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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-018021 | Care coordination outreach Next-best-action | Dennis Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018022 | Care coordination outreach Next-best-action | Shirley Shaw: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018023 | Care coordination outreach Next-best-action | Shirley Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018024 | Care coordination outreach Next-best-action | Nathan Hernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018025 | Care coordination outreach Next-best-action | Jennifer Turner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018026 | Care coordination outreach Next-best-action | Joyce Palmer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018027 | Care coordination outreach Next-best-action | Bryan Black: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018028 | Care coordination outreach Next-best-action | Joan Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018029 | Care coordination outreach Next-best-action | John Sims: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018030 | Care coordination outreach Next-best-action | Jeremy Garrett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018031 | Care coordination outreach Next-best-action | Carol Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018032 | Care coordination outreach Next-best-action | Kathryn Robinson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018033 | Care coordination outreach Next-best-action | Thomas Baker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018034 | Care coordination outreach Next-best-action | Theresa West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018035 | Care coordination outreach Next-best-action | Hiroshi Freeman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018036 | Care coordination outreach Next-best-action | Denise Berry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018037 | Care coordination outreach Next-best-action | Wayne Bailey: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018038 | Care coordination outreach Next-best-action | William Moreno: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018039 | Care coordination outreach Next-best-action | Kelly Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018040 | Care coordination outreach Next-best-action | Cynthia Sandoval: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018041 | Care coordination outreach Next-best-action | Sophia Roberts: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018042 | Care coordination outreach Next-best-action | Bruce Phillips: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018043 | Care coordination outreach Next-best-action | Jose Jensen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018044 | Care coordination outreach Next-best-action | Katherine West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018045 | Care coordination outreach Next-best-action | Robert Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018046 | Care coordination outreach Next-best-action | Gregory Palmer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018047 | Care coordination outreach Next-best-action | Nancy Delgado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018048 | Care coordination outreach Next-best-action | Isabella Wilson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018049 | Care coordination outreach Next-best-action | Larry Mendoza: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018050 | Care coordination outreach Next-best-action | Frank Allen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018051 | Care coordination outreach Next-best-action | Jesse Peterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018052 | Care coordination outreach Next-best-action | Amy Flores: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018053 | Care coordination outreach Next-best-action | Hiroshi Tran: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018054 | Care coordination outreach Next-best-action | Bradley Weber: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018055 | Care coordination outreach Next-best-action | Kimberly Boyd: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018056 | Care coordination outreach Next-best-action | Angela Foster: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018057 | Care coordination outreach Next-best-action | Jason Mills: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018058 | Care coordination outreach Next-best-action | Dylan Arnold: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018059 | Care coordination outreach Next-best-action | Shirley Reyes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018060 | Care coordination outreach Next-best-action | Douglas Cole: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018061 | Care coordination outreach Next-best-action | Jordan Fowler: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018062 | Care coordination outreach Next-best-action | George Sims: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018063 | Care coordination outreach Next-best-action | Denise Ramos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018064 | Care coordination outreach Next-best-action | Edward Reyes: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018065 | Care coordination outreach Next-best-action | Henry Reynolds: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018066 | Care coordination outreach Next-best-action | Samantha Ray: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018067 | Care coordination outreach Next-best-action | Maria Carter: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018068 | Care coordination outreach Next-best-action | Michelle Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018069 | Care coordination outreach Next-best-action | Mary Taylor: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018070 | Care coordination outreach Next-best-action | Benjamin Moreno: 4 claims, no attributed provider |
| Proposed | — |
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.