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-016945 | Outreach suppressed pending steward Outreach | CLM-415383 (Santiago Tayllor) held until CASE-003501 is decided |
| Held | — | ||
| ACT-016946 | Outreach suppressed pending steward Outreach | ENR-116655 (Teresa Taylor) held until CASE-003502 is decided |
| Held | — | ||
| ACT-016947 | Outreach suppressed pending steward Outreach | CLM-406694 (Arjun Hunt) held until CASE-003503 is decided |
| Held | — | ||
| ACT-016948 | Outreach suppressed pending steward Outreach | CLM-413681 (Madison Fields) held until CASE-003504 is decided |
| Held | — | ||
| ACT-016949 | Outreach suppressed pending steward Outreach | CLM-400458 (Janice Santiago) held until CASE-003505 is decided |
| Held | — | ||
| ACT-016950 | Outreach suppressed pending steward Outreach | TPA-50196 (Janice Santiago) held until CASE-003506 is decided |
| Held | — | ||
| ACT-016951 | Outreach suppressed pending steward Outreach | TPA-53725 (Donald Fields) held until CASE-003507 is decided |
| Held | — | ||
| ACT-016952 | Outreach suppressed pending steward Outreach | CLM-417034 (Steve Anderson) held until CASE-003508 is decided |
| Held | — | ||
| ACT-016953 | Outreach suppressed pending steward Outreach | ENR-122415 (Steven Anderson) held until CASE-003509 is decided |
| Held | — | ||
| ACT-016954 | Outreach suppressed pending steward Outreach | TPA-58155 (Gerald Ortega) held until CASE-003510 is decided |
| Held | — | ||
| ACT-016955 | Outreach suppressed pending steward Outreach | PRV-22730 (Ann Obrien) held until CASE-003511 is decided |
| Held | — | ||
| ACT-016956 | Outreach suppressed pending steward Outreach | CLM-409321 (Ann Obrien) held until CASE-003512 is decided |
| Held | — | ||
| ACT-016957 | Outreach suppressed pending steward Outreach | ENR-120554 (Anna Ortega) held until CASE-003513 is decided |
| Held | — | ||
| ACT-016958 | Outreach suppressed pending steward Outreach | CLM-415593 (Anna Ortega) held until CASE-003514 is decided |
| Held | — | ||
| ACT-016959 | Outreach suppressed pending steward Outreach | TPA-61786 (Carl Ray) held until CASE-003515 is decided |
| Held | — | ||
| ACT-016960 | Outreach suppressed pending steward Outreach | TPA-56223 (Fatima Nunez) held until CASE-003516 is decided |
| Held | — | ||
| ACT-016961 | Outreach suppressed pending steward Outreach | TPA-53980 (Wei Nelson) held until CASE-003517 is decided |
| Held | — | ||
| ACT-016962 | Outreach suppressed pending steward Outreach | TPA-57274 (Margaret Tucker) held until CASE-003518 is decided |
| Held | — | ||
| ACT-016963 | Outreach suppressed pending steward Outreach | CLM-412390 (Jack Russell) held until CASE-003519 is decided |
| Held | — | ||
| ACT-016964 | Outreach suppressed pending steward Outreach | ENR-116298 (Jack Russell) held until CASE-003520 is decided |
| Held | — | ||
| ACT-016965 | Outreach suppressed pending steward Outreach | CLM-421993 (Grace Taylor) held until CASE-003521 is decided |
| Held | — | ||
| ACT-016966 | Outreach suppressed pending steward Outreach | ENR-121951 (Jerry Willlis) held until CASE-003522 is decided |
| Held | — | ||
| ACT-016967 | Outreach suppressed pending steward Outreach | TPA-57356 (Jerry Willis) held until CASE-003523 is decided |
| Held | — | ||
| ACT-016968 | Outreach suppressed pending steward Outreach | CLM-431056 (Judith Hernandez) held until CASE-003524 is decided |
| Held | — | ||
| ACT-016969 | Outreach suppressed pending steward Outreach | TPA-63723 (Judith Hernandez) held until CASE-003525 is decided |
