Patent ID: 8521555
Filing Date: 2013-08-27
Classification: G06N,G06Q,G16H

Abstract:
1. A computer system for facilitating provisioning of a nurse intervention program, comprising: a data storage module for receiving, storing, and providing access to data related to historical insurance claim information, including historical injury information and historical insurance claim result information, and to current insurance claim transactions, including current insurance claim transaction injury information; a predictive model component, coupled to the data storage module, for determining whether to identify one of said current insurance 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 insurance claim transactions; a 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 (i) automatically training the predictive model component based on a first subset of the data related to the historical insurance claim information, including both historical injury information and historical insurance claim result information and (ii) automatically verifying the trained predictive model component based on a second subset of the data related to the historical insurance claim information, different than the first subset, in accordance with program instructions stored in the program memory and executed by the computer processor, thereby providing a trained and verified predictive model component; an output device, coupled to the computer processor, for outputting an output indicative of whether said one of said current insurance 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 insurance claim transaction and being based on an application of data for said one of said current insurance claim transactions to the trained and verified predictive model component; and a routing module for directing workflow based on the output from the output device.