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-017295 | Outreach suppressed pending steward Outreach | TPA-50804 (Betty Peters) held until CASE-003851 is decided |
| Held | — | ||
| ACT-017296 | Outreach suppressed pending steward Outreach | ENR-104472 (Roy Miller) held until CASE-003852 is decided |
| Held | — | ||
| ACT-017297 | Outreach suppressed pending steward Outreach | PRV-20982 (Roy Miller) held until CASE-003853 is decided |
| Held | — | ||
| ACT-017298 | Outreach suppressed pending steward Outreach | ENR-122833 (Mark Gibson) held until CASE-003854 is decided |
| Held | — | ||
| ACT-017299 | Outreach suppressed pending steward Outreach | CLM-417336 (Mark Gibson) held until CASE-003855 is decided |
| Held | — | ||
| ACT-017300 | Outreach suppressed pending steward Outreach | ENR-116192 (Gabriel Romero) held until CASE-003856 is decided |
| Held | — | ||
| ACT-017301 | Outreach suppressed pending steward Outreach | TPA-55426 (Gabriel Romero) held until CASE-003857 is decided |
| Held | — | ||
| ACT-017302 | Outreach suppressed pending steward Outreach | CLM-401263 (Sarah Morgan) held until CASE-003858 is decided |
| Held | — | ||
| ACT-017303 | Outreach suppressed pending steward Outreach | ENR-101634 (Sarah Morgan) held until CASE-003859 is decided |
| Held | — | ||
| ACT-017304 | Outreach suppressed pending steward Outreach | TPA-60356 (Eugeen Harper) held until CASE-003860 is decided |
| Held | — | ||
| ACT-017305 | Outreach suppressed pending steward Outreach | CLM-425143 (Michael Jimenez) held until CASE-003861 is decided |
| Held | — | ||
| ACT-017306 | Outreach suppressed pending steward Outreach | ENR-132838 (Michael Jimenez) held until CASE-003862 is decided |
| Held | — | ||
| ACT-017307 | Outreach suppressed pending steward Outreach | TPA-51715 (Brittany Maldonado) held until CASE-003863 is decided |
| Held | — | ||
| ACT-017308 | Outreach suppressed pending steward Outreach | TPA-55800 (Nathan Fernandez) held until CASE-003864 is decided |
| Held | — | ||
| ACT-017309 | Outreach suppressed pending steward Outreach | PRV-20096 (Philip Cole) held until CASE-003865 is decided |
| Held | — | ||
| ACT-017310 | Outreach suppressed pending steward Outreach | ENR-100488 (Philip Cole) held until CASE-003866 is decided |
| Held | — | ||
| ACT-017311 | Outreach suppressed pending steward Outreach | TPA-63886 (Jason Banks) held until CASE-003867 is decided |
| Held | — | ||
| ACT-017312 | Outreach suppressed pending steward Outreach | ENR-141289 (Jason Banks) held until CASE-003868 is decided |
| Held | — | ||
| ACT-017313 | Outreach suppressed pending steward Outreach | TPA-61987 (Santiago Sandoval) held until CASE-003869 is decided |
| Held | — | ||
| ACT-017314 | Outreach suppressed pending steward Outreach | TPA-54247 (Megan Hunter) held until CASE-003870 is decided |
| Held | — | ||
| ACT-017315 | Outreach suppressed pending steward Outreach | ENR-112868 (Megan Hunter) held until CASE-003871 is decided |
| Held | — | ||
| ACT-017316 | Outreach suppressed pending steward Outreach | CLM-411221 (Martha Estrada) held until CASE-003872 is decided |
| Held | — | ||
| ACT-017317 | Outreach suppressed pending steward Outreach | ENR-114761 (Martha Estrada) held until CASE-003873 is decided |
| Held | — | ||
| ACT-017318 | Outreach suppressed pending steward Outreach | TPA-51470 (Margaret Daniels) held until CASE-003874 is decided |
| Held | — | ||
| ACT-017319 | Outreach suppressed pending steward Outreach | TPA-63625 (Jerry Stevens) held until CASE-003875 is decided |
