METHOD AND SYSTEM OF INSURANCE AUTHORIZATION CREATOR AND ANALYSIS FOR APPROVAL TO MITIGATE REJECTION

Application No. 18/181,541

• Filed: Mar 09, 2023
• Examiner: AKOGYERAM II, NICHOLAS A
• Art Unit: 3686
• Tech Center: 3600 — Transportation & Electronic Commerce
• Assignee: Vettedclaims Inc.
• OA Round: 2 (Final)

Office Action

DETAILED ACTION

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 1-20, were previously pending and subject to a non-final office action filed on July 24, 2025 (the “July 24, 2025 Non-Final Office Action”). Following the July 24, 2025 Non-Final Office Action, Applicant amended claims 1, 10, 11, 14, 16, and 20, in an amendment filed on October 24, 2025 (the “October 24, 2025 Amendment”), see Applicant’s amended claims (pp. 2-5 of the October 24, 2025 Amendment). As such, claims 1-20, as recited in the October 24, 2025 Amendment, are currently pending and subject to the final office action below.

Response to Applicant’s Remarks
Response to Applicant’s Remarks Concerning Claim Objections
Applicant’s arguments, see Applicant’s Remarks, p. 6, Claim Objections Section, filed October 24, 2025, with respect to the claim objection of claim 16 have been fully considered, but they are not persuasive. Applicant's amendments to

Response to Applicant’s Remarks Concerning Rejections under 35 U.S.C. § 101
Applicant’s arguments, see Applicant’s Remarks, pp. 6-7, Claim Rejections Under Section 101 Section, filed October 24, 2025, with respect to rejections of claim 1-20 under 35 U.S.C. § 101 have been fully considered, but they are not persuasive. Further, in light of the 2019 Revised Patent Subject Matter Eligibility Guidance (available at MPEP § 2106) (the “2019 Revised PEG”), the § 101 rejections of claims 1-20 are maintained in this final office action.
Applicant generally argues that the claims are not directed to an abstract idea, because “a human cannot perform the functions recited, particularly the ones presented on the user interface”. Applicant’s Remarks, at p. 6. Examiner respectfully disagrees with this argument. While the claims recite a various steps for presenting information on a user interface, which the Examiner agrees are not features which can be performed in the human mind, this is not the test for determining whether the claims recite an abstract mental process. Claims can recite a mental process even if they are claimed as being performed on a computer. MPEP § 2106.04(a)(2)(III)(C). The Supreme Court recognized this in Benson, determining that a mathematical algorithm for converting binary coded decimal to pure binary within a computer’s shift register was an abstract idea. Id.
Similarly, in the present case, the identified abstract idea is a method for vetting insurance authorization requests and improving the chances of approval, comprising: identifying treatment guidelines; and using and applying rules to provide a confidence of approval value or indicator. Under the broadest reasonable interpretation of the claims, (1) identifying treatment guidelines (i.e., a type of observation, evaluation, judgment, and/or opinion where a person could mentally identify treatment guidelines based on information from an authorization request); and (2) using and applying rules to provide a confidence of approval value or indicator (i.e., a type of observation, evaluation, judgment, and/or opinion where a person could mentally and/or manually use and apply rules to determine a confidence of an authorization request being approved), are human cognitive functions which are capable of being performed mentally and/or reasonably with the aid of a pen and paper. The fact that Applicant’s claims apply this process on a system with conventional computer components (such as the one or more processors, display, user interface, one or more applications, and server) and the various “presenting” steps merely amounts to performing the abstract mental process in a computer environment. For example, a person acting in the role of an insurance adjuster or insurance claim evaluator naturally performs the aforementioned steps of identifying treatment guidelines based on insurance that is found in an insurance authorization request, and then that same person is able to use and apply rules to determine the likelihood that an authorization request will be approved. Therefore, the claims still recite an abstract mental process that is commonly performed by a human acting in the role of an insurance adjuster/insurance claims evaluator. For these reasons, this argument is not persuasive.
Next, Applicant generally argues that the claims provide a very specific technical solution for a technical problem and “the method provides a transformative output and a real world technical solution”. See Applicant’s Remarks, at pp. 6-7. Examiner respectfully disagrees with this assertion. The consideration of whether the claim as a whole includes an improvement to a computer or to a technological field requires an evaluation of the specification and the claim to ensure that a technical explanation of the asserted improvement is present in the specification, and that the claim reflects the asserted improvement. See MPEP § 2106.04(d)(1).
When evaluating whether claims recite an improvement to the functioning of a computer or a technical field, the disclosure must provide sufficient details such that one of ordinary skill in the art would recognize the claimed invention as providing an improvement. MPEP § 2106.05(a). The specification need not explicitly set forth the improvement, but it must describe the invention such that the improvement would be apparent to one of ordinary skill in the art. Id. Conversely, if the specification explicitly sets forth an improvement but in a conclusory manner (i.e., a bare assertion of an improvement without the detail necessary to be apparent to a person of ordinary skill in the art), the examiner should not determine the claim improves technology. An indication that the claimed invention provides an improvement can include a discussion in the specification that identifies a technical problem and explains the details of an unconventional technical solution expressed in the claim, or identifies technical improvements realized by the claim over the prior art.
For example, in the McRO, Inc. v. Bandai Namco Games Am. Inc. case, the Federal Circuit relied on the specification’s explanation of how the particular rules recited in the claim enabled the automation of specific animation tasks that previously could only be performed subjectively by humans, when determining that the claims were directed to improvements in computer animation instead of an abstract idea. Id. Conversely, the Federal Circuit has held claims which merely record, transmit, and archive data by use of conventional or generic technology in a nascent but well-known environment, without any assertion that the invention reflects an inventive solution to any problem may not be sufficient to show an improvement in computer-functionality. See MPEP § 2106.05(a) (citing the TLI Communications LLC v. AV Auto case). Further, gathering and analyzing information using conventional techniques, was also determined to be insufficient to show an improvement in computer-functionality. See MPEP § 2106.05(a) (also citing the TLI Communications case).
In the present case, Applicant’s claims do not describe an improvement to the functioning of a computer or any other technology or technical field. Similar to the TLI Communications case, Applicant’s claims merely implement conventional techniques, such as collecting data (i.e., retrieving and extracting information from an authorization request); analyzing the data (i.e., identifying treatment guidelines and using/applying rules to determine a confidence in an authorization request being approved); and displaying certain results about the collection and analysis (i.e., the “presenting” steps recited in the claims above), at a high level of generality. Any increased speed for displaying confidence indicators comes solely from applying the abstract idea on a computer. Applicant’s claims and specification do not describe a technical problem and presenting information on a display does not represent a technical solution to a problem. Therefore, this argument is not persuasive and Applicant’s claims do not recite an improvement to a technological field.
Lastly, Applicant generally argues that claims provide significantly more than the exception under Step 2B. See Applicant’s Remarks, at p. 7. Examiner respectfully disagrees with this argument. When making a determination whether the additional elements in a claim amount to significantly more than a judicial exception, the examiner should evaluate whether the elements define only well-understood, routine, conventional activity. MPEP § 2106.05(d). In this respect, the well-understood, routine, conventional consideration overlaps with other Step 2B considerations, particularly the improvement consideration (see MPEP § 2106.05(a)), the mere instructions to apply an exception consideration (see MPEP § 2106.05(f)), and the insignificant extra-solution activity consideration (see MPEP § 2106.05(g)). Id. Thus, evaluation of those other considerations may assist examiners in making a determination of whether a particular element or combination of elements is well-understood, routine, conventional activity. Id.
In the present case, the additional elements recited in the claims represent well-understood, routine, and conventional activity. Courts have held computer‐implemented processes not to be significantly more than an abstract idea (and thus ineligible) where the claim as a whole amounts to nothing more than generic computer functions merely used to implement an abstract idea, such as an idea that could be done by a human analog (i.e., by hand or by merely thinking). MPEP § 2106.05(d). Applicant’s claims were deemed to recite an abstract mental process (see above). The action steps recited in the claims (namely, the steps directed to identifying the treatment guidelines and using and applying the rules to provide the confidence indicator of approval) can be done by human analog. As described in the amended rejections under the Claim Rejections – 35 U.S.C. § 101 Section below, the additional elements (the system; one or more processors; memory containing computer instructions; user interface; server executing one or more applications; and the steps directed to: “retrieving and extracting information from an authorization request including a treatment and a diagnosis” and the various “presenting” steps) represent generic component components and functions for implementing the abstract idea. The Federal Circuit has recognized the functions of retrieving/extracting data and presenting data as well-understood, routine, and conventional activity in particular fields. See MPEP § 2106.05(d) (citing Intellectual Ventures v. Symantec, TLI Communications LLC v. AV Auto. LLC, OIP Techs., Inc., v. Amazon.com, Inc., buySAFE, Inc. v. Google, Inc., DDR Holdings, LLC v. Hotels.com, L.P., and Content Extraction and Transmission, LLC v. Wells Fargo Bank). Therefore, this argument is not persuasive and Applicant’s claims do not provide significantly more than the exception under Step 2B.
As a result, the rejections of claims 1-20 under 35 U.S.C. § 101 are maintained in this office action. Please see the amended rejections under the Claim Rejections – 35 U.S.C. § 101 Section below, for further clarification and complete analysis.

