System and methods for predicting patient care paths

A healthcare data processing system comprising:

• a processor;
• and
• memory having instructions stored thereon that, when executed by the processor, cause the processor to perform operations comprising:
• receiving, from a remote device, eligibility data for the patient, the eligibility data associated with an eligibility check for a first visit between the patient and a healthcare provider;
• retrieving medical claims data from a database comprising information for a plurality of historical medical claims;
• predicting the healthcare path for the patient by aggregating the eligibility data with the medical claims data, wherein the healthcare path comprises one or more predicted subsequent visits and a predicted amount of time until each of the one or more subsequent visits;
• and
• transmitting, to the remote device, an alert comprising the predicted healthcare path.

A non-transitory computer readable medium having instructions stored thereon that, when executed by one or more processors, cause the one or more processors to perform operations comprising:

• receiving, from a remote device, eligibility data for the patient, the eligibility data associated with an eligibility check for a first visit between the patient and a healthcare provider;
• retrieving medical claims data from a database comprising information for a plurality of historical medical claims;
• predicting the healthcare path for the patient by aggregating the eligibility data with the medical claims data, wherein the healthcare path comprises one or more predicted subsequent visits and a predicted amount of time until each of the one or more subsequent visits;
• and
• transmitting, to the remote device, an alert comprising the predicted healthcare path.