Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Status of Claims
This office action for application 14/838342 is in response to the communications filed July 24, 2025.
Claims 1, 2, 6-11, 21, 22, 25-27 and 29 were amended July 24, 2025.
Claim 31 was cancelled July 24, 2025.
Claim 32 was added as new July 24, 2025.
Claims 1-4, 6-12, 21-30 and 32 are currently pending and considered below.
Claim Rejections - 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1-4, 6-12, 21-30 and 32 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e., a law of nature, a natural phenomenon, or an abstract idea) without significantly more.
As per claim 1,
Step 1: The claim recites subject matter within a statutory category as a process.
Step 2A is a two-prong inquiry, in which Prong 1 determines whether a claim recites a judicial exception. Prong 2 determines if the additional limitations of the claim integrates the recited judicial exception into a practical application. If the additional elements of the claim fail to integrate the judicial exception into a practical application, claim is directed to the recited judicial exception, see MPEP 2106.04(II)(A).
Step 2A Prong 1: The claim recites subject matter that is directed to an abstract idea, law of nature, or natural phenomenon with the steps of a method of providing verification that transportation services have been provided from a residence of a patient to a medical treatment facility, comprising: identifying a patient who has been directed to receive a series of multiple scheduled medical treatments on multiple different days and for which a medical organization will provide compensation for non-emergent transportation services to the patient on multiple different days according to a schedule that sets the scheduled medical treatments and associating the multiple scheduled medical treatments with a transaction identifier that identifies the patient and the multiple scheduled medical treatments, receiving a data request on the is associated with the transaction identifier and corresponds to a provider of transportation services that has previously received pre-authorization to provide non-emergent transportation of the patient for the one or more of the series of scheduled medical treatments on the multiple different days, tracking locations of vehicles or workers for the provider of transportation services, and comparing the tracked locations to which the patient is to be transported by the provider of transportation services under the pre-authorization and according to times in the schedule that are associated with the transaction identifier, wherein the locations to which the patient is to be transported define a round-trip from the patient’s residence to a treatment facility for the multiple scheduled treatments at to the patient’s residence, using tracked locations and locations for the scheduled medical treatments to confirm whether the provider of transportation services actually provide the non-emergent transportation of the patient to and from the medical treatment facility before and after treatment of the patient, and generating an indication, associated with the transaction identifier and based on the confirming that the provider of transportation services actually provided the non-emergent transportation, that indicates whether a claim for compensation by the provider of transportation services is a compliant claim for services requested of the provider of transportation services, that the provider of transportation services actually provided. These steps, as drafted, under the broadest reasonable interpretation are directed to:
certain methods of organizing human activity (e.g., fundamental economic principles or practices including: hedging; insurance; mitigating risk; etc., commercial or legal interactions including: agreements in the form of contracts; legal obligations; advertising, marketing or sales activities or behaviors; business relations; etc., managing personal behavior or relationships or interactions between people including: social activities; teaching; following rules or instructions; etc.) but for recitation of generic computer components. That is, other than reciting steps as performed by the generic computer components, nothing in the claim element precludes the step from being directed to certain methods of organizing human activity. For example, but for the additional element(s), the identified abstract idea, law of nature, or natural phenomenon identified above, in the context of this claim, encompasses a certain method of organizing human activity, namely managing personal behavior or relationships or interactions between people. This is because the identified abstract idea recites a list of rules or instructions that a human person can follow in the course of their personal behavior. If a claim limitation, under its broadest reasonable interpretation, covers at least the recited methods of organizing human activity above, but for the recitation of generic computer components, then it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea. See MPEP 2106.04(a).
