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-016595 | Outreach suppressed pending steward Outreach | CLM-421530 (Omar Webb) held until CASE-003151 is decided |
| Held | — | ||
| ACT-016596 | Outreach suppressed pending steward Outreach | CLM-421529 (Omar Webb) held until CASE-003152 is decided |
| Held | — | ||
| ACT-016597 | Outreach suppressed pending steward Outreach | TPA-56434 (Jonathan Carter) held until CASE-003153 is decided |
| Held | — | ||
| ACT-016598 | Outreach suppressed pending steward Outreach | TPA-56435 (Jonathan Carter) held until CASE-003154 is decided |
| Held | — | ||
| ACT-016599 | Outreach suppressed pending steward Outreach | CLM-419813 (Jordan Sims) held until CASE-003155 is decided |
| Held | — | ||
| ACT-016600 | Outreach suppressed pending steward Outreach | TPA-58741 (Jordan Siims) held until CASE-003156 is decided |
| Held | — | ||
| ACT-016601 | Outreach suppressed pending steward Outreach | ENR-117556 (Mills Ana) held until CASE-003157 is decided |
| Held | — | ||
| ACT-016602 | Outreach suppressed pending steward Outreach | TPA-57897 (Keith Myers) held until CASE-003158 is decided |
| Held | — | ||
| ACT-016603 | Outreach suppressed pending steward Outreach | CLM-431989 (Austin Hansen) held until CASE-003159 is decided |
| Held | — | ||
| ACT-016604 | Outreach suppressed pending steward Outreach | CLM-431988 (Austin Hansen) held until CASE-003160 is decided |
| Held | — | ||
| ACT-016605 | Outreach suppressed pending steward Outreach | TPA-51641 (Mariana Bradley) held until CASE-003161 is decided |
| Held | — | ||
| ACT-016606 | Outreach suppressed pending steward Outreach | ENR-123814 (Jason Bryant) held until CASE-003162 is decided |
| Held | — | ||
| ACT-016607 | Outreach suppressed pending steward Outreach | CLM-426027 (John Hayes) held until CASE-003163 is decided |
| Held | — | ||
| ACT-016608 | Outreach suppressed pending steward Outreach | TPA-62142 (Julia Walsh) held until CASE-003164 is decided |
| Held | — | ||
| ACT-016609 | Outreach suppressed pending steward Outreach | TPA-62184 (Marcus Richardson) held until CASE-003165 is decided |
| Held | — | ||
| ACT-016610 | Outreach suppressed pending steward Outreach | TPA-51779 (Beverly Fuller) held until CASE-003166 is decided |
| Held | — | ||
| ACT-016611 | Outreach suppressed pending steward Outreach | PRV-24529 (George Hall) held until CASE-003167 is decided |
| Held | — | ||
| ACT-016612 | Outreach suppressed pending steward Outreach | ENR-135648 (Isabella Shaw) held until CASE-003168 is decided |
| Held | — | ||
| ACT-016613 | Outreach suppressed pending steward Outreach | TPA-62013 (Isabella Shaw) held until CASE-003169 is decided |
| Held | — | ||
| ACT-016614 | Outreach suppressed pending steward Outreach | CLM-422008 (Ruth Sandoval) held until CASE-003170 is decided |
| Held | — | ||
| ACT-016615 | Outreach suppressed pending steward Outreach | CLM-427313 (Brenda Stewart) held until CASE-003171 is decided |
| Held | — | ||
| ACT-016616 | Outreach suppressed pending steward Outreach | ENR-102241 (Joe Stewart) held until CASE-003172 is decided |
| Held | — | ||
| ACT-016617 | Outreach suppressed pending steward Outreach | TPA-54220 (Samantha Patterson) held until CASE-003173 is decided |
| Held | — | ||
| ACT-016618 | Outreach suppressed pending steward Outreach | TPA-57646 (Lori Obrien) held until CASE-003174 is decided |
| Held | — | ||
| ACT-016619 | Outreach suppressed pending steward Outreach | CLM-417315 (Lori Obrien) held until CASE-003175 is decided |
| Held | — | ||
