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-016095 | Outreach suppressed pending steward Outreach | CLM-428013 (Emily Sullivan) held until CASE-002651 is decided |
| Held | — | ||
| ACT-016096 | Outreach suppressed pending steward Outreach | TPA-62370 (Emily Sullivan) held until CASE-002652 is decided |
| Held | — | ||
| ACT-016097 | Outreach suppressed pending steward Outreach | CLM-402315 (Laura Alvarado) held until CASE-002653 is decided |
| Held | — | ||
| ACT-016098 | Outreach suppressed pending steward Outreach | CLM-408706 (Theresa Porter) held until CASE-002654 is decided |
| Held | — | ||
| ACT-016099 | Outreach suppressed pending steward Outreach | ENR-111472 (Theresa Porter) held until CASE-002655 is decided |
| Held | — | ||
| ACT-016100 | Outreach suppressed pending steward Outreach | TPA-51257 (Elijah Porter) held until CASE-002656 is decided |
| Held | — | ||
| ACT-016101 | Outreach suppressed pending steward Outreach | PRV-28255 (Logan Larson) held until CASE-002657 is decided |
| Held | — | ||
| ACT-016102 | Outreach suppressed pending steward Outreach | TPA-63623 (Linda Duncan) held until CASE-002658 is decided |
| Held | — | ||
| ACT-016103 | Outreach suppressed pending steward Outreach | PRV-29019 (Linda Duncan) held until CASE-002659 is decided |
| Held | — | ||
| ACT-016104 | Outreach suppressed pending steward Outreach | TPA-59532 (Laura Ellis) held until CASE-002660 is decided |
| Held | — | ||
| ACT-016105 | Outreach suppressed pending steward Outreach | TPA-58790 (Wayne Davis) held until CASE-002661 is decided |
| Held | — | ||
| ACT-016106 | Outreach suppressed pending steward Outreach | TPA-53729 (Margaret Obrien) held until CASE-002662 is decided |
| Held | — | ||
| ACT-016107 | Outreach suppressed pending steward Outreach | ENR-111183 (Margaret Obrien) held until CASE-002663 is decided |
| Held | — | ||
| ACT-016108 | Outreach suppressed pending steward Outreach | TPA-58151 (Jordan Gilbert) held until CASE-002664 is decided |
| Held | — | ||
| ACT-016109 | Outreach suppressed pending steward Outreach | TPA-58152 (Jordan Gilbert) held until CASE-002665 is decided |
| Held | — | ||
| ACT-016110 | Outreach suppressed pending steward Outreach | ENR-103317 (Joyce Martin) held until CASE-002666 is decided |
| Held | — | ||
| ACT-016111 | Outreach suppressed pending steward Outreach | TPA-50544 (Karen Martinez) held until CASE-002667 is decided |
| Held | — | ||
| ACT-016112 | Outreach suppressed pending steward Outreach | TPA-50545 (Karen Martinez) held until CASE-002668 is decided |
| Held | — | ||
| ACT-016113 | Outreach suppressed pending steward Outreach | PRV-27256 (Andrew Vargas) held until CASE-002669 is decided |
| Held | — | ||
| ACT-016114 | Outreach suppressed pending steward Outreach | ENR-132234 (Andrew Vargas) held until CASE-002670 is decided |
| Held | — | ||
| ACT-016115 | Outreach suppressed pending steward Outreach | PRV-28698 (Charles Hunter) held until CASE-002671 is decided |
| Held | — | ||
| ACT-016116 | Outreach suppressed pending steward Outreach | ENR-138968 (Charles Hunter) held until CASE-002672 is decided |
| Held | — | ||
| ACT-016117 | Outreach suppressed pending steward Outreach | CLM-428985 (Harold Hall) held until CASE-002673 is decided |
| Held | — | ||
| ACT-016118 | Outreach suppressed pending steward Outreach | CLM-426338 (Roy Campbell) held until CASE-002674 is decided |
| Held | — | ||
| ACT-016119 | Outreach suppressed pending steward Outreach | ENR-100300 (Gerald Knight) held until CASE-002675 is decided |
