DETAILED ACTION
1. The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA . This Office action is in response to Applicant’s communication filed on November 13, 2025. Replacement drawings submitted on November 13, 2025 have been accepted. Hence, the objections to the drawings are withdrawn. Amendments to claims 1, 8, and 15-17 have been entered. The claim objections have been withdrawn in view of the claim amendments. Claims 1-20 are pending and have been examined. The statement of reasons for the indication of allowable subject matter over prior art was already discussed in the Office action mailed on August 20, 2025 and hence not repeated here. The rejections and the response to arguments are given below.
Claim Rejections - 35 USC § 101
2. 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.
3. Claims 1-20 are rejected under 35 U.S.C. § 101 because the claimed invention is directed to an abstract idea without significantly more. The claim(s) recite(s) a method of outputting a second electronic document representing the insurance claim after adjusting the at least one line, which is considered a judicial exception because it falls under the category of certain methods of organizing human activity such as commercial interactions (including fulfilling agreements) as discussed below. This judicial exception is not integrated into a practical application as discussed below. The claim(s) does/do not include additional elements that are sufficient to amount to significantly more than the judicial exception as discussed below.
Analysis
Step 1: In the instant case, exemplary claim 15 is directed to a method (Process).
Step 2A – Prong one: The limitations of “A computer-implemented method comprising:
storing, by a processor of a computing system, in a database of explanation code ranks, associations between a plurality of explanation codes and a plurality of hierarchical ranks;
receiving, by the processor of the computing system, from a claims generator, a first electronic document representing an insurance claim, wherein the electronic document representing the insurance claim comprises at least one line, and wherein at least one line comprises at least one procedure code and a plurality of explanation codes;
determining, by the processor of the computing system, hierarchical ranks from a plurality of the hierarchical ranks for the plurality of explanation codes in the at least one line by at least one of:
applying, by the processor of the computing system, the at least two explanation codes to the database of explanation code ranks, and
executing, by the processor of the computing system, one or more logic rules selected according to the at least two explanation codes;
determining, by the processor of the computing system, according to the determined hierarchical ranks of the at least two explanation codes, whether at least of the plurality of explanation codes in the at least one line should be modified conflicting explanation codes;
in response to determining the at least two of the plurality of explanation codes in the at least one line comprise conflicting explanation codes, modifying, by the processor of the computing system, the at least one line when it is determined that the at least one line should be modified based on the determined hierarchical ranks for the at least two of the plurality of explanation codes in the at least one line comprising conflicting explanation codes;
ordering, by the processor of the computing system, the explanation codes in the modified at least one line according to the hierarchical ranks;
providing, by the processor of the computing system, a user interface comprising (i) display elements representing the modified at least one line with the ordered explanation codes and (ii) one or more user-operable controls operable by a user to adjust the at least one line;
adjusting, by the processor of the computing system, the at least one line responsive to user operation of the one or more user-operable controls; and
outputting, by the processor of the computing system, a second electronic document representing the insurance claim after adjusting the at least one line” as drafted, when considered collectively as an ordered combination without the italicized portions, is a process that, under the broadest reasonable interpretation, covers methods of organizing human activity such as a fundamental economic practice (processing insurance claims is a fundamental economic practice), as well as commercial or legal interactions (including fulfilling agreements). The steps of the claim when considered collectively as an ordered combination without the italicized portions is a method of processing insurance claims which is fundamental economic practice. Processing insurance claims and outputting a second electronic document representing the insurance claim after adjusting the at least one line is a form of fulfilling the terms of the insurance agreements. Hence, the steps of the claim, considered collectively as an ordered combination, covers the abstract category of methods of organizing human activity.
That is, other than, one or more hardware processors of the computing system, one or more non-transitory machine-readable storage media, a database, a claims generator, electronic documents, a user interface comprising display elements and one or more user-operable controls operable by a user, nothing in the claim precludes the steps from being performed as a method of organizing human activity. If the claim limitations, under the broadest reasonable interpretation, covers methods of organizing human activity but for the recitation of generic computer components, then it falls within the “Certain methods of organizing human activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea.
Step 2A – Prong two: The judicial exception is not integrated into a practical application. In particular, the claim only recites the additional elements of one or more hardware processors, one or more non-transitory machine-readable storage media, a database, a claims generator, electronic documents, a user interface comprising display elements and one or more user-operable controls operable by a user to perform all the steps. A plain reading of Figures 1 and 11 and associated descriptions in at least paragraphs [0061] - [0066] reveals that the one or more hardware processors of the computing system, may be general purpose microprocessors. The one or more non-transitory machine-readable storage media, and the database may be generic machine-readable storage media and a generic database respectively. The claims generator, electronic documents, a user interface comprising display elements and one or more user-operable controls operable by a user are all broadly interpreted to correspond to generic computer components suitably programmed to perform the corresponding functions. Hence, the additional elements in the claims are all generic components suitably programmed to perform their respective functions. The processor of the computing system in all the steps is implicitly recited at a high-level of generality (i.e., as a generic processor performing generic computer functions) such that it amounts no more than mere instructions to apply the exception using generic computer components. Accordingly, the additional elements do not integrate the abstract idea into a practical application because it does not impose any meaningful limits on practicing the abstract idea. Hence, claim 1 is directed to an abstract idea.
Step 2B: 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 processor of the computing system to perform the steps recited in the claim, amount to no more than mere instructions to apply the exception using a generic computer component. The additional elements of the instant underlying process, when taken in combination, together do not offer substantially more than the sum of the functions of the elements when each is taken alone. Mere instructions to apply an exception using generic computer components cannot provide an inventive concept. Hence, independent claim 1 is not patent eligible. Independent claims 8 and 15 are also not patent eligible based on similar reasoning and rationale.
