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-017495 | Outreach suppressed pending steward Outreach | CLM-429160 (Jason Thompson) held until CASE-004051 is decided |
| Held | — | ||
| ACT-017496 | Outreach suppressed pending steward Outreach | CLM-429159 (Jason Thompson) held until CASE-004052 is decided |
| Held | — | ||
| ACT-017497 | Outreach suppressed pending steward Outreach | ENR-107518 (Carl Fields) held until CASE-004053 is decided |
| Held | — | ||
| ACT-017498 | Outreach suppressed pending steward Outreach | TPA-52525 (Carl Fields) held until CASE-004054 is decided |
| Held | — | ||
| ACT-017499 | Outreach suppressed pending steward Outreach | TPA-51212 (Joyce Guerrero) held until CASE-004055 is decided |
| Held | — | ||
| ACT-017500 | Outreach suppressed pending steward Outreach | CLM-420506 (William Chapman) held until CASE-004056 is decided |
| Held | — | ||
| ACT-017501 | Outreach suppressed pending steward Outreach | ENR-126983 (Billy Chapman) held until CASE-004057 is decided |
| Held | — | ||
| ACT-017502 | Outreach suppressed pending steward Outreach | CLM-416322 (Alice Sanders) held until CASE-004058 is decided |
| Held | — | ||
| ACT-017503 | Outreach suppressed pending steward Outreach | ENR-130569 (Alexander Gardner) held until CASE-004059 is decided |
| Held | — | ||
| ACT-017504 | Outreach suppressed pending steward Outreach | TPA-60292 (Alexander Gardner) held until CASE-004060 is decided |
| Held | — | ||
| ACT-017505 | Outreach suppressed pending steward Outreach | TPA-55386 (Adam Gordon) held until CASE-004061 is decided |
| Held | — | ||
| ACT-017506 | Outreach suppressed pending steward Outreach | TPA-62690 (Kimberly Spencer) held until CASE-004062 is decided |
| Held | — | ||
| ACT-017507 | Outreach suppressed pending steward Outreach | TPA-62691 (Kimberly Spencer) held until CASE-004063 is decided |
| Held | — | ||
| ACT-017508 | Outreach suppressed pending steward Outreach | TPA-54977 (Melissa Wong) held until CASE-004064 is decided |
| Held | — | ||
| ACT-017509 | Outreach suppressed pending steward Outreach | CLM-411327 (Melissa Woong) held until CASE-004065 is decided |
| Held | — | ||
| ACT-017510 | Outreach suppressed pending steward Outreach | ENR-141525 (Terry Hansen) held until CASE-004066 is decided |
| Held | — | ||
| ACT-017511 | Outreach suppressed pending steward Outreach | CLM-421151 (Scott Rogers) held until CASE-004067 is decided |
| Held | — | ||
| ACT-017512 | Outreach suppressed pending steward Outreach | TPA-56043 (Aisha Braadley) held until CASE-004068 is decided |
| Held | — | ||
| ACT-017513 | Outreach suppressed pending steward Outreach | ENR-128917 (Brittany Carpenter) held until CASE-004069 is decided |
| Held | — | ||
| ACT-017514 | Outreach suppressed pending steward Outreach | CLM-422078 (Brittany Carpenter) held until CASE-004070 is decided |
| Held | — | ||
| ACT-017515 | Outreach suppressed pending steward Outreach | CLM-404644 (Sean Torres) held until CASE-004071 is decided |
| Held | — | ||
| ACT-017516 | Outreach suppressed pending steward Outreach | TPA-57463 (Bill Wallace) held until CASE-004072 is decided |
| Held | — | ||
| ACT-017517 | Outreach suppressed pending steward Outreach | TPA-63235 (Hannah Miller) held until CASE-004073 is decided |
| Held | — | ||
| ACT-017518 | Outreach suppressed pending steward Outreach | PRV-28773 (Hannah Miller) held until CASE-004074 is decided |
| Held | — | ||
| ACT-017519 | Outreach suppressed pending steward Outreach | CLM-415941 (Nancy Hart) held until CASE-004075 is decided |
| Held | — | ||
