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 .
DETAILED ACTION
The following is in response to the amendments and arguments filed 6/6/2025. Claims 1-17 and 19-22 are pending. Claim 18 has been canceled. Claims 21-22 are new.
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 1-17 and 19-22 are rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more. The claims recite an abstract idea. This judicial exception without significantly more. The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception.
Claims 1-17 and 19-22 are directed to a system, method, or product, which are/is one of the statutory categories of invention.
The Examiner has identified independent method Claim 10 as the claim that represents the claimed invention for analysis and is similar to independent system Claim 19 and product Claim 1.
The claims recite the steps of
receiving a file…the file includes a first healthcare claim; parsing the first healthcare claim into one or more claim data elements…wherein each claim data element includes: a claim data element field, and a claim data element value corresponding to the claim data element field; and performing an automatic discovery process on a first claim data element of the one or more data elements via an automatic …discovery process includes: identifying a replacement value for the claim data element value of the first claim data element, and…assigning an accuracy score to the replacement value; in response to the accuracy score exceeding a pre-determined score threshold, automatically replacing the claim data element value of the first claim data element with the replacement value …and confirming the replacement …in response to the accuracy score being below the pre-determined score threshold, presenting the replacement value via the user …receiving,…, an acceptance of the replacement value from the user … regarding the replacement value, and replacing the claim data element value of the first claim data element with the replacement value …
Receiving, parsing, performing, identifying, assigning, replacing, confirming, presenting and receiving steps carried out by a processor, automatic discovery module, server, mobile app, mobile device and user interface which can be any computer, and thus, it is a general purpose computer carrying out the steps of claim. (See Spec. ¶ 17). The steps may be performed manually. The discovery module is on a server, and the user interface is a mobile application.
Claim 10 falls into the category of fundamental economic practice (One aspect of the disclosure is a computer-implemented method. The method may include receiving a file. The file may include a first healthcare claim. The method may include parsing the first healthcare claim into one or more claim data elements. Each claim data element may include a claim data element field and a claim data element value that corresponds to the claim data element field.—Spec. ¶4). The claim falls within the abstract idea sub grouping of fundamental economic practice and thus falls within the abstract grouping of certain method of organizing human activity. Thus, the claim recites an abstract idea.
Under Step 2A prong 2, this judicial exception is not integrated into a practical application. The claim as a whole merely describes how to generally “apply” the concept of how to process a healthcare claim in a computer environment. The claimed computer components (a processor, automatic discovery module, server, mobile app, mobile device and user interface which can be any computer) are recited at a high level of generality and are merely invoked as tools to perform an existing economic process. Simply implementing the abstract idea on a generic computer is not a practical application of the abstract idea. Accordingly, these additional elements do not integrate the abstract idea into a practical application. The claim is directed to an abstract idea.
The claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed with respect to Step 2A prong 2, the claim describes how to generally “apply” the concept of to process a healthcare claim in a computer environment. Thus, even when viewed separately and as a whole, these additional claim elements do not provide meaningful limitations to transform the abstract idea into a patent eligible application of the abstract idea such that the claims amount to significantly more than the abstract idea itself. The claim is ineligible.
The recitation of claim limitations that attempt to cover any solution to an identified problem with no restriction on how the result is accomplished and no description of the mechanism for accomplishing the result, does not integrate a judicial exception into a practical application or provide significantly more because this type of recitation is equivalent to the words "apply it".
Dependent claims, 2-9, 11-17, 20-22, further define the abstract idea that is present in their respective independent claims. The dependent claims are abstract for the reasons presented above because there are no additional elements that integrate the abstract idea into a practical application or are sufficient to amount to significantly more than the judicial exception when considered as a whole, individually and as an ordered combination. The recitation of claim limitations that attempt to cover any solution to an identified problem with no restriction on how the result is accomplished and no description of the mechanism for accomplishing the result, does not integrate a judicial exception into a practical application or provide significantly more because this type of recitation is equivalent to the words "apply it". Thus, claims 1-17 and 19-22 are not patent-eligible.
None of the dependent claims (claim 2-9, 11-17, 20-22) alters the outcome that the claimed inventions are directed to ineligible abstract ideas, as the dependent claims fall within the abstract idea of processing a healthcare claim. All of the dependent claims are directed to aggregating and analyzing data for parsing and processing the healthcare claim using a computer.
The additional wherein steps of claim 10 do not add more to the claim to take it out of the realm of abstraction. The steps are used to perform automatic discovery in parsing and processing the healthcare claim. Claim 10 recite(s) receiving, parsing, performing, identifying, assigning, replacing, confirming, receiving and presenting steps carried out by a processor, automatic discovery module, server, and user interface which can be any computer, and thus, it is a general purpose computer carrying out the steps of claim. (See Spec. ¶ 17). The steps may be performed manually. The discovery module is on a server, and the user interface is a mobile application. The steps may be performed manually. The claim does not integrate the judicial exception into a practical application.
Claims 1-17 and 19-22 are ineligible.
Response to Arguments
Applicant's arguments filed 6/6/2025 have been fully considered but they are not persuasive.
The Applicant argues that the claims are not directed to an abstract idea. In response, the Examiner respectfully disagrees.
Claim 10 recite(s) receiving, parsing, performing, identifying, assigning, replacing, and presenting steps carried out by a processor, automatic discovery module, server, and user interface which can be any computer, and thus, it is a general purpose computer carrying out the steps of claim. (See Spec. ¶ 17). The steps may be performed manually. The discovery module is on a server, and the user interface is a mobile application.
Claim 10 falls into the category of fundamental economic practice (One aspect of the disclosure is a computer-implemented method. The method may include receiving a file. The file may include a first healthcare claim. The method may include parsing the first healthcare claim into one or more claim data elements. Each claim data element may include a claim data element field and a claim data element value that corresponds to the claim data element field.—Spec. ¶4). The claim is directed to a judicial exception to an abstract idea.
