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-016045 | Outreach suppressed pending steward Outreach | ENR-142214 (Diane Gordon) held until CASE-002601 is decided |
| Held | — | ||
| ACT-016046 | Outreach suppressed pending steward Outreach | CLM-423387 (Janice Lucas) held until CASE-002602 is decided |
| Held | — | ||
| ACT-016047 | Outreach suppressed pending steward Outreach | TPA-51081 (Larry Powell) held until CASE-002603 is decided |
| Held | — | ||
| ACT-016048 | Outreach suppressed pending steward Outreach | ENR-103259 (Larry Powell) held until CASE-002604 is decided |
| Held | — | ||
| ACT-016049 | Outreach suppressed pending steward Outreach | ENR-110682 (Diego Mason) held until CASE-002605 is decided |
| Held | — | ||
| ACT-016050 | Outreach suppressed pending steward Outreach | PRV-22385 (Diego Mason) held until CASE-002606 is decided |
| Held | — | ||
| ACT-016051 | Outreach suppressed pending steward Outreach | TPA-52947 (Douglas Schultz) held until CASE-002607 is decided |
| Held | — | ||
| ACT-016052 | Outreach suppressed pending steward Outreach | CLM-401763 (Nicholas Wilson) held until CASE-002608 is decided |
| Held | — | ||
| ACT-016053 | Outreach suppressed pending steward Outreach | ENR-102313 (Nicholas Wilson) held until CASE-002609 is decided |
| Held | — | ||
| ACT-016054 | Outreach suppressed pending steward Outreach | CLM-429568 (Christopher Wilson) held until CASE-002610 is decided |
| Held | — | ||
| ACT-016055 | Outreach suppressed pending steward Outreach | TPA-60500 (Lauren Johnston) held until CASE-002611 is decided |
| Held | — | ||
| ACT-016056 | Outreach suppressed pending steward Outreach | TPA-59143 (Emily Jones) held until CASE-002612 is decided |
| Held | — | ||
| ACT-016057 | Outreach suppressed pending steward Outreach | TPA-60926 (Keith Silva) held until CASE-002613 is decided |
| Held | — | ||
| ACT-016058 | Outreach suppressed pending steward Outreach | CLM-417290 (Jacob Russell) held until CASE-002614 is decided |
| Held | — | ||
| ACT-016059 | Outreach suppressed pending steward Outreach | CLM-425903 (Megan Aguilar) held until CASE-002615 is decided |
| Held | — | ||
| ACT-016060 | Outreach suppressed pending steward Outreach | TPA-59807 (Lauren Chen) held until CASE-002616 is decided |
| Held | — | ||
| ACT-016061 | Outreach suppressed pending steward Outreach | TPA-63445 (Juan Munoz) held until CASE-002617 is decided |
| Held | — | ||
| ACT-016062 | Outreach suppressed pending steward Outreach | CLM-430452 (Juan Munoz) held until CASE-002618 is decided |
| Held | — | ||
| ACT-016063 | Outreach suppressed pending steward Outreach | ENR-136822 (Michael Munoz) held until CASE-002619 is decided |
| Held | — | ||
| ACT-016064 | Outreach suppressed pending steward Outreach | CLM-416860 (Amber Jackson) held until CASE-002620 is decided |
| Held | — | ||
| ACT-016065 | Outreach suppressed pending steward Outreach | ENR-120295 (Carolyn Schultz) held until CASE-002621 is decided |
| Held | — | ||
| ACT-016066 | Outreach suppressed pending steward Outreach | CLM-415411 (Carolyn Schultz) held until CASE-002622 is decided |
| Held | — | ||
| ACT-016067 | Outreach suppressed pending steward Outreach | PRV-27695 (Emily Lucas) held until CASE-002623 is decided |
| Held | — | ||
| ACT-016068 | Outreach suppressed pending steward Outreach | TPA-63815 (Dorothy Lopez) held until CASE-002624 is decided |
| Held | — | ||
| ACT-016069 | Outreach suppressed pending steward Outreach | ENR-141057 (Dorothy Lopez) held until CASE-002625 is decided |