| ACT-017520 | Outreach suppressed pending steward Outreach | TPA-56983 (Nanncy Hart) held until CASE-004076 is decided |
| Held | — | ||
| ACT-017521 | Outreach suppressed pending steward Outreach | ENR-136036 (Maria Henderson) held until CASE-004077 is decided |
| Held | — | ||
| ACT-017522 | Outreach suppressed pending steward Outreach | CLM-427493 (Maria Henderson) held until CASE-004078 is decided |
| Held | — | ||
| ACT-017523 | Outreach suppressed pending steward Outreach | ENR-114003 (Carlos Thompson) held until CASE-004079 is decided |
| Held | — | ||
| ACT-017524 | Outreach suppressed pending steward Outreach | TPA-54682 (Carlos Thompson) held until CASE-004080 is decided |
| Held | — | ||
| ACT-017525 | Outreach suppressed pending steward Outreach | TPA-54273 (Hiroshi Rice) held until CASE-004081 is decided |
| Held | — | ||
| ACT-017526 | Outreach suppressed pending steward Outreach | ENR-109733 (Priya Ortiz) held until CASE-004082 is decided |
| Held | — | ||
| ACT-017527 | Outreach suppressed pending steward Outreach | CLM-407424 (Priya Ortiz) held until CASE-004083 is decided |
| Held | — | ||
| ACT-017528 | Outreach suppressed pending steward Outreach | ENR-119004 (Nancy Wright) held until CASE-004084 is decided |
| Held | — | ||
| ACT-017529 | Outreach suppressed pending steward Outreach | PRV-24232 (Nancy Wright) held until CASE-004085 is decided |
| Held | — | ||
| ACT-017530 | Outreach suppressed pending steward Outreach | CLM-429139 (Fatima Payne) held until CASE-004086 is decided |
| Held | — | ||
| ACT-017531 | Outreach suppressed pending steward Outreach | ENR-138207 (Fatima Payne) held until CASE-004087 is decided |
| Held | — | ||
| ACT-017532 | Outreach suppressed pending steward Outreach | ENR-123200 (Rachel Maldonado) held until CASE-004088 is decided |
| Held | — | ||
| ACT-017533 | Outreach suppressed pending steward Outreach | CLM-417600 (Racchel Maldonado) held until CASE-004089 is decided |
| Held | — | ||
| ACT-017534 | Outreach suppressed pending steward Outreach | ENR-119871 (Douglas Lawrence) held until CASE-004090 is decided |
| Held | — | ||
| ACT-017535 | Outreach suppressed pending steward Outreach | CLM-415089 (Doglas Lawence) held until CASE-004091 is decided |
| Held | — | ||
| ACT-017536 | Outreach suppressed pending steward Outreach | ENR-111456 (Austin Lopez) held until CASE-004092 is decided |
| Held | — | ||
| ACT-017537 | Outreach suppressed pending steward Outreach | CLM-408696 (Austin Lopez) held until CASE-004093 is decided |
| Held | — | ||
| ACT-017538 | Outreach suppressed pending steward Outreach | PRV-27525 (Aisha Maldonado) held until CASE-004094 is decided |
| Held | — | ||
| ACT-017539 | Outreach suppressed pending steward Outreach | TPA-50223 (Isabella Harrisun) held until CASE-004095 is decided |
| Held | — | ||
| ACT-017540 | Outreach suppressed pending steward Outreach | TPA-55323 (Grace Sandoval) held until CASE-004096 is decided |
| Held | — | ||
| ACT-017541 | Outreach suppressed pending steward Outreach | TPA-55322 (Grace Sandoval) held until CASE-004097 is decided |
| Held | — | ||
| ACT-017542 | Outreach suppressed pending steward Outreach | CLM-420168 (Carolyn Morales) held until CASE-004098 is decided |
| Held | — | ||
| ACT-017543 | Outreach suppressed pending steward Outreach | CLM-416194 (Dylan Williams) held until CASE-004099 is decided |
| Held | — | ||
| ACT-017544 | Outreach suppressed pending steward Outreach | ENR-133043 (Maria Williamson) held until CASE-004100 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.