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-013745 | Outreach suppressed pending steward Outreach | PRV-28949 (Denise Thomas) held until CASE-000301 is decided |
| Held | — | ||
| ACT-013746 | Outreach suppressed pending steward Outreach | TPA-64320 (Katherine Ross) held until CASE-000302 is decided |
| Held | — | ||
| ACT-013747 | Outreach suppressed pending steward Outreach | CLM-405416 (Roger Carroll) held until CASE-000303 is decided |
| Held | — | ||
| ACT-013748 | Outreach suppressed pending steward Outreach | TPA-51794 (Brenda Cook) held until CASE-000304 is decided |
| Held | — | ||
| ACT-013749 | Outreach suppressed pending steward Outreach | ENR-105421 (Brenda Cook) held until CASE-000305 is decided |
| Held | — | ||
| ACT-013750 | Outreach suppressed pending steward Outreach | ENR-140647 (Eric Flores) held until CASE-000306 is decided |
| Held | — | ||
| ACT-013751 | Outreach suppressed pending steward Outreach | CLM-430948 (Eric Flores) held until CASE-000307 is decided |
| Held | — | ||
| ACT-013752 | Outreach suppressed pending steward Outreach | CLM-427986 (George Myers) held until CASE-000308 is decided |
| Held | — | ||
| ACT-013753 | Outreach suppressed pending steward Outreach | PRV-29371 (Abigail Webb) held until CASE-000309 is decided |
| Held | — | ||
| ACT-013754 | Outreach suppressed pending steward Outreach | PRV-21286 (Nicole Smith) held until CASE-000310 is decided |
| Held | — | ||
| ACT-013755 | Outreach suppressed pending steward Outreach | ENR-135258 (Ahmed Willis) held until CASE-000311 is decided |
| Held | — | ||
| ACT-013756 | Outreach suppressed pending steward Outreach | TPA-56245 (Diego Ellis) held until CASE-000312 is decided |
| Held | — | ||
| ACT-013757 | Outreach suppressed pending steward Outreach | CLM-430147 (Fatima Anderson) held until CASE-000313 is decided |
| Held | — | ||
| ACT-013758 | Outreach suppressed pending steward Outreach | TPA-63307 (Fatima Anderson) held until CASE-000314 is decided |
| Held | — | ||
| ACT-013759 | Outreach suppressed pending steward Outreach | CLM-430146 (Fatima Anderson) held until CASE-000315 is decided |
| Held | — | ||
| ACT-013760 | Outreach suppressed pending steward Outreach | CLM-425041 (Mei Bailey) held until CASE-000316 is decided |
| Held | — | ||
| ACT-013761 | Outreach suppressed pending steward Outreach | CLM-400605 (Marcus Hall) held until CASE-000317 is decided |
| Held | — | ||
| ACT-013762 | Outreach suppressed pending steward Outreach | CLM-420063 (James Wilson) held until CASE-000318 is decided |
| Held | — | ||
| ACT-013763 | Outreach suppressed pending steward Outreach | CLM-420064 (James Wilson) held until CASE-000319 is decided |
| Held | — | ||
| ACT-013764 | Outreach suppressed pending steward Outreach | TPA-55242 (Keith Mills) held until CASE-000320 is decided |
| Held | — | ||
| ACT-013765 | Outreach suppressed pending steward Outreach | TPA-54317 (Charlotte Miills) held until CASE-000321 is decided |
| Held | — | ||
| ACT-013766 | Outreach suppressed pending steward Outreach | TPA-57467 (Nathan Gonzales) held until CASE-000322 is decided |
| Held | — | ||
| ACT-013767 | Outreach suppressed pending steward Outreach | CLM-412461 (Joyce Guzman) held until CASE-000323 is decided |
| Held | — | ||
| ACT-013768 | Outreach suppressed pending steward Outreach | CLM-429409 (Martha Carpenter) held until CASE-000324 is decided |
| Held | — | ||
| ACT-013769 | Outreach suppressed pending steward Outreach | TPA-61595 (Jack Brooks) held until CASE-000325 is decided |
| Held | — | ||
