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-016545 | Outreach suppressed pending steward Outreach | CLM-413441 (Bruce Garza) held until CASE-003101 is decided |
| Held | — | ||
| ACT-016546 | Outreach suppressed pending steward Outreach | ENR-111512 (Samuel Watkins) held until CASE-003102 is decided |
| Held | — | ||
| ACT-016547 | Outreach suppressed pending steward Outreach | CLM-413868 (Margaret Hunt) held until CASE-003103 is decided |
| Held | — | ||
| ACT-016548 | Outreach suppressed pending steward Outreach | TPA-56102 (Margaret Hunt) held until CASE-003104 is decided |
| Held | — | ||
| ACT-016549 | Outreach suppressed pending steward Outreach | PRV-26370 (Ethan Morgan) held until CASE-003105 is decided |
| Held | — | ||
| ACT-016550 | Outreach suppressed pending steward Outreach | ENR-128299 (Ethan Morgan) held until CASE-003106 is decided |
| Held | — | ||
| ACT-016551 | Outreach suppressed pending steward Outreach | TPA-58207 (Willie Miller) held until CASE-003107 is decided |
| Held | — | ||
| ACT-016552 | Outreach suppressed pending steward Outreach | TPA-58260 (Sam Oliver) held until CASE-003108 is decided |
| Held | — | ||
| ACT-016553 | Outreach suppressed pending steward Outreach | TPA-59559 (Laura Bennett) held until CASE-003109 is decided |
| Held | — | ||
| ACT-016554 | Outreach suppressed pending steward Outreach | TPA-57072 (Charles Marshall) held until CASE-003110 is decided |
| Held | — | ||
| ACT-016555 | Outreach suppressed pending steward Outreach | CLM-415311 (Jacqueline Harvey) held until CASE-003111 is decided |
| Held | — | ||
| ACT-016556 | Outreach suppressed pending steward Outreach | ENR-120183 (Jackie Harvey) held until CASE-003112 is decided |
| Held | — | ||
| ACT-016557 | Outreach suppressed pending steward Outreach | TPA-59808 (Ryn Reed) held until CASE-003113 is decided |
| Held | — | ||
| ACT-016558 | Outreach suppressed pending steward Outreach | PRV-21038 (Dennis Gardner) held until CASE-003114 is decided |
| Held | — | ||
| ACT-016559 | Outreach suppressed pending steward Outreach | CLM-403690 (Dennis Gardner) held until CASE-003115 is decided |
| Held | — | ||
| ACT-016560 | Outreach suppressed pending steward Outreach | CLM-418106 (Melissa Padilla) held until CASE-003116 is decided |
| Held | — | ||
| ACT-016561 | Outreach suppressed pending steward Outreach | ENR-123802 (Melissa Padilla) held until CASE-003117 is decided |
| Held | — | ||
| ACT-016562 | Outreach suppressed pending steward Outreach | ENR-104201 (Tyler Carroll) held until CASE-003118 is decided |
| Held | — | ||
| ACT-016563 | Outreach suppressed pending steward Outreach | PRV-20931 (Tyler Carroll) held until CASE-003119 is decided |
| Held | — | ||
| ACT-016564 | Outreach suppressed pending steward Outreach | TPA-64346 (Jnaet Hernandez) held until CASE-003120 is decided |
| Held | — | ||
| ACT-016565 | Outreach suppressed pending steward Outreach | ENR-142703 (Janet Hernandez) held until CASE-003121 is decided |
| Held | — | ||
| ACT-016566 | Outreach suppressed pending steward Outreach | TPA-64345 (Janet Hernandez) held until CASE-003122 is decided |
| Held | — | ||
| ACT-016567 | Outreach suppressed pending steward Outreach | CLM-414598 (Luis Jenkins) held until CASE-003123 is decided |
| Held | — | ||
| ACT-016568 | Outreach suppressed pending steward Outreach | TPA-54656 (Fatima McDonald) held until CASE-003124 is decided |
| Held | — | ||
| ACT-016569 | Outreach suppressed pending steward Outreach | CLM-410621 (Fatima McDonald) held until CASE-003125 is decided |
