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-015945 | Outreach suppressed pending steward Outreach | TPA-59547 (Mason Murray) held until CASE-002501 is decided |
| Held | — | ||
| ACT-015946 | Outreach suppressed pending steward Outreach | CLM-402645 (Roy Payne) held until CASE-002502 is decided |
| Held | — | ||
| ACT-015947 | Outreach suppressed pending steward Outreach | CLM-416058 (Grcae Burns) held until CASE-002503 is decided |
| Held | — | ||
| ACT-015948 | Outreach suppressed pending steward Outreach | ENR-121130 (Grace Burns) held until CASE-002504 is decided |
| Held | — | ||
| ACT-015949 | Outreach suppressed pending steward Outreach | CLM-428668 (Vincent Jordan) held until CASE-002505 is decided |
| Held | — | ||
| ACT-015950 | Outreach suppressed pending steward Outreach | TPA-62677 (Vincent Jordan) held until CASE-002506 is decided |
| Held | — | ||
| ACT-015951 | Outreach suppressed pending steward Outreach | ENR-128084 (Tiimothy Hicks) held until CASE-002507 is decided |
| Held | — | ||
| ACT-015952 | Outreach suppressed pending steward Outreach | TPA-59427 (Timothy Hicks) held until CASE-002508 is decided |
| Held | — | ||
| ACT-015953 | Outreach suppressed pending steward Outreach | CLM-423252 (Peter Patterson) held until CASE-002509 is decided |
| Held | — | ||
| ACT-015954 | Outreach suppressed pending steward Outreach | ENR-130406 (Peter Patterson) held until CASE-002510 is decided |
| Held | — | ||
| ACT-015955 | Outreach suppressed pending steward Outreach | ENR-126806 (Ronald Espinoza) held until CASE-002511 is decided |
| Held | — | ||
| ACT-015956 | Outreach suppressed pending steward Outreach | CLM-420384 (Ronald Espinoza) held until CASE-002512 is decided |
| Held | — | ||
| ACT-015957 | Outreach suppressed pending steward Outreach | TPA-51299 (Ethan Kennedy) held until CASE-002513 is decided |
| Held | — | ||
| ACT-015958 | Outreach suppressed pending steward Outreach | ENR-103940 (Ethan Kennedy) held until CASE-002514 is decided |
| Held | — | ||
| ACT-015959 | Outreach suppressed pending steward Outreach | ENR-124614 (Martha Bennett) held until CASE-002515 is decided |
| Held | — | ||
| ACT-015960 | Outreach suppressed pending steward Outreach | TPA-58270 (Martha Bennett) held until CASE-002516 is decided |
| Held | — | ||
| ACT-015961 | Outreach suppressed pending steward Outreach | TPA-58271 (Martha Bennett) held until CASE-002517 is decided |
| Held | — | ||
| ACT-015962 | Outreach suppressed pending steward Outreach | ENR-133222 (Wayne Bennett) held until CASE-002518 is decided |
| Held | — | ||
| ACT-015963 | Outreach suppressed pending steward Outreach | ENR-103278 (Jason Garza) held until CASE-002519 is decided |
| Held | — | ||
| ACT-015964 | Outreach suppressed pending steward Outreach | PRV-20743 (Jason Garza) held until CASE-002520 is decided |
| Held | — | ||
| ACT-015965 | Outreach suppressed pending steward Outreach | TPA-51091 (Jazon Garza) held until CASE-002521 is decided |
| Held | — | ||
| ACT-015966 | Outreach suppressed pending steward Outreach | PRV-20745 (Kelly Carter) held until CASE-002522 is decided |
| Held | — | ||
| ACT-015967 | Outreach suppressed pending steward Outreach | PRV-21952 (William Vasquez) held until CASE-002523 is decided |
| Held | — | ||
| ACT-015968 | Outreach suppressed pending steward Outreach | CLM-402509 (Olivia Vasquez) held until CASE-002524 is decided |
| Held | — | ||
| ACT-015969 | Outreach suppressed pending steward Outreach | TPA-53348 (Sofia Castro) held until CASE-002525 is decided |
