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
Claims 1-2, 4-6, 12-13, 20, 22 are pending.
Response to Amendment/Arguments
Applicant’s amendments filed on 11-20-25 has been entered and are addressed below.
Applicant argues that the amended claims does not recite an abstract idea and the instant claim is similar to Example 39. Examiner respectfully disagrees. Unlike Example 39 was specific to the facial images technology, the instant claim uses machine learning models to execute the abstract idea.
Applicant argues that the instant claim improves technical field. Examiner respectfully disagrees. It does not improve the computer technology itself but uses the generic computer components to perform the abstract idea. Retrieving specific protocols and uses it to preform the retrieval of data does not improve the computer itself, rather it just uses the computer to run a specific software.
Applicant argues that the claimed invention reduces memory storage. Examiner respectfully disagrees. It is not unusual to delete files that are not used. Deleting files does not improve the computer technology. It is common to delete files that is unnecessary or redundant in database technology.
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 1-2, 4-6, 12-13, 20, 22 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.
These claims are directed to an abstract idea without significantly more. Step 1 – First, Claims 1-2, 4-6, 12-13, 20, 22 are directed towards a computer implemented-method (i.e. process) which is a statutory category. Claims 12-13, are directed towards a system comprising: one or more processors; and a memory coupled to the one or more processors and comprising computer readable program code embodied in the memory that is executable by the one or more processors to perform operations (i.e. machine) which is also a statutory category. Claim 20 is directed towards a computer program product, comprising: a non-transitory computer readable storage medium comprising computer readable program code embodied in the medium that is executable by a processor to perform operations comprising: (i.e. machine) which is also a statutory category.
Claims 1, 12 and 20 recites: A computer-implemented method, comprising:
receiving, by one or more processors of an intermediary server associated with a clearing house system, a claim associated with a patient from a provider;
automatically determining, by the one or more processors, and a first machine learning model based on data associated with at least one of the claim, the patient or the provider, an indication that that supplemental medical record is needed to adjudicate the claim, wherein the first machine learning model is trained based on adjudication of historical claims to learn associations between procedure codes, provider names, or patient risk adjustment factors in the historical claims and an indication of whether supplemental clinical information was required;
determining, by one or more processors, a set of retrieval protocols associated with the provider the set of retrieval protocols including a Fast Healthcare Interoperability Resources (FHIR) protocol and an Electronic Data Interchange (EDI) format;
automatically retrieving, by the one or more processors from a networked public health information exchange storage device or a networked propriety health information storage device and, and using the set of retrieval protocols medical record associated with the patient responsive to the indication, wherein automatically retrieving the medical record comprises iteratively retrieving portions or an entirety of the medical record from different retrieval protocols of the set of retrieval protocols in an order associated with the set of retrieval protocols until an entirety of the medical record is retrieved by identifying a retrieval protocol of the set of retrieval protocols for each portion of the medical record that results in the fastest overall retrieval of the medical record; and
determining, by the one or more processors and a second machine learning model and based at least in part of the medical record, the claim and any output of the first machine learning model, a portion of the medical record as the supplemental clinical information wherein the second machine learning model is trained using historical medical records along with patient claims having relevant clinical information to learn associations between information in the historical medical records and the relevant clinical information used to supplement the patient claims;
discarding, by the one or more processors a remaining portion of the medical record which is not used as the supplemental clinical information;
automatically generating, by the one or more processors, an enriched claim including the claim and the supplemental clinical information;
transmitting by the one or more processors, the enriched claim the medical record to a payor device so that the payor had immediate access to the supplemental clinical information;
The bolded limitations, under its broadest reasonable interpretation, covers an abstract idea, which includes methods of organizing human activity and mathematical concepts. Any limitations not identified above is part of the abstract idea are deemed “additional elements”, are underlined.
As per Step 2A – Prong 1 of the subject matter eligibility analysis, the claims are directed, in part, to receiving a claim associated with a patient from a provider, automatically determining whether additional clinical information is needed to adjudicate the claim, communicating the claim and the additional clinical information to a payor responsive to determining that the additional clinical information is needed to adjudicate the claim. Furthermore; if a claim limitation, under its broadest reasonable interpretation, covers interactions between people, then it falls within the “certain methods of organizing human activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea.
