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-016195 | Outreach suppressed pending steward Outreach | CLM-425621 (Terry Soto) held until CASE-002751 is decided |
| Held | — | ||
| ACT-016196 | Outreach suppressed pending steward Outreach | ENR-141396 (Sttephen Burke) held until CASE-002752 is decided |
| Held | — | ||
| ACT-016197 | Outreach suppressed pending steward Outreach | CLM-431518 (Stephen Burke) held until CASE-002753 is decided |
| Held | — | ||
| ACT-016198 | Outreach suppressed pending steward Outreach | CLM-417314 (Jason Wheeler) held until CASE-002754 is decided |
| Held | — | ||
| ACT-016199 | Outreach suppressed pending steward Outreach | CLM-419176 (Marilyn Barnes) held until CASE-002755 is decided |
| Held | — | ||
| ACT-016200 | Outreach suppressed pending steward Outreach | CLM-415298 (Alan Cole) held until CASE-002756 is decided |
| Held | — | ||
| ACT-016201 | Outreach suppressed pending steward Outreach | ENR-110677 (Andrew Cole) held until CASE-002757 is decided |
| Held | — | ||
| ACT-016202 | Outreach suppressed pending steward Outreach | PRV-25273 (Brandon Harper) held until CASE-002758 is decided |
| Held | — | ||
| ACT-016203 | Outreach suppressed pending steward Outreach | ENR-123382 (Brandon Harper) held until CASE-002759 is decided |
| Held | — | ||
| ACT-016204 | Outreach suppressed pending steward Outreach | TPA-53292 (Daniel Le) held until CASE-002760 is decided |
| Held | — | ||
| ACT-016205 | Outreach suppressed pending steward Outreach | CLM-407505 (Daniel Le) held until CASE-002761 is decided |
| Held | — | ||
| ACT-016206 | Outreach suppressed pending steward Outreach | TPA-55457 (Wei Dunn) held until CASE-002762 is decided |
| Held | — | ||
| ACT-016207 | Outreach suppressed pending steward Outreach | ENR-116290 (Wei Dunn) held until CASE-002763 is decided |
| Held | — | ||
| ACT-016208 | Outreach suppressed pending steward Outreach | ENR-107868 (Maria Bryant) held until CASE-002764 is decided |
| Held | — | ||
| ACT-016209 | Outreach suppressed pending steward Outreach | CLM-405972 (Maria Bryant) held until CASE-002765 is decided |
| Held | — | ||
| ACT-016210 | Outreach suppressed pending steward Outreach | TPA-60699 (Charles Murray) held until CASE-002766 is decided |
| Held | — | ||
| ACT-016211 | Outreach suppressed pending steward Outreach | ENR-107596 (Lauren Little) held until CASE-002767 is decided |
| Held | — | ||
| ACT-016212 | Outreach suppressed pending steward Outreach | CLM-409906 (Pamela Sandoval) held until CASE-002768 is decided |
| Held | — | ||
| ACT-016213 | Outreach suppressed pending steward Outreach | CLM-409907 (Pamela Snadoval) held until CASE-002769 is decided |
| Held | — | ||
| ACT-016214 | Outreach suppressed pending steward Outreach | TPA-53231 (Benjamin Webb) held until CASE-002770 is decided |
| Held | — | ||
| ACT-016215 | Outreach suppressed pending steward Outreach | CLM-405386 (Isabella Andrews) held until CASE-002771 is decided |
| Held | — | ||
| ACT-016216 | Outreach suppressed pending steward Outreach | ENR-111289 (Amber Fox) held until CASE-002772 is decided |
| Held | — | ||
| ACT-016217 | Outreach suppressed pending steward Outreach | TPA-53766 (Abmer Fox) held until CASE-002773 is decided |
| Held | — | ||
| ACT-016218 | Outreach suppressed pending steward Outreach | ENR-116618 (Terry Alvarado) held until CASE-002774 is decided |
| Held | — | ||
| ACT-016219 | Outreach suppressed pending steward Outreach | TPA-55561 (Terry Alvarado) held until CASE-002775 is decided |
