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-013845 | Outreach suppressed pending steward Outreach | TPA-54508 (Vincent Wilson) held until CASE-000401 is decided |
| Held | — | ||
| ACT-013846 | Outreach suppressed pending steward Outreach | CLM-408670 (Ruth Gonzales) held until CASE-000402 is decided |
| Held | — | ||
| ACT-013847 | Outreach suppressed pending steward Outreach | ENR-111422 (Ruuth Gonzales) held until CASE-000403 is decided |
| Held | — | ||
| ACT-013848 | Outreach suppressed pending steward Outreach | CLM-414771 (Nicole Rogers) held until CASE-000404 is decided |
| Held | — | ||
| ACT-013849 | Outreach suppressed pending steward Outreach | TPA-60104 (Betty Gomez) held until CASE-000405 is decided |
| Held | — | ||
| ACT-013850 | Outreach suppressed pending steward Outreach | CLM-414155 (Daniel Bennett) held until CASE-000406 is decided |
| Held | — | ||
| ACT-013851 | Outreach suppressed pending steward Outreach | CLM-400278 (Amber Soto) held until CASE-000407 is decided |
| Held | — | ||
| ACT-013852 | Outreach suppressed pending steward Outreach | CLM-400277 (Amber Soto) held until CASE-000408 is decided |
| Held | — | ||
| ACT-013853 | Outreach suppressed pending steward Outreach | TPA-60778 (Olivia Wheeler) held until CASE-000409 is decided |
| Held | — | ||
| ACT-013854 | Outreach suppressed pending steward Outreach | ENR-102629 (Jacqueline Jensen) held until CASE-000410 is decided |
| Held | — | ||
| ACT-013855 | Outreach suppressed pending steward Outreach | TPA-51764 (Austin Rodriguez) held until CASE-000411 is decided |
| Held | — | ||
| ACT-013856 | Outreach suppressed pending steward Outreach | TPA-63140 (Lauren Franklin) held until CASE-000412 is decided |
| Held | — | ||
| ACT-013857 | Outreach suppressed pending steward Outreach | CLM-412171 (Martha Powell) held until CASE-000413 is decided |
| Held | — | ||
| ACT-013858 | Outreach suppressed pending steward Outreach | ENR-106038 (Scott Richardson) held until CASE-000414 is decided |
| Held | — | ||
| ACT-013859 | Outreach suppressed pending steward Outreach | TPA-52002 (Scott Richardson) held until CASE-000415 is decided |
| Held | — | ||
| ACT-013860 | Outreach suppressed pending steward Outreach | ENR-127886 (Mariana Park) held until CASE-000416 is decided |
| Held | — | ||
| ACT-013861 | Outreach suppressed pending steward Outreach | TPA-59349 (Mariana Park) held until CASE-000417 is decided |
| Held | — | ||
| ACT-013862 | Outreach suppressed pending steward Outreach | TPA-55542 (Lisa Myers) held until CASE-000418 is decided |
| Held | — | ||
| ACT-013863 | Outreach suppressed pending steward Outreach | TPA-55770 (Sara Espinoza) held until CASE-000419 is decided |
| Held | — | ||
| ACT-013864 | Outreach suppressed pending steward Outreach | TPA-59390 (Logan Myers) held until CASE-000420 is decided |
| Held | — | ||
| ACT-013865 | Outreach suppressed pending steward Outreach | CLM-412083 (Willie Price) held until CASE-000421 is decided |
| Held | — | ||
| ACT-013866 | Outreach suppressed pending steward Outreach | CLM-426653 (Joseph Flors) held until CASE-000422 is decided |
| Held | — | ||
| ACT-013867 | Outreach suppressed pending steward Outreach | TPA-57420 (Sandra Hoffman) held until CASE-000423 is decided |
| Held | — | ||
| ACT-013868 | Outreach suppressed pending steward Outreach | CLM-426534 (Catherine Medina) held until CASE-000424 is decided |
| Held | — | ||
| ACT-013869 | Outreach suppressed pending steward Outreach | CLM-429442 (Kevin Mills) held until CASE-000425 is decided |
