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-017645 | Outreach suppressed pending steward Outreach | ENR-107263 (Joseph Duncan) held until CASE-004201 is decided |
| Held | — | ||
| ACT-017646 | Outreach suppressed pending steward Outreach | PRV-22216 (Donna Ford) held until CASE-004202 is decided |
| Held | — | ||
| ACT-017647 | Outreach suppressed pending steward Outreach | TPA-53294 (Donna Ford) held until CASE-004203 is decided |
| Held | — | ||
| ACT-017648 | Outreach suppressed pending steward Outreach | CLM-409946 (Mason McDonald) held until CASE-004204 is decided |
| Held | — | ||
| ACT-017649 | Outreach suppressed pending steward Outreach | ENR-111774 (Marcus Gutierrez) held until CASE-004205 is decided |
| Held | — | ||
| ACT-017650 | Outreach suppressed pending steward Outreach | TPA-53904 (Marcus Gutierrez) held until CASE-004206 is decided |
| Held | — | ||
| ACT-017651 | Outreach suppressed pending steward Outreach | CLM-415346 (Margaret Obrien) held until CASE-004207 is decided |
| Held | — | ||
| ACT-017652 | Outreach suppressed pending steward Outreach | ENR-125705 (Philip Ferguson) held until CASE-004208 is decided |
| Held | — | ||
| ACT-017653 | Outreach suppressed pending steward Outreach | TPA-58604 (Philip Ferguson) held until CASE-004209 is decided |
| Held | — | ||
| ACT-017654 | Outreach suppressed pending steward Outreach | TPA-51239 (Randy Tucker) held until CASE-004210 is decided |
| Held | — | ||
| ACT-017655 | Outreach suppressed pending steward Outreach | ENR-103734 (Randy Tucker) held until CASE-004211 is decided |
| Held | — | ||
| ACT-017656 | Outreach suppressed pending steward Outreach | PRV-20600 (Roger Bryant) held until CASE-004212 is decided |
| Held | — | ||
| ACT-017657 | Outreach suppressed pending steward Outreach | ENR-102623 (Roger Bryant) held until CASE-004213 is decided |
| Held | — | ||
| ACT-017658 | Outreach suppressed pending steward Outreach | ENR-139477 (Walter Burns) held until CASE-004214 is decided |
| Held | — | ||
| ACT-017659 | Outreach suppressed pending steward Outreach | CLM-430090 (Walter Burns) held until CASE-004215 is decided |
| Held | — | ||
| ACT-017660 | Outreach suppressed pending steward Outreach | TPA-55251 (Kenneth Kim) held until CASE-004216 is decided |
| Held | — | ||
| ACT-017661 | Outreach suppressed pending steward Outreach | ENR-115683 (Kenneth Kim) held until CASE-004217 is decided |
| Held | — | ||
| ACT-017662 | Outreach suppressed pending steward Outreach | CLM-400875 (Timothy Kelly) held until CASE-004218 is decided |
| Held | — | ||
| ACT-017663 | Outreach suppressed pending steward Outreach | CLM-407624 (Betty Perkins) held until CASE-004219 is decided |
| Held | — | ||
| ACT-017664 | Outreach suppressed pending steward Outreach | CLM-427328 (Anderson Melissa) held until CASE-004220 is decided |
| Held | — | ||
| ACT-017665 | Outreach suppressed pending steward Outreach | CLM-427327 (Melissa Anderson) held until CASE-004221 is decided |
| Held | — | ||
| ACT-017666 | Outreach suppressed pending steward Outreach | TPA-53053 (Brian Contreras) held until CASE-004222 is decided |
| Held | — | ||
| ACT-017667 | Outreach suppressed pending steward Outreach | ENR-118015 (Jean Edwards) held until CASE-004223 is decided |
| Held | — | ||
| ACT-017668 | Outreach suppressed pending steward Outreach | CLM-428080 (Teresa Vargas) held until CASE-004224 is decided |
| Held | — | ||
| ACT-017669 | Outreach suppressed pending steward Outreach | CLM-428081 (Teresa Vargas) held until CASE-004225 is decided |
