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 . This is a Non-Final Office Action in response to application 15/962,777 entitled "HEALTH CARE MEDICAL CLAIMS COMPLETE PAYMENT SYSTEM FOR MULTIPLE PAYMENT PROCESSORS" with claim 1 pending.
Status of Claims
Claim 1 has been amended and is hereby entered.
Claim 1 is pending and has been examined.
Response to Amendment
The arguments filed October 16, 2025, has been entered. Claims 1 remain pending in the application. Applicant’s remarks to the Specification, Drawings, and/or Claims have been noted in response to the Non-Final Office Action mailed April 16, 2025.
Information Disclosure Statement
The information disclosure statement (IDS) submitted on April 25, 2018 is in compliance with the provisions of 37 CFR 1.97. Accordingly, the information disclosure statement is being considered by the examiner.
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.
Claim 1 is rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more.
Claim 1 is directed to a system, method, or product program, which are/is one of the statutory categories of invention. (Step 1: YES).
The claimed invention is directed to an abstract idea without significantly more.
Independent Claim 1 recites:
“… method of providing a complete payment of an adjudicated medical claim using a financial interchange system, the complete payment including an insurer portion and an associated patient portion to a medical service provider comprising: …
a) a complete payment financial interchange system operatively associated with a plurality of independent health insurance payment processing systems, the complete payment financial interchange system independently electronically receiving from each of the plurality of independent health insurance payment processing systems an insurer's data and the insurer's portion of funds from the insurer's funding sources and the complete payment financial interchange system electronically receiving a patient's portion of funds from a patient funding source distinct from the insurer's funding source associated with an adjudicated medical insurance claim for a medical service provider associated with one of the plurality of independent health insurance payment processing systems, each of the independent health insurance payment processing systems configured to process medical claim payments and associated EOBs (Explanation of Benefits) to a plurality of medical service providers for a distinct group of insurers;
b) the complete payment financial interchange system electronically transferring a single complete payment to the medical service provider, the single complete payment including a discounted payment amount relative to a total amount associated with the adjudicated medical insurance claim, the total amount including the insurer's portion of funds and the patient portion of funds;
c) the complete payment financial interchange system funding a patient reserve trust to guarantee the patient's portion of the adjudicated medical insurance claim transferred from the patient funding source, the patient reserve trust operatively associated with funding and guaranteeing the patient portion of funds associated with a plurality of adjudicated medical insurance claims processed by the plurality of health insurance payment processing systems; and
d) after electronically transferring a single complete payment to the medical service provider, the complete payment financial interchange system managing a collection of the patient portion of the funds from the patient and electronically transferring the collected funds to the patient funding source, and the complete payment financial interchange system transferring funds from the patient reserve trust to the patient funding source if the collection of the patient portion of the funds from the patient is unsuccessful.”
These limitations clearly relate to managing transactions/interactions between a customer (patient), insurer, and/or service provider. These limitations, under their broadest reasonable interpretation, cover performance of the limitation as certain methods of organizing human activity. Specific instances include instructing to obtain a credit plan or authorizing payment recite a fundamental economic principles or practice and/or commercial or legal interactions. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation as a fundamental economic, commercial, or financial action, principle, or practice then it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea. (Step 2A-Prong 1: YES. The claims recite an abstract idea).