Step 2A Prong 2: The claim does not recite additional elements that integrate the judicial exception into a practical application. In particular, the additional elements do not integrate the abstract idea into a practical application, other than the abstract idea per se, because the additional elements amount to no more than limitations which:
amount to mere instructions to apply an exception, see MPEP 2106.05(f), such as:
“computer-implemented”, “from a device”, “electronically”, “electronic” and “wherein the identifying, receiving, tracking, generating … are performed by a computer-based verification system operated by a third-party verification organization that is different than the provider of transportation services and the medical organization that will provide compensation, and that provides verification to the medical organization that will provide compensation using the electronic indication” which corresponds to merely using a computer as a tool to perform an abstract idea. Paragraph [0063] describes that the system 500 can be used for the operations described in association with any of the computer-implement methods described previously, according to one implementation. The system 500 is intended to include various forms of digital computers, such as laptops, desktops, workstations, personal digital assistants, servers, blade servers, mainframes, and other appropriate computers. This constitutes a generic computer. Implementing an abstract idea on a generic computer, does not integrate the abstract idea into a practical application in Step 2A Prong Two or add significantly more in Step 2B, similar to how the recitation of the computer in the claim in Alice amounted to mere instructions to apply the abstract idea of intermediated settlement on a generic computer.
add insignificant extra-solution activity to the abstract idea, see MPEP 2106.05(g), such as:
“transmitting the generated electronic indication in an encrypted form to the medical organization that will provide compensation for non-emergent transportation services to cause compensation by the medical organization to the provider of transportation services” and “and transmitting” which corresponds to mere data gathering and/or output.
Accordingly, this claim is directed to an abstract idea.
Step 2B: The claim does not recite additional elements that amount to significantly more than the judicial exception. As discussed above with respect to discussion of integration of the abstract idea into a practical application, the additional elements amount to no more than mere instructions to apply an exception, add insignificant extra-solution activity to the abstract idea, and/or generally link the abstract idea to a particular technological environment or field of use. Additionally, the additional limitations, other than the abstract idea per se, amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields such as:
computer functions that have been identified by the courts as well‐understood, routine, and conventional functions when they are claimed in a merely generic manner (e.g., at a high level of generality) or as insignificant extra-solution activity, see MPEP 2106.05(d)(II), such as:
“transmitting the generated electronic indication in an encrypted form to the medical organization that will provide compensation for non-emergent transportation services to cause compensation by the medical organization to the provider of transportation services” and “and transmitting” which corresponds to receiving or transmitting data over a network.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 2,
Claim 2 depends from claim 1 and inherits all the limitations of the claim from which it depends. Claim 2 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“further comprising determining distance traveled by the provider of transportation services for use in determining a payment amount” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 3,
Claim 3 depends from claim 1 and inherits all the limitations of the claim from which it depends. Claim 3 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“wherein the identifier is a unique identifier to other identifiers currently in use for identifying other services performed by the provider of transportation services or other service providers, and encodes within the identifier data about the services to be provided by the services to be provided by the service provider” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 4,
Claim 4 depends from claim 1 and inherits all the limitations of the claim from which it depends. Claim 4 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“receiving latitude/longitude data from global positioning system (GPS) systems in a plurality of vehicles on the provider of transportation services, and using the longitude/latitude data to confirm whether the provider of transportation services actually provided the non- emergent transportation” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 6,
Claim 4 depends from claim 1 and inherits all the limitations of the claim from which it depends. Claim 4 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“wherein: the service performed by the provider of transportation services comprises physical transportation of the patient between locations, a pre-authorization is received, before receiving the data request, for transportation services, the preauthorization including data identifying (a) locations at which medical transportation services are to be provided for the patient, and (b) an identifier for the provider of transportation services, and monitored location are compared to the locations at which medical transportation services are to be provided for the patient, to determine whether pre-authorized transportation services were provided by the provider of transportation services for the one or more medical patients” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 7,
Claim 7 depends from claim 6 and inherits all the limitations of the claim from which it depends. Claim 7 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“wherein a single identifier identifies all of a plurality of trips made by the provider of transportation services on behalf of the patient” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 8,
Claim 8 depends from claim 6 and inherits all the limitations of the claim from which it depends. Claim 8 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“wherein confirming whether non-emergent transportation was provided for the patient comprises using data from the pre-authorization to construct a geo-fence around a residence of the patient, and identifying that a vehicle of the provider of transportation services entered the geo-fence” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 9,
Claim 9 depends from claim 8 and inherits all the limitations of the claim from which it depends. Claim 9 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“determining that the vehicle of the provider of transportation services entered a geo-fence established around a treatment center that provides treatment to the patient that was identified in the pre-authorization” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 10,
Claim 10 depends from claim 9 and inherits all the limitations of the claim from which it depends. Claim 10 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“determining whether times when the vehicle entered the geo-fences correspond to a schedule for treatment for the patient that was established using the pre-authorization” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 11,
Claim 11 depends from claim 6 and inherits all the limitations of the claim from which it depends. Claim 11 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“providing, with the electronic data for an organization of a third party payer corresponding to the organization on whose behalf the provider of transportation services provides the non-emergent transportation, information that identifies a distance traveled by a vehicle of the provider of transportation services for the patient” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 12,
Claim 12 depends from claim 11 and inherits all the limitations of the claim from which it depends. Claim 12 merely further defines the abstract idea and/or introduces additional elements that are insufficient to provide a practical application or significantly more:
“generating information that identifies the distance traveled by the vehicle of the provider of transportation services using location reports generated by identifying actual locations of the vehicle” further describes the abstract idea. This claim limitation is still directed to “Certain Methods of Organizing Human Activity” and therefore continues to recite an abstract idea.
