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-017345 | Outreach suppressed pending steward Outreach | TPA-51429 (Arthur Halll) held until CASE-003901 is decided |
| Held | — | ||
| ACT-017346 | Outreach suppressed pending steward Outreach | CLM-428720 (Tim Silva) held until CASE-003902 is decided |
| Held | — | ||
| ACT-017347 | Outreach suppressed pending steward Outreach | TPA-53483 (Teresa Gutierrez) held until CASE-003903 is decided |
| Held | — | ||
| ACT-017348 | Outreach suppressed pending steward Outreach | CLM-407895 (Teresa Gutierrez) held until CASE-003904 is decided |
| Held | — | ||
| ACT-017349 | Outreach suppressed pending steward Outreach | CLM-406336 (Raymond Dunn) held until CASE-003905 is decided |
| Held | — | ||
| ACT-017350 | Outreach suppressed pending steward Outreach | ENR-108313 (Raymond Dunn) held until CASE-003906 is decided |
| Held | — | ||
| ACT-017351 | Outreach suppressed pending steward Outreach | PRV-26921 (Yuki Harris) held until CASE-003907 is decided |
| Held | — | ||
| ACT-017352 | Outreach suppressed pending steward Outreach | TPA-62356 (Diego Brown) held until CASE-003908 is decided |
| Held | — | ||
| ACT-017353 | Outreach suppressed pending steward Outreach | ENR-136670 (Dego Brown) held until CASE-003909 is decided |
| Held | — | ||
| ACT-017354 | Outreach suppressed pending steward Outreach | ENR-102466 (Doris Crawford) held until CASE-003910 is decided |
| Held | — | ||
| ACT-017355 | Outreach suppressed pending steward Outreach | CLM-401912 (Doris Crawford) held until CASE-003911 is decided |
| Held | — | ||
| ACT-017356 | Outreach suppressed pending steward Outreach | TPA-53651 (Susn Estrada) held until CASE-003912 is decided |
| Held | — | ||
| ACT-017357 | Outreach suppressed pending steward Outreach | PRV-28640 (Maria Rose) held until CASE-003913 is decided |
| Held | — | ||
| ACT-017358 | Outreach suppressed pending steward Outreach | PRV-28641 (Maria Rose) held until CASE-003914 is decided |
| Held | — | ||
| ACT-017359 | Outreach suppressed pending steward Outreach | TPA-54312 (Bruce Alvraez) held until CASE-003915 is decided |
| Held | — | ||
| ACT-017360 | Outreach suppressed pending steward Outreach | CLM-404943 (Russell Morales) held until CASE-003916 is decided |
| Held | — | ||
| ACT-017361 | Outreach suppressed pending steward Outreach | TPA-59967 (Willie Gomez) held until CASE-003917 is decided |
| Held | — | ||
| ACT-017362 | Outreach suppressed pending steward Outreach | CLM-422682 (Willie Gomez) held until CASE-003918 is decided |
| Held | — | ||
| ACT-017363 | Outreach suppressed pending steward Outreach | CLM-416774 (Melissa Guzman) held until CASE-003919 is decided |
| Held | — | ||
| ACT-017364 | Outreach suppressed pending steward Outreach | ENR-136759 (Ralph Lee) held until CASE-003920 is decided |
| Held | — | ||
| ACT-017365 | Outreach suppressed pending steward Outreach | CLM-428030 (Ralph Lee) held until CASE-003921 is decided |
| Held | — | ||
| ACT-017366 | Outreach suppressed pending steward Outreach | CLM-415334 (Sofia Lopez) held until CASE-003922 is decided |
| Held | — | ||
| ACT-017367 | Outreach suppressed pending steward Outreach | ENR-138638 (Richard Murphy) held until CASE-003923 is decided |
| Held | — | ||
| ACT-017368 | Outreach suppressed pending steward Outreach | TPA-63027 (Richard Murphy) held until CASE-003924 is decided |
| Held | — | ||
| ACT-017369 | Outreach suppressed pending steward Outreach | PRV-27007 (Christopher Reynolds) held until CASE-003925 is decided |
| Held | — | ||
