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-017395 | Outreach suppressed pending steward Outreach | TPA-62518 (Megan Maldonado) held until CASE-003951 is decided |
| Held | — | ||
| ACT-017396 | Outreach suppressed pending steward Outreach | ENR-137199 (Megan Maldonado) held until CASE-003952 is decided |
| Held | — | ||
| ACT-017397 | Outreach suppressed pending steward Outreach | TPA-60575 (Marcus Ramireez) held until CASE-003953 is decided |
| Held | — | ||
| ACT-017398 | Outreach suppressed pending steward Outreach | CLM-423939 (Gerald Foster) held until CASE-003954 is decided |
| Held | — | ||
| ACT-017399 | Outreach suppressed pending steward Outreach | TPA-51021 (Diana Hudson) held until CASE-003955 is decided |
| Held | — | ||
| ACT-017400 | Outreach suppressed pending steward Outreach | TPA-61891 (Frank Garcia) held until CASE-003956 is decided |
| Held | — | ||
| ACT-017401 | Outreach suppressed pending steward Outreach | PRV-28633 (Diego Harveey) held until CASE-003957 is decided |
| Held | — | ||
| ACT-017402 | Outreach suppressed pending steward Outreach | CLM-414927 (Margaret Turner) held until CASE-003958 is decided |
| Held | — | ||
| ACT-017403 | Outreach suppressed pending steward Outreach | CLM-414928 (Maggie Turner) held until CASE-003959 is decided |
| Held | — | ||
| ACT-017404 | Outreach suppressed pending steward Outreach | TPA-63008 (Brandon Salazar) held until CASE-003960 is decided |
| Held | — | ||
| ACT-017405 | Outreach suppressed pending steward Outreach | TPA-54899 (Russell Andrews) held until CASE-003961 is decided |
| Held | — | ||
| ACT-017406 | Outreach suppressed pending steward Outreach | CLM-409616 (Martha Singh) held until CASE-003962 is decided |
| Held | — | ||
| ACT-017407 | Outreach suppressed pending steward Outreach | TPA-54183 (Martha Singh) held until CASE-003963 is decided |
| Held | — | ||
| ACT-017408 | Outreach suppressed pending steward Outreach | ENR-110849 (Nicholas Williamson) held until CASE-003964 is decided |
| Held | — | ||
| ACT-017409 | Outreach suppressed pending steward Outreach | PRV-21372 (Brandon Garrett) held until CASE-003965 is decided |
| Held | — | ||
| ACT-017410 | Outreach suppressed pending steward Outreach | ENR-106233 (Brandon Garrett) held until CASE-003966 is decided |
| Held | — | ||
| ACT-017411 | Outreach suppressed pending steward Outreach | CLM-417703 (Austin Collins) held until CASE-003967 is decided |
| Held | — | ||
| ACT-017412 | Outreach suppressed pending steward Outreach | ENR-123318 (Austin Collins) held until CASE-003968 is decided |
| Held | — | ||
| ACT-017413 | Outreach suppressed pending steward Outreach | ENR-130536 (Jon Burke) held until CASE-003969 is decided |
| Held | — | ||
| ACT-017414 | Outreach suppressed pending steward Outreach | TPA-60279 (Jonathan Burke) held until CASE-003970 is decided |
| Held | — | ||
| ACT-017415 | Outreach suppressed pending steward Outreach | ENR-126994 (Michelle Murphy) held until CASE-003971 is decided |
| Held | — | ||
| ACT-017416 | Outreach suppressed pending steward Outreach | CLM-420517 (Michelle Murphy) held until CASE-003972 is decided |
| Held | — | ||
| ACT-017417 | Outreach suppressed pending steward Outreach | PRV-26710 (Arjun Carter) held until CASE-003973 is decided |
| Held | — | ||
| ACT-017418 | Outreach suppressed pending steward Outreach | TPA-62400 (Marcus Webb) held until CASE-003974 is decided |
| Held | — | ||
| ACT-017419 | Outreach suppressed pending steward Outreach | CLM-413013 (Roger Holmes) held until CASE-003975 is decided |