Looking at the limitations of the claim as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. Their collective functions merely recite an abstract idea and/or provide conventional computer implementation which does not impose a meaningful limit to integrate the abstract idea into a practical application and/or amount to no more than limitations which amount to elements that have been recognized as well-understood, routine, and conventional activity in particular fields.
As per claim 21,
Claim 21 is substantially similar to claim 1. As such. Claim 21 is rejected for the same reasons indicated in the rejection as claim 1.
As per claim 22,
Claim 22 is substantially similar to claim 2. As such. Claim 22 is rejected for the same reasons indicated in the rejection as claim 2.
As per claim 23,
Claim 23 is substantially similar to claim 3. As such. Claim 23 is rejected for the same reasons indicated in the rejection as claim 3.
As per claim 24,
Claim 24 is substantially similar to claim 4. As such. Claim 24 is rejected for the same reasons indicated in the rejection as claim 4.
As per claim 25,
Claim 25 is substantially similar to claim 6. As such. Claim 25 is rejected for the same reasons indicated in the rejection as claim 6.
As per claim 26,
Claim 26 is substantially similar to claim 7. As such. Claim 26 is rejected for the same reasons indicated in the rejection as claim 7.
As per claim 27,
Claim 27 is substantially similar to claim 8. As such. Claim 27 is rejected for the same reasons indicated in the rejection as claim 8.
As per claim 28,
Claim 28 is substantially similar to claim 9. As such. Claim 28 is rejected for the same reasons indicated in the rejection as claim 9.
As per claim 29,
Claim 29 is substantially similar to claim 11. As such. Claim 29 is rejected for the same reasons indicated in the rejection as claim 11.
As per claim 30,
Claim 30 is substantially similar to claim 12. As such. Claim 30 is rejected for the same reasons indicated in the rejection as claim 12.
As per claim 32,
Claim 32 is substantially similar to claim 1. As such. Claim 32 is rejected for the same reasons indicated in the rejection as claim 1.
Claim Rejections - 35 USC § 103
The following is a quotation of 35 U.S.C. 103 which forms the basis for all obviousness rejections set forth in this Office action:
A patent for a claimed invention may not be obtained, notwithstanding that the claimed invention is not identically disclosed as set forth in section 102, if the differences between the claimed invention and the prior art are such that the claimed invention as a whole would have been obvious before the effective filing date of the claimed invention to a person having ordinary skill in the art to which the claimed invention pertains. Patentability shall not be negated by the manner in which the invention was made.
The factual inquiries set forth in Graham v. John Deere Co., 383 U.S. 1, 148 USPQ 459 (1966), that are applied for establishing a background for determining obviousness under 35 U.S.C. 103 are summarized as follows:
1. Determining the scope and contents of the prior art.
2. Ascertaining the differences between the prior art and the claims at issue.
3. Resolving the level of ordinary skill in the pertinent art.
4. Considering objective evidence present in the application indicating obviousness or nonobviousness.
Claims 1-4, 6, 7, 21-26 and 32 are rejected under 35 U.S.C. 103 as being unpatentable over Adams et al. (US 2013/0185221; herein referred to as Adams) in view of Wyatt (US 2004/0128168).
