DETAILED ACTION
Acknowledgements
This office action is in response to the claims filed July 8, 2025.
Claims 1, 3-5, 7-14, and 16-19 are pending.
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 .
Response to Amendments
Claims 1, 3-5, 7-14, and 16-19 remain pending.
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, 3-5, 7-14, and 16-19 are rejected to under 35 U.S.C 101 as not being directed to eligible subject matter based on the grounds set out in detail below:
Independent Claims 1, 10, and 19:
Eligibility Step 1 (does the subject matter fall within a statutory category?):
Independent Claims 1 falls within the statutory category of method
Independent Claim 10 falls within the statutory category of system
Independent Claim 19 falls within the statutory category of article of manufacture
Eligibility Step 2A-1 (does the claim recite an abstract idea, law of nature, or natural phenomenon?): Independent claims 1, 10, and 19 (Claim 1 being representative) claimed invention is directed to an abstract idea without significantly more.
The claim elements which set forth the abstract idea in claims 1, 10, and 19 are (Claim 1 being representative):
Receiving eligibility data for a patient, the eligibility data associated with an eligibility check for a first visit between the patient and a healthcare provider;
subsequent to determining that the eligibility data satisfies one or more eligibility parameters, receiving medical claims data for the patient comprising a plurality of historical medical claims
filtering the medical claims data to obtain a subset of the medical claims data associated with a subset of the plurality of historical medical claims, wherein each historical medical claim of the subset of the plurality of historical medical claims includes one or more parameters matching one or more corresponding parameters of the eligibility data
merging the eligibility data with the subset of the medical claims data to generate merged data, wherein the one or more parameters include at least one of a provider specialty, geographic location, and patient demographic information;
inputting the merged data to predict a first subsequent visit
automatically identifying, at least one healthcare provider associated with the first subsequent visit based at least in part on the one or more parameters corresponding with the eligibility data;
automatically scheduling, the first subsequent visit
including transmitting, corresponding with the at least one identified healthcare provider, a first alert indicative of the scheduling of the first subsequent visit
;receiving, , a result of the first subsequent visit;
inputting, the merged data and the result of the first subsequent visit to cause to predict a second subsequent visit;
and automatically scheduling, the second subsequent visit,
including transmitting, corresponding to another healthcare provider, a second alert indicative of the scheduling of the second subsequent visit
This abstract idea is “managing personal behavior or relationships or interactions between people and following rules or instructions” within certain methods of organizing human activity to schedule appointments for patients. See MPEP § 2106.04(a)(2).
Eligibility Step 2A-2 (does the claim recite additional elements that integrate the judicial exception into a practical application?): For Independent claim 1, 10, and 19 judicial exception is not integrated into a practical application.
Independent claim 1 recites the additional claim elements below:
A computer
One or more processors
a remote device
a database
a plurality of provider systems
a remote computer system
a machine learning model
Examiner takes the applicable considerations stated in MPEP 2106.04 (d) and analyzes them below in light of the instant applications disclosure and claim elements as a whole.
Within the noted above claim, a computer with one or more processors, is performing the abstract idea and is recited as “apply-it” as a tool to execute the abstract idea
The additional element, a remote device, is merely generally linking the abstract idea to the technological environment of implementation via computers for data gathering
The additional element, a database, is merely generally linking the abstract idea to the technological environment of implementation via computers for data gathering
The additional element, a plurality of provider systems, is merely generally linking the abstract idea to the technological environment of implementation via computers for data gathering in regards to healthcare
The additional element, a remote computer system, is merely as “apply-it” as a tool to execute the abstract idea
The additional element, a machine learning model, is merely generally linking the abstract idea to the technological environment of artificial intelligence
Independent claim 10 recites the additional claim elements below not already recited in claim 1:
a processor with memory having instructions stored that are executable
Examiner takes the applicable considerations stated in MPEP 2106.04 (d) and analyzes them below in light of the instant applications disclosure and claim elements as a whole.
Within the noted above additional claim element, a processor with memory having instructions stored that are executable, is performing the abstract idea and is recited in the manner of merely invoking the element as a tool to “apply-it” or an equivalent and therefore is no more than using these generic elements as a tool to implement the abstract idea.
Independent claim 19 recites the additional claim elements below not already recited in claim 1 and 10:
One or more processors executing a non-transitory computer readable medium having instructions stored thereon
Examiner takes the applicable considerations stated in MPEP 2106.04 (d) and analyzes them below in light of the instant applications disclosure and claim elements as a whole.
