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-017939 | Care coordination outreach Next-best-action | Hiroshi Meyer: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017940 | Care coordination outreach Next-best-action | Dylan Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017941 | Care coordination outreach Next-best-action | Ethan Vasquez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017942 | Care coordination outreach Next-best-action | Peter Kelly: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017943 | Care coordination outreach Next-best-action | Kyle Myers: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017944 | Care coordination outreach Next-best-action | Henry Lane: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017945 | Care coordination outreach Next-best-action | Andrea Kennedy: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017946 | Care coordination outreach Next-best-action | Samantha Dean: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017947 | Care coordination outreach Next-best-action | Fatima Perkins: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017948 | Care coordination outreach Next-best-action | Isabella Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017949 | Care coordination outreach Next-best-action | Barbara Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017950 | Care coordination outreach Next-best-action | Brandon Bryant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017951 | Care coordination outreach Next-best-action | Ruth Stephens: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017952 | Care coordination outreach Next-best-action | Chris Meyer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017953 | Care coordination outreach Next-best-action | Camila Green: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017954 | Care coordination outreach Next-best-action | Marilyn James: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017955 | Care coordination outreach Next-best-action | Joyce Evans: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017956 | Care coordination outreach Next-best-action | Larry Martin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017957 | Care coordination outreach Next-best-action | Andrea Gray: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017958 | Care coordination outreach Next-best-action | Gloria Yang: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017959 | Care coordination outreach Next-best-action | Gerald Cox: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017960 | Care coordination outreach Next-best-action | Patricia Le: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017961 | Care coordination outreach Next-best-action | Deborah Ramos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017962 | Care coordination outreach Next-best-action | Hiroshi Harris: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017963 | Care coordination outreach Next-best-action | Grace Stephens: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017964 | Care coordination outreach Next-best-action | Eugene Nichols: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017965 | Care coordination outreach Next-best-action | Sharon Jordan: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017966 | Care coordination outreach Next-best-action | Linda Watson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017967 | Care coordination outreach Next-best-action | Scott Thomas: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017968 | Care coordination outreach Next-best-action | Karen Fowler: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017969 | Care coordination outreach Next-best-action | Aaron Johnson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017970 | Care coordination outreach Next-best-action | Jose Gordon: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017971 | Care coordination outreach Next-best-action | Stephen King: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017972 | Care coordination outreach Next-best-action | William Patterson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017973 | Care coordination outreach Next-best-action | Sophia Hill: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017974 | Care coordination outreach Next-best-action | Henry Castillo: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-017975 | Care coordination outreach Next-best-action | Richard Tucker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017976 | Care coordination outreach Next-best-action | Christopher Hawkins: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017977 | Care coordination outreach Next-best-action | Jordan Burton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017978 | Care coordination outreach Next-best-action | Ann Welch: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017979 | Care coordination outreach Next-best-action | Logan Luna: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017980 | Care coordination outreach Next-best-action | Austin Santos: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017981 | Care coordination outreach Next-best-action | Ethan Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017982 | Care coordination outreach Next-best-action | Kevin Mills: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017983 | Care coordination outreach Next-best-action | Elijah Ferguson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017984 | Care coordination outreach Next-best-action | Helen West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017985 | Care coordination outreach Next-best-action | Theresa Torres: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017986 | Care coordination outreach Next-best-action | Deborah Obrien: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017987 | Care coordination outreach Next-best-action | Carlos Chavez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017988 | Care coordination outreach Next-best-action | Denise Burns: 3 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.