Response to Applicant’s Remarks Concerning Rejections under 35 U.S.C. § 103
Applicant’s arguments, see Applicant’s Remarks, p. 8, Claim Rejections Under 35 U.S.C. 102/103 Section, filed October 24, 2025, with respect to the rejections of claims 14, 15, and 20 under 35 U.S.C. § 102 and the rejections of claims 1-13 and 16-19 under 35 U.S.C. § 103, have been fully considered, but they are not persuasive in part in light of Applicant’s amendments to independent claim 1 and they are moot in part in light of Applicant’s amendments to independent claims 14, and 20. In regard to the amendments to independent claim 1, Shapiro et al. (Pub. No. US 2024/0127934) teaches the amended limitations directed to a “display having a user interface coupled to one or more processors” (see Shapiro, paragraph [0006] which teaches a display coupled to a client computing device and displaying a graphical user interface) and “presenting the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved” (see e.g., Shapiro, paragraph [0138], where the confidence score can be expressed in the form of a percentage that shows how closely the invoice package coheres to the terms of the insurance policy and can also be sent to the insurance provider). One of ordinary skill in the art would recognize that the confidence score feature described in Shapiro reasonably reads on the amended claim limitations for presenting the confidence value as an estimated percentage of chance that a claim will be approved. Specifically, paragraph [0138] in Shapiro explicitly teaches that percentage values at a certain level, e.g., 80 or 85% or 90 or 95% or higher, would not require review by an insurance provider (indicating that they have a good chance of being approved without the need for review by a human, because they adhere more closely to the terms of the insurance policy), where a score below these limits may be subjected to review and scores below 75% or 70% or 65 or 60% may require substantive review (indicating that these claims have a lesser chance of being approved and require a review by a human, because they do not adhere to the terms of insurance policy as closely as claims with a high percentage confidence value). Therefore, Shapiro teaches the amended limitations added to claim 1 and Applicant’s arguments are not persuasive.
In regard to the amendments to independent claims 14 and 20, the amendments required further search and consideration. Therefore, the combination of the references previously cited in the July 24, 2025 Non-Final Office Action, are not relied upon to teach the newly amended claim limitations in claims 14 and 20. Consequently, any arguments pertaining to the newly amended claim limitations are moot. Please see the amended rejections under the Claim Rejections – 35 U.S.C. § 103 Section below, for further clarification and complete analysis.

Claim Objections
Claim 16 is objected to because of the following informalities:
- the claim recites "IDC-10 codes" in line 2 of claim 16. This appears to be a typographical error and should be "ICD-10 codes". For examination purposes, "IDC-10 codes" in line 2 of claim 16 will be interpreted and read the same as "ICD-10 codes". Appropriate correction is required.

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 1-20 are rejected under 35 U.S.C. §101 because the claimed invention is directed to an abstract idea without significantly more. See MPEP § 2106 (hereinafter referred to as the “2019 Revised PEG”).

Step 1 of the 2019 Revised PEG
Following Step 1 of the 2019 Revised PEG, claims 1-19 are directed to systems for vetting insurance authorization requests and improving chances of approval, which is within one of the four statutory categories (i.e., a machine or apparatus). See MPEP § 2106.03. Claim 20 is directed to a method for vetting insurance authorization requests and improving chances of approval, which is also within one of the four statutory categories (i.e., a process). See id.

Step 2A of the 2019 Revised PEG - Prong One
Following Prong One of Step 2A of the 2019 PEG, the claim limitations are to be analyzed to determine whether they “recite” a judicial exception or in other words whether a judicial exception is “set forth” or “described” in the claims. See MPEP §2106.04. An “abstract idea” judicial exception is subject matter that falls within at least one of the following groupings: (1) Mathematical Concepts; (2) Certain Methods of Organizing Human Activity, and (3) Mental Processes. See MPEP § 2106.04(a).
Claims 1-20 are rejected under 35 U.S.C. § 101, because the claimed invention is directed to an abstract idea without significantly more. Representative independent claims 1, 14, and 20 include limitations that recite an abstract idea. Note that independent claim 1 is a system, while claim 14 also covers a very similar system and claim 20 covers a similar method. Specifically, independent claim 1 recites the following limitations:
A system for vetting insurance authorization requests and improving chances of approval, comprising:

one or more processors;

a display having a user interface coupled to the one or more processors;

memory coupled to the one or more processors, the memory containing computer instructions which when executed by the one or more processors, causes the one or more processors to:

retrieve and extract information from an authorization request including a treatment and a diagnosis;

identify treatment guidelines based on the information retrieved and extracted from the authorization request;

use rules that have been converted to a standard format that is human readable and separately maintain the rules from each authority issuing the rules;

apply rules to provide a confidence of approval value or indicator;

present the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved; and

present a submission button for generating a request for authorization form.

Next, independent claim 14 recites the following limitations:

A system for vetting insurance authorization requests and improving chances of approval, comprising:

a server;

one or more applications executing on the server that:

retrieves and extracts information from an authorization request including a treatment and a diagnosis;

identifies treatment guidelines based on the information retrieved and extracted from the authorization request;

uses rules that have been converted to a standard format that is human readable;

apply rules to provide a confidence of approval value or indicator; and

present the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated.

Lastly, independent claim 20 recites the following limitations:

A method of vetting insurance authorization requests and improving chances of approval comprising an application at a server having one or more applications executing on the server which perform the functions of:

retrieving and extracting information from an authorization request including a treatment and a diagnosis;

identifying treatment guidelines based on the information retrieved and extracted from the authorization request;

applying rules that have been converted to a standard format that is human readable to provide a confidence of approval value or indicator; and

present the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a listing of requests for authorization forms, a treatment request and an indicator of confidence of approval for each treatment for a particular patient, a pop-up entry form for generating a new request, a resubmission, or expedited review, and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated.

