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

TypeAll Eligibility conflict resolved1,339 Orphan claim re-pointed9,112 Outreach address corrected2,993 Outreach suppressed pending steward4,326 Care coordination outreach1,815 New member onboarding2,081 Duplicate member record retired4,974

StatusAll proposed8,228 executed14,086 suppressed4,326 released0

Outreach suppressed pending steward, Outreach, 0 proposed

Action	Type	Title	Detail	Linked to	Status	Executed
ACT-013445	Outreach suppressed pending steward Outreach	CLM-402482 (Jackie Reyes) held until CASE-000001 is decided	case id CASE-000001 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-402482	Suppressed	—
ACT-013446	Outreach suppressed pending steward Outreach	TPA-51738 (Ethan Rios) held until CASE-000002 is decided	case id CASE-000002 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-51738	Suppressed	—
ACT-013447	Outreach suppressed pending steward Outreach	CLM-430743 (Larry Hansen) held until CASE-000003 is decided	case id CASE-000003 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-430743	Suppressed	—
ACT-013448	Outreach suppressed pending steward Outreach	TPA-60827 (Keith Varggas) held until CASE-000004 is decided	case id CASE-000004 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-60827	Suppressed	—
ACT-013449	Outreach suppressed pending steward Outreach	TPA-56717 (Kim Marquez) held until CASE-000005 is decided	case id CASE-000005 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-56717	Suppressed	—
ACT-013450	Outreach suppressed pending steward Outreach	CLM-406008 (Christine Knight) held until CASE-000006 is decided	case id CASE-000006 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-406008	Suppressed	—
ACT-013451	Outreach suppressed pending steward Outreach	ENR-101256 (Cristian Knight) held until CASE-000007 is decided	case id CASE-000007 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-101256	Suppressed	—
ACT-013452	Outreach suppressed pending steward Outreach	CLM-418429 (Diego Snyder) held until CASE-000008 is decided	case id CASE-000008 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-418429	Suppressed	—
ACT-013453	Outreach suppressed pending steward Outreach	CLM-427068 (Sean Gordon) held until CASE-000009 is decided	case id CASE-000009 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-427068	Suppressed	—
ACT-013454	Outreach suppressed pending steward Outreach	CLM-406583 (Nancy Wright) held until CASE-000010 is decided	case id CASE-000010 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-406583	Suppressed	—
ACT-013455	Outreach suppressed pending steward Outreach	CLM-403782 (Heather Walsh) held until CASE-000011 is decided	case id CASE-000011 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-403782	Suppressed	—
ACT-013456	Outreach suppressed pending steward Outreach	ENR-140230 (Julie Miller) held until CASE-000012 is decided	case id CASE-000012 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-140230	Suppressed	—
ACT-013457	Outreach suppressed pending steward Outreach	PRV-28967 (Julie Miller) held until CASE-000013 is decided	case id CASE-000013 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-28967	Suppressed	—
ACT-013458	Outreach suppressed pending steward Outreach	PRV-22634 (Kathryn Bailey) held until CASE-000014 is decided	case id CASE-000014 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-22634	Suppressed	—
ACT-013459	Outreach suppressed pending steward Outreach	ENR-122342 (Tyler Bell) held until CASE-000015 is decided	case id CASE-000015 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-122342	Suppressed	—
ACT-013460	Outreach suppressed pending steward Outreach	TPA-57098 (Jeremy Williamson) held until CASE-000016 is decided	case id CASE-000016 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-57098	Suppressed	—
ACT-013461	Outreach suppressed pending steward Outreach	PRV-28485 (Arthur Johnson) held until CASE-000017 is decided	case id CASE-000017 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-28485	Suppressed	—
ACT-013462	Outreach suppressed pending steward Outreach	TPA-64406 (Richard Perry) held until CASE-000018 is decided	case id CASE-000018 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-64406	Suppressed	—
ACT-013463	Outreach suppressed pending steward Outreach	TPA-64407 (Richard Perry) held until CASE-000019 is decided	case id CASE-000019 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-64407	Suppressed	—
ACT-013464	Outreach suppressed pending steward Outreach	ENR-141702 (Brian Rogers) held until CASE-000020 is decided	case id CASE-000020 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-141702	Suppressed	—
ACT-013465	Outreach suppressed pending steward Outreach	PRV-29290 (Brian Rogers) held until CASE-000021 is decided	case id CASE-000021 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-29290	Suppressed	—
ACT-013466	Outreach suppressed pending steward Outreach	TPA-61792 (Kelly Richardson) held until CASE-000022 is decided	case id CASE-000022 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-61792	Suppressed	—
ACT-013467	Outreach suppressed pending steward Outreach	ENR-135020 (Kelly Richardson) held until CASE-000023 is decided	case id CASE-000023 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-135020	Suppressed	—
ACT-013468	Outreach suppressed pending steward Outreach	PRV-28673 (Albert Richardson) held until CASE-000024 is decided	case id CASE-000024 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-28673	Suppressed	—
ACT-013469	Outreach suppressed pending steward Outreach	TPA-63091 (Albert Richardson) held until CASE-000025 is decided	case id CASE-000025 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-63091	Suppressed	—
ACT-013470	Outreach suppressed pending steward Outreach	ENR-107861 (Adam Riley) held until CASE-000026 is decided	case id CASE-000026 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-107861	Suppressed	—
