Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Actions

26,640 derived from the last resolution run

ActionTypeTitleDetailLinked toStatusExecuted
ACT-017789
Care coordination outreach
Next-best-action
Joe Anderson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017790
Care coordination outreach
Next-best-action
Mateo Snyder: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017791
Care coordination outreach
Next-best-action
Juan Snyder: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017792
Care coordination outreach
Next-best-action
Megan Burton: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017793
Care coordination outreach
Next-best-action
Lori Contreras: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017794
Care coordination outreach
Next-best-action
Sophia Lawrence: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017795
Care coordination outreach
Next-best-action
Thomas Snyder: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017796
Care coordination outreach
Next-best-action
Patrick Valdez: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017797
Care coordination outreach
Next-best-action
Frank Price: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017798
Care coordination outreach
Next-best-action
Albert Richards: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017799
Care coordination outreach
Next-best-action
Susan Garrett: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017800
Care coordination outreach
Next-best-action
Willie Le: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017801
Care coordination outreach
Next-best-action
Gerald Dean: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017802
Care coordination outreach
Next-best-action
Kayla Rice: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017803
Care coordination outreach
Next-best-action
Stephanie Ruiz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017804
Care coordination outreach
Next-best-action
Joshua Holmes: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017805
Care coordination outreach
Next-best-action
Willie Garcia: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017806
Care coordination outreach
Next-best-action
Ann Adams: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017807
Care coordination outreach
Next-best-action
Alice Ortiz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017808
Care coordination outreach
Next-best-action
Vincent Morgan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017809
Care coordination outreach
Next-best-action
Sandra Kim: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017810
Care coordination outreach
Next-best-action
Sara Burton: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017811
Care coordination outreach
Next-best-action
Frank Howard: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017812
Care coordination outreach
Next-best-action
Martha Weaver: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017813
Care coordination outreach
Next-best-action
Kathleen Hanson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017814
Care coordination outreach
Next-best-action
Susan Ward: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017815
Care coordination outreach
Next-best-action
Jessica Vargas: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017816
Care coordination outreach
Next-best-action
Arthur Turner: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017817
Care coordination outreach
Next-best-action
Emma Silva: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017818
Care coordination outreach
Next-best-action
Mike Simmons: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017819
Care coordination outreach
Next-best-action
Martha Rodriguez: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017820
Care coordination outreach
Next-best-action
Fatima Cook: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017821
Care coordination outreach
Next-best-action
Shirley Soto: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017822
Care coordination outreach
Next-best-action
Kyle Romero: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017823
Care coordination outreach
Next-best-action
Jack Clark: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017824
Care coordination outreach
Next-best-action
Karen Foster: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017825
Care coordination outreach
Next-best-action
Yuki Herrera: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017826
Care coordination outreach
Next-best-action
Diego Contreras: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017827
Care coordination outreach
Next-best-action
Billy Robinson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017828
Care coordination outreach
Next-best-action
Willie Sanchez: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017829
Care coordination outreach
Next-best-action
Amanda Watkins: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017830
Care coordination outreach
Next-best-action
Ralph Graham: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017831
Care coordination outreach
Next-best-action
Ann Sullivan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017832
Care coordination outreach
Next-best-action
Valentina Harris: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017833
Care coordination outreach
Next-best-action
Mary George: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017834
Care coordination outreach
Next-best-action
Zachary Watkins: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017835
Care coordination outreach
Next-best-action
Diego Richardson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017836
Care coordination outreach
Next-best-action
Andrea Cook: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017837
Care coordination outreach
Next-best-action
Carlos Henderson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017838
Care coordination outreach
Next-best-action
Marilyn Castillo: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
26,640 rows, page 88 of 533PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A 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.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.