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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-018121 | Care coordination outreach Next-best-action | Judith Murray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018122 | Care coordination outreach Next-best-action | Elizabeth Rose: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018123 | Care coordination outreach Next-best-action | Scott Evans: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018124 | Care coordination outreach Next-best-action | Harold Matthews: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018125 | Care coordination outreach Next-best-action | Amanda Aguilar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018126 | Care coordination outreach Next-best-action | Melissa Medina: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018127 | Care coordination outreach Next-best-action | Richard Boyd: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018128 | Care coordination outreach Next-best-action | Susan Burke: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018129 | Care coordination outreach Next-best-action | Megan Allen: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018130 | Care coordination outreach Next-best-action | Mason Maldonado: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018131 | Care coordination outreach Next-best-action | Jesse Kim: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018132 | Care coordination outreach Next-best-action | Kayla Valdez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018133 | Care coordination outreach Next-best-action | George Murphy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018134 | Care coordination outreach Next-best-action | Keith Cunningham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018135 | Care coordination outreach Next-best-action | Doris Murphy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018136 | Care coordination outreach Next-best-action | Cheryl Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018137 | Care coordination outreach Next-best-action | Emma Mitchell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018138 | Care coordination outreach Next-best-action | Denise Ortega: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018139 | Care coordination outreach Next-best-action | Heather Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018140 | Care coordination outreach Next-best-action | Adam Williamson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018141 | Care coordination outreach Next-best-action | Thomas Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018142 | Care coordination outreach Next-best-action | Omar Weaver: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018143 | Care coordination outreach Next-best-action | Edward Peterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018144 | Care coordination outreach Next-best-action | Ryan Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018145 | Care coordination outreach Next-best-action | Patrick Wells: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018146 | Care coordination outreach Next-best-action | Samantha Bell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018147 | Care coordination outreach Next-best-action | Heather Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018148 | Care coordination outreach Next-best-action | Zachary Green: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018149 | Care coordination outreach Next-best-action | Russell Schultz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018150 | Care coordination outreach Next-best-action | Marcus Fernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018151 | Care coordination outreach Next-best-action | Teresa Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018152 | Care coordination outreach Next-best-action | Edward Coleman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018153 | Care coordination outreach Next-best-action | Carolyn Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018154 | Care coordination outreach Next-best-action | Lori Olson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018155 | Care coordination outreach Next-best-action | Nicole Welch: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018156 | Care coordination outreach Next-best-action | Gerald Anderson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018157 | Care coordination outreach Next-best-action | Vincent Sullivan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018158 | Care coordination outreach Next-best-action | Brandon Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018159 | Care coordination outreach Next-best-action | Katherine Young: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018160 | Care coordination outreach Next-best-action | Madison Vazquez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018161 | Care coordination outreach Next-best-action | Carl Robertson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018162 | Care coordination outreach Next-best-action | Keith Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018163 | Care coordination outreach Next-best-action | James Chen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018164 | Care coordination outreach Next-best-action | Kimberly Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018165 | Care coordination outreach Next-best-action | Shirley Munoz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018166 | Care coordination outreach Next-best-action | Roger Martinez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018167 | Care coordination outreach Next-best-action | Jose Walker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018168 | Care coordination outreach Next-best-action | Nathan Crawford: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018169 | Care coordination outreach Next-best-action | Cheryl Harper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018170 | Care coordination outreach Next-best-action | Ethan Stevens: 3 claims, no attributed provider |
| Proposed | — |
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.