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-017545 | Outreach suppressed pending steward Outreach | TPA-55667 (Kimberly Mitchell) held until CASE-004101 is decided |
| Held | — | ||
| ACT-017546 | Outreach suppressed pending steward Outreach | TPA-55668 (Kimberly Mitkhell) held until CASE-004102 is decided |
| Held | — | ||
| ACT-017547 | Outreach suppressed pending steward Outreach | CLM-420453 (Yuki Elliott) held until CASE-004103 is decided |
| Held | — | ||
| ACT-017548 | Outreach suppressed pending steward Outreach | TPA-52224 (Sean Soto) held until CASE-004104 is decided |
| Held | — | ||
| ACT-017549 | Outreach suppressed pending steward Outreach | ENR-106683 (Sean Soto) held until CASE-004105 is decided |
| Held | — | ||
| ACT-017550 | Outreach suppressed pending steward Outreach | TPA-62684 (Lauren Reid) held until CASE-004106 is decided |
| Held | — | ||
| ACT-017551 | Outreach suppressed pending steward Outreach | TPA-54589 (Juan Santos) held until CASE-004107 is decided |
| Held | — | ||
| ACT-017552 | Outreach suppressed pending steward Outreach | TPA-54798 (Wilile Dunn) held until CASE-004108 is decided |
| Held | — | ||
| ACT-017553 | Outreach suppressed pending steward Outreach | CLM-406462 (Eric Long) held until CASE-004109 is decided |
| Held | — | ||
| ACT-017554 | Outreach suppressed pending steward Outreach | CLM-412065 (Shirley Lane) held until CASE-004110 is decided |
| Held | — | ||
| ACT-017555 | Outreach suppressed pending steward Outreach | ENR-115892 (Shirley Lane) held until CASE-004111 is decided |
| Held | — | ||
| ACT-017556 | Outreach suppressed pending steward Outreach | CLM-426893 (Amanda Santiiago) held until CASE-004112 is decided |
| Held | — | ||
| ACT-017557 | Outreach suppressed pending steward Outreach | TPA-54166 (Marilyn Tucker) held until CASE-004113 is decided |
| Held | — | ||
| ACT-017558 | Outreach suppressed pending steward Outreach | TPA-54165 (Marilyn Tucker) held until CASE-004114 is decided |
| Held | — | ||
| ACT-017559 | Outreach suppressed pending steward Outreach | PRV-22585 (Susan Chavez) held until CASE-004115 is decided |
| Held | — | ||
| ACT-017560 | Outreach suppressed pending steward Outreach | ENR-117827 (Joshua Bell) held until CASE-004116 is decided |
| Held | — | ||
| ACT-017561 | Outreach suppressed pending steward Outreach | TPA-59287 (Eric Castillo) held until CASE-004117 is decided |
| Held | — | ||
| ACT-017562 | Outreach suppressed pending steward Outreach | CLM-421113 (Eric Castillo) held until CASE-004118 is decided |
| Held | — | ||
| ACT-017563 | Outreach suppressed pending steward Outreach | TPA-53887 (Anthony Vega) held until CASE-004119 is decided |
| Held | — | ||
| ACT-017564 | Outreach suppressed pending steward Outreach | ENR-111708 (Anthony Vaga) held until CASE-004120 is decided |
| Held | — | ||
| ACT-017565 | Outreach suppressed pending steward Outreach | CLM-400863 (Joan Lane) held until CASE-004121 is decided |
| Held | — | ||
| ACT-017566 | Outreach suppressed pending steward Outreach | CLM-407415 (Amanda Walker) held until CASE-004122 is decided |
| Held | — | ||
| ACT-017567 | Outreach suppressed pending steward Outreach | ENR-109721 (Amanda Walker) held until CASE-004123 is decided |
| Held | — | ||
| ACT-017568 | Outreach suppressed pending steward Outreach | CLM-425053 (Mark Hughes) held until CASE-004124 is decided |
| Held | — | ||
| ACT-017569 | Outreach suppressed pending steward Outreach | TPA-61153 (Alan Wheeler) held until CASE-004125 is decided |
| Held | — | ||