| Held | — | ||
| ACT-016570 | Outreach suppressed pending steward Outreach | ENR-128802 (Grace Taylor) held until CASE-003126 is decided |
| Held | — | ||
| ACT-016571 | Outreach suppressed pending steward Outreach | PRV-26483 (Grace Taylor) held until CASE-003127 is decided |
| Held | — | ||
| ACT-016572 | Outreach suppressed pending steward Outreach | CLM-403165 (Dylan Morris) held until CASE-003128 is decided |
| Held | — | ||
| ACT-016573 | Outreach suppressed pending steward Outreach | ENR-104104 (Dyln Morris) held until CASE-003129 is decided |
| Held | — | ||
| ACT-016574 | Outreach suppressed pending steward Outreach | TPA-54706 (Jose Munoz) held until CASE-003130 is decided |
| Held | — | ||
| ACT-016575 | Outreach suppressed pending steward Outreach | CLM-410721 (Jose Munoz) held until CASE-003131 is decided |
| Held | — | ||
| ACT-016576 | Outreach suppressed pending steward Outreach | CLM-423066 (Frank Diaz) held until CASE-003132 is decided |
| Held | — | ||
| ACT-016577 | Outreach suppressed pending steward Outreach | TPA-60137 (Frank Diaz) held until CASE-003133 is decided |
| Held | — | ||
| ACT-016578 | Outreach suppressed pending steward Outreach | TPA-61848 (Theresa Gonzales) held until CASE-003134 is decided |
| Held | — | ||
| ACT-016579 | Outreach suppressed pending steward Outreach | TPA-59140 (Nathan Salazar) held until CASE-003135 is decided |
| Held | — | ||
| ACT-016580 | Outreach suppressed pending steward Outreach | PRV-26153 (Nathan Salazar) held until CASE-003136 is decided |
| Held | — | ||
| ACT-016581 | Outreach suppressed pending steward Outreach | TPA-63154 (Julia Chapman) held until CASE-003137 is decided |
| Held | — | ||
| ACT-016582 | Outreach suppressed pending steward Outreach | TPA-63153 (Julia Chapman) held until CASE-003138 is decided |
| Held | — | ||
| ACT-016583 | Outreach suppressed pending steward Outreach | TPA-59891 (Emily Chapman) held until CASE-003139 is decided |
| Held | — | ||
| ACT-016584 | Outreach suppressed pending steward Outreach | CLM-422517 (Emily Chapman) held until CASE-003140 is decided |
| Held | — | ||
| ACT-016585 | Outreach suppressed pending steward Outreach | TPA-56531 (Dnise Harrison) held until CASE-003141 is decided |
| Held | — | ||
| ACT-016586 | Outreach suppressed pending steward Outreach | TPA-57231 (Olyvia Maldonado) held until CASE-003142 is decided |
| Held | — | ||
| ACT-016587 | Outreach suppressed pending steward Outreach | CLM-420686 (Debra Warren) held until CASE-003143 is decided |
| Held | — | ||
| ACT-016588 | Outreach suppressed pending steward Outreach | CLM-420687 (Debra Warren) held until CASE-003144 is decided |
| Held | — | ||
| ACT-016589 | Outreach suppressed pending steward Outreach | CLM-401608 (Abigil Jordan) held until CASE-003145 is decided |
| Held | — | ||
| ACT-016590 | Outreach suppressed pending steward Outreach | TPA-61443 (Diana Casttro) held until CASE-003146 is decided |
| Held | — | ||
| ACT-016591 | Outreach suppressed pending steward Outreach | CLM-401995 (Vincent Salazar) held until CASE-003147 is decided |
| Held | — | ||
| ACT-016592 | Outreach suppressed pending steward Outreach | ENR-102564 (Vincent Salazar) held until CASE-003148 is decided |
| Held | — | ||
| ACT-016593 | Outreach suppressed pending steward Outreach | TPA-60940 (Benjamin Henry) held until CASE-003149 is decided |
| Held | — | ||
| ACT-016594 | Outreach suppressed pending steward Outreach | CLM-409559 (Andrew Bennett) held until CASE-003150 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.