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-017989 | Care coordination outreach Next-best-action | Brian Burke: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017990 | Care coordination outreach Next-best-action | Olivia Fox: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017991 | Care coordination outreach Next-best-action | Joan Burton: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017992 | Care coordination outreach Next-best-action | Michael Robinson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017993 | Care coordination outreach Next-best-action | Jack Austin: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017994 | Care coordination outreach Next-best-action | Kimberly Gibson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017995 | Care coordination outreach Next-best-action | Lauren Porter: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017996 | Care coordination outreach Next-best-action | Robert Price: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-017997 | Care coordination outreach Next-best-action | Bruce Chavez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017998 | Care coordination outreach Next-best-action | Richard Johnson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-017999 | Care coordination outreach Next-best-action | Madison Allen: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018000 | Care coordination outreach Next-best-action | Steven Gilbert: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018001 | Care coordination outreach Next-best-action | Olivia Gonzales: 5 claims, no attributed provider |
| Proposed | — | ||
| ACT-018002 | Care coordination outreach Next-best-action | Alice Knight: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018003 | Care coordination outreach Next-best-action | Carlos Salazar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018004 | Care coordination outreach Next-best-action | Lauuren Johnson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018005 | Care coordination outreach Next-best-action | Carolyn Harrison: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018006 | Care coordination outreach Next-best-action | Albert Sandoval: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018007 | Care coordination outreach Next-best-action | Nathan Peters: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018008 | Care coordination outreach Next-best-action | Nathan Campbell: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018009 | Care coordination outreach Next-best-action | Sara Robertson: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018010 | Care coordination outreach Next-best-action | Natalie Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018011 | Care coordination outreach Next-best-action | Priya Ellis: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018012 | Care coordination outreach Next-best-action | Henry Graham: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018013 | Care coordination outreach Next-best-action | Nicole Gonzalez: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018014 | Care coordination outreach Next-best-action | Justin Le: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018015 | Care coordination outreach Next-best-action | Alan Aguilar: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018016 | Care coordination outreach Next-best-action | Amber Bryant: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018017 | Care coordination outreach Next-best-action | Bryan Stevens: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018018 | Care coordination outreach Next-best-action | Christopher Cunningham: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018019 | Care coordination outreach Next-best-action | Ahmed Moore: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018020 | Care coordination outreach Next-best-action | David Daniels: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018021 | Care coordination outreach Next-best-action | Dennis Park: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018022 | Care coordination outreach Next-best-action | Shirley Shaw: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018023 | Care coordination outreach Next-best-action | Shirley Obrien: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018024 | Care coordination outreach Next-best-action | Nathan Hernandez: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018025 | Care coordination outreach Next-best-action | Jennifer Turner: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018026 | Care coordination outreach Next-best-action | Joyce Palmer: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018027 | Care coordination outreach Next-best-action | Bryan Black: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018028 | Care coordination outreach Next-best-action | Joan Gonzales: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018029 | Care coordination outreach Next-best-action | John Sims: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018030 | Care coordination outreach Next-best-action | Jeremy Garrett: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018031 | Care coordination outreach Next-best-action | Carol Lewis: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018032 | Care coordination outreach Next-best-action | Kathryn Robinson: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018033 | Care coordination outreach Next-best-action | Thomas Baker: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018034 | Care coordination outreach Next-best-action | Theresa West: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018035 | Care coordination outreach Next-best-action | Hiroshi Freeman: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018036 | Care coordination outreach Next-best-action | Denise Berry: 3 claims, no attributed provider |
| Proposed | — | ||
| ACT-018037 | Care coordination outreach Next-best-action | Wayne Bailey: 4 claims, no attributed provider |
| Proposed | — | ||
| ACT-018038 | Care coordination outreach Next-best-action | William Moreno: 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.