| ACT-016620 | Outreach suppressed pending steward Outreach | ENR-114031 (Ashley Ford) held until CASE-003176 is decided |
| Held | — | ||
| ACT-016621 | Outreach suppressed pending steward Outreach | TPA-54691 (Ashley Ford) held until CASE-003177 is decided |
| Held | — | ||
| ACT-016622 | Outreach suppressed pending steward Outreach | CLM-404114 (Marcus Espinoza) held until CASE-003178 is decided |
| Held | — | ||
| ACT-016623 | Outreach suppressed pending steward Outreach | ENR-105385 (Marcus Espinoza) held until CASE-003179 is decided |
| Held | — | ||
| ACT-016624 | Outreach suppressed pending steward Outreach | TPA-59493 (Austin Bishop) held until CASE-003180 is decided |
| Held | — | ||
| ACT-016625 | Outreach suppressed pending steward Outreach | ENR-128283 (Austin Bishop) held until CASE-003181 is decided |
| Held | — | ||
| ACT-016626 | Outreach suppressed pending steward Outreach | ENR-103225 (Olivia Hunt) held until CASE-003182 is decided |
| Held | — | ||
| ACT-016627 | Outreach suppressed pending steward Outreach | CLM-408862 (Logan Santos) held until CASE-003183 is decided |
| Held | — | ||
| ACT-016628 | Outreach suppressed pending steward Outreach | ENR-111705 (Logan Santos) held until CASE-003184 is decided |
| Held | — | ||
| ACT-016629 | Outreach suppressed pending steward Outreach | TPA-51784 (Ahmed Robertson) held until CASE-003185 is decided |
| Held | — | ||
| ACT-016630 | Outreach suppressed pending steward Outreach | ENR-103970 (Phlip Reynolds) held until CASE-003186 is decided |
| Held | — | ||
| ACT-016631 | Outreach suppressed pending steward Outreach | CLM-403069 (Philip Reynolds) held until CASE-003187 is decided |
| Held | — | ||
| ACT-016632 | Outreach suppressed pending steward Outreach | ENR-120446 (Raymond Johnston) held until CASE-003188 is decided |
| Held | — | ||
| ACT-016633 | Outreach suppressed pending steward Outreach | CLM-429983 (Julie Romero) held until CASE-003189 is decided |
| Held | — | ||
| ACT-016634 | Outreach suppressed pending steward Outreach | CLM-427537 (Mei Lane) held until CASE-003190 is decided |
| Held | — | ||
| ACT-016635 | Outreach suppressed pending steward Outreach | CLM-427539 (Mei Lane) held until CASE-003191 is decided |
| Held | — | ||
| ACT-016636 | Outreach suppressed pending steward Outreach | CLM-426886 (Martha McDonald) held until CASE-003192 is decided |
| Held | — | ||
| ACT-016637 | Outreach suppressed pending steward Outreach | TPA-51513 (Hiroshi Wood) held until CASE-003193 is decided |
| Held | — | ||
| ACT-016638 | Outreach suppressed pending steward Outreach | TPA-60052 (Scott Maldonado) held until CASE-003194 is decided |
| Held | — | ||
| ACT-016639 | Outreach suppressed pending steward Outreach | CLM-423249 (Daniel Crawford) held until CASE-003195 is decided |
| Held | — | ||
| ACT-016640 | Outreach suppressed pending steward Outreach | TPA-60219 (Daniel Crawford) held until CASE-003196 is decided |
| Held | — | ||
| ACT-016641 | Outreach suppressed pending steward Outreach | CLM-431211 (Arjun Crawford) held until CASE-003197 is decided |
| Held | — | ||
| ACT-016642 | Outreach suppressed pending steward Outreach | TPA-52261 (Gregory Hunt) held until CASE-003198 is decided |
| Held | — | ||
| ACT-016643 | Outreach suppressed pending steward Outreach | CLM-418467 (Brittany Rios) held until CASE-003199 is decided |
| Held | — | ||
| ACT-016644 | Outreach suppressed pending steward Outreach | PRV-20910 (Christian Lawson) held until CASE-003200 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.