| Held | — | ||
| ACT-016070 | Outreach suppressed pending steward Outreach | TPA-57243 (Keith Henderson) held until CASE-002626 is decided |
| Held | — | ||
| ACT-016071 | Outreach suppressed pending steward Outreach | TPA-51195 (Joseph Alexander) held until CASE-002627 is decided |
| Held | — | ||
| ACT-016072 | Outreach suppressed pending steward Outreach | TPA-57307 (Beverly Woods) held until CASE-002628 is decided |
| Held | — | ||
| ACT-016073 | Outreach suppressed pending steward Outreach | PRV-28837 (Judy Munoz) held until CASE-002629 is decided |
| Held | — | ||
| ACT-016074 | Outreach suppressed pending steward Outreach | CLM-430171 (Judy Munoz) held until CASE-002630 is decided |
| Held | — | ||
| ACT-016075 | Outreach suppressed pending steward Outreach | TPA-62372 (Lisa Hoffman) held until CASE-002631 is decided |
| Held | — | ||
| ACT-016076 | Outreach suppressed pending steward Outreach | CLM-426445 (Scott Garcia) held until CASE-002632 is decided |
| Held | — | ||
| ACT-016077 | Outreach suppressed pending steward Outreach | TPA-52263 (Brian Fernandez) held until CASE-002633 is decided |
| Held | — | ||
| ACT-016078 | Outreach suppressed pending steward Outreach | CLM-409090 (Jose Espinoza) held until CASE-002634 is decided |
| Held | — | ||
| ACT-016079 | Outreach suppressed pending steward Outreach | CLM-416351 (Yuki Bryant) held until CASE-002635 is decided |
| Held | — | ||
| ACT-016080 | Outreach suppressed pending steward Outreach | TPA-57175 (Yuki Bryant) held until CASE-002636 is decided |
| Held | — | ||
| ACT-016081 | Outreach suppressed pending steward Outreach | PRV-20507 (Bryan Mitchell) held until CASE-002637 is decided |
| Held | — | ||
| ACT-016082 | Outreach suppressed pending steward Outreach | PRV-20506 (Bryan Mitchell) held until CASE-002638 is decided |
| Held | — | ||
| ACT-016083 | Outreach suppressed pending steward Outreach | ENR-111118 (Arjun Vega) held until CASE-002639 is decided |
| Held | — | ||
| ACT-016084 | Outreach suppressed pending steward Outreach | PRV-25183 (Daniel Mendez) held until CASE-002640 is decided |
| Held | — | ||
| ACT-016085 | Outreach suppressed pending steward Outreach | CLM-411947 (Elijah Wood) held until CASE-002641 is decided |
| Held | — | ||
| ACT-016086 | Outreach suppressed pending steward Outreach | TPA-50903 (Philip White) held until CASE-002642 is decided |
| Held | — | ||
| ACT-016087 | Outreach suppressed pending steward Outreach | TPA-57293 (Evelyn Baker) held until CASE-002643 is decided |
| Held | — | ||
| ACT-016088 | Outreach suppressed pending steward Outreach | TPA-56410 (Paul Cooper) held until CASE-002644 is decided |
| Held | — | ||
| ACT-016089 | Outreach suppressed pending steward Outreach | TPA-62793 (Priya Rios) held until CASE-002645 is decided |
| Held | — | ||
| ACT-016090 | Outreach suppressed pending steward Outreach | PRV-27898 (Kathryn Thompson) held until CASE-002646 is decided |
| Held | — | ||
| ACT-016091 | Outreach suppressed pending steward Outreach | PRV-20733 (Julia Ortega) held until CASE-002647 is decided |
| Held | — | ||
| ACT-016092 | Outreach suppressed pending steward Outreach | CLM-402512 (Julia Ortega) held until CASE-002648 is decided |
| Held | — | ||
| ACT-016093 | Outreach suppressed pending steward Outreach | PRV-20734 (Julia Ortega) held until CASE-002649 is decided |
| Held | — | ||
| ACT-016094 | Outreach suppressed pending steward Outreach | TPA-58182 (Mei Cunningham) held until CASE-002650 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.