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-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.