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-016395 | Outreach suppressed pending steward Outreach | TPA-54436 (Dylan Oliver) held until CASE-002951 is decided |
| Held | — | ||
| ACT-016396 | Outreach suppressed pending steward Outreach | CLM-423497 (Jordan Meyre) held until CASE-002952 is decided |
| Held | — | ||
| ACT-016397 | Outreach suppressed pending steward Outreach | ENR-110711 (Daniel Meyer) held until CASE-002953 is decided |
| Held | — | ||
| ACT-016398 | Outreach suppressed pending steward Outreach | ENR-110710 (Daniel Meeyer) held until CASE-002954 is decided |
| Held | — | ||
| ACT-016399 | Outreach suppressed pending steward Outreach | CLM-424555 (Melissa Hawkins) held until CASE-002955 is decided |
| Held | — | ||
| ACT-016400 | Outreach suppressed pending steward Outreach | CLM-422303 (Patricia Hernandez) held until CASE-002956 is decided |
| Held | — | ||
| ACT-016401 | Outreach suppressed pending steward Outreach | CLM-426482 (Bradley Reid) held until CASE-002957 is decided |
| Held | — | ||
| ACT-016402 | Outreach suppressed pending steward Outreach | ENR-134739 (Bradley Reid) held until CASE-002958 is decided |
| Held | — | ||
| ACT-016403 | Outreach suppressed pending steward Outreach | ENR-110699 (Thomas Cox) held until CASE-002959 is decided |
| Held | — | ||
| ACT-016404 | Outreach suppressed pending steward Outreach | CLM-408120 (Thomas Cox) held until CASE-002960 is decided |
| Held | — | ||
| ACT-016405 | Outreach suppressed pending steward Outreach | PRV-20825 (Cynthia Gibson) held until CASE-002961 is decided |
| Held | — | ||
| ACT-016406 | Outreach suppressed pending steward Outreach | CLM-404775 (Albert Griffin) held until CASE-002962 is decided |
| Held | — | ||
| ACT-016407 | Outreach suppressed pending steward Outreach | PRV-21385 (Albert Griffin) held until CASE-002963 is decided |
| Held | — | ||
| ACT-016408 | Outreach suppressed pending steward Outreach | TPA-52520 (Sandra Baker) held until CASE-002964 is decided |
| Held | — | ||
| ACT-016409 | Outreach suppressed pending steward Outreach | ENR-107509 (Sandra Baker) held until CASE-002965 is decided |
| Held | — | ||
| ACT-016410 | Outreach suppressed pending steward Outreach | CLM-413248 (Susan Adams) held until CASE-002966 is decided |
| Held | — | ||
| ACT-016411 | Outreach suppressed pending steward Outreach | TPA-58611 (Roy Obrien) held until CASE-002967 is decided |
| Held | — | ||
| ACT-016412 | Outreach suppressed pending steward Outreach | TPA-58610 (Roy Obrien) held until CASE-002968 is decided |
| Held | — | ||
| ACT-016413 | Outreach suppressed pending steward Outreach | ENR-138992 (Christina Jimenez) held until CASE-002969 is decided |
| Held | — | ||
| ACT-016414 | Outreach suppressed pending steward Outreach | TPA-63134 (Christina Jimenez) held until CASE-002970 is decided |
| Held | — | ||
| ACT-016415 | Outreach suppressed pending steward Outreach | CLM-415799 (Alan Ramos) held until CASE-002971 is decided |
| Held | — | ||
| ACT-016416 | Outreach suppressed pending steward Outreach | CLM-416496 (Aisha Gibson) held until CASE-002972 is decided |
| Held | — | ||
| ACT-016417 | Outreach suppressed pending steward Outreach | CLM-423594 (Tyler West) held until CASE-002973 is decided |
| Held | — | ||
| ACT-016418 | Outreach suppressed pending steward Outreach | TPA-60380 (Tyler West) held until CASE-002974 is decided |
| Held | — | ||
| ACT-016419 | Outreach suppressed pending steward Outreach | CLM-422802 (Sharon Sims) held until CASE-002975 is decided |
