COMPUTER SYSTEM FOR APPLYING PREDICTIVE MODEL TO DETERMINATE AND INDETERMINATE DATA
First Claim
1. A computer system comprising:
- an indeterminate data capture module for capturing indeterminate data;
a data storage module in communication with the indeterminate data capture module, said data storage module for receiving, storing, and providing access to indeterminate data captured by the indeterminate data capture module, said data storage module also storing and providing access to determinate data, said indeterminate and determinate data stored by said data storage module related to historical claim transactions and to current claim transactions;
a predictive model component, coupled to the data storage module, for determining whether to identify a one of said current claim transactions for referral to an investigation unit;
a computer processor for executing programmed instructions and for storing and retrieving said data related to current claim transactions;
program memory, coupled to the computer processor, for storing program instruction steps for execution by the computer processor;
a model training component, coupled to the computer processor, for training the predictive model component based on the data related to the historical claim transactions in accordance with program instructions stored in the program memory and executed by the computer processor, thereby providing a trained predictive model component;
an output device, coupled to the computer processor, for outputting an output indicative of whether said one of said current claim transactions should be referred to the investigation unit, wherein the computer processor generates the output in accordance with program instructions in the program memory and executed by the computer processor, said output generated in response to application of data for said one of said current claim transactions to the trained predictive model component; and
a routing module for directing workflow based on the output from the output device.
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Accused Products
Abstract
A computer system includes a data storage module. The computer system also includes an indeterminate data capture module. The data storage module receives, stores, and provides access to both determinate data and indeterminate data that was captured by the indeterminate data capture module. The computer system also includes a computer processor and a program memory. The computer processor executes programmed instructions and stores and retrieves the data stored in the data storage module. The data stored in the data storage module is related to historical claim transactions and current claim transactions. A predictive model component is coupled to the data storage module, and determines whether to refer a current claim transaction to an investigation unit. A model training component is coupled to the computer processor and functions to train the predictive model.
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Citations
28 Claims
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1. A computer system comprising:
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an indeterminate data capture module for capturing indeterminate data; a data storage module in communication with the indeterminate data capture module, said data storage module for receiving, storing, and providing access to indeterminate data captured by the indeterminate data capture module, said data storage module also storing and providing access to determinate data, said indeterminate and determinate data stored by said data storage module related to historical claim transactions and to current claim transactions; a predictive model component, coupled to the data storage module, for determining whether to identify a one of said current claim transactions for referral to an investigation unit; a computer processor for executing programmed instructions and for storing and retrieving said data related to current claim transactions; program memory, coupled to the computer processor, for storing program instruction steps for execution by the computer processor; a model training component, coupled to the computer processor, for training the predictive model component based on the data related to the historical claim transactions in accordance with program instructions stored in the program memory and executed by the computer processor, thereby providing a trained predictive model component; an output device, coupled to the computer processor, for outputting an output indicative of whether said one of said current claim transactions should be referred to the investigation unit, wherein the computer processor generates the output in accordance with program instructions in the program memory and executed by the computer processor, said output generated in response to application of data for said one of said current claim transactions to the trained predictive model component; and a routing module for directing workflow based on the output from the output device. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A computer system comprising:
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a data storage unit for receiving, storing and providing access to historical claim data and current claim data, the current claim data representing a plurality of current claim transactions; a plurality of data input devices, in communication with the data storage unit, for supplying current claim data to the data storage unit, the plurality of data input devices including at least one data input device for capturing indeterminate data, the current claim data supplied to the data storage unit including the indeterminate data; a computer processor in communication with the data storage unit; and a program memory, coupled to the computer processor, for storing at least one application program, the at least one application program including program instruction steps for execution by the computer processor, the at least one application program including; a predictive model that has been trained on and verified with the historical claim data and that controls the computer processor to analyze the current claim data in the data storage unit and to provide a respective output for each current claim transaction represented by the current claim data, the respective output indicating whether said each current claim transaction should be referred to an investigation unit; and a routing component, responsive to the respective output for each of the current claim transactions, for selectively routing ones of the current claim transactions to the investigation unit. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22)
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23. A method of operating a computer system, the method comprising:
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using a plurality of input devices to provide determinate data and indeterminate data with respect to a first group of claim transactions; processing the indeterminate data to extract information from the indeterminate data; storing, in a computer storage unit, the determinate data and the information extracted from the indeterminate data as historical claim data; using the historical claim data to train and verify a predictive model, the predictive model for evaluating claim transactions to determine whether to refer the claim transactions to an investigation unit; using the plurality of input devices to provide determinate data and indeterminate data for current claim transactions; processing the indeterminate data for the current claim transactions to extract information from the indeterminate data for the current claim transactions; storing, in the computer storage unit, the determinate data for the current claim transactions and the information extracted from the indeterminate data for the current claim transactions; applying the trained and verified predictive model to the determinate data for the current claim transactions and to the information extracted from the indeterminate data for the current claim transactions, to generate a respective output for each of the current claim transactions; and selectively routing ones of the current claim transactions to an investigative unit based on the outputs generated by the predictive model. - View Dependent Claims (24, 25, 26, 27, 28)
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Specification