None of the dependent claims alters the outcome that the claimed inventions are directed to ineligible abstract ideas, as the dependent claims fall within the abstract idea of processing a healthcare claim. All of the dependent claims are directed to aggregating and analyzing data for parsing and processing the healthcare claim using a computer.
The additional wherein steps of claim 10 do not add more to the claim to take it out of the realm of abstraction. The steps are used to perform automatic discovery in parsing and processing the healthcare claim. Claim 10 recite(s) receiving, parsing, performing, identifying, assigning, replacing, receiving, confirming and presenting steps carried out by a processor, automatic discovery module, server, mobile application, mobile device and user interface which can be any computer, and thus, it is a general purpose computer carrying out the steps of claim. (See Spec. ¶ 17). The steps may be performed manually. The discovery module is on a server, and the user interface is a mobile application. The steps may be performed manually. The claim does not integrate the judicial exception into a practical application.
In response to applicant’s argument regarding a mobile application on a mobile device as an additional element providing a practical application , Examiner respectfully disagrees. The claim describes how to generally “apply” the concept of how to process a healthcare claim in a computer environment(mobile device).
Regarding applicant’s argument with respect to improving computer functionality,
The arguments cannot take the place of evidence in the record. Applicant need provide facts that back up the position. To show that the involvement of a computer assists in improving the technology, the claims must recite the details regarding how a computer aids the method, the extent to which the computer aids the method, or the significance of a computer to the performance of the method. Merely adding generic computer components to perform the method is not sufficient. Thus, the claim must include more than mere instructions to perform the method on a generic component or machinery to qualify as an improvement to an existing technology. See MPEP § 2106.05(f) for more information about mere instructions to apply an exception.
Examiner does not agree with applicant that the invention solves a technical problem. Applicant argues that the technical solution is achieved by technical processes that enhance the reliability and accuracy of data handling within distributed computing environments, thereby providing tangible advancements in how computer systems detect and correct data integrity issues. (rem 17). The claims are not directed to a technical problem but rather a business problem or claim processing which is solved by parsing the first healthcare claim into one or more claim data elements, performing a discovery process on a first claim data element, identifying a replacement value for the claim data element value of the first claim data element and assigning an accuracy score to the replacement value. The Specification discloses that the operation of the steps of claim 10 can be performed by a general purpose computer (see original Specifically as to claim para 93). As such, the Specification does not disclose an improvement to these computer components themselves. The improvement touted by applicant is an improvement to the field of healthcare claim processing rather than an improvement to the computer components used to process the claims. The computer components are not improved. And “[n]o matter how much of an advance in the . . . field the claims recite, the advance lies entirely in the realm of abstract ideas, with no plausibly alleged innovation in the non-abstract application realm.” SAP Am., 898 F.3d at 1163. Although applicant argues that the invention’s ability to enhance the reliability and accuracy of data handling within distributed computing environments is a technical improvement, there is no evidence that this ability is a result of improvement to the server, mobile device, data pipeline or any other computer component.
Regarding applicant’s arguments with respect to Example 42, Examiner respectfully disagrees. The example is not parallel in facts to the instant claimed invention and as such is not applicable. Further, the 2019 Guidance identifies exemplary considerations indicating that additional elements in claims “may have integrated the [judicial] exception into a practical application.” As the above analysis indicates, the Examiner has evaluated Applicant’s arguments in light of those exemplary considerations. For the reasons discussed above, however, each independent claim as a whole does not integrate the recited abstract ideas into a practical application.
Prior Art
The prior art does not disclose: assigning an accuracy score to the replacement value, in response to the accuracy score exceeding a pre-determined score threshold, automatically replacing the claim data element value of the first claim data element with the replacement value via a processor of the server, and in response to the accuracy score being below the pre-determined score threshold presenting the replacement value via a user interface communicatively coupled with the automatic discovery module, wherein the user interface is a mobile application on a mobile device; receiving an acceptance of the replacement value from the user via the user interface regarding the replacement value; and replacing the claim data element value of the first claim data element with the replacement value using the processor of the server.
The closest prior art Rao (2005/0137912). The closest NPL is “Data mining for the enterprise,” C Kleissner - Proceedings of the Thirty-First Hawaii …, 1998 - ieeexplore.ieee.org.
Conclusion
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure. Ellingsworth discloses a system for classifying documents. Lependu discloses a patient protected info system. Albert discloses a healthcare visit value calculator.
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 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 Kelly Campen whose telephone number is (571)272-6740. The examiner can normally be reached Monday-Thursday 6am-3pm.
Examiner interviews are available via telephone, in-person, and video conferencing using a USPTO supplied web-based collaboration tool. To schedule an interview, applicant is encouraged to use the USPTO Automated Interview Request (AIR) at http://www.uspto.gov/interviewpractice.
If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Abhishek Vyas can be reached at 571-270-1836. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
Information regarding the status of published or unpublished applications may be obtained from Patent Center. Unpublished application information in Patent Center is available to registered users. To file and manage patent submissions in Patent Center, visit: https://patentcenter.uspto.gov. Visit https://www.uspto.gov/patents/apply/patent-center for more information about Patent Center and https://www.uspto.gov/patents/docx for information about filing in DOCX format. For additional questions, contact the Electronic Business Center (EBC) at 866-217-9197 (toll-free). If you would like assistance from a USPTO Customer Service Representative, call 800-786-9199 (IN USA OR CANADA) or 571-272-1000.
Kelly S. Campen
Primary Examiner
Art Unit 3691
/KELLY S. CAMPEN/Primary Examiner, Art Unit 3691
Prosecution Insights