Dependent claims 2-7, 9-14 and 16-20, when analyzed as a whole are held to be patent ineligible under 35 U.S.C. 101 because the additional recited limitations only refine the abstract idea further.
For instance, in claims 2-3, 9-10 and 16-17 the claimed limitations
“the operations further comprising: transmitting the second electronic document to a claims management system for review by an analyst” and
“the operations further comprising: determining, according to a modifier in the at least one line, whether the at least one line should be modified” under the broadest reasonable interpretation, are further refinements of methods of organizing human activity because they describe the intermediate steps of the underlying process.
In claims 4-5, 11-12 and 18-19 the claimed limitations
“wherein modifying the at least one line comprises:
selecting one of the procedure codes from the at least one line of the electronic document representing the insurance claim; and
modifying the at least one line according to the selected procedure code”, and
“wherein modifying the at least one line comprises: modifying at least one of the explanation codes in the at least one line”, under the broadest reasonable interpretation, are further refinements of methods of organizing human activity because they describe the intermediate steps of the underlying process.
In claims 6, 13 and 20 the claimed limitation
“wherein modifying the at least one line comprises: deleting at least one of the explanation codes in the at least one line”, under the broadest reasonable interpretation, is a further refinement of methods of organizing human activity because it describes an intermediate step of the underlying process.
In claims 7 and 14 the claimed limitation
“the operations further comprising: determining, according to the at least one procedure code in the at least one line, whether the at least one line should be modified”, under the broadest reasonable interpretation, is a further refinement of methods of organizing human activity because it describes an intermediate step of the underlying process.
In all the dependent claims, the judicial exception is not integrated into a practical application because the limitations are recited at a high-level of generality such that it amounts no more than mere instructions to apply the exception using generic computer components. Also, the claims do not affect an improvement to another technology or technical field; the claims do not amount to an improvement to the functioning of a computer system itself; the claims do not affect a transformation or reduction of a particular article to a different state or thing; and the claims do not move beyond a general link of the use of an abstract idea to a particular technological environment. In addition, the dependent claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception. The additional elements of the instant underlying process, when taken in combination, together do not offer substantially more than the sum of the functions of the elements when each is taken alone. The claims as a whole, do not amount to significantly more than the abstract idea itself. For these reasons, the dependent claims also are not patent eligible.
Response to Arguments
4. In response to Applicants arguments on page 11 of the Applicant’s remarks that the claims are patent-eligible under 35 USC 101 when considered under MPEP 2106, the Examiner respectfully disagrees.
The fact that the claims are Patent-Ineligible when considered under the MPEP 2106 has already been addressed in the rejection and hence not repeated here. Therefore, the Applicant’s arguments are not persuasive.
For the reasons discussed in the rejection, the rejections under 35 USC § 101 are maintained.
Conclusion
5. The prior art made of record and not relied upon is considered pertinent to applicant's disclosure:
(a) Chintamaneni; Sai Giridhar et al. (US Patent 11049594 B2) discloses a system and method of facilitating revenue cycle management in healthcare. A voice module records a physician treating a patient. A speech to text engine converts the recorded voice into a text format to generate a transcription file. The rules are based on the outcome/learning of the artificial intelligence engine to processes the text to automatically populate data field(s) associated with the diagnosis and treatment in a transcription template. The artificial intelligence engine processes document(s) associated with the diagnosis and treatment of the patient to identify code(s) and populating coding field(s) with the code(s). The rules from the dynamic rules engine are used to processes data records associated with the patient to automatically populate field(s) in an insurance claim form of an insurance claim associated with the patient, and identify a payor to be billed with an appropriate amount determined based upon the code(s) identified.
(b) Fulton; Joy L. et al. (US Pub. 2017/0177810 A1) discloses technologies for identifying coding/care gaps of an insurance claim include a computing device configured to receive an insurance claim from a healthcare provider, create a claim encounter reconciliation data pack (CERDP) based on the received insurance claim, and analyze the CERDP to identify whether any coding/care gaps exist in the received insurance claim. Upon determining any coding/care gaps, the computing device is additionally configured to provide an interface to the healthcare provider usable to view and resolve the identified coding/care gaps. The computing device is further configured to receive updated claim information as a function of the resolution of the identified coding/care gaps and transmit a related insurance claim to a corresponding health plan.
6. 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 extension fee 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 date of this final action.
Any inquiry concerning this communication or earlier communications from the Examiner should be directed to Narayanswamy Subramanian whose telephone number is (571) 272-6751. The examiner can normally be reached Monday-Friday from 9:00 AM to 5:00 PM. If attempts to reach the examiner by telephone are unsuccessful, the examiner's supervisor, Abhishek Vyas can be reached at (571) 270-1836. The fax number for Formal or Official faxes and Draft to the Patent Office is (571) 273-8300.
Information regarding the status of published or unpublished applications may be obtained from Patent Center. Unpublished application information in Patent Center is available to registered users. To file and manage patent submissions in Patent Center, visit: https://patentcenter.uspto.gov. Visit https://www.uspto.gov/patents/apply/patent-center for more information about Patent Center and https://www.uspto.gov/patents/docx for information about filing in DOCX format. For additional questions, contact the Electronic Business Center (EBC) at 866-217-9197 (toll-free). If you would like assistance from a USPTO Customer Service Representative, call 800-786-9199 (IN USA OR CANADA) or 571-272-1000.
/Narayanswamy Subramanian/
Primary Examiner
Art Unit 3691
January 28, 2026