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-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.