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-017195 | Outreach suppressed pending steward Outreach | ENR-116176 (Jake James) held until CASE-003751 is decided |
| Held | — | ||
| ACT-017196 | Outreach suppressed pending steward Outreach | TPA-55420 (Jacob James) held until CASE-003752 is decided |
| Held | — | ||
| ACT-017197 | Outreach suppressed pending steward Outreach | TPA-59112 (Caarlos Dean) held until CASE-003753 is decided |
| Held | — | ||
| ACT-017198 | Outreach suppressed pending steward Outreach | TPA-58287 (Hannah Owens) held until CASE-003754 is decided |
| Held | — | ||
| ACT-017199 | Outreach suppressed pending steward Outreach | PRV-25048 (Frank Knight) held until CASE-003755 is decided |
| Held | — | ||
| ACT-017200 | Outreach suppressed pending steward Outreach | TPA-56667 (Margaret Cox) held until CASE-003756 is decided |
| Held | — | ||
| ACT-017201 | Outreach suppressed pending steward Outreach | CLM-428645 (William Wong) held until CASE-003757 is decided |
| Held | — | ||
| ACT-017202 | Outreach suppressed pending steward Outreach | TPA-51723 (Jennifer Schmidt) held until CASE-003758 is decided |
| Held | — | ||
| ACT-017203 | Outreach suppressed pending steward Outreach | CLM-429064 (Margaret Stewart) held until CASE-003759 is decided |
| Held | — | ||
| ACT-017204 | Outreach suppressed pending steward Outreach | TPA-61275 (Denise Adams) held until CASE-003760 is decided |
| Held | — | ||
| ACT-017205 | Outreach suppressed pending steward Outreach | CLM-425565 (Denise Adams) held until CASE-003761 is decided |
| Held | — | ||
| ACT-017206 | Outreach suppressed pending steward Outreach | ENR-133448 (Denise Adams) held until CASE-003762 is decided |
| Held | — | ||
| ACT-017207 | Outreach suppressed pending steward Outreach | TPA-50769 (Patrick Espinoza) held until CASE-003763 is decided |
| Held | — | ||
| ACT-017208 | Outreach suppressed pending steward Outreach | CLM-423058 (Janice Rice) held until CASE-003764 is decided |
| Held | — | ||
| ACT-017209 | Outreach suppressed pending steward Outreach | CLM-429242 (George Howell) held until CASE-003765 is decided |
| Held | — | ||
| ACT-017210 | Outreach suppressed pending steward Outreach | ENR-126024 (Ethan Kelley) held until CASE-003766 is decided |
| Held | — | ||
| ACT-017211 | Outreach suppressed pending steward Outreach | TPA-58716 (Ethan Kelley) held until CASE-003767 is decided |
| Held | — | ||
| ACT-017212 | Outreach suppressed pending steward Outreach | CLM-423400 (Carolyn Martin) held until CASE-003768 is decided |
| Held | — | ||
| ACT-017213 | Outreach suppressed pending steward Outreach | ENR-142132 (Carolyn Gonzalez) held until CASE-003769 is decided |
| Held | — | ||
| ACT-017214 | Outreach suppressed pending steward Outreach | TPA-64171 (Carolyn Gonzalez) held until CASE-003770 is decided |
| Held | — | ||
| ACT-017215 | Outreach suppressed pending steward Outreach | CLM-401519 (Melissa Collins) held until CASE-003771 is decided |
| Held | — | ||
| ACT-017216 | Outreach suppressed pending steward Outreach | PRV-20567 (Sara Holmes) held until CASE-003772 is decided |
| Held | — | ||
| ACT-017217 | Outreach suppressed pending steward Outreach | CLM-413909 (Lori Carter) held until CASE-003773 is decided |
| Held | — | ||
| ACT-017218 | Outreach suppressed pending steward Outreach | CLM-413908 (Loi Carter) held until CASE-003774 is decided |
| Held | — | ||
| ACT-017219 | Outreach suppressed pending steward Outreach | CLM-420401 (Charles Fowler) held until CASE-003775 is decided |