This judicial exception is not integrated into a practical application. In particular, the claims recite the additional elements of:
“one or more processors”, “computer implemented”: merely applying computer processing, storage, and networking technology as tools to perform an abstract idea
is recited at a high-level of generality (i.e., as a generic processor performing a generic computer function) such that it amounts no more than mere instructions to apply the exception using a generic computer components and/or electronic processes. The Specification merely states, [0013] “a computer implemented method…using one or more processors” Accordingly, these additional elements, when considered separately and as an ordered combination, do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea and are at a high level of generality. Therefore, Claim 1 is directed to an abstract idea without a practical application. (Step 2A-Prong 2: NO. The additional claimed elements are not integrated into a practical application)
The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception because, when considered separately and as an ordered combination, they do not add significantly more (also known as an “inventive concept”) to the exception. As discussed above with respect to integration of the abstract idea into a practical application, the additional element of using a computer hardware amounts to no more than mere instructions to apply the exception using a generic computer component. The Specification merely states, [0013] “a computer implemented method…using one or more processors” Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. Accordingly, these additional elements, do not change the outcome of the analysis, when considered separately and as an ordered combination. Thus, Claim 1 is not patent eligible. (Step 2B: NO. The claims do not provide significantly more)
Claim Rejections - 35 USC § 103
In the event the determination of the status of the application as subject to AIA 35 U.S.C. 102 and 103 (or as subject to pre-AIA 35 U.S.C. 102 and 103) is incorrect, any correction of the statutory basis for the rejection will not be considered a new ground of rejection if the prior art relied upon, and the rationale supporting the rejection, would be the same under either status.
This application currently names joint inventors. In considering patentability of the claims the examiner presumes that the subject matter of the various claims was commonly owned as of the effective filing date of the claimed invention(s) absent any evidence to the contrary. Applicant is advised of the obligation under 37 CFR 1.56 to point out the inventor and effective filing dates of each claim that was not commonly owned as of the effective filing date of the later invention in order for the examiner to consider the applicability of 35 U.S.C. 102(b)(2)(C) for any potential 35 U.S.C. 102(a)(2) prior art against the later invention.
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.
Claim 1 is rejected under 35 U.S.C. 103 as being unpatentable over Lefco ("SYSTEM AND METHOD FOR MANAGING PAYMENTS FOR HEALTH CARE SERVICES", U.S. Patent Number: US7769604 B1), in view of Yang (“HEALTHCARE SYSTEM INTEGRATED WITH A HEALTHCARE TRANSACTION PROCESSOR, AND METHOD FOR PROVIDING HEALTHCARE TRANSACTION PROCESSING SERVICES”, U.S. Publication Number: 20050033609 A1).
Regarding Claim 1,
Lefco teaches,
computer implemented method of providing a complete payment (Lefco [Col 1, Lines 14-15] The present invention relates generally to systems and methods for managing payments for health care services. / Lefco [Col 2, Lines 48-53] the payment services system 100 is implemented in a computer system 900 that comprises the individual computers systems of the entities 110-190 connected through a communication network 197, such as the Internet)
of an adjudicated medical claim (Lefco [Col 1, Lines 49-54] Following repricing, the third party administrator adjudicates the bill in accordance with the terms of the applicable health care benefit plan. Adjudication includes a determination of the allocation of responsibility for payment of the bill as between the employer organization and the health care benefit plan participant.)
using a financial interchange system,
(Lefco [Col 4, Lines 49-53] comprises the individual computers systems of the entities 110-190 connected through a communication network 197, such as the Internet
Lefco [Col 10, Lines 56-58] the operations described herein as being performed by entities 110-190 may in practice be performed by the computer systems
Lefco [Col 4, Lines 27-31] The trustee 180 and the treasury manager 190 may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on). As will be appreciated, system 100 may include fewer or additional entities.
Lefco [Col 1, Lines 14-15] systems... for managing payments for health care services.
Lefco [Col 10, Lines 58-60] computer systems 910-990 associated with each of the respective entities 110-190. )
the complete payment including an insurer portion and an associated patient portion to a medical service provider
(Lefco [Col 4, Lines 39-47] the operations performed by payment services system 100 may also be performed by one or more of the health care providers... the payment services system 100 may be used in connection with other types of plans, including insured health benefit plans.
Lefco [Col 10, Lines 63-67] health care provider computer systems 920 may have bill generation...to generate bills and track payment of the bills.
Lefco [Col 1, Lines 19-24] For example, health care providers may contract with multiple health care network provider organizations such as preferred provider organizations (PPOs), health management organizations (HMOs), managed care organizations, insurers, or point-of-service plan providers.
