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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-018071 | Care coordination outreach Next-best-action | Sarah Nguyen: 6 claims, no attributed provider |
| Proposed | — | ||
| ACT-018072 | Care coordination outreach Next-best-action | Emily Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018073 | Care coordination outreach Next-best-action | Charlotte Edwards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018074 | Care coordination outreach Next-best-action | Kenneth George: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018075 | Care coordination outreach Next-best-action | Debra Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018076 | Care coordination outreach Next-best-action | Jeffrey Harrison: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018077 | Care coordination outreach Next-best-action | Scott Sims: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018078 | Care coordination outreach Next-best-action | James Richardson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018079 | Care coordination outreach Next-best-action | Larry Jones: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018080 | Care coordination outreach Next-best-action | Nancy Rios: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018081 | Care coordination outreach Next-best-action | Ryan Wright: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018082 | Care coordination outreach Next-best-action | Ann Gilbert: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018083 | Care coordination outreach Next-best-action | Russell Powell: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018084 | Care coordination outreach Next-best-action | Jason Phillips: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018085 | Care coordination outreach Next-best-action | Judy Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018086 | Care coordination outreach Next-best-action | Edward Delgado: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018087 | Care coordination outreach Next-best-action | Marcus Pierce: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018088 | Care coordination outreach Next-best-action | John Mendez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018089 | Care coordination outreach Next-best-action | Justin Snyder: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018090 | Care coordination outreach Next-best-action | Walter Rice: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018091 | Care coordination outreach Next-best-action | Frank Richards: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018092 | Care coordination outreach Next-best-action | Isabella Griffin: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018093 | Care coordination outreach Next-best-action | Charlotte Burns: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018094 | Care coordination outreach Next-best-action | Lori Luna: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018095 | Care coordination outreach Next-best-action | Ralph Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018096 | Care coordination outreach Next-best-action | Albert Larson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018097 | Care coordination outreach Next-best-action | Michael Holmes: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018098 | Care coordination outreach Next-best-action | Mark Washington: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018099 | Care coordination outreach Next-best-action | Gerald Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018100 | Care coordination outreach Next-best-action | Carol Peterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018101 | Care coordination outreach Next-best-action | Zachary Mitchell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018102 | Care coordination outreach Next-best-action | Michael Flores: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018103 | Care coordination outreach Next-best-action | Alexis Elliott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018104 | Care coordination outreach Next-best-action | Wei Garza: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018105 | Care coordination outreach Next-best-action | Abigail Scott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018106 | Care coordination outreach Next-best-action | Anna Scott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018107 | Care coordination outreach Next-best-action | Maria Warren: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018108 | Care coordination outreach Next-best-action | Sandra Banks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018109 | Care coordination outreach Next-best-action | Martha Harvey: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018110 | Care coordination outreach Next-best-action | Helen Patel: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018111 | Care coordination outreach Next-best-action | Eric Castro: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018112 | Care coordination outreach Next-best-action | Amy Lawrence: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018113 | Care coordination outreach Next-best-action | Mason Jacobs: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018114 | Care coordination outreach Next-best-action | Mary Maldonado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018115 | Care coordination outreach Next-best-action | Marilyn Dominguez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018116 | Care coordination outreach Next-best-action | Austin Johnson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018117 | Care coordination outreach Next-best-action | Joshua Campbell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018118 | Care coordination outreach Next-best-action | Mei Hart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018119 | Care coordination outreach Next-best-action | Mary Patel: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018120 | Care coordination outreach Next-best-action | Andrew Fields: 3 claims, no attributed provider |
| Proposed | — |
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.