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-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.