Lefco [Col 1, Lines 38-40] The relationship between the network provider organization, the provider, the participant and the employer is defined by various agreements. )
comprising: using one or more processors: (Lefco [Col 12, Lines 41-45] The embodiments of the present invention may be implemented using an existing computer processor, or by a special purpose computer processor incorporated for this or another purpose, or by a hardwired system.)
a) a complete payment financial interchange system operatively associated with a plurality of independent health insurance payment processing systems
(Lefco [Col 3, Lines 27-36] In another exemplary embodiment, a system is configured to receive billing information from a plurality of different health care providers. The billing information relates to health care services provided to a participant. The system is further configured to combine the billing information from the plurality of different health care providers into a master bill to be sent to the participant. The master bill contains billing information for the plurality of different health care providers.
Lefco [Col 2, Lines 20-21] The receipt of bills from unknown entities, the receipt of multiple billing invoices from multiple providers
the complete payment financial interchange system
(Lefco [Col 4, Lines 16-24] an exemplary payment services system 100 ...The payment services system 100 interfaces... to promptly issue payment )
independent…processing systems:
Lefco [Col 2, Line 13] independent billing and collection services
Lefco [Col 4, Lines 49-51] comprises the individual computers systems of the entities 110-190 connected through a communication network
Lefco [Col 4, Lines 39-42] the operations performed by payment services system 100 may also be performed by one or more of the health care providers 120 and/or by one or more of the employer organizations
Lefco [Col 10, Lines 37-43] the health care providers 120, the employer organizations 140, the network provider organizations 150, the payment services manager 160, the third party administrator 170, the trustee 180, and the treasury manager 190 may each have respective computer systems 915-990 (e.g., including one or more servers and one or more user computers))
independently electronically receiving from each of the plurality of independent health insurance payment processing systems an insurer's data,
(Lefco [Figure 1] Element 100 is “the complete payment financial interchange system”, while Element 195 represents “plurality of independent health insurance payment processing systems”:
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Lefco [Col 4, Lines 28-30] may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on)
Lefco [Col 8, Lines 59-60] the financial institution 195 (e.g., the trustee 180 and/or the treasury manager 190)
Lefco [Col 9, Lines 3-4] programs maintained by the state or federal government, such as Medicare and Medicaid
Lefco [Col 4, Lines 49-51] comprises the individual computers systems of the entities 110-190 connected through a communication network
Lefco [Col 10, Lines 47-55] In another exemplary embodiment, an identification card (e.g., a smart card or other credit card-sized device) which has patient information stored in a computer accessible medium is employed with the payment services system. The card may store information concerning patient care, insurance, health history, and so on. The card may be utilized in conjunction with the health care provider's data management system to streamline the process of transferring information between the participant and provider.)
the insurer's portion of funds from the insurer's funding sources
(Lefco [Col 7, Lines 45-46] an insurance company provides trustee services
Lefco [Col 4, Lines 27-30] The trustee 180 and the treasury manager 190 may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on).
Lefco [Col 6, Lunes 21-23] The payment services manager 160 coordinates payment of the claim through the financial institution 195, which serves as the trustee 180
Lefco [Col 7, Lines 17-20] The trustee 180 moves amounts to the disbursement account 440 to fund the employer portion 330 and participant portion 340 of the claim.
Lefco [Col 6, Line 27] a disbursement account 440)
and the complete payment financial interchange system electronically receiving a patient's portion of funds from a patient funding source …. associated with an adjudicated medical insurance claim for a medical service provider associated with one of the plurality of independent health insurance payment processing systems;
(Lefco [Col 4, Lines 18-24] The payment services system 100 interfaces with a health care participant 110 (e.g., a patient)...to promptly issue payment to the health care providers 120 for health care services rendered to the health care participant
Lefco [Col 1, Lines 49-54] Following repricing, the third party administrator adjudicates the bill in accordance with the terms of the applicable health care benefit plan. Adjudication includes a determination of the allocation of responsibility for payment of the bill as between the employer organization and the health care benefit plan participant.
