Patent Document ID: 9218592
Application ID: 14010980
Patent Flag: 1

Claim One:
1. A computer system for data processing including a system for executing a trained predictive model to determine a nurse intervention program score for insurance claims based on at least injury, occupation and two or more items of co-morbidity data, determining a nurse intervention program score and determine a positive or negative nurse intervention program decision based on the score, comprising: a nurse intervention program referral determination computer system, comprising: a data storage device storing data indicative of a trained predictive model, trained on historical claim transaction data, configured to determine, based on insurance claim transaction data, a nurse intervention program score, the score indicative of a likelihood of suitability for nurse intervention programs providing health care provided by a nurse to an injured individual, of insurance claim transactions; one or more computer processors in communication with the data storage device; and a program memory, coupled to the one or more computer processors, storing program instruction steps for execution by the one or more computer processors, the program instructions, when executed by the one or more computer processors, causing the one or more computer processors to: receive data indicative of a plurality of insurance claim transactions, the data comprising at least injury data, employee occupation data, and co-morbidity data; apply the predictive model to the received data indicative of a plurality of insurance claim transactions to determine a nurse intervention program score, the predictive model being responsive to values of each of injury, occupation, and co-morbidity data, the co-morbidity data comprising at least two of (i) alcohol related co-morbidity information, (ii) drug related co-morbidity information, (iii) tobacco related co-morbidity information, (iv) arthritis related co-morbidity information, (v) diabetes related co-morbidity information, or (vi) obesity related co-morbidity information; and based on the nurse intervention program score, determine a positive or negative nurse intervention program recommendation for each of the plurality of insurance claim transactions insurance claim transactions to which the predictive model has been applied, including a positive nurse intervention program recommendation for at least one of the plurality of insurance claim transactions; responsive to a positive nurse intervention program recommendation, output data relating to the received insurance claim transaction; and a nurse intervention program computer in communication with the nurse intervention program referral determination computer system and configured to receive the data relating to the received insurance claim transaction output responsive to the positive nurse intervention program recommendation.