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-017045 | Outreach suppressed pending steward Outreach | TPA-61288 (Paul Richards) held until CASE-003601 is decided |
| Held | — | ||
| ACT-017046 | Outreach suppressed pending steward Outreach | TPA-50385 (Crl Obrien) held until CASE-003602 is decided |
| Held | — | ||
| ACT-017047 | Outreach suppressed pending steward Outreach | ENR-132352 (Douglas Santos) held until CASE-003603 is decided |
| Held | — | ||
| ACT-017048 | Outreach suppressed pending steward Outreach | TPA-60921 (Douglas Santos) held until CASE-003604 is decided |
| Held | — | ||
| ACT-017049 | Outreach suppressed pending steward Outreach | CLM-405621 (Hirohsi Kennedy) held until CASE-003605 is decided |
| Held | — | ||
| ACT-017050 | Outreach suppressed pending steward Outreach | ENR-107396 (Hiroshi Kennedy) held until CASE-003606 is decided |
| Held | — | ||
| ACT-017051 | Outreach suppressed pending steward Outreach | CLM-428637 (Pamela Herrera) held until CASE-003607 is decided |
| Held | — | ||
| ACT-017052 | Outreach suppressed pending steward Outreach | TPA-62659 (Pamela Herrera) held until CASE-003608 is decided |
| Held | — | ||
| ACT-017053 | Outreach suppressed pending steward Outreach | CLM-418902 (Heather Vazquez) held until CASE-003609 is decided |
| Held | — | ||
| ACT-017054 | Outreach suppressed pending steward Outreach | CLM-421716 (Jessica Gutierrez) held until CASE-003610 is decided |
| Held | — | ||
| ACT-017055 | Outreach suppressed pending steward Outreach | ENR-128430 (Jess Gutierrez) held until CASE-003611 is decided |
| Held | — | ||
| ACT-017056 | Outreach suppressed pending steward Outreach | PRV-29144 (Teresa Munoz) held until CASE-003612 is decided |
| Held | — | ||
| ACT-017057 | Outreach suppressed pending steward Outreach | TPA-55262 (Ana Mejia) held until CASE-003613 is decided |
| Held | — | ||
| ACT-017058 | Outreach suppressed pending steward Outreach | CLM-402003 (Dnald Grant) held until CASE-003614 is decided |
| Held | — | ||
| ACT-017059 | Outreach suppressed pending steward Outreach | TPA-51767 (Jsoeph Pena) held until CASE-003615 is decided |
| Held | — | ||
| ACT-017060 | Outreach suppressed pending steward Outreach | ENR-105332 (Joseph Pena) held until CASE-003616 is decided |
| Held | — | ||
| ACT-017061 | Outreach suppressed pending steward Outreach | ENR-129557 (Larry Foster) held until CASE-003617 is decided |
| Held | — | ||
| ACT-017062 | Outreach suppressed pending steward Outreach | CLM-422560 (Larry Foster) held until CASE-003618 is decided |
| Held | — | ||
| ACT-017063 | Outreach suppressed pending steward Outreach | TPA-59360 (Jimmy Gardner) held until CASE-003619 is decided |
| Held | — | ||
| ACT-017064 | Outreach suppressed pending steward Outreach | TPA-55413 (Samuel Hoffman) held until CASE-003620 is decided |
| Held | — | ||
| ACT-017065 | Outreach suppressed pending steward Outreach | TPA-50056 (Laura Chapman) held until CASE-003621 is decided |
| Held | — | ||
| ACT-017066 | Outreach suppressed pending steward Outreach | ENR-100199 (Laura Chapman) held until CASE-003622 is decided |
| Held | — | ||
| ACT-017067 | Outreach suppressed pending steward Outreach | CLM-404912 (Bruce Ferguson) held until CASE-003623 is decided |
| Held | — | ||
| ACT-017068 | Outreach suppressed pending steward Outreach | CLM-423299 (Nathan Turner) held until CASE-003624 is decided |
| Held | — | ||
| ACT-017069 | Outreach suppressed pending steward Outreach | ENR-129712 (Eric Perkins) held until CASE-003625 is decided |
