Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
DETAILED ACTION
Response to Arguments
In communications filed on 6/11/2026, claims 18-21, 24-25, 28-31, 33-35, and 38-44 are presented for examination. Claims 18, 24, and 34 are independent.
Amended claim(s): 18, 24, 30, 34.
New claim(s): 38-44.
Applicants’ arguments, see Applicant Arguments/Remarks filed 6/11/2026, with respect to claim(s) rejected under 35 USC 101 have been considered fully considered but are not persuasive. The claims, as drafted, are a method/system that, under its broadest reasonable interpretation, covers performance of the limitation in the mind but for the recitation of generic machine learning model. That is, other than reciting elements of “using a machine learning model,” nothing in the claim precludes the steps from practically being performed in the mind. For example, but for the “using a machine learning model,” language, receiving data, generating a disaggregate criteria, storing the criteria in the context of the claim encompasses observation, evaluation, judgment, and opinion of user and policy data. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation in the mind with a pen/paper but for the recitation of generic computer components, then it falls within the “Mental Processes” grouping of abstract ideas. Accordingly, the claim recites an abstract idea.
Applicants’ arguments, see Applicant Arguments/Remarks filed 6/11/2026, with respect to claim(s) rejected under prior art have been fully considered and are persuasive in view of amendments to the claims.
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 18-21, 24-25, 28-31, 33-35, 38-44 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e., an abstract idea) without significantly more.
Claims 18-21 are drawn to a method/system for submitting an authorization request, which is within the four statutory categories (i.e. method).
Independent Claim 18 is rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more. Claim 18 recites:
18. A method for encoding and disambiguating information, the method comprising:
receiving data of a first user;
generating, using a machine learning model, at least one disaggregate criteria for the inclusion, exclusion, or exception of the data, wherein the generating comprises: processing the data through natural language processing using embeddings defining domain-specific vocabulary as vectors, and transforming the data from human-comprehensible narrative into machine- comprehensible criteria; and
assigning concatenating criteria with logical operators such that inclusion or exclusion logic provided by the data is derivable;
storing the disaggregate criteria into a machine comprehensible checklist organized by treatment for later retrieval.
The above limitations, as drafted, is a method that, under its broadest reasonable interpretation, covers performance of the limitation in the mind but for the recitation of generic machine learning model. That is, other than reciting the above bolded elements of “using a machine learning model,” nothing in the claim precludes the steps from practically being performed in the mind. For example, but for the “using a machine learning model,” language, receiving data, generating a disaggregate criteria, storing the criteria in the context of the claim encompasses observation, evaluation, judgment, and opinion of user and policy data. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation in the mind with a pen/paper but for the recitation of generic computer components, then it falls within the “Mental Processes” grouping of abstract ideas. Accordingly, the claim recites an abstract idea. (Step 2A, prong 1)
This judicial exception is not integrated into a practical application. In particular, the claim only recites additional elements of “using a machine learning model,” to perform the claim limitations. The additional elements in each of the steps are recited at a high-level of generality (i.e., a machine learning model such as a trained machine learning algorithm they relate to a general purpose computers (Application Specification Fig. 9, ¶96). As such, the limitations amount to no more than 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). Accordingly, these additional elements do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. The claim is directed to an abstract idea. (Step 2A, prong 2)
The claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to integration of the abstract idea into a practical application, the additional elements of “using a machine learning model” to perform the claim limitations amounts to no more than mere instructions to apply the exception using a generic computer component. (i.e., a machine learning model relate to a general-purpose computers (Application Specification Fig. 9, ¶96). Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. See MPEP 2106.05(f). Further, the additional element of receiving/transmitting/storing data are well-understood, routine, conventional activity. See MPEP 2106.05(d), subsection II. The claim is not patent eligible. (Step 2B)
Dependent claims 19-21 include limitations of the independent claim and are directed to the same abstract idea as discussed above and incorporated herein. The dependent claims are rejected under 35 U.S.C. § 101 because they are directed to non-statutory subject matter. These additional claims recite what the data is and how it is analyzed. These information characteristics do not integrate the judicial exception into a practical application, and, when viewed individually or as a whole, they do not add anything substantial beyond the observation, evaluation, judgment, and opinion of data. Dependent claims 19-21 recite the additional element of “data includes a policy associated with at least one treatment; wherein the data is a human-readable document; wherein storing the disaggregate criteria comprises disaggregating at least one policy into lists of inclusion criteria, exclusion criteria, and exception rules; wherein storing the disaggregate criteria comprises assigning concatenating criteria with logical operators; and wherein storing the disaggregate criteria comprises storing the disaggregate criteria in a checklist.” Therefore the dependent claims are rejected under 35 U.S.C. § 101.
Claims 24-25, 28-31, 33-35, and 38-44 are drawn to a method/system for encoding and disambiguating payer policies, which is within the four statutory categories (i.e. method/system).
