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-017145 | Outreach suppressed pending steward Outreach | CLM-407191 (Kevin Peters) held until CASE-003701 is decided |
| Held | — | ||
| ACT-017146 | Outreach suppressed pending steward Outreach | CLM-418904 (Mei Stevens) held until CASE-003702 is decided |
| Held | — | ||
| ACT-017147 | Outreach suppressed pending steward Outreach | ENR-106510 (Ann Ryan) held until CASE-003703 is decided |
| Held | — | ||
| ACT-017148 | Outreach suppressed pending steward Outreach | CLM-404938 (Ann Ryan) held until CASE-003704 is decided |
| Held | — | ||
| ACT-017149 | Outreach suppressed pending steward Outreach | PRV-27838 (Roy Powell) held until CASE-003705 is decided |
| Held | — | ||
| ACT-017150 | Outreach suppressed pending steward Outreach | CLM-401481 (Kayla Peters) held until CASE-003706 is decided |
| Held | — | ||
| ACT-017151 | Outreach suppressed pending steward Outreach | ENR-101927 (Kayla Peters) held until CASE-003707 is decided |
| Held | — | ||
| ACT-017152 | Outreach suppressed pending steward Outreach | CLM-400674 (Randy Myers) held until CASE-003708 is decided |
| Held | — | ||
| ACT-017153 | Outreach suppressed pending steward Outreach | ENR-100912 (Randy Myers) held until CASE-003709 is decided |
| Held | — | ||
| ACT-017154 | Outreach suppressed pending steward Outreach | TPA-53015 (Susan Edwars) held until CASE-003710 is decided |
| Held | — | ||
| ACT-017155 | Outreach suppressed pending steward Outreach | CLM-416158 (Megan Diaz) held until CASE-003711 is decided |
| Held | — | ||
| ACT-017156 | Outreach suppressed pending steward Outreach | TPA-60022 (Terry Wlsh) held until CASE-003712 is decided |
| Held | — | ||
| ACT-017157 | Outreach suppressed pending steward Outreach | ENR-129856 (Terry Walsh) held until CASE-003713 is decided |
| Held | — | ||
| ACT-017158 | Outreach suppressed pending steward Outreach | TPA-53329 (Beverly Harris) held until CASE-003714 is decided |
| Held | — | ||
| ACT-017159 | Outreach suppressed pending steward Outreach | TPA-53328 (Beverly Harris) held until CASE-003715 is decided |
| Held | — | ||
| ACT-017160 | Outreach suppressed pending steward Outreach | TPA-56003 (Jerry Phillips) held until CASE-003716 is decided |
| Held | — | ||
| ACT-017161 | Outreach suppressed pending steward Outreach | TPA-58543 (Christina Morgan) held until CASE-003717 is decided |
| Held | — | ||
| ACT-017162 | Outreach suppressed pending steward Outreach | TPA-64370 (Dorothy Gomeez) held until CASE-003718 is decided |
| Held | — | ||
| ACT-017163 | Outreach suppressed pending steward Outreach | PRV-27592 (Bill Ellis) held until CASE-003719 is decided |
| Held | — | ||
| ACT-017164 | Outreach suppressed pending steward Outreach | CLM-401721 (Catherine Graham) held until CASE-003720 is decided |
| Held | — | ||
| ACT-017165 | Outreach suppressed pending steward Outreach | TPA-50757 (Catherine Graham) held until CASE-003721 is decided |
| Held | — | ||
| ACT-017166 | Outreach suppressed pending steward Outreach | CLM-411823 (Willie Black) held until CASE-003722 is decided |
| Held | — | ||
| ACT-017167 | Outreach suppressed pending steward Outreach | TPA-55209 (Willie Black) held until CASE-003723 is decided |
| Held | — | ||
| ACT-017168 | Outreach suppressed pending steward Outreach | TPA-62420 (James Hunt) held until CASE-003724 is decided |
| Held | — | ||
| ACT-017169 | Outreach suppressed pending steward Outreach | TPA-50690 (Luis Mejia) held until CASE-003725 is decided |
| Held | — | ||
