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-016745 | Outreach suppressed pending steward Outreach | CLM-405376 (Jeffrey Valdez) held until CASE-003301 is decided |
| Held | — | ||
| ACT-016746 | Outreach suppressed pending steward Outreach | ENR-107051 (Jeffrey Valdez) held until CASE-003302 is decided |
| Held | — | ||
| ACT-016747 | Outreach suppressed pending steward Outreach | CLM-426291 (Ronald Li) held until CASE-003303 is decided |
| Held | — | ||
| ACT-016748 | Outreach suppressed pending steward Outreach | CLM-408830 (Gregroy Parker) held until CASE-003304 is decided |
| Held | — | ||
| ACT-016749 | Outreach suppressed pending steward Outreach | TPA-54751 (Dylan Larson) held until CASE-003305 is decided |
| Held | — | ||
| ACT-016750 | Outreach suppressed pending steward Outreach | CLM-428006 (Joan Young) held until CASE-003306 is decided |
| Held | — | ||
| ACT-016751 | Outreach suppressed pending steward Outreach | ENR-136717 (Joan Young) held until CASE-003307 is decided |
| Held | — | ||
| ACT-016752 | Outreach suppressed pending steward Outreach | TPA-53697 (Jacqueline Adams) held until CASE-003308 is decided |
| Held | — | ||
| ACT-016753 | Outreach suppressed pending steward Outreach | CLM-420005 (Angela Sims) held until CASE-003309 is decided |
| Held | — | ||
| ACT-016754 | Outreach suppressed pending steward Outreach | PRV-26239 (Brittany Sims) held until CASE-003310 is decided |
| Held | — | ||
| ACT-016755 | Outreach suppressed pending steward Outreach | TPA-55583 (Jacqueline Simpson) held until CASE-003311 is decided |
| Held | — | ||
| ACT-016756 | Outreach suppressed pending steward Outreach | ENR-116674 (Jackie Simpson) held until CASE-003312 is decided |
| Held | — | ||
| ACT-016757 | Outreach suppressed pending steward Outreach | ENR-109177 (Judith Hamilton) held until CASE-003313 is decided |
| Held | — | ||
| ACT-016758 | Outreach suppressed pending steward Outreach | TPA-53081 (Judith Hamilton) held until CASE-003314 is decided |
| Held | — | ||
| ACT-016759 | Outreach suppressed pending steward Outreach | CLM-411735 (Juan Kelly) held until CASE-003315 is decided |
| Held | — | ||
| ACT-016760 | Outreach suppressed pending steward Outreach | PRV-26836 (Shirley Fields) held until CASE-003316 is decided |
| Held | — | ||
| ACT-016761 | Outreach suppressed pending steward Outreach | TPA-54808 (Melissa Sims) held until CASE-003317 is decided |
| Held | — | ||
| ACT-016762 | Outreach suppressed pending steward Outreach | TPA-54807 (Melissa Sims) held until CASE-003318 is decided |
| Held | — | ||
| ACT-016763 | Outreach suppressed pending steward Outreach | PRV-22922 (Sharon Ellis) held until CASE-003319 is decided |
| Held | — | ||
| ACT-016764 | Outreach suppressed pending steward Outreach | CLM-402453 (Kelly Miller) held until CASE-003320 is decided |
| Held | — | ||
| ACT-016765 | Outreach suppressed pending steward Outreach | CLM-420932 (Jessica Romero) held until CASE-003321 is decided |
| Held | — | ||
| ACT-016766 | Outreach suppressed pending steward Outreach | CLM-420934 (Jessica Roemro) held until CASE-003322 is decided |
| Held | — | ||
| ACT-016767 | Outreach suppressed pending steward Outreach | ENR-124735 (Brian Warren) held until CASE-003323 is decided |
| Held | — | ||
| ACT-016768 | Outreach suppressed pending steward Outreach | PRV-25588 (Brian Warren) held until CASE-003324 is decided |
| Held | — | ||
| ACT-016769 | Outreach suppressed pending steward Outreach | CLM-428620 (Valentina Scott) held until CASE-003325 is decided |
