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-013645 | Outreach suppressed pending steward Outreach | ENR-104457 (Bruce Cooper) held until CASE-000201 is decided |
| Held | — | ||
| ACT-013646 | Outreach suppressed pending steward Outreach | CLM-429039 (Aaron Howell) held until CASE-000202 is decided |
| Held | — | ||
| ACT-013647 | Outreach suppressed pending steward Outreach | ENR-117841 (Janet Dunn) held until CASE-000203 is decided |
| Held | — | ||
| ACT-013648 | Outreach suppressed pending steward Outreach | CLM-428530 (Emma Le) held until CASE-000204 is decided |
| Held | — | ||
| ACT-013649 | Outreach suppressed pending steward Outreach | ENR-137433 (Emma Le) held until CASE-000205 is decided |
| Held | — | ||
| ACT-013650 | Outreach suppressed pending steward Outreach | PRV-22307 (Keith Wallace) held until CASE-000206 is decided |
| Held | — | ||
| ACT-013651 | Outreach suppressed pending steward Outreach | ENR-110226 (Keith Wallace) held until CASE-000207 is decided |
| Held | — | ||
| ACT-013652 | Outreach suppressed pending steward Outreach | CLM-431522 (Christina Rios) held until CASE-000208 is decided |
| Held | — | ||
| ACT-013653 | Outreach suppressed pending steward Outreach | CLM-414196 (Santiago Aguilar) held until CASE-000209 is decided |
| Held | — | ||
| ACT-013654 | Outreach suppressed pending steward Outreach | CLM-431269 (Alice Ortiz) held until CASE-000210 is decided |
| Held | — | ||
| ACT-013655 | Outreach suppressed pending steward Outreach | ENR-120818 (Megan Ortiz) held until CASE-000211 is decided |
| Held | — | ||
| ACT-013656 | Outreach suppressed pending steward Outreach | TPA-51551 (Donald Hill) held until CASE-000212 is decided |
| Held | — | ||
| ACT-013657 | Outreach suppressed pending steward Outreach | ENR-104639 (Donald Hill) held until CASE-000213 is decided |
| Held | — | ||
| ACT-013658 | Outreach suppressed pending steward Outreach | CLM-403230 (Rachel Washington) held until CASE-000214 is decided |
| Held | — | ||
| ACT-013659 | Outreach suppressed pending steward Outreach | ENR-116882 (Alexander Washington) held until CASE-000215 is decided |
| Held | — | ||
| ACT-013660 | Outreach suppressed pending steward Outreach | TPA-52872 (Carl Pnea) held until CASE-000216 is decided |
| Held | — | ||
| ACT-013661 | Outreach suppressed pending steward Outreach | TPA-52873 (Carl Pena) held until CASE-000217 is decided |
| Held | — | ||
| ACT-013662 | Outreach suppressed pending steward Outreach | TPA-54535 (Matthew Perrez) held until CASE-000218 is decided |
| Held | — | ||
| ACT-013663 | Outreach suppressed pending steward Outreach | ENR-113642 (Matthew Perez) held until CASE-000219 is decided |
| Held | — | ||
| ACT-013664 | Outreach suppressed pending steward Outreach | CLM-423743 (Gloria Pierce) held until CASE-000220 is decided |
| Held | — | ||
| ACT-013665 | Outreach suppressed pending steward Outreach | ENR-131053 (Gloria Pierce) held until CASE-000221 is decided |
| Held | — | ||
| ACT-013666 | Outreach suppressed pending steward Outreach | PRV-21532 (Kathryn Garcia) held until CASE-000222 is decided |
| Held | — | ||
| ACT-013667 | Outreach suppressed pending steward Outreach | ENR-135430 (Arthur Davis) held until CASE-000223 is decided |
| Held | — | ||
| ACT-013668 | Outreach suppressed pending steward Outreach | TPA-61927 (Arthur Davis) held until CASE-000224 is decided |
| Held | — | ||
| ACT-013669 | Outreach suppressed pending steward Outreach | TPA-56433 (Tyler Lawson) held until CASE-000225 is decided |
