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 .
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on July 23, 2025 has been entered.
Claim Status
The following is a Non-Final Office action in response to communications received July 23, 2025.
Claims 3-5, 12-14 have been previously cancelled.
Claims 8 and 17 have been canceled.
Claims 1, 6, 9, 10, 15, 20, and 22 have been amended.
Therefore claims 1-2, 6, 7, 9-11, 15, 16, and 18-26 are pending and addressed below.
Claim Rejections - 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1-2, 6, 7, 9-11, 15, 16, and 18-26 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e., a law of nature, a natural phenomenon, or an abstract idea) without significantly more.
Step 2A Prong 1: The claims recite an abstract idea of obtaining records to determine clinical appropriateness of a medical procedure, extracting a subset of data from the record, generating a score and a preapproval decision for the procedure based on the score, generate a summary of the preapproval decision, and output the preapproval decision and summary, which is a certain method of organizing human activity (e.g. fundamental economic principles or practices including hedging, insurance, mitigating risk; commercial or legal interactions including agreements in the form of contracts, legal obligations, advertising, marketing or sales activities or behaviors, business relations; managing personal behavior or relationships or interactions between people including social activities, teaching, and following rules or instructions). The following limitations set forth the abstract idea.
Independent claim 1 and representative claims 10 and 20:
A system comprising:
obtaining an
determining a clinical appropriateness of the medical procedure or test by: i) extracting a subset of both the structured and unstructured data from the medical record relevant to the medical procedure or test, and ii) generating, at least in part by providing the subset of both the structured and unstructured data as inputs
generating a preapproval decision for the medical procedure or test based on the score, including determining that the medical procedure or test is preapproved based on the score meeting or exceeding a threshold value;
transmitting the preapproval decision to the ;
generating a summary of the preapproval decision, wherein the summary includes an indication of the preapproval decision and an indication of clinical appropriateness criteria that impacted the preapproval decision;
identifying procedure and diagnostic codes from the
responsive to determining that the medical procedure or test is preapproved, automatically generating an
transmitting a consolidated data package that includes the summary and the
Step 2A Prong 2: The claim limitations recite the following additional elements that are beyond the judicial exception:
one or more processors; and one or more memories storing processor-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform operations;
one or more processors of an intermediary computing system;
from a health care provider computing system from the intermediary computing system
One or more non-transitory computer readable media storing processor-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations;
electronic data;
machine learning;
a trained machine learning classification model;
artificial intelligence model; and
transmitting to a payor computing system remote from the intermediary computing system.
These additional elements are not indicative of integration into a practical application because:
Regarding the one or more processors; and one or more memories storing processor-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform operations, one or more processors of an intermediary computing system, one or more non-transitory computer readable media storing processor-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations, electronic data, and machine learning, a trained machine learning classification model; artificial intelligence model, and transmitting to a payor computing system remote from the intermediary computing system, they add the words “apply it” (or an equivalent) with the judicial exception, or mere instructions to implement an abstract idea on a computer, or merely uses a computer as a tool to perform an abstract idea. See MPEP 2106.05(f);
When considered as a combination, the combination of additional elements only generally limits the abstract idea to a particular technological environment of networked computing. As such the combination of additional elements does not amount to significantly more than the abstract idea.
Therefore under step 2A prong II the claims are directed to an abstract idea.
Step 2B: The claim limitations do not recite additional elements, or an ordered combination of additional elements, that are sufficient to amount to significantly more than the judicial exception.
As discussed with respect to step 2A prong 2 above, the additional elements of one or more processors; and one or more memories storing processor-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform operations, one or more processors of an intermediary computing system, one or more non-transitory computer readable media storing processor-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations, electronic data, and machine learning, a trained machine learning classification model; artificial intelligence model, and transmitting to a payor computing system remote from the intermediary computing system are mere instructions to apply an exception, and do not integrate a judicial exception into a practical application at step 2A or provide an inventive concept at step 2B.
According to the MPEP 2106, a conclusion that an additional element is mere instructions to apply an exception under step 2A should be re-evaluated at step 2B. Thus, the additional elements mentioned above are simply the use of a computer in its ordinary capacity and does not provide significantly more. See Affinity Labs v. DirecTV, 838 F.3d 1253, 1262 and MPEP 2106.05 (f). For example, the additional elements only provide a result-oriented solution and lack details as to how the computer performs the modifications, which is equivalent to “apply it”. See Alice Corp. v. CLS Bank, 134 S. Ct. 2347, 2357 and MPEP 2106.05 (f).
When considered as a combination, the additional elements only generally link the abstract idea to a technological environment of networked computing devices. Therefore the combination does not amount to significantly more.
Therefore, when considering all the additional claim elements both individually and as an ordered combination, Examiner finds that the independent claims do not amount to significantly more than the exception.
Dependent Claims 2, 6, 7, 9, 11, 15, 16, 18, 19, and 21-26 further narrow the abstract idea and/or the additional elements disclosed in the claims have been addressed above. These claims do no integrate the abstract ideas into practical applications or amount to significantly more than the abstract idea.
