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-016345 | Outreach suppressed pending steward Outreach | PRV-25556 (Wei Schultz) held until CASE-002901 is decided |
| Held | — | ||
| ACT-016346 | Outreach suppressed pending steward Outreach | CLM-429325 (Albert Flores) held until CASE-002902 is decided |
| Held | — | ||
| ACT-016347 | Outreach suppressed pending steward Outreach | CLM-427315 (Barb Le) held until CASE-002903 is decided |
| Held | — | ||
| ACT-016348 | Outreach suppressed pending steward Outreach | CLM-410219 (David Yang) held until CASE-002904 is decided |
| Held | — | ||
| ACT-016349 | Outreach suppressed pending steward Outreach | TPA-60323 (Joseph Kim) held until CASE-002905 is decided |
| Held | — | ||
| ACT-016350 | Outreach suppressed pending steward Outreach | PRV-26915 (Joseph Kim) held until CASE-002906 is decided |
| Held | — | ||
| ACT-016351 | Outreach suppressed pending steward Outreach | CLM-425130 (Wei Medina) held until CASE-002907 is decided |
| Held | — | ||
| ACT-016352 | Outreach suppressed pending steward Outreach | CLM-407449 (Jordan Parker) held until CASE-002908 is decided |
| Held | — | ||
| ACT-016353 | Outreach suppressed pending steward Outreach | ENR-109766 (Jordan Parker) held until CASE-002909 is decided |
| Held | — | ||
| ACT-016354 | Outreach suppressed pending steward Outreach | PRV-27612 (Ruth Moreno) held until CASE-002910 is decided |
| Held | — | ||
| ACT-016355 | Outreach suppressed pending steward Outreach | TPA-60316 (Carl Cook) held until CASE-002911 is decided |
| Held | — | ||
| ACT-016356 | Outreach suppressed pending steward Outreach | CLM-417697 (Pamela Lawson) held until CASE-002912 is decided |
| Held | — | ||
| ACT-016357 | Outreach suppressed pending steward Outreach | CLM-417698 (Pamela Lawson) held until CASE-002913 is decided |
| Held | — | ||
| ACT-016358 | Outreach suppressed pending steward Outreach | CLM-410363 (Mason Chen) held until CASE-002914 is decided |
| Held | — | ||
| ACT-016359 | Outreach suppressed pending steward Outreach | CLM-431023 (Aaron Freeman) held until CASE-002915 is decided |
| Held | — | ||
| ACT-016360 | Outreach suppressed pending steward Outreach | PRV-29066 (Aaron Freeman) held until CASE-002916 is decided |
| Held | — | ||
| ACT-016361 | Outreach suppressed pending steward Outreach | ENR-140741 (Aaron Freeman) held until CASE-002917 is decided |
| Held | — | ||
| ACT-016362 | Outreach suppressed pending steward Outreach | ENR-119510 (Rachel Wells) held until CASE-002918 is decided |
| Held | — | ||
| ACT-016363 | Outreach suppressed pending steward Outreach | TPA-56536 (Rachel Wells) held until CASE-002919 is decided |
| Held | — | ||
| ACT-016364 | Outreach suppressed pending steward Outreach | ENR-129223 (Andrea Wells) held until CASE-002920 is decided |
| Held | — | ||
| ACT-016365 | Outreach suppressed pending steward Outreach | PRV-25296 (Roger Moreno) held until CASE-002921 is decided |
| Held | — | ||
| ACT-016366 | Outreach suppressed pending steward Outreach | ENR-123501 (Roger Moreno) held until CASE-002922 is decided |
| Held | — | ||
| ACT-016367 | Outreach suppressed pending steward Outreach | TPA-61475 (Joe Adams) held until CASE-002923 is decided |
| Held | — | ||
| ACT-016368 | Outreach suppressed pending steward Outreach | ENR-133981 (Joe Adams) held until CASE-002924 is decided |
| Held | — | ||
| ACT-016369 | Outreach suppressed pending steward Outreach | CLM-431191 (Austin Lucas) held until CASE-002925 is decided |
| Held | — | ||
