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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-017745 | Outreach suppressed pending steward Outreach | CLM-419466 (Samuel Tucker) held until CASE-004301 is decided |
| Held | — | ||
| ACT-017746 | Outreach suppressed pending steward Outreach | CLM-419467 (Samuel Tucker) held until CASE-004302 is decided |
| Held | — | ||
| ACT-017747 | Outreach suppressed pending steward Outreach | CLM-409267 (Hiroshi Miller) held until CASE-004303 is decided |
| Held | — | ||
| ACT-017748 | Outreach suppressed pending steward Outreach | ENR-142652 (Julie Romero) held until CASE-004304 is decided |
| Held | — | ||
| ACT-017749 | Outreach suppressed pending steward Outreach | CLM-400031 (Jennifer Matthews) held until CASE-004305 is decided |
| Held | — | ||
| ACT-017750 | Outreach suppressed pending steward Outreach | ENR-100039 (Jennifer Matthews) held until CASE-004306 is decided |
| Held | — | ||
| ACT-017751 | Outreach suppressed pending steward Outreach | PRV-25071 (Susan Jakkson) held until CASE-004307 is decided |
| Held | — | ||
| ACT-017752 | Outreach suppressed pending steward Outreach | ENR-122527 (Susan Jackson) held until CASE-004308 is decided |
| Held | — | ||
| ACT-017753 | Outreach suppressed pending steward Outreach | ENR-130770 (Amber Maldonado) held until CASE-004309 is decided |
| Held | — | ||
| ACT-017754 | Outreach suppressed pending steward Outreach | CLM-408872 (Maria Ortiz) held until CASE-004310 is decided |
| Held | — | ||
| ACT-017755 | Outreach suppressed pending steward Outreach | ENR-111717 (Maria Ortiz) held until CASE-004311 is decided |
| Held | — | ||
| ACT-017756 | Outreach suppressed pending steward Outreach | ENR-102895 (Dnenis Sanders) held until CASE-004312 is decided |
| Held | — | ||
| ACT-017757 | Outreach suppressed pending steward Outreach | ENR-112809 (Jennifer Carr) held until CASE-004313 is decided |
| Held | — | ||
| ACT-017758 | Outreach suppressed pending steward Outreach | CLM-409744 (Jennifer Carr) held until CASE-004314 is decided |
| Held | — | ||
| ACT-017759 | Outreach suppressed pending steward Outreach | PRV-26870 (Karen Hoffmman) held until CASE-004315 is decided |
| Held | — | ||
| ACT-017760 | Outreach suppressed pending steward Outreach | ENR-130419 (Karen Hoffman) held until CASE-004316 is decided |
| Held | — | ||
| ACT-017761 | Outreach suppressed pending steward Outreach | ENR-141338 (Joan Jimeenz) held until CASE-004317 is decided |
| Held | — | ||
| ACT-017762 | Outreach suppressed pending steward Outreach | TPA-63902 (Joan Jimenez) held until CASE-004318 is decided |
| Held | — | ||
| ACT-017763 | Outreach suppressed pending steward Outreach | TPA-60823 (Deborah Ferrnandez) held until CASE-004319 is decided |
| Held | — | ||
| ACT-017764 | Outreach suppressed pending steward Outreach | CLM-412287 (Ssan Hansen) held until CASE-004320 is decided |
| Held | — | ||
| ACT-017765 | Outreach suppressed pending steward Outreach | ENR-116165 (Susan Hansen) held until CASE-004321 is decided |
| Held | — | ||
| ACT-017766 | Outreach suppressed pending steward Outreach | CLM-400459 (Janice Santiago) held until CASE-004322 is decided |
| Held | — | ||
| ACT-017767 | Outreach suppressed pending steward Outreach | ENR-142313 (Priya Burke) held until CASE-004323 is decided |
| Held | — | ||
| ACT-017768 | Outreach suppressed pending steward Outreach | TPA-64226 (Piya Burke) held until CASE-004324 is decided |
| Held | — | ||
| ACT-017769 | Outreach suppressed pending steward Outreach | ENR-133613 (Rebecca Foster) held until CASE-004325 is decided |
| Held | — | ||
| ACT-017770 | Outreach suppressed pending steward Outreach | TPA-61342 (Rebecca Foster) held until CASE-004326 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.