| Held | — | ||
| ACT-016770 | Outreach suppressed pending steward Outreach | CLM-411750 (Jessica Jones) held until CASE-003326 is decided |
| Held | — | ||
| ACT-016771 | Outreach suppressed pending steward Outreach | ENR-115496 (Jessica Jones) held until CASE-003327 is decided |
| Held | — | ||
| ACT-016772 | Outreach suppressed pending steward Outreach | TPA-63478 (Tony Johnston) held until CASE-003328 is decided |
| Held | — | ||
| ACT-016773 | Outreach suppressed pending steward Outreach | ENR-106340 (Chuck Peterson) held until CASE-003329 is decided |
| Held | — | ||
| ACT-016774 | Outreach suppressed pending steward Outreach | ENR-138419 (Amber Fowler) held until CASE-003330 is decided |
| Held | — | ||
| ACT-016775 | Outreach suppressed pending steward Outreach | TPA-62947 (Amber Fowler) held until CASE-003331 is decided |
| Held | — | ||
| ACT-016776 | Outreach suppressed pending steward Outreach | TPA-57624 (Adam Dunn) held until CASE-003332 is decided |
| Held | — | ||
| ACT-016777 | Outreach suppressed pending steward Outreach | CLM-418580 (Samuel Santiago) held until CASE-003333 is decided |
| Held | — | ||
| ACT-016778 | Outreach suppressed pending steward Outreach | TPA-62644 (Aisha Rojas) held until CASE-003334 is decided |
| Held | — | ||
| ACT-016779 | Outreach suppressed pending steward Outreach | CLM-411477 (Christina Maldonado) held until CASE-003335 is decided |
| Held | — | ||
| ACT-016780 | Outreach suppressed pending steward Outreach | CLM-401884 (Sean Ramirez) held until CASE-003336 is decided |
| Held | — | ||
| ACT-016781 | Outreach suppressed pending steward Outreach | ENR-102432 (Sean Ramirez) held until CASE-003337 is decided |
| Held | — | ||
| ACT-016782 | Outreach suppressed pending steward Outreach | CLM-422062 (Janet Aguilar) held until CASE-003338 is decided |
| Held | — | ||
| ACT-016783 | Outreach suppressed pending steward Outreach | TPA-61749 (Theresa Rios) held until CASE-003339 is decided |
| Held | — | ||
| ACT-016784 | Outreach suppressed pending steward Outreach | CLM-410452 (Charlotte Warren) held until CASE-003340 is decided |
| Held | — | ||
| ACT-016785 | Outreach suppressed pending steward Outreach | PRV-22988 (Keith Torres) held until CASE-003341 is decided |
| Held | — | ||
| ACT-016786 | Outreach suppressed pending steward Outreach | TPA-56521 (Janet Shw) held until CASE-003342 is decided |
| Held | — | ||
| ACT-016787 | Outreach suppressed pending steward Outreach | CLM-414806 (Janet Shaw) held until CASE-003343 is decided |
| Held | — | ||
| ACT-016788 | Outreach suppressed pending steward Outreach | TPA-54006 (Olivia Ramos) held until CASE-003344 is decided |
| Held | — | ||
| ACT-016789 | Outreach suppressed pending steward Outreach | CLM-413400 (Lauren Shaw) held until CASE-003345 is decided |
| Held | — | ||
| ACT-016790 | Outreach suppressed pending steward Outreach | PRV-21877 (Ruth McCoy) held until CASE-003346 is decided |
| Held | — | ||
| ACT-016791 | Outreach suppressed pending steward Outreach | ENR-108428 (Ruht McCoy) held until CASE-003347 is decided |
| Held | — | ||
| ACT-016792 | Outreach suppressed pending steward Outreach | TPA-60938 (Karen Perez) held until CASE-003348 is decided |
| Held | — | ||
| ACT-016793 | Outreach suppressed pending steward Outreach | CLM-429702 (Henry King) held until CASE-003349 is decided |
| Held | — | ||
| ACT-016794 | Outreach suppressed pending steward Outreach | PRV-28696 (Henry King) held until CASE-003350 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.