| ACT-017570 | Outreach suppressed pending steward Outreach | CLM-400097 (Justin Cooper) held until CASE-004126 is decided |
| Held | — | ||
| ACT-017571 | Outreach suppressed pending steward Outreach | ENR-118109 (Cheryl Cruz) held until CASE-004127 is decided |
| Held | — | ||
| ACT-017572 | Outreach suppressed pending steward Outreach | TPA-56083 (Cheryl Cruz) held until CASE-004128 is decided |
| Held | — | ||
| ACT-017573 | Outreach suppressed pending steward Outreach | CLM-406102 (Santiago Crawford) held until CASE-004129 is decided |
| Held | — | ||
| ACT-017574 | Outreach suppressed pending steward Outreach | TPA-61954 (Watson Brittany) held until CASE-004130 is decided |
| Held | — | ||
| ACT-017575 | Outreach suppressed pending steward Outreach | CLM-409406 (Olivia Campbell) held until CASE-004131 is decided |
| Held | — | ||
| ACT-017576 | Outreach suppressed pending steward Outreach | TPA-55408 (Charlotte Obrien) held until CASE-004132 is decided |
| Held | — | ||
| ACT-017577 | Outreach suppressed pending steward Outreach | CLM-429925 (Stephen Freeman) held until CASE-004133 is decided |
| Held | — | ||
| ACT-017578 | Outreach suppressed pending steward Outreach | CLM-423421 (Wei Morales) held until CASE-004134 is decided |
| Held | — | ||
| ACT-017579 | Outreach suppressed pending steward Outreach | ENR-130623 (Wei Morales) held until CASE-004135 is decided |
| Held | — | ||
| ACT-017580 | Outreach suppressed pending steward Outreach | CLM-410690 (Robertson Ahmed) held until CASE-004136 is decided |
| Held | — | ||
| ACT-017581 | Outreach suppressed pending steward Outreach | TPA-53218 (Madison Garrett) held until CASE-004137 is decided |
| Held | — | ||
| ACT-017582 | Outreach suppressed pending steward Outreach | ENR-104308 (Madison Carlson) held until CASE-004138 is decided |
| Held | — | ||
| ACT-017583 | Outreach suppressed pending steward Outreach | CLM-403315 (Madison Carllson) held until CASE-004139 is decided |
| Held | — | ||
| ACT-017584 | Outreach suppressed pending steward Outreach | CLM-414672 (Grace Cole) held until CASE-004140 is decided |
| Held | — | ||
| ACT-017585 | Outreach suppressed pending steward Outreach | CLM-417506 (Austin Green) held until CASE-004141 is decided |
| Held | — | ||
| ACT-017586 | Outreach suppressed pending steward Outreach | TPA-53095 (Benjamin Yang) held until CASE-004142 is decided |
| Held | — | ||
| ACT-017587 | Outreach suppressed pending steward Outreach | TPA-58560 (Jefrfey Wells) held until CASE-004143 is decided |
| Held | — | ||
| ACT-017588 | Outreach suppressed pending steward Outreach | TPA-51962 (Walter Coleman) held until CASE-004144 is decided |
| Held | — | ||
| ACT-017589 | Outreach suppressed pending steward Outreach | ENR-105932 (Welter Coleman) held until CASE-004145 is decided |
| Held | — | ||
| ACT-017590 | Outreach suppressed pending steward Outreach | CLM-427041 (Priya Crapenter) held until CASE-004146 is decided |
| Held | — | ||
| ACT-017591 | Outreach suppressed pending steward Outreach | ENR-135477 (Priya Carpenter) held until CASE-004147 is decided |
| Held | — | ||
| ACT-017592 | Outreach suppressed pending steward Outreach | CLM-415452 (Lawrence Richards) held until CASE-004148 is decided |
| Held | — | ||
| ACT-017593 | Outreach suppressed pending steward Outreach | ENR-107705 (Brittany Johnston) held until CASE-004149 is decided |
| Held | — | ||
| ACT-017594 | Outreach suppressed pending steward Outreach | TPA-52589 (Brittany Johnston) held until CASE-004150 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.