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-016795 | Outreach suppressed pending steward Outreach | CLM-432247 (Frank Allen) held until CASE-003351 is decided |
| Held | — | ||
| ACT-016796 | Outreach suppressed pending steward Outreach | TPA-56193 (Brian Anderson) held until CASE-003352 is decided |
| Held | — | ||
| ACT-016797 | Outreach suppressed pending steward Outreach | ENR-100117 (Nicole Andrews) held until CASE-003353 is decided |
| Held | — | ||
| ACT-016798 | Outreach suppressed pending steward Outreach | CLM-414028 (Brian Anderson) held until CASE-003354 is decided |
| Held | — | ||
| ACT-016799 | Outreach suppressed pending steward Outreach | CLM-415211 (Lucia Holmes) held until CASE-003355 is decided |
| Held | — | ||
| ACT-016800 | Outreach suppressed pending steward Outreach | CLM-428016 (Jack Chen) held until CASE-003356 is decided |
| Held | — | ||
| ACT-016801 | Outreach suppressed pending steward Outreach | CLM-416725 (Joyce Cole) held until CASE-003357 is decided |
| Held | — | ||
| ACT-016802 | Outreach suppressed pending steward Outreach | CLM-431347 (Tyler Ortiz) held until CASE-003358 is decided |
| Held | — | ||
| ACT-016803 | Outreach suppressed pending steward Outreach | TPA-56921 (Randy Griffin) held until CASE-003359 is decided |
| Held | — | ||
| ACT-016804 | Outreach suppressed pending steward Outreach | CLM-414053 (Logan Wang) held until CASE-003360 is decided |
| Held | — | ||
| ACT-016805 | Outreach suppressed pending steward Outreach | CLM-402242 (Jesse Stewart) held until CASE-003361 is decided |
| Held | — | ||
| ACT-016806 | Outreach suppressed pending steward Outreach | CLM-428917 (Donald Cooper) held until CASE-003362 is decided |
| Held | — | ||
| ACT-016807 | Outreach suppressed pending steward Outreach | CLM-410252 (David Wheeler) held until CASE-003363 is decided |
| Held | — | ||
| ACT-016808 | Outreach suppressed pending steward Outreach | CLM-411727 (Karen Watsn) held until CASE-003364 is decided |
| Held | — | ||
| ACT-016809 | Outreach suppressed pending steward Outreach | ENR-115470 (Karen Watson) held until CASE-003365 is decided |
| Held | — | ||
| ACT-016810 | Outreach suppressed pending steward Outreach | CLM-401420 (Priya Li) held until CASE-003366 is decided |
| Held | — | ||
| ACT-016811 | Outreach suppressed pending steward Outreach | CLM-400981 (David Moreno) held until CASE-003367 is decided |
| Held | — | ||
| ACT-016812 | Outreach suppressed pending steward Outreach | TPA-60871 (Bradley Russell) held until CASE-003368 is decided |
| Held | — | ||
| ACT-016813 | Outreach suppressed pending steward Outreach | TPA-53779 (Harold Bailey) held until CASE-003369 is decided |
| Held | — | ||
| ACT-016814 | Outreach suppressed pending steward Outreach | ENR-119766 (Arjun Rojas) held until CASE-003370 is decided |
| Held | — | ||
| ACT-016815 | Outreach suppressed pending steward Outreach | CLM-411250 (Luis Watsno) held until CASE-003371 is decided |
| Held | — | ||
| ACT-016816 | Outreach suppressed pending steward Outreach | ENR-114796 (Luis Watson) held until CASE-003372 is decided |
| Held | — | ||
| ACT-016817 | Outreach suppressed pending steward Outreach | TPA-52253 (Martha Jones) held until CASE-003373 is decided |
| Held | — | ||
| ACT-016818 | Outreach suppressed pending steward Outreach | CLM-400971 (Beverly Gonzales) held until CASE-003374 is decided |
| Held | — | ||
| ACT-016819 | Outreach suppressed pending steward Outreach | TPA-54888 (Kenneth Fuller) held until CASE-003375 is decided |
