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
Care coordination outreach, Next-best-action, 1,815 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-018171 | Care coordination outreach Next-best-action | Daniel Russell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018172 | Care coordination outreach Next-best-action | Kenneth Cooper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018173 | Care coordination outreach Next-best-action | Brenda Parker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018174 | Care coordination outreach Next-best-action | Timothy Weber: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018175 | Care coordination outreach Next-best-action | Amy Torres: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018176 | Care coordination outreach Next-best-action | Isabella Lee: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018177 | Care coordination outreach Next-best-action | Douglas Stewart: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018178 | Care coordination outreach Next-best-action | Logan Hoffman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018179 | Care coordination outreach Next-best-action | Juan Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018180 | Care coordination outreach Next-best-action | Rachel Lopez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018181 | Care coordination outreach Next-best-action | Emily Palmer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018182 | Care coordination outreach Next-best-action | Ralph Knight: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018183 | Care coordination outreach Next-best-action | Brenda Clark: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018184 | Care coordination outreach Next-best-action | Angela Sullivan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018185 | Care coordination outreach Next-best-action | Ahmed Riley: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018186 | Care coordination outreach Next-best-action | Brenda Hernandez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018187 | Care coordination outreach Next-best-action | Eric Schmidt: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018188 | Care coordination outreach Next-best-action | Ann Reed: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018189 | Care coordination outreach Next-best-action | Thomas Carter: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018190 | Care coordination outreach Next-best-action | Joshua Simmons: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018191 | Care coordination outreach Next-best-action | Jessica Hunt: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018192 | Care coordination outreach Next-best-action | Patricia Payne: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018193 | Care coordination outreach Next-best-action | Scott Cooper: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018194 | Care coordination outreach Next-best-action | Raymond Gardner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018195 | Care coordination outreach Next-best-action | Yuki Burton: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018196 | Care coordination outreach Next-best-action | Teresa Thompson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018197 | Care coordination outreach Next-best-action | Charles Ortiz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018198 | Care coordination outreach Next-best-action | Joseph Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018199 | Care coordination outreach Next-best-action | Jonathan Cunningham: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018200 | Care coordination outreach Next-best-action | Wei Carlson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018201 | Care coordination outreach Next-best-action | Kevin Scott: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018202 | Care coordination outreach Next-best-action | Kelly Gordon: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018203 | Care coordination outreach Next-best-action | Yuki Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018204 | Care coordination outreach Next-best-action | Arthur Robertson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018205 | Care coordination outreach Next-best-action | Virginia Cunningham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018206 | Care coordination outreach Next-best-action | Kelly Lucas: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018207 | Care coordination outreach Next-best-action | Arjun Sullivan: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018208 | Care coordination outreach Next-best-action | Anna Carlson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018209 | Care coordination outreach Next-best-action | Paul Estrada: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018210 | Care coordination outreach Next-best-action | Albert Rogers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018211 | Care coordination outreach Next-best-action | Sophia Hunt: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018212 | Care coordination outreach Next-best-action | Camila James: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018213 | Care coordination outreach Next-best-action | Mark Howell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018214 | Care coordination outreach Next-best-action | John Salazar: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018215 | Care coordination outreach Next-best-action | James Hanson: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018216 | Care coordination outreach Next-best-action | Ryan Espinoza: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018217 | Care coordination outreach Next-best-action | Pamela Gonzalez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018218 | Care coordination outreach Next-best-action | Karen Ruiz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018219 | Care coordination outreach Next-best-action | Mary Powell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018220 | Care coordination outreach Next-best-action | Mary Mason: 5 claims, no attributed provider |
| Proposed | — |
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.