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-015895 | Outreach suppressed pending steward Outreach | TPA-55389 (Melissa Mendez) held until CASE-002451 is decided |
| Held | — | ||
| ACT-015896 | Outreach suppressed pending steward Outreach | CLM-412232 (Melissa Mendez) held until CASE-002452 is decided |
| Held | — | ||
| ACT-015897 | Outreach suppressed pending steward Outreach | CLM-413077 (Cheryl Ray) held until CASE-002453 is decided |
| Held | — | ||
| ACT-015898 | Outreach suppressed pending steward Outreach | CLM-411260 (Evelyn Castro) held until CASE-002454 is decided |
| Held | — | ||
| ACT-015899 | Outreach suppressed pending steward Outreach | PRV-24347 (Christine Garcia) held until CASE-002455 is decided |
| Held | — | ||
| ACT-015900 | Outreach suppressed pending steward Outreach | CLM-417589 (Andrea Le) held until CASE-002456 is decided |
| Held | — | ||
| ACT-015901 | Outreach suppressed pending steward Outreach | CLM-421745 (Donadl Fowleer) held until CASE-002457 is decided |
| Held | — | ||
| ACT-015902 | Outreach suppressed pending steward Outreach | ENR-117810 (Gerald Gordon) held until CASE-002458 is decided |
| Held | — | ||
| ACT-015903 | Outreach suppressed pending steward Outreach | CLM-413614 (Gerald Gordon) held until CASE-002459 is decided |
| Held | — | ||
| ACT-015904 | Outreach suppressed pending steward Outreach | TPA-52757 (William Stewart) held until CASE-002460 is decided |
| Held | — | ||
| ACT-015905 | Outreach suppressed pending steward Outreach | TPA-52597 (Deborah Baker) held until CASE-002461 is decided |
| Held | — | ||
| ACT-015906 | Outreach suppressed pending steward Outreach | TPA-52136 (Zachary Simpson) held until CASE-002462 is decided |
| Held | — | ||
| ACT-015907 | Outreach suppressed pending steward Outreach | TPA-60442 (Jacqueline Daniels) held until CASE-002463 is decided |
| Held | — | ||
| ACT-015908 | Outreach suppressed pending steward Outreach | CLM-431672 (Jaackie Singh) held until CASE-002464 is decided |
| Held | — | ||
| ACT-015909 | Outreach suppressed pending steward Outreach | ENR-114172 (Jacob Lucas) held until CASE-002465 is decided |
| Held | — | ||
| ACT-015910 | Outreach suppressed pending steward Outreach | CLM-410793 (Jacob Lucas) held until CASE-002466 is decided |
| Held | — | ||
| ACT-015911 | Outreach suppressed pending steward Outreach | PRV-25473 (Kayla Brooks) held until CASE-002467 is decided |
| Held | — | ||
| ACT-015912 | Outreach suppressed pending steward Outreach | ENR-100734 (Scott Stephens) held until CASE-002468 is decided |
| Held | — | ||
| ACT-015913 | Outreach suppressed pending steward Outreach | TPA-50242 (Scott Stephens) held until CASE-002469 is decided |
| Held | — | ||
| ACT-015914 | Outreach suppressed pending steward Outreach | PRV-28660 (Stevens Zachary) held until CASE-002470 is decided |
| Held | — | ||
| ACT-015915 | Outreach suppressed pending steward Outreach | TPA-55492 (Jonathan Morgan) held until CASE-002471 is decided |
| Held | — | ||
| ACT-015916 | Outreach suppressed pending steward Outreach | CLM-424826 (Dennis Thompson) held until CASE-002472 is decided |
| Held | — | ||
| ACT-015917 | Outreach suppressed pending steward Outreach | CLM-415676 (Shirley Chavez) held until CASE-002473 is decided |
| Held | — | ||
| ACT-015918 | Outreach suppressed pending steward Outreach | CLM-415680 (Shirley Chavez) held until CASE-002474 is decided |
| Held | — | ||
| ACT-015919 | Outreach suppressed pending steward Outreach | CLM-415678 (Shirley Chavez) held until CASE-002475 is decided |