| ACT-017370 | Outreach suppressed pending steward Outreach | CLM-423781 (Christopher Reynolds) held until CASE-003926 is decided |
| Held | — | ||
| ACT-017371 | Outreach suppressed pending steward Outreach | ENR-134229 (Douglas Edwards) held until CASE-003927 is decided |
| Held | — | ||
| ACT-017372 | Outreach suppressed pending steward Outreach | TPA-61538 (Douglas Edwards) held until CASE-003928 is decided |
| Held | — | ||
| ACT-017373 | Outreach suppressed pending steward Outreach | TPA-55999 (Amber Dean) held until CASE-003929 is decided |
| Held | — | ||
| ACT-017374 | Outreach suppressed pending steward Outreach | CLM-426971 (Timothy Flores) held until CASE-003930 is decided |
| Held | — | ||
| ACT-017375 | Outreach suppressed pending steward Outreach | CLM-426972 (Timothy Floores) held until CASE-003931 is decided |
| Held | — | ||
| ACT-017376 | Outreach suppressed pending steward Outreach | CLM-416627 (Christopher Bryant) held until CASE-003932 is decided |
| Held | — | ||
| ACT-017377 | Outreach suppressed pending steward Outreach | CLM-416626 (Christopher Bryant) held until CASE-003933 is decided |
| Held | — | ||
| ACT-017378 | Outreach suppressed pending steward Outreach | ENR-108176 (Kathryn Perkins) held until CASE-003934 is decided |
| Held | — | ||
| ACT-017379 | Outreach suppressed pending steward Outreach | PRV-21814 (Kathryn Perkins) held until CASE-003935 is decided |
| Held | — | ||
| ACT-017380 | Outreach suppressed pending steward Outreach | TPA-57058 (Frances Reed) held until CASE-003936 is decided |
| Held | — | ||
| ACT-017381 | Outreach suppressed pending steward Outreach | CLM-409639 (Bryan Gonzalez) held until CASE-003937 is decided |
| Held | — | ||
| ACT-017382 | Outreach suppressed pending steward Outreach | ENR-112695 (Bryan Gonzalez) held until CASE-003938 is decided |
| Held | — | ||
| ACT-017383 | Outreach suppressed pending steward Outreach | ENR-116294 (Brandon Munoz) held until CASE-003939 is decided |
| Held | — | ||
| ACT-017384 | Outreach suppressed pending steward Outreach | TPA-60386 (Thomas Day) held until CASE-003940 is decided |
| Held | — | ||
| ACT-017385 | Outreach suppressed pending steward Outreach | ENR-140991 (Matthew Ford) held until CASE-003941 is decided |
| Held | — | ||
| ACT-017386 | Outreach suppressed pending steward Outreach | CLM-431212 (Matt Ford) held until CASE-003942 is decided |
| Held | — | ||
| ACT-017387 | Outreach suppressed pending steward Outreach | ENR-111902 (Margaret Ramirez) held until CASE-003943 is decided |
| Held | — | ||
| ACT-017388 | Outreach suppressed pending steward Outreach | CLM-408996 (Margaret Ramirez) held until CASE-003944 is decided |
| Held | — | ||
| ACT-017389 | Outreach suppressed pending steward Outreach | PRV-28823 (Zachary Harvey) held until CASE-003945 is decided |
| Held | — | ||
| ACT-017390 | Outreach suppressed pending steward Outreach | TPA-60205 (William Knight) held until CASE-003946 is decided |
| Held | — | ||
| ACT-017391 | Outreach suppressed pending steward Outreach | TPA-62285 (Jack Moore) held until CASE-003947 is decided |
| Held | — | ||
| ACT-017392 | Outreach suppressed pending steward Outreach | TPA-59978 (Daniel Guerrero) held until CASE-003948 is decided |
| Held | — | ||
| ACT-017393 | Outreach suppressed pending steward Outreach | ENR-129738 (Danny Guerrero) held until CASE-003949 is decided |
| Held | — | ||
| ACT-017394 | Outreach suppressed pending steward Outreach | TPA-54187 (Bradley Lynch) held until CASE-003950 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.