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-015995 | Outreach suppressed pending steward Outreach | CLM-430727 (Janice West) held until CASE-002551 is decided |
| Held | — | ||
| ACT-015996 | Outreach suppressed pending steward Outreach | CLM-407323 (Jean Black) held until CASE-002552 is decided |
| Held | — | ||
| ACT-015997 | Outreach suppressed pending steward Outreach | CLM-424686 (Teresa Johnson) held until CASE-002553 is decided |
| Held | — | ||
| ACT-015998 | Outreach suppressed pending steward Outreach | TPA-51136 (Amy Murray) held until CASE-002554 is decided |
| Held | — | ||
| ACT-015999 | Outreach suppressed pending steward Outreach | CLM-424275 (Charlees Murray) held until CASE-002555 is decided |
| Held | — | ||
| ACT-016000 | Outreach suppressed pending steward Outreach | TPA-60264 (Harold Ramirez) held until CASE-002556 is decided |
| Held | — | ||
| ACT-016001 | Outreach suppressed pending steward Outreach | TPA-58046 (Isabella Harper) held until CASE-002557 is decided |
| Held | — | ||
| ACT-016002 | Outreach suppressed pending steward Outreach | CLM-426403 (Dorothy Alexander) held until CASE-002558 is decided |
| Held | — | ||
| ACT-016003 | Outreach suppressed pending steward Outreach | CLM-419677 (Abigail Armstrong) held until CASE-002559 is decided |
| Held | — | ||
| ACT-016004 | Outreach suppressed pending steward Outreach | TPA-52657 (Zachary Romero) held until CASE-002560 is decided |
| Held | — | ||
| ACT-016005 | Outreach suppressed pending steward Outreach | TPA-57734 (Judy Vega) held until CASE-002561 is decided |
| Held | — | ||
| ACT-016006 | Outreach suppressed pending steward Outreach | ENR-118360 (Arthur Vega) held until CASE-002562 is decided |
| Held | — | ||
| ACT-016007 | Outreach suppressed pending steward Outreach | CLM-414023 (Arthur Vega) held until CASE-002563 is decided |
| Held | — | ||
| ACT-016008 | Outreach suppressed pending steward Outreach | ENR-105658 (Joshua Vega) held until CASE-002564 is decided |
| Held | — | ||
| ACT-016009 | Outreach suppressed pending steward Outreach | TPA-58119 (Michelle Kennedy) held until CASE-002565 is decided |
| Held | — | ||
| ACT-016010 | Outreach suppressed pending steward Outreach | CLM-431381 (Carolyn Payne) held until CASE-002566 is decided |
| Held | — | ||
| ACT-016011 | Outreach suppressed pending steward Outreach | TPA-54027 (Daniel Pena) held until CASE-002567 is decided |
| Held | — | ||
| ACT-016012 | Outreach suppressed pending steward Outreach | CLM-414671 (Frank Walker) held until CASE-002568 is decided |
| Held | — | ||
| ACT-016013 | Outreach suppressed pending steward Outreach | CLM-427245 (Stephen Carter) held until CASE-002569 is decided |
| Held | — | ||
| ACT-016014 | Outreach suppressed pending steward Outreach | TPA-59901 (Ssan Sandoval) held until CASE-002570 is decided |
| Held | — | ||
| ACT-016015 | Outreach suppressed pending steward Outreach | PRV-25904 (Christopher Bishop) held until CASE-002571 is decided |
| Held | — | ||
| ACT-016016 | Outreach suppressed pending steward Outreach | CLM-419883 (Chris Bishop) held until CASE-002572 is decided |
| Held | — | ||
| ACT-016017 | Outreach suppressed pending steward Outreach | CLM-419760 (Mei Moreno) held until CASE-002573 is decided |
| Held | — | ||
| ACT-016018 | Outreach suppressed pending steward Outreach | CLM-404562 (Kathryn Burns) held until CASE-002574 is decided |
| Held | — | ||
| ACT-016019 | Outreach suppressed pending steward Outreach | TPA-64110 (Evelyn Simmons) held until CASE-002575 is decided |
