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-017095 | Outreach suppressed pending steward Outreach | TPA-59668 (Olivia Reed) held until CASE-003651 is decided |
| Held | — | ||
| ACT-017096 | Outreach suppressed pending steward Outreach | ENR-100091 (Isabella Russell) held until CASE-003652 is decided |
| Held | — | ||
| ACT-017097 | Outreach suppressed pending steward Outreach | TPA-50650 (Kimberly Russell) held until CASE-003653 is decided |
| Held | — | ||
| ACT-017098 | Outreach suppressed pending steward Outreach | TPA-50651 (Kimbberly Russell) held until CASE-003654 is decided |
| Held | — | ||
| ACT-017099 | Outreach suppressed pending steward Outreach | TPA-56991 (Sandra Russell) held until CASE-003655 is decided |
| Held | — | ||
| ACT-017100 | Outreach suppressed pending steward Outreach | TPA-58394 (Amber Fernandez) held until CASE-003656 is decided |
| Held | — | ||
| ACT-017101 | Outreach suppressed pending steward Outreach | ENR-124929 (Amber Fernandez) held until CASE-003657 is decided |
| Held | — | ||
| ACT-017102 | Outreach suppressed pending steward Outreach | CLM-430371 (Linda Burton) held until CASE-003658 is decided |
| Held | — | ||
| ACT-017103 | Outreach suppressed pending steward Outreach | CLM-430372 (Linda Burton) held until CASE-003659 is decided |
| Held | — | ||
| ACT-017104 | Outreach suppressed pending steward Outreach | CLM-432613 (Samantha Martiin) held until CASE-003660 is decided |
| Held | — | ||
| ACT-017105 | Outreach suppressed pending steward Outreach | ENR-142808 (Samantha Martin) held until CASE-003661 is decided |
| Held | — | ||
| ACT-017106 | Outreach suppressed pending steward Outreach | CLM-408627 (James Nguyen) held until CASE-003662 is decided |
| Held | — | ||
| ACT-017107 | Outreach suppressed pending steward Outreach | ENR-111374 (James Nguyen) held until CASE-003663 is decided |
| Held | — | ||
| ACT-017108 | Outreach suppressed pending steward Outreach | CLM-423664 (Janice Banks) held until CASE-003664 is decided |
| Held | — | ||
| ACT-017109 | Outreach suppressed pending steward Outreach | ENR-112459 (Perez Bobby) held until CASE-003665 is decided |
| Held | — | ||
| ACT-017110 | Outreach suppressed pending steward Outreach | PRV-22765 (Bobby Perz) held until CASE-003666 is decided |
| Held | — | ||
| ACT-017111 | Outreach suppressed pending steward Outreach | ENR-125124 (Brandon Kennedy) held until CASE-003667 is decided |
| Held | — | ||
| ACT-017112 | Outreach suppressed pending steward Outreach | CLM-419052 (Brandon Kennedy) held until CASE-003668 is decided |
| Held | — | ||
| ACT-017113 | Outreach suppressed pending steward Outreach | TPA-58607 (Kathryn Owens) held until CASE-003669 is decided |
| Held | — | ||
| ACT-017114 | Outreach suppressed pending steward Outreach | ENR-128611 (Ralph Pierce) held until CASE-003670 is decided |
| Held | — | ||
| ACT-017115 | Outreach suppressed pending steward Outreach | TPA-59603 (Ralph Pierce) held until CASE-003671 is decided |
| Held | — | ||
| ACT-017116 | Outreach suppressed pending steward Outreach | TPA-53637 (Elizabeth Ramirez) held until CASE-003672 is decided |
| Held | — | ||
| ACT-017117 | Outreach suppressed pending steward Outreach | TPA-53636 (Elizabeth Ramirez) held until CASE-003673 is decided |
| Held | — | ||
| ACT-017118 | Outreach suppressed pending steward Outreach | TPA-53635 (Elizabeth Ramirez) held until CASE-003674 is decided |
| Held | — | ||
| ACT-017119 | Outreach suppressed pending steward Outreach | TPA-54408 (Steen Nelson) held until CASE-003675 is decided |