| Held | — | ||
| ACT-016220 | Outreach suppressed pending steward Outreach | TPA-55560 (Terry Alvarado) held until CASE-002776 is decided |
| Held | — | ||
| ACT-016221 | Outreach suppressed pending steward Outreach | TPA-50844 (Rachel Duncan) held until CASE-002777 is decided |
| Held | — | ||
| ACT-016222 | Outreach suppressed pending steward Outreach | ENR-138263 (Aisha Powell) held until CASE-002778 is decided |
| Held | — | ||
| ACT-016223 | Outreach suppressed pending steward Outreach | PRV-28554 (Aisha Powell) held until CASE-002779 is decided |
| Held | — | ||
| ACT-016224 | Outreach suppressed pending steward Outreach | TPA-63892 (Jessse Bennett) held until CASE-002780 is decided |
| Held | — | ||
| ACT-016225 | Outreach suppressed pending steward Outreach | CLM-407884 (Alice Hayes) held until CASE-002781 is decided |
| Held | — | ||
| ACT-016226 | Outreach suppressed pending steward Outreach | ENR-141974 (Yuki Freeman) held until CASE-002782 is decided |
| Held | — | ||
| ACT-016227 | Outreach suppressed pending steward Outreach | TPA-64105 (Yuki Freeman) held until CASE-002783 is decided |
| Held | — | ||
| ACT-016228 | Outreach suppressed pending steward Outreach | CLM-419048 (David Yang) held until CASE-002784 is decided |
| Held | — | ||
| ACT-016229 | Outreach suppressed pending steward Outreach | PRV-24592 (Samntha Harris) held until CASE-002785 is decided |
| Held | — | ||
| ACT-016230 | Outreach suppressed pending steward Outreach | PRV-24593 (Samantha Harris) held until CASE-002786 is decided |
| Held | — | ||
| ACT-016231 | Outreach suppressed pending steward Outreach | ENR-101321 (Terry Wels) held until CASE-002787 is decided |
| Held | — | ||
| ACT-016232 | Outreach suppressed pending steward Outreach | PRV-20323 (Terry Wells) held until CASE-002788 is decided |
| Held | — | ||
| ACT-016233 | Outreach suppressed pending steward Outreach | TPA-63825 (Frank Cox) held until CASE-002789 is decided |
| Held | — | ||
| ACT-016234 | Outreach suppressed pending steward Outreach | CLM-427574 (Deb Nichols) held until CASE-002790 is decided |
| Held | — | ||
| ACT-016235 | Outreach suppressed pending steward Outreach | TPA-62183 (Deborah Nichols) held until CASE-002791 is decided |
| Held | — | ||
| ACT-016236 | Outreach suppressed pending steward Outreach | CLM-410482 (Sean Bishop) held until CASE-002792 is decided |
| Held | — | ||
| ACT-016237 | Outreach suppressed pending steward Outreach | CLM-406134 (Theresa Reid) held until CASE-002793 is decided |
| Held | — | ||
| ACT-016238 | Outreach suppressed pending steward Outreach | CLM-420454 (Sharon Haarper) held until CASE-002794 is decided |
| Held | — | ||
| ACT-016239 | Outreach suppressed pending steward Outreach | TPA-58991 (Sharon Harper) held until CASE-002795 is decided |
| Held | — | ||
| ACT-016240 | Outreach suppressed pending steward Outreach | CLM-425222 (Jacqueline Hayes) held until CASE-002796 is decided |
| Held | — | ||
| ACT-016241 | Outreach suppressed pending steward Outreach | ENR-132971 (Jacqueline Hayes) held until CASE-002797 is decided |
| Held | — | ||
| ACT-016242 | Outreach suppressed pending steward Outreach | ENR-131914 (Isabella Adams) held until CASE-002798 is decided |
| Held | — | ||
| ACT-016243 | Outreach suppressed pending steward Outreach | TPA-51469 (Green Deba) held until CASE-002799 is decided |
| Held | — | ||
| ACT-016244 | Outreach suppressed pending steward Outreach | TPA-51468 (Green Deba) held until CASE-002800 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.