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-016495 | Outreach suppressed pending steward Outreach | CLM-420021 (Hiroshi Guerrero) held until CASE-003051 is decided |
| Held | — | ||
| ACT-016496 | Outreach suppressed pending steward Outreach | CLM-426726 (Bobby Ferguson) held until CASE-003052 is decided |
| Held | — | ||
| ACT-016497 | Outreach suppressed pending steward Outreach | TPA-61805 (Bobby Ferguson) held until CASE-003053 is decided |
| Held | — | ||
| ACT-016498 | Outreach suppressed pending steward Outreach | CLM-412286 (Janice Cook) held until CASE-003054 is decided |
| Held | — | ||
| ACT-016499 | Outreach suppressed pending steward Outreach | TPA-55414 (Jnice Cook) held until CASE-003055 is decided |
| Held | — | ||
| ACT-016500 | Outreach suppressed pending steward Outreach | PRV-26647 (Nicole Thomas) held until CASE-003056 is decided |
| Held | — | ||
| ACT-016501 | Outreach suppressed pending steward Outreach | ENR-129530 (Nicole Thomas) held until CASE-003057 is decided |
| Held | — | ||
| ACT-016502 | Outreach suppressed pending steward Outreach | TPA-50861 (Sean Alvarado) held until CASE-003058 is decided |
| Held | — | ||
| ACT-016503 | Outreach suppressed pending steward Outreach | TPA-56988 (Arthur Kim) held until CASE-003059 is decided |
| Held | — | ||
| ACT-016504 | Outreach suppressed pending steward Outreach | TPA-50531 (Yuki Stone) held until CASE-003060 is decided |
| Held | — | ||
| ACT-016505 | Outreach suppressed pending steward Outreach | PRV-27543 (Aaron Nunez) held until CASE-003061 is decided |
| Held | — | ||
| ACT-016506 | Outreach suppressed pending steward Outreach | CLM-425617 (Aaron Nunez) held until CASE-003062 is decided |
| Held | — | ||
| ACT-016507 | Outreach suppressed pending steward Outreach | CLM-403818 (Kelly Carroll) held until CASE-003063 is decided |
| Held | — | ||
| ACT-016508 | Outreach suppressed pending steward Outreach | TPA-51658 (Kelly Carroll) held until CASE-003064 is decided |
| Held | — | ||
| ACT-016509 | Outreach suppressed pending steward Outreach | CLM-403819 (Kelly Carroll) held until CASE-003065 is decided |
| Held | — | ||
| ACT-016510 | Outreach suppressed pending steward Outreach | ENR-108852 (Andrew Crawford) held until CASE-003066 is decided |
| Held | — | ||
| ACT-016511 | Outreach suppressed pending steward Outreach | CLM-406783 (Andrew Crawford) held until CASE-003067 is decided |
| Held | — | ||
| ACT-016512 | Outreach suppressed pending steward Outreach | TPA-63854 (Alice Snyder) held until CASE-003068 is decided |
| Held | — | ||
| ACT-016513 | Outreach suppressed pending steward Outreach | ENR-141197 (Alice Snyder) held until CASE-003069 is decided |
| Held | — | ||
| ACT-016514 | Outreach suppressed pending steward Outreach | TPA-54496 (Martha Price) held until CASE-003070 is decided |
| Held | — | ||
| ACT-016515 | Outreach suppressed pending steward Outreach | ENR-131785 (Heather Medina) held until CASE-003071 is decided |
| Held | — | ||
| ACT-016516 | Outreach suppressed pending steward Outreach | PRV-27162 (Heather Medina) held until CASE-003072 is decided |
| Held | — | ||
| ACT-016517 | Outreach suppressed pending steward Outreach | PRV-27387 (Steven Gibson) held until CASE-003073 is decided |
| Held | — | ||
| ACT-016518 | Outreach suppressed pending steward Outreach | ENR-129546 (Frances Long) held until CASE-003074 is decided |
| Held | — | ||
| ACT-016519 | Outreach suppressed pending steward Outreach | CLM-400198 (Robert Jenkins) held until CASE-003075 is decided |