| ACT-017170 | Outreach suppressed pending steward Outreach | TPA-50689 (Luis Mejia) held until CASE-003726 is decided |
| Held | — | ||
| ACT-017171 | Outreach suppressed pending steward Outreach | TPA-51486 (Dylan Dominguez) held until CASE-003727 is decided |
| Held | — | ||
| ACT-017172 | Outreach suppressed pending steward Outreach | CLM-417277 (Wei Hamilton) held until CASE-003728 is decided |
| Held | — | ||
| ACT-017173 | Outreach suppressed pending steward Outreach | CLM-417276 (Wei Hamilton) held until CASE-003729 is decided |
| Held | — | ||
| ACT-017174 | Outreach suppressed pending steward Outreach | TPA-58201 (Charles Armstrong) held until CASE-003730 is decided |
| Held | — | ||
| ACT-017175 | Outreach suppressed pending steward Outreach | TPA-61600 (Ruth Dixon) held until CASE-003731 is decided |
| Held | — | ||
| ACT-017176 | Outreach suppressed pending steward Outreach | TPA-58916 (Sarah Adams) held until CASE-003732 is decided |
| Held | — | ||
| ACT-017177 | Outreach suppressed pending steward Outreach | PRV-25448 (Gloria Johnston) held until CASE-003733 is decided |
| Held | — | ||
| ACT-017178 | Outreach suppressed pending steward Outreach | CLM-418380 (Gloria Johnston) held until CASE-003734 is decided |
| Held | — | ||
| ACT-017179 | Outreach suppressed pending steward Outreach | ENR-142964 (Wagner Jacob) held until CASE-003735 is decided |
| Held | — | ||
| ACT-017180 | Outreach suppressed pending steward Outreach | PRV-25061 (Sarah Jenkins) held until CASE-003736 is decided |
| Held | — | ||
| ACT-017181 | Outreach suppressed pending steward Outreach | ENR-122469 (Sarah Jenkins) held until CASE-003737 is decided |
| Held | — | ||
| ACT-017182 | Outreach suppressed pending steward Outreach | TPA-60526 (Albert Garrett) held until CASE-003738 is decided |
| Held | — | ||
| ACT-017183 | Outreach suppressed pending steward Outreach | ENR-126630 (Autin Ray) held until CASE-003739 is decided |
| Held | — | ||
| ACT-017184 | Outreach suppressed pending steward Outreach | TPA-54075 (Alan Nichols) held until CASE-003740 is decided |
| Held | — | ||
| ACT-017185 | Outreach suppressed pending steward Outreach | ENR-112368 (Alan Nichols) held until CASE-003741 is decided |
| Held | — | ||
| ACT-017186 | Outreach suppressed pending steward Outreach | CLM-432078 (Terry Ward) held until CASE-003742 is decided |
| Held | — | ||
| ACT-017187 | Outreach suppressed pending steward Outreach | CLM-432079 (Terry Ward) held until CASE-003743 is decided |
| Held | — | ||
| ACT-017188 | Outreach suppressed pending steward Outreach | CLM-406188 (Jerry Meyer) held until CASE-003744 is decided |
| Held | — | ||
| ACT-017189 | Outreach suppressed pending steward Outreach | ENR-108140 (Jerry Meyer) held until CASE-003745 is decided |
| Held | — | ||
| ACT-017190 | Outreach suppressed pending steward Outreach | CLM-416976 (Contreras Mark) held until CASE-003746 is decided |
| Held | — | ||
| ACT-017191 | Outreach suppressed pending steward Outreach | ENR-141465 (Sean Cunningham) held until CASE-003747 is decided |
| Held | — | ||
| ACT-017192 | Outreach suppressed pending steward Outreach | ENR-140492 (Roy Coleman) held until CASE-003748 is decided |
| Held | — | ||
| ACT-017193 | Outreach suppressed pending steward Outreach | CLM-430823 (Roy Coleman) held until CASE-003749 is decided |
| Held | — | ||
| ACT-017194 | Outreach suppressed pending steward Outreach | CLM-424943 (Dylan Harper) held until CASE-003750 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.