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-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.