As per claim 1,
Adams teaches identifying a patient who has have been directed to receive a series of scheduled medical treatments over time for which a medical organization will provide compensation for non-emergent transportation services to the patient on multiple different days according to a schedule that sets the scheduled medical treatments, and associating the multiple scheduled medical treatments with a transaction identifier that identifies the patient and the multiple scheduled medical treatments and receiving a data request from a device that is associated with the transaction identifier that corresponds to a provider of transportation services that has previously received pre-authorization to provide non-emergent transportation of the patient4 for one or more of the scheduled medical treatments on the multiple different days:
(Paragraphs [0003], [0004], [0031], [0035], [0038], [0040] and [0058] of Adams. The teaching describes a system that relates to a non-emergency medical transportation environment wherein respective medical patients, members, are transported to and from their respective medical appointments via a third party transportation provider. In the preferred embodiment, a central brokerage system 10 is utilized wherein the respective member 12 corresponds with the brokerage system identifying the need for transportation services and the brokerage system organizes the appropriate services with a particular transportation provider 14. The third party transportation provider uses a scheduled itinerary to provide multiple trips for multiple patients for each day. The teaching makes it clear that the transportation provider would have a different itinerary for each defined time of use, such as a day, but can reasonably be interpreted as multiple days. Payment for these non-emergency transportation services is to be paid by Medicaid and a patient’s Medicaid ID is logged into the brokerage system. Because the Deficit Reduction Act of 2005 gave States the option to establish a non-emergency medical transportation brokerage program in order to cost-effectively provide transportation for Medicaid beneficiaries and the central brokerage system uses a patient’s Medicaid ID, this is construed as a pre-authorization of the transportation benefit. Because this Medicaid ID is on every request for service, it can reasonably be construed as also a transaction identifier.)
Adams further teaches electronically tracking locations of vehicles or workers for the provider of transportation services, and comparing the tracked locations to locations to which the patient to be transported by the provider of transportation services under the pre-authorization and according to times in the schedule, using the tracked locations and locations for the scheduled medical treatments to confirm whether the provider of transportation services actually provided the non-emergent transportation of the one or more medical patients to locations to which the one or more medical patients were to be transported at times set in the schedule that are associated with the transaction identifier, and using the tracked locations and locations for the scheduled medical treatments to confirm whether the provider of transportation services actually provided the non-emergent transportation of the one or more medical patients to locations to which the one or more medical patients were to be transported at times set in the schedule:
(Paragraphs [0027], [0032] and [0038] of Adams. The teaching describes that geocode information 20 of the location where the transportation provider picks up the respective member is noted by a location determination system such as a gps system associated with the transportation provider as well as the geocode information for the location where the transportation provider drops the member off for the respective appointment. The geocodes of the actual locations of the member pickup and drop off are cross-checked with the respective geocodes of the initial member itinerary. Should a discrepancy exist between the respective geocodes the remittance of funds for the services provided by the transportation provider may be denied. The system provides a mechanism for detecting fraudulent activity and notifying those of that activity. The system has the capability to alert those affected based on a number of predetermined indicators. As shown in FIG. 7, a typical data record would include the member's name, a pickup location which would have an associated geocode and an associated date and time, a drop off location for the appointment which would have an associated geocode and an associated date and time, and a composite itinerary if multiple trip legs are required for this particular visit such as an initial visit to a doctor facility and a subsequent visit to a lab for certain procedures.)
Adams does not explicitly teach wherein the locations to which the patient is to be transported define a round-trip from the patient’s residence to a treatment facility for the multiple scheduled medical treatments and to the patient’s residence or provided the non-emergent transportation of the patient to and from the medical treatment facility before and after treatment of the patient.
However, Adams teaches a transportation itinerary in which multiple locations are planned for the patient to be transported:
(Paragraph [0038] of Adams. As shown in FIG. 7, a typical data record would include the member's name, a pickup location which would have an associated geocode and an associated date and time, a drop off location for the appointment which would have an associated geocode and an associated date and time, and a composite itinerary if multiple trip legs are required for this particular visit such as an initial visit to a doctor facility and a subsequent visit to a lab for certain procedures.)