Lefco [Col 4, Lines 49-51] comprises the individual computers systems of the entities 110-190 connected through a communication network
Lefco [Col 8, Lines 19-22] As indicated previously, the participant portion 340 of claims is initially paid using funds from the employer deposit account 420 for the respective employer 140 of that participant 110.)
each of the independent health insurance payment processing systems configured to process medical claim payments and associated EOBs (Explanation of Benefits) to a plurality of medical service provider for a distinct group of insurers;
(Lefco [Col 4, Lines 39-43] operations performed by payment services system 100 may also be performed by one or more of the health care providers 120 and/or by one or more of the employer organizations
Lefco [Col 4, Lines 30-54] “As will be appreciated, system 100 may include fewer or additional entities. For example, a network provider organization 150 may be included. Also, as will be appreciated, although various operations are described as being performed by different respective entities, the various operations may be performed by any combination of entities which each perform one or more of the operations described herein, … it will be appreciated that the payment services system 100 may be used in connection with other types of plans, including insured health benefit plans. In an exemplary embodiment, the payment services system 100 is implemented in a computer system 900 that comprises the individual computers systems of the entities 110-190 connected through a communication network 197, such as the Internet
Lefco [Col 10, Lines 56-62] “As may be appreciated, the operations described herein as being performed by entities 110-190 may in practice be performed by the computer systems 910-990 associated with each of the respective entities 110-190. That is, each of the computer systems 910-990 may include program logic 915-995 configured to perform the operations described herein as being performed by entities 110-190.”
Lefco [Col 2, Lines 24-28] As a part of the claims adjudication process, a considerable number of mailings are sent to the participant (e.g., statements of billed charges, multiple explanations of benefits...).
Lefco [Col 3, Lines 65-68] FIG. 8 is a block diagram illustrating the statement with itemized explanation of benefits, according to an exemplary embodiment.
Lefco [Col 9, Lines 30-36] The statement 800 may include an itemized explanation of benefits 810 including a line item listing 820 of health care service provided by various providers
Lefco [Col 4, Lines 28-30] implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on).
Lefco [Col 7, Lines 41-46] financial institution that provides trustee services … an insurance company provides trustee services )
b) the complete financial payment interchange system electronically transferring a single complete payment to the medical service provider,
(Lefco [Col 4, Lines 18-24] The payment services system 100 interfaces with a health care participant 110 (e.g., a patient)...to promptly issue payment to the health care providers 120 for health care services rendered to the health care participant 110. / Lefco [Col 1, Lines 49-54] Following repricing, the third party administrator adjudicates the bill in accordance with the terms of the applicable health care benefit plan. Adjudication includes a determination of the allocation of responsibility for payment of the bill as between the employer organization and the health care benefit plan participant./ Lefco [Col 6, Lines 55-58] Both the employer portion and the employee portion of the claim are remitted to the provider in a single combined payment through the payment services manager 160. )
the single complete payment (Lefco [Col 6, Lines 55-58] Both the employer portion and the employee portion of the claim are remitted to the provider in a single combined payment through the payment services manager 160. / Lefco [Col 6, Lines 62-64] Therefore, the provider 120 may receive both the employer portion 330 and participant portion 340 of the claim 320 in a single payment.)
including a discounted payment amount relative to a total amount associated with the adjudicated medical insurance claim;
(Lefco [Col 5, Lines 3-6] At step 230, the third party administrator 170 may re-price and adjudicate the billable charge, e.g., by discounting the billable charge under a prior agreement with the health care provider 120.)
the total amount
(Lefco [Col 7, Lines 20-22] For example, each week the payment services manager 160 may provide the trustee 180 with the total amount for the claims to be paid
Lefco [Col 11, Lines 55-58] The payment services manager 160 may notify (e.g., throughout the fiscal calendar) the trustee 180 of running totals on the employer reserve account 910 and the disbursement account 440.)