| ACT-016370 | Outreach suppressed pending steward Outreach | TPA-60488 (Anna Wong) held until CASE-002926 is decided |
| Held | — | ||
| ACT-016371 | Outreach suppressed pending steward Outreach | CLM-400749 (Natalie Jacobs) held until CASE-002927 is decided |
| Held | — | ||
| ACT-016372 | Outreach suppressed pending steward Outreach | ENR-100999 (Natalie Jacobs) held until CASE-002928 is decided |
| Held | — | ||
| ACT-016373 | Outreach suppressed pending steward Outreach | TPA-55997 (Dnaiel Sanchez) held until CASE-002929 is decided |
| Held | — | ||
| ACT-016374 | Outreach suppressed pending steward Outreach | CLM-413036 (Michael George) held until CASE-002930 is decided |
| Held | — | ||
| ACT-016375 | Outreach suppressed pending steward Outreach | ENR-113171 (Mason Brooks) held until CASE-002931 is decided |
| Held | — | ||
| ACT-016376 | Outreach suppressed pending steward Outreach | TPA-54371 (Mason Brooks) held until CASE-002932 is decided |
| Held | — | ||
| ACT-016377 | Outreach suppressed pending steward Outreach | ENR-106619 (Camila Cook) held until CASE-002933 is decided |
| Held | — | ||
| ACT-016378 | Outreach suppressed pending steward Outreach | CLM-405021 (Camila Cook) held until CASE-002934 is decided |
| Held | — | ||
| ACT-016379 | Outreach suppressed pending steward Outreach | TPA-58949 (Jean Martin) held until CASE-002935 is decided |
| Held | — | ||
| ACT-016380 | Outreach suppressed pending steward Outreach | CLM-429111 (Christopher Stevens) held until CASE-002936 is decided |
| Held | — | ||
| ACT-016381 | Outreach suppressed pending steward Outreach | CLM-417673 (Andrea Patel) held until CASE-002937 is decided |
| Held | — | ||
| ACT-016382 | Outreach suppressed pending steward Outreach | TPA-64354 (Ahmed Adams) held until CASE-002938 is decided |
| Held | — | ||
| ACT-016383 | Outreach suppressed pending steward Outreach | CLM-428340 (Scott Medina) held until CASE-002939 is decided |
| Held | — | ||
| ACT-016384 | Outreach suppressed pending steward Outreach | TPA-62803 (Russell Lee) held until CASE-002940 is decided |
| Held | — | ||
| ACT-016385 | Outreach suppressed pending steward Outreach | TPA-61487 (Aaron Morales) held until CASE-002941 is decided |
| Held | — | ||
| ACT-016386 | Outreach suppressed pending steward Outreach | PRV-27656 (Aaron Morales) held until CASE-002942 is decided |
| Held | — | ||
| ACT-016387 | Outreach suppressed pending steward Outreach | CLM-411909 (Randy Webb) held until CASE-002943 is decided |
| Held | — | ||
| ACT-016388 | Outreach suppressed pending steward Outreach | CLM-418860 (Abigail Garza) held until CASE-002944 is decided |
| Held | — | ||
| ACT-016389 | Outreach suppressed pending steward Outreach | ENR-124828 (Abigail Garza) held until CASE-002945 is decided |
| Held | — | ||
| ACT-016390 | Outreach suppressed pending steward Outreach | TPA-53547 (Samuel Wheeler) held until CASE-002946 is decided |
| Held | — | ||
| ACT-016391 | Outreach suppressed pending steward Outreach | TPA-52553 (Astin Riley) held until CASE-002947 is decided |
| Held | — | ||
| ACT-016392 | Outreach suppressed pending steward Outreach | ENR-142561 (Hannah Dominguez) held until CASE-002948 is decided |
| Held | — | ||
| ACT-016393 | Outreach suppressed pending steward Outreach | TPA-53594 (Ana Richards) held until CASE-002949 is decided |
| Held | — | ||
| ACT-016394 | Outreach suppressed pending steward Outreach | PRV-22408 (Ana Richards) held until CASE-002950 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.