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-016145 | Outreach suppressed pending steward Outreach | CLM-419389 (Shirley Gutierrez) held until CASE-002701 is decided |
| Held | — | ||
| ACT-016146 | Outreach suppressed pending steward Outreach | CLM-431785 (Christina Howard) held until CASE-002702 is decided |
| Held | — | ||
| ACT-016147 | Outreach suppressed pending steward Outreach | ENR-141693 (Christina Howard) held until CASE-002703 is decided |
| Held | — | ||
| ACT-016148 | Outreach suppressed pending steward Outreach | ENR-103909 (Aaron Hernandez) held until CASE-002704 is decided |
| Held | — | ||
| ACT-016149 | Outreach suppressed pending steward Outreach | CLM-403021 (Aaron Hernandez) held until CASE-002705 is decided |
| Held | — | ||
| ACT-016150 | Outreach suppressed pending steward Outreach | CLM-420739 (Sara Carpenter) held until CASE-002706 is decided |
| Held | — | ||
| ACT-016151 | Outreach suppressed pending steward Outreach | ENR-127265 (Sara Carpenter) held until CASE-002707 is decided |
| Held | — | ||
| ACT-016152 | Outreach suppressed pending steward Outreach | CLM-413045 (Brandon Kim) held until CASE-002708 is decided |
| Held | — | ||
| ACT-016153 | Outreach suppressed pending steward Outreach | CLM-413044 (Brandon Kim) held until CASE-002709 is decided |
| Held | — | ||
| ACT-016154 | Outreach suppressed pending steward Outreach | CLM-426428 (Arjun Le) held until CASE-002710 is decided |
| Held | — | ||
| ACT-016155 | Outreach suppressed pending steward Outreach | ENR-134651 (Arjun Le) held until CASE-002711 is decided |
| Held | — | ||
| ACT-016156 | Outreach suppressed pending steward Outreach | TPA-59097 (Christopher Lucas) held until CASE-002712 is decided |
| Held | — | ||
| ACT-016157 | Outreach suppressed pending steward Outreach | CLM-429342 (Diana Bishop) held until CASE-002713 is decided |
| Held | — | ||
| ACT-016158 | Outreach suppressed pending steward Outreach | ENR-138503 (Dyana Bishop) held until CASE-002714 is decided |
| Held | — | ||
| ACT-016159 | Outreach suppressed pending steward Outreach | CLM-406686 (Virginia Hoffman) held until CASE-002715 is decided |
| Held | — | ||
| ACT-016160 | Outreach suppressed pending steward Outreach | TPA-50939 (Kimberly Morris) held until CASE-002716 is decided |
| Held | — | ||
| ACT-016161 | Outreach suppressed pending steward Outreach | TPA-50938 (Kimberly Morris) held until CASE-002717 is decided |
| Held | — | ||
| ACT-016162 | Outreach suppressed pending steward Outreach | ENR-140858 (Ahmed Coleman) held until CASE-002718 is decided |
| Held | — | ||
| ACT-016163 | Outreach suppressed pending steward Outreach | CLM-422677 (Sophia Foster) held until CASE-002719 is decided |
| Held | — | ||
| ACT-016164 | Outreach suppressed pending steward Outreach | CLM-426906 (Aaron Vazquez) held until CASE-002720 is decided |
| Held | — | ||
| ACT-016165 | Outreach suppressed pending steward Outreach | ENR-135292 (Aaron Vazquez) held until CASE-002721 is decided |
| Held | — | ||
| ACT-016166 | Outreach suppressed pending steward Outreach | CLM-426210 (Victoria Burke) held until CASE-002722 is decided |
| Held | — | ||
| ACT-016167 | Outreach suppressed pending steward Outreach | ENR-134341 (Vicky Burke) held until CASE-002723 is decided |
| Held | — | ||
| ACT-016168 | Outreach suppressed pending steward Outreach | TPA-57528 (Brian Gutierrez) held until CASE-002724 is decided |
| Held | — | ||
| ACT-016169 | Outreach suppressed pending steward Outreach | TPA-57529 (Brian Gutierrez) held until CASE-002725 is decided |
