SYSTEM AND METHOD USING A PREDICTIVE MODEL FOR NURSE INTERVENTION PROGRAM DECISIONS
First Claim
1. A computer system for facilitating provisioning of nurse intervention program, comprising:
- a data storage module for receiving, storing, and providing access to data related to historical claim information, including historical injury information and historical claim result information, and to current claim transactions, including current claim transaction injury information;
a predictive model component, coupled to the data storage module, for determining whether to identify one of said current claim transactions for referral to the nurse intervention program;
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 information 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 nurse intervention program, 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 a notice of injury received in connection with said one of said current claim transaction and being based on an 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.
1 Assignment
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Accused Products
Abstract
According to some embodiments, historical claim data may be stored in a computer storage unit. The historical claim data may be used to train and verify a predictive model, the predictive model being associated with an evaluation of claim transactions to determine whether to refer each claim transactions to a nurse intervention program. Data for current claim transactions may be processed, and the trained and verified predictive model may be applied to the data for the current claim transactions to generate a respective output for each of the current claim transactions. Some of the current claim transactions may be selectively routed to a case management center associated with the nurse intervention program based on the outputs generated by the predictive model.
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Citations
23 Claims
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1. A computer system for facilitating provisioning of nurse intervention program, comprising:
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a data storage module for receiving, storing, and providing access to data related to historical claim information, including historical injury information and historical claim result information, and to current claim transactions, including current claim transaction injury information; a predictive model component, coupled to the data storage module, for determining whether to identify one of said current claim transactions for referral to the nurse intervention program; 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 information 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 nurse intervention program, 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 a notice of injury received in connection with said one of said current claim transaction and being based on an 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 method of operating a computer system to facilitate provisioning of a nurse intervention program, the method comprising:
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storing, in a computer storage unit, 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 the nurse intervention program; processing data for current claim transactions; automatically applying the trained and verified predictive model to the 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 a case management center associated with the nurse intervention program based on the outputs generated by the predictive model. - 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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storing, in a computer storage unit, historical claim data; using the historical claim data to develop a predictive model having a plurality of historical claim data inputs and variables, developing the predictive model including; performing data cleansing to eliminate one or more data inputs in the predictive model; performing data reduction to reduce the number of variables in the predictive model; and performing data transformations to normalize variables in the predictive model, the predictive model for evaluating claim transactions to determine whether to refer the claim transactions to a nurse intervention program; automatically applying the trained and verified predictive model to the 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 a case management center associated with the nurse intervention program based on the outputs generated by the predictive model.
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Specification