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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-016845 | Outreach suppressed pending steward Outreach | PRV-28939 (Kathryn Ray) held until CASE-003401 is decided |
| Held | — | ||
| ACT-016846 | Outreach suppressed pending steward Outreach | CLM-403358 (Jose Dixon) held until CASE-003402 is decided |
| Held | — | ||
| ACT-016847 | Outreach suppressed pending steward Outreach | TPA-60341 (Vincent Perry) held until CASE-003403 is decided |
| Held | — | ||
| ACT-016848 | Outreach suppressed pending steward Outreach | ENR-113386 (Katherine Romero) held until CASE-003404 is decided |
| Held | — | ||
| ACT-016849 | Outreach suppressed pending steward Outreach | CLM-410172 (Romero Katherine) held until CASE-003405 is decided |
| Held | — | ||
| ACT-016850 | Outreach suppressed pending steward Outreach | ENR-137879 (Madison Flores) held until CASE-003406 is decided |
| Held | — | ||
| ACT-016851 | Outreach suppressed pending steward Outreach | CLM-428889 (Madison Flores) held until CASE-003407 is decided |
| Held | — | ||
| ACT-016852 | Outreach suppressed pending steward Outreach | TPA-57965 (Kayla Turner) held until CASE-003408 is decided |
| Held | — | ||
| ACT-016853 | Outreach suppressed pending steward Outreach | ENR-111221 (Stephanie Turner) held until CASE-003409 is decided |
| Held | — | ||
| ACT-016854 | Outreach suppressed pending steward Outreach | TPA-51232 (Stephen Ray) held until CASE-003410 is decided |
| Held | — | ||
| ACT-016855 | Outreach suppressed pending steward Outreach | ENR-140853 (Laura Cruz) held until CASE-003411 is decided |
| Held | — | ||
| ACT-016856 | Outreach suppressed pending steward Outreach | ENR-136110 (Donald Mendez) held until CASE-003412 is decided |
| Held | — | ||
| ACT-016857 | Outreach suppressed pending steward Outreach | PRV-28070 (Donald Mendez) held until CASE-003413 is decided |
| Held | — | ||
| ACT-016858 | Outreach suppressed pending steward Outreach | CLM-407119 (Frank Bowman) held until CASE-003414 is decided |
| Held | — | ||
| ACT-016859 | Outreach suppressed pending steward Outreach | CLM-410355 (Pamela Richards) held until CASE-003415 is decided |
| Held | — | ||
| ACT-016860 | Outreach suppressed pending steward Outreach | TPA-53288 (Teresa Hansen) held until CASE-003416 is decided |
| Held | — | ||
| ACT-016861 | Outreach suppressed pending steward Outreach | TPA-53287 (Teresa Hansen) held until CASE-003417 is decided |
| Held | — | ||
| ACT-016862 | Outreach suppressed pending steward Outreach | TPA-54301 (Charlotte Greene) held until CASE-003418 is decided |
| Held | — | ||
| ACT-016863 | Outreach suppressed pending steward Outreach | ENR-112994 (Charlotte Greene) held until CASE-003419 is decided |
| Held | — | ||
| ACT-016864 | Outreach suppressed pending steward Outreach | CLM-416650 (Christine Smipson) held until CASE-003420 is decided |
| Held | — | ||
| ACT-016865 | Outreach suppressed pending steward Outreach | ENR-141667 (Diego Larsun) held until CASE-003421 is decided |
| Held | — | ||
| ACT-016866 | Outreach suppressed pending steward Outreach | CLM-431767 (Diego Larson) held until CASE-003422 is decided |
| Held | — | ||
| ACT-016867 | Outreach suppressed pending steward Outreach | CLM-424879 (Masno Price) held until CASE-003423 is decided |
| Held | — | ||
| ACT-016868 | Outreach suppressed pending steward Outreach | TPA-63404 (Arthur Burns) held until CASE-003424 is decided |
| Held | — | ||
| ACT-016869 | Outreach suppressed pending steward Outreach | CLM-400037 (Donna Hunter) held until CASE-003425 is decided |