| Held | — | ||
| ACT-017070 | Outreach suppressed pending steward Outreach | CLM-432015 (Roy Stewart) held until CASE-003626 is decided |
| Held | — | ||
| ACT-017071 | Outreach suppressed pending steward Outreach | TPA-64121 (Roy Stewart) held until CASE-003627 is decided |
| Held | — | ||
| ACT-017072 | Outreach suppressed pending steward Outreach | ENR-126858 (Terry Singh) held until CASE-003628 is decided |
| Held | — | ||
| ACT-017073 | Outreach suppressed pending steward Outreach | CLM-420417 (Terry Singh) held until CASE-003629 is decided |
| Held | — | ||
| ACT-017074 | Outreach suppressed pending steward Outreach | TPA-53316 (Thomas Mendoza) held until CASE-003630 is decided |
| Held | — | ||
| ACT-017075 | Outreach suppressed pending steward Outreach | CLM-417261 (Patrick Ellis) held until CASE-003631 is decided |
| Held | — | ||
| ACT-017076 | Outreach suppressed pending steward Outreach | TPA-51462 (Christine Ruzi) held until CASE-003632 is decided |
| Held | — | ||
| ACT-017077 | Outreach suppressed pending steward Outreach | TPA-56543 (Debbie Gonzalez) held until CASE-003633 is decided |
| Held | — | ||
| ACT-017078 | Outreach suppressed pending steward Outreach | TPA-57065 (Albert Vargas) held until CASE-003634 is decided |
| Held | — | ||
| ACT-017079 | Outreach suppressed pending steward Outreach | CLM-416130 (Albert Vargas) held until CASE-003635 is decided |
| Held | — | ||
| ACT-017080 | Outreach suppressed pending steward Outreach | CLM-431372 (William Collins) held until CASE-003636 is decided |
| Held | — | ||
| ACT-017081 | Outreach suppressed pending steward Outreach | TPA-51643 (Cheryl Collins) held until CASE-003637 is decided |
| Held | — | ||
| ACT-017082 | Outreach suppressed pending steward Outreach | TPA-51642 (Cherl Collins) held until CASE-003638 is decided |
| Held | — | ||
| ACT-017083 | Outreach suppressed pending steward Outreach | CLM-428574 (Nicholas Tran) held until CASE-003639 is decided |
| Held | — | ||
| ACT-017084 | Outreach suppressed pending steward Outreach | CLM-428575 (Nicholas Tran) held until CASE-003640 is decided |
| Held | — | ||
| ACT-017085 | Outreach suppressed pending steward Outreach | PRV-24521 (Timothy Weber) held until CASE-003641 is decided |
| Held | — | ||
| ACT-017086 | Outreach suppressed pending steward Outreach | CLM-430459 (Ben Ferguson) held until CASE-003642 is decided |
| Held | — | ||
| ACT-017087 | Outreach suppressed pending steward Outreach | CLM-420848 (Emily Harper) held until CASE-003643 is decided |
| Held | — | ||
| ACT-017088 | Outreach suppressed pending steward Outreach | CLM-420847 (Emily Herper) held until CASE-003644 is decided |
| Held | — | ||
| ACT-017089 | Outreach suppressed pending steward Outreach | CLM-424690 (Julia Dan) held until CASE-003645 is decided |
| Held | — | ||
| ACT-017090 | Outreach suppressed pending steward Outreach | CLM-426965 (Keith Collins) held until CASE-003646 is decided |
| Held | — | ||
| ACT-017091 | Outreach suppressed pending steward Outreach | CLM-426966 (Keith Collins) held until CASE-003647 is decided |
| Held | — | ||
| ACT-017092 | Outreach suppressed pending steward Outreach | PRV-21667 (Daniel Herrera) held until CASE-003648 is decided |
| Held | — | ||
| ACT-017093 | Outreach suppressed pending steward Outreach | CLM-412969 (Heather Pierce) held until CASE-003649 is decided |
| Held | — | ||
| ACT-017094 | Outreach suppressed pending steward Outreach | PRV-23757 (Heather Pierce) held until CASE-003650 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.