However, the Examiner submits that the foregoing underlined limitations constitute a process that, under its broadest reasonable interpretation, falls within the “Mental Processes” grouping of abstract ideas. See 2019 Revised PEG. The Mental Processes category covers concepts which are capable of being performed in the human mind or encompasses a human performing the step(s) mentally with the aid of a pen and paper (including an observation, evaluation, judgment, or opinion) (i.e., a method for vetting insurance authorization requests and improving chances of approval, comprising: identifying treatment guidelines; and using and applying rules to provide a confidence of approval value or indicator). See MPEP § 2106.04(a)(2)(III). That is, other than reciting some computer components and functions (the foregoing limitations in claims 1, 14, and 20 which are not underlined), the context of claims 1, 14, and 20 encompasses concepts that are capable of being performed in the human mind or encompasses a human performing the step(s) mentally with the aid of a pen and paper (including an observation, evaluation, judgment, and/or opinion) (i.e., a method for vetting insurance authorization requests and improving chances of approval, comprising: identifying treatment guidelines; and using and applying rules to provide a confidence of approval value or indicator).
The aforementioned claim limitations described in claims 1, 14, and 20 are analogous to claim limitations directed toward concepts which are capable of being performed in the human mind or encompasses a human performing the step(s) mentally with the aid of a pen and paper, because they merely recite limitations which encompass: (1) a person mentally and/or manually identifying treatment guidelines based on information that is retrieved and extracted from an authorization request (i.e., a type of observation, evaluation, judgment, and/or opinion where a person could mentally identify treatment guidelines based on information from an authorization request); and (2) a person mentally using and applying rules to provide a confidence of approval value or indicator (i.e., a type of observation, evaluation, judgment, and/or opinion where a person could mentally and/or manually use and apply rules to determine a confidence of an authorization request being approved).
Further, Applicant’s claims are similar to claims which have been held to recite an abstract mental process. For example, the Federal Circuit held the a claim directed to “collecting information, analyzing it, and displaying certain results of the collection and analysis”, where the data analysis steps are recited at a high level of generality amounted to steps that could practically be performed in the human mind. See MPEP § 2106.04(a)(2)(III)(A) (citing Electric Power Group v. Alstom, S.A.). Similarly, Applicant’s claims recite steps for collecting information (i.e., retrieving and extracting information from an authorization request); analyzing the data (i.e., identifying treatment guidelines and using/applying rules to determine a confidence in an authorization request being approved); and displaying certain results about the collection and analysis (i.e., the “presenting” steps recited in the claims above), at a high level of generality. Therefore, the aforementioned underlined claim limitations may reasonably be interpreted as mental/manual observations, evaluations, judgments, and/or opinions made by a person, such as an insurance claims adjuster. If a claim limitation, under its broadest reasonable interpretation, covers concepts which are capable of being performed in the human mind or encompasses a human performing the step(s) mentally with the aid of a pen and paper, then it falls within the “Mental Processes” grouping of abstract ideas. See 2019 Revised PEG. Accordingly, claims 1, 14, and 20 recite an abstract idea that falls within the Mental Processes category.
Furthermore, Examiner notes that dependent claims 2-13 and 15-19 further define the at least one abstract idea (and thus fail to make the abstract idea any less abstract) as set forth below. Examiner notes that: (1) dependent claims 3, 9, 10, 11, and 18 include limitations that are deemed to be additional elements, and require further analysis under Prong Two of Step 2A; and (2) dependent claims 2, 4-8, 12, 13, 15-17, and 19 do not provide any limitations that are deemed to be additional elements which require further analysis under Prong Two of Step 2A. For example, claims 2, 4-8, 12, 13, and 19 merely recite the additional mental steps for determining which rules to apply; tracking the tracking the claims and feedback; and generating the submission score (i.e., these steps are deemed to be reasonably performed mentally or manually using a pen and paper, because they add additional steps that could be observations, evaluations, judgments, and/or opinions made by a person, such as an insurance adjuster when evaluating an insurance authorization request). Similarly, claims 15-17 merely recite the type of information that is used to generate the authorization requests (i.e., these steps are also deemed to be reasonably performed mentally or manually using a pen and paper, because they modify the data that is used for the observations, evaluations, judgments, and/or opinions indicative of the authorization requests).

Step 2A of the 2019 Revised PEG - Prong Two
Regarding Prong Two of Step 2A of the 2019 Revised PEG, it must be determined whether the claim as a whole integrates the abstract idea into a practical application. As noted in the 2019 Revised PEG, it must be determined whether any additional elements in the claims are indicative of integrating the abstract idea into a practical application in a manner that imposes a meaningful limit on the judicial exception. The courts have indicated that additional elements merely using a computer to implement an abstract idea, adding insignificant extra solution activity, or generally linking use of a judicial exception to a particular technological environment or field of use do not integrate a judicial exception into a “practical application.” See MPEP §§ 2106.05 (f)-(h).
In the present case, for independent claim 1, the additional limitations beyond the above-noted at least one abstract idea are as follows (where the bolded portions are the “additional elements” while the underlined portions continue to represent the at least one “abstract idea”):
A system (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)) for vetting insurance authorization requests and improving chances of approval, comprising:

one or more processors (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f));

a display having a user interface (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)) coupled to the one or more processors (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f));

memory coupled to the one or more processors, the memory containing computer instructions which when executed by the one or more processors, causes the one or more processors to (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)):

retrieve and extract information from an authorization request including a treatment and a diagnosis (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of electronic scanning or extracting data from a physical document, as evidenced by the Content Extraction and Transmission, LLC v. Wells Fargo Bank case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d));

identify treatment guidelines based on the information retrieved and extracted from the authorization request;

use rules that have been converted to a standard format that is human readable and separately maintain the rules from each authority issuing the rules;

apply rules to provide a confidence of approval value or indicator;

present the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)); and

present a submission button for generating a request for authorization form (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)).

Next, independent claim 14 recites the following additional limitations beyond the above-noted at least one abstract idea (where the bolded portions are the “additional elements” while the underlined portions continue to represent the at least one “abstract idea”):
A system (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)) for vetting insurance authorization requests and improving chances of approval, comprising:

a server (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f));

one or more applications executing on the server that (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)):

retrieves and extracts information from an authorization request including a treatment and a diagnosis (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of electronic scanning or extracting data from a physical document, as evidenced by the Content Extraction and Transmission, LLC v. Wells Fargo Bank case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d));

identifies treatment guidelines based on the information retrieved and extracted from the authorization request;

uses rules that have been converted to a standard format that is human readable;

apply rules to provide a confidence of approval value or indicator; and

present the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)).

Lastly, independent claim 20 recites the following additional limitations beyond the above-noted at least one abstract idea (where the bolded portions are the “additional elements” while the underlined portions continue to represent the at least one “abstract idea”):
A method of vetting insurance authorization requests and improving chances of approval comprising an application at a server (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)) having one or more applications executing on the server which perform the functions of (the Examiner submits that this additional element amounts to adding the words “apply it” (or an equivalent), or mere instructions to implement the abstract idea on a computer, see MPEP § 2106.05(f)):

retrieving and extracting information from an authorization request including a treatment and a diagnosis (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of electronic scanning or extracting data from a physical document, as evidenced by the Content Extraction and Transmission, LLC v. Wells Fargo Bank case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d));

identifying treatment guidelines based on the information retrieved and extracted from the authorization request;

applying rules that have been converted to a standard format that is human readable to provide a confidence of approval value or indicator; and

present the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a listing of requests for authorization forms, a treatment request and an indicator of confidence of approval for each treatment for a particular patient, a pop-up entry form for generating a new request, a resubmission, or expedited review, and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)).

However, the recitation of these generic computer components and functions in , such that it amounts to no more than: (1) adding the words “apply it” (or is the equivalent of) with the judicial exception; mere instructions to implement an abstract idea on a computer; or merely uses a computer as a tool to perform an abstract idea; and (2) adding insignificant extra-solution activity to the judicial exception. See MPEP §§ 2106.05(f) and (g). For the following reasons, the Examiner submits that the above identified additional limitations do not integrate the above-noted at least one abstract idea into a practical application.
- The following is an example of court decisions that demonstrate merely applying instructions by reciting the computer structure as a tool to implement the claimed limitations (e.g., see MPEP § 2106.05(f)):
- A commonplace business method or mathematical algorithm being applied on a general purpose computer, e.g., see Alice Corp. Pty. Ltd. v. CLS Bank Int’l – similarly, the current invention implements the commonplace insurance vetting method of using rules to authorize or deny authorization requests (i.e., the Examiner submits that the additional elements directed to the system, comprising: one or more processors; memory containing computer instructions; and server executing one or more applications, are generic computer devices implementing generic software).
- Requiring the use of software to tailor information and provide it to the user on a generic computer, e.g., see Intellectual Ventures I LLC v. Capital One Bank (USA) – similarly, the current invention requires software components and the system (i.e., the one or more applications/instructions that are executed by the system) to perform the abstract idea.
- The following is an example of an insignificant extra-solution activity (e.g., see MPEP § 2106.05(g)):
- Example of Mere Data Gathering/Mere Data Outputting:
- Obtaining information about transactions using the Internet to verify credit card transactions, e.g., see CyberSource v. Retail Decisions, Inc. – similarly, the steps directed to: “retrieving and extracting information from an authorization request including a treatment and a diagnosis”; “presenting the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved”; “presenting a submission button for generating a request for authorization form”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; and “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a listing of requests for authorization forms, a treatment request and an indicator of confidence of approval for each treatment for a particular patient, a pop-up entry form for generating a new request, a resubmission, or expedited review, and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”, described in claims 1, 14, and 20, are a necessary data gathering/outputting steps (i.e., “retrieving and extracting information from the authorization request” is a necessary data gathering step in order to apply the rules and the various “presenting” steps are necessary data outputting steps in order to convey the results to a user.).
Thus, the additional elements in independent claims 1, 14, and 20 are not indicative of integrating the judicial exception into a practical application. Similarly, dependent claims 2, 4-8, 12, 13, 15-17, and 19 do not recite any additional elements outside of those identified as being directed to the abstract idea described above. Examiner notes that dependent claims 3, 9, 10, 11, and 18 recite the following additional elements identified in bold font below (with limitations deemed to be part of the above identified abstract idea identified in underlined font):
wherein the one or more processors are further configured to fetch a rule file or rule files based on the treatment in the authorization request (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)) (as described in claim 3);

wherein the one or more processors are configured to present an excerpt of the rule file applied to allow determination of why a claim or authorization is approved or denied (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)) (as described in claim 9);

wherein the user interface further includes a pop-up entry form for generating a new request, a resubmission, or expedited review (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)) (as described in claim 10);

wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)); and

wherein a second questionnaire is generated and sent to the patient based on the CPT codes entered by the physician (the Examiner submits that this additional element amounts to adding insignificant extra-solution activity as noted below, see MPEP § 2106.05(g); and the Examiner further submits that such steps are not unconventional as they merely consist of receiving data over a network, as evidenced by the Intellectual Ventures v. Symantec case, as noted below in the Step 2B Analysis Section, see MPEP § 2106.05(d)) (as described in claim 18).

