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

TypeAllEligibility conflict resolved1,339Orphan claim re-pointed9,112Outreach address corrected2,993Outreach suppressed pending steward4,326Care coordination outreach1,815New member onboarding2,081Duplicate member record retired4,974
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-006240
Orphan claim re-pointed
Claims processor
CLM-432288 → UHC-75959-53 (Cheryl Johnson)
Member id
UHC-75959-53
Confidence
1
Method
probabilistic
MBR-000283CLM-432288
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006241
Orphan claim re-pointed
Claims processor
CLM-419178 → UHC-95164-43 (Jordan Flores)
Member id
UHC-95164-43
Confidence
0.94
Method
probabilistic
MBR-002147CLM-419178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006242
Orphan claim re-pointed
Claims processor
CLM-426969 → UHC-79906-78 (Delgado Christine)
Member id
UHC-79906-78
Confidence
0.98
Method
probabilistic
MBR-012765CLM-426969
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006243
Orphan claim re-pointed
Claims processor
CLM-429154 → UHC-03491-04 (Anna Wallace)
Member id
UHC-03491-04
Confidence
0.87
Method
probabilistic
MBR-006420CLM-429154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006244
Orphan claim re-pointed
Claims processor
CLM-432480 → UHC-41101-83 (Willie Bennett)
Member id
UHC-41101-83
Confidence
1
Method
probabilistic
MBR-001378CLM-432480
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006245
Orphan claim re-pointed
Claims processor
CLM-418240 → UHC-25880-45 (Abigail Lawrence)
Member id
UHC-25880-45
Confidence
1
Method
probabilistic
MBR-026744CLM-418240
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006246
Orphan claim re-pointed
Claims processor
CLM-402470 → UHC-88883-33 (Joyce Carr)
Member id
UHC-88883-33
Confidence
1
Method
probabilistic
MBR-013770CLM-402470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006247
Orphan claim re-pointed
Claims processor
CLM-418225 → UHC-16307-85 (Mariana Reid)
Member id
UHC-16307-85
Confidence
1
Method
probabilistic
MBR-013418CLM-418225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006248
Orphan claim re-pointed
Claims processor
CLM-410815 → UHC-44213-31 (Mason Jenkins)
Member id
UHC-44213-31
Confidence
0.97
Method
deterministic
MBR-022308CLM-410815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006249
Orphan claim re-pointed
Claims processor
CLM-409451 → UHC-21212-52 (Rachel Walker)
Member id
UHC-21212-52
Confidence
0.90
Method
probabilistic
MBR-011146CLM-409451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006250
Orphan claim re-pointed
Claims processor
CLM-415542 → UHC-50444-71 (Kenneth Morgan)
Member id
UHC-50444-71
Confidence
1
Method
probabilistic
MBR-042473CLM-415542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006251
Orphan claim re-pointed
Claims processor
CLM-422395 → UHC-40350-50 (Joshua Payne)
Member id
UHC-40350-50
Confidence
0.97
Method
deterministic
MBR-026952CLM-422395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006252
Orphan claim re-pointed
Claims processor
CLM-430891 → UHC-11124-73 (Christopher Yang)
Member id
UHC-11124-73
Confidence
1
Method
probabilistic
MBR-025302CLM-430891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006253
Orphan claim re-pointed
Claims processor
CLM-424931 → UHC-36040-90 (Wayne Morrison)
Member id
UHC-36040-90
Confidence
1
Method
probabilistic
MBR-014665CLM-424931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006254
Orphan claim re-pointed
Claims processor
CLM-404746 → UHC-98269-55 (Kathleen Rivera)
Member id
UHC-98269-55
Confidence
1
Method
probabilistic
MBR-022705CLM-404746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006255
Orphan claim re-pointed
Claims processor
CLM-411991 → UHC-17863-08 (Valentina Ortiz)
Member id
UHC-17863-08
Confidence
1
Method
probabilistic
