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-017889
Care coordination outreach
Next-best-action
Lauren Johnson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017890
Care coordination outreach
Next-best-action
Nathan Lawrence: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017891
Care coordination outreach
Next-best-action
Maria Meyer: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017892
Care coordination outreach
Next-best-action
Sean Castro: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017893
Care coordination outreach
Next-best-action
Wayne Santos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017894
Care coordination outreach
Next-best-action
William Freeman: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017895
Care coordination outreach
Next-best-action
Ralph Knight: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017896
Care coordination outreach
Next-best-action
Jonathan Murphy: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017897
Care coordination outreach
Next-best-action
Kyle Salazar: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017898
Care coordination outreach
Next-best-action
Matthew Day: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017899
Care coordination outreach
Next-best-action
Sarah Scott: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017900
Care coordination outreach
Next-best-action
Sara Hicks: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017901
Care coordination outreach
Next-best-action
Gary Weber: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017902
Care coordination outreach
Next-best-action
Samantha Walker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017903
Care coordination outreach
Next-best-action
Philip Tucker: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017904
Care coordination outreach
Next-best-action
Peter Gilbert: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017905
Care coordination outreach
Next-best-action
Gabriel Robertson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017906
Care coordination outreach
Next-best-action
Marilyn Miller: 6 claims, no attributed provider
Claims
6
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017907
Care coordination outreach
Next-best-action
Gregory Reid: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017908
Care coordination outreach
Next-best-action
Alexis Ramirez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017909
Care coordination outreach
Next-best-action
Henry Hunter: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017910
Care coordination outreach
Next-best-action
Nicole Richardson: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017911
Care coordination outreach
Next-best-action
Priya Tucker: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017912
Care coordination outreach
Next-best-action
Charlotte Bryant: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017913
Care coordination outreach
Next-best-action
Virginia Weber: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017914
Care coordination outreach
Next-best-action
Sophia Fox: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017915
Care coordination outreach
Next-best-action
Dorothy Bradley: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017916
Care coordination outreach
Next-best-action
Linda Garrett: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017917
Care coordination outreach
Next-best-action
Sean Wright: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017918
Care coordination outreach
Next-best-action
Lawrence Hoffman: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017919
Care coordination outreach
Next-best-action
Noah Le: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017920
Care coordination outreach
Next-best-action
John Ramos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017921
Care coordination outreach
Next-best-action
Frank Lawrence: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017922
Care coordination outreach
Next-best-action
Nicholas Santos: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017923
Care coordination outreach
Next-best-action
Mason Ramirez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017924
Care coordination outreach
Next-best-action
Jesse Price: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017925
Care coordination outreach
Next-best-action
Julie Vasquez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017926
Care coordination outreach
Next-best-action
William Allen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017927
Care coordination outreach
Next-best-action
Catherine Collins: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017928
Care coordination outreach
Next-best-action
Katherine James: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017929
Care coordination outreach
Next-best-action
Hannah Nguyen: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017930
Care coordination outreach
Next-best-action
Gerald Cunningham: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017931
Care coordination outreach
Next-best-action
Heather Fuller: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017932
Care coordination outreach
Next-best-action
Ahmed Wallace: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017933
Care coordination outreach
Next-best-action
Albert Cruz: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017934
Care coordination outreach
Next-best-action
Hannah Nelson: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017935
Care coordination outreach
Next-best-action
Billy Barnes: 5 claims, no attributed provider
Claims
5
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017936
Care coordination outreach
Next-best-action
Austin Henry: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017937
Care coordination outreach
Next-best-action
Mason Vasquez: 3 claims, no attributed provider
Claims
3
Recommendation
assign PCP and schedule care-coordination call
Proposed—
ACT-017938
Care coordination outreach
Next-best-action
Emma Harrison: 4 claims, no attributed provider
Claims
4
Recommendation
assign PCP and schedule care-coordination call
Proposed—
26,640 rows, page 90 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.