For the recitation of generic computer components like a processor, a system, these function, when considered as a whole, describe receiving a patient claim from a provider, determining whether additional information is needed for adjudication, retrieve a response, accessing a directory that includes retrieval techniques, and prioritizing the best retrieval technique. Thus, the steps recited in these claims describe managing personal behavior or interactions between, people, for a pharmacist can receive claim adjudication information regarding a patient, determine that additional information is needed regarding the adjudication, and receive additional information regarding the claim by accessing a directory to retrieve public health information using a priority of retrieval techniques.
Furthermore, dependent claims 2, 4-6, 13, 22 include similar limitations. However these claims are directed fundamentally to the same abstract idea as dependent claims 1, 12, and 20.
As per Step 2A – Prong 2 of the of the subject matter eligibility analysis, this judicial exception is not integrated into a practical application because the additional elements “processor”, “a memory coupled to the processor and comprising computer readable program code”, “a non-transitory computer readable storage medium”. These elements amount to no more than the instructions “apply it” with a computer because otherwise-abstract steps of receiving a patient claim from a provider, determining whether additional information is needed for adjudication, retrieve a response, accessing a directory that includes retrieval techniques, and prioritizing the best retrieval technique customer are merely being digitized with computing components recited at a high level of generality. Accordingly, each independent claim as whole is directed to an abstract idea without integration into a practical application. Applicant’s disclosure indicates that the invention is implemented in a generic environment that “The functionality of the intermediary server 130 of FIG. 1, the claim processing server 140 of FIG. 1, the claim enrichment systems 340, 440, and 740 of FIGS. 3, 4, and 7, and the data processing system of FIG. 8 may each be implemented as a single processor system, a multi-processor system, a multi-core processor system, or even a network of stand-alone computer systems, in accordance with various embodiments of the inventive concept. Each of these processor/computer systems may be referred to as a "processor" or "data processing system."” [0057] “These apparatuses may be embodied as one or more enterprise, application, personal, pervasive and/or embedded computer systems and/or apparatus that are operable to receive, transmit, process and store data using any suitable combination of software, firmware and/or hardware and that may be standalone or interconnected by any public and/or private, real and/or virtual, wired and/or wireless network including all or a portion of the global communication network known as the Internet, and may include various types of tangible, non-transitory computer readable media” [0058]Accordingly, these additional elements do not integrate the abstract idea into a practical application because they are mere instructions to implement the abstract idea on a computer.
Furthermore, dependent claims 2, 4-6, and 13, 22 are similarly rejected as they include other limitations that further define the abstract idea. Accordingly, even in combination, these additional elements do not integrate the abstract idea into a practical application. The claims are directed to the same abstract idea as independent claims 1, 12, and 20.
As per Step 2B of the subject matter eligibility analysis, the claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. The additional elements are mere instructions to apply the abstract idea on a computer. As discussed above with respect to a practical application, the additional element of using a general-purpose computer (or components thereof) to perform the noted steps amounts to no more than mere instructions to apply the exception using a generic computer component. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept (“significantly more”). Furthermore, the additional elements of machine learning models and artificial intelligence systems recites the additional element of a processor to either apply the abstract idea or generally link the abstract idea to a particular technological environment or field of use. Per MPEP 2106.05(a), merely reciting the words “apply it” (or an equivalent) with the judicial exception or merely including instructions to implement an abstract idea on a computer, or merely using a computer as a tool to perform an abstract idea is insufficient to provide significantly more.
Dependent claims 2, 4-6, 13, 22 further refine the abstract idea. These claims do not provide a meaningful linking to the judicial exception. Rather, these claims offer further descriptive limitations of elements found in the independent claims and addressed above – such as by describing the nature and content of the data that is machine learning. While these descriptive elements may provide further helpful context for the claimed invention these elements do not serve to confer subject matter eligibility to the invention since their individual and combined significance is still not significantly more than the abstract concepts at the core of the claimed invention.
Therefore, whether taken individually or as an ordered combination, Claims 1-2, 4-6, 12-13, 20, 22 are nonetheless rejected under 35 U.S.C 101 as being directed towards non-statutory subject matter.
Conclusion
THIS ACTION IS MADE FINAL. 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 nonprovisional extension fee (37 CFR 1.17(a)) 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 mailing date of this final action.
Any inquiry concerning this communication or earlier communications from the examiner should be directed to REGINALD R REYES whose telephone number is (571)270-5212. The examiner can normally be reached 8:00-4:30 M-F.
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If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Shahid R. Merchant can be reached at (571) 270-1360. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
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REGINALD R. REYES
Primary Examiner
Art Unit 3684
/REGINALD R REYES/Primary Examiner, Art Unit 3684