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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-013795 | Outreach suppressed pending steward Outreach | TPA-59466 (Danielle Weaver) held until CASE-000351 is decided |
| Held | — | ||
| ACT-013796 | Outreach suppressed pending steward Outreach | TPA-62792 (Gregory Gonzales) held until CASE-000352 is decided |
| Held | — | ||
| ACT-013797 | Outreach suppressed pending steward Outreach | CLM-428949 (Gregory Gonzales) held until CASE-000353 is decided |
| Held | — | ||
| ACT-013798 | Outreach suppressed pending steward Outreach | TPA-59697 (Nancy Ryan) held until CASE-000354 is decided |
| Held | — | ||
| ACT-013799 | Outreach suppressed pending steward Outreach | TPA-59698 (Nancy Ryan) held until CASE-000355 is decided |
| Held | — | ||
| ACT-013800 | Outreach suppressed pending steward Outreach | TPA-62244 (Beverly Padilla) held until CASE-000356 is decided |
| Held | — | ||
| ACT-013801 | Outreach suppressed pending steward Outreach | CLM-411461 (Carl Montgomery) held until CASE-000357 is decided |
| Held | — | ||
| ACT-013802 | Outreach suppressed pending steward Outreach | PRV-29325 (Patrick Spencer) held until CASE-000358 is decided |
| Held | — | ||
| ACT-013803 | Outreach suppressed pending steward Outreach | CLM-431887 (Patrick Spencer) held until CASE-000359 is decided |
| Held | — | ||
| ACT-013804 | Outreach suppressed pending steward Outreach | TPA-55716 (Luca Young) held until CASE-000360 is decided |
| Held | — | ||
| ACT-013805 | Outreach suppressed pending steward Outreach | CLM-412995 (Lucia Young) held until CASE-000361 is decided |
| Held | — | ||
| ACT-013806 | Outreach suppressed pending steward Outreach | TPA-53351 (Russell Marshall) held until CASE-000362 is decided |
| Held | — | ||
| ACT-013807 | Outreach suppressed pending steward Outreach | TPA-51509 (David Hall) held until CASE-000363 is decided |
| Held | — | ||
| ACT-013808 | Outreach suppressed pending steward Outreach | PRV-24118 (Dennis Contreras) held until CASE-000364 is decided |
| Held | — | ||
| ACT-013809 | Outreach suppressed pending steward Outreach | TPA-56710 (Keith Scott) held until CASE-000365 is decided |
| Held | — | ||
| ACT-013810 | Outreach suppressed pending steward Outreach | CLM-409010 (Jennifer Scott) held until CASE-000366 is decided |
| Held | — | ||
| ACT-013811 | Outreach suppressed pending steward Outreach | TPA-53949 (Jennifer Scott) held until CASE-000367 is decided |
| Held | — | ||
| ACT-013812 | Outreach suppressed pending steward Outreach | ENR-109561 (Kayla Graham) held until CASE-000368 is decided |
| Held | — | ||
| ACT-013813 | Outreach suppressed pending steward Outreach | CLM-407303 (Kayla Graham) held until CASE-000369 is decided |
| Held | — | ||
| ACT-013814 | Outreach suppressed pending steward Outreach | TPA-55636 (Thomas Rose) held until CASE-000370 is decided |
| Held | — | ||
| ACT-013815 | Outreach suppressed pending steward Outreach | CLM-412826 (Thomas Rsoe) held until CASE-000371 is decided |
| Held | — | ||
| ACT-013816 | Outreach suppressed pending steward Outreach | TPA-55193 (Mary Guerrero) held until CASE-000372 is decided |
| Held | — | ||
| ACT-013817 | Outreach suppressed pending steward Outreach | PRV-26189 (Kathleen Clark) held until CASE-000373 is decided |
| Held | — | ||
| ACT-013818 | Outreach suppressed pending steward Outreach | TPA-59228 (Kathy Clark) held until CASE-000374 is decided |
| Held | — | ||
| ACT-013819 | Outreach suppressed pending steward Outreach | CLM-400558 (Mateo Espinoza) held until CASE-000375 is decided |
