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-017839
Care coordination outreach
Next-best-action
Amanda Shaw: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017840
Care coordination outreach
Next-best-action
Jon Parker: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017841
Care coordination outreach
Next-best-action
Kevin Johnston: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017842
Care coordination outreach
Next-best-action
Kenneth Austin: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017843
Care coordination outreach
Next-best-action
Christian Butler: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017844
Care coordination outreach
Next-best-action
Donald Gonzales: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017845
Care coordination outreach
Next-best-action
Lucia Vargas: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017846
Care coordination outreach
Next-best-action
Abigail Hunt: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017847
Care coordination outreach
Next-best-action
Ryan Lee: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017848
Care coordination outreach
Next-best-action
Sophia Walker: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017849
Care coordination outreach
Next-best-action
Roger Hamilton: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017850
Care coordination outreach
Next-best-action
Emily White: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017851
Care coordination outreach
Next-best-action
Donald Russell: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017852
Care coordination outreach
Next-best-action
Carl Montgomery: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017853
Care coordination outreach
Next-best-action
Julia Rice: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017854
Care coordination outreach
Next-best-action
Emily Henderson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017855
Care coordination outreach
Next-best-action
Jacob King: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017856
Care coordination outreach
Next-best-action
Jesse Morrison: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017857
Care coordination outreach
Next-best-action
Austin Santos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017858
Care coordination outreach
Next-best-action
Frances Jacobs: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017859
Care coordination outreach
Next-best-action
Rebecca Chavez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017860
Care coordination outreach
Next-best-action
Gerald Miller: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017861
Care coordination outreach
Next-best-action
Natalie Ramos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017862
Care coordination outreach
Next-best-action
Timothy Welch: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017863
Care coordination outreach
Next-best-action
Roy Tucker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017864
Care coordination outreach
Next-best-action
Jack Espinoza: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017865
Care coordination outreach
Next-best-action
Natalie Tran: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017866
Care coordination outreach
Next-best-action
Jose Mejia: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017867
Care coordination outreach
Next-best-action
Sara Franklin: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017868
Care coordination outreach
Next-best-action
Samuel Guerrero: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017869
Care coordination outreach
Next-best-action
Brian Fox: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017870
Care coordination outreach
Next-best-action
Joseph Flores: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017871
Care coordination outreach
Next-best-action
Vincent George: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017872
Care coordination outreach
Next-best-action
Diana Chen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017873
Care coordination outreach
Next-best-action
Eric Morgan: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017874
Care coordination outreach
Next-best-action
Alexander Rose: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017875
Care coordination outreach
Next-best-action
Ralph Phillips: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017876
Care coordination outreach
Next-best-action
Betty Oliver: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017877
Care coordination outreach
Next-best-action
Sofia Lewis: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017878
Care coordination outreach
Next-best-action
Charlotte Ortiz: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017879
Care coordination outreach
Next-best-action
Douglas Henderson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017880
Care coordination outreach
Next-best-action
Evelyn Ramos: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017881
Care coordination outreach
Next-best-action
Ralph Andrews: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017882
Care coordination outreach
Next-best-action
Natalie McCoy: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017883
Care coordination outreach
Next-best-action
Saamntha Cox: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017884
Care coordination outreach
Next-best-action
Henry Little: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017885
Care coordination outreach
Next-best-action
Sofia Gonzalez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017886
Care coordination outreach
Next-best-action
Mason Porter: 6 claims, no attributed provider
Claims
6
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017887
Care coordination outreach
Next-best-action
Becky Williams: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017888
Care coordination outreach
Next-best-action
Gary Burton: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
26,640 rows, page 89 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.