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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-013695 | Outreach suppressed pending steward Outreach | TPA-60473 (Jeremy Black) held until CASE-000251 is decided |
| Held | — | ||
| ACT-013696 | Outreach suppressed pending steward Outreach | CLM-428787 (Ann Santiago) held until CASE-000252 is decided |
| Held | — | ||
| ACT-013697 | Outreach suppressed pending steward Outreach | CLM-405924 (Nicole Johnston) held until CASE-000253 is decided |
| Held | — | ||
| ACT-013698 | Outreach suppressed pending steward Outreach | CLM-405925 (Nicole Johnston) held until CASE-000254 is decided |
| Held | — | ||
| ACT-013699 | Outreach suppressed pending steward Outreach | PRV-23901 (Bobby Miller) held until CASE-000255 is decided |
| Held | — | ||
| ACT-013700 | Outreach suppressed pending steward Outreach | ENR-126223 (Judy Willis) held until CASE-000256 is decided |
| Held | — | ||
| ACT-013701 | Outreach suppressed pending steward Outreach | TPA-51250 (Jonathan Greene) held until CASE-000257 is decided |
| Held | — | ||
| ACT-013702 | Outreach suppressed pending steward Outreach | CLM-406913 (Priya Barnes) held until CASE-000258 is decided |
| Held | — | ||
| ACT-013703 | Outreach suppressed pending steward Outreach | TPA-53034 (Priya Barnes) held until CASE-000259 is decided |
| Held | — | ||
| ACT-013704 | Outreach suppressed pending steward Outreach | TPA-50233 (Christian Carpenter) held until CASE-000260 is decided |
| Held | — | ||
| ACT-013705 | Outreach suppressed pending steward Outreach | TPA-60524 (Sandra Santiago) held until CASE-000261 is decided |
| Held | — | ||
| ACT-013706 | Outreach suppressed pending steward Outreach | ENR-100347 (Margaret Hicks) held until CASE-000262 is decided |
| Held | — | ||
| ACT-013707 | Outreach suppressed pending steward Outreach | TPA-60507 (Diana Porter) held until CASE-000263 is decided |
| Held | — | ||
| ACT-013708 | Outreach suppressed pending steward Outreach | TPA-63040 (Raymond Duncan) held until CASE-000264 is decided |
| Held | — | ||
| ACT-013709 | Outreach suppressed pending steward Outreach | CLM-404718 (Samuel Johnston) held until CASE-000265 is decided |
| Held | — | ||
| ACT-013710 | Outreach suppressed pending steward Outreach | ENR-140262 (Cheryl Banks) held until CASE-000266 is decided |
| Held | — | ||
| ACT-013711 | Outreach suppressed pending steward Outreach | CLM-430665 (Cheryl Banks) held until CASE-000267 is decided |
| Held | — | ||
| ACT-013712 | Outreach suppressed pending steward Outreach | CLM-409472 (Betty Mendez) held until CASE-000268 is decided |
| Held | — | ||
| ACT-013713 | Outreach suppressed pending steward Outreach | TPA-59861 (Shirley Baker) held until CASE-000269 is decided |
| Held | — | ||
| ACT-013714 | Outreach suppressed pending steward Outreach | TPA-50721 (Christina Sandoval) held until CASE-000270 is decided |
| Held | — | ||
| ACT-013715 | Outreach suppressed pending steward Outreach | CLM-416414 (Nancy Sandoval) held until CASE-000271 is decided |
| Held | — | ||
| ACT-013716 | Outreach suppressed pending steward Outreach | ENR-122642 (Robert Sandoval) held until CASE-000272 is decided |
| Held | — | ||
| ACT-013717 | Outreach suppressed pending steward Outreach | CLM-430172 (Lucia Ryees) held until CASE-000273 is decided |
| Held | — | ||
| ACT-013718 | Outreach suppressed pending steward Outreach | ENR-139573 (Lucia Reyes) held until CASE-000274 is decided |
| Held | — | ||
| ACT-013719 | Outreach suppressed pending steward Outreach | TPA-50778 (Ann Reyes) held until CASE-000275 is decided |
