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-016895 | Outreach suppressed pending steward Outreach | CLM-401063 (Danielle Harper) held until CASE-003451 is decided |
| Held | — | ||
| ACT-016896 | Outreach suppressed pending steward Outreach | TPA-62711 (Joan Coleman) held until CASE-003452 is decided |
| Held | — | ||
| ACT-016897 | Outreach suppressed pending steward Outreach | ENR-100197 (Aaron Medina) held until CASE-003453 is decided |
| Held | — | ||
| ACT-016898 | Outreach suppressed pending steward Outreach | TPA-50054 (Aaron Medina) held until CASE-003454 is decided |
| Held | — | ||
| ACT-016899 | Outreach suppressed pending steward Outreach | CLM-405377 (Mary Ramirez) held until CASE-003455 is decided |
| Held | — | ||
| ACT-016900 | Outreach suppressed pending steward Outreach | TPA-52357 (Mery Ramirez) held until CASE-003456 is decided |
| Held | — | ||
| ACT-016901 | Outreach suppressed pending steward Outreach | CLM-400923 (Betty Howard) held until CASE-003457 is decided |
| Held | — | ||
| ACT-016902 | Outreach suppressed pending steward Outreach | TPA-50423 (Betty Howard) held until CASE-003458 is decided |
| Held | — | ||
| ACT-016903 | Outreach suppressed pending steward Outreach | CLM-417666 (Frank James) held until CASE-003459 is decided |
| Held | — | ||
| ACT-016904 | Outreach suppressed pending steward Outreach | CLM-417665 (Frank James) held until CASE-003460 is decided |
| Held | — | ||
| ACT-016905 | Outreach suppressed pending steward Outreach | PRV-20154 (Joseph Jordan) held until CASE-003461 is decided |
| Held | — | ||
| ACT-016906 | Outreach suppressed pending steward Outreach | TPA-61540 (Hiroshi Garza) held until CASE-003462 is decided |
| Held | — | ||
| ACT-016907 | Outreach suppressed pending steward Outreach | TPA-60415 (Arjun Jones) held until CASE-003463 is decided |
| Held | — | ||
| ACT-016908 | Outreach suppressed pending steward Outreach | TPA-60414 (Arjun Jones) held until CASE-003464 is decided |
| Held | — | ||
| ACT-016909 | Outreach suppressed pending steward Outreach | TPA-54150 (Jacob Aguilar) held until CASE-003465 is decided |
| Held | — | ||
| ACT-016910 | Outreach suppressed pending steward Outreach | ENR-106052 (Mei Morales) held until CASE-003466 is decided |
| Held | — | ||
| ACT-016911 | Outreach suppressed pending steward Outreach | CLM-404587 (Mei Morales) held until CASE-003467 is decided |
| Held | — | ||
| ACT-016912 | Outreach suppressed pending steward Outreach | CLM-405576 (Steve Silva) held until CASE-003468 is decided |
| Held | — | ||
| ACT-016913 | Outreach suppressed pending steward Outreach | ENR-107334 (Steven Silva) held until CASE-003469 is decided |
| Held | — | ||
| ACT-016914 | Outreach suppressed pending steward Outreach | CLM-429143 (Heather Nelson) held until CASE-003470 is decided |
| Held | — | ||
| ACT-016915 | Outreach suppressed pending steward Outreach | CLM-422844 (Ana Gilbert) held until CASE-003471 is decided |
| Held | — | ||
| ACT-016916 | Outreach suppressed pending steward Outreach | CLM-431213 (Sophia Daniiels) held until CASE-003472 is decided |
| Held | — | ||
| ACT-016917 | Outreach suppressed pending steward Outreach | PRV-23209 (Alan Morgan) held until CASE-003473 is decided |
| Held | — | ||
| ACT-016918 | Outreach suppressed pending steward Outreach | CLM-405919 (Nancy Taylor) held until CASE-003474 is decided |
| Held | — | ||
| ACT-016919 | Outreach suppressed pending steward Outreach | CLM-423819 (Niccholas Gonzalez) held until CASE-003475 is decided |
| Held | — | ||
