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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-004990 | Orphan claim re-pointed Claims processor | CLM-409063 → UHC-15058-92 (Gloria Murray) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004991 | Orphan claim re-pointed Claims processor | CLM-408091 → UHC-11947-28 (Hiroshi Burns) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004992 | Orphan claim re-pointed Claims processor | CLM-410576 → UHC-06958-21 (Larry Sanhez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004993 | Orphan claim re-pointed Claims processor | CLM-404822 → UHC-61173-72 (Michelle Gutierrez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004994 | Orphan claim re-pointed Claims processor | CLM-404567 → UHC-54937-30 (Grace Gardner) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004995 | Orphan claim re-pointed Claims processor | CLM-402267 → UHC-87849-68 (Camila Snyder) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004996 | Orphan claim re-pointed Claims processor | CLM-426281 → UHC-83107-81 (Nathan Crawford) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004997 | Orphan claim re-pointed Claims processor | CLM-401788 → UHC-47261-99 (Amanda Wallace) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004998 | Orphan claim re-pointed Claims processor | CLM-403825 → UHC-40594-68 (Scott Schultz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-004999 | Orphan claim re-pointed Claims processor | CLM-415578 → UHC-47268-78 (Mark Jones) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005000 | Orphan claim re-pointed Claims processor | CLM-404482 → UHC-68748-96 (Maria Fields) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005001 | Orphan claim re-pointed Claims processor | CLM-401625 → UHC-99873-07 (Abigail Perkins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005002 | Orphan claim re-pointed Claims processor | CLM-431418 → UHC-90045-65 (Joan Elliott) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005003 | Orphan claim re-pointed Claims processor | CLM-431860 → UHC-62190-94 (Randy Ross) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005004 | Orphan claim re-pointed Claims processor | CLM-426199 → UHC-20056-04 (Cheryl Padilla) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005005 | Orphan claim re-pointed Claims processor | CLM-425256 → UHC-36645-75 (Sophia Hunt) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005006 | Orphan claim re-pointed Claims processor | CLM-429941 → UHC-58486-46 (Patrick Sanders) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005007 | Orphan claim re-pointed Claims processor | CLM-417438 → UHC-96426-29 (Samuel Rodriguez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005008 | Orphan claim re-pointed Claims processor | CLM-422476 → UHC-02124-02 (Ryan Fox) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005009 | Orphan claim re-pointed Claims processor | CLM-432510 → UHC-09172-06 (Susan Perez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005010 | Orphan claim re-pointed Claims processor | CLM-428393 → UHC-18772-45 (Aaron Gonzalez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005011 | Orphan claim re-pointed Claims processor | CLM-402290 → UHC-69231-03 (Anna Young) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005012 | Orphan claim re-pointed Claims processor | CLM-401363 → UHC-19223-34 (Cheryl Chen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005013 | Orphan claim re-pointed Claims processor | CLM-428878 → UHC-30320-78 (Judy Murray) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005014 | Orphan claim re-pointed Claims processor | CLM-412157 → UHC-81661-07 (Michelle Hayes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005015 | Orphan claim re-pointed Claims processor | CLM-419690 → UHC-99443-53 (Charles Ray) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005016 | Orphan claim re-pointed Claims processor | CLM-423093 → UHC-66987-31 (Olivia Cooper) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005017 | Orphan claim re-pointed Claims processor | CLM-415972 → UHC-83367-14 (Peter Padilla) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005018 | Orphan claim re-pointed Claims processor | CLM-428415 → UHC-65934-13 (Nicholas Santos) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005019 | Orphan claim re-pointed Claims processor | CLM-425241 → UHC-25986-60 (Carol Weber) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005020 | Orphan claim re-pointed Claims processor | CLM-407105 → UHC-63140-98 (Emma Harrison) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005021 | Orphan claim re-pointed Claims processor | CLM-431658 → UHC-98030-27 (Billy Fisher) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005022 | Orphan claim re-pointed Claims processor | CLM-417911 → UHC-56078-78 (Christina Hernandez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005023 | Orphan claim re-pointed Claims processor | CLM-416385 → UHC-48980-78 (Laura Perez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005024 | Orphan claim re-pointed Claims processor | CLM-408582 → UHC-52339-52 (Steven Burns) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005025 | Orphan claim re-pointed Claims processor | CLM-406395 → UHC-17083-49 (Judith Collins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005026 | Orphan claim re-pointed Claims processor | CLM-413714 → UHC-92123-72 (Samantha Diaz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005027 | Orphan claim re-pointed Claims processor | CLM-402364 → UHC-44962-11 (Peter Vazquez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005028 | Orphan claim re-pointed Claims processor | CLM-424368 → UHC-06095-01 (Billy Burns) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005029 | Orphan claim re-pointed Claims processor | CLM-429943 → UHC-58486-46 (Patrick Sanders) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005030 | Orphan claim re-pointed Claims processor | CLM-430910 → UHC-86460-92 (Theresa Lewiis) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005031 | Orphan claim re-pointed Claims processor | CLM-427600 → UHC-27057-19 (Timothy Rios) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005032 | Orphan claim re-pointed Claims processor | CLM-415963 → UHC-65136-03 (Kelly Contreras) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005033 | Orphan claim re-pointed Claims processor | CLM-419164 → UHC-46535-81 (Anthony Wells) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005034 | Orphan claim re-pointed Claims processor | CLM-400074 → UHC-66377-79 (Joseph Williamson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005035 | Orphan claim re-pointed Claims processor | CLM-400182 → UHC-59123-12 (Larry Chapman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005036 | Orphan claim re-pointed Claims processor | CLM-419158 → UHC-72128-31 (Janice McCoy) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005037 | Orphan claim re-pointed Claims processor | CLM-405426 → UHC-48728-33 (Sara Patel) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005038 | Orphan claim re-pointed Claims processor | CLM-404776 → UHC-02464-83 (Maria Ray) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005039 | Orphan claim re-pointed Claims processor | CLM-402428 → UHC-30142-52 (James Chen) |
| Executed | resolution_agent 2026-10-22 12:47:23 |
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.