| Held | — | ||
| ACT-015970 | Outreach suppressed pending steward Outreach | CLM-410392 (Jeffrey Matthews) held until CASE-002526 is decided |
| Held | — | ||
| ACT-015971 | Outreach suppressed pending steward Outreach | ENR-113656 (Jeffrey Matthews) held until CASE-002527 is decided |
| Held | — | ||
| ACT-015972 | Outreach suppressed pending steward Outreach | CLM-423127 (Arthur Anderson) held until CASE-002528 is decided |
| Held | — | ||
| ACT-015973 | Outreach suppressed pending steward Outreach | TPA-54795 (Lawrence Ortega) held until CASE-002529 is decided |
| Held | — | ||
| ACT-015974 | Outreach suppressed pending steward Outreach | CLM-427945 (Nicholas Garcia) held until CASE-002530 is decided |
| Held | — | ||
| ACT-015975 | Outreach suppressed pending steward Outreach | ENR-134138 (Marcus Singh) held until CASE-002531 is decided |
| Held | — | ||
| ACT-015976 | Outreach suppressed pending steward Outreach | CLM-426071 (Markus Singh) held until CASE-002532 is decided |
| Held | — | ||
| ACT-015977 | Outreach suppressed pending steward Outreach | CLM-412724 (Cheryl Carr) held until CASE-002533 is decided |
| Held | — | ||
| ACT-015978 | Outreach suppressed pending steward Outreach | ENR-116715 (Cheryl Carr) held until CASE-002534 is decided |
| Held | — | ||
| ACT-015979 | Outreach suppressed pending steward Outreach | CLM-414662 (Sue Carr) held until CASE-002535 is decided |
| Held | — | ||
| ACT-015980 | Outreach suppressed pending steward Outreach | ENR-105110 (Albert Patel) held until CASE-002536 is decided |
| Held | — | ||
| ACT-015981 | Outreach suppressed pending steward Outreach | TPA-51702 (Albert Patel) held until CASE-002537 is decided |
| Held | — | ||
| ACT-015982 | Outreach suppressed pending steward Outreach | TPA-51778 (Beverly Fuller) held until CASE-002538 is decided |
| Held | — | ||
| ACT-015983 | Outreach suppressed pending steward Outreach | TPA-51777 (Beverly Fuller) held until CASE-002539 is decided |
| Held | — | ||
| ACT-015984 | Outreach suppressed pending steward Outreach | CLM-405010 (Richard Morgan) held until CASE-002540 is decided |
| Held | — | ||
| ACT-015985 | Outreach suppressed pending steward Outreach | TPA-53995 (Kelly Bailye) held until CASE-002541 is decided |
| Held | — | ||
| ACT-015986 | Outreach suppressed pending steward Outreach | CLM-402151 (Henry Montgomery) held until CASE-002542 is decided |
| Held | — | ||
| ACT-015987 | Outreach suppressed pending steward Outreach | ENR-102741 (Henry Montgomery) held until CASE-002543 is decided |
| Held | — | ||
| ACT-015988 | Outreach suppressed pending steward Outreach | TPA-55407 (Alice Gomez) held until CASE-002544 is decided |
| Held | — | ||
| ACT-015989 | Outreach suppressed pending steward Outreach | TPA-55406 (Alice Gomez) held until CASE-002545 is decided |
| Held | — | ||
| ACT-015990 | Outreach suppressed pending steward Outreach | CLM-400099 (Joseph Simpson) held until CASE-002546 is decided |
| Held | — | ||
| ACT-015991 | Outreach suppressed pending steward Outreach | CLM-421276 (Janet Brown) held until CASE-002547 is decided |
| Held | — | ||
| ACT-015992 | Outreach suppressed pending steward Outreach | PRV-24875 (Priya Brown) held until CASE-002548 is decided |
| Held | — | ||
| ACT-015993 | Outreach suppressed pending steward Outreach | ENR-103171 (Karen Simspon) held until CASE-002549 is decided |
| Held | — | ||
| ACT-015994 | Outreach suppressed pending steward Outreach | ENR-138936 (Brandon West) held until CASE-002550 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.