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-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.