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-016995 | Outreach suppressed pending steward Outreach | ENR-117870 (Bobby Watson) held until CASE-003551 is decided |
| Held | — | ||
| ACT-016996 | Outreach suppressed pending steward Outreach | CLM-413613 (Jacqueline Espinoza) held until CASE-003552 is decided |
| Held | — | ||
| ACT-016997 | Outreach suppressed pending steward Outreach | ENR-117809 (Jacqueline Espinoza) held until CASE-003553 is decided |
| Held | — | ||
| ACT-016998 | Outreach suppressed pending steward Outreach | TPA-64068 (Cynthia Le) held until CASE-003554 is decided |
| Held | — | ||
| ACT-016999 | Outreach suppressed pending steward Outreach | CLM-424727 (Jerry Jordan) held until CASE-003555 is decided |
| Held | — | ||
| ACT-017000 | Outreach suppressed pending steward Outreach | CLM-418151 (Christine Boyd) held until CASE-003556 is decided |
| Held | — | ||
| ACT-017001 | Outreach suppressed pending steward Outreach | ENR-123861 (Christine Boyd) held until CASE-003557 is decided |
| Held | — | ||
| ACT-017002 | Outreach suppressed pending steward Outreach | ENR-113015 (Ronald Hunt) held until CASE-003558 is decided |
| Held | — | ||
| ACT-017003 | Outreach suppressed pending steward Outreach | TPA-54310 (Ronald Hunt) held until CASE-003559 is decided |
| Held | — | ||
| ACT-017004 | Outreach suppressed pending steward Outreach | TPA-50601 (Mason Guzman) held until CASE-003560 is decided |
| Held | — | ||
| ACT-017005 | Outreach suppressed pending steward Outreach | CLM-411806 (Gabriel Woods) held until CASE-003561 is decided |
| Held | — | ||
| ACT-017006 | Outreach suppressed pending steward Outreach | TPA-60796 (Ramirez Ryan) held until CASE-003562 is decided |
| Held | — | ||
| ACT-017007 | Outreach suppressed pending steward Outreach | ENR-135696 (Edward Henry) held until CASE-003563 is decided |
| Held | — | ||
| ACT-017008 | Outreach suppressed pending steward Outreach | CLM-407066 (Brenda Wells) held until CASE-003564 is decided |
| Held | — | ||
| ACT-017009 | Outreach suppressed pending steward Outreach | PRV-25250 (Mariana Ryan) held until CASE-003565 is decided |
| Held | — | ||
| ACT-017010 | Outreach suppressed pending steward Outreach | TPA-50321 (Matthew Johnston) held until CASE-003566 is decided |
| Held | — | ||
| ACT-017011 | Outreach suppressed pending steward Outreach | ENR-100945 (Matthew Johnston) held until CASE-003567 is decided |
| Held | — | ||
| ACT-017012 | Outreach suppressed pending steward Outreach | TPA-60227 (Stephen Gonzales) held until CASE-003568 is decided |
| Held | — | ||
| ACT-017013 | Outreach suppressed pending steward Outreach | CLM-427002 (Daniel Jensen) held until CASE-003569 is decided |
| Held | — | ||
| ACT-017014 | Outreach suppressed pending steward Outreach | CLM-408598 (Amber Weber) held until CASE-003570 is decided |
| Held | — | ||
| ACT-017015 | Outreach suppressed pending steward Outreach | CLM-408599 (Amber Weber) held until CASE-003571 is decided |
| Held | — | ||
| ACT-017016 | Outreach suppressed pending steward Outreach | CLM-418199 (Laura Guzman) held until CASE-003572 is decided |
| Held | — | ||
| ACT-017017 | Outreach suppressed pending steward Outreach | CLM-424070 (Jackie Yang) held until CASE-003573 is decided |
| Held | — | ||
| ACT-017018 | Outreach suppressed pending steward Outreach | CLM-424069 (Jacqueline Yang) held until CASE-003574 is decided |
| Held | — | ||
| ACT-017019 | Outreach suppressed pending steward Outreach | TPA-60983 (Nicole Gilbert) held until CASE-003575 is decided |
