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-016645 | Outreach suppressed pending steward Outreach | PRV-25516 (Jesse Cunningham) held until CASE-003201 is decided |
| Held | — | ||
| ACT-016646 | Outreach suppressed pending steward Outreach | ENR-124479 (Jesse Cunningham) held until CASE-003202 is decided |
| Held | — | ||
| ACT-016647 | Outreach suppressed pending steward Outreach | CLM-413828 (Karen Gibson) held until CASE-003203 is decided |
| Held | — | ||
| ACT-016648 | Outreach suppressed pending steward Outreach | TPA-60987 (Henry Fisher) held until CASE-003204 is decided |
| Held | — | ||
| ACT-016649 | Outreach suppressed pending steward Outreach | CLM-405373 (Robert Hoffman) held until CASE-003205 is decided |
| Held | — | ||
| ACT-016650 | Outreach suppressed pending steward Outreach | TPA-59106 (Nicole Larson) held until CASE-003206 is decided |
| Held | — | ||
| ACT-016651 | Outreach suppressed pending steward Outreach | TPA-55969 (Mary Cox) held until CASE-003207 is decided |
| Held | — | ||
| ACT-016652 | Outreach suppressed pending steward Outreach | TPA-55968 (Mary Cox) held until CASE-003208 is decided |
| Held | — | ||
| ACT-016653 | Outreach suppressed pending steward Outreach | ENR-103710 (Catherine Cook) held until CASE-003209 is decided |
| Held | — | ||
| ACT-016654 | Outreach suppressed pending steward Outreach | ENR-123339 (Sophia Kelley) held until CASE-003210 is decided |
| Held | — | ||
| ACT-016655 | Outreach suppressed pending steward Outreach | CLM-417724 (Sophia Kelley) held until CASE-003211 is decided |
| Held | — | ||
| ACT-016656 | Outreach suppressed pending steward Outreach | ENR-115565 (Cynthiia Matthews) held until CASE-003212 is decided |
| Held | — | ||
| ACT-016657 | Outreach suppressed pending steward Outreach | TPA-55195 (Cynthia Maatthews) held until CASE-003213 is decided |
| Held | — | ||
| ACT-016658 | Outreach suppressed pending steward Outreach | TPA-62679 (Russell Bell) held until CASE-003214 is decided |
| Held | — | ||
| ACT-016659 | Outreach suppressed pending steward Outreach | ENR-128519 (Betty Jimenez) held until CASE-003215 is decided |
| Held | — | ||
| ACT-016660 | Outreach suppressed pending steward Outreach | TPA-59572 (Betty Jimenez) held until CASE-003216 is decided |
| Held | — | ||
| ACT-016661 | Outreach suppressed pending steward Outreach | ENR-111747 (Mracus Olson) held until CASE-003217 is decided |
| Held | — | ||
| ACT-016662 | Outreach suppressed pending steward Outreach | PRV-28611 (Harold Green) held until CASE-003218 is decided |
| Held | — | ||
| ACT-016663 | Outreach suppressed pending steward Outreach | PRV-26857 (Camila Kelly) held until CASE-003219 is decided |
| Held | — | ||
| ACT-016664 | Outreach suppressed pending steward Outreach | CLM-423212 (Camila Kelly) held until CASE-003220 is decided |
| Held | — | ||
| ACT-016665 | Outreach suppressed pending steward Outreach | ENR-104879 (Cheryl Scott) held until CASE-003221 is decided |
| Held | — | ||
| ACT-016666 | Outreach suppressed pending steward Outreach | ENR-136270 (Ann Salazar) held until CASE-003222 is decided |
| Held | — | ||
| ACT-016667 | Outreach suppressed pending steward Outreach | CLM-427678 (Ann Salazar) held until CASE-003223 is decided |
| Held | — | ||
| ACT-016668 | Outreach suppressed pending steward Outreach | CLM-417687 (Rebecca Salazar) held until CASE-003224 is decided |
| Held | — | ||
| ACT-016669 | Outreach suppressed pending steward Outreach | ENR-123301 (Rebecca Salazer) held until CASE-003225 is decided |
| Held | — | ||