| Held | — | ||
| ACT-016420 | Outreach suppressed pending steward Outreach | TPA-63182 (Lauren Sullivan) held until CASE-002976 is decided |
| Held | — | ||
| ACT-016421 | Outreach suppressed pending steward Outreach | CLM-400739 (David Sullivan) held until CASE-002977 is decided |
| Held | — | ||
| ACT-016422 | Outreach suppressed pending steward Outreach | ENR-100985 (David Sullivan) held until CASE-002978 is decided |
| Held | — | ||
| ACT-016423 | Outreach suppressed pending steward Outreach | TPA-57206 (Noah Woods) held until CASE-002979 is decided |
| Held | — | ||
| ACT-016424 | Outreach suppressed pending steward Outreach | TPA-57205 (Noah Woods) held until CASE-002980 is decided |
| Held | — | ||
| ACT-016425 | Outreach suppressed pending steward Outreach | CLM-420304 (Gregory Rivera) held until CASE-002981 is decided |
| Held | — | ||
| ACT-016426 | Outreach suppressed pending steward Outreach | ENR-126694 (Gregory Rivera) held until CASE-002982 is decided |
| Held | — | ||
| ACT-016427 | Outreach suppressed pending steward Outreach | ENR-130801 (Tyler Li) held until CASE-002983 is decided |
| Held | — | ||
| ACT-016428 | Outreach suppressed pending steward Outreach | CLM-423544 (Tyler Li) held until CASE-002984 is decided |
| Held | — | ||
| ACT-016429 | Outreach suppressed pending steward Outreach | ENR-100435 (Danielle Oliver) held until CASE-002985 is decided |
| Held | — | ||
| ACT-016430 | Outreach suppressed pending steward Outreach | TPA-62575 (Megan Edwards) held until CASE-002986 is decided |
| Held | — | ||
| ACT-016431 | Outreach suppressed pending steward Outreach | CLM-422981 (Omar Schultz) held until CASE-002987 is decided |
| Held | — | ||
| ACT-016432 | Outreach suppressed pending steward Outreach | TPA-58674 (Lisa Varges) held until CASE-002988 is decided |
| Held | — | ||
| ACT-016433 | Outreach suppressed pending steward Outreach | TPA-53254 (Tony Holmes) held until CASE-002989 is decided |
| Held | — | ||
| ACT-016434 | Outreach suppressed pending steward Outreach | PRV-20672 (Denny Sandeers) held until CASE-002990 is decided |
| Held | — | ||
| ACT-016435 | Outreach suppressed pending steward Outreach | CLM-402272 (Denny Sanders) held until CASE-002991 is decided |
| Held | — | ||
| ACT-016436 | Outreach suppressed pending steward Outreach | CLM-407360 (Robert Patel) held until CASE-002992 is decided |
| Held | — | ||
| ACT-016437 | Outreach suppressed pending steward Outreach | PRV-20118 (William Burton) held until CASE-002993 is decided |
| Held | — | ||
| ACT-016438 | Outreach suppressed pending steward Outreach | ENR-100561 (William Burton) held until CASE-002994 is decided |
| Held | — | ||
| ACT-016439 | Outreach suppressed pending steward Outreach | PRV-21617 (Sofia Sims) held until CASE-002995 is decided |
| Held | — | ||
| ACT-016440 | Outreach suppressed pending steward Outreach | ENR-126089 (Brian Hart) held until CASE-002996 is decided |
| Held | — | ||
| ACT-016441 | Outreach suppressed pending steward Outreach | TPA-50359 (Billy Thomas) held until CASE-002997 is decided |
| Held | — | ||
| ACT-016442 | Outreach suppressed pending steward Outreach | ENR-120083 (Nancy Marshall) held until CASE-002998 is decided |
| Held | — | ||
| ACT-016443 | Outreach suppressed pending steward Outreach | CLM-415235 (Nancy Marshall) held until CASE-002999 is decided |
| Held | — | ||
| ACT-016444 | Outreach suppressed pending steward Outreach | PRV-22598 (Willie Rivera) held until CASE-003000 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.