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-017595 | Outreach suppressed pending steward Outreach | CLM-431979 (Ralph Rodriguez) held until CASE-004151 is decided |
| Held | — | ||
| ACT-017596 | Outreach suppressed pending steward Outreach | CLM-420543 (Kevin Chen) held until CASE-004152 is decided |
| Held | — | ||
| ACT-017597 | Outreach suppressed pending steward Outreach | ENR-127029 (Kevin Chen) held until CASE-004153 is decided |
| Held | — | ||
| ACT-017598 | Outreach suppressed pending steward Outreach | TPA-50451 (Garrett Jason) held until CASE-004154 is decided |
| Held | — | ||
| ACT-017599 | Outreach suppressed pending steward Outreach | CLM-403451 (Ken Kim) held until CASE-004155 is decided |
| Held | — | ||
| ACT-017600 | Outreach suppressed pending steward Outreach | ENR-104481 (Kenneth Kim) held until CASE-004156 is decided |
| Held | — | ||
| ACT-017601 | Outreach suppressed pending steward Outreach | PRV-20948 (Keith Bennett) held until CASE-004157 is decided |
| Held | — | ||
| ACT-017602 | Outreach suppressed pending steward Outreach | TPA-51439 (Keith Bennett) held until CASE-004158 is decided |
| Held | — | ||
| ACT-017603 | Outreach suppressed pending steward Outreach | ENR-104307 (Keith Bennett) held until CASE-004159 is decided |
| Held | — | ||
| ACT-017604 | Outreach suppressed pending steward Outreach | ENR-142522 (Alan Etrada) held until CASE-004160 is decided |
| Held | — | ||
| ACT-017605 | Outreach suppressed pending steward Outreach | TPA-57608 (Barbara Garza) held until CASE-004161 is decided |
| Held | — | ||
| ACT-017606 | Outreach suppressed pending steward Outreach | ENR-131676 (Yuki Ramos) held until CASE-004162 is decided |
| Held | — | ||
| ACT-017607 | Outreach suppressed pending steward Outreach | CLM-424223 (Yuki Ramos) held until CASE-004163 is decided |
| Held | — | ||
| ACT-017608 | Outreach suppressed pending steward Outreach | CLM-416165 (Ralph Simmons) held until CASE-004164 is decided |
| Held | — | ||
| ACT-017609 | Outreach suppressed pending steward Outreach | ENR-121276 (Ralph Simmons) held until CASE-004165 is decided |
| Held | — | ||
| ACT-017610 | Outreach suppressed pending steward Outreach | TPA-56471 (Mariana Luna) held until CASE-004166 is decided |
| Held | — | ||
| ACT-017611 | Outreach suppressed pending steward Outreach | TPA-56470 (Mariana Luna) held until CASE-004167 is decided |
| Held | — | ||
| ACT-017612 | Outreach suppressed pending steward Outreach | TPA-64470 (Wayne Simmons) held until CASE-004168 is decided |
| Held | — | ||
| ACT-017613 | Outreach suppressed pending steward Outreach | ENR-143088 (Wayne Simmons) held until CASE-004169 is decided |
| Held | — | ||
| ACT-017614 | Outreach suppressed pending steward Outreach | CLM-415903 (Judith Lucas) held until CASE-004170 is decided |
| Held | — | ||
| ACT-017615 | Outreach suppressed pending steward Outreach | ENR-120956 (Judith Lucas) held until CASE-004171 is decided |
| Held | — | ||
| ACT-017616 | Outreach suppressed pending steward Outreach | ENR-129288 (Jessica Duncan) held until CASE-004172 is decided |
| Held | — | ||
| ACT-017617 | Outreach suppressed pending steward Outreach | TPA-51188 (Linda Oliver) held until CASE-004173 is decided |
| Held | — | ||
| ACT-017618 | Outreach suppressed pending steward Outreach | TPA-56914 (Noah Black) held until CASE-004174 is decided |
| Held | — | ||
| ACT-017619 | Outreach suppressed pending steward Outreach | TPA-56913 (Noah Black) held until CASE-004175 is decided |
| Held | — | ||