| Held | — | ||
| ACT-013820 | Outreach suppressed pending steward Outreach | TPA-50102 (Angela Ezpinoza) held until CASE-000376 is decided |
| Held | — | ||
| ACT-013821 | Outreach suppressed pending steward Outreach | TPA-56628 (Amanda Carter) held until CASE-000377 is decided |
| Held | — | ||
| ACT-013822 | Outreach suppressed pending steward Outreach | ENR-104425 (Pamela Carter) held until CASE-000378 is decided |
| Held | — | ||
| ACT-013823 | Outreach suppressed pending steward Outreach | ENR-129735 (Arjun Carter) held until CASE-000379 is decided |
| Held | — | ||
| ACT-013824 | Outreach suppressed pending steward Outreach | CLM-418144 (Pat Ortega) held until CASE-000380 is decided |
| Held | — | ||
| ACT-013825 | Outreach suppressed pending steward Outreach | ENR-115963 (Mark Ortiz) held until CASE-000381 is decided |
| Held | — | ||
| ACT-013826 | Outreach suppressed pending steward Outreach | TPA-60440 (Linda Barnes) held until CASE-000382 is decided |
| Held | — | ||
| ACT-013827 | Outreach suppressed pending steward Outreach | CLM-423717 (Linda Barnes) held until CASE-000383 is decided |
| Held | — | ||
| ACT-013828 | Outreach suppressed pending steward Outreach | CLM-407690 (Eugene Kelly) held until CASE-000384 is decided |
| Held | — | ||
| ACT-013829 | Outreach suppressed pending steward Outreach | TPA-61731 (Matthew Spencer) held until CASE-000385 is decided |
| Held | — | ||
| ACT-013830 | Outreach suppressed pending steward Outreach | ENR-134811 (Matthew Spencer) held until CASE-000386 is decided |
| Held | — | ||
| ACT-013831 | Outreach suppressed pending steward Outreach | CLM-432550 (Russell Jacobs) held until CASE-000387 is decided |
| Held | — | ||
| ACT-013832 | Outreach suppressed pending steward Outreach | CLM-401672 (Nicole Rivera) held until CASE-000388 is decided |
| Held | — | ||
| ACT-013833 | Outreach suppressed pending steward Outreach | CLM-401671 (Nicole Rivera) held until CASE-000389 is decided |
| Held | — | ||
| ACT-013834 | Outreach suppressed pending steward Outreach | TPA-57340 (Dorothy Wagner) held until CASE-000390 is decided |
| Held | — | ||
| ACT-013835 | Outreach suppressed pending steward Outreach | PRV-23213 (Sarah Carlson) held until CASE-000391 is decided |
| Held | — | ||
| ACT-013836 | Outreach suppressed pending steward Outreach | ENR-114539 (Sarah Carlzon) held until CASE-000392 is decided |
| Held | — | ||
| ACT-013837 | Outreach suppressed pending steward Outreach | CLM-405788 (Stephen Lewis) held until CASE-000393 is decided |
| Held | — | ||
| ACT-013838 | Outreach suppressed pending steward Outreach | CLM-423425 (Evlyn Mendez) held until CASE-000394 is decided |
| Held | — | ||
| ACT-013839 | Outreach suppressed pending steward Outreach | ENR-130631 (Evelyn Mendez) held until CASE-000395 is decided |
| Held | — | ||
| ACT-013840 | Outreach suppressed pending steward Outreach | TPA-62878 (Mei Griffin) held until CASE-000396 is decided |
| Held | — | ||
| ACT-013841 | Outreach suppressed pending steward Outreach | PRV-21643 (Robert Tucker) held until CASE-000397 is decided |
| Held | — | ||
| ACT-013842 | Outreach suppressed pending steward Outreach | TPA-58194 (George Li) held until CASE-000398 is decided |
| Held | — | ||
| ACT-013843 | Outreach suppressed pending steward Outreach | TPA-55864 (Lawrence Anderson) held until CASE-000399 is decided |
| Held | — | ||
| ACT-013844 | Outreach suppressed pending steward Outreach | CLM-410308 (Vincent Wilson) held until CASE-000400 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.