c) the complete payment financial interchange system funding a patient reserve trust
(Lefco [Col 5, Lines 46-49] employer organization 140 maintains an employer deposit account 410 and an employer reserve account 420 with the financial institution 195 that serves as the trustee 180 and the treasury manager 190. / Lefco [Col 6, Lines 45-53] The employer reserve account 420, which may also comprise separate respective sub-accounts for each employer, is used to receive and hold a reserve of funds for the payment of the participant portion 340 of claims from the health care providers 120. In an exemplary embodiment, the employer deposit account 420 holds a reserve amount of funds (e.g., two weeks worth of payments) which is used on an interim basis to pay the participant portion 340 of claims from the health care providers 120.)
the patient reserve trust operatively associated with funding and guaranteeing the patient portion of funds associated with a plurality of adjudicated medical insurance claims processed by the plurality of health insurance payment processing systems.
(Lefco [Col 4, Lines 28-30] The trustee 180 and the treasury manager 190 may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on). / Lefco [Col 6, Lines 22-27] The payment services manager 160 coordinates payment of the claim through the financial institution 195, which serves as the trustee 180 and the treasury manager 190. To this end, a plurality of accounts are used including an employer deposit account 410, an employer reserve account 420, a claim payment account 430, a disbursement account 440, and provider deposit accounts 450. / Lefco [Col 6, Lines 33-44] the third party administrator 170 may notify each employer of the amount of claims to be funded for the upcoming week and may notify the trustee 180 of all expected wire transfers by employer and relevant amounts. Each employer organization 140 may then transfer funds into its respective claim payment account 430, and the trustee 180 may notify the payment services manager 160 of the funds transfers received by employer organization and amount. The funds may be directly transferred into the claim payment account 430. Subsequently, these funds may be transferred to the disbursement account 440 for payment of the employer portion of the health care claims. / Lefco [Col 7, Lines 18-20] The trustee 180 moves amounts to the disbursement account 440 to fund the employer portion 330 and participant portion 340 of the claim.)
and d) after electronically transferring a single complete payment to the medical service provider, the complete payment financial interchange system managing a collection of the patient portion of the funds from the patient and electronically transferring the collected funds to the patient funding source,
(Lefco [Col 12, Lines 7-13] The trustee 180 may deliver to the payment services manager 160 an electronic report of all amounts received in the lock box account. The trustee 180 and the payment services manager 160 may issue an electronic report of all debits and credits to each employer reserve account.
Lefco [Col 10, Lines 4-8] The master bill 800 may include a summary of account activity listing all previous balances, payments and additional chargers and/or new patient responsibilities.
Lefco [Col 8, Lines 19-22] As indicated previously, the participant portion 340 of claims is initially paid using funds from the employer deposit account 420 for the respective employer 140 of that participant 110.
Lefco [Col 7, Lines 27-30] The provider deposit account 450, or health care provider's account, receives payments from the payment services system 100.)
Lefco does not teach the insurer's portion of funds; from the insurer's funding source; and patient's portion of funds from a patient funding source distinct from the insurer's funding source; including the insurer's portion of funds and the patient portion of funds; to guarantee the patient's portion of the adjudicated medical insurance claim; transferred from the patient funding source; if the collection of the patient portion of the funds from the patient is unsuccessful.
Yang teaches,
the insurer's portion of funds; from the insurer's funding source; including the insurer's portion of funds
(Yang [Abstract] the payments for the payer-responsible portion of such charges by the healthcare payer
Yang [0004] one or more healthcare payers (e.g., the insurance companies, state/federal funded healthcare systems, or self-insured employers), ...to determine the amount that the payer is responsible for (i.e., the payer-responsible portion)
Yang [0067] funded through a credit card network, e.g., a bank …that is capable of issuing credit/debit cards and handling credit/debit transactions.)
and patient's portion of funds from a patient funding source distinct from the insurer's funding source; and the patient portion of funds; transferred from the patient funding source;
(Yang [Abstract] paying for the patient-responsible portion of the healthcare charges
Yang [0004] determine...the amount that the patient is responsible for (i.e., the patient-responsible portion).
