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-017889 | Care coordination outreach Next-best-action | Lauren Johnson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017890 | Care coordination outreach Next-best-action | Nathan Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017891 | Care coordination outreach Next-best-action | Maria Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017892 | Care coordination outreach Next-best-action | Sean Castro: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017893 | Care coordination outreach Next-best-action | Wayne Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017894 | Care coordination outreach Next-best-action | William Freeman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017895 | Care coordination outreach Next-best-action | Ralph Knight: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017896 | Care coordination outreach Next-best-action | Jonathan Murphy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017897 | Care coordination outreach Next-best-action | Kyle Salazar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017898 | Care coordination outreach Next-best-action | Matthew Day: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017899 | Care coordination outreach Next-best-action | Sarah Scott: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017900 | Care coordination outreach Next-best-action | Sara Hicks: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017901 | Care coordination outreach Next-best-action | Gary Weber: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017902 | Care coordination outreach Next-best-action | Samantha Walker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017903 | Care coordination outreach Next-best-action | Philip Tucker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017904 | Care coordination outreach Next-best-action | Peter Gilbert: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017905 | Care coordination outreach Next-best-action | Gabriel Robertson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017906 | Care coordination outreach Next-best-action | Marilyn Miller: 6 claims, no attributed provider |
| Proposed | — | ||
| ACT-017907 | Care coordination outreach Next-best-action | Gregory Reid: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017908 | Care coordination outreach Next-best-action | Alexis Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017909 | Care coordination outreach Next-best-action | Henry Hunter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017910 | Care coordination outreach Next-best-action | Nicole Richardson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017911 | Care coordination outreach Next-best-action | Priya Tucker: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017912 | Care coordination outreach Next-best-action | Charlotte Bryant: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017913 | Care coordination outreach Next-best-action | Virginia Weber: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017914 | Care coordination outreach Next-best-action | Sophia Fox: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017915 | Care coordination outreach Next-best-action | Dorothy Bradley: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017916 | Care coordination outreach Next-best-action | Linda Garrett: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017917 | Care coordination outreach Next-best-action | Sean Wright: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017918 | Care coordination outreach Next-best-action | Lawrence Hoffman: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017919 | Care coordination outreach Next-best-action | Noah Le: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017920 | Care coordination outreach Next-best-action | John Ramos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017921 | Care coordination outreach Next-best-action | Frank Lawrence: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017922 | Care coordination outreach Next-best-action | Nicholas Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017923 | Care coordination outreach Next-best-action | Mason Ramirez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017924 | Care coordination outreach Next-best-action | Jesse Price: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017925 | Care coordination outreach Next-best-action | Julie Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017926 | Care coordination outreach Next-best-action | William Allen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017927 | Care coordination outreach Next-best-action | Catherine Collins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017928 | Care coordination outreach Next-best-action | Katherine James: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017929 | Care coordination outreach Next-best-action | Hannah Nguyen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017930 | Care coordination outreach Next-best-action | Gerald Cunningham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017931 | Care coordination outreach Next-best-action | Heather Fuller: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017932 | Care coordination outreach Next-best-action | Ahmed Wallace: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017933 | Care coordination outreach Next-best-action | Albert Cruz: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017934 | Care coordination outreach Next-best-action | Hannah Nelson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017935 | Care coordination outreach Next-best-action | Billy Barnes: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017936 | Care coordination outreach Next-best-action | Austin Henry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017937 | Care coordination outreach Next-best-action | Mason Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017938 | Care coordination outreach Next-best-action | Emma Harrison: 4 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.