| Held | — | ||
| ACT-017120 | Outreach suppressed pending steward Outreach | TPA-63242 (Jack Pierce) held until CASE-003676 is decided |
| Held | — | ||
| ACT-017121 | Outreach suppressed pending steward Outreach | TPA-53645 (Brenda Banks) held until CASE-003677 is decided |
| Held | — | ||
| ACT-017122 | Outreach suppressed pending steward Outreach | ENR-141659 (Omar Vasquez) held until CASE-003678 is decided |
| Held | — | ||
| ACT-017123 | Outreach suppressed pending steward Outreach | CLM-431760 (Omar Vasquez) held until CASE-003679 is decided |
| Held | — | ||
| ACT-017124 | Outreach suppressed pending steward Outreach | ENR-118036 (Christina Vasquez) held until CASE-003680 is decided |
| Held | — | ||
| ACT-017125 | Outreach suppressed pending steward Outreach | CLM-408084 (Randy Wod) held until CASE-003681 is decided |
| Held | — | ||
| ACT-017126 | Outreach suppressed pending steward Outreach | CLM-428541 (John Marshall) held until CASE-003682 is decided |
| Held | — | ||
| ACT-017127 | Outreach suppressed pending steward Outreach | TPA-62529 (Juan Marshall) held until CASE-003683 is decided |
| Held | — | ||
| ACT-017128 | Outreach suppressed pending steward Outreach | CLM-400096 (Justin Cooper) held until CASE-003684 is decided |
| Held | — | ||
| ACT-017129 | Outreach suppressed pending steward Outreach | ENR-102555 (Walter Allen) held until CASE-003685 is decided |
| Held | — | ||
| ACT-017130 | Outreach suppressed pending steward Outreach | CLM-401984 (Walter Allen) held until CASE-003686 is decided |
| Held | — | ||
| ACT-017131 | Outreach suppressed pending steward Outreach | CLM-423572 (Megan Larson) held until CASE-003687 is decided |
| Held | — | ||
| ACT-017132 | Outreach suppressed pending steward Outreach | ENR-130850 (Megan Larson) held until CASE-003688 is decided |
| Held | — | ||
| ACT-017133 | Outreach suppressed pending steward Outreach | CLM-427431 (Michelle Gray) held until CASE-003689 is decided |
| Held | — | ||
| ACT-017134 | Outreach suppressed pending steward Outreach | ENR-135952 (Michelle Gray) held until CASE-003690 is decided |
| Held | — | ||
| ACT-017135 | Outreach suppressed pending steward Outreach | TPA-63334 (Larry Moreno) held until CASE-003691 is decided |
| Held | — | ||
| ACT-017136 | Outreach suppressed pending steward Outreach | ENR-107399 (Timothy Garza) held until CASE-003692 is decided |
| Held | — | ||
| ACT-017137 | Outreach suppressed pending steward Outreach | CLM-405622 (Timothy Garza) held until CASE-003693 is decided |
| Held | — | ||
| ACT-017138 | Outreach suppressed pending steward Outreach | CLM-411270 (Debra Ramos) held until CASE-003694 is decided |
| Held | — | ||
| ACT-017139 | Outreach suppressed pending steward Outreach | ENR-114828 (Debra Ramos) held until CASE-003695 is decided |
| Held | — | ||
| ACT-017140 | Outreach suppressed pending steward Outreach | ENR-118949 (Gregory Cruz) held until CASE-003696 is decided |
| Held | — | ||
| ACT-017141 | Outreach suppressed pending steward Outreach | CLM-414392 (Gregory Cruz) held until CASE-003697 is decided |
| Held | — | ||
| ACT-017142 | Outreach suppressed pending steward Outreach | TPA-51520 (Michael Kelly) held until CASE-003698 is decided |
| Held | — | ||
| ACT-017143 | Outreach suppressed pending steward Outreach | TPA-51397 (Rachel Washington) held until CASE-003699 is decided |
| Held | — | ||
| ACT-017144 | Outreach suppressed pending steward Outreach | TPA-53146 (Kevin Peters) held until CASE-003700 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.