| Held | — | ||
| ACT-016820 | Outreach suppressed pending steward Outreach | CLM-432671 (Ahmed Luna) held until CASE-003376 is decided |
| Held | — | ||
| ACT-016821 | Outreach suppressed pending steward Outreach | ENR-142888 (Ahmed Luna) held until CASE-003377 is decided |
| Held | — | ||
| ACT-016822 | Outreach suppressed pending steward Outreach | ENR-100105 (Natalie Salazar) held until CASE-003378 is decided |
| Held | — | ||
| ACT-016823 | Outreach suppressed pending steward Outreach | TPA-50026 (Natalie Salazar) held until CASE-003379 is decided |
| Held | — | ||
| ACT-016824 | Outreach suppressed pending steward Outreach | CLM-400076 (Natalie Salazar) held until CASE-003380 is decided |
| Held | — | ||
| ACT-016825 | Outreach suppressed pending steward Outreach | PRV-26033 (Mason Foster) held until CASE-003381 is decided |
| Held | — | ||
| ACT-016826 | Outreach suppressed pending steward Outreach | TPA-62096 (Mei Vasquez) held until CASE-003382 is decided |
| Held | — | ||
| ACT-016827 | Outreach suppressed pending steward Outreach | TPA-60834 (Carlos Hoffman) held until CASE-003383 is decided |
| Held | — | ||
| ACT-016828 | Outreach suppressed pending steward Outreach | ENR-141796 (Ryan Aguilar) held until CASE-003384 is decided |
| Held | — | ||
| ACT-016829 | Outreach suppressed pending steward Outreach | TPA-64044 (Ryan Aguilar) held until CASE-003385 is decided |
| Held | — | ||
| ACT-016830 | Outreach suppressed pending steward Outreach | CLM-414817 (Jeffrey Aguilar) held until CASE-003386 is decided |
| Held | — | ||
| ACT-016831 | Outreach suppressed pending steward Outreach | TPA-54421 (Ruth Herrera) held until CASE-003387 is decided |
| Held | — | ||
| ACT-016832 | Outreach suppressed pending steward Outreach | TPA-54420 (Ruth Herrera) held until CASE-003388 is decided |
| Held | — | ||
| ACT-016833 | Outreach suppressed pending steward Outreach | CLM-416434 (Ray Lynch) held until CASE-003389 is decided |
| Held | — | ||
| ACT-016834 | Outreach suppressed pending steward Outreach | CLM-401282 (Charlotte Guzman) held until CASE-003390 is decided |
| Held | — | ||
| ACT-016835 | Outreach suppressed pending steward Outreach | TPA-50389 (Marcus Wallace) held until CASE-003391 is decided |
| Held | — | ||
| ACT-016836 | Outreach suppressed pending steward Outreach | CLM-419734 (George Delgado) held until CASE-003392 is decided |
| Held | — | ||
| ACT-016837 | Outreach suppressed pending steward Outreach | CLM-406794 (Julie Pena) held until CASE-003393 is decided |
| Held | — | ||
| ACT-016838 | Outreach suppressed pending steward Outreach | PRV-21701 (Terry James) held until CASE-003394 is decided |
| Held | — | ||
| ACT-016839 | Outreach suppressed pending steward Outreach | CLM-418079 (Ann Webb) held until CASE-003395 is decided |
| Held | — | ||
| ACT-016840 | Outreach suppressed pending steward Outreach | TPA-57986 (Ann Webb) held until CASE-003396 is decided |
| Held | — | ||
| ACT-016841 | Outreach suppressed pending steward Outreach | CLM-416946 (Ralph Montgomery) held until CASE-003397 is decided |
| Held | — | ||
| ACT-016842 | Outreach suppressed pending steward Outreach | TPA-55835 (Katherine Gomez) held until CASE-003398 is decided |
| Held | — | ||
| ACT-016843 | Outreach suppressed pending steward Outreach | PRV-23850 (Katherine Gomez) held until CASE-003399 is decided |
| Held | — | ||
| ACT-016844 | Outreach suppressed pending steward Outreach | ENR-140130 (Kathryn Ray) held until CASE-003400 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.