Yang [0009] The Patient Easy Pay Consent form proposed by VISA® allows the healthcare provider to capture credit card information and to request written authorize from the patient for subsequent charge of the VISA® card for the patient-responsible portion of the healthcare expenses at the point of service. After adjudication, the healthcare provider uses the captured credit card information to obtain payments from VISA® for the patient-responsible portion of the healthcare expenses.
Yang [0067] funded through a credit card network, e.g., ... other financial institution that is capable of issuing credit/debit cards and handling credit/debit transactions)
to guarantee the patient's portion of the adjudicated medical insurance claim;
(Yang [0015] can effectively guarantee payments for the patient-responsible portion of the healthcare expenses)
if the collection of the patient portion of the funds from the patient is unsuccessful.
(Yang [0010] because the credit card company automatically denies the charge if it causes the account balance for the credit/debit cards to exceed the maximum credit limit
Yang [0004] a claim payment advice (CPA) that summarizes the adjudication results and pays the payer-responsible portion of the charges)
It is prima facie obvious to one of ordinary skill in the art before the effective filing date of the claimed invention to have modified the health care payments of Lefco to incorporate the healthcare transaction processing of Yang “for reviewing and processing healthcare charge statements from the healthcare providers and claim payment statements from the healthcare payers, paying for the patient-responsible portion of the healthcare charges, and providing to the patients consolidated healthcare transaction statements.” (Yang [Abstract]). The modification would have been obvious, because it is merely applying a known technique (i.e. healthcare transaction processing) to a known concept (i.e. health care payments) ready for improvement to yield predictable result (i.e. “to provide a healthcare system that does not require real time adjudication, but can effectively guarantee payments for the patient-responsible portion of the healthcare expenses, so as to reduce the administrative costs for the healthcare provider associated with collecting such payments from individual patients” Yang [0015])
Response to Remarks
Applicant's arguments filed on October 16, 2025, have been fully considered and Examiner’s remarks to Applicant’s amendments follow.
Response Remarks on Claim Rejections - 35 USC § 101
The Applicant states:
“In other words, the claim recites a computer implemented method of using a financial interchange system to electronical transfer a single complete payment, as claimed, NOT simply organizing human activity… This process of using a complete payment interchange system to provide a complete payment to a medical service provider, including a patient's responsibility of the medical claim, …. provides an improvement over prior systems including the availability of multiple independent health payment processing systems… to provide complete payments of an insured claim… to a medical service provider without any financial risk to the health payment processing systems."
Examiner responds:
To electronically “transfer a single complete payment… to provide a complete payment to a medical service provider, including a patient's responsibility of the medical claim… to provide complete payments of an insured claim… to a medical service provider without any financial risk to the health payment processing systems” recites a fundamental economic principles or practice and/or commercial or legal interactions. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation as a fundamental economic, commercial, or financial action, principle, or practice then it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas.
An additional element is a technical component. The Applicant’s alleged additional element “to provide complete payments of an insured claim… to a medical service provider without any financial risk to the health payment processing systems” is not a technological component but rather a furtherance of the abstract idea.
An abstract idea cannot integrate another abstract idea into a practical application.
The Applicant’s claims do not require a particular machine, effect a physical transformation, or apply an abstract idea in some meaningful way beyond generally linking the use of the abstract idea to a computer environment.
The focus of the claims is not on such an improvement in computers as tools, but on certain independently abstract ideas that use computers as tools. The claims at issue do not require any nonconventional computer, network, or display components, or even a “non-conventional and non-generic arrangement of known, conventional pieces,” but merely call for performance of the claimed information collection, analysis, and display functions on a set of generic computer components and display devices. Nothing in the claims, understood in light of the specification, requires anything other than off-the-shelf, conventional computer, network, and display technology for gathering, sending, and presenting the desired information. The Specification only requires [0013] “a computer implemented method…using one or more processors”
The issue solved by the Applicant’s invention is a business problem not a technology problem. Computer are only used as a tool to automate a process that can be performed by humans. The computer only performs transmitting of data over network, receiving/processing/storing data, and performing calculation (manipulating data based on model/algorithm). Covered by MPEP 2106.5(d). The data conversion here is not converting a data format unique to certain machine into a standardized format. The format of the data remains the same.