| Held | — | ||
| ACT-013670 | Outreach suppressed pending steward Outreach | CLM-427271 (Kyle Myers) held until CASE-000226 is decided |
| Held | — | ||
| ACT-013671 | Outreach suppressed pending steward Outreach | TPA-59802 (Omaar Myres) held until CASE-000227 is decided |
| Held | — | ||
| ACT-013672 | Outreach suppressed pending steward Outreach | TPA-62715 (Jacqueline Schultz) held until CASE-000228 is decided |
| Held | — | ||
| ACT-013673 | Outreach suppressed pending steward Outreach | ENR-137747 (Jacqueline Schultz) held until CASE-000229 is decided |
| Held | — | ||
| ACT-013674 | Outreach suppressed pending steward Outreach | CLM-428068 (Stephen Rios) held until CASE-000230 is decided |
| Held | — | ||
| ACT-013675 | Outreach suppressed pending steward Outreach | ENR-136800 (Stephen Rios) held until CASE-000231 is decided |
| Held | — | ||
| ACT-013676 | Outreach suppressed pending steward Outreach | CLM-418198 (Larry Burke) held until CASE-000232 is decided |
| Held | — | ||
| ACT-013677 | Outreach suppressed pending steward Outreach | PRV-25392 (Larry Burke) held until CASE-000233 is decided |
| Held | — | ||
| ACT-013678 | Outreach suppressed pending steward Outreach | TPA-62246 (Noah Brooks) held until CASE-000234 is decided |
| Held | — | ||
| ACT-013679 | Outreach suppressed pending steward Outreach | ENR-136370 (Noah Brooks) held until CASE-000235 is decided |
| Held | — | ||
| ACT-013680 | Outreach suppressed pending steward Outreach | CLM-429767 (Eric Burke) held until CASE-000236 is decided |
| Held | — | ||
| ACT-013681 | Outreach suppressed pending steward Outreach | CLM-405275 (Roy Hansen) held until CASE-000237 is decided |
| Held | — | ||
| ACT-013682 | Outreach suppressed pending steward Outreach | ENR-106906 (Roy Hansen) held until CASE-000238 is decided |
| Held | — | ||
| ACT-013683 | Outreach suppressed pending steward Outreach | CLM-418116 (Kimberly Burns) held until CASE-000239 is decided |
| Held | — | ||
| ACT-013684 | Outreach suppressed pending steward Outreach | ENR-117235 (Patricia Williams) held until CASE-000240 is decided |
| Held | — | ||
| ACT-013685 | Outreach suppressed pending steward Outreach | PRV-23800 (Patricia Williams) held until CASE-000241 is decided |
| Held | — | ||
| ACT-013686 | Outreach suppressed pending steward Outreach | TPA-54185 (Albert Hayes) held until CASE-000242 is decided |
| Held | — | ||
| ACT-013687 | Outreach suppressed pending steward Outreach | CLM-423220 (Rachel Coleman) held until CASE-000243 is decided |
| Held | — | ||
| ACT-013688 | Outreach suppressed pending steward Outreach | PRV-20090 (Philip Le) held until CASE-000244 is decided |
| Held | — | ||
| ACT-013689 | Outreach suppressed pending steward Outreach | CLM-420872 (Donna Cook) held until CASE-000245 is decided |
| Held | — | ||
| ACT-013690 | Outreach suppressed pending steward Outreach | TPA-59912 (Keith Foster) held until CASE-000246 is decided |
| Held | — | ||
| ACT-013691 | Outreach suppressed pending steward Outreach | CLM-411164 (Gabriel Ortega) held until CASE-000247 is decided |
| Held | — | ||
| ACT-013692 | Outreach suppressed pending steward Outreach | ENR-114678 (Gabriel Ortega) held until CASE-000248 is decided |
| Held | — | ||
| ACT-013693 | Outreach suppressed pending steward Outreach | TPA-50439 (Justin Ortiz) held until CASE-000249 is decided |
| Held | — | ||
| ACT-013694 | Outreach suppressed pending steward Outreach | CLM-431076 (Robert Mason) held until CASE-000250 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.