Independent Claim 34 (representative of independent claims 24, 34) is rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more. Claim recites:
34. A system for encoding and disambiguating payer policies, comprising:
an interface configured to receive, from repositories of health plans, one or more payer policies as human-readable documents;
at least one processor executing a machine learning model configured to disaggregate, the one or more payer policies into lists of inclusion criteria, exclusion criteria, and exception rules for inclusion, exclusion, or exception of members from coverage under the one or more payer policies, and to assign concatenating criteria with logical operators to the inclusion criteria, the exclusion criteria, and the exception rules such that any inclusion or exclusion logic provided by the one or more payer policies is derivable, wherein the disaggregating comprises:
processing the one or more payer policies through natural language processing using healthcare-specific embeddings defining medical vocabulary as vectors, and transforming the one or more payer policies from human-comprehensible medical narrative into machine-comprehensible policy criteria configured for matching and evaluating policy requirements with electronic health record data;
an error detection module configured to verify accuracy of the disaggregated criteria using automated rule-based verification and AI-based verification; and
a database storing the disaggregated criteria as machine-comprehensible simplified checklists of criteria organized by treatment for later retrieval, wherein the database is configured such that the simplified checklists of criteria are retrievable during processing of prior authorization service requests for matching and evaluating policy requirements with electronic health record data
The above limitations, as drafted, is a method/system that, under its broadest reasonable interpretation, covers performance of the limitation in the mind but for the recitation of generic computer components. That is, other than reciting the above bolded elements of “interface configured to receive, from repositories,” “at least one processor executing a machine learning model,” “a database,” “AI-based,” nothing in the claim element precludes the step from practically being performed in the mind with the help of pen/paper. For example, but for the “interface configured to receive, from repositories,” “at least one processor executing a machine learning model,” “a database,” language, receiving data, generating a disaggregate criteria, storing the criteria in the context of the claim encompasses observation, evaluation, judgment, and opinion of user and policy data. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation in the mind with a pen/paper but for the recitation of generic computer components, then it falls within the “Mental Processes” grouping of abstract ideas. Accordingly, the claim recites an abstract idea in the context of the claim encompasses observation, evaluation, judgment, and opinion of user and policy data. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation in the mind but for the recitation of generic computer components, then it falls within the “Mental Processes” grouping of abstract ideas. Accordingly, the claim recites an abstract idea. (Step 2A, prong 1)
This judicial exception is not integrated into a practical application. In particular, the claim only recites additional elements of “interface configured to receive, from repositories,” “at least one processor executing a machine learning model,” “a database,” “AI-based,” to perform the claim limitations. The additional elements in each of the steps are recited at a high-level of generality (i.e., a machine learning model such as a trained machine learning algorithm they relate to a general purpose computers (Application Specification Fig. 9, ¶96). As such, the limitations amount to no more than 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). Accordingly, these additional elements do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. The claim is directed to an abstract idea. (Step 2A, prong 2)
The claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to integration of the abstract idea into a practical application, the additional elements of “interface configured to receive, from repositories,” “at least one processor executing a machine learning model,” “a database,” to perform the claim limitations amounts to no more than mere instructions to apply the exception using a generic computer component. (i.e., a machine learning model relate to a general-purpose computers (Application Specification Fig. 9, ¶96). Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. See MPEP 2106.05(f). Further, the additional element of receiving/transmitting/storing data are well-understood, routine, conventional activity. See MPEP 2106.05(d), subsection II. The claim is not patent eligible. (Step 2)
Dependent claims 25, 28-31, 33, 35, and 38-44 include limitations of the independent claim and are directed to the same abstract idea as discussed above and incorporated herein. The dependent claims are rejected under 35 U.S.C. § 101 because they are directed to non-statutory subject matter. These additional claims recite what the data is and how it is analyzed. These information characteristics do not integrate the judicial exception into a practical application, and, when viewed individually or as a whole, they do not add anything substantial beyond the observation, evaluation, judgment, and opinion of data. Furthermore, the combination of elements does not indicate a significant improvement to the functioning of a computer or any other technology. Therefore the dependent claims are rejected under 35 U.S.C. § 101.
Conclusion
Applicant's amendment necessitated the new ground(s) of rejection presented in this Office action. Accordingly, THIS ACTION IS MADE FINAL. See MPEP § 706.07(a). Applicant is reminded of the extension of time policy as set forth in 37 CFR 1.136(a).
A shortened statutory period for reply to this final action is set to expire THREE MONTHS from the mailing date of this action. In the event a first reply is filed within TWO MONTHS of the mailing date of this final action and the advisory action is not mailed until after the end of the THREE-MONTH shortened statutory period, then the shortened statutory period will expire on the date the advisory action is mailed, and any nonprovisional extension fee (37 CFR 1.17(a)) pursuant to 37 CFR 1.136(a) will be calculated from the mailing date of the advisory action. In no event, however, will the statutory period for reply expire later than SIX MONTHS from the mailing date of this final action.
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/SYED A ZAIDI/Primary Examiner, Art Unit 2432
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