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-017245 | Outreach suppressed pending steward Outreach | TPA-54743 (Benjamin Turner) held until CASE-003801 is decided |
| Held | — | ||
| ACT-017246 | Outreach suppressed pending steward Outreach | ENR-141629 (Christine Gonzales) held until CASE-003802 is decided |
| Held | — | ||
| ACT-017247 | Outreach suppressed pending steward Outreach | ENR-141628 (Christine Gonzales) held until CASE-003803 is decided |
| Held | — | ||
| ACT-017248 | Outreach suppressed pending steward Outreach | ENR-103739 (Elizabeth Mendez) held until CASE-003804 is decided |
| Held | — | ||
| ACT-017249 | Outreach suppressed pending steward Outreach | CLM-402900 (Elizabeth Mendez) held until CASE-003805 is decided |
| Held | — | ||
| ACT-017250 | Outreach suppressed pending steward Outreach | ENR-127814 (Brenda Simmons) held until CASE-003806 is decided |
| Held | — | ||
| ACT-017251 | Outreach suppressed pending steward Outreach | TPA-59325 (Brenda Simmons) held until CASE-003807 is decided |
| Held | — | ||
| ACT-017252 | Outreach suppressed pending steward Outreach | CLM-406060 (Thomas Ruiz) held until CASE-003808 is decided |
| Held | — | ||
| ACT-017253 | Outreach suppressed pending steward Outreach | ENR-107986 (Tom Ruiz) held until CASE-003809 is decided |
| Held | — | ||
| ACT-017254 | Outreach suppressed pending steward Outreach | CLM-400139 (Sofia Nunez) held until CASE-003810 is decided |
| Held | — | ||
| ACT-017255 | Outreach suppressed pending steward Outreach | CLM-411607 (Noah Burton) held until CASE-003811 is decided |
| Held | — | ||
| ACT-017256 | Outreach suppressed pending steward Outreach | TPA-54474 (Sarah Edwards) held until CASE-003812 is decided |
| Held | — | ||
| ACT-017257 | Outreach suppressed pending steward Outreach | PRV-25696 (Theresa McDonald) held until CASE-003813 is decided |
| Held | — | ||
| ACT-017258 | Outreach suppressed pending steward Outreach | ENR-125240 (Theresa McDonald) held until CASE-003814 is decided |
| Held | — | ||
| ACT-017259 | Outreach suppressed pending steward Outreach | ENR-102956 (Aaron Chapan) held until CASE-003815 is decided |
| Held | — | ||
| ACT-017260 | Outreach suppressed pending steward Outreach | TPA-50976 (Aaron Chapman) held until CASE-003816 is decided |
| Held | — | ||
| ACT-017261 | Outreach suppressed pending steward Outreach | ENR-109543 (Peter Elliott) held until CASE-003817 is decided |
| Held | — | ||
| ACT-017262 | Outreach suppressed pending steward Outreach | PRV-22164 (Peter Elliott) held until CASE-003818 is decided |
| Held | — | ||
| ACT-017263 | Outreach suppressed pending steward Outreach | CLM-430001 (Kyle Powell) held until CASE-003819 is decided |
| Held | — | ||
| ACT-017264 | Outreach suppressed pending steward Outreach | TPA-54405 (Jerry Flores) held until CASE-003820 is decided |
| Held | — | ||
| ACT-017265 | Outreach suppressed pending steward Outreach | TPA-57573 (Carlos Berry) held until CASE-003821 is decided |
| Held | — | ||
| ACT-017266 | Outreach suppressed pending steward Outreach | CLM-419045 (Fatima Bryant) held until CASE-003822 is decided |
| Held | — | ||
| ACT-017267 | Outreach suppressed pending steward Outreach | CLM-407929 (Bryan Ryan) held until CASE-003823 is decided |
| Held | — | ||
| ACT-017268 | Outreach suppressed pending steward Outreach | PRV-25024 (Sharon Little) held until CASE-003824 is decided |
| Held | — | ||
| ACT-017269 | Outreach suppressed pending steward Outreach | CLM-422163 (Gloria Obrien) held until CASE-003825 is decided |
