404 is decided |
| Held | — | ||
| ACT-015849 | Outreach suppressed pending steward Outreach | CLM-410548 (Danielle Ford) held until CASE-002405 is decided |
| Held | — | ||
| ACT-015850 | Outreach suppressed pending steward Outreach | TPA-57130 (Andrea Collins) held until CASE-002406 is decided |
| Held | — | ||
| ACT-015851 | Outreach suppressed pending steward Outreach | TPA-63990 (Jason Bailey) held until CASE-002407 is decided |
| Held | — | ||
| ACT-015852 | Outreach suppressed pending steward Outreach | CLM-432637 (Joan Silva) held until CASE-002408 is decided |
| Held | — | ||
| ACT-015853 | Outreach suppressed pending steward Outreach | TPA-64391 (Joan Silva) held until CASE-002409 is decided |
| Held | — | ||
| ACT-015854 | Outreach suppressed pending steward Outreach | TPA-63946 (Andrea Silva) held until CASE-002410 is decided |
| Held | — | ||
| ACT-015855 | Outreach suppressed pending steward Outreach | PRV-29236 (Andrea Silva) held until CASE-002411 is decided |
| Held | — | ||
| ACT-015856 | Outreach suppressed pending steward Outreach | CLM-419069 (Christine Banks) held until CASE-002412 is decided |
| Held | — | ||
| ACT-015857 | Outreach suppressed pending steward Outreach | TPA-59049 (Bryan Ryan) held until CASE-002413 is decided |
| Held | — | ||
| ACT-015858 | Outreach suppressed pending steward Outreach | ENR-114303 (Joseph Watkins) held until CASE-002414 is decided |
| Held | — | ||
| ACT-015859 | Outreach suppressed pending steward Outreach | CLM-410912 (Joseph Watkins) held until CASE-002415 is decided |
| Held | — | ||
| ACT-015860 | Outreach suppressed pending steward Outreach | CLM-407623 (William McDonald) held until CASE-002416 is decided |
| Held | — | ||
| ACT-015861 | Outreach suppressed pending steward Outreach | CLM-407622 (William McDonald) held until CASE-002417 is decided |
| Held | — | ||
| ACT-015862 | Outreach suppressed pending steward Outreach | ENR-119741 (Eugene Moreno) held until CASE-002418 is decided |
| Held | — | ||
| ACT-015863 | Outreach suppressed pending steward Outreach | PRV-24395 (Eugene Moreno) held until CASE-002419 is decided |
| Held | — | ||
| ACT-015864 | Outreach suppressed pending steward Outreach | CLM-431181 (Debra Bennett) held until CASE-002420 is decided |
| Held | — | ||
| ACT-015865 | Outreach suppressed pending steward Outreach | TPA-63780 (Deebra Bennett) held until CASE-002421 is decided |
| Held | — | ||
| ACT-015866 | Outreach suppressed pending steward Outreach | TPA-63779 (Debra Bennett) held until CASE-002422 is decided |
| Held | — | ||
| ACT-015867 | Outreach suppressed pending steward Outreach | ENR-122509 (Nicole Owens) held until CASE-002423 is decided |
| Held | — | ||
| ACT-015868 | Outreach suppressed pending steward Outreach | CLM-432158 (Amber Greene) held until CASE-002424 is decided |
| Held | — | ||
| ACT-015869 | Outreach suppressed pending steward Outreach | CLM-400460 (Julia Obrien) held until CASE-002425 is decided |
| Held | — | ||
| ACT-015870 | Outreach suppressed pending steward Outreach | TPA-51202 (Luis Wallace) held until CASE-002426 is decided |
| Held | — | ||
| ACT-015871 | Outreach suppressed pending steward Outreach | CLM-419401 (Edward Green) held until CASE-002427 is decided |
| Held | — | ||
| ACT-015872 | Outreach suppressed pending steward Outreach | ENR-125559 (Edward Green) held until CASE-002428 is decided |
| Held | — | ||
| ACT-015873 | Outreach suppressed pending steward Outreach | CLM-402103 (Laura Rojas) held until CASE-002429 is decided |
| Held | — | ||
| ACT-015874 | Outreach suppressed pending steward Outreach | TPA-62207 (Jordan Banks) held until CASE-002430 is decided |
| Held | — | ||
| ACT-015875 | Outreach suppressed pending steward Outreach | TPA-62208 (Jordan Banks) held until CASE-002431 is decided |
| Held | — | ||
| ACT-015876 | Outreach suppressed pending steward Outreach | TPA-63264 (Billy Medina) held until CASE-002432 is decided |
| Held | — | ||
| ACT-015877 | Outreach suppressed pending steward Outreach | CLM-429870 (Austin Contreras) held until CASE-002433 is decided |
| Held | — | ||
| ACT-015878 | Outreach suppressed pending steward Outreach | CLM-405929 (Julie Peters) held until CASE-002434 is decided |
| Held | — | ||
| ACT-015879 | Outreach suppressed pending steward Outreach | TPA-61546 (Ryan Gibson) held until CASE-002435 is decided |
| Held | — | ||
| ACT-015880 | Outreach suppressed pending steward Outreach | TPA-60868 (Dorothhy Fox) held until CASE-002436 is decided |
| Held | — | ||
| ACT-015881 | Outreach suppressed pending steward Outreach | TPA-60867 (Doorthy Fox) held until CASE-002437 is decided |
| Held | — | ||
| ACT-015882 | Outreach suppressed pending steward Outreach | TPA-54698 (Evelyn Williams) held until CASE-002438 is decided |
| Held | — | ||
| ACT-015883 | Outreach suppressed pending steward Outreach | PRV-20029 (Nancy Morrison) held until CASE-002439 is decided |
| Held | — | ||
| ACT-015884 | Outreach suppressed pending steward Outreach | TPA-51511 (Sharon Boyd) held until CASE-002440 is decided |
| Held | — | ||
| ACT-015885 | Outreach suppressed pending steward Outreach | TPA-60307 (Aaron Dominguez) held until CASE-002441 is decided |
| Held | — | ||
| ACT-015886 | Outreach suppressed pending steward Outreach | ENR-130632 (Aaron Dominguez) held until CASE-002442 is decided |
| Held | — | ||
| ACT-015887 | Outreach suppressed pending steward Outreach | CLM-401152 (Deborah Dominguez) held until CASE-002443 is decided |
| Held | — | ||
| ACT-015888 | Outreach suppressed pending steward Outreach | CLM-411982 (Christian Fuller) held until CASE-002444 is decided |
| Held | — | ||
| ACT-015889 | Outreach suppressed pending steward Outreach | CLM-418194 (Peter Santiago) held until CASE-002445 is decided |
| Held | — | ||
| ACT-015890 | Outreach suppressed pending steward Outreach | ENR-117993 (Ruth Johnson) held until CASE-002446 is decided |
| Held | — | ||
| ACT-015891 | Outreach suppressed pending steward Outreach | CLM-431248 (Katherine Jenkins) held until CASE-002447 is decided |
| Held | — | ||
| ACT-015892 | Outreach suppressed pending steward Outreach | CLM-419001 (Daniel Johnson) held until CASE-002448 is decided |
| Held | — | ||
| ACT-015893 | Outreach suppressed pending steward Outreach | TPA-58426 (Danny Johnson) held until CASE-002449 is decided |
| Held | — | ||
| ACT-015894 | Outreach suppressed pending steward Outreach | PRV-27518 (Aaron Watkins) held until CASE-002450 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.