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-016295 | Outreach suppressed pending steward Outreach | TPA-57250 (Janet Dean) held until CASE-002851 is decided |
| Held | — | ||
| ACT-016296 | Outreach suppressed pending steward Outreach | TPA-60861 (Frances Boyd) held until CASE-002852 is decided |
| Held | — | ||
| ACT-016297 | Outreach suppressed pending steward Outreach | TPA-50784 (Walter Harris) held until CASE-002853 is decided |
| Held | — | ||
| ACT-016298 | Outreach suppressed pending steward Outreach | CLM-416606 (Abigail Palmer) held until CASE-002854 is decided |
| Held | — | ||
| ACT-016299 | Outreach suppressed pending steward Outreach | TPA-53661 (Brandon Johnston) held until CASE-002855 is decided |
| Held | — | ||
| ACT-016300 | Outreach suppressed pending steward Outreach | PRV-22478 (Arjun Chavez) held until CASE-002856 is decided |
| Held | — | ||
| ACT-016301 | Outreach suppressed pending steward Outreach | TPA-50007 (Kathryn Austin) held until CASE-002857 is decided |
| Held | — | ||
| ACT-016302 | Outreach suppressed pending steward Outreach | CLM-400028 (Kathryn Austin) held until CASE-002858 is decided |
| Held | — | ||
| ACT-016303 | Outreach suppressed pending steward Outreach | CLM-419788 (Kevin Jordan) held until CASE-002859 is decided |
| Held | — | ||
| ACT-016304 | Outreach suppressed pending steward Outreach | PRV-23849 (Walter Bowmna) held until CASE-002860 is decided |
| Held | — | ||
| ACT-016305 | Outreach suppressed pending steward Outreach | PRV-21442 (Santago Ross) held until CASE-002861 is decided |
| Held | — | ||
| ACT-016306 | Outreach suppressed pending steward Outreach | ENR-106558 (Santiago Ross) held until CASE-002862 is decided |
| Held | — | ||
| ACT-016307 | Outreach suppressed pending steward Outreach | CLM-414769 (Susan Armstrong) held until CASE-002863 is decided |
| Held | — | ||
| ACT-016308 | Outreach suppressed pending steward Outreach | CLM-427414 (Heather Coleman) held until CASE-002864 is decided |
| Held | — | ||
| ACT-016309 | Outreach suppressed pending steward Outreach | TPA-62110 (Heather Coleman) held until CASE-002865 is decided |
| Held | — | ||
| ACT-016310 | Outreach suppressed pending steward Outreach | TPA-50296 (David Medina) held until CASE-002866 is decided |
| Held | — | ||
| ACT-016311 | Outreach suppressed pending steward Outreach | PRV-20196 (David Medina) held until CASE-002867 is decided |
| Held | — | ||
| ACT-016312 | Outreach suppressed pending steward Outreach | ENR-103836 (Christian Meidna) held until CASE-002868 is decided |
| Held | — | ||
| ACT-016313 | Outreach suppressed pending steward Outreach | CLM-402960 (Christian Medina) held until CASE-002869 is decided |
| Held | — | ||
| ACT-016314 | Outreach suppressed pending steward Outreach | TPA-50486 (Dnaiel Bailey) held until CASE-002870 is decided |
| Held | — | ||
| ACT-016315 | Outreach suppressed pending steward Outreach | ENR-122218 (Angela Peerz) held until CASE-002871 is decided |
| Held | — | ||
| ACT-016316 | Outreach suppressed pending steward Outreach | CLM-416909 (Angela Perez) held until CASE-002872 is decided |
| Held | — | ||
| ACT-016317 | Outreach suppressed pending steward Outreach | PRV-25166 (Sean Carpenter) held until CASE-002873 is decided |
| Held | — | ||
| ACT-016318 | Outreach suppressed pending steward Outreach | CLM-412857 (Barbara Fox) held until CASE-002874 is decided |
| Held | — | ||
| ACT-016319 | Outreach suppressed pending steward Outreach | CLM-403744 (Jennifer Perez) held until CASE-002875 is decided |
