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-016245 | Outreach suppressed pending steward Outreach | TPA-61522 (Douglas Woods) held until CASE-002801 is decided |
| Held | — | ||
| ACT-016246 | Outreach suppressed pending steward Outreach | CLM-409030 (Patricia Andrews) held until CASE-002802 is decided |
| Held | — | ||
| ACT-016247 | Outreach suppressed pending steward Outreach | TPA-61984 (Santiago Sandoval) held until CASE-002803 is decided |
| Held | — | ||
| ACT-016248 | Outreach suppressed pending steward Outreach | CLM-429834 (Brian Ramos) held until CASE-002804 is decided |
| Held | — | ||
| ACT-016249 | Outreach suppressed pending steward Outreach | TPA-55774 (Christina Carter) held until CASE-002805 is decided |
| Held | — | ||
| ACT-016250 | Outreach suppressed pending steward Outreach | TPA-54723 (Rachel Guzman) held until CASE-002806 is decided |
| Held | — | ||
| ACT-016251 | Outreach suppressed pending steward Outreach | CLM-410774 (Rachel Guzman) held until CASE-002807 is decided |
| Held | — | ||
| ACT-016252 | Outreach suppressed pending steward Outreach | CLM-416560 (Nathan Gonzalez) held until CASE-002808 is decided |
| Held | — | ||
| ACT-016253 | Outreach suppressed pending steward Outreach | ENR-121758 (Nathan Gonzalez) held until CASE-002809 is decided |
| Held | — | ||
| ACT-016254 | Outreach suppressed pending steward Outreach | CLM-430658 (Chriistian Gonzales) held until CASE-002810 is decided |
| Held | — | ||
| ACT-016255 | Outreach suppressed pending steward Outreach | TPA-56331 (Billy Parkeer) held until CASE-002811 is decided |
| Held | — | ||
| ACT-016256 | Outreach suppressed pending steward Outreach | TPA-55922 (Isabella Nelson) held until CASE-002812 is decided |
| Held | — | ||
| ACT-016257 | Outreach suppressed pending steward Outreach | CLM-411100 (Emma Aguilar) held until CASE-002813 is decided |
| Held | — | ||
| ACT-016258 | Outreach suppressed pending steward Outreach | CLM-406865 (Amanda Hicks) held until CASE-002814 is decided |
| Held | — | ||
| ACT-016259 | Outreach suppressed pending steward Outreach | CLM-413712 (Frank Baker) held until CASE-002815 is decided |
| Held | — | ||
| ACT-016260 | Outreach suppressed pending steward Outreach | CLM-425307 (Gloria King) held until CASE-002816 is decided |
| Held | — | ||
| ACT-016261 | Outreach suppressed pending steward Outreach | TPA-61175 (Glooria King) held until CASE-002817 is decided |
| Held | — | ||
| ACT-016262 | Outreach suppressed pending steward Outreach | TPA-54230 (Jeremy Kim) held until CASE-002818 is decided |
| Held | — | ||
| ACT-016263 | Outreach suppressed pending steward Outreach | CLM-422329 (Mei Garcia) held until CASE-002819 is decided |
| Held | — | ||
| ACT-016264 | Outreach suppressed pending steward Outreach | CLM-422328 (Mei Garcia) held until CASE-002820 is decided |
| Held | — | ||
| ACT-016265 | Outreach suppressed pending steward Outreach | CLM-423782 (Sam Andrews) held until CASE-002821 is decided |
| Held | — | ||
| ACT-016266 | Outreach suppressed pending steward Outreach | CLM-424450 (Emma Rogers) held until CASE-002822 is decided |
| Held | — | ||
| ACT-016267 | Outreach suppressed pending steward Outreach | ENR-131965 (Emma Rogers) held until CASE-002823 is decided |
| Held | — | ||
| ACT-016268 | Outreach suppressed pending steward Outreach | TPA-53051 (Nicole Daniels) held until CASE-002824 is decided |
| Held | — | ||
| ACT-016269 | Outreach suppressed pending steward Outreach | ENR-114609 (Nicholas Daniels) held until CASE-002825 is decided |