| ACT-016920 | Outreach suppressed pending steward Outreach | ENR-139171 (Ralph Wagner) held until CASE-003476 is decided |
| Held | — | ||
| ACT-016921 | Outreach suppressed pending steward Outreach | CLM-429876 (Ralph Wagner) held until CASE-003477 is decided |
| Held | — | ||
| ACT-016922 | Outreach suppressed pending steward Outreach | CLM-404085 (Jacqueline Black) held until CASE-003478 is decided |
| Held | — | ||
| ACT-016923 | Outreach suppressed pending steward Outreach | CLM-428569 (Angela Burns) held until CASE-003479 is decided |
| Held | — | ||
| ACT-016924 | Outreach suppressed pending steward Outreach | TPA-62624 (Angela Burns) held until CASE-003480 is decided |
| Held | — | ||
| ACT-016925 | Outreach suppressed pending steward Outreach | TPA-52625 (Beverly Burns) held until CASE-003481 is decided |
| Held | — | ||
| ACT-016926 | Outreach suppressed pending steward Outreach | TPA-52624 (Beverly Burns) held until CASE-003482 is decided |
| Held | — | ||
| ACT-016927 | Outreach suppressed pending steward Outreach | ENR-109136 (Eric Bishop) held until CASE-003483 is decided |
| Held | — | ||
| ACT-016928 | Outreach suppressed pending steward Outreach | CLM-406992 (Eric Bishop) held until CASE-003484 is decided |
| Held | — | ||
| ACT-016929 | Outreach suppressed pending steward Outreach | TPA-52814 (Marcus Munoz) held until CASE-003485 is decided |
| Held | — | ||
| ACT-016930 | Outreach suppressed pending steward Outreach | CLM-406295 (Sarah Smith) held until CASE-003486 is decided |
| Held | — | ||
| ACT-016931 | Outreach suppressed pending steward Outreach | CLM-427010 (Joe Dean) held until CASE-003487 is decided |
| Held | — | ||
| ACT-016932 | Outreach suppressed pending steward Outreach | CLM-407145 (Brenda Mills) held until CASE-003488 is decided |
| Held | — | ||
| ACT-016933 | Outreach suppressed pending steward Outreach | PRV-27520 (Adnrea Salazar) held until CASE-003489 is decided |
| Held | — | ||
| ACT-016934 | Outreach suppressed pending steward Outreach | TPA-51960 (Ykui Mitchell) held until CASE-003490 is decided |
| Held | — | ||
| ACT-016935 | Outreach suppressed pending steward Outreach | ENR-105917 (Yuki Mitchell) held until CASE-003491 is decided |
| Held | — | ||
| ACT-016936 | Outreach suppressed pending steward Outreach | CLM-405624 (Timothy Howell) held until CASE-003492 is decided |
| Held | — | ||
| ACT-016937 | Outreach suppressed pending steward Outreach | CLM-428137 (Sarah Howell) held until CASE-003493 is decided |
| Held | — | ||
| ACT-016938 | Outreach suppressed pending steward Outreach | CLM-428136 (Sarah Howell) held until CASE-003494 is decided |
| Held | — | ||
| ACT-016939 | Outreach suppressed pending steward Outreach | TPA-61486 (Christian Salazar) held until CASE-003495 is decided |
| Held | — | ||
| ACT-016940 | Outreach suppressed pending steward Outreach | CLM-401852 (Jacob Holmes) held until CASE-003496 is decided |
| Held | — | ||
| ACT-016941 | Outreach suppressed pending steward Outreach | CLM-425236 (Brittany Morales) held until CASE-003497 is decided |
| Held | — | ||
| ACT-016942 | Outreach suppressed pending steward Outreach | TPA-55403 (David Hansen) held until CASE-003498 is decided |
| Held | — | ||
| ACT-016943 | Outreach suppressed pending steward Outreach | ENR-118575 (Grace Collins) held until CASE-003499 is decided |
| Held | — | ||
| ACT-016944 | Outreach suppressed pending steward Outreach | CLM-414172 (Grace Collins) held until CASE-003500 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.