Within the noted above additional claim element, One or more processors executing a non-transitory computer readable medium having instructions stored thereon, is performing the abstract idea and is recited in the manner of merely invoking the element as a tool to “apply-it” or an equivalent and therefore is no more than using these generic elements as a tool to implement the abstract idea.
Accordingly, independent claims 1, 10, and 19 as a whole do not integrate the recited abstract idea into a practical application (MPEP 2106.05(f) and 2106.04(d)(1).
Eligibility Step 2B (Does the claim amount to significantly more?): The independent claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception because the computer elements as analyzed above in step 2A prong 2, are merely generally linking and/or applying the abstract idea with general computer elements and therefore, do not amount to significantly more. The claims are patent ineligible.
Dependent Claims 3-5, 7-9, 11-14, and 16-18:
Eligibility Step 1 (does the subject matter fall within a statutory category?):
The dependent claims 3-5 and 7-9 fall within the statutory category of method
The dependent claims 11-14, 16-18 fall within the statutory category of system
Eligibility Step 2A-1 (does the claim recite an abstract idea, law of nature, or natural phenomenon?): Dependent claims 3-5, 7-9, 11-14, and 16-18 claimed invention is directed to an abstract idea without significantly more. The claims continue to limit the independent claims 1 and 10 abstract idea by (1) further limiting the healthcare path, (2) further limiting the types of data, and (3) further limiting the predicting of the subsequent visits. Therefore, the dependent claims inherit the same abstract idea which is “managing personal behavior or relationships or interactions between people and following rules or instructions” within certain methods of organizing human activity to schedule appointments for patients. See MPEP § 2106.04(a)(2).
Eligibility Step 2A-2 (does the claim recite additional elements that integrate the judicial exception into a practical application?): For claims 3-5, 7-9, 11-14, and 16-18 this judicial exception is not integrated into a practical application.
The dependent claims recite the below additional claim elements not already recited in the independent claims:
a graphical user interface
Examiner takes the applicable considerations stated in MPEP 2106.04 (d) and analyzes them below in light of the instant applications disclosure and claim elements as a whole.
The additional element, a graphical user interface, is merely generally linking the abstract idea to the technological environment of implementation by computers
Accordingly, the dependent claims as a whole do not integrate the recited abstract idea into a practical application (MPEP 2106.05(f) and 2106.04(d)(1).
Eligibility Step 2B (Does the claim amount to significantly more?): The dependent claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception because the computer elements as analyzed above in step 2A prong 2, are merely generally linking with general computer elements and therefore, do not amount to significantly more. The claims are patent ineligible.
Subject Matter Free of Prior Art
Claims 1, 3-5, 7-14, and 16-19 would be allowable if rewritten or amended to overcome the rejection(s) under 35 U.S.C. 101.
The cited prior art of record fails to expressly teach or suggest, either alone or in combination, the features found within the independent claims (Claim 1 recited here as representative). In particular, the cited prior art of record fails to expressly teach or suggest the combination of: “A computer-implemented method comprising: receiving, by one or more processors and from a remote device, eligibility data for a patient, the eligibility data associated with an eligibility check for a first visit between the patient and a healthcare provider; subsequent to determining, by the one or more processors, that the eligibility data satisfies one or more eligibility parameters, receiving medical claims data for the patient from a database comprising a plurality of historical medical claims associated with a plurality of provider systems; filtering, by the one or more processors, the medical claims data to obtain a subset of the medical claims data associated with a subset of the plurality of historical medical claims, wherein each historical medical claim of the subset of the plurality of historical medical claims includes one or more parameters matching one or more corresponding parameters of the eligibility data; merging, by the one or more processors, the eligibility data with the subset of the medical claims data to generate merged data, wherein the one or more parameters include at least one of a provider specialty, geographic location, and patient demographic information; inputting, by the one or more processors, the merged data into a machine learning model trained with the plurality of historical medical claims,
The most remarkable prior art of record is as follows:
• Perkins et. al (hereinafter Perkins) (US20160357921A1)
o The present invention is a system and method for providing medical care information to medical care providers identified through the analysis of electronic requests for reimbursement where such information may comprise treatment advice.