As such, the additional elements in claims 1, 3, 9, 10, 11, 14, 18, and 20 are not indicative of integrating the judicial exception into a practical application. Looking at the additional limitations as an ordered combination adds nothing that is not already present when looking at the elements taken individually. For instance, unlike the claims that have been held as a whole to be directed to an improvement or otherwise directed to something more than the abstract idea, claims 1-20: (1) are not directed to improvements to the functioning of a computer, or to any other technology or technical field similar to the Enfish, LLC v. Microsoft Corp. case (see MPEP § 2106.05(a)); (2) do not apply or use a judicial exception to effect a particular treatment or prophylaxis for a disease or medical condition (see MPEP § 2106.04(d)(2)); (3) do not apply the judicial exception with, or by use of, a particular machine (see MPEP § 2106.05(b)); (4) do not effect a transformation or reduction of a particular article to a different state or thing (see MPEP § 2106.05(c)); nor do they (5) apply or use the judicial exception in some other meaningful way beyond generally linking the use of the judicial exception to a particular technological environment, such that the claim as whole is more than a drafting effort designed to monopolize the exception (see MPEP § 2106.05(e) and MPEP § 2106.04(d)(2)). For these reasons, claims 1-20 do not recite additional elements that integrate the judicial exception into a practical application.

Step 2B of the 2019 Revised PEG
Regarding Step 2B of the 2019 Revised PEG, claims 1-20 do not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above, with respect to integration of abstract idea into a practical application, the additional elements of claims 1, 3, 9, 10, 11, 14, 18, and 20 amount to no more than: (1) adding the words “apply it” (or is the equivalent of) with the judicial exception; mere instructions to implement an abstract idea on a computer; or merely uses a computer as a tool to perform an abstract idea; (2) adding insignificant extra-solution activity to the judicial exception; and (3) generally linking the use of a judicial exception to a particular technological environment or field of use. See MPEP §§ 2106.05(f)-(h). Further the additional elements, other than the abstract idea per se, when considered both individually and as an ordered combination, amount to no more than limitations consistent with what the courts recognize, or those having ordinary skill in the art would recognize, to be well-understood, routine, and conventional computer components. See MPEP § 2106.05 (d).
Specifically, the Examiner submits that the additional elements of claims 1, 3, 9, 10, 11, 14, 18, and 20, as recited, the system; one or more processors; memory containing computer instructions; user interface; server executing one or more applications; and the steps directed to: “retrieving and extracting information from an authorization request including a treatment and a diagnosis”; “presenting the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved”; “presenting a submission button for generating a request for authorization form”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a listing of requests for authorization forms, a treatment request and an indicator of confidence of approval for each treatment for a particular patient, a pop-up entry form for generating a new request, a resubmission, or expedited review, and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; “wherein the one or more processors are further configured to fetch a rule file or rule files based on the treatment in the authorization request”; “wherein the one or more processors are configured to present an excerpt of the rule file applied to allow determination of why a claim or authorization is approved or denied”; “wherein the user interface further includes a pop-up entry form for generating a new request, a resubmission, or expedited review”; “wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; and “wherein a second questionnaire is generated and sent to the patient based on the CPT codes entered by the physician”, are well-understood, routine, and conventional functions. See MPEP § 2106.05(d)(II).
- In regard to the system; one or more processors; memory containing computer instructions; user interface; server executing one or more applications, these additional elements or combination of elements in the claims, other than the abstract idea per se, amount to no more than well-understood, routine, and conventional activities previously known to the industry, because:
- Applicant’s disclosure supports this assertion. For example, Applicant discloses that: (1) the system is operational with numerous other general purpose computing system environments, such as “personal computer systems, server computer systems, thin clients, hand-held or laptop devices, notebook computing devices, multiprocessor systems, mobile devices, microprocessor-based systems, set top boxes, programmable consumer electronics, network PCs, minicomputer systems, mainframe computer systems, Internet-enabled television, and distributed cloud computing environments that include any of the above systems or devices, and the like” (see Applicant’s specification, as filed on March 9, 2023, paragraph [00051]); (2) the user interface can include a display, speaker, one or more indicator lights, one or more transducers that generate audible indicators, a keyboard, a keypad, mouse, track pad, touch screen, microphone, video camera, or other type of sensor (see Applicant’s specification, as filed on March 9, 2023, paragraph [00058]); and (3) “the instructions can include instructions for monitoring, instructions for analyzing, instructions for retrieving and sending information and related configuration parameters and data that would enable and facilitate an IoT powered e-charting system” (see Applicant’s specification, as filed on March 9, 2023, paragraph [00060]). Thus, Applicant’s disclosure indicates that hardware components are conventional in nature (i.e., well-understood, routine, and conventional computer devices and software instructions). Therefore, the Examiner submits that these devices and software instructions represent well-understood, routine, and conventional computer devices and functions which are known in the medical industry.
- The Examiner submits that these limitations amount to merely using a computer or other machinery as tools for performing their typical functionality in conjunction with performing the above-noted at least one abstract idea (see MPEP § 2106.05(f) and analysis of these limitations under Step 2A, Prong Two above).
Therefore, these limitations are also deemed to be well-understood, routine, and conventional under Step 2B for similar reasons since they are claimed in a generic manner.
- Regarding the steps and features directed to: “retrieving and extracting information from an authorization request including a treatment and a diagnosis”; “presenting the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved”; “presenting a submission button for generating a request for authorization form”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a listing of requests for authorization forms, a treatment request and an indicator of confidence of approval for each treatment for a particular patient, a pop-up entry form for generating a new request, a resubmission, or expedited review, and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; “wherein the one or more processors are further configured to fetch a rule file or rule files based on the treatment in the authorization request”; “wherein the one or more processors are configured to present an excerpt of the rule file applied to allow determination of why a claim or authorization is approved or denied”; “wherein the user interface further includes a pop-up entry form for generating a new request, a resubmission, or expedited review”; “wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; and “wherein a second questionnaire is generated and sent to the patient based on the CPT codes entered by the physician” - The following represents examples that courts have identified to be well-understood, routine, and conventional activities (e.g., see MPEP § 2106.05(d)):
- Receiving or transmitting data over a network, e.g., see Intellectual Ventures v. Symantec – similarly the limitations directed to: “presenting the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved”; “presenting a submission button for generating a request for authorization form”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; “presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface further includes a listing of requests for authorization forms, a treatment request and an indicator of confidence of approval for each treatment for a particular patient, a pop-up entry form for generating a new request, a resubmission, or expedited review, and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; “wherein the one or more processors are further configured to fetch a rule file or rule files based on the treatment in the authorization request”; “wherein the one or more processors are configured to present an excerpt of the rule file applied to allow determination of why a claim or authorization is approved or denied”; “wherein the user interface further includes a pop-up entry form for generating a new request, a resubmission, or expedited review”; “wherein the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated”; and “wherein a second questionnaire is generated and sent to the patient based on the CPT codes entered by the physician”, are similarly deemed to be well-understood, routine, and conventional activity in the medical field, because they also represent the mere collection and transmission of data over a network (i.e., the aforementioned limitations are each the equivalent of receiving and transmitting data over a network). See MPEP § 2106.05(d).
- Electronically scanning or extracting data from a physical document, e.g., see Content Extraction and Transmission, LLC v. Wells Fargo Bank – similarly the limitations directed to: “retrieving and extracting information from an authorization request including a treatment and a diagnosis”, are similarly deemed to be well-understood, routine, and conventional activity in the medical field, because they also represent the mere extraction of information from a physical document. See MPEP § 2106.05(d).
Therefore, the additional elements described in claims 1, 3, 9, 10, 11, 14, 18, and 20 are deemed to be additional elements which do not amount to significantly more than the abstract idea identified above.
Thus, taken alone, the additional elements of claims 1, 3, 9, 10, 11, 14, 18, and 20 do not amount to significantly more than the above-identified judicial exception (the abstract idea). Furthermore, looking at the limitations as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functionality of a computer or improves any other technology, and their collective functions merely provide conventional computer implementation. Therefore, whether taken individually or as an ordered combination, claims 1, 3, 9, 10, 11, 14, 18, and 20 are nonetheless rejected under 35 U.S.C. § 101 as being directed to non-statutory subject matter.
Additionally, dependent claims 2, 4-8, 12, 13, 15-17, and 19 (which depend on claims 1 and 14 due to their respective chains of dependency), do not include additional elements that are sufficient to amount to significantly more than the judicial exception. Examiner notes that dependent claims 2, 4-8, 12, 13, 15-17, and 19 do not include any additional elements beyond those identified as well-understood, routine, and conventional components as described above in the subject matter eligibility rejections of independent claims 1 and 14. Dependent claims 2, 4-8, 12, 13, 15-17, and 19 merely add limitations that further narrow the abstract idea described in independent claims 1 and 14. Therefore, claims 1-20 are nonetheless rejected under 35 U.S.C. § 101 as being directed to non-statutory subject matter.