| Held | — | ||
| ACT-017670 | Outreach suppressed pending steward Outreach | ENR-139714 (Albert Lynch) held until CASE-004226 is decided |
| Held | — | ||
| ACT-017671 | Outreach suppressed pending steward Outreach | CLM-430256 (Albert Lynch) held until CASE-004227 is decided |
| Held | — | ||
| ACT-017672 | Outreach suppressed pending steward Outreach | CLM-402806 (Laura Harper) held until CASE-004228 is decided |
| Held | — | ||
| ACT-017673 | Outreach suppressed pending steward Outreach | ENR-103614 (Laura Harper) held until CASE-004229 is decided |
| Held | — | ||
| ACT-017674 | Outreach suppressed pending steward Outreach | CLM-430233 (Cynthai Ross) held until CASE-004230 is decided |
| Held | — | ||
| ACT-017675 | Outreach suppressed pending steward Outreach | PRV-28858 (Cynthia Ross) held until CASE-004231 is decided |
| Held | — | ||
| ACT-017676 | Outreach suppressed pending steward Outreach | TPA-53610 (Isabella Fernandez) held until CASE-004232 is decided |
| Held | — | ||
| ACT-017677 | Outreach suppressed pending steward Outreach | CLM-416361 (Betty Rodriguez) held until CASE-004233 is decided |
| Held | — | ||
| ACT-017678 | Outreach suppressed pending steward Outreach | ENR-121509 (Betty Rodriguez) held until CASE-004234 is decided |
| Held | — | ||
| ACT-017679 | Outreach suppressed pending steward Outreach | CLM-431802 (Carolyn Dominguez) held until CASE-004235 is decided |
| Held | — | ||
| ACT-017680 | Outreach suppressed pending steward Outreach | ENR-141722 (Carolyn Dominguez) held until CASE-004236 is decided |
| Held | — | ||
| ACT-017681 | Outreach suppressed pending steward Outreach | CLM-415120 (Ana Webb) held until CASE-004237 is decided |
| Held | — | ||
| ACT-017682 | Outreach suppressed pending steward Outreach | ENR-119903 (Ana Webb) held until CASE-004238 is decided |
| Held | — | ||
| ACT-017683 | Outreach suppressed pending steward Outreach | TPA-63958 (Yuki Park) held until CASE-004239 is decided |
| Held | — | ||
| ACT-017684 | Outreach suppressed pending steward Outreach | TPA-59649 (Sean Chen) held until CASE-004240 is decided |
| Held | — | ||
| ACT-017685 | Outreach suppressed pending steward Outreach | ENR-134564 (Raymond Wesst) held until CASE-004241 is decided |
| Held | — | ||
| ACT-017686 | Outreach suppressed pending steward Outreach | PRV-27772 (Raymond West) held until CASE-004242 is decided |
| Held | — | ||
| ACT-017687 | Outreach suppressed pending steward Outreach | CLM-403088 (Frank Ramireez) held until CASE-004243 is decided |
| Held | — | ||
| ACT-017688 | Outreach suppressed pending steward Outreach | TPA-59657 (Alice Mills) held until CASE-004244 is decided |
| Held | — | ||
| ACT-017689 | Outreach suppressed pending steward Outreach | PRV-23111 (Bryan West) held until CASE-004245 is decided |
| Held | — | ||
| ACT-017690 | Outreach suppressed pending steward Outreach | ENR-114156 (Bryan West) held until CASE-004246 is decided |
| Held | — | ||
| ACT-017691 | Outreach suppressed pending steward Outreach | TPA-58425 (Katherine Perry) held until CASE-004247 is decided |
| Held | — | ||
| ACT-017692 | Outreach suppressed pending steward Outreach | ENR-125032 (Kathy Perry) held until CASE-004248 is decided |
| Held | — | ||
| ACT-017693 | Outreach suppressed pending steward Outreach | TPA-61629 (Albert Wells) held until CASE-004249 is decided |
| Held | — | ||
| ACT-017694 | Outreach suppressed pending steward Outreach | CLM-426326 (Albert Wells) held until CASE-004250 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.