| Held | — | ||
| ACT-016170 | Outreach suppressed pending steward Outreach | TPA-59354 (Randy Lawrence) held until CASE-002726 is decided |
| Held | — | ||
| ACT-016171 | Outreach suppressed pending steward Outreach | CLM-421005 (Adam McDonald) held until CASE-002727 is decided |
| Held | — | ||
| ACT-016172 | Outreach suppressed pending steward Outreach | CLM-414436 (Wei Washington) held until CASE-002728 is decided |
| Held | — | ||
| ACT-016173 | Outreach suppressed pending steward Outreach | CLM-430587 (Ahmed Ford) held until CASE-002729 is decided |
| Held | — | ||
| ACT-016174 | Outreach suppressed pending steward Outreach | TPA-58646 (Valentina Santiago) held until CASE-002730 is decided |
| Held | — | ||
| ACT-016175 | Outreach suppressed pending steward Outreach | ENR-113447 (Lauren Butler) held until CASE-002731 is decided |
| Held | — | ||
| ACT-016176 | Outreach suppressed pending steward Outreach | TPA-57785 (Josh Snyder) held until CASE-002732 is decided |
| Held | — | ||
| ACT-016177 | Outreach suppressed pending steward Outreach | TPA-57784 (Joshua Snyder) held until CASE-002733 is decided |
| Held | — | ||
| ACT-016178 | Outreach suppressed pending steward Outreach | ENR-123229 (Joshua Snyder) held until CASE-002734 is decided |
| Held | — | ||
| ACT-016179 | Outreach suppressed pending steward Outreach | TPA-59092 (Kelly Johnston) held until CASE-002735 is decided |
| Held | — | ||
| ACT-016180 | Outreach suppressed pending steward Outreach | CLM-406740 (Samantha Russell) held until CASE-002736 is decided |
| Held | — | ||
| ACT-016181 | Outreach suppressed pending steward Outreach | TPA-52958 (Samantha Russell) held until CASE-002737 is decided |
| Held | — | ||
| ACT-016182 | Outreach suppressed pending steward Outreach | PRV-23294 (Tyler Rojas) held until CASE-002738 is decided |
| Held | — | ||
| ACT-016183 | Outreach suppressed pending steward Outreach | CLM-424064 (Jessica Dean) held until CASE-002739 is decided |
| Held | — | ||
| ACT-016184 | Outreach suppressed pending steward Outreach | CLM-400895 (Ethan Hudson) held until CASE-002740 is decided |
| Held | — | ||
| ACT-016185 | Outreach suppressed pending steward Outreach | PRV-20279 (Ethan Hudson) held until CASE-002741 is decided |
| Held | — | ||
| ACT-016186 | Outreach suppressed pending steward Outreach | ENR-137322 (Willie Rojas) held until CASE-002742 is decided |
| Held | — | ||
| ACT-016187 | Outreach suppressed pending steward Outreach | ENR-126905 (Patricia Vazquez) held until CASE-002743 is decided |
| Held | — | ||
| ACT-016188 | Outreach suppressed pending steward Outreach | ENR-137334 (Kylle Peters) held until CASE-002744 is decided |
| Held | — | ||
| ACT-016189 | Outreach suppressed pending steward Outreach | ENR-123610 (Benjamin Chen) held until CASE-002745 is decided |
| Held | — | ||
| ACT-016190 | Outreach suppressed pending steward Outreach | CLM-407949 (Sara Sanders) held until CASE-002746 is decided |
| Held | — | ||
| ACT-016191 | Outreach suppressed pending steward Outreach | CLM-428099 (Dot Baker) held until CASE-002747 is decided |
| Held | — | ||
| ACT-016192 | Outreach suppressed pending steward Outreach | CLM-421333 (Marcus Riley) held until CASE-002748 is decided |
| Held | — | ||
| ACT-016193 | Outreach suppressed pending steward Outreach | TPA-54389 (Fatima Simmons) held until CASE-002749 is decided |
| Held | — | ||
| ACT-016194 | Outreach suppressed pending steward Outreach | ENR-133528 (Terry Soto) held until CASE-002750 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.