• Zahora et. al (US20230317260Al)
o In an illustrative embodiment, a system for providing automation and virtual assistance to medical claims processing includes a predictive analytics platform configured to receive patient information for a medical claim from a claims processing system, cross-reference the patient information with stored data to identify a patient record, apply the patient information to machine learning classifier(s) to estimate a likelihood of match between the patient information and the patient record, provide patient record information to the claims system, receive claims data from the claims system, access, from a data universe, requirements corresponding to a payer corresponding to the medical claim, the requirements having been generated through training machine learning classifier(s) with claims data corresponding to claims denied by the payer, verify the claims data in view of the requirements, and provide an indication of missing claims information and/or invalid claims information to the claims system.
Albert (US2018/0240547A1)
o A healthcare visit value calculation system wherein a processor coupled with a memory executes computerized code which analyzes data regarding patients , doctors , and financial information to generate a visit value score . The system will then notify end users of this visit value score , monitor the score , and attempt to improve the score via automated and manual intervention .
Velaga (US20210183505A1)
o Methods and systems are provided for managing healthcare information . A data retrieval application includes a fraud detection engine that monitors medical claims of a user submitted to a third party insurer , a database of a plurality of healthcare providers , and a database of one or more users . The data retrieval application allows remote access to a centralized information store for the user , a primary health care provider , and the third party insurer . The centralized information store houses the pre - visit identifying documentation for the user and allows for reusability of the information .
Hagan et. al (hereinafter Hagan) (US2006/0004772A1)
o Personal information of users is used to customize the browsing experiences of the users on a World-Wide-Web Site. To ensure privacy of the users personal information, each user is assigned a unique Universal Anonymous Identifier (UAI). The UAI is generated by a trusted third party and provided to the Web site operator. The Web site operator then indexes the users personal information by UAI. Only the user has the ability to correlate his/her true identity with his/her personal information.
Response to Arguments Regarding 35 U.S.C § 101 Rejection
Applicant argues on pages 3-6 of the remarks that claims 1, 3-5, 7-14, and 16-19 are rejected under 35 U.S.C. § 101 as directed to ineligible subject matter should be withdrawn for the following reasons.
Applicant amends claim 1 to recite, inter alia: automatically scheduling . . . the first subsequent visit, including transmitting, to at least one provider system corresponding with the at least one identified healthcare provider, a first alert indicative of the scheduling of the first subsequent visit, wherein the at least one provider system is a remote computer system; receiving,... from the at least one provider system, a result of the first subsequent visit; inputting . . . the merged data and the result of the first subsequent visit into the machine learning model to cause the machine learning model to predict a second subsequent visit; and automatically scheduling . . . the second subsequent visit, including transmitting, to the at least one provider system or another provider system corresponding to another healthcare provider, a second alert indicative of the scheduling of the second subsequent visit, wherein the another provider system is a remote computer system. Applicant respectfully submits, even assuming arguendo that amended claim 1 recites the alleged abstract idea, that claim 1 is not "directed to" that abstract idea at least for the following reasons. i. Amended claim 1 of the present application and claim 1 of Example 42 of the Patent Eligibility Guidance (PEG) Examples are patent-eligible for similar reasons Applicant respectfully submits amended claim 1 as a whole integrates the alleged abstract idea into a practical application at least for reasons similar to claim 1 of Example 42 of the PEG Examples. Claim 1 of Example 42 recites, inter alia: a) storing information in a standardized format about a patient's condition in a plurality of network-based non-transitory storage devices having a collection of medical records stored thereon; b) providing remote access to users over a network so any one of the users can update the information about the patient's condition in the collection of medical records in real time through a graphical user interface, wherein the one of the users provides the updated information in a non-standardized format dependent on the hardware and software platform used by the one of the users; c) converting, by a content server, the non-standardized updated information into the standardized format, d) storing the standardized updated information about the patient's condition in the collection of medical records in the standardized format; e) automatically generating a message containing the updated information about the patient's condition by the content server whenever updated information has been stored; and f) transmitting the message to all of the users over the computer network in real time, so that each user has immediate access to up- to-date patient information. Subject Matter Eligibility Examples 37 to 42 at p.18. The 2019 PEG states that claim 1 of Example 42 is patent eligible because, inter alia: The claim recites a combination of additional elements including storing information, providing remote access over a network, converting updated information that was input by a user in a non- standardized form to a standardized format, automatically generating a message whenever updated information is stored, and transmitting the message to all of the users. The claim as a whole integrates the method of organizing human activity into a practical application. Specifically, the additional elements recite a specific improvement over prior art systems by allowing remote users to share information in real time in a standardized format regardless of the format in which the information was input by the user. Thus, the claim is eligible because it is not directed to the recited judicial exception (abstract idea). Id. Amended claim 1 of the instant application recites elements similar in kind to various elements recited in claim 1 of Example 42. For example, amended claim 1 recites, inter alia: automatically scheduling . . . the first subsequent visit, including transmitting,... to at least one provider system corresponding with the at least one identified healthcare provider, a first alert indicative of the scheduling of the first subsequent visit, wherein the at least one provider system is a remote computer system; receiving,... from the at least one provider system, a result of the first subsequent visit; . .. automatically scheduling, by the one or more processors, the second subsequent visit, including transmitting,.. . to the at least one provider system or another provider system corresponding to another healthcare provider, a second alert indicative of the scheduling of the second subsequent visit, wherein the another provider system is a remote computer system.