| Held | — | ||
| ACT-016520 | Outreach suppressed pending steward Outreach | ENR-101633 (Wayne James) held until CASE-003076 is decided |
| Held | — | ||
| ACT-016521 | Outreach suppressed pending steward Outreach | CLM-401262 (Wayne James) held until CASE-003077 is decided |
| Held | — | ||
| ACT-016522 | Outreach suppressed pending steward Outreach | ENR-106215 (Harold Ortega) held until CASE-003078 is decided |
| Held | — | ||
| ACT-016523 | Outreach suppressed pending steward Outreach | TPA-52063 (Harold Ortega) held until CASE-003079 is decided |
| Held | — | ||
| ACT-016524 | Outreach suppressed pending steward Outreach | CLM-409975 (Emma Ortiz) held until CASE-003080 is decided |
| Held | — | ||
| ACT-016525 | Outreach suppressed pending steward Outreach | CLM-409976 (Emma Ortiz) held until CASE-003081 is decided |
| Held | — | ||
| ACT-016526 | Outreach suppressed pending steward Outreach | TPA-50642 (Roger Ortiz) held until CASE-003082 is decided |
| Held | — | ||
| ACT-016527 | Outreach suppressed pending steward Outreach | TPA-63495 (Liz Riley) held until CASE-003083 is decided |
| Held | — | ||
| ACT-016528 | Outreach suppressed pending steward Outreach | CLM-430562 (Elizabeth Riley) held until CASE-003084 is decided |
| Held | — | ||
| ACT-016529 | Outreach suppressed pending steward Outreach | CLM-403707 (Andrea Riley) held until CASE-003085 is decided |
| Held | — | ||
| ACT-016530 | Outreach suppressed pending steward Outreach | CLM-403706 (Andrea Riley) held until CASE-003086 is decided |
| Held | — | ||
| ACT-016531 | Outreach suppressed pending steward Outreach | CLM-413105 (Henry Hanson) held until CASE-003087 is decided |
| Held | — | ||
| ACT-016532 | Outreach suppressed pending steward Outreach | CLM-411983 (Fuller Christian) held until CASE-003088 is decided |
| Held | — | ||
| ACT-016533 | Outreach suppressed pending steward Outreach | TPA-54681 (Lawrence Cunningham) held until CASE-003089 is decided |
| Held | — | ||
| ACT-016534 | Outreach suppressed pending steward Outreach | TPA-51422 (Omar Rios) held until CASE-003090 is decided |
| Held | — | ||
| ACT-016535 | Outreach suppressed pending steward Outreach | ENR-106049 (Donna Austin) held until CASE-003091 is decided |
| Held | — | ||
| ACT-016536 | Outreach suppressed pending steward Outreach | CLM-404583 (Donna Austin) held until CASE-003092 is decided |
| Held | — | ||
| ACT-016537 | Outreach suppressed pending steward Outreach | PRV-21943 (Priya Adams) held until CASE-003093 is decided |
| Held | — | ||
| ACT-016538 | Outreach suppressed pending steward Outreach | ENR-108678 (Priya Adams) held until CASE-003094 is decided |
| Held | — | ||
| ACT-016539 | Outreach suppressed pending steward Outreach | ENR-123792 (Mark Miller) held until CASE-003095 is decided |
| Held | — | ||
| ACT-016540 | Outreach suppressed pending steward Outreach | TPA-57996 (Mark Miller) held until CASE-003096 is decided |
| Held | — | ||
| ACT-016541 | Outreach suppressed pending steward Outreach | TPA-60043 (Eugene Anderson) held until CASE-003097 is decided |
| Held | — | ||
| ACT-016542 | Outreach suppressed pending steward Outreach | TPA-51941 (Obrien Joyce) held until CASE-003098 is decided |
| Held | — | ||
| ACT-016543 | Outreach suppressed pending steward Outreach | ENR-122807 (Ryan Washington) held until CASE-003099 is decided |
| Held | — | ||
| ACT-016544 | Outreach suppressed pending steward Outreach | TPA-57644 (Ryan Washington) held until CASE-003100 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.