| ACT-013770 | Outreach suppressed pending steward Outreach | TPA-57131 (Elizabeth Li) held until CASE-000326 is decided |
| Held | — | ||
| ACT-013771 | Outreach suppressed pending steward Outreach | ENR-123676 (Joan Robertson) held until CASE-000327 is decided |
| Held | — | ||
| ACT-013772 | Outreach suppressed pending steward Outreach | CLM-417999 (Joan Robertson) held until CASE-000328 is decided |
| Held | — | ||
| ACT-013773 | Outreach suppressed pending steward Outreach | CLM-414227 (Jesse Reyes) held until CASE-000329 is decided |
| Held | — | ||
| ACT-013774 | Outreach suppressed pending steward Outreach | CLM-416990 (Douglas Howell) held until CASE-000330 is decided |
| Held | — | ||
| ACT-013775 | Outreach suppressed pending steward Outreach | ENR-121429 (Julia Hall) held until CASE-000331 is decided |
| Held | — | ||
| ACT-013776 | Outreach suppressed pending steward Outreach | TPA-57684 (Melissa Edwards) held until CASE-000332 is decided |
| Held | — | ||
| ACT-013777 | Outreach suppressed pending steward Outreach | TPA-51166 (Jordan McDonald) held until CASE-000333 is decided |
| Held | — | ||
| ACT-013778 | Outreach suppressed pending steward Outreach | CLM-411519 (Rachel Harrison) held until CASE-000334 is decided |
| Held | — | ||
| ACT-013779 | Outreach suppressed pending steward Outreach | CLM-414233 (Adam Green) held until CASE-000335 is decided |
| Held | — | ||
| ACT-013780 | Outreach suppressed pending steward Outreach | TPA-63082 (Benjamin Hudson) held until CASE-000336 is decided |
| Held | — | ||
| ACT-013781 | Outreach suppressed pending steward Outreach | CLM-429605 (Benjamin Hudson) held until CASE-000337 is decided |
| Held | — | ||
| ACT-013782 | Outreach suppressed pending steward Outreach | PRV-25360 (Richard Harrison) held until CASE-000338 is decided |
| Held | — | ||
| ACT-013783 | Outreach suppressed pending steward Outreach | TPA-57975 (Richard Harrison) held until CASE-000339 is decided |
| Held | — | ||
| ACT-013784 | Outreach suppressed pending steward Outreach | ENR-100706 (Isabella Harrison) held until CASE-000340 is decided |
| Held | — | ||
| ACT-013785 | Outreach suppressed pending steward Outreach | TPA-50222 (Isabella Harrison) held until CASE-000341 is decided |
| Held | — | ||
| ACT-013786 | Outreach suppressed pending steward Outreach | CLM-431641 (Christian Wells) held until CASE-000342 is decided |
| Held | — | ||
| ACT-013787 | Outreach suppressed pending steward Outreach | TPA-60402 (Austin Kelly) held until CASE-000343 is decided |
| Held | — | ||
| ACT-013788 | Outreach suppressed pending steward Outreach | PRV-26969 (Austin Kelly) held until CASE-000344 is decided |
| Held | — | ||
| ACT-013789 | Outreach suppressed pending steward Outreach | ENR-130915 (Austin Kelly) held until CASE-000345 is decided |
| Held | — | ||
| ACT-013790 | Outreach suppressed pending steward Outreach | PRV-28442 (Lawrence Yang) held until CASE-000346 is decided |
| Held | — | ||
| ACT-013791 | Outreach suppressed pending steward Outreach | ENR-136923 (Aisha Stevens) held until CASE-000347 is decided |
| Held | — | ||
| ACT-013792 | Outreach suppressed pending steward Outreach | TPA-62963 (Valentina Stevens) held until CASE-000348 is decided |
| Held | — | ||
| ACT-013793 | Outreach suppressed pending steward Outreach | PRV-25721 (Shirley Wheeler) held until CASE-000349 is decided |
| Held | — | ||
| ACT-013794 | Outreach suppressed pending steward Outreach | TPA-58503 (Shirley Wheeler) held until CASE-000350 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.