Claim Rejections - 35 USC § 103
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 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.

Claims 1-9, 12, and 13 are rejected under 35 U.S.C. 103 as being unpatentable over:
- Shapiro (Pub. No. US 2024/0127934), in view of:
- Erramilli et al. (Pub. No. US 2022/0254463).

Regarding claim 1,
- Shapiro (Pub. No. US 2024/0127934) teaches:
- a system for vetting insurance authorization requests and improving chances of approval (Shapiro, paragraph [0005]; Paragraph [0005] teaches a system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments.), comprising:
- one or more processors (Shapiro, paragraph [0174]; Paragraph [0174] teaches that the system includes one or more of a server, having a processor (i.e., one or more processors).);
- a display having a user interface coupled to the one or more processors (Shaprio, paragraph [0006]; Paragraph [0006] teaches a display coupled to a client computing device (i.e., a display coupled to one or more processors) and displaying a graphical user interface (i.e., the display has a user interface).);
- memory coupled to the one or more processors, the memory containing computer instructions which when executed by the one or more processors, causes the one or more processors to (Shapiro, paragraph [0027]; Paragraph [0027] teaches a non-transitory computer readable medium (i.e., a memory) for storing instructions that, when executed by one or more processors of a computing device of the system (i.e., the memory is coupled to the one or more processors which executes the computer instructions), e.g., a client computing device and/or a server, such as a processing engine of a server of the system, so as to cause the one or more processors to perform one or more methods disclosed herein, such as for identifying, authenticating, evaluating, adjusting, and/or submitting claims to the third-party obligator.):
- retrieve and extract information from an authorization request including a treatment and a diagnosis (Shapiro, paragraph [0114]; Paragraph [0114] teaches that the system collects and evaluates different elements submitted with regard to generating a claim (i.e., an authorization request), such as the basic requirements to build a claim. For example, the rules are applied to entered data to ensure that all the required fields are complete including determining that all of the treatments applied have been filled out (i.e., retrieving and extracting treatment data from the authorization request). Paragraph [0081] also teaches that the required data also includes the diagnoses (i.e., retrieving and extracting diagnosis data from the authorization request).);
- identify treatment guidelines based on the information retrieved and extracted from the authorization request (Shapiro, paragraph [0089]; Paragraph [0089] teaches that the system is configured for determining if patient conditions meet government established guidelines mandating treatment (i.e., identifying treatment guidelines) and if the conditions precedent for receiving approval are present the procedure should be approved (i.e., the guidelines are based on information extracted from the authorization request).);
- use rules that have been converted to a standard format that is human readable and separately maintain the rules from each authority issuing the rules (Shapiro, paragraphs [0036] and [0037]; Paragraph [0036] teaches that system may retrieve one or more rules from a rules database associated with the system server, the rules database storing a plurality or rules setting forth a set of requirements for receiving payment of the claim (i.e., rules that have been converted to a standard format that is human readable and separately maintained from other authorities issuing rules). Paragraph [0037] teaches that the retrieved rules are may be compared to the characterizations of the conditions of the patient, so as to determine if the information of the claim in that regard is accurate or includes a deficiency (i.e., the rules are used).);
- apply rules to provide a confidence of approval value or indicator (Shapiro, paragraph [0037]; Paragraph [0037] teaches that the system may then compare the retrieved rules to the characterizations of the one or more services being, or having been, provided so as to determine if the information of the claim in that regard includes a deficiency (i.e., the rules are applied to the authorization request). If a deficiency is determined, it may then be flagged and/or corrected. Further, once corrected, if needed, then the method may include engaging a score generator of the system so as generate a score representing a likelihood that the claim will be paid upon by the third-party obligator (i.e., the rules are used to provide a confidence of approval value or indicator, being the generated score that represents the likelihood that a claim will be paid by the third-party obligator).); and
- present the confidence value or indicator on the user interface based on the rules applied by providing an estimated percentage of chance that a claim will be approved (Shapiro, paragraphs [0026] and [0138]; Paragraph [0026] generally teaches that the generated score for the one or more claims can be sent back to a first computing device (i.e., presenting the confidence value or indicator on a user interface) and/or may be used to generate an invoice. Paragraph [0138] teaches that the confidence score can be expressed in the form of a percentage that shows how closely the invoice package coheres to the terms of the insurance policy (i.e., the percentage that shows how closely the invoice package adheres to the terms of an insurance policy is interpreted as “a confidence value is provided as an estimated percentage chance that a claim will be approved”) and can also be sent to the insurance provider. Further, paragraph [0138] teaches that the percentage values at a certain level, e.g., 80 or 85% or 90 or 95% or higher, would not require review by an insurance provider (i.e., indicating that they have a good chance of being approved without the need for review by a human, because they adhere more closely to the terms of the insurance policy), where a score below these limits may be subjected to review and scores below 75% or 70% or 65 or 60% may require substantive review (indicating that these claims have a lesser chance of being approved and require a review by a human, because they do not adhere to the terms of insurance policy as closely as claims with a high percentage confidence value).).
- Shapiro does not explicitly teach, however, in analogous art of in analogous art of systems and methods for processing medical claims, Erramilli et al. (Pub. No. US 2022/0254463) teaches a system, comprising instructions to cause the one or more processors to:
- present a submission button for generating a request for authorization form (Erramilli, paragraph [0021]; Paragraph [0021] teaches that the content generation GUI 30 also includes a generate affordance 90 (e.g., a submit button) (i.e., presenting a submission button for generating a request for authorization). Paragraph [0015] teaches that this feature is beneficial for processing medical claims.).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, to incorporate a step and feature directed to including a submit button on a screen to generate medical claims, as taught by Erramilli, in order to process medical claims. See Erramilli, paragraph [0015]; see also MPEP § 2143 G.