| ACT-017620 | Outreach suppressed pending steward Outreach | ENR-133438 (Evelyn Nelson) held until CASE-004176 is decided |
| Held | — | ||
| ACT-017621 | Outreach suppressed pending steward Outreach | TPA-61273 (Evelyn Nelson) held until CASE-004177 is decided |
| Held | — | ||
| ACT-017622 | Outreach suppressed pending steward Outreach | TPA-63794 (Zachary Armmstrong) held until CASE-004178 is decided |
| Held | — | ||
| ACT-017623 | Outreach suppressed pending steward Outreach | TPA-63795 (Zachary Armstrong) held until CASE-004179 is decided |
| Held | — | ||
| ACT-017624 | Outreach suppressed pending steward Outreach | CLM-407190 (Kimberly Robinson) held until CASE-004180 is decided |
| Held | — | ||
| ACT-017625 | Outreach suppressed pending steward Outreach | ENR-123286 (Carol Jones) held until CASE-004181 is decided |
| Held | — | ||
| ACT-017626 | Outreach suppressed pending steward Outreach | PRV-25236 (Carol Jones) held until CASE-004182 is decided |
| Held | — | ||
| ACT-017627 | Outreach suppressed pending steward Outreach | ENR-133831 (Bruce Bradley) held until CASE-004183 is decided |
| Held | — | ||
| ACT-017628 | Outreach suppressed pending steward Outreach | PRV-27619 (Bruce Bradley) held until CASE-004184 is decided |
| Held | — | ||
| ACT-017629 | Outreach suppressed pending steward Outreach | ENR-129516 (Kevin Marshall) held until CASE-004185 is decided |
| Held | — | ||
| ACT-017630 | Outreach suppressed pending steward Outreach | PRV-26645 (Kevin Marshall) held until CASE-004186 is decided |
| Held | — | ||
| ACT-017631 | Outreach suppressed pending steward Outreach | CLM-420927 (Tyler Perry) held until CASE-004187 is decided |
| Held | — | ||
| ACT-017632 | Outreach suppressed pending steward Outreach | ENR-127517 (Tyler Perry) held until CASE-004188 is decided |
| Held | — | ||
| ACT-017633 | Outreach suppressed pending steward Outreach | CLM-402471 (Janice Rodriguez) held until CASE-004189 is decided |
| Held | — | ||
| ACT-017634 | Outreach suppressed pending steward Outreach | CLM-402472 (Janice Rodriguez) held until CASE-004190 is decided |
| Held | — | ||
| ACT-017635 | Outreach suppressed pending steward Outreach | CLM-431937 (Natalie Nguyen) held until CASE-004191 is decided |
| Held | — | ||
| ACT-017636 | Outreach suppressed pending steward Outreach | TPA-55005 (Pamela Burns) held until CASE-004192 is decided |
| Held | — | ||
| ACT-017637 | Outreach suppressed pending steward Outreach | TPA-55006 (Pamela Burns) held until CASE-004193 is decided |
| Held | — | ||
| ACT-017638 | Outreach suppressed pending steward Outreach | ENR-130620 (Ralph Montgomery) held until CASE-004194 is decided |
| Held | — | ||
| ACT-017639 | Outreach suppressed pending steward Outreach | CLM-414020 (Fatima Boyd) held until CASE-004195 is decided |
| Held | — | ||
| ACT-017640 | Outreach suppressed pending steward Outreach | TPA-56189 (Fatima Boyd) held until CASE-004196 is decided |
| Held | — | ||
| ACT-017641 | Outreach suppressed pending steward Outreach | TPA-60948 (Christopher Contreras) held until CASE-004197 is decided |
| Held | — | ||
| ACT-017642 | Outreach suppressed pending steward Outreach | TPA-50869 (Arthur Grant) held until CASE-004198 is decided |
| Held | — | ||
| ACT-017643 | Outreach suppressed pending steward Outreach | CLM-402008 (Arthur Grant) held until CASE-004199 is decided |
| Held | — | ||
| ACT-017644 | Outreach suppressed pending steward Outreach | CLM-405516 (Joe Duncan) held until CASE-004200 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.