| Held | — | ||
| ACT-016120 | Outreach suppressed pending steward Outreach | CLM-400204 (Gerald Knight) held until CASE-002676 is decided |
| Held | — | ||
| ACT-016121 | Outreach suppressed pending steward Outreach | TPA-55256 (Christine Scott) held until CASE-002677 is decided |
| Held | — | ||
| ACT-016122 | Outreach suppressed pending steward Outreach | ENR-104146 (Collins Scoott) held until CASE-002678 is decided |
| Held | — | ||
| ACT-016123 | Outreach suppressed pending steward Outreach | TPA-53207 (Ann Washington) held until CASE-002679 is decided |
| Held | — | ||
| ACT-016124 | Outreach suppressed pending steward Outreach | CLM-421906 (Stephanie Campbell) held until CASE-002680 is decided |
| Held | — | ||
| ACT-016125 | Outreach suppressed pending steward Outreach | CLM-413842 (Jonathan Nguyen) held until CASE-002681 is decided |
| Held | — | ||
| ACT-016126 | Outreach suppressed pending steward Outreach | ENR-118100 (Jonathan Nguyen) held until CASE-002682 is decided |
| Held | — | ||
| ACT-016127 | Outreach suppressed pending steward Outreach | TPA-57112 (Larry Richardson) held until CASE-002683 is decided |
| Held | — | ||
| ACT-016128 | Outreach suppressed pending steward Outreach | PRV-28290 (Edward Jenkins) held until CASE-002684 is decided |
| Held | — | ||
| ACT-016129 | Outreach suppressed pending steward Outreach | CLM-415237 (Martha Ferguson) held until CASE-002685 is decided |
| Held | — | ||
| ACT-016130 | Outreach suppressed pending steward Outreach | CLM-411274 (Diego George) held until CASE-002686 is decided |
| Held | — | ||
| ACT-016131 | Outreach suppressed pending steward Outreach | TPA-56873 (Mason Wong) held until CASE-002687 is decided |
| Held | — | ||
| ACT-016132 | Outreach suppressed pending steward Outreach | ENR-128673 (Julie Carroll) held until CASE-002688 is decided |
| Held | — | ||
| ACT-016133 | Outreach suppressed pending steward Outreach | TPA-59615 (Julie Carroll) held until CASE-002689 is decided |
| Held | — | ||
| ACT-016134 | Outreach suppressed pending steward Outreach | CLM-423205 (Keith Griffin) held until CASE-002690 is decided |
| Held | — | ||
| ACT-016135 | Outreach suppressed pending steward Outreach | TPA-62620 (Nathan Bryannt) held until CASE-002691 is decided |
| Held | — | ||
| ACT-016136 | Outreach suppressed pending steward Outreach | TPA-51899 (Pamela Harvey) held until CASE-002692 is decided |
| Held | — | ||
| ACT-016137 | Outreach suppressed pending steward Outreach | CLM-404357 (Pamela Harvey) held until CASE-002693 is decided |
| Held | — | ||
| ACT-016138 | Outreach suppressed pending steward Outreach | TPA-63842 (Carl Sims) held until CASE-002694 is decided |
| Held | — | ||
| ACT-016139 | Outreach suppressed pending steward Outreach | ENR-116385 (Nathan Hanson) held until CASE-002695 is decided |
| Held | — | ||
| ACT-016140 | Outreach suppressed pending steward Outreach | TPA-55483 (Nathan Hanson) held until CASE-002696 is decided |
| Held | — | ||
| ACT-016141 | Outreach suppressed pending steward Outreach | PRV-25145 (Roger Edwards) held until CASE-002697 is decided |
| Held | — | ||
| ACT-016142 | Outreach suppressed pending steward Outreach | CLM-419821 (Kyle Garrett) held until CASE-002698 is decided |
| Held | — | ||
| ACT-016143 | Outreach suppressed pending steward Outreach | ENR-133284 (Kayla Turner) held until CASE-002699 is decided |
| Held | — | ||
| ACT-016144 | Outreach suppressed pending steward Outreach | PRV-27497 (Kayla Turner) held until CASE-002700 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.