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-017445 | Outreach suppressed pending steward Outreach | TPA-58092 (Gary Hart) held until CASE-004001 is decided |
| Held | — | ||
| ACT-017446 | Outreach suppressed pending steward Outreach | TPA-58091 (Gary Hart) held until CASE-004002 is decided |
| Held | — | ||
| ACT-017447 | Outreach suppressed pending steward Outreach | ENR-134074 (Elijah Mitchell) held until CASE-004003 is decided |
| Held | — | ||
| ACT-017448 | Outreach suppressed pending steward Outreach | CLM-426031 (Eliijah Mitchell) held until CASE-004004 is decided |
| Held | — | ||
| ACT-017449 | Outreach suppressed pending steward Outreach | TPA-53713 (Roy Mendez) held until CASE-004005 is decided |
| Held | — | ||
| ACT-017450 | Outreach suppressed pending steward Outreach | CLM-430590 (Brittany Holmes) held until CASE-004006 is decided |
| Held | — | ||
| ACT-017451 | Outreach suppressed pending steward Outreach | CLM-423244 (Kyle Harper) held until CASE-004007 is decided |
| Held | — | ||
| ACT-017452 | Outreach suppressed pending steward Outreach | CLM-414276 (Christina Moreno) held until CASE-004008 is decided |
| Held | — | ||
| ACT-017453 | Outreach suppressed pending steward Outreach | ENR-118768 (Christian Morenno) held until CASE-004009 is decided |
| Held | — | ||
| ACT-017454 | Outreach suppressed pending steward Outreach | TPA-63630 (Julia Reyes) held until CASE-004010 is decided |
| Held | — | ||
| ACT-017455 | Outreach suppressed pending steward Outreach | CLM-430837 (Julia Reyes) held until CASE-004011 is decided |
| Held | — | ||
| ACT-017456 | Outreach suppressed pending steward Outreach | ENR-142306 (Jerry Chapman) held until CASE-004012 is decided |
| Held | — | ||
| ACT-017457 | Outreach suppressed pending steward Outreach | CLM-432221 (Jerry Chapman) held until CASE-004013 is decided |
| Held | — | ||
| ACT-017458 | Outreach suppressed pending steward Outreach | TPA-62508 (Isabella Mjia) held until CASE-004014 is decided |
| Held | — | ||
| ACT-017459 | Outreach suppressed pending steward Outreach | ENR-137168 (Isabella Mejia) held until CASE-004015 is decided |
| Held | — | ||
| ACT-017460 | Outreach suppressed pending steward Outreach | TPA-55979 (Steven Carr) held until CASE-004016 is decided |
| Held | — | ||
| ACT-017461 | Outreach suppressed pending steward Outreach | CLM-413599 (Steven Carr) held until CASE-004017 is decided |
| Held | — | ||
| ACT-017462 | Outreach suppressed pending steward Outreach | PRV-25456 (Noah Munoz) held until CASE-004018 is decided |
| Held | — | ||
| ACT-017463 | Outreach suppressed pending steward Outreach | ENR-124232 (Noah Munoz) held until CASE-004019 is decided |
| Held | — | ||
| ACT-017464 | Outreach suppressed pending steward Outreach | ENR-113362 (Kayla Jenkins) held until CASE-004020 is decided |
| Held | — | ||
| ACT-017465 | Outreach suppressed pending steward Outreach | CLM-410141 (Kayla Jenkins) held until CASE-004021 is decided |
| Held | — | ||
| ACT-017466 | Outreach suppressed pending steward Outreach | CLM-412401 (Pamela West) held until CASE-004022 is decided |
| Held | — | ||
| ACT-017467 | Outreach suppressed pending steward Outreach | ENR-116311 (Pamela West) held until CASE-004023 is decided |
| Held | — | ||
| ACT-017468 | Outreach suppressed pending steward Outreach | CLM-401339 (Linda Greene) held until CASE-004024 is decided |
| Held | — | ||
| ACT-017469 | Outreach suppressed pending steward Outreach | ENR-101722 (Linda Geene) held until CASE-004025 is decided |
| Held | — | ||