MBR-003130CLM-411991
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006256
Orphan claim re-pointed
Claims processor
CLM-415354 → UHC-75623-35 (Kenneth Kennedy)
Member id
UHC-75623-35
Confidence
1
Method
probabilistic
MBR-025934CLM-415354
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006257
Orphan claim re-pointed
Claims processor
CLM-418699 → UHC-36004-77 (George Shaw)
Member id
UHC-36004-77
Confidence
0.89
Method
probabilistic
MBR-001375CLM-418699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006258
Orphan claim re-pointed
Claims processor
CLM-418460 → UHC-74181-40 (Jack Dunn)
Member id
UHC-74181-40
Confidence
1
Method
probabilistic
MBR-006708CLM-418460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006259
Orphan claim re-pointed
Claims processor
CLM-423607 → UHC-51692-81 (Bruce Hart)
Member id
UHC-51692-81
Confidence
1
Method
probabilistic
MBR-004488CLM-423607
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006260
Orphan claim re-pointed
Claims processor
CLM-411116 → UHC-10107-56 (Becky Bryant)
Member id
UHC-10107-56
Confidence
1
Method
probabilistic
MBR-021756CLM-411116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006261
Orphan claim re-pointed
Claims processor
CLM-405027 → UHC-11856-62 (George Jensen)
Member id
UHC-11856-62
Confidence
1
Method
probabilistic
MBR-033090CLM-405027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006262
Orphan claim re-pointed
Claims processor
CLM-412317 → UHC-80658-32 (John Burke)
Member id
UHC-80658-32
Confidence
1
Method
probabilistic
MBR-019321CLM-412317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006263
Orphan claim re-pointed
Claims processor
CLM-413253 → UHC-03469-36 (Jason Larson)
Member id
UHC-03469-36
Confidence
1
Method
probabilistic
MBR-022649CLM-413253
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006264
Orphan claim re-pointed
Claims processor
CLM-413190 → UHC-98170-43 (Frank Salazar)
Member id
UHC-98170-43
Confidence
1
Method
probabilistic
MBR-029708CLM-413190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006265
Orphan claim re-pointed
Claims processor
CLM-403673 → UHC-13848-92 (Carl Hill)
Member id
UHC-13848-92
Confidence
1
Method
probabilistic
MBR-030952CLM-403673
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006266
Orphan claim re-pointed
Claims processor
CLM-401196 → UHC-54131-68 (Noah West)
Member id
UHC-54131-68
Confidence
0.97
Method
probabilistic
MBR-026836CLM-401196
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006267
Orphan claim re-pointed
Claims processor
CLM-426646 → UHC-22256-78 (Teresa Park)
Member id
UHC-22256-78
Confidence
1
Method
probabilistic
MBR-012835CLM-426646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006268
Orphan claim re-pointed
Claims processor
CLM-425505 → UHC-68889-27 (Lauren Burke)
Member id
UHC-68889-27
Confidence
1
Method
probabilistic
MBR-004655CLM-425505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006269
Orphan claim re-pointed
Claims processor
CLM-418998 → UHC-17308-74 (Cynthia Mitchell)
Member id
UHC-17308-74
Confidence
0.97
Method
deterministic
MBR-040781CLM-418998
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006270
Orphan claim re-pointed
Claims processor
CLM-406137 → UHC-53245-53 (Diana Berry)
Member id
UHC-53245-53
Confidence
1
Method
probabilistic
MBR-014000CLM-406137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006271
Orphan claim re-pointed
Claims processor
CLM-407893 → UHC-56808-89 (Alexis Olson)
Member id
UHC-56808-89
Confidence
0.97
Method
deterministic
MBR-036754CLM-407893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006272
Orphan claim re-pointed
Claims processor
CLM-431903 → UHC-97072-12 (Marilyn Bradley)
Member id
UHC-97072-12
Confidence
1
Method
probabilistic
MBR-011055CLM-431903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006273