| ACT-016670 | Outreach suppressed pending steward Outreach | ENR-125041 (Hannah Hoffman) held until CASE-003226 is decided |
| Held | — | ||
| ACT-016671 | Outreach suppressed pending steward Outreach | CLM-419006 (Hannaah Hoffman) held until CASE-003227 is decided |
| Held | — | ||
| ACT-016672 | Outreach suppressed pending steward Outreach | CLM-418332 (Tyler Hoffman) held until CASE-003228 is decided |
| Held | — | ||
| ACT-016673 | Outreach suppressed pending steward Outreach | CLM-425685 (Alexander Mason) held until CASE-003229 is decided |
| Held | — | ||
| ACT-016674 | Outreach suppressed pending steward Outreach | TPA-61338 (Alexander Mason) held until CASE-003230 is decided |
| Held | — | ||
| ACT-016675 | Outreach suppressed pending steward Outreach | CLM-418518 (Virginia Hudson) held until CASE-003231 is decided |
| Held | — | ||
| ACT-016676 | Outreach suppressed pending steward Outreach | TPA-52711 (Linda Gomez) held until CASE-003232 is decided |
| Held | — | ||
| ACT-016677 | Outreach suppressed pending steward Outreach | ENR-135542 (Albert Davis) held until CASE-003233 is decided |
| Held | — | ||
| ACT-016678 | Outreach suppressed pending steward Outreach | CLM-427107 (Albert Davis) held until CASE-003234 is decided |
| Held | — | ||
| ACT-016679 | Outreach suppressed pending steward Outreach | TPA-56739 (Jacike McCoy) held until CASE-003235 is decided |
| Held | — | ||
| ACT-016680 | Outreach suppressed pending steward Outreach | TPA-56740 (Jacqueline McCoy) held until CASE-003236 is decided |
| Held | — | ||
| ACT-016681 | Outreach suppressed pending steward Outreach | TPA-53237 (Brian Vazquez) held until CASE-003237 is decided |
| Held | — | ||
| ACT-016682 | Outreach suppressed pending steward Outreach | ENR-117343 (Noah Hawkins) held until CASE-003238 is decided |
| Held | — | ||
| ACT-016683 | Outreach suppressed pending steward Outreach | TPA-55813 (Noah Hawkins) held until CASE-003239 is decided |
| Held | — | ||
| ACT-016684 | Outreach suppressed pending steward Outreach | TPA-50889 (Thomas Harvey) held until CASE-003240 is decided |
| Held | — | ||
| ACT-016685 | Outreach suppressed pending steward Outreach | CLM-410929 (Alice Armstrong) held until CASE-003241 is decided |
| Held | — | ||
| ACT-016686 | Outreach suppressed pending steward Outreach | CLM-422733 (Heather Hart) held until CASE-003242 is decided |
| Held | — | ||
| ACT-016687 | Outreach suppressed pending steward Outreach | CLM-421024 (Justin Griffin) held until CASE-003243 is decided |
| Held | — | ||
| ACT-016688 | Outreach suppressed pending steward Outreach | TPA-62171 (Eric Simmons) held until CASE-003244 is decided |
| Held | — | ||
| ACT-016689 | Outreach suppressed pending steward Outreach | CLM-424897 (Frank Roberts) held until CASE-003245 is decided |
| Held | — | ||
| ACT-016690 | Outreach suppressed pending steward Outreach | CLM-427299 (Richard Graham) held until CASE-003246 is decided |
| Held | — | ||
| ACT-016691 | Outreach suppressed pending steward Outreach | ENR-118682 (Jason Greene) held until CASE-003247 is decided |
| Held | — | ||
| ACT-016692 | Outreach suppressed pending steward Outreach | CLM-414231 (Jason Greene) held until CASE-003248 is decided |
| Held | — | ||
| ACT-016693 | Outreach suppressed pending steward Outreach | ENR-121934 (Stephanie Arnold) held until CASE-003249 is decided |
| Held | — | ||
| ACT-016694 | Outreach suppressed pending steward Outreach | CLM-416701 (Stephanie Arnold) held until CASE-003250 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.