| Held | — | ||
| ACT-017220 | Outreach suppressed pending steward Outreach | ENR-126829 (Charles Fowelr) held until CASE-003776 is decided |
| Held | — | ||
| ACT-017221 | Outreach suppressed pending steward Outreach | CLM-411288 (Diego Gray) held until CASE-003777 is decided |
| Held | — | ||
| ACT-017222 | Outreach suppressed pending steward Outreach | TPA-56114 (Kathleen Stavens) held until CASE-003778 is decided |
| Held | — | ||
| ACT-017223 | Outreach suppressed pending steward Outreach | TPA-56113 (Kathleen Stevens) held until CASE-003779 is decided |
| Held | — | ||
| ACT-017224 | Outreach suppressed pending steward Outreach | ENR-113751 (Olivia Riz) held until CASE-003780 is decided |
| Held | — | ||
| ACT-017225 | Outreach suppressed pending steward Outreach | PRV-23020 (Olivia Ruiz) held until CASE-003781 is decided |
| Held | — | ||
| ACT-017226 | Outreach suppressed pending steward Outreach | ENR-119072 (Diego Boyd) held until CASE-003782 is decided |
| Held | — | ||
| ACT-017227 | Outreach suppressed pending steward Outreach | PRV-23831 (Karen Barnes) held until CASE-003783 is decided |
| Held | — | ||
| ACT-017228 | Outreach suppressed pending steward Outreach | CLM-413203 (Karen Barnes) held until CASE-003784 is decided |
| Held | — | ||
| ACT-017229 | Outreach suppressed pending steward Outreach | CLM-419397 (Nicole Barnes) held until CASE-003785 is decided |
| Held | — | ||
| ACT-017230 | Outreach suppressed pending steward Outreach | TPA-58884 (Wei Griffin) held until CASE-003786 is decided |
| Held | — | ||
| ACT-017231 | Outreach suppressed pending steward Outreach | ENR-142464 (Amy Powell) held until CASE-003787 is decided |
| Held | — | ||
| ACT-017232 | Outreach suppressed pending steward Outreach | ENR-142465 (Amy Powell) held until CASE-003788 is decided |
| Held | — | ||
| ACT-017233 | Outreach suppressed pending steward Outreach | CLM-421418 (Jean Jones) held until CASE-003789 is decided |
| Held | — | ||
| ACT-017234 | Outreach suppressed pending steward Outreach | CLM-409410 (Carlos Mendez) held until CASE-003790 is decided |
| Held | — | ||
| ACT-017235 | Outreach suppressed pending steward Outreach | ENR-112378 (Carlos Mendez) held until CASE-003791 is decided |
| Held | — | ||
| ACT-017236 | Outreach suppressed pending steward Outreach | CLM-422479 (Dorothy Wood) held until CASE-003792 is decided |
| Held | — | ||
| ACT-017237 | Outreach suppressed pending steward Outreach | CLM-428816 (Betty Stephens) held until CASE-003793 is decided |
| Held | — | ||
| ACT-017238 | Outreach suppressed pending steward Outreach | TPA-50992 (Gibson Gabriel) held until CASE-003794 is decided |
| Held | — | ||
| ACT-017239 | Outreach suppressed pending steward Outreach | ENR-103003 (Gabriel Gibsson) held until CASE-003795 is decided |
| Held | — | ||
| ACT-017240 | Outreach suppressed pending steward Outreach | CLM-420945 (Frances Hudson) held until CASE-003796 is decided |
| Held | — | ||
| ACT-017241 | Outreach suppressed pending steward Outreach | TPA-62759 (Diane George) held until CASE-003797 is decided |
| Held | — | ||
| ACT-017242 | Outreach suppressed pending steward Outreach | TPA-57281 (Ethan Welch) held until CASE-003798 is decided |
| Held | — | ||
| ACT-017243 | Outreach suppressed pending steward Outreach | TPA-64197 (Nicholas Kennedy) held until CASE-003799 is decided |
| Held | — | ||
| ACT-017244 | Outreach suppressed pending steward Outreach | ENR-114204 (Benjamin Turner) held until CASE-003800 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.