| Held | — | ||
| ACT-017320 | Outreach suppressed pending steward Outreach | TPA-59385 (Benjamin Dean) held until CASE-003876 is decided |
| Held | — | ||
| ACT-017321 | Outreach suppressed pending steward Outreach | CLM-409478 (Bryan Owens) held until CASE-003877 is decided |
| Held | — | ||
| ACT-017322 | Outreach suppressed pending steward Outreach | TPA-54112 (Bryan Owens) held until CASE-003878 is decided |
| Held | — | ||
| ACT-017323 | Outreach suppressed pending steward Outreach | TPA-60404 (Doris Torres) held until CASE-003879 is decided |
| Held | — | ||
| ACT-017324 | Outreach suppressed pending steward Outreach | CLM-425805 (Scott Sullivan) held until CASE-003880 is decided |
| Held | — | ||
| ACT-017325 | Outreach suppressed pending steward Outreach | CLM-425806 (Scott Sulivan) held until CASE-003881 is decided |
| Held | — | ||
| ACT-017326 | Outreach suppressed pending steward Outreach | ENR-111250 (Helen Ray) held until CASE-003882 is decided |
| Held | — | ||
| ACT-017327 | Outreach suppressed pending steward Outreach | TPA-53752 (Ray Helen) held until CASE-003883 is decided |
| Held | — | ||
| ACT-017328 | Outreach suppressed pending steward Outreach | TPA-51701 (Margaret Kelley) held until CASE-003884 is decided |
| Held | — | ||
| ACT-017329 | Outreach suppressed pending steward Outreach | ENR-132498 (Kenneth West) held until CASE-003885 is decided |
| Held | — | ||
| ACT-017330 | Outreach suppressed pending steward Outreach | CLM-413313 (Teresa Larson) held until CASE-003886 is decided |
| Held | — | ||
| ACT-017331 | Outreach suppressed pending steward Outreach | ENR-126135 (Ahmed Elliiott) held until CASE-003887 is decided |
| Held | — | ||
| ACT-017332 | Outreach suppressed pending steward Outreach | TPA-58749 (Ahmed Elliott) held until CASE-003888 is decided |
| Held | — | ||
| ACT-017333 | Outreach suppressed pending steward Outreach | CLM-428804 (Billy Bailey) held until CASE-003889 is decided |
| Held | — | ||
| ACT-017334 | Outreach suppressed pending steward Outreach | CLM-417902 (Ana Fernandez) held until CASE-003890 is decided |
| Held | — | ||
| ACT-017335 | Outreach suppressed pending steward Outreach | ENR-123547 (Ana Fernandez) held until CASE-003891 is decided |
| Held | — | ||
| ACT-017336 | Outreach suppressed pending steward Outreach | CLM-421231 (Catherine Anderson) held until CASE-003892 is decided |
| Held | — | ||
| ACT-017337 | Outreach suppressed pending steward Outreach | ENR-119140 (Sharon Walsh) held until CASE-003893 is decided |
| Held | — | ||
| ACT-017338 | Outreach suppressed pending steward Outreach | CLM-414543 (Sharon Walsh) held until CASE-003894 is decided |
| Held | — | ||
| ACT-017339 | Outreach suppressed pending steward Outreach | CLM-406921 (Bobby Ward) held until CASE-003895 is decided |
| Held | — | ||
| ACT-017340 | Outreach suppressed pending steward Outreach | ENR-109041 (Bobby Ward) held until CASE-003896 is decided |
| Held | — | ||
| ACT-017341 | Outreach suppressed pending steward Outreach | ENR-138843 (Ryan Moore) held until CASE-003897 is decided |
| Held | — | ||
| ACT-017342 | Outreach suppressed pending steward Outreach | CLM-429610 (Ryan Moore) held until CASE-003898 is decided |
| Held | — | ||
| ACT-017343 | Outreach suppressed pending steward Outreach | CLM-422188 (Marilyn Hoffman) held until CASE-003899 is decided |
| Held | — | ||
| ACT-017344 | Outreach suppressed pending steward Outreach | ENR-140625 (Alice Russell) held until CASE-003900 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.