Regarding claim 2,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 2 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are further configured to index the treatment and diagnosis from the authorization request (Shapiro, paragraph [0017]; Paragraph [0017] teaches all of the data in the data containing the patient data packets and their contents may be classified and tagged in accordance with one or more categories (i.e., indexing the authorization requests from the patient data, including the treatment and diagnosis data).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 3,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 3 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are further configured to fetch a rule file or rule files based on the treatment in the authorization request (Shapiro, paragraph [0014]; Paragraph [0014] teaches that a processing engine may be configured to retrieve from the memory, the one more rules, such as the one or more rules being identified as being applicable to the patient’s obligation agreement and the treatment provided to the patient by the healthcare professional (i.e., the one or more processors fetch a rule based on the treatment in the authorization request).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 4,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 4 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are further configured to determine if an approval is unconditional or conditional (Shapiro, paragraph [0028]; Paragraph [0028] generally teaches that the one or more rules may include a requirement that should be met for receiving payment on the claim (i.e., the one or more rules that are implemented by the one or more processors naturally determine if an approval is conditioned on certain requirements or not, i.e., whether the approval is conditional or unconditional).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 5,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 4 (which claim 5 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are configured to indicate the approval if the approval is unconditional or all conditional requirements are met (Shapiro, paragraph [0250]; Paragraph [0250] teaches that in various instances the one or more rules may include a requirement that should be met for receiving payment on the claim, and the method may include determining that all requirements have been met (i.e., the one or more processors are configured to indicate that all conditional requirements are met).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 6,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 4 (which claim 6 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are configured to solicit for more information to determine claim status if the approval is conditional (Shapiro, paragraph [0250]; Paragraph [0250] teaches that where information may be inaccurate or missing, the method may include retrieving accurate information when it is determined that the information in the claim packet is deficient because of it being either missing or inaccurate (i.e., the one or more processors are configured to solicit for more information, i.e., the deficient, missing, or inaccurate information, to determine the claim status when the approval is conditional).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 7,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 7 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are further configured to use configuration files to determine which rule files apply (Shapiro, paragraph [0028]; Paragraph [0028] teaches that the generating of a claim may include identifying one or more rules applicable to one or more of the treatment and the provisions of the agreement (i.e., determining which rule files apply to the claim).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 8,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 8 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are configured to determine if the rule file is a latest version (Shapiro, paragraph [0130]; Paragraph [0130] teaches that the system may be configured to query whether the currently applied rules are the most update rules (i.e., the one or more processors are configured to determine if the rule file is the latest version of the rules), and when it is found that one or more rules are outdated, the system may revise the applied rules and/or signal that an update to the rules is required to be entered into the system, e.g., manually, prior to indicating that a given claim is complete.).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 9,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 9 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are configured to present an excerpt of the rule file applied to allow determination of why a claim or authorization is approved or denied (Shapiro, paragraph [0033]; Paragraph [0033] teaches that there may be situations when there is a conflict related to one or more of a treatment proposed by a healthcare provider (i.e., an indication that a claim or authorization will be denied). In such situations, paragraph [0033] teaches that where an inconsistency results, but the information necessary to resolve the conflict is determined by the system or a user thereof, then the system may autonomously substitute the correct information into a data packet so as to thereby resolve any issues. In various instances, before such a correction is made, the system may present the proposed correction to a user of the system such as for approval thereby prior to making the correction (i.e., presenting an excerpt of why a claim will be denied and the information that is needed to fix the issue to a user to allow a determination of why the claim will be denied).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 12,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 12 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the one or more processors are configured to iteratively determine and present the confidence value or indicator on the user interface based on the rules applied as the claim is presented and modified (Shapiro, paragraph [0058]; Paragraph [0058] teaches that where a deficiency is present, the methods may include retrieving from an associated database the deficient information in response to the indication, so as to produce an updated claim, the updated claim having the deficiency resolved (i.e., iteratively updating the status of the claim as the claim is modified).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Regarding claim 13,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 13 depends on), as described above.
- Shapiro further teaches a system, wherein:
- wherein the one or more processors are configured to provide a submission score for every authorization request submitted where the score is dependent on a probability that the authorization request adheres to the rules or insurance guidelines (Shapiro, paragraph [0138]; Paragraph [0138] teaches the confidence score determines how closely the invoice package coheres to the terms of the insurance policy can also be sent to the insurance provider (i.e., the scores indicate a probability that an authorization request adheres to the insurance guidelines).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Erramilli, described in the analysis of the obviousness rejection of claim 1 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Claim 10 and 11 are rejected under 35 U.S.C. 103 as being unpatentable over:
- The combination of: Shapiro (Pub. No. US 2024/0127934), as modified in view of: Erramilli et al. (Pub. No. US 2022/0254463) as applied to claim 1 above, and further in view of:
- Gice et al. (Pub. No. US 2011/0288879).

Regarding claim 10,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 10 depends on), as described above.
- The combination of: Shapiro, as modified in view of Erramilli, does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Gice et al. (Pub. No. US 2011/0288879) teaches a system, wherein:
- the user interface further includes a pop-up entry form for generating a new request, a resubmission, or expedited review (Gice, paragraph [0261]; Paragraph [0261] teaches that a claim professional responsible for handling a claim for a bodily injury is able to access a user interface for generating diagnostics, treatment and pricing information appropriate for the claim (i.e., the user interface includes a pop-up entry form for generating a new request). Paragraph [0261] teaches that the interface includes form fields and other interface elements allowing the claim professional to enter data associated with the claim (i.e., the user interface includes a pop-up entry form for generating a new request). Paragraph [0261] teaches that these features are beneficial for implementing a claim data entry system.).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to further modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, as modified in view of Erramilli, to incorporate a step and feature directed to including an entry form for generating new requests, as taught by Gice, in order to implement a claim data entry system. See Gice, paragraph [0261]; see also MPEP § 2143 G.

Regarding claim 11,
- The combination of: Shapiro, as modified in view of Erramilli, teaches the limitations of claim 1 (which claim 11 depends on), as described above.
- The combination of: Shapiro, as modified in view of Erramilli, does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Gice et al. (Pub. No. US 2011/0288879) teaches a system, wherein:
- the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated (Gice, paragraph [0261]; Paragraph [0261] teaches that a claim professional responsible for handling a claim for a bodily injury is able to access a user interface for generating diagnostics, treatment and pricing information appropriate for the claim (i.e., the user interface includes a form for generating a treatment request). Paragraph [0261] further teaches that the interface includes form fields and other interface elements allowing the claim professional to enter data associated with the claim. Still further, paragraph [0262] further teaches that the claim professional enters a type of bodily injury. In one example, the claim professional selects the type of bodily injury from a dropdown menu containing a plurality of available injury types (e.g., cervical strain/sprain whiplash, finger injury). (i.e., the user interface includes a pull-down menu for further detailed services for a particular body system being treated).).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to further modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, as modified in view of Erramilli, to incorporate a step and feature directed to including an entry form for generating treatment requests and a pull-down menu for further detailed services for a particular body system that is being treated, as taught by Gice, in order to implement a claim data entry system. See Gice, paragraph [0261]; see also MPEP § 2143 G.

Claims 14 and 15 are rejected under 35 U.S.C. 103 as being unpatentable over:
- Shapiro (Pub. No. US 2024/0127934), in view of:
- Gice et al. (Pub. No. US 2011/0288879).

Regarding claim 14,
- Shapiro (Pub. No. US 2024/0127934) teaches:
- a system for vetting insurance authorization requests and improving chances of approval (Shapiro, paragraph [0005]; Paragraph [0005] teaches a system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments.), comprising:
- a server; and one or more applications executing on the server that (Shapiro, paragraphs [0027] and [0121]; Paragraph [0027] teaches a server, such as a processing engine of a server of the system, so as to cause the one or more processors to perform one or more methods disclosed herein. Paragraph [0121] teaches that the system includes a downloadable application running on the client computing device.):
- retrieves and extracts information from an authorization request including a treatment and a diagnosis (Shapiro, paragraph [0114]; Paragraph [0114] teaches that the system collects and evaluates different elements submitted with regard to generating a claim (i.e., an authorization request), such as the basic requirements to build a claim. For example, the rules are applied to entered data to ensure that all the required fields are complete including determining that all of the treatments applied have been filled out (i.e., retrieving and extracting treatment data from the authorization request). Paragraph [0081] also teaches that the required data also includes the diagnoses (i.e., retrieving and extracting diagnosis data from the authorization request).);
- identifies treatment guidelines based on the information retrieved and extracted from the authorization request (Shapiro, paragraph [0089]; Paragraph [0089] teaches that the system is configured for determining if patient conditions meet government established guidelines mandating treatment (i.e., identifying treatment guidelines) and if the conditions precedent for receiving approval are present the procedure should be approved (i.e., the guidelines are based on information extracted from the authorization request).);
- uses rules that have been converted to a standard format that is human readable (Shapiro, paragraphs [0036] and [0037]; Paragraph [0036] teaches that the system may retrieve one or more rules from a rules database associated with the system server, the rules database storing a plurality or rules setting forth a set of requirements for receiving payment of the claim (i.e., rules that have been converted to a standard format that is human readable and separately maintained from other authorities issuing rules). Paragraph [0037] teaches that the retrieved rules are may be compared to the characterizations of the conditions of the patient, so as to determine if the information of the claim in that regard is accurate or includes a deficiency (i.e., the rules are used).);
- apply rules to provide a confidence of approval value or indicator (Shapiro, paragraph [0037]; Paragraph [0037] teaches that the system may then compare the retrieved rules to the characterizations of the one or more services being, or having been, provided so as to determine if the information of the claim in that regard includes a deficiency (i.e., the rules are applied to the authorization request). If a deficiency is determined, it may then be flagged and/or corrected. Further, once corrected, if needed, then the method may include engaging a score generator of the system so as generate a score representing a likelihood that the claim will be paid upon by the third-party obligator (i.e., the rules are used to provide a confidence of approval value or indicator, being the generated score that represents the likelihood that a claim will be paid by the third-party obligator).); and
- present the confidence value or indicator on a user interface based on the rules applied (Shapiro, paragraph [0026]; Paragraph [0026] generally teaches that the generated score for the one or more claims can be sent back to a first computing device (i.e., presenting the confidence value or indicator on a user interface) and/or may be used to generate an invoice.).
- Shapiro does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Gice et al. (Pub. No. US 2011/0288879) teaches a system, wherein:
- the user interface further includes a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated (Gice, paragraph [0261]; Paragraph [0261] teaches that a claim professional responsible for handling a claim for a bodily injury is able to access a user interface for generating diagnostics, treatment and pricing information appropriate for the claim (i.e., the user interface includes a form for generating a treatment request). Paragraph [0261] further teaches that the interface includes form fields and other interface elements allowing the claim professional to enter data associated with the claim. Still further, paragraph [0262] further teaches that the claim professional enters a type of bodily injury. In one example, the claim professional selects the type of bodily injury from a dropdown menu containing a plurality of available injury types (e.g., cervical strain/sprain whiplash, finger injury). (i.e., the user interface includes a pull-down menu for further detailed services for a particular body system being treated).).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, to incorporate a step and feature directed to including an entry form for generating treatment requests and a pull-down menu for further detailed services for a particular body system that is being treated, as taught by Gice, in order to implement a claim data entry system. See Gice, paragraph [0261]; see also MPEP § 2143 G.