ACT-013471	Outreach suppressed pending steward Outreach	CLM-405967 (Adam Riley) held until CASE-000027 is decided	case id CASE-000027 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-405967	Suppressed	—
ACT-013472	Outreach suppressed pending steward Outreach	CLM-430009 (Tyler Moreno) held until CASE-000028 is decided	case id CASE-000028 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-430009	Suppressed	—
ACT-013473	Outreach suppressed pending steward Outreach	CLM-428337 (Frances Hunter) held until CASE-000029 is decided	case id CASE-000029 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-428337	Suppressed	—
ACT-013474	Outreach suppressed pending steward Outreach	TPA-62514 (Frances Hunter) held until CASE-000030 is decided	case id CASE-000030 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-62514	Suppressed	—
ACT-013475	Outreach suppressed pending steward Outreach	CLM-429375 (Mason Walsh) held until CASE-000031 is decided	case id CASE-000031 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-429375	Suppressed	—
ACT-013476	Outreach suppressed pending steward Outreach	CLM-430591 (Frank Willis) held until CASE-000032 is decided	case id CASE-000032 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-430591	Suppressed	—
ACT-013477	Outreach suppressed pending steward Outreach	TPA-63509 (Frank Willis) held until CASE-000033 is decided	case id CASE-000033 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-63509	Suppressed	—
ACT-013478	Outreach suppressed pending steward Outreach	CLM-413208 (Matthew Burke) held until CASE-000034 is decided	case id CASE-000034 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-413208	Suppressed	—
ACT-013479	Outreach suppressed pending steward Outreach	ENR-115466 (William Brooks) held until CASE-000035 is decided	case id CASE-000035 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-115466	Suppressed	—
ACT-013480	Outreach suppressed pending steward Outreach	ENR-112951 (Jose Jackson) held until CASE-000036 is decided	case id CASE-000036 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-112951	Suppressed	—
ACT-013481	Outreach suppressed pending steward Outreach	ENR-126848 (Alexander Jackson) held until CASE-000037 is decided	case id CASE-000037 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-126848	Suppressed	—
ACT-013482	Outreach suppressed pending steward Outreach	CLM-422333 (Andrew Jackson) held until CASE-000038 is decided	case id CASE-000038 source CLM reason identity below confidence threshold; sensitive communication withheld	CLM-422333	Suppressed	—
ACT-013483	Outreach suppressed pending steward Outreach	PRV-25896 (Sandra Lawis) held until CASE-000039 is decided	case id CASE-000039 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-25896	Suppressed	—
ACT-013484	Outreach suppressed pending steward Outreach	TPA-59395 (Cynthia Baker) held until CASE-000040 is decided	case id CASE-000040 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-59395	Suppressed	—
ACT-013485	Outreach suppressed pending steward Outreach	TPA-59396 (Cyntiha Baker) held until CASE-000041 is decided	case id CASE-000041 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-59396	Suppressed	—
ACT-013486	Outreach suppressed pending steward Outreach	ENR-128007 (Cynthia Baker) held until CASE-000042 is decided	case id CASE-000042 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-128007	Suppressed	—
ACT-013487	Outreach suppressed pending steward Outreach	ENR-130444 (Christine Robinnson) held until CASE-000043 is decided	case id CASE-000043 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-130444	Suppressed	—
ACT-013488	Outreach suppressed pending steward Outreach	PRV-26873 (Christine Robinson) held until CASE-000044 is decided	case id CASE-000044 source PRV reason identity below confidence threshold; sensitive communication withheld	PRV-26873	Suppressed	—
ACT-013489	Outreach suppressed pending steward Outreach	TPA-57030 (Nancy Freeman) held until CASE-000045 is decided	case id CASE-000045 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-57030	Suppressed	—
ACT-013490	Outreach suppressed pending steward Outreach	TPA-51230 (Michael Fernandez) held until CASE-000046 is decided	case id CASE-000046 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-51230	Suppressed	—
ACT-013491	Outreach suppressed pending steward Outreach	ENR-103705 (Michael Fernandez) held until CASE-000047 is decided	case id CASE-000047 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-103705	Suppressed	—
ACT-013492	Outreach suppressed pending steward Outreach	ENR-100604 (Austin Fernandez) held until CASE-000048 is decided	case id CASE-000048 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-100604	Suppressed	—
ACT-013493	Outreach suppressed pending steward Outreach	TPA-56952 (Doris Meyer) held until CASE-000049 is decided	case id CASE-000049 source TPA reason identity below confidence threshold; sensitive communication withheld	TPA-56952	Suppressed	—
ACT-013494	Outreach suppressed pending steward Outreach	ENR-112895 (Russell Price) held until CASE-000050 is decided	case id CASE-000050 source ENR reason identity below confidence threshold; sensitive communication withheld	ENR-112895	Suppressed	—

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Derivation rules

Evaluated after every gold rebuild

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
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
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
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
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
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
Duplicate member record retired
Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.