| Held | — | ||
| ACT-016320 | Outreach suppressed pending steward Outreach | TPA-51630 (Jennifer Perez) held until CASE-002876 is decided |
| Held | — | ||
| ACT-016321 | Outreach suppressed pending steward Outreach | CLM-422790 (Sharon Garza) held until CASE-002877 is decided |
| Held | — | ||
| ACT-016322 | Outreach suppressed pending steward Outreach | TPA-60006 (Sharon Garza) held until CASE-002878 is decided |
| Held | — | ||
| ACT-016323 | Outreach suppressed pending steward Outreach | TPA-52358 (Wayne Cunningham) held until CASE-002879 is decided |
| Held | — | ||
| ACT-016324 | Outreach suppressed pending steward Outreach | CLM-429976 (Alexys Duncan) held until CASE-002880 is decided |
| Held | — | ||
| ACT-016325 | Outreach suppressed pending steward Outreach | TPA-58687 (Isabella Li) held until CASE-002881 is decided |
| Held | — | ||
| ACT-016326 | Outreach suppressed pending steward Outreach | ENR-125914 (Isabella Li) held until CASE-002882 is decided |
| Held | — | ||
| ACT-016327 | Outreach suppressed pending steward Outreach | TPA-51393 (Michael Campbell) held until CASE-002883 is decided |
| Held | — | ||
| ACT-016328 | Outreach suppressed pending steward Outreach | CLM-424279 (Adam Taylor) held until CASE-002884 is decided |
| Held | — | ||
| ACT-016329 | Outreach suppressed pending steward Outreach | CLM-401103 (Jacqueline Kelley) held until CASE-002885 is decided |
| Held | — | ||
| ACT-016330 | Outreach suppressed pending steward Outreach | TPA-60783 (Mason Kelley) held until CASE-002886 is decided |
| Held | — | ||
| ACT-016331 | Outreach suppressed pending steward Outreach | TPA-55165 (Andrew Phillips) held until CASE-002887 is decided |
| Held | — | ||
| ACT-016332 | Outreach suppressed pending steward Outreach | PRV-28565 (Ken Hunter) held until CASE-002888 is decided |
| Held | — | ||
| ACT-016333 | Outreach suppressed pending steward Outreach | ENR-138312 (Kenneth Hunter) held until CASE-002889 is decided |
| Held | — | ||
| ACT-016334 | Outreach suppressed pending steward Outreach | TPA-58502 (Wei Hamilton) held until CASE-002890 is decided |
| Held | — | ||
| ACT-016335 | Outreach suppressed pending steward Outreach | PRV-23802 (Sean Hunter) held until CASE-002891 is decided |
| Held | — | ||
| ACT-016336 | Outreach suppressed pending steward Outreach | TPA-55769 (Sean Hunter) held until CASE-002892 is decided |
| Held | — | ||
| ACT-016337 | Outreach suppressed pending steward Outreach | ENR-113768 (Sara Hicks) held until CASE-002893 is decided |
| Held | — | ||
| ACT-016338 | Outreach suppressed pending steward Outreach | CLM-404959 (Bryan Henderson) held until CASE-002894 is decided |
| Held | — | ||
| ACT-016339 | Outreach suppressed pending steward Outreach | ENR-126533 (Helen Gibson) held until CASE-002895 is decided |
| Held | — | ||
| ACT-016340 | Outreach suppressed pending steward Outreach | CLM-420160 (Helen Gibosn) held until CASE-002896 is decided |
| Held | — | ||
| ACT-016341 | Outreach suppressed pending steward Outreach | PRV-26793 (Jefffrey Payne) held until CASE-002897 is decided |
| Held | — | ||
| ACT-016342 | Outreach suppressed pending steward Outreach | CLM-406363 (Jordan Richards) held until CASE-002898 is decided |
| Held | — | ||
| ACT-016343 | Outreach suppressed pending steward Outreach | ENR-128220 (Wane Washington) held until CASE-002899 is decided |
| Held | — | ||
| ACT-016344 | Outreach suppressed pending steward Outreach | CLM-427930 (Jack Taylor) held until CASE-002900 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.