| ACT-017470 | Outreach suppressed pending steward Outreach | CLM-430302 (Debbie Perez) held until CASE-004026 is decided |
| Held | — | ||
| ACT-017471 | Outreach suppressed pending steward Outreach | TPA-61881 (Gregory Lawson) held until CASE-004027 is decided |
| Held | — | ||
| ACT-017472 | Outreach suppressed pending steward Outreach | TPA-61882 (Grgeory Lawson) held until CASE-004028 is decided |
| Held | — | ||
| ACT-017473 | Outreach suppressed pending steward Outreach | CLM-418562 (Vincent Laawson) held until CASE-004029 is decided |
| Held | — | ||
| ACT-017474 | Outreach suppressed pending steward Outreach | ENR-124438 (Vincent Lawson) held until CASE-004030 is decided |
| Held | — | ||
| ACT-017475 | Outreach suppressed pending steward Outreach | TPA-58766 (Ronald Burton) held until CASE-004031 is decided |
| Held | — | ||
| ACT-017476 | Outreach suppressed pending steward Outreach | TPA-64095 (Jacqueline Sandoval) held until CASE-004032 is decided |
| Held | — | ||
| ACT-017477 | Outreach suppressed pending steward Outreach | TPA-52240 (Sophia Wilson) held until CASE-004033 is decided |
| Held | — | ||
| ACT-017478 | Outreach suppressed pending steward Outreach | CLM-405466 (Gabriel Lawson) held until CASE-004034 is decided |
| Held | — | ||
| ACT-017479 | Outreach suppressed pending steward Outreach | TPA-52406 (Gabriel Lawson) held until CASE-004035 is decided |
| Held | — | ||
| ACT-017480 | Outreach suppressed pending steward Outreach | CLM-430122 (Noah Bowman) held until CASE-004036 is decided |
| Held | — | ||
| ACT-017481 | Outreach suppressed pending steward Outreach | ENR-139518 (Noah Bowman) held until CASE-004037 is decided |
| Held | — | ||
| ACT-017482 | Outreach suppressed pending steward Outreach | TPA-60066 (Joe Rivera) held until CASE-004038 is decided |
| Held | — | ||
| ACT-017483 | Outreach suppressed pending steward Outreach | ENR-129968 (Joe Rivera) held until CASE-004039 is decided |
| Held | — | ||
| ACT-017484 | Outreach suppressed pending steward Outreach | CLM-404925 (Keith Baker) held until CASE-004040 is decided |
| Held | — | ||
| ACT-017485 | Outreach suppressed pending steward Outreach | TPA-52149 (Keith Baker) held until CASE-004041 is decided |
| Held | — | ||
| ACT-017486 | Outreach suppressed pending steward Outreach | TPA-55341 (Danielle Diaz) held until CASE-004042 is decided |
| Held | — | ||
| ACT-017487 | Outreach suppressed pending steward Outreach | ENR-115960 (Danielle Diaz) held until CASE-004043 is decided |
| Held | — | ||
| ACT-017488 | Outreach suppressed pending steward Outreach | CLM-420912 (Megan Young) held until CASE-004044 is decided |
| Held | — | ||
| ACT-017489 | Outreach suppressed pending steward Outreach | CLM-420802 (Angela Cole) held until CASE-004045 is decided |
| Held | — | ||
| ACT-017490 | Outreach suppressed pending steward Outreach | TPA-59919 (Sara Garrett) held until CASE-004046 is decided |
| Held | — | ||
| ACT-017491 | Outreach suppressed pending steward Outreach | ENR-129586 (Sara Garrett) held until CASE-004047 is decided |
| Held | — | ||
| ACT-017492 | Outreach suppressed pending steward Outreach | CLM-406113 (Juan Banks) held until CASE-004048 is decided |
| Held | — | ||
| ACT-017493 | Outreach suppressed pending steward Outreach | CLM-416445 (Beverly Aguilar) held until CASE-004049 is decided |
| Held | — | ||
| ACT-017494 | Outreach suppressed pending steward Outreach | TPA-50835 (Christopher Thompson) held until CASE-004050 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.