It would have been obvious to one of ordinary skill in the art before the time of filing that if the system includes a trip with multiple destinations, one of ordinary skill in the art would have added the final leg of the trip to be the return of the patient to the residence. This is a clear and obvious modification based on the teaching of Adams which begs the question of ‘if the itinerary takes the patient to a doctor facility and then to a lab facility, where does the patient go after these appointments?’. The patient is obviously not going to stay at the lab for the rest of their life. It is clear to the Examiner that if the patient is in need of transportation services from their residence to a plurality of locations, they are also need of transportation back home. Accordingly, this is an obvious modification.
Adams does not explicitly teach transmitting the generated electronic indication to the medical organization that will provide compensation for non-emergent transportation services
However, Wyatt teaches transmitting a generated electronic indication in an encrypted form to a medical organization that will provide compensation for non-emergent transportation services to cause compensation by the medical organization to the provider of transportation services:
(Paragraphs [0008], [0010], [0031], [0069], [0071] and [0081]-[0083] of Wyatt. The teaching describes receiving “approval number delivered to the hospital and the healthcare facility via the computer network wherein the approval number is associated with the reimbursement for the transfer of a patient from the hospital to the healthcare facility”. This identifies a patient for which a medical organization, their insurance, will reimburse costs associated with transportation of the patient from one location to another and transmitting this information to the medical organization for compensation. The teaching further describes “healthcare resources 410 may include a transportation resource 416 which may complete the transfer of the patient to the healthcare facility 414 by transporting the patient from the hospital 412 to the healthcare facility 414. The transportation resource 416 may be, for example, an ambulance service and/or another vehicle, such as, for example, an airplane, helicopter, ship or any combination thereof. It should be understood that the system 400 may include more than one hospital 412, healthcare facility 414 and/or transportation resource 416. Moreover, any other type of healthcare facility 414, such as, for example, the continuing care facility and/or transportation resource 416, such as, for example, the ambulance service may be used with the present invention. The present invention should not be deemed as limited to the embodiments of a specific healthcare facility and/or a specific transportation resource”. This identifies that the transportation used may be emergent or non-emergent depending on what the situation may be through the teaching of any transport may be used. When seen in light of the preceding prior art, this transportation is interpreted as non-emergent. Before each patient is transferred, the transfer request to be approved may contain information, such as, for example, medical information, current treatment information and/or treatment need information upon discharge to a healthcare facility. The CMS makes the determination if the healthcare facility is appropriate to transfer the patient to. This is construed as the patient being directed to receive a series of scheduled medical treatments over time as directed by their discharge orders. The CMS knows that these treatments are scheduled because they have to make the determination as to whether the facility can handle the expected treatment of the patient. The agent may receive thousands of the transfer requests per day, which is construed as one or more patients in need of transportation services on multiple different days which have been provided and compensated for by the time the transfer request is approved. The transmission of medical data is transmitted securely over a network which is construed as some form of encrypted transmission.)
It would have been obvious to one of ordinary skill in the art before the time of filing to add to the teaching of Adams, the teachings of Wyatt. Paragraphs [0008]-[0010] of Wyatt describe that the system disclosed improves field of transporting patients from a hospital in such a way that keeps close track of the patient and allows this transfer to be done with the cooperation of the patient’s insurance provider. One of ordinary skill in the art in possession of Adams would have looked to Wyatt to increase its capacity to combat fraud. One of ordinary skill in the art would have added to the teaching of Adams, the teaching of Wyatt based on this incentive without yielding unexpected results.