The gathering, sharing, and manipulation of data amounts to Insignificant Extra-Solution Activity [MPEP 2106.05(g)], Mere Data Gathering [Obtaining information about transactions using the Internet to verify credit card transactions, CyberSource v. Retail Decisions, Inc., 654 F.3d 1366, 1375, 99 USPQ2d 1690, 1694 (Fed. Cir. 2011)], and Selecting A Particular Data Source or Type Of Data To Be Manipulated [Selecting information, based on types of information and availability of information in a power-grid environment, for collection, analysis and display, Electric Power Group, LLC v. Alstom S.A., 830 F.3d 1350, 1354-55, 119 USPQ2d 1739, 1742 (Fed. Cir. 2016)]
Therefore, the rejection under 35 USC § 101 remains.
Response Remarks on Claim Rejections - 35 USC § 103
Applicant's arguments facilitated the application of NO new/additional prior art.
Lefco teaches the amended claim limitations:
the complete payment financial interchange system
Lefco [Col 4, Lines 16-24] an exemplary payment services system 100 ...The payment services system 100 interfaces... to promptly issue payment
from each of the plurality of independent health insurance payment processing systems
Lefco [Figure 1] Element 100 is “the complete payment financial interchange system”, while Element 195 represents “a plurality of health insurance payment processing systems”:
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Lefco [Col 4, Lines 28-30] may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on)
Lefco [Col 8, Lines 59-60] the financial institution 195 (e.g., the trustee 180 and/or the treasury manager 190)
Lefco [Col 10, Lines 39-44] the payment services manager 160, the third party administrator 170, the trustee 180, and the treasury manager 190 may each have respective computer systems 915-990 (e.g., including one or more servers and one or more user computers) that are interconnected through a communication network
Lefco [Col 9, Lines 3-4] programs maintained by the state or federal government, such as Medicare and Medicaid
The Applicant states:
“the claimed subject matter is distinguishable from Lefco et al. and includes the use of a complete payment financial interchange system … operatively associated with a plurality of health insurance payment processing systems "
Examiner responds:
Lefco teaches that a payment processing system operatively associated with a plurality of health insurance payment processing systems:
Lefco [Figure 1] Element 100 is “the complete payment financial interchange system”, while Element 195 represents “a plurality of health insurance payment processing systems”:
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Lefco [Col 4, Lines 28-30] may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on)
Lefco [Col 8, Lines 59-60] the financial institution 195 (e.g., the trustee 180 and/or the treasury manager 190)
Lefco [Col 9, Lines 3-4] programs maintained by the state or federal government, such as Medicare and Medicaid
The Applicant states:
“In other words, Lefco et al. does not disclose a single health payment processing system operatively associated operatively associated with a plurality of health insurance payment processing systems to provide a complete payment of an adjudicated medical claim, each of the health insurance payment processing systems configured to process medical claim payments and associated EOBs (Explanation of Benefits) to a plurality of medical service providers for a distinct group of insurers;… the claimed subject matter is distinguishable from Yang and includes the use of a complete payment financial interchange system operatively associated operatively associated with a plurality of health insurance payment processing systems"
Examiner responds:
The combination of references teach:
Lefco [Figure 1] Element 100 is “the complete payment financial interchange system”, while Element 195 represents “plurality of independent health insurance payment processing systems”:
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Lefco [Col 4, Lines 28-30] may, for example, be implemented by a financial institution 195 (e.g., an FDIC insured bank, insurance company, and so on)
Lefco [Col 8, Lines 59-60] the financial institution 195 (e.g., the trustee 180 and/or the treasury manager 190)
Lefco [Col 9, Lines 3-4] programs maintained by the state or federal government, such as Medicare and Medicaid
“a single health payment processing system”:
Lefco [Abstract] A health care claim payment system [singular]