| Held | — | ||
| ACT-016870 | Outreach suppressed pending steward Outreach | TPA-59309 (Gabriel Castro) held until CASE-003426 is decided |
| Held | — | ||
| ACT-016871 | Outreach suppressed pending steward Outreach | CLM-413971 (Kelly Duncan) held until CASE-003427 is decided |
| Held | — | ||
| ACT-016872 | Outreach suppressed pending steward Outreach | TPA-56364 (Linda Patterson) held until CASE-003428 is decided |
| Held | — | ||
| ACT-016873 | Outreach suppressed pending steward Outreach | CLM-414433 (Donna Jacobs) held until CASE-003429 is decided |
| Held | — | ||
| ACT-016874 | Outreach suppressed pending steward Outreach | ENR-132437 (Alan Dean) held until CASE-003430 is decided |
| Held | — | ||
| ACT-016875 | Outreach suppressed pending steward Outreach | CLM-424840 (Alan Dean) held until CASE-003431 is decided |
| Held | — | ||
| ACT-016876 | Outreach suppressed pending steward Outreach | ENR-115782 (Julie Bowman) held until CASE-003432 is decided |
| Held | — | ||
| ACT-016877 | Outreach suppressed pending steward Outreach | TPA-62510 (Jerry Snyder) held until CASE-003433 is decided |
| Held | — | ||
| ACT-016878 | Outreach suppressed pending steward Outreach | CLM-428328 (Jerry Snyder) held until CASE-003434 is decided |
| Held | — | ||
| ACT-016879 | Outreach suppressed pending steward Outreach | CLM-425226 (Jose Matthews) held until CASE-003435 is decided |
| Held | — | ||
| ACT-016880 | Outreach suppressed pending steward Outreach | PRV-27411 (Jose Matthews) held until CASE-003436 is decided |
| Held | — | ||
| ACT-016881 | Outreach suppressed pending steward Outreach | TPA-54893 (Patrick Alexander) held until CASE-003437 is decided |
| Held | — | ||
| ACT-016882 | Outreach suppressed pending steward Outreach | ENR-130816 (Ryan Cox) held until CASE-003438 is decided |
| Held | — | ||
| ACT-016883 | Outreach suppressed pending steward Outreach | TPA-60365 (Ryan Cox) held until CASE-003439 is decided |
| Held | — | ||
| ACT-016884 | Outreach suppressed pending steward Outreach | PRV-26297 (Dyln Bowman) held until CASE-003440 is decided |
| Held | — | ||
| ACT-016885 | Outreach suppressed pending steward Outreach | TPA-57538 (Russell Matthews) held until CASE-003441 is decided |
| Held | — | ||
| ACT-016886 | Outreach suppressed pending steward Outreach | CLM-409800 (Santiago Munoz) held until CASE-003442 is decided |
| Held | — | ||
| ACT-016887 | Outreach suppressed pending steward Outreach | PRV-28853 (Austin Miller) held until CASE-003443 is decided |
| Held | — | ||
| ACT-016888 | Outreach suppressed pending steward Outreach | CLM-405038 (Carlos Young) held until CASE-003444 is decided |
| Held | — | ||
| ACT-016889 | Outreach suppressed pending steward Outreach | ENR-125231 (Eugene Bell) held until CASE-003445 is decided |
| Held | — | ||
| ACT-016890 | Outreach suppressed pending steward Outreach | CLM-419150 (Eugene Bell) held until CASE-003446 is decided |
| Held | — | ||
| ACT-016891 | Outreach suppressed pending steward Outreach | TPA-56035 (Christian Burton) held until CASE-003447 is decided |
| Held | — | ||
| ACT-016892 | Outreach suppressed pending steward Outreach | PRV-20491 (Gloria Chapman) held until CASE-003448 is decided |
| Held | — | ||
| ACT-016893 | Outreach suppressed pending steward Outreach | CLM-425551 (Nancy Vaga) held until CASE-003449 is decided |
| Held | — | ||
| ACT-016894 | Outreach suppressed pending steward Outreach | CLM-401064 (Danielle Harper) held until CASE-003450 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.