Regarding claim 15,
- The combination of: Shapiro, as modified in view of Gice, teaches the limitations of claim 14 (which claim 15 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the authorization request is created with information from a first questionnaire from a patient that includes primarily patient demographic information from the patient (Shapiro, paragraphs [0173] and [0237]; Paragraph [0173] teaches that the system may be configured for generating an interview, such as an interactive, intuitive interview, whereby the interview may include a number of interrogatories that are configured to elicit responses from a user (i.e., the authorization request is created from a first questionnaire from a patient) with respect to their personal history, physiological or biological or medical background, psychology, and/or environment. In various embodiments, the system may prompt a user, e.g., patient and/or healthcare provider, to upload, e.g., via a secure, encrypted network connection, one or more personal records, such as a personal electronic health or medical record, genetic data, and the like (i.e., this data includes patient demographic information from the patient). Specifically, paragraph [0237] teaches that the received patient data may be grouped into a number of categories, including demographics national origin, ethnic/religious background, sexual orientation, etc.) and the like (i.e., this data includes patient demographic information from the patient).).
The motivation and rationale for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of Gice, described in the analysis of the obviousness rejection of claim 14 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Claims 16 and 17 are rejected under 35 U.S.C. 103 as being unpatentable over:
- The combination of: Shapiro (Pub. No. US 2024/0127934), as modified in view of: Gice et al. (Pub. No. US 2011/0288879) as applied to claim 15 above, and further in view of:
- Chen et al. (Pub. No. US 2024/0047055).

Regarding claim 16,
- The combination of: Shapiro, as modified in view of Gice, teaches the limitations of claim 15 (which claim 16 depends on), as described above.
- The combination of: Shapiro, as modified in view of Gice, does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Chen et al. (Pub. No. US 2024/0047055) teaches a system, wherein:
- the authorization request is further created with physician examination notes including CPT codes and IDC-10 codes (Chen, paragraph [0066]; Paragraph [0066] teaches that medical claim forms include codes, including CPT codes and ICD-10 codes (i.e., the authorization request includes CPT codes and ICD-10 codes). Paragraph [0066] teaches that this feature is beneficial for determining reimbursement to a provider/facility.).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to further modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, as modified in view of Gice, to incorporate a step and feature directed to including CPT codes and ICD-10 codes in an authorization request, as taught by Chen, in order to determine reimbursement to a provider/facility. See Chen, paragraph [0066]; see also MPEP § 2143 G.

Regarding claim 17,
- The combination of: Shapiro, as modified in view of: Gice and Chen, teaches the limitations of claim 16 (which claim 17 depends on), as described above.
- Shapiro further teaches a system, wherein:
- the authorization request is further created with uploaded files and lab tests (Shapiro, paragraph [0017]; Paragraph [0017] teaches all of interactive interview may prompt the user to upload one or more person records (i.e., the authorization request is created with uploaded files), such as genetic data and the like. Paragraph [0017] further teaches that the source of the genetic data may be derived and/or received from commercial diagnostic laboratories (i.e., the authorization request is created with lab test data).).
The motivations and rationales for modifying the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, in view of: Gice and Chen, described in the analysis of the obviousness rejection of claim 16 similarly apply to this obviousness rejection, and are incorporated herein by reference.

Claim 18 is rejected under 35 U.S.C. 103 as being unpatentable over:
- The combination of: Shapiro (Pub. No. US 2024/0127934), as modified in view of: Gice et al. (Pub. No. US 2011/0288879) and Chen et al. (Pub. No. US 2024/0047055) as applied to claim 16 above, and further in view of:
- Saliman et al. (Pub. No. US 2017/0372029).

Regarding claim 18,
- The combination of: Shapiro, as modified in view of: Gice and Chen, teaches the limitations of claim 16 (which claim 18 depends on), as described above.
- The combination of: Shapiro, as modified in view of: Gice and Chen, does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Saliman et al. (Pub. No. US 2017/0372029) teaches a system, wherein:
- a second questionnaire is generated and sent to the patient based on the CPT codes entered by the physician (Saliman, paragraphs [0039] and [0178]; Paragraph [0039] generally teaches that scheduling of the treatment may act as a trigger for the administration of a questionnaire to a patient and, in response to the scheduling each medical questionnaire stored in the questionnaire database is indexed with a treatment identifier, such as a CPT code (i.e., the second questionnaire is based on the CPT codes entered by the physician). The medical questionnaire that is indexed with an identifier of the scheduled treatment for provision to the patient may then be selected for provision to the patient and provision of the selected medical questionnaire to the patient may be facilitated (i.e., a second questionnaire is generated and sent to the patient based on the CPT codes entered by the physician). Paragraph [0178] teaches that this feature is beneficial for determining which, if any, treatment and/or diagnostic codes are appropriate.).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to further modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, as modified in view of: Gice and Chen, to incorporate a step and feature directed to transmitting a medical questionnaire to a patient based on entered CPT codes, as taught by Saliman, in order to determine which, if any, treatment and/or diagnostic codes are appropriate. See Saliman, paragraph [0178]; see also MPEP § 2143 G.

Claim 19 is rejected under 35 U.S.C. 103 as being unpatentable over:
- The combination of: Shapiro (Pub. No. US 2024/0127934), as modified in view of: Gice et al. (Pub. No. US 2011/0288879) as applied to claim 14 above, and further in view of:
- Ligon (Pub. No. US 2022/0044328).