Lefco [Col 4, Lines 39-42] the operations performed by payment services system [singular] may also be performed by one or more of the health care providers 120 and/or by one or more of the employer organizations
“operatively associated with a plurality of health insurance payment processing systems to provide a complete payment of an adjudicated medical claim”:
Lefco [Col 4, Lines 39-42] the operations performed by payment services system 100 may also be performed by one or more of the health care providers 120 and/or by one or more of the employer organizations
Lefco [Col 4, Lines 49-51] comprises the individual computers systems of the entities 110-190 connected through a communication network
Lefco [Col 10, Lines 37-43] the health care providers 120, the employer organizations 140, the network provider organizations 150, the payment services manager 160, the third party administrator 170, the trustee 180, and the treasury manager 190 may each have respective computer systems 915-990 (e.g., including one or more servers and one or more user computers)
Lefco [Col 2, Lines 48-53] the payment services system 100 is implemented in a computer system 900 that comprises the individual computers systems of the entities 110-190 connected through a communication network 197, such as the Internet
Lefco [Col 3, Lines 27-36] a system is configured to receive billing information from a plurality of different health care providers. The billing information relates to health care services provided to a participant. The system is further configured to combine the billing information from the plurality of different health care providers into a master bill to be sent to the participant. The master bill contains billing information for the plurality of different health care providers.
Lefco [Col 2, Lines 24-28] As a part of the claims adjudication process, a considerable number of mailings are sent to the participant (e.g., statements of billed charges, multiple explanations of benefits...).
Therefore, a rejection under 35 USC § 103 remains.
Prior Art Cited But Not Applied
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure:
Davis (“MEDICAL CLAIMS PAYMENT SYSTEM WITH PAYMENT CONSOLIDATION FROM MULTIPLE EMPLOYER ACCOUNTS”, U.S. Publication Number: 2014/0088999 A1) proposes receiving payments for medical insurance claims and an explanation of the medical services of multiple medical service providers against which parts of the payment are to be applied and explanations of amounts due by individual patients.
Lash (“INTEGRATED HEALTH AND FINANCIAL BENEFITS SYSTEM AND METHOD”, U.S. Publication Number: 2012/0303379 A1) provides a medical shared savings unit that divides a savings fund between the insurer and the employer based on a medical savings plan model when the patient undergoes the medical procedure.
Koziol (“INSURANCE TRANSACTION SYSTEM AND METHOD”, U.S. Patent: 8566128 B2) proposes a system and method of creating insurance with a switching device that limits the liability of the insurer.
Frank (“METHOD AND APPARATUS FOR HEALTHCARE FUNDING EXCHANGE”, U.S. Publication Number: 2010/0211416 A1) provides a Healthcare Funding Exchange ("HFX") is implemented as a business service domain of service components communicating with each other wherein the execution of a complete interaction with an external actor is affected by the combined performance of executions by the service components.
Conclusion
Applicant's amendment necessitated the new ground(s) of rejection presented in this Office action. Accordingly, THIS ACTION IS MADE FINAL. See MPEP § 706.07(a). Applicant is reminded of the extension of time policy as set forth in 37 CFR 1.136(a). A shortened statutory period for reply to this final action is set to expire THREE MONTHS from the mailing date of this action. In the event a first reply is filed within TWO MONTHS of the mailing date of this final action and the advisory action is not mailed until after the end of the THREE-MONTH shortened statutory period, then the shortened statutory period will expire on the date the advisory action is mailed, and any extension fee pursuant to 37 CFR 1.136(a) will be calculated from the mailing date of the advisory action. In no event, however, will the statutory period for reply expire later than SIX MONTHS from the date of this final action.
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/C.E./Examiner, Art Unit 3695
/CHRISTINE M Tran/Supervisory Patent Examiner, Art Unit 3695