| Held | — | ||
| ACT-017270 | Outreach suppressed pending steward Outreach | TPA-59727 (Gloria Obrien) held until CASE-003826 is decided |
| Held | — | ||
| ACT-017271 | Outreach suppressed pending steward Outreach | TPA-62101 (Justin Ruiz) held until CASE-003827 is decided |
| Held | — | ||
| ACT-017272 | Outreach suppressed pending steward Outreach | CLM-424388 (Sofia Montgomery) held until CASE-003828 is decided |
| Held | — | ||
| ACT-017273 | Outreach suppressed pending steward Outreach | CLM-425275 (Joan Webb) held until CASE-003829 is decided |
| Held | — | ||
| ACT-017274 | Outreach suppressed pending steward Outreach | TPA-61161 (Joan Webb) held until CASE-003830 is decided |
| Held | — | ||
| ACT-017275 | Outreach suppressed pending steward Outreach | CLM-428065 (Jason Hunt) held until CASE-003831 is decided |
| Held | — | ||
| ACT-017276 | Outreach suppressed pending steward Outreach | CLM-417516 (Denise Oliver) held until CASE-003832 is decided |
| Held | — | ||
| ACT-017277 | Outreach suppressed pending steward Outreach | ENR-123082 (Denise Oliver) held until CASE-003833 is decided |
| Held | — | ||
| ACT-017278 | Outreach suppressed pending steward Outreach | TPA-53158 (Christine Munoz) held until CASE-003834 is decided |
| Held | — | ||
| ACT-017279 | Outreach suppressed pending steward Outreach | ENR-109428 (Chris Munoz) held until CASE-003835 is decided |
| Held | — | ||
| ACT-017280 | Outreach suppressed pending steward Outreach | PRV-22165 (Joyce Thompson) held until CASE-003836 is decided |
| Held | — | ||
| ACT-017281 | Outreach suppressed pending steward Outreach | CLM-428774 (Michael Duncan) held until CASE-003837 is decided |
| Held | — | ||
| ACT-017282 | Outreach suppressed pending steward Outreach | CLM-428775 (Michael Duncan) held until CASE-003838 is decided |
| Held | — | ||
| ACT-017283 | Outreach suppressed pending steward Outreach | TPA-51850 (Maria Estrada) held until CASE-003839 is decided |
| Held | — | ||
| ACT-017284 | Outreach suppressed pending steward Outreach | TPA-51849 (Maria Estrada) held until CASE-003840 is decided |
| Held | — | ||
| ACT-017285 | Outreach suppressed pending steward Outreach | CLM-415052 (Albert Hall) held until CASE-003841 is decided |
| Held | — | ||
| ACT-017286 | Outreach suppressed pending steward Outreach | CLM-424455 (Walter Estrada) held until CASE-003842 is decided |
| Held | — | ||
| ACT-017287 | Outreach suppressed pending steward Outreach | ENR-131971 (Walter Estrada) held until CASE-003843 is decided |
| Held | — | ||
| ACT-017288 | Outreach suppressed pending steward Outreach | TPA-53856 (Randy Hernandez) held until CASE-003844 is decided |
| Held | — | ||
| ACT-017289 | Outreach suppressed pending steward Outreach | CLM-411665 (Emma Washington) held until CASE-003845 is decided |
| Held | — | ||
| ACT-017290 | Outreach suppressed pending steward Outreach | CLM-410194 (Rob Phillips) held until CASE-003846 is decided |
| Held | — | ||
| ACT-017291 | Outreach suppressed pending steward Outreach | PRV-28988 (Angela Nelson) held until CASE-003847 is decided |
| Held | — | ||
| ACT-017292 | Outreach suppressed pending steward Outreach | ENR-120362 (Joyce Grza) held until CASE-003848 is decided |
| Held | — | ||
| ACT-017293 | Outreach suppressed pending steward Outreach | CLM-415463 (Joyce Garza) held until CASE-003849 is decided |
| Held | — | ||
| ACT-017294 | Outreach suppressed pending steward Outreach | TPA-63471 (Omar Espinoza) held until CASE-003850 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.