Like claim 1 of Example 42, the invention of amended claim 1 recites a specific improvement over prior systems, in this case specifically by providing remote access over a network, automatically generating an alert when a visit is scheduled, and automatically transmitting the alert to corresponding healthcare providers. Therefore, Applicant respectfully submits that amended claim 1 is patent eligible at least for reasons similar to claim 1 of Example 42.
ii. Amended claim 1 provides technical improvements Additionally, Applicant respectfully submits that, assuming arguendo that amended claim 1 recites the alleged abstract idea, amended claim 1 as a whole integrates the alleged abstract idea into a practical application for the additional reason that the invention of amended claim 1 "improves the functioning of a computer or improves another technology or technical field." MPEP § 2106.04(d)(1). More specifically, the invention of amended claim 1 improves the accuracy of healthcare path machine-learning based predictions by using a result from a previous visit to aid the machine-learning based prediction of a subsequent visit. A healthcare path (e.g., sequence of healthcare provider office visits, procedures, etc.) may depend on the patient's first office visit, the patient's conditions and characteristics, and relevant healthcare provider's specialty and availability. A trained machine learning model may predict a healthcare path based on these factors. However, in some scenarios, a subsequent office visit may depend on a result of a previous office visit. In such scenarios, incorporating the result of the previous office visit in the machine-learning based predictions of subsequent office visits as the healthcare path progresses may enhance the accuracy of those machine-learning based predictions. As stated in the specification: A care path is generally determined based on the patient's first visit to a healthcare provider (e.g., for a particular ailment or procedure). For example, the care path for a patient visiting a cardiologist about a heart condition may include subsequent visits to the cardiologist, tests (e.g., a stress test, an electrocardiogram (ECG), etc.), procedures (e.g., heart surgery), etc. Accordingly, care paths may vary significantly between different patients and even an established care path may be variable. For example, parameters (e.g., provider specialty, urgency, etc.) or results of a first visit may determine or impact the type, timing, location, etc., of a subsequent visit. Specification at para. [0027] (emphasis added). Compared to making a one-time prediction of a series of office visits based on the first visit, predicting a subsequent visit based the result from a previous visit can provide greater accuracy. Amended claim 1 recites, inter alia, "inputting ... the merged data and the result of the first subsequent visit into the machine learning model to cause the machine learning model to predict a second subsequent visit." Accordingly, amended claim 1 reflects the technical improvement discussed above. Applicant therefore submits that amended claim 1 is patent-eligible for this additional reason.
iii. Other claims Independent claims 10 and 19 recite elements similar to those recited by amended claim 1. For at least reasons similar to those discussed above for independent 1, claims 10 and 19 are also patent-eligible. Dependent claims 3-5, 7-9, 12-14, and 16-18 incorporate by reference each and every element recited by their respective base claims. Accordingly, for at least the same reasons as those discussed above for their respective base claims, claims 3-5, 7-9, 12-14, and 16-18 are also patent-eligible.
Applicant's arguments have been fully considered but they are not persuasive.
The MPEP 2106.04(a)(2) explains that "the sub-grouping 'managing personal behavior or
relationships or interactions between people' include social activities, teaching, and following
rules or instructions." As a primary example, the MPEP points to Intellectual Ventures ILLC v.
Capital One Bank (USA), 792 F.3d 1363, 115 USPQ2d 1636 (Fed. Cir. 2015) in which the
courts identified an abstract idea of "tracking financial transactions to determine whether they
exceed a pre-set spending limit (i.e., budgeting)." The MPEP also provides several other
examples of abstract ideas in this sub-grouping, including:
i. filtering content, BASCOM Global Internet v. AT&T Mobility, LLC, 827 F.3d 1341,
1345-46, 119 USPQ2d 1236, 1239 (Fed. Cir. 2016) (finding that filtering content was an
abstract idea under step 2A, but reversing an invalidity judgment of ineligibility due to an
inadequate step 2B analysis);
ii. considering historical usage information while inputting data, BSG Tech. LLC v.