The combined teaching of Adams and Wyatt would then teach generating an electronic indication, associated with the transaction identifier and based on a confirming that the provider of transportation services actually provided the -nonemergent transportation, that indicates whether a claim for compensation by the provider of transportation services is a compliant claim for services requested of the provider of transportation services, that the services were actually provided, wherein the identifying, receiving, tracking, generating and transmitting are performed by a computer-based verification system operated by a third-party verification organization that is different than the provider of transportation services and the medical organization that will provide compensation, and that provides verification to the medical organization that will provide compensation using the electronic indication:
(Paragraphs [0003], [0004], [0031], [0035], [0038], [0040] and [0058] of Adams. The teaching describes a system that relates to a non-emergency medical transportation environment wherein respective medical patients, members, are transported to and from their respective medical appointments via a third party transportation provider. In the preferred embodiment, a central brokerage system 10 is utilized wherein the respective member 12 corresponds with the brokerage system identifying the need for transportation services and the brokerage system organizes the appropriate services with a particular transportation provider 14. The third party transportation provider uses a scheduled itinerary to provide multiple trips for multiple patients for each day. The teaching makes it clear that the transportation provider would have a different itinerary for each defined time of use, such as a day, but can reasonably be interpreted as multiple days. Payment for these non-emergency transportation services is to be paid by Medicaid and a patient’s Medicaid ID is logged into the brokerage system. Because the Deficit Reduction Act of 2005 gave States the option to establish a non-emergency medical transportation brokerage program in order to cost-effectively provide transportation for Medicaid beneficiaries and the central brokerage system uses a patient’s Medicaid ID, this is construed as a pre-authorization of the transportation benefit.)
(Paragraphs [0027] and [0032] of Adams. The teaching describes that geocode information 20 of the location where the transportation provider picks up the respective member is noted by a location determination system such as a gps system associated with the transportation provider as well as the geocode information for the location where the transportation provider drops the member off for the respective appointment. The geocodes of the actual locations of the member pickup and drop off are cross-checked with the respective geocodes of the initial member itinerary. Should a discrepancy exist between the respective geocodes the remittance of funds for the services provided by the transportation provider may be denied. The system provides a mechanism for detecting fraudulent activity and notifying those of that activity. The system has the capability to alert those affected based on a number of predetermined indicators.)
(Paragraphs [0008], [0010], [0031], [0069], [0071] and [0081]-[0083] of Wyatt. The teaching describes receiving “approval number delivered to the hospital and the healthcare facility via the computer network wherein the approval number is associated with the reimbursement for the transfer of a patient from the hospital to the healthcare facility”. This identifies a patient for which a medical organization, their insurance, will reimburse costs associated with transportation of the patient from one location to another and transmitting this information to the medical organization for compensation. The teaching further describes “healthcare resources 410 may include a transportation resource 416 which may complete the transfer of the patient to the healthcare facility 414 by transporting the patient from the hospital 412 to the healthcare facility 414. The transportation resource 416 may be, for example, an ambulance service and/or another vehicle, such as, for example, an airplane, helicopter, ship or any combination thereof. It should be understood that the system 400 may include more than one hospital 412, healthcare facility 414 and/or transportation resource 416. Moreover, any other type of healthcare facility 414, such as, for example, the continuing care facility and/or transportation resource 416, such as, for example, the ambulance service may be used with the present invention. The present invention should not be deemed as limited to the embodiments of a specific healthcare facility and/or a specific transportation resource”. This identifies that the transportation used may be emergent or non-emergent depending on what the situation may be through the teaching of any transport may be used. When seen in light of the preceding prior art, this transportation is interpreted as non-emergent. Before each patient is transferred, the transfer request to be approved may contain information, such as, for example, medical information, current treatment information and/or treatment need information upon discharge to a healthcare facility. The CMS makes the determination if the healthcare facility is appropriate to transfer the patient to. This is construed as the patient being directed to receive a series of scheduled medical treatments over time as directed by their discharge orders. The CMS knows that these treatments are scheduled because they have to make the determination as to whether the facility can handle the expected treatment of the patient. The agent may receive thousands of the transfer requests per day, which is construed as one or more patients in need of transportation services on multiple different days which have been provided and compensated for by the time the transfer request is approved. The transmission of medical data is transmitted securely over a network which is construed as some form of encrypted transmission.)
Here, the third party organization that is different than the provider of transportation services and the medical organization is the central brokerage system of Adams. Paragraphs [0031]-[0035] of Adams make it clear that the central brokerage system 10 is used for multiple transportation providers, indicating that the system is a third-party system not affiliated with any particular provider. Hence, the identifying, receiving, tracking, generating and transmitting functions would have been carried out by this central broker in the combined teaching of Adams and Wyatt.
