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 and entered with the RCE filed 06/02/2026. Claims 1-17 and 19-20, 22-27 are pending. Claims 18 and 21 have been canceled. Claims 23-27 are new.
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on 06/02/2026 has been entered.
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 19-20, 22-27 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 19-20, 22-27 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 method claim 23, 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 identifying…an error in a claim data element among the one or more claim data elements prior to storing the claim data element …,the error includes at least one of: claim data element value absent from the corresponding claim data element field, the claim data element value in an incorrect format, or the claim data element value transposed from the corresponding claim data element field, and identifying the error includes…detecting the absence of the claim data element value by comparison to a list of required fields stored in the data storage, detecting the incorrect format by determining that a claim data element value includes characters or numbers not expected for the corresponding claim data element field in the data storage, or detecting the claim data element value transposed by comparison to a set of known values stored in the data storage; and in response to identifying the error…:modifying the identified claim data element, including at least one of: generating a missing claim data element based on similar claim data elements stored in the data storage, exchanging values between claim data elements determined to be transposed, or converting the claim data element value to a correct format; storing the modified claim data element in the data storage; and presenting the modified claim data element, including the claim data element value…; 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, storing, 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, 24-27 further define the abstract idea that is present in their respective independent claims (further defining the healthcare claim, element fields, identifying replacement value, assigning the accuracy score, storing data, identify errors, a second claim element is absent, for example). 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 19-20, 22-27 are not patent-eligible.
None of the dependent claims (claim 2-9, 11-17, 20, 22, 24-27) 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.
Further note, 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, identifying, storing, modifying, storing, performing, identifying, assigning, replacing, confirming, receiving and presenting steps carried out by a processor, automatic discovery module, server, mobile app 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 19-20, 22-27 are ineligible.
Response to Arguments
Applicant's arguments filed 6/2/2026 have been fully considered but they are not persuasive.
Regarding applicant’s argument the claims are not directed to an abstract idea, Examiner respectfully disagrees. 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.
Regarding applicants argument “the claims are directed to a specific improvement in networked computer data handling-namely, a server-implemented pipeline that ingests distributed healthcare-claim files, parses them into structured elements, computes a confidence (accuracy) score for candidate replacements, gates automatic modification based on a pre-set threshold, and when below the threshold, orchestrates a remote, mobile user confirmation workflow before committing data to storage physically or logically separate from the server,” Examiner respectfully disagrees. 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. The arguments cannot take the place of evidence in the record. Applicant need provide facts that back up the position. Applicant argues that the technical solution is achieved by technical processes of computer-implemented data-quality workflow that improves how distributed computing systems ingest, validate, standardize, correct, and commit structured claim data (rem 13-14). The claims are not directed to a technical problem but rather a business problem of 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 specification 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 business 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 improves how distributed computing systems ingest, validate, standardize, correct, and commit structured claim data is a technical improvement, there is no evidence that this ability is a result of improvement to the processor, automatic discovery module, server, mobile app, mobile device and user interface which can be any computer.
Regarding applicant’s arguments to Step 2A Prong 2 (practical application), Examiner respectfully disagrees. Although these computer-related limitations are not wholly generic in nature, they are described at a high level in the Specification without any meaningful detail about their structure or configuration. As such, the computer-related limitations are not sufficient to integrate the judicial exception into a practical application.
Accordingly, the claim as a whole does not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. Thus, because the Specification describes the additional elements in general terms, without describing the particulars, the claim limitations may be broadly but reasonably construed as reciting conventional computer components and techniques, particularly in light of the Specification, as quoted in the above rejection.
Further, 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.
Regarding applicant’s argument directed to “ Enfish (improving computer data handling) and DDR (solution rooted in networked computer technology),” Examiner respectfully disagrees. Applicant’s response fails to link the legal concepts to the facts of the application under examination. Arguments cannot take the place of evidence in the record. Applicant need provide facts that back up the position.
Regarding applicant’s argument “the ordered combination of additional elements provides an inventive concept” and to novelty, Examiner respectfully disagrees. One must keep in mind that judicial exceptions need not be old or long‐prevalent, and that even newly discovered judicial exceptions are still exceptions, despite their novelty. For example, the mathematical formula in Flook, the laws of nature in Mayo, and the isolated DNA in Myriad were all novel, but nonetheless were considered by the Supreme Court to be judicial exceptions because they were “‘basic tools of scientific and technological work’ that lie beyond the domain of patent protection.” (Parker v. Flook, 437 U.S. 584, 591‐92 (1978); and Myriad Genetics, 133 S. Ct. at 2116, quoting Mayo Collaborative Svcs. v. Prometheus Labs., 566 U.S. __, 132 S. Ct. 1289, 1293 (2012).). The steps may be performed manually. The claim does not integrate the judicial exception into a practical application nor significantly more when evaluated individually, as a whole, or as an ordered combination (see specification paragraphs [0096-97]).
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.
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Kelly S. Campen
Primary Examiner
Art Unit 3691
/KELLY S. CAMPEN/ Primary Examiner, Art Unit 3691
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