Buyseasons, Inc., 899 F.3d 1281, 1286, 127 USPQ2d 1688, 1691 (Fed. Cir. 2018); and
iii. a mental process that a neurologist should follow when testing a patient for nervous
system malfunctions, In re Meyer, 688 F.2d 789, 791-93, 215 USPQ 193, 194-96 (CCPA
1982)." The MPEP 2106.04(a)(2) also states, “Examiners should determine whether a claim
recites an abstract idea by (1) identifying the specific limitation(s) in the claim under
examination that the examiner believes recites an abstract idea and (2) determining whether the
identified limitations(s) fall within at least one of the groupings of abstract ideas listed above.”
Examiner disagrees as almost all of the elements argued except for additional elements outlined in this office action are wholly abstract. Examiner must review the positive recitation of the claim in light of the specification and identify if the claims are directed to an abstract idea based on the substance of the claim. The substance of the instant applications positively recited claims in light of the specification is to receive and analyze data, inclusive of historical data to predict a healthcare path for a patient such as an upcoming visit that needs to be scheduled and identify an associated healthcare provider. This is certain methods of organizing human activity such as personal behavior and interactions between people as the substance of the claim is directed to analyzing data to determine an interaction that a provider and a patient should or will have. The use of generic computers and machine learning to providing remote access over a network, automatically generating an alert when a visit is scheduled, and automatically transmitting the alert to corresponding healthcare providers as reflected in the instant application claims and specification is mere automation of organized human activity that can be completed without the computer and machine learning therefore still directed to an abstract idea of scheduling visits for a patient. The instant application does not solve a technical problem such as the one in example 42 and has no nexus with the instant application.
Examiner notes that the abstract idea is not integrated into a practical application. The abstract idea cannot provide the improvement or practical application rather additional elements identified by the examiner are used to determine if a practical application or significantly more is present based on the recited claim language. Applicant argues that the technical improvement is improving the accuracy of healthcare path machine-learning based predictions by using a result from a previous visit to aid the machine-learning based prediction of a subsequent visit. The claims do not positively recite a technological improvement in the field of machine learning models in regards to accuracy of predictive outputs. Rather the claims recitation is confined to general purpose computers (supported by instant applications spec. [0036] which explicitly states the processor is a general purpose processor) and linking the analysis of the data to a general purpose machine learning model with no specific blueprint set forth on improving the prediction of machine learning. Rather the machine learning is at best used as a tool to determine when a future appointment may need to take place and with what provider. Moreover, the entire problem of predicting a healthcare path such as scheduling a visit and identifying a provider is not reasonably understood to be a problem arising in technology, but instead a real world problem arising in the business of managing a person’s health decisions between a provider and a patient. The claimed invention is using computers as a tool and generally linking to machine learning and any improvement present is an improvement to the abstract idea. Finally were applicants line of reasoning correct, the invention in Alice Corp. would have been subject matter eligible as it is an improvement to settlement risk mitigation. Therefore, the claims can also not provide significantly more.
Examiner maintains the rejection under 35 U.S.C 101.
Response to Arguments Regarding 35 U.S.C § 103 Rejection
Applicant has overcome the 35 U.S.C § 103 Rejection.
Prior Art Cited but Not Relied Upon
Joubert - US20060173712
A computerized system for monitoring and maintaining the health of a person comprising the steps of (a) obtaining parameter data from the patient and inputting the parameter data into a computer database; (b) analyzing the parameter data using a computerized statistical modeling technique module and a computerized adaptive expert System shell for the prediction of a health event in the lifetime of the patient; (c) using the analyzed data to developed a health maintenance schedule for the patient, and (d) embedding and/or linking Such data onto a microprocessor powered Smart card.
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 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 Ashley Elizabeth Evans whose telephone number is (571) 270-
0110. The examiner can normally be reached Monday – Friday 8:00 AM – 5:00 PM.
If attempts to reach the examiner by telephone are unsuccessful, the examiner’s
supervisor, Mamon Obeid can be reached on (571) 270-1813. The fax phone number for the
organization where this application or proceeding is assigned 571-273-8300.
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/ASHLEY ELIZABETH EVANS/
Examiner, Art Unit 3687
/MAMON OBEID/Supervisory Patent Examiner, Art Unit 3687