| Held | — | ||
| ACT-017420 | Outreach suppressed pending steward Outreach | CLM-417257 (Carl Robinson) held until CASE-003976 is decided |
| Held | — | ||
| ACT-017421 | Outreach suppressed pending steward Outreach | ENR-122744 (Carl Robinson) held until CASE-003977 is decided |
| Held | — | ||
| ACT-017422 | Outreach suppressed pending steward Outreach | CLM-430016 (Diego Chavez) held until CASE-003978 is decided |
| Held | — | ||
| ACT-017423 | Outreach suppressed pending steward Outreach | CLM-424797 (Santiago Jacobs) held until CASE-003979 is decided |
| Held | — | ||
| ACT-017424 | Outreach suppressed pending steward Outreach | CLM-424796 (Santiago Jacobs) held until CASE-003980 is decided |
| Held | — | ||
| ACT-017425 | Outreach suppressed pending steward Outreach | TPA-55169 (Melissa Stephens) held until CASE-003981 is decided |
| Held | — | ||
| ACT-017426 | Outreach suppressed pending steward Outreach | TPA-54064 (Kathryn Nichols) held until CASE-003982 is decided |
| Held | — | ||
| ACT-017427 | Outreach suppressed pending steward Outreach | TPA-54065 (Kathryn Nichols) held until CASE-003983 is decided |
| Held | — | ||
| ACT-017428 | Outreach suppressed pending steward Outreach | CLM-426648 (Olivia Berry) held until CASE-003984 is decided |
| Held | — | ||
| ACT-017429 | Outreach suppressed pending steward Outreach | ENR-134943 (Olivia Berry) held until CASE-003985 is decided |
| Held | — | ||
| ACT-017430 | Outreach suppressed pending steward Outreach | TPA-50779 (Ross Edward) held until CASE-003986 is decided |
| Held | — | ||
| ACT-017431 | Outreach suppressed pending steward Outreach | ENR-102336 (Edward Ross) held until CASE-003987 is decided |
| Held | — | ||
| ACT-017432 | Outreach suppressed pending steward Outreach | CLM-420195 (Sharon Woods) held until CASE-003988 is decided |
| Held | — | ||
| ACT-017433 | Outreach suppressed pending steward Outreach | PRV-21198 (James Cunningham) held until CASE-003989 is decided |
| Held | — | ||
| ACT-017434 | Outreach suppressed pending steward Outreach | ENR-105593 (James Cunningham) held until CASE-003990 is decided |
| Held | — | ||
| ACT-017435 | Outreach suppressed pending steward Outreach | CLM-417234 (Sophia Larson) held until CASE-003991 is decided |
| Held | — | ||
| ACT-017436 | Outreach suppressed pending steward Outreach | TPA-61009 (Barbara Ruiz) held until CASE-003992 is decided |
| Held | — | ||
| ACT-017437 | Outreach suppressed pending steward Outreach | ENR-107284 (Jesse Tucker) held until CASE-003993 is decided |
| Held | — | ||
| ACT-017438 | Outreach suppressed pending steward Outreach | ENR-114467 (Denie Harper) held until CASE-003994 is decided |
| Held | — | ||
| ACT-017439 | Outreach suppressed pending steward Outreach | TPA-54818 (Denise Harper) held until CASE-003995 is decided |
| Held | — | ||
| ACT-017440 | Outreach suppressed pending steward Outreach | CLM-417502 (Justin Reyes) held until CASE-003996 is decided |
| Held | — | ||
| ACT-017441 | Outreach suppressed pending steward Outreach | CLM-429178 (Jake Collins) held until CASE-003997 is decided |
| Held | — | ||
| ACT-017442 | Outreach suppressed pending steward Outreach | PRV-28560 (Jacob Collins) held until CASE-003998 is decided |
| Held | — | ||
| ACT-017443 | Outreach suppressed pending steward Outreach | CLM-406779 (Donna Russell) held until CASE-003999 is decided |
| Held | — | ||
| ACT-017444 | Outreach suppressed pending steward Outreach | CLM-406780 (Donna Russell) held until CASE-004000 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.