| Held | — | ||
| ACT-013720 | Outreach suppressed pending steward Outreach | CLM-429307 (Alan Contreras) held until CASE-000276 is decided |
| Held | — | ||
| ACT-013721 | Outreach suppressed pending steward Outreach | TPA-64080 (Zachary Ramos) held until CASE-000277 is decided |
| Held | — | ||
| ACT-013722 | Outreach suppressed pending steward Outreach | CLM-408755 (Ethan Ramos) held until CASE-000278 is decided |
| Held | — | ||
| ACT-013723 | Outreach suppressed pending steward Outreach | CLM-419691 (Alice Alvarez) held until CASE-000279 is decided |
| Held | — | ||
| ACT-013724 | Outreach suppressed pending steward Outreach | ENR-125932 (Alice Alvarez) held until CASE-000280 is decided |
| Held | — | ||
| ACT-013725 | Outreach suppressed pending steward Outreach | TPA-61434 (Robert Moore) held until CASE-000281 is decided |
| Held | — | ||
| ACT-013726 | Outreach suppressed pending steward Outreach | ENR-129548 (Diego Richards) held until CASE-000282 is decided |
| Held | — | ||
| ACT-013727 | Outreach suppressed pending steward Outreach | PRV-26654 (Diego Richards) held until CASE-000283 is decided |
| Held | — | ||
| ACT-013728 | Outreach suppressed pending steward Outreach | ENR-142431 (Jack Graham) held until CASE-000284 is decided |
| Held | — | ||
| ACT-013729 | Outreach suppressed pending steward Outreach | TPA-54702 (Ahmed Jacobs) held until CASE-000285 is decided |
| Held | — | ||
| ACT-013730 | Outreach suppressed pending steward Outreach | CLM-408662 (Mary George) held until CASE-000286 is decided |
| Held | — | ||
| ACT-013731 | Outreach suppressed pending steward Outreach | ENR-116990 (Daniel George) held until CASE-000287 is decided |
| Held | — | ||
| ACT-013732 | Outreach suppressed pending steward Outreach | ENR-140447 (Linda Carpenter) held until CASE-000288 is decided |
| Held | — | ||
| ACT-013733 | Outreach suppressed pending steward Outreach | TPA-63606 (Linda Carpenter) held until CASE-000289 is decided |
| Held | — | ||
| ACT-013734 | Outreach suppressed pending steward Outreach | PRV-29419 (Alan Lynch) held until CASE-000290 is decided |
| Held | — | ||
| ACT-013735 | Outreach suppressed pending steward Outreach | TPA-63337 (Janice Marshall) held until CASE-000291 is decided |
| Held | — | ||
| ACT-013736 | Outreach suppressed pending steward Outreach | CLM-410192 (Denise Guerrero) held until CASE-000292 is decided |
| Held | — | ||
| ACT-013737 | Outreach suppressed pending steward Outreach | TPA-58752 (Doris Hoffman) held until CASE-000293 is decided |
| Held | — | ||
| ACT-013738 | Outreach suppressed pending steward Outreach | TPA-61121 (Jeryr Hamilton) held until CASE-000294 is decided |
| Held | — | ||
| ACT-013739 | Outreach suppressed pending steward Outreach | CLM-416349 (Arjun Anderson) held until CASE-000295 is decided |
| Held | — | ||
| ACT-013740 | Outreach suppressed pending steward Outreach | CLM-427696 (Billy Henderson) held until CASE-000296 is decided |
| Held | — | ||
| ACT-013741 | Outreach suppressed pending steward Outreach | CLM-431823 (Jessica Henderson) held until CASE-000297 is decided |
| Held | — | ||
| ACT-013742 | Outreach suppressed pending steward Outreach | TPA-53716 (Brenda Garrett) held until CASE-000298 is decided |
| Held | — | ||
| ACT-013743 | Outreach suppressed pending steward Outreach | TPA-60470 (Alexis Edwards) held until CASE-000299 is decided |
| Held | — | ||
| ACT-013744 | Outreach suppressed pending steward Outreach | TPA-63514 (Denise Thomas) held until CASE-000300 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.