Regarding claim 19,
- The combination of: Shapiro, as modified in view of Gice, teaches the limitations of claim 14 (which claim 19 depends on), as described above.
- Shapiro further teaches that the system, provides:
- a submission score for every authorization request submitted where the score is dependent on a probability that the authorization request adheres to the rules or insurance guidelines (Shapiro, paragraph [0138]; Paragraph [0138] teaches that the confidence score, determined by the system, shows how closely the invoice package coheres to the terms of the insurance policy (i.e., the score is dependent on a probability that the authorization request adheres to the rules or insurance guidelines) and can also be sent to the insurance provider, whereby with a score at one level, e.g., 80 or 85% or 90 or 95% or higher, less review by the insurance provider is necessary, whereas a score of below these limits, may be subjected to further review, and scores below 75% or 70% Or 65 or 60% may require substantive review (i.e., this disclosure is also interpreted as teaching that the system provides a submission score, in this case the confidence score, for every authorization request submitted, where the score is dependent on a probability that that the authorization request adheres to the rules or insurance guidelines).).
- The combination of: Shapiro, as modified in view of Gice, does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Ligon (Pub. No. US 2022/0044328) teaches a system, where:
- a red indicator indicates a high probability of rejection of the authorization request and a green indicator indicates a high probability of allowance of the authorization request (Ligon, paragraphs [0027] and [0083]; Paragraph [0083] generally teaches that the evaluate claim module (or some other module) may be configured in some embodiments to keep track of the user’s actions to cure and/or remedy potential issues, defects, deficiencies, and/or the like identified for the insurance claim. For example, a “stop light” graphical indicator may be displayed on the user interface that changes a denial data object (e.g., the corresponding potential issue, defect, deficiency, and/or the like) from red to green once the user has completed one or more mitigating actions to cure and/or remedy the corresponding potential issue, defect, deficiency, and/or the like (i.e., when a claim is denied, it is indicated as red on the stop light feature, this teaching is interpreted to be the equivalent of “a red indicator indicating a high probability of rejection of the authorization request. Likewise, when a the user has cured the deficiencies (i.e., fixed the issues so the claim can move forward and be approved), it is indicated as green on the stop light feature, this teaching is interpreted to be the equivalent of “a green indicator indicating a high probability of allowance of the authorization request.). Paragraph [0027] teaches that this feature is beneficial for presenting the propensity to deny data objects to a user through a user interface.).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to further modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, as modified in view of Gice, to incorporate a step and feature directed to displaying a stop light with a red indicator that shows when a claim will be denied and a green indicator that shows when all potential issues, defects, and deficiencies have been cured, as taught by Ligon, in order to present the propensity to deny data objects to a user through a user interface. See Ligon, paragraph [0027]; see also MPEP § 2143 G.

Claims 20 is rejected under 35 U.S.C. 103 as being unpatentable over:
- Shapiro (Pub. No. US 2024/0127934), in view of:
- Stueckemann et al. (Pub. No. US 2016/0342752); and
- Gice et al. (Pub. No. US 2011/0288879).

Regarding claim 20,
- Shapiro (Pub. No. US 2024/0127934) teaches:
- a method of vetting insurance authorization requests and improving chances of approval (Shapiro, paragraph [0005]; Paragraph [0005] teaches a method for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments.) comprising an application at a server having one or more applications executing on the server which perform the functions of (Shapiro, paragraphs [0027] and [0121]; Paragraph [0027] teaches a server, such as a processing engine of a server of the system, so as to cause the one or more processors to perform one or more methods disclosed herein. Paragraph [0121] teaches that the system includes a downloadable application running on the client computing device.):
- retrieving and extracting information from an authorization request including a treatment and a diagnosis (Shapiro, paragraph [0114]; Paragraph [0114] teaches that the system collects and evaluates different elements submitted with regard to generating a claim (i.e., an authorization request), such as the basic requirements to build a claim. For example, the rules are applied to entered data to ensure that all the required fields are complete including determining that all of the treatments applied have been filled out (i.e., retrieving and extracting treatment data from the authorization request). Paragraph [0081] also teaches that the required data also includes the diagnoses (i.e., retrieving and extracting diagnosis data from the authorization request).);
- identifying treatment guidelines based on the information retrieved and extracted from the authorization request (Shapiro, paragraph [0089]; Paragraph [0089] teaches that the system is configured for determining if patient conditions meet government established guidelines mandating treatment (i.e., identifying treatment guidelines) and if the conditions precedent for receiving approval are present the procedure should be approved (i.e., the guidelines are based on information extracted from the authorization request).);
- applying rules that have been converted to a standard format that is human readable to provide a confidence of approval value or indicator (Shapiro, paragraphs [0036] and [0037]; Paragraph [0036] teaches that system may retrieve one or more rules from a rules database associated with the system server, the rules database storing a plurality or rules setting forth a set of requirements for receiving payment of the claim (i.e., rules that have been converted to a standard format that is human readable and separately maintained from other authorities issuing rules). Paragraph [0037] teaches that the system may then compare the retrieved rules to the characterizations of the one or more services being, or having been, provided so as to determine if the information of the claim in that regard includes a deficiency (i.e., the rules are applied to the authorization request). If a deficiency is determined, it may then be flagged and/or corrected. Further, once corrected, if needed, then the method may include engaging a score generator of the system so as generate a score representing a likelihood that the claim will be paid upon by the third-party obligator (i.e., the rules are used to provide a confidence of approval value or indicator, being the generated score that represents the likelihood that a claim will be paid by the third-party obligator).); and
- presenting the confidence value or indicator on a user interface based on the rules applied, wherein the user interface includes an indicator of confidence approval for each treatment for a particular patient (Shapiro, paragraph [0026]; Paragraph [0026] generally teaches that the generated score for the one or more claims can be sent back to a first computing device (i.e., presenting the confidence value or indicator on a user interface) and/or may be used to generate an invoice. Paragraphs [0138] and [0144] teach that the confidence score, which can be expressed as a percentage that indicates the likelihood that an invoice packet will be approved and paid may be sent to an insurance provider (i.e., the user interface includes an indicator of confidence approval for each treatment for a particular patient).).
- Shapiro does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Stueckemann et al. (Pub. No. US 2016/0342752) teaches a system, wherein:
- the user interface further includes a listing of requests for authorization forms, and a treatment request (Stueckemann, paragraphs [0137], [0213], and [0239], FIG. 22; Paragraph [0213] teaches that when a healthcare provider logs into his/her account, he/she can view the current status of all the insurance authorization forms of his/her patients (i.e., the user interface includes a listing of requests for authorization forms). Paragraph [0137] teaches that patients who have open referrals (i.e., treatment requests) can be listed in area 2206 (see Figure 22) (i.e., the user interface includes treatment requests). Paragraph [0239] teaches that this feature is beneficial for improving patient on-boarding rates by offering the benefits of reduced paperwork and reliable PA form completion to clinics.).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, to incorporate a step and feature directed to including a listing of requests for authorization forms and treatment requests in the user interface, as taught by Stueckemann, in order to improve patient on-boarding rates by offering the benefits of reduced paperwork and reliable PA form completion to clinics. See Stueckemann, paragraph [0239]; see also MPEP § 2143 G.
- Further, the combination of: Shapiro, as modified in view of Stueckemann, does not explicitly teach, however, in analogous art of systems and methods for processing medical claims, Gice et al. (Pub. No. US 2011/0288879) teaches a system, wherein:
- the user interface further includes a pop-up entry form for generating a new request, a resubmission, or expedited review (Gice, paragraph [0261]; Paragraph [0261] teaches that a claim professional responsible for handling a claim for a bodily injury is able to access a user interface for generating diagnostics, treatment and pricing information appropriate for the claim (i.e., the user interface includes a pop-up entry form for generating a new request). Paragraph [0261] teaches that the interface includes form fields and other interface elements allowing the claim professional to enter data associated with the claim (i.e., the user interface includes a pop-up entry form for generating a new request).), and a treatment request and a pull-down menu for further detailed services or goods required for a particular body system being treated (Gice, paragraph [0261]; Paragraph [0261] teaches that a claim professional responsible for handling a claim for a bodily injury is able to access a user interface for generating diagnostics, treatment and pricing information appropriate for the claim (i.e., the user interface includes a form for generating a treatment request). Paragraph [0261] further teaches that the interface includes form fields and other interface elements allowing the claim professional to enter data associated with the claim. Still further, paragraph [0262] further teaches that the claim professional enters a type of bodily injury. In one example, the claim professional selects the type of bodily injury from a dropdown menu containing a plurality of available injury types (e.g., cervical strain/sprain whiplash, finger injury). (i.e., the user interface includes a pull-down menu for further detailed services for a particular body system being treated).).
Therefore, it would have been obvious to one of ordinary skill in the art of systems and methods for processing medical claims at the time of the effective filing date of the claimed invention to further modify the system for evaluating and processing claims on behalf of a patient receiving health treatments from a third-party obligator under an agreement to provide for the proposed treatments taught by Shapiro, as modified in view of Stueckemann, to incorporate steps and features directed to: (i) including an entry form for generating new requests, and (ii) including an entry form for generating treatment requests and a pull-down menu for further detailed services for a particular body system that is being treated, as taught by Gice, in order to implement a claim data entry system. See Gice, paragraph [0261]; see also MPEP § 2143 G.

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).
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/N.A.A./Examiner, Art Unit 3686

/JONATHON A. SZUMNY/Primary Examiner, Art Unit 3686

Prosecution Timeline

• Mar 09, 2023: Application Filed
• Jul 12, 2025: Non-Final Rejection — §101, §103
• Oct 24, 2025: Response Filed
• Dec 19, 2025: Final Rejection — §101, §103 (current)