As per claim 2,
The combined teaching of Adams and Wyatt teaches the limitations of claim 1.
Adams further teaches determining distance traveled by the provider of transportation services for use in determining a payment amount:
(Paragraph [0037] of Adams. The teaching describes that the provider is identified with specific drivers, vehicles and rates. The rates may be based on mileage, hourly, no shows in addition to ancillary rates.)
As per claim 3,
The combined teaching of Adams and Wyatt teaches the limitations of claim 1.
Adams further teaches wherein the identifier is a unique identifier relative to other identifiers currently in use for identifying other services performed by the service provider or other service providers, and encodes data about the services to be provided by the service provider:
(Paragraphs [0003], [0004], [0031], [0035], [0038], [0040] and [0058] of Adams. The teaching describes a system that relates to a non-emergency medical transportation environment wherein respective medical patients, members, are transported to and from their respective medical appointments via a third party transportation provider. In the preferred embodiment, a central brokerage system 10 is utilized wherein the respective member 12 corresponds with the brokerage system identifying the need for transportation services and the brokerage system organizes the appropriate services with a particular transportation provider 14. The third party transportation provider uses a scheduled itinerary to provide multiple trips for multiple patients for each day. The teaching makes it clear that the transportation provider would have a different itinerary for each defined time of use, such as a day, but can reasonably be interpreted as multiple days. Payment for these non-emergency transportation services is to be paid by Medicaid and a patient’s Medicaid ID is logged into the brokerage system. Because the Deficit Reduction Act of 2005 gave States the option to establish a non-emergency medical transportation brokerage program in order to cost-effectively provide transportation for Medicaid beneficiaries and the central brokerage system uses a patient’s Medicaid ID, this is construed as a pre-authorization of the transportation benefit. The Medicaid ID is construed to be an identifier which is generated as part of a pre-authorization process by the organization who pays for the transportation. The Medicaid ID is a unique ID.)
As per claim 4,
The combined teaching of Adams and Wyatt teaches the limitations of claim 1.
Adams further teaches receiving latitude/longitude data from global positioning system (GPS) systems in a plurality of vehicles of the provider of transportation services, and using the longitude latitude data to confirm whether the provider of transportation services actually provided the non-emergent transportation:
(Paragraphs [0027] [0031] and [0032] of Adams. The teaching describes that geocode information 20 of the location where the transportation provider picks up the respective member is noted by a location determination system such as a gps system associated with the transportation provider as well as the geocode information for the location where the transportation provider drops the member off for the respective appointment. The geocodes of the actual locations of the member pickup and drop off are cross-checked with the respective geocodes of the initial member itinerary. Should a discrepancy exist between the respective geocodes the remittance of funds for the services provided by the transportation provider may be denied. The system provides a mechanism for detecting fraudulent activity and notifying those of that activity. The system has the capability to alert those affected based on a number of predetermined indicators. This geocode information may constitute the longitude, latitude, coordinate reference system, or other geospatial attribute of the locations.)
As per claim 6,
The combined teaching of Adams and Wyatt teaches the limitations of claim 1.
Adams further teaches wherein: the service performed by the provider of transportation services comprises physical transportation of the patient between locations, a pre-authorization is received, before receiving the data request, for transportation services, the pre-authorization including (a) locations at which medical transportation services are to be provided for the patient, and (b) an identifier for the provider of transportation services, and monitored locations are compared to the locations at which medical transportation services are to be provided for the patient, to determine whether pre-authorized transportation services were provided by the provider of transportation services for the one or more medical patients:
(Paragraphs [0003], [0004], [0031], [0035], [0038], [0040] and [0058] of Adams. The teaching describes a system that relates to a non-emergency medical transportation environment wherein respective medical patients, members, are transported to and from their respective medical appointments via a third party transportation provider. In the preferred embodiment, a central brokerage system 10 is utilized wherein the respective member 12 corresponds with the brokerage system identifying the need for transport