| Held | — | ||
| ACT-017020 | Outreach suppressed pending steward Outreach | ENR-124928 (Sofia Gilbert) held until CASE-003576 is decided |
| Held | — | ||
| ACT-017021 | Outreach suppressed pending steward Outreach | CLM-406309 (Joseph Thompson) held until CASE-003577 is decided |
| Held | — | ||
| ACT-017022 | Outreach suppressed pending steward Outreach | ENR-108285 (Joseph Thompson) held until CASE-003578 is decided |
| Held | — | ||
| ACT-017023 | Outreach suppressed pending steward Outreach | TPA-59130 (Eric Johnston) held until CASE-003579 is decided |
| Held | — | ||
| ACT-017024 | Outreach suppressed pending steward Outreach | ENR-127346 (Eric Johnston) held until CASE-003580 is decided |
| Held | — | ||
| ACT-017025 | Outreach suppressed pending steward Outreach | CLM-422892 (Douglas Matthews) held until CASE-003581 is decided |
| Held | — | ||
| ACT-017026 | Outreach suppressed pending steward Outreach | CLM-415075 (Janet Lawson) held until CASE-003582 is decided |
| Held | — | ||
| ACT-017027 | Outreach suppressed pending steward Outreach | ENR-119852 (Janet Lawson) held until CASE-003583 is decided |
| Held | — | ||
| ACT-017028 | Outreach suppressed pending steward Outreach | TPA-52343 (Edward Herrera) held until CASE-003584 is decided |
| Held | — | ||
| ACT-017029 | Outreach suppressed pending steward Outreach | ENR-106988 (Edward Herrera) held until CASE-003585 is decided |
| Held | — | ||
| ACT-017030 | Outreach suppressed pending steward Outreach | CLM-414537 (Joyce Tran) held until CASE-003586 is decided |
| Held | — | ||
| ACT-017031 | Outreach suppressed pending steward Outreach | CLM-429348 (Terry Wlsh) held until CASE-003587 is decided |
| Held | — | ||
| ACT-017032 | Outreach suppressed pending steward Outreach | ENR-138510 (Terry Walsh) held until CASE-003588 is decided |
| Held | — | ||
| ACT-017033 | Outreach suppressed pending steward Outreach | ENR-111714 (Mei Johnston) held until CASE-003589 is decided |
| Held | — | ||
| ACT-017034 | Outreach suppressed pending steward Outreach | PRV-22628 (Mei Johnston) held until CASE-003590 is decided |
| Held | — | ||
| ACT-017035 | Outreach suppressed pending steward Outreach | ENR-104717 (Aaron Snigh) held until CASE-003591 is decided |
| Held | — | ||
| ACT-017036 | Outreach suppressed pending steward Outreach | ENR-107067 (Zachary Berry) held until CASE-003592 is decided |
| Held | — | ||
| ACT-017037 | Outreach suppressed pending steward Outreach | TPA-52361 (Zachary Berry) held until CASE-003593 is decided |
| Held | — | ||
| ACT-017038 | Outreach suppressed pending steward Outreach | CLM-411664 (Jacoob Richards) held until CASE-003594 is decided |
| Held | — | ||
| ACT-017039 | Outreach suppressed pending steward Outreach | ENR-115366 (Jacob Richards) held until CASE-003595 is decided |
| Held | — | ||
| ACT-017040 | Outreach suppressed pending steward Outreach | TPA-51539 (Anna Grant) held until CASE-003596 is decided |
| Held | — | ||
| ACT-017041 | Outreach suppressed pending steward Outreach | ENR-104608 (Anna Grant) held until CASE-003597 is decided |
| Held | — | ||
| ACT-017042 | Outreach suppressed pending steward Outreach | TPA-62480 (Karen Fisher) held until CASE-003598 is decided |
| Held | — | ||
| ACT-017043 | Outreach suppressed pending steward Outreach | CLM-402205 (Lucia Sims) held until CASE-003599 is decided |
| Held | — | ||
| ACT-017044 | Outreach suppressed pending steward Outreach | TPA-61287 (Paul Richards) held until CASE-003600 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.