| Held | — | ||
| ACT-016270 | Outreach suppressed pending steward Outreach | CLM-412575 (Joe Ford) held until CASE-002826 is decided |
| Held | — | ||
| ACT-016271 | Outreach suppressed pending steward Outreach | TPA-52636 (Amber Oliver) held until CASE-002827 is decided |
| Held | — | ||
| ACT-016272 | Outreach suppressed pending steward Outreach | TPA-55615 (Christina Larson) held until CASE-002828 is decided |
| Held | — | ||
| ACT-016273 | Outreach suppressed pending steward Outreach | CLM-432744 (Rachel Young) held until CASE-002829 is decided |
| Held | — | ||
| ACT-016274 | Outreach suppressed pending steward Outreach | CLM-432745 (Rachel Young) held until CASE-002830 is decided |
| Held | — | ||
| ACT-016275 | Outreach suppressed pending steward Outreach | CLM-411142 (Juan Gilbert) held until CASE-002831 is decided |
| Held | — | ||
| ACT-016276 | Outreach suppressed pending steward Outreach | PRV-23224 (Juan Gilbert) held until CASE-002832 is decided |
| Held | — | ||
| ACT-016277 | Outreach suppressed pending steward Outreach | CLM-400753 (Christina Peters) held until CASE-002833 is decided |
| Held | — | ||
| ACT-016278 | Outreach suppressed pending steward Outreach | CLM-422223 (William Morales) held until CASE-002834 is decided |
| Held | — | ||
| ACT-016279 | Outreach suppressed pending steward Outreach | ENR-127413 (Noah Hall) held until CASE-002835 is decided |
| Held | — | ||
| ACT-016280 | Outreach suppressed pending steward Outreach | ENR-127968 (Lysa Pena) held until CASE-002836 is decided |
| Held | — | ||
| ACT-016281 | Outreach suppressed pending steward Outreach | CLM-421337 (Lisa Pena) held until CASE-002837 is decided |
| Held | — | ||
| ACT-016282 | Outreach suppressed pending steward Outreach | TPA-56228 (Jonathan Peterson) held until CASE-002838 is decided |
| Held | — | ||
| ACT-016283 | Outreach suppressed pending steward Outreach | CLM-425910 (Aisha Lopez) held until CASE-002839 is decided |
| Held | — | ||
| ACT-016284 | Outreach suppressed pending steward Outreach | TPA-62076 (Karen Lopez) held until CASE-002840 is decided |
| Held | — | ||
| ACT-016285 | Outreach suppressed pending steward Outreach | PRV-22263 (Jacob Mills) held until CASE-002841 is decided |
| Held | — | ||
| ACT-016286 | Outreach suppressed pending steward Outreach | TPA-59783 (Henry Burtn) held until CASE-002842 is decided |
| Held | — | ||
| ACT-016287 | Outreach suppressed pending steward Outreach | PRV-26578 (Henry Burton) held until CASE-002843 is decided |
| Held | — | ||
| ACT-016288 | Outreach suppressed pending steward Outreach | TPA-56852 (Martha Campbell) held until CASE-002844 is decided |
| Held | — | ||
| ACT-016289 | Outreach suppressed pending steward Outreach | CLM-415547 (Carol Guzman) held until CASE-002845 is decided |
| Held | — | ||
| ACT-016290 | Outreach suppressed pending steward Outreach | CLM-415546 (Carol Guzman) held until CASE-002846 is decided |
| Held | — | ||
| ACT-016291 | Outreach suppressed pending steward Outreach | PRV-26548 (Mariana Franlkin) held until CASE-002847 is decided |
| Held | — | ||
| ACT-016292 | Outreach suppressed pending steward Outreach | ENR-129073 (Mariana Franklin) held until CASE-002848 is decided |
| Held | — | ||
| ACT-016293 | Outreach suppressed pending steward Outreach | CLM-414735 (Shirley Alvarez) held until CASE-002849 is decided |
| Held | — | ||
| ACT-016294 | Outreach suppressed pending steward Outreach | PRV-25561 (Amanda McCoy) held until CASE-002850 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.