Orphan claim re-pointed
Claims processor
CLM-418044 → UHC-30065-10 (Susan Murphy)
Member id
UHC-30065-10
Confidence
1
Method
probabilistic
MBR-016399CLM-418044
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006274
Orphan claim re-pointed
Claims processor
CLM-427812 → UHC-48990-31 (Sophia Ryan)
Member id
UHC-48990-31
Confidence
0.99
Method
probabilistic
MBR-004899CLM-427812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006275
Orphan claim re-pointed
Claims processor
CLM-420328 → UHC-47052-61 (Kyle Smith)
Member id
UHC-47052-61
Confidence
1
Method
probabilistic
MBR-015444CLM-420328
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006276
Orphan claim re-pointed
Claims processor
CLM-432087 → UHC-15097-94 (Bruce Collins)
Member id
UHC-15097-94
Confidence
1
Method
probabilistic
MBR-023076CLM-432087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006277
Orphan claim re-pointed
Claims processor
CLM-417537 → UHC-80596-07 (Alexis Tran)
Member id
UHC-80596-07
Confidence
1
Method
probabilistic
MBR-023156CLM-417537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006278
Orphan claim re-pointed
Claims processor
CLM-425015 → UHC-09937-27 (Alan Mendez)
Member id
UHC-09937-27
Confidence
1
Method
probabilistic
MBR-019391CLM-425015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006279
Orphan claim re-pointed
Claims processor
CLM-426449 → UHC-50583-39 (Evelyn Palmer)
Member id
UHC-50583-39
Confidence
1
Method
probabilistic
MBR-000851CLM-426449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006280
Orphan claim re-pointed
Claims processor
CLM-419216 → UHC-00875-09 (Heather Hunt)
Member id
UHC-00875-09
Confidence
1
Method
probabilistic
MBR-000255CLM-419216
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006281
Orphan claim re-pointed
Claims processor
CLM-417757 → UHC-74409-30 (Carlos Gibson)
Member id
UHC-74409-30
Confidence
1
Method
probabilistic
MBR-010806CLM-417757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006282
Orphan claim re-pointed
Claims processor
CLM-419661 → UHC-71122-27 (Robert Webb)
Member id
UHC-71122-27
Confidence
1
Method
probabilistic
MBR-022414CLM-419661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006283
Orphan claim re-pointed
Claims processor
CLM-416156 → UHC-03974-15 (Priya Welch)
Member id
UHC-03974-15
Confidence
1
Method
probabilistic
MBR-018793CLM-416156
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006284
Orphan claim re-pointed
Claims processor
CLM-401533 → UHC-84044-07 (Donna Myers)
Member id
UHC-84044-07
Confidence
0.99
Method
probabilistic
MBR-013042CLM-401533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006285
Orphan claim re-pointed
Claims processor
CLM-409612 → UHC-82287-41 (Virginia Marrtin)
Member id
UHC-82287-41
Confidence
0.97
Method
deterministic
MBR-016998CLM-409612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006286
Orphan claim re-pointed
Claims processor
CLM-406726 → UHC-76376-81 (Sarah James)
Member id
UHC-76376-81
Confidence
1
Method
probabilistic
MBR-005610CLM-406726
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006287
Orphan claim re-pointed
Claims processor
CLM-421588 → UHC-19735-38 (Patricia Ellis)
Member id
UHC-19735-38
Confidence
1
Method
probabilistic
MBR-015162CLM-421588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006288
Orphan claim re-pointed
Claims processor
CLM-404593 → UHC-26271-13 (Eugene Tucker)
Member id
UHC-26271-13
Confidence
1
Method
probabilistic
MBR-038487CLM-404593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006289
Orphan claim re-pointed
Claims processor
CLM-407792 → UHC-98913-03 (Carol Garrett)
Member id
UHC-98913-03
Confidence
1
Method
probabilistic
MBR-033661CLM-407792
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 99 of 282PreviousNext

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.