| Held | — | ||
| ACT-013870 | Outreach suppressed pending steward Outreach | ENR-138630 (Kevin Mills) held until CASE-000426 is decided |
| Held | — | ||
| ACT-013871 | Outreach suppressed pending steward Outreach | ENR-142030 (Mateo Sims) held until CASE-000427 is decided |
| Held | — | ||
| ACT-013872 | Outreach suppressed pending steward Outreach | TPA-64131 (Mateo Sims) held until CASE-000428 is decided |
| Held | — | ||
| ACT-013873 | Outreach suppressed pending steward Outreach | CLM-427223 (Teresa Sims) held until CASE-000429 is decided |
| Held | — | ||
| ACT-013874 | Outreach suppressed pending steward Outreach | TPA-64132 (Mateo Sims) held until CASE-000430 is decided |
| Held | — | ||
| ACT-013875 | Outreach suppressed pending steward Outreach | TPA-52606 (Pamela Jones) held until CASE-000431 is decided |
| Held | — | ||
| ACT-013876 | Outreach suppressed pending steward Outreach | ENR-107736 (Pamela Jones) held until CASE-000432 is decided |
| Held | — | ||
| ACT-013877 | Outreach suppressed pending steward Outreach | CLM-408081 (Marilyn Lane) held until CASE-000433 is decided |
| Held | — | ||
| ACT-013878 | Outreach suppressed pending steward Outreach | ENR-110643 (Marilyn Lane) held until CASE-000434 is decided |
| Held | — | ||
| ACT-013879 | Outreach suppressed pending steward Outreach | CLM-406505 (Carlos Gordon) held until CASE-000435 is decided |
| Held | — | ||
| ACT-013880 | Outreach suppressed pending steward Outreach | TPA-52049 (Ashley Gordon) held until CASE-000436 is decided |
| Held | — | ||
| ACT-013881 | Outreach suppressed pending steward Outreach | PRV-21355 (Ashley Gordon) held until CASE-000437 is decided |
| Held | — | ||
| ACT-013882 | Outreach suppressed pending steward Outreach | TPA-60410 (Eugene Morales) held until CASE-000438 is decided |
| Held | — | ||
| ACT-013883 | Outreach suppressed pending steward Outreach | CLM-418020 (Jessica Gordon) held until CASE-000439 is decided |
| Held | — | ||
| ACT-013884 | Outreach suppressed pending steward Outreach | CLM-418529 (Susan Wang) held until CASE-000440 is decided |
| Held | — | ||
| ACT-013885 | Outreach suppressed pending steward Outreach | CLM-412245 (Victoria Ross) held until CASE-000441 is decided |
| Held | — | ||
| ACT-013886 | Outreach suppressed pending steward Outreach | TPA-55709 (Kathleen Alvarez) held until CASE-000442 is decided |
| Held | — | ||
| ACT-013887 | Outreach suppressed pending steward Outreach | CLM-412980 (Kathleen Alvarez) held until CASE-000443 is decided |
| Held | — | ||
| ACT-013888 | Outreach suppressed pending steward Outreach | TPA-62854 (Mariana Williamson) held until CASE-000444 is decided |
| Held | — | ||
| ACT-013889 | Outreach suppressed pending steward Outreach | CLM-424538 (Mark Scott) held until CASE-000445 is decided |
| Held | — | ||
| ACT-013890 | Outreach suppressed pending steward Outreach | TPA-60822 (Mark Scott) held until CASE-000446 is decided |
| Held | — | ||
| ACT-013891 | Outreach suppressed pending steward Outreach | ENR-132073 (Mark Scott) held until CASE-000447 is decided |
| Held | — | ||
| ACT-013892 | Outreach suppressed pending steward Outreach | CLM-427820 (Jean Phillips) held until CASE-000448 is decided |
| Held | — | ||
| ACT-013893 | Outreach suppressed pending steward Outreach | TPA-63440 (Matthew Ellis) held until CASE-000449 is decided |
| Held | — | ||
| ACT-013894 | Outreach suppressed pending steward Outreach | CLM-413333 (Douglas Henderson) held until CASE-000450 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.