Therefore the dependent claims fail to cure this deficiency and are rejected accordingly.
Claim Rejections - 35 USC § 103
The 35 U.S.C. 103 rejections of claims 1-2, 6-11, 15-26 rejected under as being unpatentable over US Patent 10446266 – Daniel et al. hereinafter as DANIEL in view of US PG Pubs 20170329910 – Selwanes et al. hereinafter as SELWANES in further view of US 20220012815 A1 -Kearney et al. hereinafter KEARNEY is hereby withdrawn pursuant to the amendments filed on July 10, 2025.
Response to Arguments
Applicant's arguments have been fully considered but are moot in view of the new ground(s) of rejection or are not persuasive.
The rejection under 35 U.S.C. 101 has been maintained.
Applicant specifically argues that the claims integrate any alleged abstract idea into a practical application, and are therefore not directed to an abstract idea and that the claims recite significantly more than the alleged abstract idea.
In response, Examiner respectfully disagrees. The claims do not integrate the abstract idea into a practical application, and do not include additional elements that provide an inventive concept (are sufficient to amount to significantly more than the abstract idea). (Digitech Image Tech., LLC v. Electronics for Imaging, Inc. (Fed. Cir. 2014)). This judicial exception is not integrated into a practical application. In particular, the claim only recites additional elements of the one or more processors; and one or more memories storing processor-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform operations, one or more processors of an intermediary computing system, one or more non-transitory computer readable media storing processor-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations, electronic data, and machine learning, a trained machine learning classification model; artificial intelligence model, and transmitting to a payor computing system remote from the intermediary computing system. The elements in each of these independent claims are recited at a high-level of generality (i.e., the one or more processors; and one or more memories storing processor-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform operations, one or more processors of an intermediary computing system, one or more non-transitory computer readable media storing processor-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations, electronic data, and machine learning, a trained machine learning classification model; artificial intelligence model, and transmitting to a payor computing system remote from the intermediary computing system), such that the claims are directed to utilizing general purpose computer components (Application Specification [0028], [0029], [0054]). As such, the limitations amount to no more than adding the words “apply it” (or an equivalent) with the judicial exception, or mere instructions to implement an abstract idea on a computer, or merely uses a computer as a tool to perform an abstract idea. See MPEP 2106.05(f).
As a result, there are no meaningful limitations in the claim that transform the exception into a patent eligible application such that the claim amounts to significantly more than the exception itself, and the claims are properly rejected under 35 U.S.C. 101 as being directed to non-statutory subject matter. Thus, the claims do not recite additional limitations that integrate the exception into a Practical Application.
The problem the present invention faces, is the abstract idea of obtaining preauthorization for recommended medical procedures and generating claims faster, efficiently and effectively, not an improvement to computer technology. The present invention makes the preauthorization and claim generation (the abstract idea) faster and more efficient, not the computer. This is not a technical solution to a technical problem. It is further respectfully submitted that the present Specification lists a plurality of ML models ([0054]), not as ones invented or improved by Applicant, but as ones available at the time the invention was filed, with which to apply the abstract idea. Further, paragraphs [0028] and [0029] of the Specification make clear that these processes where previously done manually. The inclusion of the additional elements, beyond the manual processes, recited at a high level, simply help to automate a process that was previously done manually, but not as evidence that such additional elements were improved. Finally, please see MPEP 2106.05(a) “Improvements to the Functioning of a Computer or To Any Other Technology or Technical Field” section I. IMPROVEMENTS TO COMPUTER FUNCTIONALITY, which provides examples that the courts have indicated may not be sufficient to show an improvement in computer-functionality: “iii. Mere automation of manual processes, such as using a generic computer to process an application for financing a purchase, Credit Acceptance Corp. v. Westlake Services, 859 F.3d 1044, 1055, 123 USPQ2d 1100, 1108-09 (Fed. Cir. 2017)”.
Accordingly, it does not amount to significantly more, and the application of the abstract idea is therefore not eligible.
In response Applicant's arguments with respect to the 35 USC § 103, the 35 U.S.C. 103 rejections of claims 1-2, 6-11, 15-26 rejected under as being unpatentable over US Patent 10446266 – Daniel et al. hereinafter as DANIEL in view of US PG Pubs 20170329910 – Selwanes et al. hereinafter as SELWANES in further view of US 20220012815 A1 -Kearney et al. hereinafter KEARNEY is hereby withdrawn pursuant to the amendments filed on July 10, 2025.
CONCLUSION
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure.
Token-based pre-approval systems and methods for payment request submissions (US 11574365 B2) teaches generating a pre-approval token for a claim payment request based at least in part on draft claim data.
Any inquiry concerning this communication or earlier communications from the examiner should be directed to Amber Misiaszek whose telephone number is (571)270-1362. The examiner can normally be reached Monday - Thursday 8:00 AM-6:00 PM.
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If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Fonya Long can be reached at (571) 270-5096. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
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/AMBER A MISIASZEK/Primary Examiner, Art Unit 3682