| Held | — | ||
| ACT-016020 | Outreach suppressed pending steward Outreach | ENR-141983 (Evelyn Siimmons) held until CASE-002576 is decided |
| Held | — | ||
| ACT-016021 | Outreach suppressed pending steward Outreach | ENR-120674 (Astin Kennedy) held until CASE-002577 is decided |
| Held | — | ||
| ACT-016022 | Outreach suppressed pending steward Outreach | CLM-403972 (Tyler Wagner) held until CASE-002578 is decided |
| Held | — | ||
| ACT-016023 | Outreach suppressed pending steward Outreach | TPA-62740 (Hannah Santiago) held until CASE-002579 is decided |
| Held | — | ||
| ACT-016024 | Outreach suppressed pending steward Outreach | CLM-428854 (Hannah Santiago) held until CASE-002580 is decided |
| Held | — | ||
| ACT-016025 | Outreach suppressed pending steward Outreach | CLM-432365 (Maria Russell) held until CASE-002581 is decided |
| Held | — | ||
| ACT-016026 | Outreach suppressed pending steward Outreach | CLM-432366 (Maria Russll) held until CASE-002582 is decided |
| Held | — | ||
| ACT-016027 | Outreach suppressed pending steward Outreach | CLM-416055 (Brenda Harper) held until CASE-002583 is decided |
| Held | — | ||
| ACT-016028 | Outreach suppressed pending steward Outreach | TPA-63067 (Luis Nichols) held until CASE-002584 is decided |
| Held | — | ||
| ACT-016029 | Outreach suppressed pending steward Outreach | TPA-63068 (Luis Nichols) held until CASE-002585 is decided |
| Held | — | ||
| ACT-016030 | Outreach suppressed pending steward Outreach | PRV-20380 (Donald Brown) held until CASE-002586 is decided |
| Held | — | ||
| ACT-016031 | Outreach suppressed pending steward Outreach | TPA-62527 (David Hernandez) held until CASE-002587 is decided |
| Held | — | ||
| ACT-016032 | Outreach suppressed pending steward Outreach | TPA-55657 (Jezse Lopez) held until CASE-002588 is decided |
| Held | — | ||
| ACT-016033 | Outreach suppressed pending steward Outreach | ENR-116897 (Jesse Lopez) held until CASE-002589 is decided |
| Held | — | ||
| ACT-016034 | Outreach suppressed pending steward Outreach | CLM-409853 (Denise Stephens) held until CASE-002590 is decided |
| Held | — | ||
| ACT-016035 | Outreach suppressed pending steward Outreach | TPA-52828 (Abigail Vazquez) held until CASE-002591 is decided |
| Held | — | ||
| ACT-016036 | Outreach suppressed pending steward Outreach | PRV-22964 (Bryan Lynch) held until CASE-002592 is decided |
| Held | — | ||
| ACT-016037 | Outreach suppressed pending steward Outreach | ENR-113452 (Bryan Lynch) held until CASE-002593 is decided |
| Held | — | ||
| ACT-016038 | Outreach suppressed pending steward Outreach | CLM-418537 (Samantha Anderson) held until CASE-002594 is decided |
| Held | — | ||
| ACT-016039 | Outreach suppressed pending steward Outreach | TPA-54976 (Cheryl Andrews) held until CASE-002595 is decided |
| Held | — | ||
| ACT-016040 | Outreach suppressed pending steward Outreach | ENR-136119 (Michael Robertson) held until CASE-002596 is decided |
| Held | — | ||
| ACT-016041 | Outreach suppressed pending steward Outreach | PRV-28072 (Michael Robertson) held until CASE-002597 is decided |
| Held | — | ||
| ACT-016042 | Outreach suppressed pending steward Outreach | TPA-60995 (Debrah Luna) held until CASE-002598 is decided |
| Held | — | ||
| ACT-016043 | Outreach suppressed pending steward Outreach | CLM-408971 (Meyer Diego) held until CASE-002599 is decided |
| Held | — | ||
| ACT-016044 | Outreach suppressed pending steward Outreach | ENR-111861 (Diego Meyer) held until CASE-002600 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.