| Held | — | ||
| ACT-015920 | Outreach suppressed pending steward Outreach | TPA-60252 (Thomas Gibson) held until CASE-002476 is decided |
| Held | — | ||
| ACT-015921 | Outreach suppressed pending steward Outreach | ENR-119938 (Mariana Morrison) held until CASE-002477 is decided |
| Held | — | ||
| ACT-015922 | Outreach suppressed pending steward Outreach | CLM-415142 (Mariana Morrison) held until CASE-002478 is decided |
| Held | — | ||
| ACT-015923 | Outreach suppressed pending steward Outreach | ENR-130875 (Palu Morgan) held until CASE-002479 is decided |
| Held | — | ||
| ACT-015924 | Outreach suppressed pending steward Outreach | PRV-26950 (Paul Morgan) held until CASE-002480 is decided |
| Held | — | ||
| ACT-015925 | Outreach suppressed pending steward Outreach | ENR-133970 (Isabella Ferguson) held until CASE-002481 is decided |
| Held | — | ||
| ACT-015926 | Outreach suppressed pending steward Outreach | CLM-426665 (Roger Banks) held until CASE-002482 is decided |
| Held | — | ||
| ACT-015927 | Outreach suppressed pending steward Outreach | TPA-53765 (Olivia Banks) held until CASE-002483 is decided |
| Held | — | ||
| ACT-015928 | Outreach suppressed pending steward Outreach | ENR-111288 (Olivia Banks) held until CASE-002484 is decided |
| Held | — | ||
| ACT-015929 | Outreach suppressed pending steward Outreach | ENR-108259 (Kathryn Lawson) held until CASE-002485 is decided |
| Held | — | ||
| ACT-015930 | Outreach suppressed pending steward Outreach | TPA-52786 (Kathryn Lawson) held until CASE-002486 is decided |
| Held | — | ||
| ACT-015931 | Outreach suppressed pending steward Outreach | TPA-60554 (Luis Hunt) held until CASE-002487 is decided |
| Held | — | ||
| ACT-015932 | Outreach suppressed pending steward Outreach | TPA-57720 (Santiago Romero) held until CASE-002488 is decided |
| Held | — | ||
| ACT-015933 | Outreach suppressed pending steward Outreach | TPA-64464 (Jennifer Cunningham) held until CASE-002489 is decided |
| Held | — | ||
| ACT-015934 | Outreach suppressed pending steward Outreach | TPA-52213 (Donna Torres) held until CASE-002490 is decided |
| Held | — | ||
| ACT-015935 | Outreach suppressed pending steward Outreach | CLM-405066 (Donna Torres) held until CASE-002491 is decided |
| Held | — | ||
| ACT-015936 | Outreach suppressed pending steward Outreach | CLM-403594 (Harold Adams) held until CASE-002492 is decided |
| Held | — | ||
| ACT-015937 | Outreach suppressed pending steward Outreach | ENR-122226 (Amber Hudson) held until CASE-002493 is decided |
| Held | — | ||
| ACT-015938 | Outreach suppressed pending steward Outreach | PRV-25010 (Amber Hudson) held until CASE-002494 is decided |
| Held | — | ||
| ACT-015939 | Outreach suppressed pending steward Outreach | TPA-51536 (Jakc Gibson) held until CASE-002495 is decided |
| Held | — | ||
| ACT-015940 | Outreach suppressed pending steward Outreach | CLM-403526 (Jack Gibson) held until CASE-002496 is decided |
| Held | — | ||
| ACT-015941 | Outreach suppressed pending steward Outreach | CLM-416230 (Larry Richardson) held until CASE-002497 is decided |
| Held | — | ||
| ACT-015942 | Outreach suppressed pending steward Outreach | PRV-24158 (Wei Moore) held until CASE-002498 is decided |
| Held | — | ||
| ACT-015943 | Outreach suppressed pending steward Outreach | ENR-118717 (Wei Moore) held until CASE-002499 is decided |
| Held | — | ||
| ACT-015944 | Outreach suppressed pending steward Outreach | CLM-421733 (Mason Murray) held until CASE-002500 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.