| Held | — | ||
| ACT-016970 | Outreach suppressed pending steward Outreach | CLM-424516 (Santiago Silva) held until CASE-003526 is decided |
| Held | — | ||
| ACT-016971 | Outreach suppressed pending steward Outreach | TPA-58795 (Doris Jordan) held until CASE-003527 is decided |
| Held | — | ||
| ACT-016972 | Outreach suppressed pending steward Outreach | CLM-409149 (Sandra Maldonado) held until CASE-003528 is decided |
| Held | — | ||
| ACT-016973 | Outreach suppressed pending steward Outreach | ENR-112075 (Sandar Maldonado) held until CASE-003529 is decided |
| Held | — | ||
| ACT-016974 | Outreach suppressed pending steward Outreach | CLM-428008 (Sophia Johnston) held until CASE-003530 is decided |
| Held | — | ||
| ACT-016975 | Outreach suppressed pending steward Outreach | PRV-27687 (Martha Snyder) held until CASE-003531 is decided |
| Held | — | ||
| ACT-016976 | Outreach suppressed pending steward Outreach | TPA-64442 (Eugene Obrien) held until CASE-003532 is decided |
| Held | — | ||
| ACT-016977 | Outreach suppressed pending steward Outreach | CLM-423185 (Stephen Henry) held until CASE-003533 is decided |
| Held | — | ||
| ACT-016978 | Outreach suppressed pending steward Outreach | CLM-429100 (Brenda Phillips) held until CASE-003534 is decided |
| Held | — | ||
| ACT-016979 | Outreach suppressed pending steward Outreach | TPA-57143 (Greg Valdez) held until CASE-003535 is decided |
| Held | — | ||
| ACT-016980 | Outreach suppressed pending steward Outreach | CLM-416272 (Greegory Valdez) held until CASE-003536 is decided |
| Held | — | ||
| ACT-016981 | Outreach suppressed pending steward Outreach | PRV-23204 (Larua Li) held until CASE-003537 is decided |
| Held | — | ||
| ACT-016982 | Outreach suppressed pending steward Outreach | ENR-104058 (Deb Ortega) held until CASE-003538 is decided |
| Held | — | ||
| ACT-016983 | Outreach suppressed pending steward Outreach | PRV-20883 (Deborah Ortaga) held until CASE-003539 is decided |
| Held | — | ||
| ACT-016984 | Outreach suppressed pending steward Outreach | CLM-421234 (Virginia Ray) held until CASE-003540 is decided |
| Held | — | ||
| ACT-016985 | Outreach suppressed pending steward Outreach | CLM-414759 (Alice Marquez) held until CASE-003541 is decided |
| Held | — | ||
| ACT-016986 | Outreach suppressed pending steward Outreach | CLM-413039 (Rachel Black) held until CASE-003542 is decided |
| Held | — | ||
| ACT-016987 | Outreach suppressed pending steward Outreach | ENR-117110 (Rachel Black) held until CASE-003543 is decided |
| Held | — | ||
| ACT-016988 | Outreach suppressed pending steward Outreach | CLM-421813 (Camila Lawrence) held until CASE-003544 is decided |
| Held | — | ||
| ACT-016989 | Outreach suppressed pending steward Outreach | TPA-59579 (Camila Lawrence) held until CASE-003545 is decided |
| Held | — | ||
| ACT-016990 | Outreach suppressed pending steward Outreach | TPA-62242 (Jen McCoy) held until CASE-003546 is decided |
| Held | — | ||
| ACT-016991 | Outreach suppressed pending steward Outreach | CLM-427713 (Jennifer McCoy) held until CASE-003547 is decided |
| Held | — | ||
| ACT-016992 | Outreach suppressed pending steward Outreach | ENR-107793 (Alice Carroll) held until CASE-003548 is decided |
| Held | — | ||
| ACT-016993 | Outreach suppressed pending steward Outreach | TPA-52629 (Carroll Alice) held until CASE-003549 is decided |
| Held | — | ||
| ACT-016994 | Outreach suppressed pending steward Outreach | TPA-56000 (Bobby Watson) held until CASE-003550 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.